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Buckert M, Streibel C, Hartmann M, Monzer N, Kopf S, Szendrödi J, Wild B. Cross-sectional associations of self-perceived stress and hair cortisol with metabolic outcomes and microvascular complications in type 2 diabetes. Front Public Health 2024; 12:1289689. [PMID: 38813430 PMCID: PMC11133512 DOI: 10.3389/fpubh.2024.1289689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Increasing evidence supports chronic psychological stress as a risk factor for the development of type 2 diabetes. Much less is known, however, about the role of chronic stress in established diabetes. Methods The aim of the current study was to comprehensively assess chronic stress in a sample of 73 patients with type 2 diabetes and 48 non-diabetic control participants, and to investigate associations with indicators of glycemic control (HbA1c), insulin resistance (HOMA-IR), β-cell functioning (C-peptide), illness duration, and the presence of microvascular complications. Chronic stress was measured using questionnaires [the Perceived Stress Scale (PSS), the Screening Scale of the Trier Inventory of Chronic Stress (SSCS), the Perceived Health Questionnaire (PHQ) as well as the Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R)]; hair cortisol was used as a biological indicator. Results We found that patients with type 2 diabetes had higher levels of hair cortisol in comparison to the control group (F(1,112) = 5.3; p = 0.023). Within the diabetic group, higher hair cortisol was associated with a longer duration of the illness (r = 0.25, p = 0.04). General perceived stress did not show significant associations with metabolic outcomes in type 2 diabetes patients. In contrast, higher diabetes-related distress, as measured with the QSD-R, was associated with lower glycemic control (r = 0.28, p = 0.02), higher insulin resistance (r = 0.26, p = 0.03) and a longer duration of the illness (r = 0.30, p = 0.01). Discussion Our results corroborate the importance of chronic psychological stress in type 2 diabetes. It appears, however, that once type 2 diabetes has developed, diabetes-specific distress gains in importance over general subjective stress. On a biological level, increased cortisol production could be linked to the course of the illness.
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Affiliation(s)
- Magdalena Buckert
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Carmen Streibel
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Nelly Monzer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Kopf
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Szendrödi
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Januzzi JL, Liu Y, Sattar N, Yavin Y, Pollock CA, Butler J, Jardine M, Heerspink HJL, Masson S, Breyer M, Hansen MK. Vascular endothelial growth factors and risk of cardio-renal events: Results from the CREDENCE trial. Am Heart J 2024; 271:38-47. [PMID: 38401646 DOI: 10.1016/j.ahj.2024.02.016] [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: 10/01/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Circulating concentrations of vascular endothelial growth factor (VEGF) family members may be abnormally elevated in type 2 diabetes (T2D). The roles of placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFLT-1), and VEGF-A in cardio-renal complications of T2D are not established. METHOD The 2602 individuals with diabetic kidney disease (DKD) from the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation trial were randomized to receive canagliflozin or placebo and followed for incident cardio-renal outcomes. PlGF, sFLT-1, and VEGF-A were measured at baseline, year 1, and year 3. Primary outcome was a composite of end-stage kidney disease, doubling of the serum creatinine, or renal/cardiovascular death. Cox proportional hazard regression was used to investigate the association between biomarkers with adverse clinical events. RESULTS At baseline, individuals with higher PlGF levels had more prevalent cardiovascular disease compared to those with lower values. Treatment with canagliflozin did not meaningfully change PlGF, sFLT-1, and VEGF-A concentrations at years 1 and 3. In a multivariable model, 1 unit increases in baseline log PlGF (hazard ratio [HR]: 1.76, 95% confidence interval [CI]: 1.23, 2.54, P-value = .002), sFLT-1 (HR: 3.34, [95% CI: 1.71, 6.52], P-value < .001), and PlGF/sFLT-1 ratio (HR: 4.83, [95% CI: 0.86, 27.01], P-value = .07) were associated with primary composite outcome, while 1 unit increase in log VEGF-A did not increase the risk of primary outcome (HR: 0.96 [95% CI: 0.81, 1.07]). Change by 1 year of each biomarker was also assessed: HR (95% CI) of primary composite outcome was 2.45 (1.70, 3.54) for 1 unit increase in 1-year concentration of log PlGF, 4.19 (2.18, 8.03) for 1 unit increase in 1-year concentration of log sFLT-1, and 21.08 (3.79, 117.4) for 1 unit increase in 1-year concentration of log PlGF/sFLT-1. Increase in 1-year concentrations of log VEGF-A was not associated with primary composite outcome (HR: 1.08, [95% CI: 0.93, 1.24], P-value = .30). CONCLUSIONS People with T2D and DKD with elevated levels of PlGF, sFLT-1, and PlGF/sFLT-1 ratio were at a higher risk for cardiorenal events. Canagliflozin did not meaningfully decrease concentrations of PlGF, sFLT-1, and VEGF-A. CLINICAL TRIAL CREDENCE, https://clinicaltrials.gov/ct2/show/NCT02065791.
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Affiliation(s)
- James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, MA.
| | - Yuxi Liu
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Yshai Yavin
- Janssen Research & Development, LLC, Spring House, PA
| | - Carol A Pollock
- Kolling Institute, Royal North Shore Hospital University of Sydney, Sydney, NSW, Australia
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS; Baylor Scott & White Institute, Dallas, TX
| | - Meg Jardine
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Hiddo J L Heerspink
- Department Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Serge Masson
- Roche Diagnostics International, Rotkreuz, Switzerland
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Zhao L, Gao F, Zheng C, Sun X. The Impact of Optimal Glycemic Control on Tuberculosis Treatment Outcomes in Patients With Diabetes Mellitus: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e53948. [PMID: 38564244 PMCID: PMC11022131 DOI: 10.2196/53948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) increases the risk of developing tuberculosis (TB), and optimal glycemic control has been shown to reduce the risk of complications and improve the TB treatment outcomes in patients with DM. OBJECTIVE This study aims to investigate the role of glycemic control in improving TB treatment outcomes among patients with DM. METHODS MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) assessing the impact of oral glycemic control in patients with TB who have DM. Outcomes of interest were radiological findings, treatment success, sputum positivity, and mortality. Evaluations were reported as risk ratios (RRs) with 95% CIs using weighted random-effects models. RESULTS The analysis included 6919 patients from 7 observational studies. Our meta-analysis showed significant differences between patients with optimal glycemic control and those with poor glycemic control with regard to improved treatment outcomes (RR 1.13, 95% CI 1.02-1.25; P=.02; I²=65%), reduced sputum positivity (RR 0.23, 95% CI 0.09-0.61; P=.003; I²=66%), and fewer cavitary lesions (RR 0.59, 95% CI 0.51-0.68; P<.001; I²=0%) in radiological findings. There was no significant difference between the 2 groups in terms of mortality (RR 0.57, 95% CI 0.22-1.49; P=.25; I²=0%), multilobar involvement (RR 0.57, 95% CI 0.22-1.49; P=.25; I²=0%) on radiologic examination, and upper lobe (RR 0.94, 95% CI 0.76-1.17; P=.58; I²=0%) and lower lobe (RR 1.05, 95% CI 0.48-2.30; P=.91; I²=75%) involvement on radiologic examination. CONCLUSIONS We concluded that optimal glycemic control is crucial for reducing susceptibility, minimizing complications, and improving treatment outcomes in patients with TB with DM. Emphasizing effective health management and health care strategies are essential in achieving this control. Integrating comprehensive care among patients with TB with DM will enhance patient outcomes and alleviate the burden of disease in this population. TRIAL REGISTRATION PROSPERO CRD42023427362; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=427362.
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Affiliation(s)
- Li Zhao
- Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, China
| | - Feng Gao
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunlan Zheng
- Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, China
| | - Xuezhi Sun
- Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, China
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Boussageon R, Meunier PY, Chanelière M, Shaughnessy AF, Cosgrove L. Are American Diabetes Association's new guidelines reliable? J Eval Clin Pract 2024; 30:403-405. [PMID: 38083876 DOI: 10.1111/jep.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 04/18/2024]
Affiliation(s)
- Rémy Boussageon
- Collège Universitaire de Médecine Générale, UCBL Lyon 1, Lyon, France
- UMR 5558, LBBE, EMET, CNRS, Université Claude Bernard, Lyon 1, Lyon, France
| | | | - Marc Chanelière
- Collège Universitaire de Médecine Générale, UCBL Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Allen F Shaughnessy
- Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Lisa Cosgrove
- University of Massachusetts-Boston, Boston, Massachusetts, USA
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Ninsiima D, Lwanga T, Oluka GK, Okodoi EO, Aine W, Lwibasira H, Ndibarema B, Abaho H, Olum R, Andia-Biraro I, Bongomin F. Knowledge, attitudes and practices towards glycemic control among persons with diabetes mellitus at two tertiary hospitals in Uganda. Afr Health Sci 2024; 24:171-186. [PMID: 38962346 PMCID: PMC11217846 DOI: 10.4314/ahs.v24i1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Background Intensive glycaemic control reduces the risk of microvascular complications in persons with diabetes mellitus (DM). Owing to limited data available, we aimed to determine the knowledge, attitude, and practices (KAPs) toward glycaemic control among Ugandans with DM at two large tertiary healthcare facilities. Methods A cross-sectional study was conducted among persons with DM attending outpatient clinics at Kiruddu National Referral Hospital (KNRH) and Mulago National Specialized Hospital (MNSH) between March and April 2022. Eligible participants provided written informed consent and were recruited through a systematic sampling technique and relevant data was collected using a pretested, interviewer-administered, semi-structured questionnaire. Results Of the 452 participants, 318 (70.4%) were females. The median age was 52 years (IQR: 45-60 years), with more than two-thirds diagnosed with DM at ≥36 years (69.8%, n=310). Overall, 274 participants (60.6%) had good knowledge on glycemic control. At multivariable logistic regression analysis, good knowledge about glycaemic control was significantly associated with having received training on glycaemic control (aOR: 2.3, 95% CI: 1.4 - 3.7, p=0.002), level of education: diploma (aOR: 4.3, 95% CI: 1.1 - 17.8, p=0.042), degree aOR: 4.9, 95% CI: 1.0 - 23.1, p=0.046) compared to informal education, and nearest distance from the health facility (aOR: 3.1, 95% CI: 1.0 - 9.6, p=0.047). Conclusions More than half of the patients had good knowledge about glycaemic control and this was associated with level of education, distance from the health facility and having received training. Further studies assessing the correlations between actual level of glycaemic control and patient related KAPs are recommended.
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Affiliation(s)
- Daphine Ninsiima
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Timothy Lwanga
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gerald Kevin Oluka
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Oguti Okodoi
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Aine
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Lwibasira
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Brian Ndibarema
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hama Abaho
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, Nsambya Hospital, Kampala, Uganda
| | - Irene Andia-Biraro
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Charu V, Liang JW, Chertow GM, Li J, Montez-Rath ME, Geldsetzer P, de Boer IH, Tian L, Tamura MK. Heterogeneous Treatment Effects of Intensive Glycemic Control on Kidney Microvascular Outcomes and Mortality in ACCORD. J Am Soc Nephrol 2024; 35:216-228. [PMID: 38073026 PMCID: PMC10843221 DOI: 10.1681/asn.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/30/2023] [Indexed: 12/26/2023] Open
Abstract
SIGNIFICANCE STATEMENT Identifying and quantifying treatment effect variation across patients is the fundamental challenge of precision medicine. Here we quantify heterogeneous treatment effects of intensive glycemic control in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, considering three outcomes of interest-a composite kidney outcome (driven by macroalbuminuria), all-cause mortality, and first assisted hypoglycemic event. We demonstrate that the effects of intensive glycemic control vary with risk of kidney failure, as predicted by the kidney failure risk equation (KFRE). Participants at highest risk of kidney failure gain the largest absolute kidney benefit of intensive glycemic control but also experience the largest absolute risk of death and hypoglycemic events. Our findings illustrate the value of identifying clinically meaningful treatment heterogeneity, particularly when treatments have different effects on multiple end points. OBJECTIVE Clear criteria to individualize glycemic targets in patients with type II diabetes are lacking. In this post hoc analysis of the ACCORD, we evaluate whether the KFRE can identify patients for whom intensive glycemic control confers more benefit in preventing kidney microvascular outcomes. RESEARCH DESIGN AND METHODS We divided the ACCORD trial population into quartiles on the basis of 5-year kidney failure risk using the KFRE. We estimated conditional treatment effects within each quartile and compared them with the average treatment effect in the trial. The treatment effects of interest were the 7-year restricted mean survival time (RMST) differences between intensive and standard glycemic control arms on ( 1 ) time-to-first development of severely elevated albuminuria or kidney failure and ( 2 ) all-cause mortality. RESULTS We found evidence that the effect of intensive glycemic control on kidney microvascular outcomes and all-cause mortality varies with baseline risk of kidney failure. Patients with elevated baseline risk of kidney failure derived the most from intensive glycemic control in reducing kidney microvascular outcomes (7-year RMST difference of 114.8 [95% confidence interval 58.1 to 176.4] versus 48.4 [25.3 to 69.6] days in the entire trial population) However, this same patient group also experienced a shorter time to death (7-year RMST difference of -56.7 [-100.2 to -17.5] v. -23.6 [-42.2 to -6.6] days). CONCLUSIONS We found evidence of heterogenous treatment effects of intensive glycemic control on kidney microvascular outcomes in ACCORD as a function of predicted baseline risk of kidney failure. Patients with higher kidney failure risk experienced the most pronounced reduction in kidney microvascular outcomes but also experienced the highest risk of all-cause mortality.
