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Kim A, Jeon E, Lee H, Heo H, Woo K. Risk factors for prediabetes in community-dwelling adults: A generalized estimating equation logistic regression approach with natural language processing insights. Res Nurs Health 2024. [PMID: 38961672 DOI: 10.1002/nur.22413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 05/11/2024] [Accepted: 06/22/2024] [Indexed: 07/05/2024]
Abstract
The global prevalence of prediabetes is expected to reach 8.3% (587 million people) by 2045, with 70% of people with prediabetes developing diabetes during their lifetimes. We aimed to classify community-dwelling adults with a high risk for prediabetes based on prediabetes-related symptoms and to identify their characteristics, which might be factors associated with prediabetes. We analyzed homecare nursing records (n = 26,840) of 1628 patients aged over 20 years. Using a natural language processing algorithm, we classified each nursing episode as either low-risk or high-risk for prediabetes based on the detected number and category of prediabetes-symptom words. To identify differences between the risk groups, we employed t-tests, chi-square tests, and data visualization. Risk factors for prediabetes were identified using multiple logistic regression models with generalized estimating equations. A total of 3270 episodes (12.18%) were classified as potentially high-risk for prediabetes. There were significant differences in the personal, social, and clinical factors between groups. Results revealed that female sex, age, cancer coverage as part of homecare insurance coverage, and family caregivers were significantly associated with an increased risk of prediabetes. Although prediabetes is not a life-threatening disease, uncontrolled blood glucose can cause unfavorable outcomes for other major diseases. Thus, medical professionals should consider the associated symptoms and risk factors of prediabetes. Moreover, the proposed algorithm may support the detection of individuals at a high risk for prediabetes. Implementing this approach could facilitate proactive monitoring and early intervention, leading to reduced healthcare expenses and better health outcomes for community-dwelling adults.
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Affiliation(s)
- Aeri Kim
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Eunjoo Jeon
- Technology Research, Samsung SDS, Seoul, South Korea
| | - Hana Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Hyunsook Heo
- Seoul National University Hospital, Seoul, South Korea
| | - Kyungmi Woo
- College of Nursing, Seoul National University, Seoul, South Korea
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Ziyab AH, Mohammad A, Almousa Z, Mohammad T. Sex differences in the association between vitamin D and prediabetes in adults: A cross-sectional study. Nutr Diabetes 2024; 14:49. [PMID: 38956028 PMCID: PMC11219834 DOI: 10.1038/s41387-024-00311-4] [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: 11/20/2023] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND/OBJECTIVES Vitamin D status has been shown to be associated with prediabetes risk. However, epidemiologic evidence on whether sex modulates the association between vitamin D and prediabetes is limited. The present study investigated sex-specific associations between vitamin D and prediabetes. SUBJECTS/METHODS The Kuwait Wellbeing Study, a population-based cross-sectional study, enrolled nondiabetic adults. Prediabetes was defined as 5.7 ≤ HbA1c% ≤6.4; 25-hydroxyvitamin D (25(OH)D) was measured in venous blood and analyzed as a continuous, dichotomous (deficiency: <50 nmol/L vs. insufficiency/sufficiency ≥50 nmol/L), and categorical (tertiles) variable. Associations were evaluated by estimating adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), while stratifying by sex. RESULTS A total of 384 participants (214 males and 170 females) were included in the current analysis, with a median age of 40.5 (interquartile range: 33.0-48.0) years. The prevalence of prediabetes was 35.2%, and 63.0% of participants had vitamin D deficiency. Assessments of statistical interaction between sex and 25(OH)D status were statistically significant (PSex × 25(OH)D Interaction < 0.05). In the sex-stratified analysis, after adjustment for confounding factors, decreased 25(OH)D levels were associated with increased prevalence of prediabetes in males (aPRDeficiency vs. In-/Sufficiency: 2.35, 95% CI: 1.36-4.07), but not in females (aPRDeficiency vs. In-/Sufficiency: 1.03, 95% CI: 0.60-1.77). Moreover, the prevalence of prediabetes differed between males and females at 25(OH)D levels of ≤35 nmol/L, with a higher prevalence of prediabetes in males compared to females. Such a sex-specific difference was not observed at 25(OH)D levels of >35 nmol/L. CONCLUSIONS Sex modified the association between vitamin D levels and prediabetes, with an inverse association observed among males, but not among females. Moreover, the observed sex-disparity in the prevalence of prediabetes was only pronounced at 25(OH)D levels of ≤35 nmol/L.
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Affiliation(s)
- Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Safat, Kuwait.
| | - Anwar Mohammad
- Dasman Diabetes Institute, Biochemistry and Molecular Biology Department, Kuwait City, Kuwait
| | - Zainab Almousa
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Safat, Kuwait
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Yanto TA, Vatvani AD, Hariyanto TI, Suastika K. Glucagon-like peptide-1 receptor agonist and new-onset diabetes in overweight/obese individuals with prediabetes: A systematic review and meta-analysis of randomized trials. Diabetes Metab Syndr 2024; 18:103069. [PMID: 38963997 DOI: 10.1016/j.dsx.2024.103069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/24/2024] [Accepted: 06/30/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Glucagon-like peptide-1 receptor agonist (GLP-1RA) is incretin-based therapy that possessed significant glucose lowering and weight loss properties. The present study aims to analyze the efficacy of GLP-1RA in the management of overweight/obese individuals with prediabetes. METHODS A thorough search was carried out on the Cochrane Library, ClinicalTrials.gov, Scopus, and Medline databases until April 3rd, 2024, using a mix of pertinent keywords. This review incorporates randomized clinical trials (RCTs) concerning the efficacy of GLP-1RA for prediabetes. The primary outcome was regression to normoglycemia and/or progression to type 2 diabetes (T2D). We used random-effect models to examine the odds ratio (OR) and mean difference (MD). RESULTS A total of eight RCTs were incorporated. The results of our meta-analysis indicated that GLP-1RA therapy was associated with higher odds of regression to normoglycemia (OR 4.80; 95%CI: 3.40-6.77, p < 0.00001, I2 = 67 %) and lower risk of progression into T2D (OR 0.27; 95%CI: 0.18-0.42, p < 0.00001, I2 = 0 %) in overweight/obese individuals with prediabetes. Administration of GLP-1RA was also associated with higher reduction in HbA1c (MD -0.28 %; p < 0.00001), fasting glucose (MD -0.45 mmol/L; p < 0.00001), and BMI (MD -1.71 kg/m2; p < 0.00001) in comparison to placebo. However, the administration of GLP-1RA was associated with higher incidence of total adverse events (TAEs), treatment discontinuation due to AEs, hypoglycemia, and gastrointestinal AEs. CONCLUSIONS This study indicates that while GLP-1RA is a potent therapeutic agent for prediabetes, its adverse effects are concerning, thereby precluding its recommendation as a prediabetes therapy.
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Affiliation(s)
- Theo Audi Yanto
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, 15811, Indonesia.
| | - Akhil Deepak Vatvani
- Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, 15811, Indonesia.
| | | | - Ketut Suastika
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, 80232, Indonesia.
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Li Y, Chen GC, Moon JY, Arthur R, Sotres-Alvarez D, Daviglus ML, Pirzada A, Mattei J, Perreira KM, Rotter JI, Taylor KD, Chen YDI, Wassertheil-Smoller S, Wang T, Rohan TE, Kaufman JD, Kaplan R, Qi Q. Genetic Subtypes of Prediabetes, Healthy Lifestyle, and Risk of Type 2 Diabetes. Diabetes 2024; 73:1178-1187. [PMID: 38602922 PMCID: PMC11189833 DOI: 10.2337/db23-0699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
Prediabetes is a heterogenous metabolic state with various risks for development of type 2 diabetes (T2D). In this study, we used genetic data on 7,227 US Hispanic/Latino participants without diabetes from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and 400,149 non-Hispanic White participants without diabetes from the UK Biobank (UKBB) to calculate five partitioned polygenetic risk scores (pPRSs) representing various pathways related to T2D. Consensus clustering was performed in participants with prediabetes in HCHS/SOL (n = 3,677) and UKBB (n = 16,284) separately based on these pPRSs. Six clusters of individuals with prediabetes with distinctive patterns of pPRSs and corresponding metabolic traits were identified in the HCHS/SOL, five of which were confirmed in the UKBB. Although baseline glycemic traits were similar across clusters, individuals in cluster 5 and cluster 6 showed an elevated risk of T2D during follow-up compared with cluster 1 (risk ratios [RRs] 1.29 [95% CI 1.08, 1.53] and 1.34 [1.13, 1.60], respectively). Inverse associations between a healthy lifestyle score and risk of T2D were observed across different clusters, with a suggestively stronger association observed in cluster 5 compared with cluster 1. Among individuals with a healthy lifestyle, those in cluster 5 had a similar risk of T2D compared with those in cluster 1 (RR 1.03 [0.91, 1.18]). This study identified genetic subtypes of prediabetes that differed in risk of progression to T2D and in benefits from a healthy lifestyle. ARTICLE HIGHLIGHTS
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Affiliation(s)
- Yang Li
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Rhonda Arthur
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Krista M. Perreira
- Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Kent D. Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | | | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Thomas E. Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Joel D. Kaufman
- Environmental and Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, WA
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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Wang L, Bai Y, Cao Z, Guo Z, Lian Y, Liu P, Zeng Y, Lyu W, Chen Q. Histone deacetylases and inhibitors in diabetes mellitus and its complications. Biomed Pharmacother 2024; 177:117010. [PMID: 38941890 DOI: 10.1016/j.biopha.2024.117010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024] Open
Abstract
Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia, with its prevalence linked to both genetic predisposition and environmental factors. Epigenetic modifications, particularly through histone deacetylases (HDACs), have been recognized for their significant influence on DM pathogenesis. This review focuses on the classification of HDACs, their role in DM and its complications, and the potential therapeutic applications of HDAC inhibitors. HDACs, which modulate gene expression without altering DNA sequences, are categorized into four classes with distinct functions and tissue specificity. HDAC inhibitors (HDACi) have shown efficacy in various diseases, including DM, by targeting these enzymes. The review highlights how HDACs regulate β-cell function, insulin sensitivity, and hepatic gluconeogenesis in DM, as well as their impact on diabetic cardiomyopathy, nephropathy, and retinopathy. Finally, we suggest that targeted histone modification is expected to become a key method for the treatment of diabetes and its complications. The study of HDACi offers insights into new treatment strategies for DM and its associated complications.
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Affiliation(s)
- Li Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province 610072, PR China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, PR China
| | - Yuning Bai
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, PR China
| | - Zhengmin Cao
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, PR China
| | - Ziwei Guo
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, PR China
| | - Yanjie Lian
- Department of Cardiovascular Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, PR China
| | - Pan Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province 610072, PR China
| | - Yixian Zeng
- Department of Proctology, Beibei Hospital of Traditional Chinese Medicine, Chongqing 400799, PR China
| | - Wenliang Lyu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, PR China.
| | - Qiu Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province 610072, PR China.
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Ngema M, Xulu ND, Ngubane PS, Khathi A. A Review of Fetal Development in Pregnancies with Maternal Type 2 Diabetes Mellitus (T2DM)-Associated Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation: Possible Links to Pregestational Prediabetes. Biomedicines 2024; 12:1372. [PMID: 38927579 PMCID: PMC11201628 DOI: 10.3390/biomedicines12061372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Research has identified fetal risk factors for adult diseases, forming the basis for the Developmental Origins of Health and Disease (DOHaD) hypothesis. DOHaD suggests that maternal insults during pregnancy cause structural and functional changes in fetal organs, increasing the risk of chronic diseases like type 2 diabetes mellitus (T2DM) in adulthood. It is proposed that altered maternal physiology, such as increased glucocorticoid (GC) levels associated with a dysregulated hypothalamic-pituitary-adrenal (HPA) axis in maternal stress and T2DM during pregnancy, exposes the fetus to excess GC. Prenatal glucocorticoid exposure reduces fetal growth and programs the fetal HPA axis, permanently altering its activity into adulthood. This programmed HPA axis is linked to increased risks of hypertension, cardiovascular diseases, and mental disorders in adulthood. With the global rise in T2DM, particularly among young adults of reproductive age, it is crucial to prevent its onset. T2DM is often preceded by a prediabetic state, a condition that does not show any symptoms, causing many to unknowingly progress to T2DM. Studying prediabetes is essential, as it is a reversible stage that may help prevent T2DM-related pregnancy complications. The existing literature focuses on HPA axis dysregulation in T2DM pregnancies and its link to fetal programming. However, the effects of prediabetes on HPA axis function, specifically glucocorticoid in pregnancy and fetal outcomes, are not well understood. This review consolidates research on T2DM during pregnancy, its impact on fetal programming via the HPA axis, and possible links with pregestational prediabetes.
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Affiliation(s)
| | | | | | - Andile Khathi
- School of Laboratory Medicine & Medical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4001, South Africa; (M.N.); (N.D.X.); (P.S.N.)