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Affiliation(s)
- Vivek Charu
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Jane W. Liang
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Glenn M. Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - June Li
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Maria E. Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Pascal Geldsetzer
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ian H. de Boer
- Division of Nephrology, Department of Medicine, and the Kidney Research Institute, University of Washington, Seattle, Washington
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Manjula Kurella Tamura
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Geriatric Research and Education Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Obeso-Fernández J, Millan-Alanis JM, Sáenz-Flores M, Rodríguez-Bautista M, Medrano-Juarez S, Oyervides-Fuentes S, Gonzalez-Cruz D, Manzanares-Gallegos DM, González-González JG, Rodríguez-Gutiérrez R. Benefits of metabolic surgery on macrovascular outcomes in adult patients with type 2 diabetes: a systematic review and meta-analysis. Surg Obes Relat Dis 2024; 20:202-212. [PMID: 37845131 DOI: 10.1016/j.soard.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/02/2023] [Accepted: 08/28/2023] [Indexed: 10/18/2023]
Abstract
Type 2 diabetes (T2D) is a chronic metabolic disorder that affects millions of individuals associated with an increased risk of mortality and macrovascular complications. We aimed to synthesize the benefit of metabolic surgery (MS) on macrovascular outcomes in adult patients with T2D.We included both cohort studies and randomized controlled trials (RCTs) that evaluated MS added to medical therapy compared with medical therapy alone in the treatment of adult patients with T2D. Studies must have evaluated the incidence of any macrovascular complication of the disease for a period of at least 6 months. We performed our search using PubMed, Scopus, EMBASE, Web of Science, and COCHRANE Central database which was performed from inception date until March 2022. The trial protocol was previously registered at PROSPERO (CRD42021243739). A total of 6338 references were screened throughout the selection process from which 16 studies involving 179,246 participants fulfilled inclusion criteria. MS reduced the risk of any cardiovascular event by 44% (relative risk .56 [95% CI, .42-.75]; P = < .001), myocardial infarction by 54% (.46 [95% CI, .26-.83]; P = .009), coronary artery disease by 40% (.60 [95% CI, .42-.85]; P = .004) and heart failure by 71% (.29 [95% CI, .14-.61]; P = .001). It also provided a risk reduction of stroke by 29% (.71 [95% CI, .51-.99]; P = .04) and 38% (.62 [95% CI, .46-.85]; P = .001) for cerebrovascular events. On mortality, MS yields a risk reduction of 55% (.45 [95% CI, .36-.57]; P <.001) in overall mortality and 69% in cardiovascular mortality (relative risk .31 [95% CI, .22-.42]; P < .001). Peripheral vascular disease risk was also reduced. MS in adult patients with T2D can reduce the risk of mortality and of any macrovascular outcomes. However, there is a need for the planning of randomized clinical trials to further analyze and confirm the results.
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Affiliation(s)
- Javier Obeso-Fernández
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Juan Manuel Millan-Alanis
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Melissa Sáenz-Flores
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mario Rodríguez-Bautista
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Samantha Medrano-Juarez
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Stephie Oyervides-Fuentes
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Daniela Gonzalez-Cruz
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Dulce Maria Manzanares-Gallegos
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - José Gerardo González-González
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México; Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - René Rodríguez-Gutiérrez
- Plataforma INVEST Medicina UANL, KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México; Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, México.
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Pérez A, Redondo-Antón J, Romera I, Lizán L, Rubio-de Santos M, Díaz-Cerezo S, Orozco-Beltrán D. Disease and Economic Burden of Poor Metabolic and Weight Control in Type 2 Diabetes in Spain: A Systematic Literature Review. Diabetes Ther 2024; 15:325-341. [PMID: 37989829 PMCID: PMC10838877 DOI: 10.1007/s13300-023-01503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Poor metabolic control and excess body weight are frequently present in people with type 2 diabetes (PwT2D). METHODS A systematic literature review was conducted to identify observational studies reporting clinical, economic, and health-related quality of life (HRQoL) outcomes associated with poor metabolic (according to HbA1c, blood pressure [BP] and low density lipoprotein cholesterol [LDL-C] levels) and/or weight control (defined by a body mass index [BMI] ≥ 30 kg/m2) in adults with T2D in Spain, including articles published in either Spanish or English between 2013 and 2022 and conference abstracts from the last 2 years. RESULTS Nine observational studies were included in the analysis. Poor glycemic control (HbA1c ≥ 7%) was associated with cardiovascular disease (CVD), increased requirements for antidiabetic medications, higher and more frequent weight gain, a greater probability of hypoglycemia and dyslipidemia, and worse health-related quality of life (HRQoL). Uncontrolled BP in PwT2D was related with the presence of CVD, worse metabolic control, and higher BMI and abdominal perimeter values. Poor LDL-C control or dyslipidemia was associated with CVD, hypoglycemia, and elevated HbA1c and triglycerides levels. The presence of a BMI ≥ 30 kg/m2 was related to CVD and hypoglycemia, a higher prevalence of metabolic syndrome and worse BP control. Direct medical costs were found to be higher in PwT2D when coexisting with HbA1c levels ≥ 7%, uncontrolled BP or obesity. Increased total costs, including productivity losses, were also detected in those who presented uncontrolled BP and a BMI ≥ 30 kg/m2, and when poor weight control existed together with HbA1c ≥ 8% and poorly controlled BP. CONCLUSION Gathered evidence supports the high clinical, economic and HRQoL burden of poor metabolic and/or weight control in PwT2D in Spain and reinforces the importance of prioritizing its control to reduce the associated burden, at both the individual and healthcare system levels.
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Affiliation(s)
- Antonio Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | | | - Irene Romera
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Luís Lizán
- Outcomes'10, S.L., Castellón de la Plana, Spain
- Departamento de Medicina, Universidad Jaume I, Castellón de la Plana, Spain
| | | | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
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Bahari H, Ashtary-Larky D, Goudarzi K, Mirmohammadali SN, Asbaghi O, Hosseini Kolbadi KS, Naderian M, Hosseini A. The effects of pomegranate consumption on glycemic indices in adults: A systematic review and meta-analysis. Diabetes Metab Syndr 2024; 18:102940. [PMID: 38194826 DOI: 10.1016/j.dsx.2024.102940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/16/2023] [Accepted: 01/01/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND AND AIM Epidemiologic studies have shown that type 2 diabetes (T2D) is more prevalent worldwide; therefore, improving glycemic indices to prevent or control T2D is vital. Randomized controlled trials (RCTs) on the effects of pomegranate consumption on glycemic indices have shown inconsistent results. Therefore, we aim to evaluate the impact of pomegranate consumption on fasting blood glucose (FBG), fasting insulin, hemoglobin A1c (HbA1c), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) in adults. METHODS A systematic literature search was performed using electronic databases, including PubMed, Web of Science, and Scopus, up to May 2023 to identify eligible RCTs evaluating the effect of pomegranate consumption on glycemic indices. Heterogeneity tests of the included trials were performed using the I2 statistic. Random effects models were assessed based on the heterogeneity tests, and pooled data were determined as the weighted mean difference with a 95 % confidence interval. RESULTS Of 1999 records, 32 eligible RCTs were included in the current study. Our meta-analysis of the pooled findings showed that pomegranate consumption significantly reduced FBG (WMD: -2.22 mg/dL; 95 % CI: -3.95 to -0.50; p = 0.012), fasting insulin (WMD: -1.06 μU/ml; 95%CI: -1.79 to -0.33; p = 0.004), HbA1c (WMD: -0.22 %; 95% CI: -0.43 to -0.01; p = 0.037), and HOMA-IR (WMD: -0.30; 95%CI: -0.61 to -0.00; p = 0.046). CONCLUSION Overall, the results demonstrated that pomegranate consumption benefits glycemic indices in adults. However, further research with long-term interventions is required. PROSPERO REGISTRATION CODE CRD42023422780.
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Affiliation(s)
- Hossein Bahari
- Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Damoon Ashtary-Larky
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Kian Goudarzi
- Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | | | - Omid Asbaghi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Moslem Naderian
- Department of Pharmacognosy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
| | - Ali Hosseini
- Department of Pharmacognosy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
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10
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González-Saldivar G, González-González JG, Chow DR, Mohamed-Hamsho J, González-Cortés JH, Sánchez-García A, Rodríguez-Gutiérrez R. Retinal Microvascular Density and Perfusion during an Insulin-Induced Hypoglycemia Episode: A Warning Call. Int J Clin Pract 2023; 2023:9928582. [PMID: 37876724 PMCID: PMC10593551 DOI: 10.1155/2023/9928582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/13/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
Aim To evaluate retinal vascular perfusion and density by optical coherence tomography angiography (OCTA) before, during, and after hypoglycemia in individuals with diabetes mellitus with or without diabetic retinopathy (DR). Methods A focused clinical history was performed, followed by an ophthalmological examination to document retinopathy status. OCTA was performed at baseline, at hypoglycemia, and at glucose normalization. Eye tracking and eye alignment devices on the platform were used to obtain a macular thickness cube (512 × 128) and vascular perfusion and density protocols of 3 × 3 mm. Retinal vascular reactivity was analyzed with superficial plexus vascular perfusion and density protocols on OCTA. Results Fifty-two participants encompassing 97 eyes fulfilled the eligibility criteria. Their mean age was 42.9 ± 15.1 years (range, 22 to 65), and 20 (38.2%) were men. We found a statistically significant difference in vascular perfusion and density when comparing all groups at baseline. The controls had higher vascular perfusion and density values than the cases. Vascular perfusion and density were significantly reduced in all groups during the hypoglycemia episode, except for vascular density in DR cases. Conclusion Acute hypoglycemia significantly alters the retinal vascularity in DM patients with and without DR, suggesting that repeated episodes of acute hypoglycemia could exacerbate retinopathy in the long term.
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Affiliation(s)
- Gerardo González-Saldivar
- Department of Ophthalmology, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Calle Dr. Eduardo Aguirre Pequeño s/n, Sotano Edificio CRIDS, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
| | - José Gerardo González-González
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Calle Dr. Eduardo Aguirre Pequeño s/n, Sotano Edificio CRIDS, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
- Endocrinology Division, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
| | - David Robert Chow
- Department of Ophthalmology, St. Michael's Hospital, Toronto, ON, Canada
| | - Jesús Mohamed-Hamsho
- Department of Ophthalmology, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
| | - Jesús Hernan González-Cortés
- Department of Ophthalmology, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
| | - Adriana Sánchez-García
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Calle Dr. Eduardo Aguirre Pequeño s/n, Sotano Edificio CRIDS, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
- Endocrinology Division, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
| | - René Rodríguez-Gutiérrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Calle Dr. Eduardo Aguirre Pequeño s/n, Sotano Edificio CRIDS, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
- Endocrinology Division, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
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11
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Mahamud B, Suthar RK, Mohamed A, Hamid K, Mlawa G. Effectiveness of Bariatric Surgery in the Management of Type 2 Diabetes Mellitus: A Case Report and Literature Review. Cureus 2023; 15:e47843. [PMID: 38021602 PMCID: PMC10677717 DOI: 10.7759/cureus.47843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Type 2 diabetes (T2DM) and obesity represent major global health burdens and economic costs to healthcare systems. T2DM management is challenging due to multiple comorbidities and limited drug efficacy. Bariatric surgery has emerged as an effective treatment approach. A 65-year-old man with refractory obesity (BMI > 35 kg/m2) and poorly controlled T2DM underwent gastric bypass surgery in 2018. Prior to surgery, medication noncompliance and dietary measures failed to achieve adequate glycemic control or weight loss. Postoperatively, the patient lost 20 kg and achieved improved T2DM control (HbA1C reduction), allowing complete cessation of diabetic medications. The patient's case demonstrates bariatric surgery's potential to significantly alter the clinical course of obesity and T2DM versus standard care. National guidelines outline eligibility criteria for bariatric referral; however, utilization rates remain low (<1%) despite over two million eligible individuals in the United Kingdom. Improved access could reduce disease burden and healthcare costs from diabetes complications over the long term. This case report provides a real-world example supporting bariatric surgery as an effective intervention for appropriately selected patients with obesity and uncontrolled T2DM, with the potential to improve clinical outcomes and lower costs associated with diabetes management.
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Affiliation(s)
- Bashir Mahamud
- Medicine, Trakia Medical University, Stara Zagora, BGR
- Acute Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Rohan K Suthar
- Respiratory Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Ayan Mohamed
- Internal Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Kedir Hamid
- Internal Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Gideon Mlawa
- Internal Medicine and Diabetes and Endocrinology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
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12
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Galindo RJ, Trujillo JM, Low Wang CC, McCoy RG. Advances in the management of type 2 diabetes in adults. BMJ MEDICINE 2023; 2:e000372. [PMID: 37680340 PMCID: PMC10481754 DOI: 10.1136/bmjmed-2022-000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/27/2023] [Indexed: 09/09/2023]
Abstract
Type 2 diabetes is a chronic and progressive cardiometabolic disorder that affects more than 10% of adults worldwide and is a major cause of morbidity, mortality, disability, and high costs. Over the past decade, the pattern of management of diabetes has shifted from a predominantly glucose centric approach, focused on lowering levels of haemoglobin A1c (HbA1c), to a directed complications centric approach, aimed at preventing short term and long term complications of diabetes, and a pathogenesis centric approach, which looks at the underlying metabolic dysfunction of excess adiposity that both causes and complicates the management of diabetes. In this review, we discuss the latest advances in patient centred care for type 2 diabetes, focusing on drug and non-drug approaches to reducing the risks of complications of diabetes in adults. We also discuss the effects of social determinants of health on the management of diabetes, particularly as they affect the treatment of hyperglycaemia in type 2 diabetes.
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Affiliation(s)
- Rodolfo J Galindo
- Division of Endocrinology, Diabetes, and Metabolism, University of Miami Miller School of Medicine, Miami, Florida, USA
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jennifer M Trujillo
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cecilia C Low Wang
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Rozalina G McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- University of Maryland Institute for Health Computing, Bethesda, Maryland, USA
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13
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Butayeva J, Ratan ZA, Downie S, Hosseinzadeh H. The impact of health literacy interventions on glycemic control and self-management outcomes among type 2 diabetes mellitus: A systematic review. J Diabetes 2023; 15:724-735. [PMID: 37407516 PMCID: PMC10509520 DOI: 10.1111/1753-0407.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/03/2023] [Indexed: 07/07/2023] Open
Abstract
Diabetes imposes an increasing health and economic burden on individuals living with it and their societies worldwide. Glycemic control is necessary to reduce morbidity and mortality of type 2 diabetes mellitus (T2DM). Self-management is the primary tool for managing diabetes. Health literacy (HL) is the primary driver of self-management activities. The aim of this review is to evaluate the impact of HL interventions on glycemic control and self-management outcomes among T2DM. MEDLINE, CINAHL, PubMed, Cochrane, Scopus, and Web of Science were searched for eligible papers. Fifteen randomized controlled trials published in English between 1997 and 2021, used HL-driven intervention, and measured the level of glycohemoglobin A1c (HbA1c) and self-management of T2DM patients were included in this review. The findings showed that HL-driven intervention had a positive impact on glycemic control and improved self-management behaviors. The level of glycemic control and self-management skills were improved through individual and telephone-based intervention respectively. Community worker-led interventions were effective in improvements in diabetes knowledge and self-care behaviors; however, nurse-led interventions were effective in glycemic control. Better glycemic control is achieved in hospital settings compared to outpatient settings. HL interventions yielded better improvement in self-management among people with longer diabetes duration (more than 7 years). It was possible to achieve a large reduction in HbA1c level after a 3-month intervention in hospital settings. HL-driven interventions are effective in glycemic and diabetes self-management outcomes.
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Affiliation(s)
- Jamila Butayeva
- School of Health & Society, Faculty of the Arts, Social Sciences and HumanitiesUniversity of WollongongWollongongNew South WalesAustralia
| | - Zubair Ahmed Ratan
- School of Health & Society, Faculty of the Arts, Social Sciences and HumanitiesUniversity of WollongongWollongongNew South WalesAustralia
| | - Sue Downie
- Discipline of Medical and Exercise Science, Faculty of Science, Medicine and Health, School of MedicineUniversity of WollongongWollongongNew South WalesAustralia
| | - Hassan Hosseinzadeh
- School of Health & Society, Faculty of the Arts, Social Sciences and HumanitiesUniversity of WollongongWollongongNew South WalesAustralia
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14
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Moldovan M, Păpurică AM, Muntean M, Bungărdean RM, Gheban D, Moldovan B, Katona G, David L, Filip GA. Effects of Gold Nanoparticles Phytoreduced with Rutin in an Early Rat Model of Diabetic Retinopathy and Cataracts. Metabolites 2023; 13:955. [PMID: 37623898 PMCID: PMC10456405 DOI: 10.3390/metabo13080955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/12/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023] Open
Abstract
Diabetic retinopathy (DR) and cataracts (CA) have an early onset in diabetes mellitus (DM) due to the redox imbalance and inflammation triggered by hyperglycaemia. Plant-based therapies are characterised by low tissue bioavailability. The study aimed to investigate the effect of gold nanoparticles phytoreduced with Rutin (AuNPsR), as a possible solution. Insulin, Rutin, and AuNPsR were administered to an early, six-week rat model of DR and CA. Oxidative stress (MDA, CAT, SOD) was assessed in serum and eye homogenates, and inflammatory cytokines (IL-1 beta, IL-6, TNF alpha) were quantified in ocular tissues. Eye fundus of retinal arterioles, transmission electron microscopy (TEM) of lenses, and histopathology of retinas were also performed. DM was linked to constricted retinal arterioles, reduced endogen antioxidants, and eye inflammation. Histologically, retinal wall thickness decreased. TEM showed increased lens opacity and fibre disorganisation. Rutin improved retinal arteriolar diameter, while reducing oxidative stress and inflammation. Retinas were moderately oedematous. Lens structure was preserved on TEM. Insulin restored retinal arteriolar diameter, while increasing MDA, and amplifying TEM lens opacity. The best outcomes were obtained for AuNPsR, as it improved fundus appearance of retinal arterioles, decreased MDA and increased antioxidant capacity. Retinal edema and disorganisation in lens fibres were still present.
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Affiliation(s)
- Mădălina Moldovan
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Clinicilor Street, No. 1, 400006 Cluj-Napoca, Romania; (A.-M.P.); (G.A.F.)
| | - Ana-Maria Păpurică
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Clinicilor Street, No. 1, 400006 Cluj-Napoca, Romania; (A.-M.P.); (G.A.F.)
| | - Mara Muntean
- Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, Pasteur Street, No. 6, 400349 Cluj-Napoca, Romania;
| | - Raluca Maria Bungărdean
- Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Clinicilor Street, No. 3-5, 400340 Cluj-Napoca, Romania; (R.M.B.); (D.G.)
| | - Dan Gheban
- Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Clinicilor Street, No. 3-5, 400340 Cluj-Napoca, Romania; (R.M.B.); (D.G.)
- Department of Pathology, Emergency Clinical Hospital for Children, Motilor Street, No. 41T-42T, 400370 Cluj-Napoca, Romania
| | - Bianca Moldovan
- Faculty of Chemistry and Chemical Engineering, Babes-Bolyai University, Arany Janos Street, No. 11, 400028 Cluj-Napoca, Romania; (B.M.); (G.K.); (L.D.)
| | - Gabriel Katona
- Faculty of Chemistry and Chemical Engineering, Babes-Bolyai University, Arany Janos Street, No. 11, 400028 Cluj-Napoca, Romania; (B.M.); (G.K.); (L.D.)
| | - Luminița David
- Faculty of Chemistry and Chemical Engineering, Babes-Bolyai University, Arany Janos Street, No. 11, 400028 Cluj-Napoca, Romania; (B.M.); (G.K.); (L.D.)
| | - Gabriela Adriana Filip
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Clinicilor Street, No. 1, 400006 Cluj-Napoca, Romania; (A.-M.P.); (G.A.F.)
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15
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Lam SH, Liu HK, Chung SY, Chang JL, Hong MX, Kuo SC, Liaw CC. Diterpenoids and Their Glycosides from the Stems of Tinospora crispa with Beta-Cell Protective Activity. JOURNAL OF NATURAL PRODUCTS 2023; 86:1437-1448. [PMID: 37200063 DOI: 10.1021/acs.jnatprod.3c00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Seven previously undescribed diterpenoids, tinocrisposides A-D (1-4) and borapetic acids A (5), B (6), and C (7), together with 16 known compounds, were isolated from the stem of Tinospora crispa (Menispermaceae). The structures of the new isolates were elucidated by spectroscopic and chemical methods. The β-cell protective effect of the tested compounds was examined on insulin-secreting BRIN-BD11 cells under dexamethasone treatment. Diterpene glycosides 12, 14-16, and 18 presented a substantial protective effect on BRIN-BD11 cells treated with dexamethasone in a dose-dependent manner. Compounds 4 and 17 with two sugar moieties exhibited clear protective effects on β-cells.
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Affiliation(s)
- Sio-Hong Lam
- School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Hui-Kang Liu
- Division of Basic Chinese Medicine, National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei 112, Taiwan
- Ph.D. Program in the Clinical Drug Development of Herbal Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Shih-Yuan Chung
- Department of Marine Biotechnology and Resource, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Graduate Institute of Pharmaceutical Chemistry, China Medical University, Taichung 404, Taiwan
| | - Jia-Ling Chang
- Department of Science Application and Dissemination, National Taichung University of Education, Taichung 403, Taiwan
| | - Mao-Xuan Hong
- Department of Marine Biotechnology and Resource, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Sheng-Chu Kuo
- Graduate Institute of Pharmaceutical Chemistry, China Medical University, Taichung 404, Taiwan
| | - Chih-Chuang Liaw
- Department of Marine Biotechnology and Resource, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Graduate Institute of Natural Products, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Pharmacognosy, Taipei Medical University, Taipei 11031, Taiwan
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Charu V, Liang JW, Chertow GM, Li ZJ, Montez-Rath ME, Geldsetzer P, de Boer IH, Tian L, Tamura MK. Heterogeneous treatment effects of intensive glycemic control on kidney microvascular outcomes in ACCORD. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.14.23291396. [PMID: 37398349 PMCID: PMC10312895 DOI: 10.1101/2023.06.14.23291396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Objective Clear criteria to individualize glycemic targets are lacking. In this post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes trial (ACCORD), we evaluate whether the kidney failure risk equation (KFRE) can identify patients who disproportionately benefit from intensive glycemic control on kidney microvascular outcomes. Research design and methods We divided the ACCORD trial population in quartiles based on 5-year kidney failure risk using the KFRE. We estimated conditional treatment effects within each quartile and compared them to the average treatment effect in the trial. The treatment effects of interest were the 7-year restricted-mean-survival-time (RMST) differences between intensive and standard glycemic control arms on (1) time-to-first development of severely elevated albuminuria or kidney failure and (2) all-cause mortality. Results We found evidence that the effect of intensive glycemic control on kidney microvascular outcomes and all-cause mortality varies with baseline risk of kidney failure. Patients with elevated baseline risk of kidney failure benefitted the most from intensive glycemic control on kidney microvascular outcomes (7-year RMST difference of 115 v. 48 days in the entire trial population) However, this same patient group also experienced shorter times to death (7-year RMST difference of -57 v. -24 days). Conclusions We found evidence of heterogenous treatment effects of intensive glycemic control on kidney microvascular outcomes in ACCORD as a function of predicted baseline risk of kidney failure. Patients with higher kidney failure risk experienced the most pronounced benefits of treatment on kidney microvascular outcomes but also experienced the highest risk of all-cause mortality.
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Affiliation(s)
- Vivek Charu
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Jane W. Liang
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Glenn M. Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Zhuo Jun Li
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Maria E. Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Pascal Geldsetzer
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Ian H. de Boer
- Division of Nephrology, Department of Medicine, and the Kidney Research Institute, University of Washington, Seattle, WA
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA
| | - Manjula Kurella Tamura
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Geriatric Research and Education Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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Ismail CAN. Issues and challenges in diabetic neuropathy management: A narrative review. World J Diabetes 2023; 14:741-757. [PMID: 37383599 PMCID: PMC10294062 DOI: 10.4239/wjd.v14.i6.741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/24/2023] [Accepted: 04/11/2023] [Indexed: 06/14/2023] Open
Abstract
Diabetic neuropathy (DN) is a devastating disorder with an increasing prevalence globally. This epidemic can pose a critical burden on individuals and com-munities, subsequently affecting the productivity and economic output of a country. With more people living a sedentary lifestyle, the incidence of DN is escalating worldwide. Many researchers have relentlessly worked on ways to combat this devastating disease. Their efforts have given rise to a number of commercially available therapies that can alleviate the symptoms of DN. Unfortunately, most of these therapies are only partially effective. Worse still, some are associated with unfavorable side effects. This narrative review aims to highlight current issues and challenges in the management of DN, especially from the perspective of molecular mechanisms that lead to its progression, with the hope of providing future direction in the management of DN. To improve the approaches to diabetic management, the suggested resolutions in the literature are also discussed in this review. This review will provide an in-depth understanding of the causative mechanisms of DN, apart from the insights to improve the quality and strategic approaches to DN management.
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Affiliation(s)
- Che Aishah Nazariah Ismail
- Department of Physiology, School of Medical Sciences, University Sains Malaysia Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
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Tsai YC, Wu CF, Hung WW, Yu PS, Liu CC, Hsieh TJ, Chen CC, Li SS, Chen JJ, Chiu YW, Hwang SJ, Wu MT. Environmental melamine exposure and adverse kidney outcomes in patients with type 2 diabetes mellitus. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 331:121883. [PMID: 37236580 DOI: 10.1016/j.envpol.2023.121883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/19/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023]
Abstract
The impact of melamine exposure on kidney outcomes in type 2 diabetes mellitus (T2D) patients remains unclear. In this prospective cohort study, 561 T2D patients during October 2016 and June 2020 were enrolled and followed until December 2021. Baseline one-spot urinary corrected melamine levels were measured by LC-MS/MS. Average daily intake (ADI) of melamine represented environmental melamine exposure in daily life, and was estimated using urinary corrected melamine level by creatinine excretion (CE)-based model. Primary kidney outcomes were defined as doubling of serum creatinine levels or end stage kidney disease (ESKD), and secondary kidney outcomes included rapid decline in kidney function as estimated glomerular filtration rate (eGFR) decline >5 ml/min/1.73 m2/year. Baseline median urinary corrected melamine levels and estimated DI of melamine were 0.8 μg/mmol and 0.3 μg/kg/day in 561 T2D patients. During 3.7 years of follow-up, urinary corrected melamine level was positively correlated with reaching composite outcomes of either doubling of serum creation levels or ESKD and rapid decline in kidney function. Those with the highest quartile of urinary corrected melamine had 2.96-fold risk of composite outcomes of either doubling of serum creation levels or ESKD and 2.47-fold risk of eGFR decline >5 ml/min/1.73 m2/year. Estimated ADI of melamine also had significant correlation with adverse kidney outcomes. Furthermore, the positive relationship between melamine exposure and rapid decline in kidney function was only found in T2D patients with male, baseline eGFR ≥60 ml/min/1.73 m2 or glycated hemoglobin ≤7%. In conclusion, melamine exposure is significantly associated with adverse kidney outcomes in T2D patients, especially in those with male, well sugar control or good baseline kidney function.
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Affiliation(s)
- Yi-Chun Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of General Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Fang Wu
- International Master Program of Translational Medicine, National United University, Miaoli, Taiwan
| | - Wei-Wen Hung
- Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Shaou Yu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Kaohsiung Municipal CiJin Hospital, Kaohsiung, Taiwan
| | - Chia-Chu Liu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tusty-Jiuan Hsieh
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chu-Chih Chen
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Taiwan
| | - Sih-Syuan Li
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Jen Chen
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Tsang Wu
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
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Alsaidan AA, Alotaibi SF, Thirunavukkarasu A, ALruwaili BF, Alharbi RH, Arnous MM, Alsaidan OA, Alduraywish AS, Alwushayh YA. Medication Adherence and Its Associated Factors among Patients with Type 2 Diabetes Mellitus Attending Primary Health Centers of Eastern Province, Saudi Arabia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050989. [PMID: 37241220 DOI: 10.3390/medicina59050989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/15/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
Medication adherence by patients with diabetes is critical, as it plays a crucial role in individuals' long-term health and well-being. We evaluated the medication adherence, illness perception, diabetes knowledge, and associated factors among patients with type 2 diabetes mellitus (T2DM) attending primary health centers (PHCs) in the eastern province of the Kingdom of Saudi Arabia (KSA) using a validated Arabic version of a data collection form. In order to identify the variables that are associated with medication adherence, we applied a logistic regression analysis. Furthermore, we performed the Spearman test to find the correlation between medication adherence, illness perception, and diabetes knowledge. Of the 390 studied patients, 21.5% had low medication adherence, and it was significantly associated with gender (adjusted OR (AOR) = 1.89, 95% CI = 1.27-2.73, p = 0.003) and duration of diabetes (AOR = 0.83, 95% CI = 0.67-0.95, p = 0.017). Furthermore, we found a significant positive correlation between medication adherence and illness perception (rho = 0.217, p = 0.007) and knowledge of diabetes and medication adherence (rho = 0.425, p < 0.001). We recommend improving T2DM patients' knowledge about the importance of adherence to their medication regimen in several health education sessions at the PHCs. In addition, we recommend mixed-method medication adherence assessment surveys in different parts of the KSA.