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Dimba NR, Mzimela N, Khathi A. Improved Gut Health May Be a Potential Therapeutic Approach for Managing Prediabetes: A Literature Review. Biomedicines 2024; 12:1275. [PMID: 38927482 PMCID: PMC11201806 DOI: 10.3390/biomedicines12061275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Given the growing global threat and rising prevalence of type 2 diabetes mellitus (T2DM), addressing this metabolic disease is imperative. T2DM is preceded by prediabetes (PD), an intermediate hyperglycaemia that goes unnoticed for years in patients. Several studies have shown that gut microbial diversity and glucose homeostasis in PD or T2DM patients are affected. Therefore, this review aims to synthesize the existing literature to elucidate the association between high-calorie diets, intestinal permeability and their correlation with PD or T2DM. Moreover, it discusses the beneficial effects of different dietary interventions on improving gut health and glucose metabolism. The primary factor contributing to complications seen in PD or T2DM patients is the chronic consumption of high-calorie diets, which alters the gut microbial composition and increases the translocation of toxic substances from the intestinal lumen into the bloodstream. This causes an increase in inflammatory response that further impairs glucose regulation. Several dietary approaches or interventions have been implemented. However, only a few are currently in use and have shown promising results in improving beneficial microbiomes and glucose metabolism. Therefore, additional well-designed studies are still necessary to thoroughly investigate whether improving gut health using other types of dietary interventions can potentially manage or reverse PD, thereby preventing the onset of T2DM.
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Affiliation(s)
| | | | - Andile Khathi
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville 4000, South Africa; (N.R.D.); (N.M.)
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Chianelli M, Busetto L, Vettor R, Annibale B, Paoletta A, Papini E, Albanese A, Carabotti M, Casarotto D, De Pergola G, Disoteo OE, Grandone I, Medea G, Nisoli E, Raffaelli M, Schiff S, Vignati F, Cinquini M, Gonzalez-Lorenzo M, Fittipaldo VA, Minozzi S, Monteforte M, Tralongo AC, Novizio R, Persichetti A, Samperi I, Scoppola A, Borretta G, Carruba M, Carbonelli MG, De Luca M, Frontoni S, Corradini SG, Muratori F, Attanasio R. Italian guidelines for the management of adult individuals with overweight and obesity and metabolic comorbidities that are resistant to behavioral treatment. J Endocrinol Invest 2024; 47:1361-1371. [PMID: 38630213 DOI: 10.1007/s40618-024-02361-y] [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: 12/06/2023] [Accepted: 03/09/2024] [Indexed: 06/02/2024]
Abstract
AIM This guideline (GL) is aimed at providing a clinical practice reference for the management of adult patients with overweight or obesity associated with metabolic complications who are resistant to lifestyle modification. METHODS Surgeons, endocrinologists, gastroenterologists, psychologists, pharmacologists, a general practitioner, a nutritionist, a nurse and a patients' representative acted as multi-disciplinary panel. This GL has been developed following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A systematic review and network meta-analysis was performed by a methodologic group. For each question, the panel identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" were considered in the systematic review of evidence. Those classified as "critical" were considered for clinical practice recommendations. Consensus on the direction (for or against) and strength (strong or conditional) of recommendations was reached through a majority vote. RESULTS The present GL provides recommendations about the role of both pharmacological and surgical treatment for the clinical management of the adult patient population with BMI > 27 kg/m2 and < 40 kg/m2 associated with weight-related metabolic comorbidities, resistant to lifestyle changes. The panel: suggests the timely implementation of therapeutic interventions in addition to diet and physical activity; recommends the use of semaglutide 2.4 mg/week and suggests liraglutide 3 mg/day in patients with obesity or overweight also affected by diabetes or pre-diabetes; recommends semaglutide 2.4 mg/week in patients with obesity or overweight also affected by non-alcoholic fatty liver disease; recommends semaglutide 2.4 mg/week as first-line drug in patients with obesity or overweight that require a larger weight loss to reduce comorbidities; suggests the use of orlistat in patients with obesity or overweight also affected by hypertriglyceridemia that assume high-calorie and high-fat diet; suggests the use of naltrexone/bupropion combination in patients with obesity or overweight, with emotional eating; recommends surgical intervention (sleeve gastrectomy, Roux-en-Y gastric bypass, or metabolic gastric bypass/gastric bypass with single anastomosis/gastric mini bypass in patients with BMI ≥ 35 kg/m2 who are suitable for metabolic surgery; and suggests gastric banding as a possible, though less effective, surgical alternative. CONCLUSION The present GL is directed to all physicians addressing people with obesity-working in hospitals, territorial services or private practice-and to general practitioners and patients. The recommendations should also consider the patient's preferences and the available resources and expertise.
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Affiliation(s)
- M Chianelli
- Endocrinology, Regina Apostolorum Hospital, Albano Laziale, RM, Italy
| | - L Busetto
- Department of Medicine, Center for Medical and Surgical Therapy of Obesity, University of Padua, Padua University Hospital, President of the Italian Society for Obesity, Padua, Italy
| | - R Vettor
- Department of Medicine, Medical Clinic 3rd, Endocrine-Metabolic Unit, Padua University Hospital, Center for the Study and Integrated Treatment of Obesity, University of Padua, Padua, Italy
| | - B Annibale
- President of the Italian Society of Gastroenterology and Digestive Endoscopy, Department of Medico-Surgical Sciences and Translational Medicine, Unit of Diseases of the Digestive System and Liver, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - A Paoletta
- Endocrinology, ULSS6 Euganea, Padua, Italy
| | - E Papini
- Endocrinology, Regina Apostolorum Hospital, Albano Laziale, RM, Italy
| | - A Albanese
- Bariatric Surgery Unit, University Hospital of Padua, Padua, Italy
| | - M Carabotti
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | | | - G De Pergola
- Clinical Nutrition Center for Research and Treatment of Obesity and Metabolic Diseases, IRCCS De Bellis, Castellana Grotte, BA, Italy
| | - O E Disoteo
- Diabetology Unit, ASST Grande Ospedale Metropolitano Di Niguarda, Milan, Italy
| | - I Grandone
- Diabetology, Dietology and Clinical Nutrition Unit, Santa Maria Hospital, Terni, Italy
| | - G Medea
- General Practitioner, ATS Brescia, Brescia, Italy
| | - E Nisoli
- Center for the Study and Research on Obesity, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - M Raffaelli
- Endocrine and Metabolic Surgery Unit, Agostino Gemelli IRCCS University Polyclinic Foundation, Center for Research in Endocrine Gland and Obesity Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - S Schiff
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - F Vignati
- Endocrine Diseases and Diabetology Unit, Referral Center for the Study, Diagnosis and Treatment of Obesity, Sant'Anna Hospital, ASST Lariana, Como, Italy
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - V A Fittipaldo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - S Minozzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M Monteforte
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A C Tralongo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - R Novizio
- Endocrinology and Metabolism Unit, Catholic University of the Sacred Heart, Rome, Italy.
| | - A Persichetti
- Ministry of Interior - Department of Firefighters, Public Rescue and Civil Defense, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - I Samperi
- Endocrinology, ASL Novara, Novara, Italy
| | - A Scoppola
- UOSD Endocrinologia ASL, Roma 1, Rome, Italy
| | - G Borretta
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - M Carruba
- Center for the Study and Research on Obesity, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - M G Carbonelli
- Dietetics and Nutrition Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - M De Luca
- Department of General Surgery, Rovigo Hospital, Rovigo, Italy
| | - S Frontoni
- Endocrinology Diabetes and Metabolism Unit, Fatebenefratelli Hospital, Rome, Italy
| | - S G Corradini
- Gastroenterology, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico Umberto I University Hospital, Rome, Italy
| | - F Muratori
- Endocrine Diseases and Diabetology Unit, Referral Center for the Study, Diagnosis and Treatment of Obesity, Sant'Anna Hospital, ASST Lariana, Como, Italy
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Mkhize BC, Mosili P, Mzimela N, Ngubane PS, Khathi A. The relationship between adipose tissue RAAS activity and the risk factors of prediabetes in different ethnicities: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e33095. [PMID: 38788045 PMCID: PMC11124753 DOI: 10.1097/md.0000000000033095] [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: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The incidence and prevalence of prediabetes has become a global concern. The risk factors of prediabetes, such as insulin resistance, adiposity, lipotoxicity and obesity, in conjunction with the alteration of the renin-angiotensin-aldosterone system (RAAS), have been positively correlated with the high morbidity and mortality rate. Thus, this systematic review seeks to establish the relationship between the risk factors of prediabetes, namely insulin resistance adiposity, lipotoxicity, obesity and the RAAS. Therefore, a synthesis of these risk factors, their clinical indicators and the RAAS components will be compiled in order to establish the association between the RAAS alteration and obesity in prediabetic patients. METHODS This protocol for a systematic review was developed in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) standards. This will be accomplished by searching clinical Medical Subject Headings categories in MEDLINE with full texts, EMBASE, Web of Science, PubMed, Cochrane Library, Academic Search Complete, ICTRP and ClinicalTrial.gov. Reviewers will examine all of the findings and select the studies that meet the qualifying criteria. To check for bias, the Downs and Black Checklist will be used, followed by a Review Manager v5. A Forrest plot will be used for the meta-analysis and sensitivity analysis. Furthermore, the strength of the evidence will be assessed utilizing the Grading of Recommendations Assessment, Development, and Evaluation procedure (GRADE). The protocol has been registered with PROSPERO CRD42022320252. This systematic review and meta-analysis will include published randomized clinical trials, observational studies and case-control studies from the years 2000 to 2022.
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Affiliation(s)
| | - Palesa Mosili
- University of KwaZulu-Natal, Westville, KwaZulu, Natal, South Africa
| | - Nomusa Mzimela
- University of KwaZulu-Natal, Westville, KwaZulu, Natal, South Africa
| | | | - Andile Khathi
- University of KwaZulu-Natal, Westville, KwaZulu, Natal, South Africa
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10
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Ngema M, Xulu ND, Ngubane PS, Khathi A. Pregestational Prediabetes Induces Maternal Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation and Results in Adverse Foetal Outcomes. Int J Mol Sci 2024; 25:5431. [PMID: 38791468 PMCID: PMC11122116 DOI: 10.3390/ijms25105431] [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: 03/26/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Maternal type 2 diabetes mellitus (T2DM) has been shown to result in foetal programming of the hypothalamic-pituitary-adrenal (HPA) axis, leading to adverse foetal outcomes. T2DM is preceded by prediabetes and shares similar pathophysiological complications. However, no studies have investigated the effects of maternal prediabetes on foetal HPA axis function and postnatal offspring development. Hence, this study investigated the effects of pregestational prediabetes on maternal HPA axis function and postnatal offspring development. Pre-diabetic (PD) and non-pre-diabetic (NPD) female Sprague Dawley rats were mated with non-prediabetic males. After gestation, male pups born from the PD and NPD groups were collected. Markers of HPA axis function, adrenocorticotropin hormone (ACTH) and corticosterone, were measured in all dams and pups. Glucose tolerance, insulin and gene expressions of mineralocorticoid (MR) and glucocorticoid (GR) receptors were further measured in all pups at birth and their developmental milestones. The results demonstrated increased basal concentrations of ACTH and corticosterone in the dams from the PD group by comparison to NPD. Furthermore, the results show an increase basal ACTH and corticosterone concentrations, disturbed MR and GR gene expression, glucose intolerance and insulin resistance assessed via the Homeostasis Model Assessment (HOMA) indices in the pups born from the PD group compared to NPD group at all developmental milestones. These observations reveal that pregestational prediabetes is associated with maternal dysregulation of the HPA axis, impacting offspring HPA axis development along with impaired glucose handling.
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Affiliation(s)
| | | | | | - Andile Khathi
- School of Laboratory Medicine & Medical Sciences, University of KwaZulu-Natal, Westville, Private Bag X54001, Durban 4041, KwaZulu Natal, South Africa; (M.N.); (N.D.X.); (P.S.N.)
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11
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Robertson S, Clarke ED, Gómez-Martín M, Cross V, Collins CE, Stanford J. Do Precision and Personalised Nutrition Interventions Improve Risk Factors in Adults with Prediabetes or Metabolic Syndrome? A Systematic Review of Randomised Controlled Trials. Nutrients 2024; 16:1479. [PMID: 38794717 PMCID: PMC11124316 DOI: 10.3390/nu16101479] [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: 03/28/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
This review aimed to synthesise existing literature on the efficacy of personalised or precision nutrition (PPN) interventions, including medical nutrition therapy (MNT), in improving outcomes related to glycaemic control (HbA1c, post-prandial glucose [PPG], and fasting blood glucose), anthropometry (weight, BMI, and waist circumference [WC]), blood lipids, blood pressure (BP), and dietary intake among adults with prediabetes or metabolic syndrome (MetS). Six databases were systematically searched (Scopus, Medline, Embase, CINAHL, PsycINFO, and Cochrane) for randomised controlled trials (RCTs) published from January 2000 to 16 April 2023. The Academy of Nutrition and Dietetics Quality Criteria were used to assess the risk of bias. Seven RCTs (n = 873), comprising five PPN and two MNT interventions, lasting 3-24 months were included. Consistent and significant improvements favouring PPN and MNT interventions were reported across studies that examined outcomes like HbA1c, PPG, and waist circumference. Results for other measures, including fasting blood glucose, HOMA-IR, blood lipids, BP, and diet, were inconsistent. Longer, more frequent interventions yielded greater improvements, especially for HbA1c and WC. However, more research in studies with larger sample sizes and standardised PPN definitions is needed. Future studies should also investigate combining MNT with contemporary PPN factors, including genetic, epigenetic, metabolomic, and metagenomic data.