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Affiliation(s)
- Aseel Awad Alsaidan
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka, Aljouf 72388, Saudi Arabia
| | - Sultan Fahad Alotaibi
- Department of Public Health, Hafr Al-Batin Health Affairs, Al Baladiyah, Hafr Al Batin 39921, Saudi Arabia
| | - Ashokkumar Thirunavukkarasu
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka, Aljouf 72388, Saudi Arabia
| | - Bashayer Farhan ALruwaili
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka, Aljouf 72388, Saudi Arabia
| | - Rami Hamdan Alharbi
- Department of Family and Community Medicine, Prince Sultan Military Medical Center, Riyadh City 12233, Saudi Arabia
| | - Maha M Arnous
- Department of Family and Community Medicine, Security Forces Hospital Program, Riyadh City 12625, Saudi Arabia
| | - Omar Awad Alsaidan
- Department of Pharmaceutics, College of Pharmacy, Jouf University, Sakaka 72341, Saudi Arabia
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20
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Végh D, Bencze B, Banyai D, Vegh A, Rózsa N, Nagy Dobó C, Biczo Z, Kammerhofer G, Ujpal M, Díaz Agurto L, Pedrinaci I, Peña Cardelles JF, Magrin GL, Padhye NM, Mente L, Payer M, Hermann P. Preoperative HbA1c and Blood Glucose Measurements in Diabetes Mellitus before Oral Surgery and Implantology Treatments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4745. [PMID: 36981651 PMCID: PMC10048655 DOI: 10.3390/ijerph20064745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Diabetes mellitus has become a worldwide epidemic and is frequently accompanied by a number of complications proportional to the duration of hyperglycemia. The aim of this narrative review is to assess the most up-to-date guidelines on DM provided by both diabetes and dental associations. Furthermore, to gather evidence on the uni/bidirectional relationships of elevated HbA1c levels on dental surgery, implantology, bone augmentation, and periodontology and to demonstrate the importance of measuring HbA1c levels before invasive dental treatments. HbA1c and blood glucose measurements are a minimally invasive method for preventing complications in diabetes mellitus. The authors conducted a literature review to determine which oral conditions are affected by diabetes mellitus. MEDLINE served as a source with the use of a specific search key. Regarding oral complications of diabetes, prevention is the most vital factor. With this publication, we hope to assist physicians and dentists to make prompt diagnoses and to help in recognizing various oral manifestations of diabetes and follow the existing guidelines.
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Affiliation(s)
- Dániel Végh
- Department of Prosthodontics, Semmelweis University, 1088 Budapest, Hungary
- Division of Oral Surgery and Orthodontics, Department of Dentistry and Oral Health, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria
| | - Bulcsú Bencze
- Department of Prosthodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Dorottya Banyai
- Department of Pedodontics and Orthodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Adam Vegh
- Department of Oral Diagnostics, Semmelweis University, 1088 Budapest, Hungary
| | - Noémi Rózsa
- Department of Pedodontics and Orthodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Csaba Nagy Dobó
- Department of Oral Diagnostics, Semmelweis University, 1088 Budapest, Hungary
| | - Zita Biczo
- Department of Maxillofacial and Oral Surgery, Semmelweis University, 1088 Budapest, Hungary
| | - Gabor Kammerhofer
- Department of Maxillofacial and Oral Surgery, Semmelweis University, 1088 Budapest, Hungary
| | - Marta Ujpal
- Department of Maxillofacial and Oral Surgery, Semmelweis University, 1088 Budapest, Hungary
| | - Leonardo Díaz Agurto
- Faculty of Dentistry, Postgraduate School, Universidad de Chile, Santiago 7520355, Chile
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, 55131 Mainz, Germany
| | - Ignacio Pedrinaci
- Section of Graduate Periodontology, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Restorative Dentistry and Biomaterials Science, Harvard School of Dental Medicine, Harvard University, Boston, MA 02115, USA
| | - Juan Francisco Peña Cardelles
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain
- Department of Basic Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Oral and Maxillofacial Surgery Department, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
| | - Gabriel Leonardo Magrin
- Section of Graduate Periodontology, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain
- Center for Education and Research on Dental Implants (CEPID), Department of Dentistry, Federal University of Santa Catarina (UFSC), 88040-900 Florianopolis, Brazil
| | - Ninad Milind Padhye
- Centre for Oral Clinical Research, Queen Mary University and The London School of Medicine and Dentistry, The Royal London Dental Hospital, London E1 1FR, UK
| | - Laura Mente
- Division of Oral Surgery and Orthodontics, Department of Dentistry and Oral Health, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria
| | - Michael Payer
- Division of Oral Surgery and Orthodontics, Department of Dentistry and Oral Health, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria
| | - Peter Hermann
- Department of Prosthodontics, Semmelweis University, 1088 Budapest, Hungary
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21
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Chadha M, Jain SM, Chawla R, Dharmalingam M, Chaudhury T, Talwalkar P, Tripathi S, Singh S, Gutch M, Dasgupta A. Evolution of Guideline Recommendations on Insulin Therapy in Type 2 Diabetes Mellitus Over the Last Two Decades: A Narrative Review. Curr Diabetes Rev 2023; 19:e160123212777. [PMID: 36650625 PMCID: PMC10617785 DOI: 10.2174/1573399819666230116150205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/08/2022] [Accepted: 11/10/2022] [Indexed: 01/19/2023]
Abstract
The prevalence of type 2 diabetes mellitus has been increasing worldwide. As the therapeutic options for type 2 diabetes mellitus have evolved over the last 2 decades, national and global guidelines related to type 2 diabetes mellitus pharmacotherapy issued by various organizations have tended to vary in their recommendations. This narrative review aimed to analyze the key recommendations by major global and national guidelines on the initiation of insulin therapy in patients with type 2 diabetes mellitus over the last 20 years. Strategies for insulin therapy for titration and intensification were also assessed. All guidelines recommend initiation of insulin (basal/ premixed/other formulations) when glycemic targets are not achieved despite lifestyle measures and oral antidiabetic drugs. In the recent decade, early initiation of insulin has been recommended when the glycated hemoglobin levels are >10% or blood glucose levels are ≥300 mg/dL (16.7 mmol/L). Initiation is recommended at a dose of 10 units or 0.1-0.2 U/kg. Titration is advised to achieve the optimal dosage, while intensification is recommended when glycemic targets are not achieved despite titrating to an acceptable level. Glucose monitoring at periodic intervals is recommended for adequate glycemic control. The guidelines further suggest that the choice of insulin should be individualized, considering the clinical status of patients with type 2 diabetes mellitus. The physicians as well as patients should be a part of the decisions made regarding the therapeutic choice of regimen, preparation, and delivery device.
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Affiliation(s)
- Manoj Chadha
- Department of Endocrinology, P.D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - Sunil M. Jain
- TOTALL Diabetes Hormone Institute, Indore, Madhya Pradesh, India
| | - Rajeev Chawla
- Department of Endocrinology, North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - Mala Dharmalingam
- Department of Endocrinology, MSR Medical College & Hospital, Bangalore, Karnataka, India
| | | | | | - Sudhir Tripathi
- Department of Endocrinology & Metabolism, Sir Gangaram Hospital, New Delhi, India
| | - S.K. Singh
- Department of Endocrinology, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| | - Manish Gutch
- Department of Endocrinology and Diabetes, Medanta Hospital, Lucknow, Uttar Pradesh, India
| | - Arundhati Dasgupta
- Department of Endocrinology, Rudraksh Superspeciality Care, Siliguri, West Bengal, India
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22
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Juraschek SP, Wang D, McEvoy JW, Harrap S, Harris K, Mancia G, Marre M, Neal B, Patel A, Poulter NR, Williams B, Chalmers J, Woodward M, Selvin E. Effects of glucose and blood pressure reduction on subclinical cardiac damage: Results from ADVANCE. Int J Cardiol 2022; 358:103-109. [PMID: 35439582 PMCID: PMC9148188 DOI: 10.1016/j.ijcard.2022.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/25/2022] [Accepted: 04/13/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Observational data suggest a potential for subclinical cardiac damage from intensive blood glucose or blood pressure (BP) control, particularly in adults with very low blood glucose and BP levels. However, this has not been tested in a randomized trial. METHODS The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Research Controlled Evaluation (ADVANCE) study was a factorial, randomized trial designed to test the effects of intensive blood glucose (hemoglobin A1c ≤6.5% versus usual care) and intensive BP (combination of perindopril-indapamide versus placebo) control on vascular events in adults with diabetes. Using mixed effects tobit models, we determined the effect of the randomized interventions on change in subclinical cardiac injury (high sensitivity cardiac troponin T [hs-cTnT]) and strain (N-terminal b-type pro natriuretic peptide [NT-proBNP]), 1 year after randomization. RESULTS Among the 682 participants, mean age was 66.1 (SD, 6.5) years; 40% were women. Mean baseline hemoglobin A1c was 7.4% (SD, 1.5) and systolic/diastolic BP was 147 (SD,21)/81 (SD,11) mmHg. After 1 year, intensive versus standard glucose control did not significantly change hs-cTnT (1.5%; 95%CI:-4.9,8.2) or NT-proBNP (-10.3%; 95%CI: -20.2%,0.9%). Intensive versus standard BP control also did not affect hs-cTnT (-2.9%; 95%CI: -8.9,3.6), but did significantly lower NT-proBNP by 21.6% (95%CI:-30.2%,-11.9%). Changes in systolic BP at 1 year (versus baseline) were strongly associated with NT-proBNP (P = 0.004), but not hs-cTnT (P = 0.95). CONCLUSIONS In adults with diabetes, intensive BP control reduced NT-proBNP without increasing hs-cTnT, supporting the benefits and safety of intensive BP control in adults with diabetes. This trial is registered at clinicaltrials.gov, number: NCT00145925.
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Affiliation(s)
- Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Dan Wang
- Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John W McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Stephen Harrap
- The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Michel Marre
- Clinique Ambroise Paré, Diabétologie-Endocrinologie, Neuilly-sur-Seine, France; Cordeliers Research Centre, Paris, France
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.; School of Public Health, Imperial College London, London, United Kingdom
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Neil R Poulter
- School of Public Health, Imperial College London, London, United Kingdom
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.; The George Institute for Global Health, Imperial College London, United Kingdom
| | - Elizabeth Selvin
- Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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23
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Association between Blood Glucose Control and Subjective Cognitive Decline in Korean Patients with Diabetes Aged over 50 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127267. [PMID: 35742517 PMCID: PMC9223580 DOI: 10.3390/ijerph19127267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 12/10/2022]
Abstract
This study aimed to investigate the association between blood glucose control and subjective cognitive decline in adult patients with diabetes. Using the 2018 data from the community health survey, we included 18,789 patients with diabetes aged ≥50 years who had complete responses recorded. Blood glucose control was the independent variable, and subjective cognitive decline was the dependent variable. Multivariable logistic regression analysis was used to analyze the association between blood glucose control and subjective cognitive decline. Multivariable logistic regression analysis showed that blood glucose control was inversely associated with subjective cognitive decline in patients with diabetes. Patients with uncontrolled blood glucose levels had higher odds of subjective cognitive decline than those with controlled blood glucose levels (odds ratio = 1.22; 95% confidence interval: 1.10, 1.34). Our findings suggest that patients with diabetes may demonstrate subjective cognitive decline if their blood glucose levels are not well-controlled.
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24
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Mao D, Lau ES, Wu H, Yang A, Fan B, Shi M, Tam CH, Chow E, Kong AP, Ma RC, Luk A, Chan JC. Risk Associations of Glycemic Burden and Obesity With Liver Cancer-A 10-Year Analysis of 15,280 Patients With Type 2 Diabetes. Hepatol Commun 2022; 6:1350-1360. [PMID: 35044101 PMCID: PMC9134801 DOI: 10.1002/hep4.1891] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/21/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022] Open
Abstract
Liver is a major site for glucose metabolism. Patients with type 2 diabetes (T2D) and obesity have increased risk of liver cancer. We explored the association of glycemic burden (GB) and obesity with liver cancer in T2D in the prospective Hong Kong Diabetes Register (1995-2019). We calculated GB using the area under the curve above hemoglobin A1c (HbA1c) of 5.7% and defined obesity as body mass index (BMI) ≥ 25 kg/m2 . We used Cox proportional hazards models to evaluate the association between GB and liver cancer. We included 15,280 patients with at least 10 years of disease duration before liver cancer occurred or censor date, ≥3 years of observation, and ≥5 HbA1c measurements (64% male, age: 58.23 ± 12.47 years, HbA1c: 7.60 ± 1.65%, BMI: 25.58 ± 4.10 kg/m2 ). We excluded 3 years of HbA1c values before liver cancer to avoid reverse causality. Every 1-SD increase in GB was associated with an adjusted hazard ratio (aHR) of liver cancer of 1.22 (95% confidence interval [CI]: 1.01-1.47). The top GB quartile group (range: >2.41) had aHR of 1.78 (1.01-3.13) versus the lowest quartile group (0-1.19). The aHRs for each SD increase in GB were 1.34 (1.05, 1.70) in the obese group and 1.12 (0.81-1.53) in the nonobese group, but no interaction (Pinteraction = 0.120). When stratified by GB median (1.69 [1.13, 2.43]) and obesity, obese patients with high GB had the highest aHR of 2.51 (1.44-4.37) for liver cancer versus the nonobese group with low GB, but no interaction (Pinteraction = 0.071). Subgroup analysis of patients with available hepatitis B surface antigen status (n = 9,248) yielded similar results. Conclusion: Our results emphasized the importance of glycemic and weight control for reducing the risk of liver cancer in T2D.
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Affiliation(s)
- Dandan Mao
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - Eric S.H. Lau
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - Hongjiang Wu
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - Aimin Yang
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityHong Kong SARChina
| | - Baoqi Fan
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - Mai Shi
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - Claudia H.T. Tam
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - Elaine Chow
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityHong Kong SARChina
- Phase 1 Clinical Trial CenterThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - Alice P.S. Kong
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityHong Kong SARChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - Ronald C.W. Ma
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityHong Kong SARChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - Andrea Luk
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityHong Kong SARChina
- Phase 1 Clinical Trial CenterThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - Juliana C.N. Chan
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityHong Kong SARChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
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25
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Al-Ma'aitah OH, Demant D, Jakimowicz S, Perry L. Glycaemic control and its associated factors in patients with type 2 diabetes in the Middle East and North Africa: An updated systematic review and meta-analysis. J Adv Nurs 2022; 78:2257-2276. [PMID: 35621355 PMCID: PMC9541219 DOI: 10.1111/jan.15255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 02/05/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022]
Abstract
Aims To examine the patient‐related factors that have been linked to glycaemic control in people living with type 2 diabetes mellitus in Middle Eastern countries. Design A systematic review and meta‐analysis. Data Sources A computerized search was conducted using the databases MEDLINE (via PubMed and Ovid), EMBASE, Scopus and CINAHL to identify peer‐reviewed articles published in English between 1 January 2010 and 21 May 2020. On 28 June 2021, the search was updated with the same keywords and databases; however, no further relevant studies were identified. Review Methods Extracted data were analysed using Review Manager 5.4. Results The final sample consisted of 54 articles with a total of 41,079 participants. Pooled data showed an increased risk of inadequate glycaemic control in smokers [OR = 1.26, 95% confidence interval (CI): 1.05, 1.52; p = .010], obese patients (OR = 1.30, 95% CI: 1.10, 1.54; p = .002), patients with elevated waist to hip ratio (OR = 1.62, 95% CI: 1.16, 2.26; p = .004) and longer disease duration (OR = 2.01, 95% CI: 1.64, 2.48; p < .001). A lower risk of inadequate control was associated with physical activity (OR = 0.40, 95% CI: 0.24, 0.67; p < .001) and self‐management (OR = 0.49, 95% CI: 0.29, 0.82; p = .006). Conclusion These findings highlight the opportunity to address factors to improve glycaemic control. Further longitudinal studies are required to better understand these variations, to assess all predictors of glycaemic control in participants with type 2 diabetes, and to provide a strong basis for future measures to optimize glycaemic control.
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Affiliation(s)
- Odai Hamed Al-Ma'aitah
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Samantha Jakimowicz
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia
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Han Y, Yun CC. Metformin Inhibits Na +/H + Exchanger NHE3 Resulting in Intestinal Water Loss. Front Physiol 2022; 13:867244. [PMID: 35444557 PMCID: PMC9014215 DOI: 10.3389/fphys.2022.867244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/07/2022] [Indexed: 11/14/2022] Open
Abstract
Glycemic control is the key to the management of type 2 diabetes. Metformin is an effective, widely used drug for controlling plasma glucose levels in diabetes, but it is often the culprit of gastrointestinal adverse effects such as abdominal pain, nausea, indigestion, vomiting, and diarrhea. Diarrhea is a complex disease and altered intestinal transport of electrolytes and fluid is a common cause of diarrhea. Na+/H+ exchanger 3 (NHE3, SLC9A3) is the major Na+ absorptive mechanism in the intestine and our previous study has demonstrated that decreased NHE3 contributes to diarrhea associated with type 1 diabetes. The goal of this study is to investigate whether metformin regulates NHE3 and inhibition of NHE3 contributes to metformin-induced diarrhea. We first determined whether metformin alters intestinal water loss, the hallmark of diarrhea, in type 2 diabetic db/db mice. We found that metformin decreased intestinal water absorption mediated by NHE3. Metformin increased fecal water content although mice did not develop watery diarrhea. To determine the mechanism of metformin-mediated regulation of NHE3, we used intestinal epithelial cells. Metformin inhibited NHE3 activity and the effect of metformin on NHE3 was mimicked by a 5'-AMP-activated protein kinase (AMPK) activator and blocked by pharmacological inhibition of AMPK. Metformin increased phosphorylation and ubiquitination of NHE3, resulting in retrieval of NHE3 from the plasma membrane. Previous studies have demonstrated the role of neural precursor cell expressed, developmentally down-regulated 4-2 (Nedd4-2) in regulation of human NHE3. Silencing of Nedd4-2 mitigated NHE3 inhibition and ubiquitination by metformin. Our findings suggest that metformin-induced diarrhea in type 2 diabetes is in part caused by reduced Na+ and water absorption that is associated with NHE3 inhibition, probably by AMPK.
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Affiliation(s)
- Yiran Han
- Gastroenterology Research, Atlanta Veterans Administration Medical Center, Decatur, GA, United States
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - C. Chris Yun
- Gastroenterology Research, Atlanta Veterans Administration Medical Center, Decatur, GA, United States
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, United States
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Karalliedde J, Winocour P, Chowdhury TA, De P, Frankel AH, Montero RM, Pokrajac A, Banerjee D, Dasgupta I, Fogarty D, Sharif A, Wahba M, Mark PB, Zac-Varghese S, Patel DC, Bain SC. Clinical practice guidelines for management of hyperglycaemia in adults with diabetic kidney disease. Diabet Med 2022; 39:e14769. [PMID: 35080257 DOI: 10.1111/dme.14769] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 01/03/2023]
Abstract
A significant percentage of people with diabetes develop chronic kidney disease and diabetes is also a leading cause of end-stage kidney disease (ESKD). The term diabetic kidney disease (DKD) includes both diabetic nephropathy (DN) and diabetes mellitus and chronic kidney disease (DM CKD). DKD is associated with high morbidity and mortality, which are predominantly related to cardiovascular disease. Hyperglycaemia is a modifiable risk factor for cardiovascular complications and progression of DKD. Recent clinical trials of people with DKD have demonstrated improvement in clinical outcomes with sodium glucose co-transporter-2 (SGLT-2) inhibitors. SGLT-2 inhibitors have significantly reduced progression of DKD and onset of ESKD and these reno-protective effects are independent of glucose lowering. At the time of this update Canagliflozin and Dapagliflozin have been approved for delaying the progression of DKD. The Association of British Clinical Diabetologists (ABCD) and UK Kidney Association (UKKA) Diabetic Kidney Disease Clinical Speciality Group have undertaken a literature review and critical appraisal of the available evidence to inform clinical practice guidelines for management of hyperglycaemia in adults with DKD. This 2021 guidance is for the variety of clinicians who treat people with DKD, including GPs and specialists in diabetes, cardiology and nephrology.
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Affiliation(s)
- Janaka Karalliedde
- Consultant Diabetologist, Guy's and St Thomas' Hospital London and King's College London, London, UK
| | - Peter Winocour
- Consultant Diabetologist, East and North Herts Institute of Diabetes and Endocrinology, East and North Herts NHS Trust, Welwyn Garden City, UK
| | | | - Parijat De
- Consultant Diabetologist, City Hospital, Birmingham, UK
| | - Andrew H Frankel
- Consultant Nephrologist, Imperial College Healthcare NHS Trust, London, UK
| | - Rosa M Montero
- Consultant Nephrologist, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Ana Pokrajac
- Consultant Diabetologist, West Hertfordshire Hospitals, Watford, UK
| | | | | | - Damian Fogarty
- Consultant Nephrologist, Belfast Health and Social Care Trust, Belfast, UK
| | - Adnan Sharif
- Consultant Nephrologist, University Hospitals Birmingham, Birmingham, UK
| | - Mona Wahba
- Consultant Nephrologist, St Helier Hospital, Carshalton, UK
| | - Patrick B Mark
- Professor of Nephrology, Institute of Cardiovascular and Medical Sciences University of Glasgow, Glasgow, UK
| | - Sagen Zac-Varghese
- Consultant Diabetologist, East and North Herts NHS Trust, Welwyn Garden City, UK
| | - Dipesh C Patel
- Consultant Endocrinologist, Royal Free London NHS Foundation Trust, London, UK
- Honorary Associate Professor, UCL, London, UK
| | - Stephen C Bain
- Professor of Medicine (Diabetes), Swansea University, Swansea, UK
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Telehealth Interventions to Improve Diabetes Management Among Black and Hispanic Patients: a Systematic Review and Meta-Analysis. J Racial Ethn Health Disparities 2022; 9:2375-2386. [PMID: 35000144 PMCID: PMC8742712 DOI: 10.1007/s40615-021-01174-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previous systematic reviews have found that telehealth is an effective strategy for implementing interventions to improve glycemic control and other clinical outcomes for diabetes patients. However, these reviews have not meaningfully focused on Black and Hispanic patients-partly because of the lack of adequate representation of people from racial and ethnic minority groups in clinical trials. It is unclear whether telehealth interventions are effective at improving glycemic control among Black and Hispanic patients given the disproportionate number of barriers they face accessing health care. OBJECTIVES A systematic review and meta-analysis of randomized control trials that used telehealth interventions for improving glycemic control among Black and Hispanic diabetes patients. METHODS We reviewed PubMed, Embase, Web of Science, CINAHL, PsycINFO, and clinicalTrials.gov from inception to March 2021. We used a narrative summary approach to describe key study characteristics and graded the quality of studies using two reviewers. The pooled net change in HbA1c values was estimated across studies using a random-effects model. RESULTS We identified 10 studies that met our inclusion and exclusion criteria. Nine studies were included in the meta-analysis. Only one study was rated as having low bias. Telehealth interventions were primarily delivered by telephone calls, text messages, web-based portals, and virtual visits. Most interventions involved delivering diabetes self-management education. Telehealth intervention pooled across studies with a mix of Black and Hispanic participants (> 50% sample) was associated with a - 0.465 ([CI: - 0.648 to - 0.282], p = 0.000) reduction in HbA1c. CONCLUSIONS Our findings suggest telehealth interventions are effective at improving glycemic control among Black and Hispanic diabetes patients.
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Ye D, Fairchild TJ, Vo L, Drummond PD. Painful diabetic peripheral neuropathy: Role of oxidative stress and central sensitisation. Diabet Med 2022; 39:e14729. [PMID: 34674302 DOI: 10.1111/dme.14729] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/20/2021] [Indexed: 12/22/2022]
Abstract
AIMS Diabetic peripheral neuropathy (DPN) occurs in about half of people with diabetes, of whom a quarter may develop chronic pain. Pain may remain for years yet be difficult to treat because the underlying mechanisms remain unclear. There is consensus that processing excessive glucose leads to oxidative stress, interfering with normal metabolism. In this narrative review, we argue that oxidative stress may also contribute to pain. METHODS We reviewed literature in PubMed published between January 2005 and August 2021. RESULTS AND CONCLUSIONS In diabetes, hyperglycaemia and associated production of reactive species can directly increase pain signalling and activate sensory neurons; or the effects can be indirect, mediated by mitochondrial damage and enhanced inflammation. Furthermore, pain processing in the central nervous system is compromised in painful DPN. This is implicated in central sensitisation and dysfunctional pain modulation. However, central pain modulatory function is understudied in diabetes. Future research is required to clarify whether central sensitisation and/or disturbances in central pain modulation contribute to painful DPN. Positive results would facilitate early detection and future treatment.
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Affiliation(s)
- Di Ye
- Discipline of Psychology and Healthy Ageing Research Centre, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Timothy J Fairchild
- Discipline of Exercise Science and Healthy Ageing Research Centre, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Lechi Vo
- Discipline of Psychology and Healthy Ageing Research Centre, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Peter D Drummond
- Discipline of Psychology and Healthy Ageing Research Centre, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
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Galosi E, Hu X, Michael N, Nyengaard JR, Truini A, Karlsson P. Redefining distal symmetrical polyneuropathy features in type 1 diabetes: a systematic review. Acta Diabetol 2022; 59:1-19. [PMID: 34213655 PMCID: PMC8758619 DOI: 10.1007/s00592-021-01767-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Diabetic neuropathy is among the most frequent complications of both type 1 (T1DM) and type 2 diabetes (T2DM) and commonly manifests as a distal symmetrical polyneuropathy (DSPN). Despite evidence that T1DM- and T2DM-related DSPN are separate entities, most of our knowledge on diabetic DSPN derives from studies focused on type 2 diabetes. This systematic review provides an overview of current evidence on DSPN in T1DM, including its epidemiological, pathophysiological and clinical features, along with principal diagnostic tests findings. This review included 182 clinical and preclinical studies. The results indicate that DSPN is a less frequent complication in T1DM compared with T2DM and that distinctive pathophysiological mechanisms underlie T1DM-related DSPN development, with hyperglycemia as a major determinant. T1DM-related DSPN more frequently manifests with non-painful than painful symptoms, with lower neuropathic pain prevalence compared with T2DM-associated DSPN. The overt clinical picture seems characterized by a higher prevalence of large fiber-related clinical signs (e.g., ankle reflexes reduction and vibration hypoesthesia) and to a lesser extent small fiber damage (e.g., thermal or pinprick hypoesthesia). These findings as a whole suggest that large fibers impairment plays a dominant role in the clinical picture of symptomatic T1DM-related DSPN. Nevertheless, small fiber diagnostic testing shows high diagnostic accuracy in detecting early nerve damage and may be an appropriate diagnostic tool for disease monitoring and screening.