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Affiliation(s)
- Seaton Robertson
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia (C.E.C.)
| | - Erin D. Clarke
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia (C.E.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - María Gómez-Martín
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia (C.E.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Victoria Cross
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia (C.E.C.)
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia (C.E.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Jordan Stanford
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia (C.E.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
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12
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Stowell M, Dobson R, Garner K, Baig M, Nehren N, Whittaker R. Digital interventions for self-management of prediabetes: A scoping review. PLoS One 2024; 19:e0303074. [PMID: 38728296 PMCID: PMC11086829 DOI: 10.1371/journal.pone.0303074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Rates of prediabetes, which can lead to type 2 diabetes, are increasing worldwide. Interventions for prediabetes mainly focus on lifestyle changes to diet and exercise. While these interventions are effective, they are often delivered face-to-face, which may pose a barrier to those with limited access to healthcare. Given the evidence for digital interventions addressing other noncommunicable diseases, these may also be effective for prediabetes self-management. The aim of this scoping review was to assess the breadth of evidence around digital interventions for prediabetes self-management. METHODS We developed a targeted search strategy and relevant studies were identified through searches conducted in four bibliographic databases (Medline, Embase, PsycInfo, and Scopus). Published studies were eligible if they included a digital intervention to support adults aged 18+ with prediabetes self-management. Titles and abstracts were first screened for relevance by one researcher. Full texts of selected records were assessed against the review criteria independently by two researchers for inclusion in the final analysis. RESULTS Twenty-nine studies were included, of which nine were randomised controlled trials. Most efficacy studies reported significant changes in at least one primary and/or secondary outcome, including participants' glycaemic control, weight loss and/or physical activity levels. About one-third of studies reported mixed outcomes or early significant outcomes that were not sustained at long-term follow-up. Interventions varied in length, digital modalities, and complexity. Delivery formats included text messages, mobile apps, virtually accessible dietitians/health coaches, online peer groups, and web-based platforms. Approximately half of studies assessed participant engagement/acceptability outcomes. CONCLUSION Whilst the evidence here suggests that digital interventions to support prediabetes self-management are acceptable and have the potential to reduce one's risk of progression to type 2 diabetes, more research is needed to understand which interventions, and which components specifically, have the greatest reach to diverse populations, are most effective at promoting user engagement, and are most effective in the longer term.
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Affiliation(s)
- Melanie Stowell
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Katie Garner
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | | | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
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13
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Liu Y, Yu S, Feng W, Mo H, Hua Y, Zhang M, Zhu Z, Zhang X, Wu Z, Zheng L, Wu X, Shen J, Qiu W, Lou J. A meta-analysis of diabetes risk prediction models applied to prediabetes screening. Diabetes Obes Metab 2024; 26:1593-1604. [PMID: 38302734 DOI: 10.1111/dom.15457] [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: 09/18/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024]
Abstract
AIM To provide a systematic overview of diabetes risk prediction models used for prediabetes screening to promote primary prevention of diabetes. METHODS The Cochrane, PubMed, Embase, Web of Science and China National Knowledge Infrastructure (CNKI) databases were searched for a comprehensive search period of 30 August 30, 2023, and studies involving diabetes prediction models for screening prediabetes risk were included in the search. The Quality Assessment Checklist for Diagnostic Studies (QUADAS-2) tool was used for risk of bias assessment and Stata and R software were used to pool model effect sizes. RESULTS A total of 29 375 articles were screened, and finally 20 models from 24 studies were included in the systematic review. The most common predictors were age, body mass index, family history of diabetes, history of hypertension, and physical activity. Regarding the indicators of model prediction performance, discrimination and calibration were only reported in 79.2% and 4.2% of studies, respectively, resulting in significant heterogeneity in model prediction results, which may be related to differences between model predictor combinations and lack of important methodological information. CONCLUSIONS Numerous models are used to predict diabetes, and as there is an association between prediabetes and diabetes, researchers have also used such models for screening the prediabetic population. Although it is a new clinical practice to explore, differences in glycaemic metabolic profiles, potential complications, and methods of intervention between the two populations cannot be ignored, and such differences have led to poor validity and accuracy of the models. Therefore, there is no recommended optimal model, and it is not recommended to use existing models for risk identification in alternative populations; future studies should focus on improving the clinical relevance and predictive performance of existing models.
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Affiliation(s)
- Yujin Liu
- Nursing Department, The second Hosiptal of Jinhua, Jinhua, China
- School of Medicine, Huzhou University, Huzhou, China
| | - Sunrui Yu
- Department of Anesthesiology, Jinhua Municipal Central Hospital, Jinhua, China
| | | | - Hangfeng Mo
- School of Medicine, Huzhou University, Huzhou, China
| | - Yuting Hua
- School of Medicine, Huzhou University, Huzhou, China
| | - Mei Zhang
- School of Medicine, Huzhou University, Huzhou, China
| | - Zhichao Zhu
- School of Medicine, Huzhou University, Huzhou, China
- Emergency Department, Jinhua Municipal Central Hospital Medical Group, Jinhua, China
| | - Xiaoping Zhang
- Nursing Department, The second Hosiptal of Jinhua, Jinhua, China
| | - Zhen Wu
- Nursing Department, The second Hosiptal of Jinhua, Jinhua, China
| | - Lanzhen Zheng
- Nursing Department, The second Hosiptal of Jinhua, Jinhua, China
| | - Xiaoqiu Wu
- Nursing Department, The second Hosiptal of Jinhua, Jinhua, China
| | - Jiantong Shen
- School of Medicine, Huzhou University, Huzhou, China
| | - Wei Qiu
- Department of Endocrinology, Huzhou Central Hospital, Huzhou, China
| | - Jianlin Lou
- Huzhou Key Laboratory of Precise Prevention and Control of Major Chronic Diseases, Huzhou University, Huzhou, China
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14
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Vidhyalakshmi R, Prabhasankar P, Muthukumar SP, Prathima C, Meera MS. The impact of addition of pearl millet starch-germ complex in white bread on nutritional, textural, structural, and glycaemic response: Single blinded randomized controlled trial in healthy and pre-diabetic participants. Food Res Int 2024; 183:114186. [PMID: 38760125 DOI: 10.1016/j.foodres.2024.114186] [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: 10/25/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 05/19/2024]
Abstract
The rise of pre-diabetes at the global level has created a significant interest in developing low glycaemic index food products. The pearl millet is a cheaper source of starch and its germ contains significant amount of protein and fat. The complexing of pearl millet starch and germ by dry heat treatment (PMSGH) resulted an increase in the resistant starch content upto 45.09 % due to formation of amylose-glutelin-linoleic acid complex. The resulting pearl millet starch germ complex was incorporated into wheat bread at 20, 25, and 30 %. The PMSGH incorporated into bread at 30 % reduced the glycaemic index to 52.31. The PMSGH incorporated bread had significantly (p < 0.05)increased in the hardness with a reduction in springiness and cohesiveness. The structural attributes of the 30 % PMSGH incorporated bread revealed a significant (p < 0.05)increase in 1040/1020 cm-1 ratio and relative crystallinity. The consumption of functional bread incorporated with pearl millet starch germ complex reduced blood glucose levels and in vivo glycaemic index in healthy and pre-diabetic participants when compared to white bread. Hence, the study showed that the incorporation of pearl millet starch-germ complex into food products could be a potential new and healthier approach for improving dietary options in pre-diabetes care.
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Affiliation(s)
- R Vidhyalakshmi
- Department of Grain Science and Technology, CSIR-Central Food Technological Research Institute, Mysore, Karnataka 570020, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Pichan Prabhasankar
- Department of Flour Milling, Baking, and Confectionery Technology, CSIR-Central Food Technological Research Institute, Mysore, Karnataka 570020, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - S P Muthukumar
- Department of Biochemistry, CSIR-Central Food Technological Research Institute, Mysore, Karnataka 570020, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - C Prathima
- Department of Pharmacology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka 570015, India
| | - M S Meera
- Department of Grain Science and Technology, CSIR-Central Food Technological Research Institute, Mysore, Karnataka 570020, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
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15
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Steiner B, Leitner C, Stadler D, Prugger EM, Magnes C, Herzog PL. Enzymatic detection of α-hydroxybutyrate, an important marker of insulin resistance, and comparison with LC-MS/MS detection. Pract Lab Med 2024; 40:e00398. [PMID: 38745675 PMCID: PMC11091673 DOI: 10.1016/j.plabm.2024.e00398] [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: 10/24/2023] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
Aim The metabolite α-hydroxybutyrate (α-HB) is an important marker of insulin resistance and impaired glucose tolerance allowing to identify patients at risk of developing diabetes and related metabolic disorders before any symptoms become apparent. At present, its exact quantification requires mass spectrometry (LC-MS), which is not compatible with routine laboratory use. Accordingly, a simple enzymatic-based method was assessed and its applicability and measuring accuracy compared with LC-MS was investigated. Methods Standards, serum, and plasma samples containing α-HB were prepared with routine procedures and their α-HB contents measured with the XpressGT® enzymatic test kit photometrically or with LC-MS and multiple reaction monitoring. Results α-HB detection with XpressGT® yielded highly linear calibration curves and 102 % recovery of stocks added to commercial samples. Stability of the analyte in serum and plasma samples prepared with various anti-coagulants was >90 % after 46 h for several widely used preparations and recovery after 3 freeze-thaw cycles was ≥95 % with these anti-coagulants. A direct comparison of 75 samples indicated very good agreement of α-HB levels determined by both methods, 86 % of XpressGT® samples being within ±20 % of LC-MS values and even 93 % within ±20 % considering only samples above 30 μM concentration. Conclusion XpressGT®-based detection of α-HB is an easily applicable method which can be used for accurate and reliable quantification of the metabolite in clinical practice. Routine α-HB determination in patients at risk of developing diabetes would allow early establishment of preventive measures or pharmacological intervention reducing the risk for the onset of serious diabetes-related health problems.
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Affiliation(s)
| | | | | | - Eva-Maria Prugger
- JOANNEUM RESEARCH Forschungsgesellschaft mbH HEALTH - Institute for Biomedicine and Health Sciences, Neue Stiftingtalstraße 2, 8010, Graz, Austria
| | - Christoph Magnes
- JOANNEUM RESEARCH Forschungsgesellschaft mbH HEALTH - Institute for Biomedicine and Health Sciences, Neue Stiftingtalstraße 2, 8010, Graz, Austria
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16
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Berezin AE, Berezina TA, Hoppe UC, Lichtenauer M, Berezin AA. Methods to predict heart failure in diabetes patients. Expert Rev Endocrinol Metab 2024; 19:241-256. [PMID: 38622891 DOI: 10.1080/17446651.2024.2342812] [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: 01/26/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is one of the leading causes of cardiovascular disease and powerful predictor for new-onset heart failure (HF). AREAS COVERED We focus on the relevant literature covering evidence of risk stratification based on imaging predictors and circulating biomarkers to optimize approaches to preventing HF in DM patients. EXPERT OPINION Multiple diagnostic algorithms based on echocardiographic parameters of cardiac remodeling including global longitudinal strain/strain rate are likely to be promising approach to justify individuals at higher risk of incident HF. Signature of cardiometabolic status may justify HF risk among T2DM individuals with low levels of natriuretic peptides, which preserve their significance in HF with clinical presentation. However, diagnostic and predictive values of conventional guideline-directed biomarker HF strategy may be non-optimal in patients with obesity and T2DM. Alternative biomarkers affecting cardiac fibrosis, inflammation, myopathy, and adipose tissue dysfunction are plausible tools for improving accuracy natriuretic peptides among T2DM patients at higher HF risk. In summary, risk identification and management of the patients with T2DM with established HF require conventional biomarkers monitoring, while the role of alternative biomarker approach among patients with multiple CV and metabolic risk factors appears to be plausible tool for improving clinical outcomes.
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Affiliation(s)
- Alexander E Berezin
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Tetiana A Berezina
- VitaCenter, Department of Internal Medicine & Nephrology, Zaporozhye, Ukraine
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
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17
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Deschênes SS, Nearchou F, McInerney A, Schmitz N, Pouwer F, Nouwen A. Childhood maltreatment and the risk of impaired glucose metabolism or type 2 diabetes in young adults: Findings from the Lifelines Cohort Study. J Health Psychol 2024:13591053241243285. [PMID: 38600690 DOI: 10.1177/13591053241243285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
We examined the associations between childhood maltreatment and the risk of impaired glucose metabolism (IGM) or type 2 diabetes (T2D) in young adults aged 18-35. Participants (N = 8506) from the Lifelines Cohort Study without IGM or diabetes at baseline (2007-2013) were included. Childhood maltreatment was assessed by the Childhood Trauma Questionnaire (CTQ) and incident IGM/T2D was assessed by haemoglobin A1c levels (≥5.7%) in 2014-2017. There were 223 (2.6%) cases of IGM/T2D during the follow-up period. After adjusting for sociodemographic and health/lifestyle covariates and follow-up time, only the CTQ Sexual Abuse subscale was significantly associated with IGM/T2D (RR = 1.05 [95% CI = 1.01, 1.10]). The association remained when additionally accounting for depressive and anxiety symptoms (RR = 1.05 [95% CI = 1.00, 1.09]). Childhood sexual abuse was associated with an increased risk of IGM/T2D in young adults, highlighting the long-term metabolic consequences of childhood maltreatment.