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Affiliation(s)
- Eleonora Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy.
| | - Xiaoli Hu
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
| | - Nivatha Michael
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Randel Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Páll Karlsson
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
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Alhassan Y, Kwakye AO, Dwomoh AK, Baah-Nyarkoh E, Ganu VJ, Appiah B, Kretchy IA. Determinants of blood pressure and blood glucose control in patients with co-morbid hypertension and type 2 diabetes mellitus in Ghana: A hospital-based cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001342. [PMID: 36962917 PMCID: PMC10022155 DOI: 10.1371/journal.pgph.0001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
Hypertension and diabetes are major risk factors for cardiovascular diseases and optimal control of blood pressure (BP) and blood glucose are associated with reduced cardiovascular disease events. This study, therefore, sought to estimate the prevalence and associated factors of controlled BP and blood glucose levels among patients diagnosed with both hypertension and Type 2- diabetes mellitus (T2DM). A quantitative cross-sectional study was conducted in a primary health setting in Ghana among patients 18 years and older diagnosed with both hypertension and T2DM. Pearson's chi-square was used to assess the association between BP and blood glucose levels and the independent variables. The multivariable binary logistic regression model was used to assess the adjusted odds of controlled BP and blood glucose levels. Among the 329 participants diagnosed with both hypertension and T2DM, 41.3% (95% CI: 36.1-46.8%) had controlled BP, 57.1% (95% CI: 51.7-62.4%) had controlled blood glucose whilst 21.8% (95% CI: 17.7-26.7%) had both controlled BP and blood glucose levels. Increased age, non-formal education, non-married, employed, single-dose anti-hypertensives or anti-diabetic medications, and hyperlipidaemia or stroke co-morbidities were positively associated with controlled BP levels. Being female, married, taking 2 or more anti-hypertensive medications, and moderate to high medication-related burden were positively associated with controlled blood glucose levels. In terms of both controlled BP and blood glucose levels, being employed, reduced income level, being registered with national health insurance, single anti-diabetes or anti-hypertensive medications, hyperlipidaemia or stroke co-morbidities, and moderate to high medication-related burden were positively associated with having both controlled BP and blood glucose levels. One in five patients with hypertension and T2DM had both BP and blood glucose levels under control. The benefits and risks of blood pressure and blood glucose targets should thus be factored into the management of patients with hypertension and T2DM.
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Affiliation(s)
- Yakubu Alhassan
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Adwoa Oforiwaa Kwakye
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Andrews K Dwomoh
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Emmanuella Baah-Nyarkoh
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | - Bernard Appiah
- Department of Public Health, Falk College, Syracuse University, Syracuse, NY, United States of America
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
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Glycated hemoglobin as a surrogate for evaluating the effectiveness of drugs in diabetes mellitus trials: a systematic review and trial-level meta-analysis. Int J Technol Assess Health Care 2021; 38:e12. [PMID: 34933703 DOI: 10.1017/s0266462321001689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of this study was to investigate whether glycated hemoglobin (HbA1c) is a valid surrogate for evaluating the effectiveness of antihyperglycemic drugs in diabetes mellitus (DM) trials. METHODS We conducted a systematic review of placebo-controlled randomized clinical trials (RCTs) evaluating the effect of a treatment on HbA1c (mean difference between groups) and clinical outcomes (relative risk of mortality, myocardial infarction, stroke, heart failure, and/or kidney injury) in patients with DM. Then, we investigated the association between treatment effects on HbA1c and clinical outcomes using regression analysis at the trial level. Lastly, we interpreted the correlation coefficients (R) using the cut-off points suggested by the Institute for Quality and Efficiency in Healthcare (IQWiG). HbA1c was considered a valid surrogate if it demonstrated a strong association: lower limit of the 95 percent confidence interval (95 percent CI) of R greater than or equal to .85. RESULTS Nineteen RCTs were identified. All studies included adults with type 2 DM. None of the associations evaluated was strong enough to validate HbA1c as a surrogate for any clinical outcome: mortality (R = .34; 95 percent CI -.14 to .69), myocardial infarction (R = .20; -.30 to .61), heart failure (R = .08; -.40 to .53), kidney injury (R = -.04; -.52 to .47), and stroke (R = .81; .54 to .93). CONCLUSIONS The evidence from multiple placebo-controlled RCTs does not support the use of HbA1c as a surrogate to measure the effectiveness of antihyperglycemic drugs in DM studies.
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Rodríguez-Gutiérrez R, Millan-Alanis JM, Barrera FJ, McCoy RG. Value of Patient-Centered Glycemic Control in Patients with Type 2 Diabetes. Curr Diab Rep 2021; 21:63. [PMID: 34902079 PMCID: PMC8693335 DOI: 10.1007/s11892-021-01433-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Present the value of a person-centered approach in diabetes management and review current evidence supporting its practice. RECENT FINDINGS Early evidence from glycemic control trials in diabetes resulted in most practice guidelines adopting a glucose-centric intensive approach for management of the disease, consistently relying on HbA1c as a marker of metabolic control and success. This paradigm has been recently dispelled by new evidence that shows that intensive glycemic control does not provide a significant benefit regarding patient-important microvascular and macrovascular hard outcomes when compared to moderate glycemic targets. The goals of diabetes therapy are to reduce the risks of acute and chronic complications and increase quality of life while incurring least burden of treatment and disruption to the patient's life. A person-centered approach to diabetes management is achieved through shared decision making, integration of evidence-based care and patient´s needs, values and preferences, and minimally disruptive approaches to diabetes care and at the same time offer practical guidance to clinicians and patients on achieving this type of care.
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Affiliation(s)
- René Rodríguez-Gutiérrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, Mexico.
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Francisco I. Madero y Av. Gonzalitos s/n, Mitras Centro, Monterrey, 64460, México.
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.
| | - Juan Manuel Millan-Alanis
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Francisco J Barrera
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Rozalina G McCoy
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN, 55905, USA
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Rogvi SÁ, Guassora AD, Tvistholm N, Wind G, Christensen U. "It Is a Full-time Job to Be Ill": Patient Work Involved in Attending Formal Diabetes Care Among Socially Vulnerable Danish Type 2 Diabetes Patients. QUALITATIVE HEALTH RESEARCH 2021; 31:2629-2640. [PMID: 34612745 DOI: 10.1177/10497323211041590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Previous research has shown social inequality in type 2 diabetes prevalence and that socially vulnerable type 2 diabetes patients benefit less than average from health services. Based on ethnographic fieldwork carried out between February 2017 and March 2018 in a Danish specialized outpatient clinic, this article focuses on patient work among socially vulnerable type 2 diabetes patients. Through attending to the border zone between formal health care and self-care, we show that patients do a lot of work requiring skills, resources, and initiative, to access and benefit from formal care. This work is complex and implicit in the organization of care. Patients' social situations, especially their employment situation, complicate getting patient work done. Attending to patient work and implicit tasks in care organization may help us to see how social inequality in type 2 diabetes outcomes develops, and may be combated.
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Affiliation(s)
- Sofie Á Rogvi
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nina Tvistholm
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Gitte Wind
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Ulla Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Verma D, Bahurupi Y, Kant R, Singh M, Aggarwal P, Saxena V. Effect of mHealth Interventions on Glycemic Control and HbA1c Improvement among Type II Diabetes Patients in Asian Population: A Systematic Review and Meta-Analysis. Indian J Endocrinol Metab 2021; 25:484-492. [PMID: 35355920 PMCID: PMC8959192 DOI: 10.4103/ijem.ijem_387_21] [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: 09/03/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Due to the high prevalence of diabetes mellitus, it is pertinent to educate and inform diabetes patients about their self-management. It can be done effectively using innovative methods like mobile health (mHealth), which includes mobile applications, phone calls, and text messages. Thus, this meta-analysis was conducted to summarize the effectiveness of mHealth interventions for the management of diabetes compared with usual care in the Asian population. MATERIALS AND METHODS Searches were performed in electronic databases, namely PubMed, Scopus, Embase, and Cochrane Library, in August and September 2020. Search terms used were "Diabetes Mellitus," "mHealth," "glycemic control", "HbA1c levels," and "Blood glucose levels." The primary outcome was glycated hemoglobin and blood glucose levels. Trials were pooled, and heterogeneity was quantified using the I2 statistic. RESULTS The search yielded 3980 abstracts, of which 18 trials met the inclusion criteria. Lowering of Hba1c levels was reported in the majority of trials, which aided in Glycemic control. For post prandial blood glucose (PPBG) levels, a statistically significant reduction of value -20.13 (95%CI -35.16 to -5.10, P = 0.009, I2 = 59%) was seen in the mean in the intervention group, whereas for HbA1c levels the mean reduction in the intervention group was -0.44 (95%CI, -0.79 to 0.10, P = 0.01, I2 = 87%). Although these interventions proved beneficial for these outcomes, there was a difference in the amount of effects caused by different mHealth interventions. CONCLUSION This study acknowledged the effects of different mHealth interventions as per their accessibility and availability in recent years. There is a need to include more studies in future reviews to generate a larger body of evidence for the reported outcomes. The researchers should give the utmost priority to the transparency while reporting the interventions for effective interpretation of the retrieved data.
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Affiliation(s)
- Divya Verma
- School of Public Health, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ravi Kant
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mahendra Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pradeep Aggarwal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vartika Saxena
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Sun S, Hisland L, Grenet G, Gueyffier F, Cornu C, Jaafari N, Boussageon R. Reappraisal of the efficacy of intensive glycaemic control on microvascular complications in patients with type 2 diabetes: A meta-analysis of randomised control-trials. Therapie 2021; 77:413-423. [PMID: 34782145 DOI: 10.1016/j.therap.2021.10.002] [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: 12/01/2020] [Revised: 07/21/2021] [Accepted: 10/05/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To re-assess the effect of tight glycaemic control on diabetic microvascular complications. METHOD Meta-analysis and trial sequential analyses of randomised trials included in Hemmingsen et al that specifically assessed glycaemic control with a specific HbA1c level targeted in the intervention group, and compared intensive glycaemic control versus standard glycaemic control. RESULTS Seven clinical trials that randomised 28,614 participants with type 2 diabetes (15,269 to intensive control and 13,345 to conventional control), including 3 sub-studies, were included. Strict control of blood glucose levels is associated with a reduction of retinopathy progression (RR=0.77, 95% CI: 0.66-0.89, I2=33%), incidence or progression of macular oedema (RR=0.66, 95% CI: 0.40-0.99, I2=0%), number of photocoagulations (RR=0.84, 95% CI: 0.73-0.97, I2=0%), risk of microalbuminuria (RR=0.76, 95% CI: 0.64-0.9, I2=76%) and risk of "macroalbuminuria or proteinuria" (RR=0.68, 95% CI: 0.55-0.85, I2=36%). CONCLUSION This meta-analysis has shown that a tight control of blood glucose levels is associated with a decrease of specific microvascular complication of diabetes: photocoagulation, progression of diabetic retinopathy, incidence or progression of macular oedema, risk of microalbuminuria and risk of macroalbuminuria or proteinuria. Regarding all the other outcomes (vision loss, surgery of cataract, proliferative or non-proliferative retinopathy, death related to kidney disease, development of kidney disease, doubling of serum creatinine, neuropathy), no significant result was found.
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Affiliation(s)
- Sophie Sun
- Collège universitaire de médecine générale de Lyon, 69003 Lyon, France
| | - Lucie Hisland
- Département de médecine générale de Poitiers, 86034 Poitiers, France
| | - Guillaume Grenet
- Laboratoire de biométrie et biologie évolutive, EMET, UMR 5558, CNRS, université Lyon 1, université de Lyon, 69100 Villeurbanne, France
| | - François Gueyffier
- Laboratoire de biométrie et biologie évolutive, EMET, UMR 5558, CNRS, université Lyon 1, université de Lyon, 69100 Villeurbanne, France
| | - Catherine Cornu
- Laboratoire de biométrie et biologie évolutive, EMET, UMR 5558, CNRS, université Lyon 1, université de Lyon, 69100 Villeurbanne, France
| | - Nemat Jaafari
- Centre d'investigation clinique, Inserm U802 de Poitiers, 86000 Poitiers, France; Centre hospitalier de Poitiers, 86021 Poitiers, France
| | - Rémy Boussageon
- Collège universitaire de médecine générale de Lyon, 69003 Lyon, France; Laboratoire de biométrie et biologie évolutive, EMET, UMR 5558, CNRS, université Lyon 1, université de Lyon, 69100 Villeurbanne, France.
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Liu S, Wang L, Wu X, Wu J, Liu D, Yu H. Overexpression of hsa_circ_0022742 suppressed hyperglycemia-induced endothelial dysfunction by targeting the miR-503-5p/FBXW7 axis. Microvasc Res 2021; 139:104249. [PMID: 34516983 DOI: 10.1016/j.mvr.2021.104249] [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: 06/13/2021] [Revised: 08/11/2021] [Accepted: 09/06/2021] [Indexed: 02/08/2023]
Abstract
Type I and II diabetes adversely affect the microvasculature of several organs, although the regulatory mechanisms remain unclear. Previous studies have found that differentially expressed circRNAs associated with hyperglycemia (HG) induce endothelial dysfunction. In the present study, high-throughput sequencing was employed to assess abnormal circRNA expression in human umbilical vein endothelial cells (HUVECs) after HG treatment. Then, bioinformatics analysis, luciferase reporting analysis, angiogenic differentiation analysis, flow cytometry, and qRT-PCR analysis were performed to investigate the underlying regulatory mechanism and targets. The results demonstrate that hsa_circ_0022742 expression in HUVECs was decreased by HG treatment and overexpression of hsa_circ_0022742 suppressed HG-induced endothelial dysfunction. Luciferase analysis showed that miR-503-5p and FBXW7 were downstream targets of hsa_circ_0022742. Both overexpression of FBXW7 and inhibition of miR-503-5p reversed the protective effect of hsa_circ_0022742 against HG-induced endothelial dysfunction, including apoptosis, abnormal vascular differentiation, and secretion of inflammatory factors, indicating that hsa_circ_0022742 enhanced FBXW7 expression by sponging miR-503-5p. Taken together, these findings demonstrate that overexpression of hsa_circ_0022742 suppressed HG-induced endothelial dysfunction by targeting the miR-503-5p/FBXW7 axis.
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Affiliation(s)
- Siyang Liu
- Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Liyun Wang
- Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Xueyan Wu
- Department of Human Anatomy, Chengde Medical College, China
| | - Jianlong Wu
- Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Dawei Liu
- Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Hongbin Yu
- Chengde Central Hospital, Chengde, Hebei 067000, China.