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Affiliation(s)
| | | | | | | | - Frans Pouwer
- University of Southern Denmark, Denmark
- Steno Diabetes Center Odense, Denmark
- Vrije Universiteit Amsterdam, The Netherlands
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18
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Dlamini M, Khathi A. Investigating the Effects of Diet-Induced Prediabetes on Skeletal Muscle Strength in Male Sprague Dawley Rats. Int J Mol Sci 2024; 25:4076. [PMID: 38612885 PMCID: PMC11012655 DOI: 10.3390/ijms25074076] [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: 03/06/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Type 2 diabetes mellitus, a condition preceded by prediabetes, is documented to compromise skeletal muscle health, consequently affecting skeletal muscle structure, strength, and glucose homeostasis. A disturbance in skeletal muscle functional capacity has been demonstrated to induce insulin resistance and hyperglycemia. However, the modifications in skeletal muscle function in the prediabetic state are not well elucidated. Hence, this study investigated the effects of diet-induced prediabetes on skeletal muscle strength in a prediabetic model. Male Sprague Dawley rats were randomly assigned to one of the two groups (n = 6 per group; six prediabetic (PD) and six non-pre-diabetic (NPD)). The PD group (n = 6) was induced with prediabetes for 20 weeks. The diet that was used to induce prediabetes consisted of fats (30% Kcal/g), proteins (15% Kcal/g), and carbohydrates (55% Kcal/g). In addition to the diet, the experimental animals (n = 6) were supplied with drinking water that was supplemented with 15% fructose. The control group (n = 6) was allowed access to normal rat chow, consisting of 35% carbohydrates, 30% protein, 15% fats, and 20% other components, as well as ordinary tap water. At the end of week 20, the experimental animals were diagnosed with prediabetes using the American Diabetes Association (ADA) prediabetes impaired fasting blood glucose criteria (5.6-6.9 mmol/L). Upon prediabetes diagnosis, the animals were subjected to a four-limb grip strength test to assess skeletal muscle strength at week 20. After the grip strength test was conducted, the animals were euthanized for blood and tissue collection to analyze glycated hemoglobin (HbA1c), plasma insulin, and insulin resistance using the homeostatic model of insulin resistance (HOMA-IR) index and malondialdehyde (MDA) concentration. Correlation analysis was performed to examine the associations of skeletal muscle strength with HOMA-IR, plasma glucose, HbA1c, and MDA concentration. The results demonstrated increased HbA1c, FBG, insulin, HOMA-IR, and MDA concentrations in the PD group compared to the NPD group. Grip strength was reduced in the PD group compared to the NPD group. Grip strength was negatively correlated with HbA1c, plasma glucose, HOMA-IR, and MDA concentration in the PD group. These observations suggest that diet-induced prediabetes compromises muscle function, which may contribute to increased levels of sedentary behavior during prediabetes progression, and this may contribute to the development of hyperglycemia in T2DM.
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Affiliation(s)
| | - Andile Khathi
- Department of Human Physiology, School of Laboratory Medicine, Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban X54001, South Africa;
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19
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Al Rifai M, Al-Mallah MH, Blaha MJ, Patel J, McEvoy JW, Nasir K, Shahid I, Patel KV, Sharma G, Marrugat J, Tizon-Marcos H, Erbel R, Stang A, Jöckel KH, Lehmann N, Schramm S, Schmidt B, Blumenthal RS, Virani SS, Nambi V, Cainzos-Achirica M. Epidemiology and Prognostic Implications of Coronary Artery Calcium in Asymptomatic Individuals With Prediabetes: A Multicohort Study. Diabetes Care 2024; 47:698-706. [PMID: 38329795 DOI: 10.2337/dc23-1864] [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: 10/04/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To describe the epidemiology and prognostic value of coronary artery calcium (CAC) in individuals with prediabetes. RESEARCH DESIGN AND METHODS We pooled participants free of clinical atherosclerotic cardiovascular disease (ASCVD) from four prospective cohorts: the Multi-Ethnic Study of Atherosclerosis, Heinz Nixdorf Recall Study, Framingham Heart Study, and Jackson Heart Study. Two definitions were used for prediabetes: inclusive (fasting plasma glucose [FPG] ≥100 to <126 mg/dL and hemoglobin A1c [HbA1c] ≥5.7% to <6.5%, if available, and no glucose-lowering medications) and restrictive (FPG ≥110 to <126 mg/dL and HbA1c ≥5.7% to <6.5%, if available, among participants not taking glucose-lowering medications). RESULTS The study included 13,376 participants (mean age 58 years; 54% women; 57% White; 27% Black). The proportions with CAC ≥100 were 17%, 22%, and 37% in those with euglycemia, prediabetes, and diabetes, respectively. Over a median (25th-75th percentile) follow-up time of 14.6 (interquartile range 7.8-16.4) years, individuals with prediabetes and CAC ≥100 had a higher unadjusted 10-year incidence of ASCVD (13.4%) than the overall group of those with diabetes (10.6%). In adjusted analyses, using the inclusive definition of prediabetes, compared with euglycemia, the hazard ratios (HRs) for ASCVD were 0.79 (95% CI 0.62, 1.01) for prediabetes and CAC 0, 0.70 (0.54, 0.89) for prediabetes and CAC 1-99, 1.54 (1.27, 1.88) for prediabetes and CAC ≥100, and 1.64 (1.39, 1.93) for diabetes. Using the restrictive definition, the HR for ASCVD was 1.63 (1.29, 2.06) for prediabetes and CAC ≥100. CONCLUSIONS CAC ≥100 is frequent among individuals with prediabetes and identifies a high ASCVD risk subgroup in which the adjusted ASCVD risk is similar to that in individuals with diabetes.
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Affiliation(s)
| | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- Johns Hopkins Heart Center, Greater Baltimore Medical Center, Baltimore, MD
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Houston Methodist Academic Institute, Houston, TX
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Izza Shahid
- Houston Methodist Academic Institute, Houston, TX
| | - Kershaw V Patel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Houston Methodist Academic Institute, Houston, TX
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- Inova Women's Cardiovascular Health, Fairfax, VA
| | - Jaume Marrugat
- Hospital del Mar, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Helena Tizon-Marcos
- Hospital del Mar, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Salim S Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Houston, TX
- Baylor College of Medicine, Houston, TX
| | - Vijay Nambi
- Section of Cardiology, Baylor College of Medicine, Houston, TX
- Center for Cardiometabolic Disease Prevention, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- Hospital del Mar, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
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20
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Nour Eldein MM, Babakr AT. Evaluation of a Lipid Profile in Normoglycemic and Pre-diabetic Saudi Office Employees in Makka Region: A Case-Control Study. Cureus 2024; 16:e57608. [PMID: 38707051 PMCID: PMC11069631 DOI: 10.7759/cureus.57608] [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: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) poses a significant health challenge worldwide. The impact of a sedentary lifestyle in predicting and managing complications of diabetes represents an urgent need for health strategies. The objective of this study was to evaluate the lipid profile among normoglycemic and prediabetic Saudi office workers. METHODS The research was a case-control study carried out in Makkah al-Mukarramah (Kingdom of Saudi Arabia, KSA). Seventy-five office worker volunteers between the ages of 19 and 45 years were recruited for the study. The participants were divided into two groups: a control group of non-diabetic normal subjects (NGT) and prediabetic subjects with impaired fasting plasma glucose and/or impaired glucose tolerance (IGT), based on the American Diabetes Association recommendations. Measurements of glucose, hemoglobin A1C (HbA1C), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were performed using standard procedures and commercial kits. Statistical analysis was performed to compare the lipid profile in the two groups, and a P-value of <0.05 was considered statistically significant. RESULTS A proportion (58.7%) of the office workers are prediabetics; prediabetic office workers had higher total cholesterol compared to the control group (p < 0.05). Triglyceride levels were higher in office workers with prediabetes compared to the normoglycemic group (p < 0.05). LDL levels were elevated in the prediabetic office workers compared to the control group (p < 0.05). CONCLUSION Office employees with prediabetes exhibit elevated levels of cholesterol, triglycerides, and LDL. The disturbance in lipid profile may be linked to impaired glucose tolerance in individuals with a sedentary lifestyle, such as office workers.
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Bogaert L, Willems I, Calders P, Dirinck E, Kinaupenne M, Decraene M, Lapauw B, Strumane B, Van Daele M, Verbestel V, De Craemer M. Explanatory variables of objectively measured 24-h movement behaviors in people with prediabetes and type 2 diabetes: A systematic review. Diabetes Metab Syndr 2024; 18:102995. [PMID: 38583307 DOI: 10.1016/j.dsx.2024.102995] [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: 09/10/2023] [Revised: 02/13/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
AIM Physical activity (PA), sedentary behavior (SB) and sleep (i.e. 24-h movement behaviors) are associated with health indicators in people with prediabetes and type 2 diabetes (T2D). To optimize 24-h movement behaviors, it is crucial to identify explanatory variables related to these behaviors. This review aimed to summarize the explanatory variables of 24-h movement behaviors in people with prediabetes or T2D. METHODS A systematic search of four databases (PubMed, Web of Science, Scopus & Embase) was performed. Only objective measurements of 24-h movement behaviors were included in the search strategy. The explanatory variables were classified according to the levels of the socio-ecological model (i.e. intrapersonal, interpersonal and environmental). The risk of bias was assessed using the Joanna Briggs Institute appraisal checklist. RESULTS None of the 78 included studies investigated 24-h movement behaviors. The majority of the studies investigated PA in isolation. Most studied explanatory variables were situated at the intrapersonal level. Being male was associated with more moderate to vigorous PA but less light PA in people with T2D, and more total PA in people with prediabetes. An older age was associated with a decrease in all levels of PA in people with T2D. HbA1c was positively associated with sleep and SB in both groups. No associations were found at the interpersonal or environmental level. CONCLUSION The results of this review underscore the lack of a socio-ecological approach toward explanatory variables of 24-h movement behaviors and the lack of focus on an integrated 24-h movement behavior approach in both populations.
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Affiliation(s)
- Lotte Bogaert
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium.
| | - Iris Willems
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium; Research Foundation Flanders, Brussels, Belgium.
| | - Patrick Calders
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium.
| | - Eveline Dirinck
- Department of Endocrinology, Antwerp University Hospital & University of Antwerp, Antwerp, Belgium.
| | - Manon Kinaupenne
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium.
| | - Marga Decraene
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium; Ghent University, Department of Movement and Sports Sciences, Ghent, Belgium.
| | - Bruno Lapauw
- Department of Endocrinology & Department of Internal Medicine and Pediatrics, Ghent University Hospital & Ghent University, Ghent, Belgium.
| | - Boyd Strumane
- Faculty of Medicine and Health Sciences, Ghent, Belgium.
| | | | - Vera Verbestel
- Faculty of Health, Medicine and Life Sciences, Department of Health Promotion, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, the Netherlands; Faculty of Health, Medicine and Life Sciences, Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands.
| | - Marieke De Craemer
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium.
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22
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Kim NY, Lee H, Kim S, Kim YJ, Lee H, Lee J, Kwak SH, Lee S. The clinical relevance of a polygenic risk score for type 2 diabetes mellitus in the Korean population. Sci Rep 2024; 14:5749. [PMID: 38459065 PMCID: PMC10923897 DOI: 10.1038/s41598-024-55313-0] [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: 05/30/2023] [Accepted: 02/22/2024] [Indexed: 03/10/2024] Open
Abstract
The clinical utility of a type 2 diabetes mellitus (T2DM) polygenic risk score (PRS) in the East Asian population remains underexplored. We aimed to examine the potential prognostic value of a T2DM PRS and assess its viability as a clinical instrument. We first established a T2DM PRS for 5490 Korean individuals using East Asian Biobank data (269,487 samples). Subsequently, we assessed the predictive capability of this T2DM PRS in a prospective longitudinal study with baseline data and data from seven additional follow-ups. Our analysis showed that the T2DM PRS could predict the transition of glucose tolerance stages from normal glucose tolerance to prediabetes and from prediabetes to T2DM. Moreover, T2DM patients in the top-decile PRS group were more likely to be treated with insulin (hazard ratio = 1.69, p value = 2.31E-02) than were those in the remaining PRS groups. T2DM PRS values were significantly high in the severe diabetes subgroup, characterized by insulin resistance and β -cell dysfunction (p value = 0.0012). The prediction models with the T2DM PRS had significantly greater Harrel's C-indices than did corresponding models without it. By utilizing prospective longitudinal study data and extensive clinical risk factor information, our analysis provides valuable insights into the multifaceted clinical utility of the T2DM PRS.
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Affiliation(s)
- Na Yeon Kim
- Graduate School of Data Science, Seoul National University, Seoul, South Korea
| | - Haekyung Lee
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Sehee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea
| | - Hyunsuk Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
- Genomic Medicine Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Junhyeong Lee
- Graduate School of Data Science, Seoul National University, Seoul, South Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seunggeun Lee
- Graduate School of Data Science, Seoul National University, Seoul, South Korea.
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Karvela M, Golden CT, Bell N, Martin-Li S, Bedzo-Nutakor J, Bosnic N, DeBeaudrap P, de Mateo-Lopez S, Alajrami A, Qin Y, Eze M, Hon TK, Simón-Sánchez J, Sahoo R, Pearson-Stuttard J, Soon-Shiong P, Toumazou C, Oliver N. Assessment of the impact of a personalised nutrition intervention in impaired glucose regulation over 26 weeks: a randomised controlled trial. Sci Rep 2024; 14:5428. [PMID: 38443427 PMCID: PMC10914757 DOI: 10.1038/s41598-024-55105-6] [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: 10/30/2023] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
Dietary interventions can reduce progression to type 2 diabetes mellitus (T2DM) in people with non-diabetic hyperglycaemia. In this study we aimed to determine the impact of a DNA-personalised nutrition intervention in people with non-diabetic hyperglycaemia over 26 weeks. ASPIRE-DNA was a pilot study. Participants were randomised into three arms to receive either (i) Control arm: standard care (NICE guidelines) (n = 51), (ii) Intervention arm: DNA-personalised dietary advice (n = 50), or (iii) Exploratory arm: DNA-personalised dietary advice via a self-guided app and wearable device (n = 46). The primary outcome was the difference in fasting plasma glucose (FPG) between the Control and Intervention arms after 6 weeks. 180 people were recruited, of whom 148 people were randomised, mean age of 59 years (SD = 11), 69% of whom were female. There was no significant difference in the FPG change between the Control and Intervention arms at 6 weeks (- 0.13 mmol/L (95% CI [- 0.37, 0.11]), p = 0.29), however, we found that a DNA-personalised dietary intervention led to a significant reduction of FPG at 26 weeks in the Intervention arm when compared to standard care (- 0.019 (SD = 0.008), p = 0.01), as did the Exploratory arm (- 0.021 (SD = 0.008), p = 0.006). HbA1c at 26 weeks was significantly reduced in the Intervention arm when compared to standard care (- 0.038 (SD = 0.018), p = 0.04). There was some evidence suggesting prevention of progression to T2DM across the groups that received a DNA-based intervention (p = 0.06). Personalisation of dietary advice based on DNA did not result in glucose changes within the first 6 weeks but was associated with significant reduction of FPG and HbA1c at 26 weeks when compared to standard care. The DNA-based diet was effective regardless of intervention type, though results should be interpreted with caution due to the low sample size. These findings suggest that DNA-based dietary guidance is an effective intervention compared to standard care, but there is still a minimum timeframe of adherence to the intervention before changes in clinical outcomes become apparent.Trial Registration: www.clinicaltrials.gov.uk Ref: NCT03702465.
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Affiliation(s)
- Maria Karvela
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, UK
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Caroline T Golden
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, UK
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Nikeysha Bell
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Stephanie Martin-Li
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, UK
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Judith Bedzo-Nutakor
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, UK
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Natalie Bosnic
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, UK
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Pierre DeBeaudrap
- Centre for Population and Development (Ceped), French National Institute for Sustainable Development (IRD), and Paris University, Inserm ERL, 1244, Paris, France
| | - Sara de Mateo-Lopez
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, UK
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Ahmed Alajrami
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Yun Qin
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Maria Eze
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Tsz-Kin Hon
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Javier Simón-Sánchez
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | - Rashmita Sahoo
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK
| | | | - Patrick Soon-Shiong
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Christofer Toumazou
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, UK.
- DnaNudge Ltd, Scale Space, Imperial College London, White City Campus, London, UK.
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
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Han CY, Lim SL, Ong KW, Johal J, Gulyani A. Behavioral Lifestyle Intervention Program Using Mobile Application Improves Diet Quality in Adults With Prediabetes (D'LITE Study): A Randomized Controlled Trial. J Acad Nutr Diet 2024; 124:358-371. [PMID: 37820787 DOI: 10.1016/j.jand.2023.10.005] [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: 12/13/2022] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Mobile health applications (mHealth apps) are increasingly being used in weight loss interventions. However, evidence on the effects of such interventions on diet quality and their correlation with weight loss is lacking. OBJECTIVE The objective of this study was to examine whether changes in the diet quality of adults with prediabetes followed the use of an mHealth-enabled lifestyle intervention, compared with those who did not, and whether these changes correlated with weight loss. DESIGN A secondary analysis of a 6-month randomized controlled trial Diabetes Lifestyle Intervention using Technology Empowerment (D'LITE) was conducted, with participants recruited from October 2017 to September 2019. PARTICIPANTS/SETTING Community-dwelling adults (n = 148) in Singapore diagnosed with prediabetes and body mass index (BMI) ≥23 were included in this study. INTERVENTION Participants were randomized to receive either a 6-month mHealth-enabled lifestyle intervention program (diet and physical activity) or standard care dietary advice. MAIN OUTCOME MEASURES Dietary data were collected in the form of 2-day food records at baseline, 3, and 6 months. Changes in Alternate Healthy Eating Index-2010 (AHEI-2010) scores and food groups (servings/day), calculated from the dietary data, and correlation between changes in AHEI-2010 and weight loss at 3 and 6 months, were examined. STATISTICAL ANALYSES Between-group comparisons of continuous variables and within-participants variation were performed using longitudinal mixed-effect models, intention-to-treat principles. The models included treatment groups, time (baseline, 3 months, and 6 months), and covariates (age, sex, and BMI), as well as the group × time interactions, as fixed variables and within-participant variation in outcome values as random variable. The random intercept for participants accounted for the dependence of repeated measures. A likelihood ratio test was also conducted to test random effect variance. Spearman correlation test was used to examine correlation between changes in AHEI-2010 scores and weight loss. RESULTS There was a significant improvement in overall diet quality as ascertained by the AHEI-2010, by 6.2 points (95% confidence interval [CI], 3.8-8.7; P < 0.001) in the intervention group as compared with the control. The participants in the intervention group had a significantly greater reduction in intake of sugar-sweetened beverages (SSB) by 0.5 servings/day (95% CI, -0.8, -0.2; P < 0.001) and sodium by 726 mg/day (95% CI, -983, -468; P < .001), compared with those receiving standard care. At 3 and 6 months, a significant decrease in SSB (0.8 servings/day; 0.7 servings/day, respectively) and sodium (297 mg/day; 296 mg/day, respectively) intakes were reported compared with baseline intakes. Small positive correlations (r = 0.2; P < 0.05) were observed between changes in AHEI-2010 scores from baseline and percentage weight loss at 3 and 6 months. CONCLUSION For adults with prediabetes in Singapore, diet quality can be improved with an mHealth-enabled lifestyle intervention program. A small positive correlation exists between AHEI-2010 scores and weight loss.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia; NOVI Health, Singapore.
| | - Su Lin Lim
- Dietetics Department, National University Hospital, National University Health System, Singapore
| | - Kai Wen Ong
- Dietetics Department, National University Hospital, National University Health System, Singapore
| | - Jolyn Johal
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Aarti Gulyani
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
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25
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Qiu S, Cai X, Zhou X, Xu J, Sun Z, Guo H, Wu T. Muscle Quality in Relation to Prediabetes Phenotypes: A Population-Based Study With Mediation Analysis. J Clin Endocrinol Metab 2024; 109:e1151-e1158. [PMID: 37878955 DOI: 10.1210/clinem/dgad630] [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: 07/03/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Abstract
CONTEXT Prediabetes is associated with an increased risk of physical disability, yet no studies have assessed the extent to which muscle quality, a measure reflecting muscle functionality, was altered in prediabetes and its specific phenotype. OBJECTIVE We evaluated their associations in a general US population with mediation analysis. METHODS This was a cross-sectional study based on the National Health and Nutrition Examination Survey 2011-2014. Participants with prediabetes were stratified as having an isolated defect (impaired fasting glucose [IFG], impaired glucose tolerance [IGT], or impaired hemoglobin A1c [IA1c]), 2 defects (IFG + IGT, IFG + IA1c, or IGT + IA1c), or all defects (IFG + IGT + IA1c). Muscle quality was calculated as dominant grip strength divided by dominant arm muscle mass measured by dual-energy X-ray absorptiometry. RESULTS We included 2351 participants (938 with prediabetes and 1413 with normoglycemia). Despite higher grip strength and larger arm muscle mass, arm muscle quality was lower in prediabetes and all prediabetes phenotypes (except for IGT) than normoglycemia (all P < .04), and was unrelated to prediabetes awareness. Arm muscle quality was decreased and the odds of low arm muscle quality was increased in prediabetes with increasing numbers of glucometabolic defects (both P < .001), with insulin resistance being the predominant mediator. HbA1c-defined prediabetes (IA1c) had lower arm muscle quality and higher odds of low arm muscle quality than blood glucose-defined prediabetes (IFG, IGT, or IFG + IGT). CONCLUSION Muscle quality was impaired in prediabetes and its specific phenotype. Relative to blood glucose, elevated HbA1c might be a better predictor of reduced muscle quality.
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Affiliation(s)
- Shanhu Qiu
- Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, China
- Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Xue Cai
- Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Xiaoying Zhou
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, China
| | - Jinshui Xu
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210000, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, China
| | - Haijian Guo
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210000, China
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5000, Australia
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Holm TF, Udsen FW, Færch K, Jensen MH, von Scholten BJ, Hejlesen OK, Hangaard S. The Effectiveness of Digital Health Lifestyle Interventions on People With Prediabetes: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression. JMIR Res Protoc 2024; 13:e50340. [PMID: 38335018 PMCID: PMC10891485 DOI: 10.2196/50340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND There has been an increasing interest in the use of digital health lifestyle interventions for people with prediabetes, as these interventions may offer a scalable approach to preventing type 2 diabetes. Previous systematic reviews on digital health lifestyle interventions for people with prediabetes had limitations, such as a narrow focus on certain types of interventions, a lack of statistical pooling, and no broader subgroup analysis of intervention characteristics. The identified limitations observed in previous systematic reviews substantiate the necessity of conducting a comprehensive review to address these gaps within the field. This will enable a comprehensive understanding of the effectiveness of digital health lifestyle interventions for people with prediabetes. OBJECTIVE The objective of this systematic review, meta-analysis, and meta-regression is to systematically investigate the effectiveness of digital health lifestyle interventions on prediabetes-related outcomes in comparison with any comparator without a digital component among adults with prediabetes. METHODS This systematic review will include randomized controlled trials that investigate the effectiveness of digital health lifestyle interventions on adults (aged 18 years or older) with prediabetes and compare the digital interventions with nondigital interventions. The primary outcome will be change in body weight (kg). Secondary outcomes include, among others, change in glycemic status, markers of cardiometabolic health, feasibility outcomes, and incidence of type 2 diabetes. Embase, PubMed, CINAHL, and CENTRAL (Cochrane Central Register of Controlled Trials) will be systematically searched. The data items to be extracted include study characteristics, participant characteristics, intervention characteristics, and relevant outcomes. To estimate the overall effect size, a meta-analysis will be conducted using the mean difference. Additionally, if feasible, meta-regression on study, intervention, and participant characteristics will be performed. The Cochrane risk of bias tool will be applied to assess study quality, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to assess the certainty of evidence. RESULTS The results are projected to yield an overall estimate of the effectiveness of digital health lifestyle interventions on adults with prediabetes and elucidate the characteristics that contribute to their effectiveness. CONCLUSIONS The insights gained from this study may help clarify the potential of digital health lifestyle interventions for people with prediabetes and guide the decision-making regarding future intervention components. TRIAL REGISTRATION PROSPERO CRD42023426919; http://tinyurl.com/d3enrw9j. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50340.
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Affiliation(s)
- Tanja Fredensborg Holm
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Flemming Witt Udsen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Kristine Færch
- Data Science, Novo Nordisk A/S, Søborg, Denmark
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Morten Hasselstrøm Jensen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Data Science, Novo Nordisk A/S, Søborg, Denmark
| | | | | | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
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Zhou Y, Jing J, Zhang Z, Pan Y, Cai X, Zhu W, Li Z, Liu C, Liu H, Meng X, Cheng J, Wang Y, Li H, Wang S, Niu H, Wen W, Sachdev PS, Wei T, Liu T, Wang Y. Disrupted pattern of rich-club organization in structural brain network from prediabetes to diabetes: A population-based study. Hum Brain Mapp 2024; 45:e26598. [PMID: 38339955 PMCID: PMC10839741 DOI: 10.1002/hbm.26598] [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: 04/28/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
The network nature of the brain is gradually becoming a consensus in the neuroscience field. A set of highly connected regions in the brain network called "rich-club" are crucial high efficiency communication hubs in the brain. The abnormal rich-club organization can reflect underlying abnormal brain function and metabolism, which receives increasing attention. Diabetes is one of the risk factors for neurological diseases, and most individuals with prediabetes will develop overt diabetes within their lifetime. However, the gradual impact of hyperglycemia on brain structures, including rich-club organization, remains unclear. We hypothesized that the brain follows a special disrupted pattern of rich-club organization in prediabetes and diabetes. We used cross-sectional baseline data from the population-based PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study, which included 2218 participants with a mean age of 61.3 ± 6.6 years and 54.1% females comprising 1205 prediabetes, 504 diabetes, and 509 normal control subjects. The rich-club organization and network properties of the structural networks derived from diffusion tensor imaging data were investigated using a graph theory approach. Linear mixed models were used to assess associations between rich-club organization disruptions and the subjects' glucose status. Based on the graphical analysis methods, we observed the disrupted pattern of rich-club organization was from peripheral regions mainly located in frontal areas to rich-club regions mainly located in subcortical areas from prediabetes to diabetes. The rich-club organization disruptions were associated with elevated glucose levels. These findings provided more details of the process by which hyperglycemia affects the brain, contributing to a better understanding of the potential neurological consequences. Furthermore, the disrupted pattern observed in rich-club organization may serve as a potential neuroimaging marker for early detection and monitoring of neurological disorders in individuals with prediabetes or diabetes.