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Glycemic Variability Impacted by SGLT2 Inhibitors and GLP 1 Agonists in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10184078. [PMID: 34575189 PMCID: PMC8470178 DOI: 10.3390/jcm10184078] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
To investigate the effect of sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists on glycemic variability (GV), the mean amplitude of glucose excursion (MAGE), mean blood glucose (MBG) levels, and percentage of time maintaining euglycemia were evaluated. Randomized controlled trials evaluating the efficacy of SGLT-2 inhibitors and GLP-1 agonists for treating people with diabetes were selected through searches of PubMed, EMBASE, and other databases. Sixteen studies were finally analyzed. There were no differences in the reductions in MAGE after treatment with SGLT-2 inhibitors or GLP-1 agonists (standardized mean difference (SMD) = −0.59, 95% CI = −0.82 to −0.36 vs. SMD = −0.43, 95% CI = −0.51 to −0.35, respectively), and treatment with SGLT-2 inhibitors was associated with an increased reduction in MBG levels (SMD = −0.56, 95% CI = −0.65 to −0.48, p < 0.00001). Monotherapy and add-on therapy with medications were correlated with MAGE and MBG level reductions. In conclusion, SGLT-2 inhibitors and GLP-1 agonists were associated with a reduction in GV and could be alternatives for treating people with diabetes.
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Su YC, Shao SC, Lai ECC, Lee CN, Hung MJ, Lai CC, Hsu SM, Hung JH. Risk of diabetic macular oedema with sodium-glucose cotransporter-2 inhibitors in type 2 diabetes patients: A multi-institutional cohort study in Taiwan. Diabetes Obes Metab 2021; 23:2067-2076. [PMID: 34047442 DOI: 10.1111/dom.14445] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 12/19/2022]
Abstract
AIMS To investigate the risk of diabetic macular oedema (DMO) associated with the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS We conducted a retrospective cohort study by analysing a large multi-institutional electronic medical records database in Taiwan. We included adult patients with T2DM without DMO newly receiving either SGLT2 inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1RAs) during the period 2016 to 2018. We used propensity scores with inverse probability of treatment weighting to generate comparable groups. The study outcome was incident DMO, determined by clinical diagnosis during outpatient visits or admissions. We followed patients from the index date to either DMO occurrence, last clinical visit, patient death, or December 31, 2020. We performed Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of DMO. RESULTS We included 9986 new users of SGLT2 inhibitors (mean [SD] age 59.6 (12.1) years, median [interquartile range {IQR}] glycated haemoglobin [HbA1c] 70 (61-81)mmol/mol, estimated glomerular filtration rate [eGFR] 89.1 [71.4-108.7] mL/min/1.73 m2 and urine albumin-creatinine ratio [UACR] 26.1 [9.7-117.6] mg/g) and 1067 new users of GLP-1RAs (mean [SD] age 58.4 (41.5) years, median [IQR] HbA1c 73 [64-84] mmol/mol, eGFR 91.6 [68.6-114.0] mL/min/1.73 m2 and UACR 37.6 [11.1-153.2] mg/g) with similar baseline characteristics. Lower DMO risks were observed among patients newly receiving SGLT2 inhibitors (7.9/1000 person-years), compared to those receiving GLP-1RAs (10.7/1000 person-years) with an HR of 0.75 (95% CI 0.64-0.88). CONCLUSIONS Our findings suggest use of SGLT2 inhibitors was associated with lower risk of DMO in T2DM patients in clinical practice, compared to use of GLP-1RAs. Future studies are necessary to confirm this observation.
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Affiliation(s)
- Yu-Chen Su
- Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chaw-Ning Lee
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Jui Hung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jia-Horung Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Evolution of Type 2 Diabetes Management from a Glucocentric Approach to Cardio-Renal Risk Reduction: The New Paradigm of Care. Drugs 2021; 81:1373-1379. [PMID: 34302636 DOI: 10.1007/s40265-021-01554-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 02/06/2023]
Abstract
For many years, clinical studies could not show that lowering glucose in patients with type 2 diabetes leads to better macrovascular outcomes. In the past few years, new data have shown that treatment with two classes of dugs developed as "glucose-lowering agents," SGLT2 inhibitors and GLP-1 receptor agonists, can reduce macrovascular and renal complications. These studies have prompted debate about the main aim of type 2 diabetes management. In this review, three eras of diabetes management are described according to the treatment recommendations, such as the ADA/EASD consensus, moving from a pure glucocentric view into the present cardio-renal outcome-oriented approach, this has been endorsed by major diabetes and cardiology societies. While in the first era normalizing HbA1c was the only focus (e.g., UK Prospective Diabetes Study), failing to show a reduction in cardiovascular morbidity and mortality, further studies analyzing the pros and cons of intensified control such as ACCORD, VADT, ADVANCE recognized that treatment intensification was associated with weight gain and hypoglycemia, thereby potentially reducing the benefits of glycemic control. Therefore, the focus in the second area was on controlling HbA1c without these unwanted effects. The consistent beneficial results of several cardiovascular outcome trials with SGLT2 inhibitors and GLP-1 receptor agonists showing significantly improved cardio-renal outcomes, induced a paradigm shift: a change from (only) control of HbA1c to an organ-protective approach with the main focus now on cardio-renal risk; this is now considered as the third era. Recent data indicating beneficial effects of glucose-lowering agents in particular SGLT2 inhibitors even in subjects without diabetes, improving hospitalization for heart failure and renal outcomes might reveal another new era, which could then be considered a fourth era. While current international guidelines call for this paradigm shift, registry data show that we are still far from translating this objective into real-world practice.
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González-González JG, Díaz González-Colmenero A, Millán-Alanís JM, Lytvyn L, Solis RC, Mustafa RA, Palmer SC, Li S, Hao Q, Alvarez-Villalobos NA, Vandvik PO, Rodríguez-Gutiérrez R. Values, preferences and burden of treatment for the initiation of GLP-1 receptor agonists and SGLT-2 inhibitors in adult patients with type 2 diabetes: a systematic review. BMJ Open 2021; 11:e049130. [PMID: 34244276 PMCID: PMC8273479 DOI: 10.1136/bmjopen-2021-049130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Assess values, preferences and burden of treatment that patients with type 2 diabetes consider when initiating glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-2i) compared with other glucose-lowering options. METHODS Paired reviewers independently included studies reporting quantitative or qualitative methods to assess values, preferences and burden of treatment reported by patients with type 2 diabetes regarding the initiation of GLP-1 RA or SGLT-2i over other alternatives. A systematic search in MEDLINE, Scopus, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials from inception until May 2020 was performed by an experienced librarian. Risk of bias was assessed with a specifically designed tool for values and preferences studies. RESULTS 17 studies (7296 patients) proved eligible. Studies fulfilling criteria for SGLT-2i were not identified. Five studies (2662 patients) evaluated preferences for GLP-1 RA compared with other glucose-lowering medications. 12 studies (4634 patients) evaluated preferences between, at least, two kinds of GLP-1 RA or their injection devices based on the following attributes: efficacy, dose, application frequency, device characteristics. Among studies comparing GLP-1 RA to other glucose-lowering medications, some preferences were observed for dypeptil peptidase-4 inhibitors compared with once daily liraglutide. Comparing different attributes of GLP-1 RA drugs and devices, cardiovascular risk reduction, glucose lowering potential, once weekly and simple administered regimens were the most preferred. CONCLUSIONS As no evidence for preferences on SGLT-2i was available, only preferences for GLP-1 RA were assessed; however, evidence is still limited for the latter. Studies comparing preferences for GLP1-RA to other glucose-lowering alternatives only included twice daily or once daily injection regimens of GLP-1 RA drugs. According to our findings, once weekly alternatives are widely preferred than the formers. The extent to which patients with type 2 diabetes value reduced adverse cardiovascular and kidney outcomes, weighed benefits against harms and burden of treatment is limited and with very low certainty. PROSPERO REGISTRATION NUMBER CRD42020159284.
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Affiliation(s)
- José Gerardo González-González
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon Facultad de Medicina, Monterrey, Nuevo León, Mexico
- Endocrinology Division, Department of Internal Medicine, Hospital Universitario Dr José Eleuterio González, Monterrey, Nuevo León, Mexico
| | - Alejandro Díaz González-Colmenero
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Juan Manuel Millán-Alanís
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ricardo Cesar Solis
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Reem A Mustafa
- Internal Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Division of Population Health and Genomics, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, UK
| | - Qiukui Hao
- The center of Gerontology and Geriatrics, National Center for Geriatric Clinical Research, Sichuan University, Chengdu, Sichuan, China
| | - Neri Alejandro Alvarez-Villalobos
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - René Rodríguez-Gutiérrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon Facultad de Medicina, Monterrey, Nuevo León, Mexico
- Endocrinology Division, Department of Internal Medicine, Hospital Universitario Dr José Eleuterio González, Monterrey, Nuevo León, Mexico
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Ferrario L, Schettini F, Avogaro A, Bellia C, Bertuzzi F, Bonetti G, Ceriello A, Ciaccio M, Corsi Romanelli M, Dozio E, Falqui L, Girelli A, Nicolucci A, Perseghin G, Plebani M, Valentini U, Zaninotto M, Castaldi S, Foglia E. Glycated Albumin for Glycemic Control in T2DM Population: A Multi-Dimensional Evaluation. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:453-464. [PMID: 34079308 PMCID: PMC8166313 DOI: 10.2147/ceor.s304868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/23/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose To investigate the glycated albumin (GA) introduction implications, as an add-on strategy to traditional glycemic control (Hb1Ac and fasting plasma glucose – FPG) instruments, considering insulin-naïve individuals with type 2 diabetes mellitus (T2DM), treated with oral therapies. Methods A Health Technology Assessment was conducted in Italy, as a multi-dimensional approach useful to validate any innovative technology. The HTA dimensions, derived from the EUnetHTA Core Model, were deployed by means of literature evidence, health economics tools and qualitative questionnaires, filled-in by 15 professionals. Results Literature stated that the GA introduction could lead to a higher number of individuals achieving therapeutic success after 3 months of therapy (97.0% vs 71.6% without GA). From an economic point of view, considering a projection of 1,955,447 T2DM insulin-naïve individuals, potentially treated with oral therapy, GA introduction would imply fewer individuals requiring a therapy switch (−89.44%), with a 1.06% in costs reduction, on annual basis, thus being also the preferable solution from a cost-effectiveness perspective (cost-effectiveness value: 237.74 vs 325.53). According to experts opinions, lower perceptions on GA emerged with regard to equity aspects (0.13 vs 0.72, p-value>0.05), whereas it would improve both individuals (2.17 vs 1.33, p-value=0.000) and caregivers quality of life (1.50 vs 0.83, p-value=0.000). Even if in the short term, GA required additional investments in training courses (−0.80 vs 0.10, p-value = 0.036), in the long run, GA could become the preferable technology (0.30 vs 0.01, p-value=0.018) from an organisational perspective. Conclusion Adding GA to traditional glycaemic control instruments could improve the clinical pathway of individuals with T2DM, leading to economic and organisational advantages for both hospitals and National Healthcare Systems.
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Affiliation(s)
- Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Fabrizio Schettini
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Angelo Avogaro
- Department of Medicine, University-Hospital of Padova, Padova, Italy
| | - Chiara Bellia
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Federico Bertuzzi
- Diabetology Unit, Grande Ospedale Metropolitano Niguarda Hospital, Milan, Italy
| | | | - Antonio Ceriello
- Department of Cardiovascular and Metabolic Diseases, Multimedica Research Institute, Milan, Italy
| | - Marcello Ciaccio
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy.,Department of Laboratory Medicine, University-Hospital of Palermo, Palermo, Italy
| | - Massimiliano Corsi Romanelli
- Service of Laboratory Medicine 1-Clinical Pathology, Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Elena Dozio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Luca Falqui
- Department of Medicine, Diabetes and Endocrinology, Multimedica Research Institute, Milan, Italy
| | - Angela Girelli
- Diabetes Care Unit, Spedali Civili Hospital, Brescia, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Gianluca Perseghin
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.,Department of Medicine and Rehabilitation, Unit of Metabolic Medicine, Policlinico di Monza, Monza, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | | | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Fondazione Ca' Granda Ospedale Maggiore Policlinico Research Institute of Milano, Milano, Italy
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
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Li S, Vandvik PO, Lytvyn L, Guyatt GH, Palmer SC, Rodriguez-Gutierrez R, Foroutan F, Agoritsas T, Siemieniuk RAC, Walsh M, Frere L, Tunnicliffe DJ, Nagler EV, Manja V, Åsvold BO, Jha V, Vermandere M, Gariani K, Zhao Q, Ren Y, Cartwright EJ, Gee P, Wickes A, Ferns L, Wright R, Li L, Hao Q, Mustafa RA. SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: a clinical practice guideline. BMJ 2021; 373:n1091. [PMID: 33975892 DOI: 10.1136/bmj.n1091] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CLINICAL QUESTION What are the benefits and harms of sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists when added to usual care (lifestyle interventions and/or other diabetes drugs) in adults with type 2 diabetes at different risk for cardiovascular and kidney outcomes? CURRENT PRACTICE Clinical decisions about treatment of type 2 diabetes have been led by glycaemic control for decades. SGLT-2 inhibitors and GLP-1 receptor agonists are traditionally used in people with elevated glucose level after metformin treatment. This has changed through trials demonstrating atherosclerotic cardiovascular disease (CVD) and chronic kidney disease (CKD) benefits independent of medications' glucose-lowering potential. RECOMMENDATIONS The guideline panel issued risk-stratified recommendations concerning the use of SGLT-2 inhibitors or GLP-1 receptor agonists in adults with type 2 diabetes• Three or fewer cardiovascular risk factors without established CVD or CKD: Weak recommendation against starting SGLT-2 inhibitors or GLP-1 receptor agonists.• More than three cardiovascular risk factors without established CVD or CKD: Weak recommendation for starting SGLT-2 inhibitors and weak against starting GLP-1 receptor agonists.• Established CVD or CKD: Weak recommendation for starting SGLT-2 inhibitors and GLP-1 receptor agonists.• Established CVD and CKD: Strong recommendation for starting SGLT-2 inhibitors and weak recommendation for starting GLP-1 receptor agonists.• For those committed to further reducing their risk for CVD and CKD outcomes: Weak recommendation for starting SGLT-2 inhibitors rather than GLP-1 receptor agonists. HOW THIS GUIDELINE WAS CREATED An international panel including patients, clinicians, and methodologists created these recommendations following standards for trustworthy guidelines and using the GRADE approach. The panel applied an individual patient perspective. THE EVIDENCE A linked systematic review and network meta-analysis (764 randomised trials included 421 346 participants) of benefits and harms found that SGLT-2 inhibitors and GLP-1 receptor agonists generally reduce overall death, and incidence of myocardial infarctions, and end-stage kidney disease or kidney failure (moderate to high certainty evidence). These medications exert different effects on stroke, hospitalisations for heart failure, and key adverse events in different subgroups. Absolute effects of benefit varied widely based on patients' individual risk (for example, from five fewer deaths in the lowest risk to 48 fewer deaths in the highest risk, for 1000 patients treated over five years). A prognosis review identified 14 eligible risk prediction models, one of which (RECODe) informed most baseline risk estimates in evidence summaries to underpin the risk-stratified recommendations. Concerning patients' values and preferences, the recommendations were supported by evidence from a systematic review of published literature, a patient focus group study, a practical issues summary, and a guideline panel survey. UNDERSTANDING THE RECOMMENDATION We stratified the recommendations by the levels of risk for CVD and CKD and systematically considered the balance of benefits, harms, other considerations, and practical issues for each risk group. The strong recommendation for SGLT-2 inhibitors in patients with CVD and CKD reflects what the panel considered to be a clear benefit. For all other adults with type 2 diabetes, the weak recommendations reflect what the panel considered to be a finer balance between benefits, harms, and burdens of treatment options. Clinicians using the guideline can identify their patient's individual risk for cardiovascular and kidney outcomes using credible risk calculators such as RECODe. Interactive evidence summaries and decision aids may support well informed treatment choices, including shared decision making.