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Affiliation(s)
- Yijun Zhou
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
| | - Jing Jing
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Zhe Zhang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xueli Cai
- Department of Neurology, Lishui HospitalZhejiang University School of MedicineLishuiZhejiangChina
| | - Wanlin Zhu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Chang Liu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
| | - Hao Liu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
| | - Xia Meng
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Jian Cheng
- School of Computer Science and Engineering, Beihang UniversityBeijingChina
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Hao Li
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Suying Wang
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of MedicineLishuiZhejiangChina
| | - Haijun Niu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
| | - Wei Wen
- Division of Psychiatry and Mental Health, Faculty of Medicine and Health, Centre for Healthy Brain Ageing (CHeBA)UNSWSydneyNew South WalesAustralia
- Neuropsychiatric Institute, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Perminder S. Sachdev
- Division of Psychiatry and Mental Health, Faculty of Medicine and Health, Centre for Healthy Brain Ageing (CHeBA)UNSWSydneyNew South WalesAustralia
- Neuropsychiatric Institute, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Tiemin Wei
- Department of Cardiology, Lishui HospitalZhejiang University School of MedicineZhejiangChina
| | - Tao Liu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Research Unit of Artificial Intelligence in Cerebrovascular DiseaseChinese Academy of Medical Sciences, 2019RU018BeijingChina
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Gumede NAC, Khathi A. The Role of Pro-Opiomelanocortin Derivatives in the Development of Type 2 Diabetes-Associated Myocardial Infarction: Possible Links with Prediabetes. Biomedicines 2024; 12:314. [PMID: 38397916 PMCID: PMC10887103 DOI: 10.3390/biomedicines12020314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/14/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Myocardial infarction is a major contributor to CVD-related mortality. T2DM is a risk factor for MI. Stress activates the HPA axis, SNS, and endogenous OPS. These POMC derivatives increase the blood glucose and cardiovascular response by inhibiting the PI3K/AkT insulin signaling pathway and increasing cardiac contraction. Opioids regulate the effect of the HPA axis and SNS and they are cardioprotective. The chronic activation of the stress response may lead to insulin resistance, cardiac dysfunction, and MI. Stress and T2DM, therefore, increase the risk of MI. T2DM is preceded by prediabetes. Studies have shown that prediabetes is associated with an increased risk of MI because of inflammation, hyperlipidemia, endothelial dysfunction, and hypertension. The HPA axis is reported to be dysregulated in prediabetes. However, the SNS and the OPS have not been explored during prediabetes. The effect of prediabetes on POMC derivatives has yet to be fully explored and understood. The impact of stress and prediabetes on the cardiovascular response needs to be investigated. This study sought to review the potential impact of prediabetes on the POMC derivatives and pathways that could lead to MI.
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Affiliation(s)
- Nompumelelo Anna-Cletta Gumede
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban X54001, South Africa;
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Kakisingi C, Mwamba C, Kasongo Muteba M, Kasamba E, Kabamba M, Tanon A, Situakibanza H. Prevalence and Associated Factors of Diabetes Mellitus Among Newly Enrolled Tuberculosis Patients in Lubumbashi (DRC). Risk Manag Healthc Policy 2024; 17:171-180. [PMID: 38250217 PMCID: PMC10800086 DOI: 10.2147/rmhp.s436873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
Background Tuberculosis and diabetes mellitus are major public health challenges worldwide. The two scourges have bidirectional relationship with high morbidity and mortality. Objective The present study was conducted to determine the prevalence of diabetes mellitus and identify related factors in patients with tuberculosis. Methods A cross-sectional study was conducted in 11 tuberculosis screening and treatment centers in Lubumbashi (DRC) from September to December 2022. Adult patient with a positive smear for tuberculosis were systematically screened for diabetes mellitus. Demographic characteristics, history and symptomatology were the variables of interest. Data was entered using Microsoft Excel software. STATA 16 software was used for analysis. Results A total of 255 tuberculosis patients were recruited and the prevalence of diabetes mellitus among these patients was 11.4% (ie, 29 out of 255). After uni and multivariate logistic regression, a BMI ≤ 18.5 Kg/m2, lack of employment, polyuria and intense thirst were the factors associated with diabetes mellitus in tuberculosis patients. Conclusion The prevalence of diabetes mellitus in smear positive tuberculosis patients in the present study was higher than the one observed in Central Africa.
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Affiliation(s)
- Christian Kakisingi
- Internal Medicine Department, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Claude Mwamba
- Internal Medicine Department, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Michel Kasongo Muteba
- Division of Epidemiology and Biostatistics, University ofWitwatersrand, Johannesburg, Republic of South Africa
| | - Eric Kasamba
- Department of Basics Sciences. University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Michel Kabamba
- Public Health Department, University of Kamina, Kamina, Democratic Republic of the Congo
| | - Aristophane Tanon
- Specialities and Medicine Department, University of Félix Houphouët-Boigny of Abidjan Cocody, Abidjan, Ivory Coast
| | - Hippolyte Situakibanza
- Internal Medicine Department, Tropical Diseases, Infectious and Parasitic Department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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El Sawy S, Bekhit M, Abdelhamid A, Esmat S, Ashraf H, Naguib M. Assessment of early macular microangiopathy in subjects with prediabetes using optical coherence tomography angiography and fundus photography. Acta Diabetol 2024; 61:69-77. [PMID: 37689606 PMCID: PMC10806077 DOI: 10.1007/s00592-023-02167-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
AIMS Early detection of retinal microangiopathy in patients with prediabetes may reduce diabetic retinopathy complications. The aim of this study was to assess early macular vascular changes in prediabetics before development of over diabetes using OCTA and fundus photography. METHODS In this cross-sectional study, 66 prediabetic individuals and 66 normal controls underwent clinical, laboratory, and fundus photography evaluation followed by OCTA macular imaging to examine for the foveal avascular zone, and area of capillary non-perfusion, thickness, disorganization of vessels, and vessel density perfusion percentage of superficial capillary plexus and deep capillary plexus. RESULTS Retinal microangiopathy was detected in 36.4% of prediabetics by OCTA and only in 10.6% by fundus photography. None of clinical or laboratory parameters had significant association with DR. Area of capillary non-perfusion and disorganization of SCP were detected in 53.8% and 56.8%, respectively, in prediabetics. VDP of SCP and DCP of whole image, parafoveal, and perifoveal areas was significantly lower in prediabetes group compared to normal control. VDP of DCP of perifoveal area (β coefficient: - 0.10, OR: 0.91, 95% CI: 0.86-0.96, P < 0.001) and disorganization of DCP (β coefficient: 1.93, OR: 6.89, 95% CI: 2.5-18.8, P < 0.001) were significant predictors of DR in prediabetics. There was no difference in FAZ in prediabetics with and without retinopathy. CONCLUSIONS OCTA could detect early retinal vascular changes during the prediabetic state before developing diabetes. VDP was significantly reduced in prediabetic patients. Furthermore, VDP of DCP of perifoveal area and disorganization of DCP were the most important predictors of retinopathy in prediabetic patients.
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Affiliation(s)
- Shereen El Sawy
- Internal Medicine Department, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, 41 Manial Street, Cairo, 11451, Egypt
| | - Mirrette Bekhit
- Internal Medicine Department, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, 41 Manial Street, Cairo, 11451, Egypt
| | - Alaa Abdelhamid
- Kasr Al-Ainy Vascular Laboratory, Cairo University, Cairo, Egypt
| | - Sohair Esmat
- Ophthalmology Department, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Hala Ashraf
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mervat Naguib
- Internal Medicine Department, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, 41 Manial Street, Cairo, 11451, Egypt.
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Amelia R, Harahap J, Zulham, Fujiati II, Wijaya H. Educational Model and Prevention on Prediabetes: A Systematic Review. Curr Diabetes Rev 2024; 20:e101023221945. [PMID: 37818560 PMCID: PMC10909827 DOI: 10.2174/0115733998275518231006074504] [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: 08/29/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Prediabetes is a reversible condition before the onset of Type 2 Diabetes Mellitus. Untreated condition of prediabetes will develop into diabetes and its complications. The prevalence of prediabetes has been emerging worldwide and has a considerable socioeconomic impact. The current study reviews the roles of early detection, educational models, life modification, and prophylaxis of individuals with prediabetes in preventing the progression of prediabetes into Type 2 Diabetes Mellitus and complications in the future. METHODS This study included published articles from several electronic databases. The obtained articles were limited to March 2023. Articles that were not open access and not in Indonesian or English were excluded. The protocol for this study used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020. RESULTS Of 39627 articles, 39601 were excluded due to duplication and did not meet the eligibility criteria. At the final, there were 26 articles that were eligible for systematic review. CONCLUSION Prevention of the development of prediabetes into diabetes is essential. A comprehensive understanding and training on intensive lifestyle modification protocols from local and national experts in diabetes prevention through digital-based education models and linguistically and culturally approach can be considered. Intensive lifestyle modification and pharmacological approaches may improve the outcome. Regular monitoring of glycemic control is also important for early diagnosis of diabetes, especially in patients with special conditions.
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Affiliation(s)
- Rina Amelia
- Department of Community Medicine/Public Health Sumatera Utara, Faculty of Medicine, Universitas Sumatera Utara, Utara, Indonesia
| | - Juliandi Harahap
- Department of Community Medicine/Public Health Sumatera Utara, Faculty of Medicine, Universitas Sumatera Utara, Utara, Indonesia
| | - Zulham
- Department of Histology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Isti Ilmiati Fujiati
- Department of Community Medicine/Public Health Sumatera Utara, Faculty of Medicine, Universitas Sumatera Utara, Utara, Indonesia
| | - Hendri Wijaya
- Department of Paediatics, Faculty of Medicine, Universitas Sumatera Utara, H. Adam Malik General Hospital, Madan, Indonesia
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Dlamini M, Khathi A. Prediabetes-Associated Changes in Skeletal Muscle Function and Their Possible Links with Diabetes: A Literature Review. Int J Mol Sci 2023; 25:469. [PMID: 38203642 PMCID: PMC10778616 DOI: 10.3390/ijms25010469] [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: 10/30/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
The skeletal muscle plays a critical role in regulating systemic blood glucose homeostasis. Impaired skeletal muscle glucose homeostasis associated with type 2 diabetes mellitus (T2DM) has been observed to significantly affect the whole-body glucose homeostasis, thereby resulting in other diabetic complications. T2DM does not only affect skeletal muscle glucose homeostasis, but it also affects skeletal muscle structure and functional capacity. Given that T2DM is a global health burden, there is an urgent need to develop therapeutic medical therapies that will aid in the management of T2DM. Prediabetes (PreDM) is a prominent risk factor of T2DM that usually goes unnoticed in many individuals as it is an asymptomatic condition. Hence, research on PreDM is essential because establishing diabetic biomarkers during the prediabetic state would aid in preventing the development of T2DM, as PreDM is a reversible condition if it is detected in the early stages. The literature predominantly documents the changes in skeletal muscle during T2DM, but the changes in skeletal muscle during prediabetes are not well elucidated. In this review, we seek to review the existing literature on PreDM- and T2DM-associated changes in skeletal muscle function.
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Affiliation(s)
| | - Andile Khathi
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban X54001, South Africa;
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Ng HY, Chan LTW. Prediabetes in children and adolescents: An updated review. World J Clin Pediatr 2023; 12:263-272. [PMID: 38178932 PMCID: PMC10762598 DOI: 10.5409/wjcp.v12.i5.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 12/08/2023] Open
Abstract
Prediabetes, the precursor of type 2 diabetes mellitus, is an intermediate stage between normal glucose homeostasis and overt diabetes. This asymptomatic metabolic state is increasingly prevalent in pediatric population and is very difficult to detect without appropriate screening. Studies have shown that a certain proportion of children with prediabetes will develop diabetes in a few years. Even more alarming is the evidence that youth-onset diabetes has a more aggressive clinical course with progressive beta-cell decline and accelerated end-organ damage. Despite its importance, several aspects involving prediabetes in childhood are disputed or unknown. This review presents the latest insights into this challenging entity and outlines a simplified screening approach to aid clinical practice. In summary, childhood prediabetes is an important clinical condition indicating the need for proper screening and timely intervention.
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Affiliation(s)
- Hak Yung Ng
- Department of Paediatrics and Adolescent Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Louis Tsz Wang Chan
- Department of Paediatrics and Adolescent Medicine, Tseung Kwan O Hospital, Hong Kong, China
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JOKAR MOZHGAN, ZANDI MITRA, EBADI ABBAS, MOMENAN AMIRABBAS, MARTINI MARIANO, BEHZADIFAR MASOUD. Adults' perceived health promotion needs in the prediabetes stage: a meta-synthesis study. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E411-E428. [PMID: 38379738 PMCID: PMC10876036 DOI: 10.15167/2421-4248/jpmh2023.64.4.3152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024]
Abstract
Introduction One of the methods to promote pre-diabetic patients' adherence to preventive behaviors and improving their lifestyle is to pay attention to their needs in the designed educational programs. Therefore, this study was conducted with the aim of identifying the needs of individuals with prediabetes. Methodology Three databases, including ISI/Web of Sciences, PubMed, Scopus were searched without time limitation until August 2022. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines and to achieve the research goal, Sandelowski and Barroso's seven-step meta-synthesis method (2007) was used. Thematic synthesis was used to analyses the data. Results Out of the 1934 studies obtained, 34 studies were finally examined and 805 codes were recorded based on the extracted data. Through synthesizing and analyzing the primary studies, 8 main themes were extracted regarding individuals' needs in the prediabetes stage: Information needs, Cultural needs, psychological needs, Social support needs, Education needs, Financial needs, Service needs and Skill needs. Discussion and Conclusions The perceived needs and their types in each of the dimensions in detail can be a proper guide for designing educational programs and various interventions to control the prediabetes condition, leading to a reduction in the prevalence of type 2 diabetes in the society.