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Affiliation(s)
- Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
| | - Per Olav Vandvik
- University of Oslo, Oslo, Norway
- MAGIC Evidence Ecosystem Foundation
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - René Rodriguez-Gutierrez
- Plataforma INVEST Medicina UANL - KER Unit (KER Unit México), Subdirección de Investigación, Universidad Autónoma de Nuevo León, Monterrey, 64460, México
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, 64460, México
| | | | - Thomas Agoritsas
- Service of Endocrinology, Diabetes, Nutrition and Patient Therapeutic Education, Geneva University Hospitals, Geneva, Switzerland
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Michael Walsh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David J Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Evi V Nagler
- Renal Division, Ghent University Hospital, Belgium
| | | | - Bjørn Olav Åsvold
- Department of Endocrinology, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vivekanand Jha
- The George Institute for Global Health, UNSW, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Mieke Vermandere
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Karim Gariani
- Service of Endocrinology, Diabetes, Nutrition and Patient Therapeutic Education, Geneva University Hospitals, Geneva, Switzerland
| | - Qian Zhao
- International Medical Center / Ward of General Practice, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | | | - Patrick Gee
- Founder & CEHD, iAdvocate, Inc., Virginia, Patient partner
| | | | | | | | - Ling Li
- Chinese Evidence-based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiukui Hao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas, Kansas City, USA
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Abstract
Neuropathy is a common complication of long-term diabetes that impairs quality of life by producing pain, sensory loss and limb amputation. The presence of neuropathy in both insulin-deficient (type 1) and insulin resistant (type 2) diabetes along with the slowing of progression of neuropathy by improved glycemic control in type 1 diabetes has caused the majority of preclinical and clinical investigations to focus on hyperglycemia as the initiating pathogenic lesion. Studies in animal models of diabetes have identified multiple plausible mechanisms of glucotoxicity to the nervous system including post-translational modification of proteins by glucose and increased glucose metabolism by aldose reductase, glycolysis and other catabolic pathways. However, it is becoming increasingly apparent that factors not necessarily downstream of hyperglycemia can also contribute to the incidence, progression and severity of neuropathy and neuropathic pain. For example, peripheral nerve contains insulin receptors that transduce the neurotrophic and neurosupportive properties of insulin, independent of systemic glucose regulation, while the detection of neuropathy and neuropathic pain in patients with metabolic syndrome and failure of improved glycemic control to protect against neuropathy in cohorts of type 2 diabetic patients has placed a focus on the pathogenic role of dyslipidemia. This review provides an overview of current understanding of potential initiating lesions for diabetic neuropathy and the multiple downstream mechanisms identified in cell and animal models of diabetes that may contribute to the pathogenesis of diabetic neuropathy and neuropathic pain.
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45
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Sim R, Lee SWH. Patient Preference and Satisfaction with the Use of Telemedicine for Glycemic Control in Patients with Type 2 Diabetes: A Review. Patient Prefer Adherence 2021; 15:283-298. [PMID: 33603347 PMCID: PMC7882448 DOI: 10.2147/ppa.s271449] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Telemedicine has the potential to improve patient care and management for various chronic diseases such as type 2 diabetes. To ensure the success of any telemedicine program, there is a need to understand the patients' satisfaction and their preferences. This review aims to collate and provide evidence related to practices that may influence the performance of telemedicine for patients with type 2 diabetes. METHODS We searched three electronic databases for studies examining patients' satisfaction and preferences for using telemedicine in type 2 diabetes. An evaluation matrix was developed to collect the data from the included articles. A total of 20 articles were identified and data on the key outcomes identified were narratively synthesized. RESULTS Patients were generally satisfied with the use of telemedicine for management of type 2 diabetes. Users reported that telemedicine was beneficial as it provided constant monitoring, improved access to healthcare providers, and reduced waiting time. When adopting a telemedicine platform, most patients expressed preference for mobile health (mHealth) as the telemedicine modality, especially if it has been endorsed by their physician. To improve usability and sustainability, patients suggested that modules related to diabetes education be enhanced, together with sufficient technical and physician support when adopting telemedicine. Patients also expressed the importance of having a sufficiently flexible platform that could be adapted to their needs. CONCLUSION Personalized telemedicine strategies coupled with appropriate physician endorsement greatly influences a patient's decision to undertake telemedicine. Future work should focus on improving telemedicine infrastructure and increasing physician's involvement, especially during the implementation phase.
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Affiliation(s)
- Ruth Sim
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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46
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Oktora MP, Kerr KP, Hak E, Denig P. Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: A scoping review. Diabet Med 2021; 38:e14408. [PMID: 32969063 PMCID: PMC7891362 DOI: 10.1111/dme.14408] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/20/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Individualizing goals for people with type 2 diabetes may result in deintensification of medication, but a comprehensive picture of deprescribing practices is lacking. AIMS To conduct a scoping review in order to assess the rates, determinants and success of implementing deprescribing of glucose-, blood pressure- or lipid-lowering medications in people with diabetes. METHODS A systematic search on MEDLINE and Embase between January 2007 and January 2019 was carried out for deprescribing studies among people with diabetes. Outcomes were rates of deprescribing related to participant characteristics, the determinants and success of deprescribing, and its implementation. Critical appraisal was conducted using predefined tools. RESULTS Fourteen studies were included; eight reported on rates, nine on determinants and six on success and implementation. Bias was high for studies on success of deprescribing. Deprescribing rates ranged from 14% to 27% in older people with low HbA1c levels, and from 16% to 19% in older people with low systolic blood pressure. Rates were not much affected by age, gender, frailty or life expectancy. Rates were higher when a reminder system was used to identify people with hypoglycaemia, which led to less overtreatment and fewer hypoglycaemic events. Most healthcare professionals accepted the concept of deprescribing but differed on when to conduct it. Deprescribing glucose-lowering medications could be successfully conducted in 62% to 75% of participants with small rises in HbA1c . CONCLUSIONS Deprescribing of glucose-lowering medications seems feasible and acceptable, but was not widely implemented in the covered period. Support systems may enhance deprescribing. More studies on deprescribing blood pressure- and lipid-lowering medications in people with diabetes are needed.
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Affiliation(s)
- M. P. Oktora
- Department of Clinical Pharmacy and PharmacologyUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - K. P. Kerr
- School of Biomedical Sciences and PharmacyFaculty of Health and MedicineUniversity of NewcastleNewcastleNSWAustralia
| | - E. Hak
- Unit of PharmacoTherapy, Epidemiology and EconomicsGroningen Research Institute of PharmacyUniversity of GroningenGroningenThe Netherlands
| | - P. Denig
- Department of Clinical Pharmacy and PharmacologyUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
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47
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AlKinani AA, Alkhrizi IM, Alkathiri SH, Alzubaidi HLA, Alghanmi AA, Alghanmi AM, Alnashri IA, B AAM. Diabetes Mellitus type 2: Management and follow up in Primary Health Care Center. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/mvmt9sdifp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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48
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López-Díez R, Egaña-Gorroño L, Senatus L, Shekhtman A, Ramasamy R, Schmidt AM. Diabetes and Cardiovascular Complications: The Epidemics Continue. Curr Cardiol Rep 2021; 23:74. [PMID: 34081211 PMCID: PMC8173334 DOI: 10.1007/s11886-021-01504-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The cardiovascular complications of type 1 and 2 diabetes are major causes of morbidity and mortality. Extensive efforts have been made to maximize glycemic control; this strategy reduces certain manifestations of cardiovascular complications. There are drawbacks, however, as intensive glycemic control does not impart perennial protective benefits, and these efforts are not without potential adverse sequelae, such as hypoglycemic events. RECENT FINDINGS Here, the authors have focused on updates into key areas under study for mechanisms driving these cardiovascular disorders in diabetes, including roles for epigenetics and gene expression, interferon networks, and mitochondrial dysfunction. Updates on the cardioprotective roles of the new classes of hyperglycemia-targeting therapies, the sodium glucose transport protein 2 inhibitors and the agonists of the glucagon-like peptide 1 receptor system, are reviewed. In summary, insights from ongoing research and the cardioprotective benefits of the newer type 2 diabetes therapies are providing novel areas for therapeutic opportunities in diabetes and CVD.
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Affiliation(s)
- Raquel López-Díez
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, 435 East 30th Street, Science Building, Room 615, New York, NY 10016 USA
| | - Lander Egaña-Gorroño
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, 435 East 30th Street, Science Building, Room 615, New York, NY 10016 USA
| | - Laura Senatus
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, 435 East 30th Street, Science Building, Room 615, New York, NY 10016 USA
| | - Alexander Shekhtman
- Department of Chemistry, The State University of New York at Albany, Albany, NY USA
| | - Ravichandran Ramasamy
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, 435 East 30th Street, Science Building, Room 615, New York, NY 10016 USA
| | - Ann Marie Schmidt
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, 435 East 30th Street, Science Building, Room 615, New York, NY, 10016, USA.
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49
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Barrera FJ, Toloza FJ, Ponce OJ, Zuñiga-Hernandez JA, Prokop LJ, Shah ND, Guyatt G, Rodriguez-Gutierrez R, Montori VM. The validity of cost-effectiveness analyses of tight glycemic control. A systematic survey of economic evaluations of pharmacological interventions in patients with type 2 diabetes. Endocrine 2021; 71:47-58. [PMID: 32959229 DOI: 10.1007/s12020-020-02489-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/31/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Currently available randomized trial evidence has shown no reductions in type 2 diabetes (T2D) complications important to patients with tight glycemic control. Yet, economic analyses consistently find tight glycemic control to be cost-effective. To understand this apparent paradox, we systematically identified and appraised economic analyses of tight glycemic control for T2D. METHODS We searched multiple databases from January 2016 to January 2018 for cost-effectiveness or cost-utility analyses of any glucose-lowering treatments for adults with T2D using simulations with long-40 years to lifetime-time horizons. Reviewers selected and appraised each study independently and in duplicate with good reproducibility. RESULTS We found 30 analyses, most comparing the glycemic impact of glucose-lowering drugs and applying their impact on HbA1c to model (most commonly IMS CORE or Cardiff T2DM) their impact on the incidence of diabetes-related complication. Models drew from observational evidence of the correlation of HbA1c levels and diabetes-related complication rates; none used estimates of the effect of lowering HbA1c on these outcomes from systematic reviews of randomized trials. Sensitivity analyses, when conducted, demonstrate substantial loss of cost-effectiveness as simulations approach the results seen in these trials. CONCLUSIONS Reliance on the association between glycemic control and diabetes-related complications evident in observational studies but not apparent in randomized trial bias the estimates of the cost-effectiveness of interventions to improve glycemic control.
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Affiliation(s)
- Francisco J Barrera
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Freddy Jk Toloza
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Oscar J Ponce
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jorge A Zuñiga-Hernandez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | - Nilay D Shah
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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50
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Jin HY, Moon SS, Calcutt NA. Lost in Translation? Measuring Diabetic Neuropathy in Humans and Animals. Diabetes Metab J 2021; 45:27-42. [PMID: 33307618 PMCID: PMC7850880 DOI: 10.4093/dmj.2020.0216] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022] Open
Abstract
The worldwide diabetes epidemic is estimated to currently afflict almost 500 million persons. Long-term diabetes damages multiple organ systems with the blood vessels, eyes, kidneys and nervous systems being particularly vulnerable. These complications of diabetes reduce lifespan, impede quality of life and impose a huge social and economic burden on both the individual and society. Peripheral neuropathy is a debilitating complication that will impact over half of all persons with diabetes. There is no treatment for diabetic neuropathy and a disturbingly long history of therapeutic approaches showing promise in preclinical studies but failing to translate to the clinic. These failures have prompted re-examination of both the animal models and clinical trial design. This review focuses on the functional and structural parameters used as indices of peripheral neuropathy in preclinical and clinical studies and the extent to which they share a common pathogenesis and presentation. Nerve conduction studies in large myelinated fibers have long been the mainstay of preclinical efficacy screening programs and clinical trials, supplemented by quantitative sensory tests. However, a more refined approach is emerging that incorporates measures of small fiber density in the skin and cornea alongside these traditional assays at both preclinical and clinical phases.
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Affiliation(s)
- Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
USA
| | - Seong-Su Moon
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju,
USA
- Division of Endocrinology, Department of Internal Medicine, Nazareth General Hospital, Daegu,
Korea,
USA
| | - Nigel A. Calcutt
- Department of Pathology, University of California San Diego, La Jolla, CA,
USA
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