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Affiliation(s)
- MOZHGAN JOKAR
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MITRA ZANDI
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - ABBAS EBADI
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Research Center for Life & Health Sciences & Biotechnology of the Police, Direction of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
| | - AMIR ABBAS MOMENAN
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- TLGS Unit Manager, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
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Gumede N, Khathi A. The role of fibrinolysis in the development of prediabetes-associated coronary heart disease: a focus on the plasminogen activator inhibitor -1 and its potential use as a predictive marker in diet-induced prediabetes. Front Nutr 2023; 10:1256427. [PMID: 38024366 PMCID: PMC10652797 DOI: 10.3389/fnut.2023.1256427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular diseases (CVD). However, the onset of T2DM is preceded by prediabetes, which is associated with sedentary lifestyles and consumption of high-calorie diets. Studies have shown that impaired glucose homeostasis creates an environment for developing T2DM-related complications. Using a high-fat-high-carbohydrate diet-induced prediabetes animal model, this study sought to assess the risk factors of coronary heart disease (CHD) in diet-induced prediabetes and identify biomarkers that can be used for early detection of prediabetes-associated CHD. Methods Male Sprague Dawley rats were randomly grouped into two groups and were kept on different diets for 20 weeks (n = 6 in each group). One group was fed standard rat chow to serve as a non-prediabetes (NPD) control, while the other group consumed a high-fat-high-carbohydrate diet to induce prediabetes (PD). Post induction, the homeostasis model assessment- insulin resistance (HOMA-IR) and glycated haemoglobin (HbA1c) was used to test for insulin resistance. Body weight, mean arterial pressure (MAP), resting heart rate (HR), inflammatory cytokines (C-reactive protein (CRP), tumor necrosis factor (TNF-α), interleukin-6 (IL-6)), lipids (total cholesterol (TC), triglyceride (TG), lipoproteins (HDL, LDL, VLDL)), endothelial function (endothelial nitric oxide (eNOS), endothelin -1 (ET-1)), fibrinolysis (plasminogen activator inhibitor-1 (PAI-1)) were all measured to assess the risk of CHD. All data were expressed as means ± S.E.M. Statistical comparisons were performed with Graph Pad. Instat Software using Student's two-sided t-test. The Pearson correlation coefficient and linear regression were calculated to assess the association. The value of p < 0.05 was considered statistically significant. Results There was significant insulin resistance accompanied by significantly increased HbA1c and body weight in PD compared to NPD. Simultaneously, there was a significant increase in inflammatory cytokines in PD compared to NPD. This was accompanied by significantly increased TG and VLDL and endothelial dysfunction in PD. The association between HOMA-IR and PAI-1 was insignificantly positive in NPD, whereas a significantly strong positive association was observed in PD. Conclusion There is a positive correlation between insulin resistance and PAI-1 during prediabetes; therefore, suggesting that prediabetes increases the risk of developing vascular thrombosis. The current therefore study warrants further investigation on PAI-1 and other markers of fibrinolysis for the early detection of thrombosis and risk of CHD in prediabetes.
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Affiliation(s)
- Nompumelelo Gumede
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Munshi R, Karande-Patil S, Kumbhar D, Deshmukh A, Hingorani L. A randomized, controlled, comparative, proof-of-concept study to evaluate the efficacy and safety of Nisha-Amalaki capsules in prediabetic patients for preventing progression to diabetes. J Ayurveda Integr Med 2023; 14:100806. [PMID: 37857033 PMCID: PMC10587713 DOI: 10.1016/j.jaim.2023.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Prediabetes is an intermediate state of hyperglycemia, which acts as a precursor to Diabetes mellitus if left untreated. Nisha (Curcuma longa) and Amalaki (Emblica officinalis) combination has been advocated as drugs of choice to treat the early manifestations of Diabetes mellitus. OBJECTIVE This prospective, randomized, single-blind, placebo-controlled, comparative study was planned to assess the efficacy and safety of Nisha-Amalaki capsules in preventing progression to Diabetes mellitus in prediabetic patients when administered for 6 months. METHODS The study was conducted on prediabetic participants randomized to receive either Nisha-Amalaki (500 mg) or placebo one capsule twice a day for six months. The effect of study medications on IDRS (Indian Diabetes Risk Score), BMI (Body Mass Index), blood sugar, serum insulin, HOMA-IR (Homeostasis Model Assessment-Estimated Insulin Resistance), HbA1c (glycated hemoglobin), oxidative markers, Ayurvedic symptoms and Quality of Life (QoL) scores was assessed at regular intervals. RESULTS 58 of the 62 participants enrolled completed the study. Significant fall in IDRS score [p < 0.001], BMI [p < 0.001], fasting, and 2 h post-OGTT sugar, insulin, HbA1c, HOMA-IR, and oxidative stress markers [p < 0.001] was observed in patients receiving Nisha-Amalaki at 6 months. Ayurvedic symptoms and QoL scores also improved at 6 months in the treatment group. CONCLUSION Treatment with Nisha-Amalaki capsules improved all study parameters including insulin sensitivity at 6 months as compared to placebo in prediabetic patients. Thus Nisha-Amalaki should be considered as prophylactic therapy in prediabetics to delay progression to diabetes.
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Affiliation(s)
- Renuka Munshi
- Department of Clinical Pharmacology, TN Medical College & BYL Nair Charitable Hospital, Mumbai Central, Mumbai 400 008, India.
| | - Shilpa Karande-Patil
- Department of Medicine, TN Medical College & BYL Nair Charitable Hospital, Mumbai Central, Mumbai 400 008, India
| | - Dipti Kumbhar
- Department of Clinical Pharmacology, TN Medical College & BYL Nair Charitable Hospital, Mumbai Central, Mumbai 400 008, India
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Asmelash D, Mesfin Bambo G, Sahile S, Asmelash Y. Prevalence and associated factors of prediabetes in adult East African population: A systematic review and meta-analysis. Heliyon 2023; 9:e21286. [PMID: 37928032 PMCID: PMC10623273 DOI: 10.1016/j.heliyon.2023.e21286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Diabetes mellitus is a major public health problem with serious consequences, and more than three-fourths of diabetes live in low- and middle-income countries. According to a recent study, people with prediabetes have nearly six times the risk of developing diabetes than those with normal glucose levels. However, due to the inconsistency and absence of representative data, this study aimed to estimate the prevalence of prediabetes and its associated factors in the adult East African population. Methods Databases were systematically searched for articles published between January 1, 2013, and December 30, 2022. All observational community-based studies that reported prediabetes prevalence and/or associated factors in adult East African populations were included in the meta-analyses. Three authors independently extracted all required data using the Excel data extraction format and analyzed using Stata™ Version 11. An I2 test was conducted to determine significant heterogeneity. Finally, a random effects model was used to determine the overall prevalence of prediabetes and its associated factors. The study was registered with Prospero number CRD42023389745. Results The search strategy identified 267 articles. After screening for full-text review, twenty-one articles were included in the final analysis. The overall prevalence of prediabetes was 12.58 % (95 % CI:10.30, 14.86 %) in the adult East African population. Furthermore, the subgroup analysis revealed that prediabetes in the urban population 20 % (95 % CI: 1.60, 38.37) was twice as prevalent as in rural 10.0 % (95 % CI: 5.52, 14.48) populations. The prevalence of prediabetes by the ADA diagnostic criteria was 21.45 % (95 % CI: 15.54, 27.35) three times higher than the WHO 7.20 % (95 % CI: 5.70, 8.69). Moreover, prediabetes was significantly associated with old age (OR = 1.64, 95 %, CI: 1.07, 2.53), hypertension (OR = 2.43, 95 %, CI: 1.02-5.79), obesity and overweight (OR = 1.70, 95 %, CI: 1.09,2.65). Conclusion This study showed a high prevalence of prediabetes, which was significantly associated with old age, hypertension, and high BMI. This study suggests that health policymakers should pay attention to the prevention and control strategies that is targeted at those with obesity, hypertension, and old age.
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Affiliation(s)
- Daniel Asmelash
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Getachew Mesfin Bambo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Samuel Sahile
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Yemane Asmelash
- Department of Statistics, College of Natural and Computational Science, Aksum University, Aksum, Ethiopia
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Dudzik JM, Senkus KE, Evert AB, Raynor HA, Rozga M, Handu D, Moloney LM. The effectiveness of medical nutrition therapy provided by a dietitian in adults with prediabetes: a systematic review and meta-analysis. Am J Clin Nutr 2023; 118:892-910. [PMID: 37689140 DOI: 10.1016/j.ajcnut.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND A total of 374 million adults worldwide are living with prediabetes, 70% of whom will develop type 2 diabetes mellitus (T2DM) in their lifetime. Medical nutrition therapy (MNT) provided by a dietitian, such as that found in lifestyle interventions, has the potential to improve glycemic control and prevent progression to T2DM. OBJECTIVES The objective of this systematic review was to examine the effectiveness of MNT provided by a dietitian, compared with standard care, on glycemic, cardiometabolic, and anthropometric outcomes in adults with prediabetes. METHODS Searches were conducted for randomized controlled trials (RCTs) published between 1995 and 2022 using electronic databases MEDLINE, CINHAL, and Cochrane Central. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for RCTs. Meta-analyses were conducted using a random-effects model. The certainty of evidence was assessed for each outcome using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method, and a summary of findings table was created using the GRADEpro Guideline Development Tool. RESULTS Thirteen RCTs were included in the analysis, showcasing a variety of MNT interventions delivered by dietitians. Intervention durations ranged from 3 to 24 mo. Compared with standard care, MNT improved hemoglobin A1c (HbA1c) (mean difference [95% confidence interval]: -0.30% [-0.49, -0.12]) and fasting blood glucose (FBG) (-4.97 mg/dL [-6.24, -3.71]). Statistically significant improvements were found in anthropometrics (weight, body mass index, and waist circumference), cholesterol (total, high-, and low-density lipoproteins), and blood pressure (systolic and diastolic). No significant effect was found on T2DM or triglycerides. The certainty of evidence was moderate for FBG and low for HbA1c and incidence of T2DM. CONCLUSIONS In adults with prediabetes, MNT was effective in improving glycemic outcomes, anthropometrics, blood pressure, and most lipid levels. However, most studies had a risk of bias because of the randomization process or deviations from intended interventions. MNT plays a key role in improving cardiometabolic risk factors in adults with prediabetes. TRIAL REGISTRATION NUMBER This study was registered with the registration ID #351421, available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351421.
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Affiliation(s)
- Josephine M Dudzik
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, United States
| | - Katelyn E Senkus
- Department of Human Nutrition and Hospitality Management, College of Human Environmental Sciences, The University of Alabama, Tuscaloosa, AL, United States
| | - Alison B Evert
- University of Washington Medicine Primary Care, UW Neighborhood Clinics, Seattle, WA, United States
| | - Hollie A Raynor
- Department of Nutrition, College of Education, Health and Human Sciences, University of Tennessee Knoxville, Knoxville, TN, United States
| | - Mary Rozga
- Academy of Nutrition and Dietetics, Evidence Analysis Library, Chicago, IL, United States
| | - Deepa Handu
- Academy of Nutrition and Dietetics, Evidence Analysis Library, Chicago, IL, United States
| | - Lisa M Moloney
- Academy of Nutrition and Dietetics, Evidence Analysis Library, Chicago, IL, United States.
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Prakoso DA, Mahendradhata Y, Istiono W. Family Involvement to Stop the Conversion of Prediabetes to Diabetes. Korean J Fam Med 2023; 44:303-310. [PMID: 37582666 PMCID: PMC10667073 DOI: 10.4082/kjfm.23.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/01/2023] [Indexed: 08/17/2023] Open
Abstract
Prediabetes is a condition associated with an increased risk of developing diabetes, in which blood glucose levels are high but not high enough to be diagnosed as diabetes. The rapid increase in the prevalence of prediabetes is a major global health challenge. The incidence of prediabetes has increased to pandemic levels and can lead to serious consequences. Unfortunately, nearly 90% of prediabetic individuals are unaware of their ailment. A quarter of prediabetic individuals develop type 2 diabetes mellitus (T2DM) within 3-5 years. Although prediabetes is a reversible condition, the prevention of diabetes has received little attention. It is essential for prediabetic individuals to implement new health-improvement techniques. Focusing on family systems is one strategy to promote health, which is determined by health patterns that are often taught, established, and adjusted within family contexts. For disease prevention, a family-based approach may be beneficial. Family support is essential for the metabolic control of the disease. This study aimed to show several strategies for involving the patient's family members in preventing the conversion of prediabetes to T2DM and to emphasize that the patient's family members are a valuable resource to reduce the incidence of diabetes.
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Affiliation(s)
- Denny Anggoro Prakoso
- Postgraduate Programme in Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yodi Mahendradhata
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wahyudi Istiono
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Qiu S, Zhu Y, Xie B, Chen W, Wang D, Cai X, Sun Z, Wu T. Prediabetes Progression and Regression on Objectively- Measured Physical Function: A Prospective Cohort Study. Diabetes Metab J 2023; 47:859-868. [PMID: 37915187 PMCID: PMC10695714 DOI: 10.4093/dmj.2022.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/29/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGRUOUND Prediabetes leads to declines in physical function in older adults, but the impact of prediabetes progression or regression on physical function is unknown. This study assessed this longitudinal association, with physical function objectivelymeasured by grip strength, walking speed, and standing balance, based on the Health and Retirement Study enrolling United States adults aged >50 years. METHODS Participants with prediabetes were followed-up for 4-year to ascertain prediabetes status alteration (maintained, regressed, or progressed), and another 4-year to assess their impacts on physical function. Weak grip strength was defined as <26 kg for men and <16 kg for women, slow walking speed was as <0.8 m/sec, and poor standing balance was as an uncompleted fulltandem standing testing. Logistic and linear regression analyses were performed. RESULTS Of the included 1,511 participants with prediabetes, 700 maintained as prediabetes, 306 progressed to diabetes, and 505 regressed to normoglycemia over 4 years. Grip strength and walking speed were declined from baseline during the 4-year followup, regardless of prediabetes status alteration. Compared with prediabetes maintenance, prediabetes progression increased the odds of developing weak grip strength by 89% (95% confidence interval [CI], 0.04 to 2.44) and exhibited larger declines in grip strength by 0.85 kg (95% CI, -1.65 to -0.04). However, prediabetes progression was not related to impairments in walking speed or standing balance. Prediabetes regression also did not affect any measures of physical function. CONCLUSION Prediabetes progression accelerates grip strength decline in aging population, while prediabetes regression may not prevent physical function decline due to aging.
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Affiliation(s)
- Shanhu Qiu
- Department of General Practice, Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yiming Zhu
- Department of Endocrinology, Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bo Xie
- Department of General Practice, Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wenji Chen
- Department of General Practice, Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Xue Cai
- Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zilin Sun
- Department of Endocrinology, Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Ivić V, Zjalić M, Blažetić S, Fenrich M, Labak I, Scitovski R, Szűcs KF, Ducza E, Tábi T, Bagamery F, Szökő É, Vuković R, Rončević A, Mandić D, Debeljak Ž, Berecki M, Balog M, Seres-Bokor A, Sztojkov-Ivanov A, Hajagos-Tóth J, Gajović S, Imširović A, Bakula M, Mahiiovych S, Gaspar R, Vari SG, Heffer M. Elderly rats fed with a high-fat high-sucrose diet developed sex-dependent metabolic syndrome regardless of long-term metformin and liraglutide treatment. Front Endocrinol (Lausanne) 2023; 14:1181064. [PMID: 37929025 PMCID: PMC10623428 DOI: 10.3389/fendo.2023.1181064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Aim/Introduction The study aimed to determine the effectiveness of early antidiabetic therapy in reversing metabolic changes caused by high-fat and high-sucrose diet (HFHSD) in both sexes. Methods Elderly Sprague-Dawley rats, 45 weeks old, were randomized into four groups: a control group fed on the standard diet (STD), one group fed the HFHSD, and two groups fed the HFHSD along with long-term treatment of either metformin (HFHSD+M) or liraglutide (HFHSD+L). Antidiabetic treatment started 5 weeks after the introduction of the diet and lasted 13 weeks until the animals were 64 weeks old. Results Unexpectedly, HFHSD-fed animals did not gain weight but underwent significant metabolic changes. Both antidiabetic treatments produced sex-specific effects, but neither prevented the onset of prediabetes nor diabetes. Conclusion Liraglutide vested benefits to liver and skeletal muscle tissue in males but induced signs of insulin resistance in females.
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Affiliation(s)
- Vedrana Ivić
- Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Milorad Zjalić
- Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Senka Blažetić
- Department of Biology, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Matija Fenrich
- Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Irena Labak
- Department of Biology, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Rudolf Scitovski
- School of Applied Mathematics and Computer Science, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Kálmán Ferenc Szűcs
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Eszter Ducza
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Tamás Tábi
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Fruzsina Bagamery
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Éva Szökő
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Rosemary Vuković
- Department of Biology, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Alen Rončević
- Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Neurosurgery, Osijek University Hospital, Osijek, Croatia
| | - Dario Mandić
- Clinical Institute of Laboratory Diagnostics, Osijek University Hospital, Osijek, Croatia
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Željko Debeljak
- Clinical Institute of Laboratory Diagnostics, Osijek University Hospital, Osijek, Croatia
- Department of Pharmacology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Monika Berecki
- Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marta Balog
- Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Adrienn Seres-Bokor
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Anita Sztojkov-Ivanov
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Judit Hajagos-Tóth
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Srećko Gajović
- Croatian Institute for Brain Research, and BIMIS - Biomedical Research Institute Šalata, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Alen Imširović
- Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marina Bakula
- Department of Clinical Pathology and Forensic Medicine, Osijek University Hospital, Osijek, Croatia
| | - Solomiia Mahiiovych
- Department of Therapy № 1 and Medical Diagnostics, Hematology and Transfusiology, Faculty of Postgraduate Education, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Robert Gaspar
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Sandor G. Vari
- Cedars-Sinai Medical Center, International Research and Innovation in Medicine Program, Los Angeles, CA, United States
| | - Marija Heffer
- Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Iglesies-Grau J, Dionne V, Latour É, Gayda M, Besnier F, Gagnon D, Debray A, Gagnon C, Pelletier V, Nigam A, L'Allier PL, Juneau M, Bouabdallaoui N, Bherer L. Mediterranean diet and time-restricted eating as a cardiac rehabilitation approach for patients with coronary heart disease and pre-diabetes: the DIABEPIC-1 protocol of a feasibility trial. BMJ Open 2023; 13:e073763. [PMID: 37848307 PMCID: PMC10582969 DOI: 10.1136/bmjopen-2023-073763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Despite proven programmes, implementing lifestyle interventions for pre-diabetes and type 2 diabetes is challenging. Cardiac rehabilitation, provide a valuable opportunity to promote the adoption of healthy lifestyle behaviours for patients with atherosclerotic cardiovascular disease (ASCVD). However, only a limited number of studies have explored the potential for reversing the underlying causes of ASCVD in this setting. OBJECTIVES The DIABEPIC1 study is an ongoing single-arm lifestyle clinical trial to assess the feasibility of an upgraded 6-month intensive cardiac rehabilitation programme combining an innovative diet assignment with exercise training to reverse newly onset pre-diabetes (glycated haemoglobin 5.7%-6.4%) to normal glucose concentrations in patients with coronary heart disease. METHODS AND ANALYSIS 36 patients referred from the Montreal Heart Institute for cardiac rehabilitation, aged ≥40 years with a recent diagnosis of pre-diabetes in the last 6 months, will be offered to participate in the upgraded programme. Interventions will include four sessions of nutritional counselling on ultra-processed foods intake reduction and a moderate-carbohydrate (<40%) ad libitum Mediterranean diet coupled with 36 1-hour sessions of supervised exercise training (continuous and interval aerobic training, and resistance training) and educational intervention. Phase 2 will continue the same interventions adding 8:16 hour time-restricting eating (TRE) at least 5 days per week. During this second phase, exercise training will be performed with autonomy. The primary objectives will be to evaluate the recruitment rate, the completion rates at 3 and 6 months, and the compliance of participants. The secondary objectives will be to assess the proportion of prediabetic participants in remission of pre-diabetes at the programme's end and to characterise the factors associated with remission. ETHICS AND DISSEMINATION The DIABEPIC1 feasibility study is approved by the Research Ethics Board of the Montreal Heart Institute (Project Number ICM 2022-3005). Written informed consent will be obtained from each participant prior to inclusion. Results will be available through research articles and conferences. CONCLUSIONS The DIABEPIC1 trial will examine the feasibility and effectiveness of an enhanced cardiac rehabilitation programme combining exercise training with an ultra-processed food reduction intervention, a Mediterranean diet, and TRE counselling to remit pre-diabetes to normal glucose concentrations. TRIAL REGISTRATION NUMBER NCT05459987.
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Affiliation(s)
- Josep Iglesies-Grau
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
| | - Valérie Dionne
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
| | - Élise Latour
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
| | - Mathieu Gayda
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
- Université de Montréal, Montreal, Québec, Canada
| | | | - Daniel Gagnon
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
- Université de Montréal, Montreal, Québec, Canada
| | - Amélie Debray
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
| | - Christine Gagnon
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
| | - Véronique Pelletier
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
| | - Anil Nigam
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
| | - Philippe L L'Allier
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
| | - Martin Juneau
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
| | - Nadia Bouabdallaoui
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
- Montreal Heart Institute, Montreal, Québec, Canada
| | - Louis Bherer
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
- Université de Montréal, Montreal, Québec, Canada
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
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McMullen B, Duncanson K, Schmidt D, Collins C, MacDonald-Wicks L. A critical realist exploration of factors influencing engagement in diabetes prevention programs in rural settings. Aust J Prim Health 2023; 29:510-519. [PMID: 37121604 DOI: 10.1071/py22256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/04/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Diabetes prevention programs are intended to reduce progression to type 2 diabetes, but are underutilised. This study aimed to explore people with prediabetes' knowledge and attitudes about prediabetes, and their perceptions about engagement in preventive programs in a rural setting. The findings will inform strategies and recommendations to increase preventive health program engagement. METHODS Using a qualitative approach with a critical realist methodology, semi-structured interviews were conducted with 20 rural participants with prediabetes from the Northern New South Wales Local Health District in 2021. Interviews were audio-recorded, transcribed verbatim and thematically analysed. The social-ecological model was used as a framework to interpret and action the study findings. RESULTS Factors that empowered participants and facilitated a desire to engage in preventive programs included knowledge about prediabetes, a high level of social support, trusting and supportive relationships with health professionals, and a strong desire not to progress to diabetes. Barriers to program engagement included low health literacy levels, limited support, negative experiences with health services, and social and physical constraints. The factors that influenced engagement with preventive health programs were mapped to an individual, interpersonal, organisational, community and policy level, which highlighted the complex nature of behaviour change and the influence of underlying mechanisms. CONCLUSIONS Engagement in diabetes prevention programs was dependent on individual agency factors and structural barriers, each of which related to a level of the social-ecological model. Understanding the perceptions of people with prediabetes will inform strategies to overcome multi-level barriers to preventive health program engagement in rural settings.
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Affiliation(s)
- Britney McMullen
- Northern New South Wales Local Health District, Lismore, NSW 2480, Australia; and School of Health Sciences, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kerith Duncanson
- School of Health Sciences, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; and Health Education and Training Institute, NSW Health, St Leonards, NSW 2065, Australia; and Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - David Schmidt
- Health Education and Training Institute, NSW Health, St Leonards, NSW 2065, Australia
| | - Clare Collins
- School of Health Sciences, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; and Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; and Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
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Echiverri A, Harrison WW. Evaluation of retinal structure and function in prediabetes. DIABETES EPIDEMIOLOGY AND MANAGEMENT 2023; 12:100154. [PMID: 38037572 PMCID: PMC10688557 DOI: 10.1016/j.deman.2023.100154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Purpose Alterations in retinal structure and function have been well documented in type 2 diabetes (T2DM). However, few studies have evaluated the eye in prediabetes (preDM), a precursor to T2DM. It is unknown which retinal deficits, if any, occur before T2DM diagnosis. This study evaluates retinal structure via optical coherence tomography (OCT) and retinal function via multifocal electroretinogram (mfERG) N1 and P1 in those with PreDM. The goal is to evaluate associations between structure and function across glucose dysfunction. Methods 85 subjects (aged 28-69yrs) were tested with VERIS mfERG and Heidelberg Spectralis OCT. Demographic and health information was collected. Subjects were grouped by HbA1c: 33 controls (HbA1c <5.7%), 31 with preDM (HbA1c 5.7-6.4%), and 21 with T2DM (HbA1c >6.4% at the time of testing or diagnosed by physician) and mild or no retinopathy. mfERG N1 and P1 latency and amplitude were measured for the right eye in the foveal hexagon (central 2.4°). Average macular thickness was also measured over the central 3.3°. Groups were compared with ANOVA and corrected t-tests. Models of these associations with diabetes diagnosis (in groups above) were created with backward multivariate regression. Results The T2DM group was exceptionally well-controlled with an HbA1c of 7.0% ± 0.68 but also had elevated systolic blood pressure compared to other groups (P<0.01). The age of the control group was younger (P<0.01), so other testing was age controlled. There was a borderline but statistically significant difference in P1 between the control group and both the preDM and T2DM groups after Bonferroni corrections (P<0.03). There was also a difference in N1 latency between the control and other groups (P<0.001). A multivariate model demonstrated a significant relationship between T2DM/PreDM diagnosis and delayed N1 latency, reduced foveal thickness, and age. Conclusions Structure and function together can provide an associative model of preDM or T2DM changes for patients. Based on this multivariate model, N1 is strongly associated with preDM and T2DM. N1 findings and decreasing foveal thickness are additive and can together inform ocular health related to preDM. Future longitudinal studies are needed to understand changes in function and structure in preDM and T2DM.
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Affiliation(s)
- Angelica Echiverri
- University of Houston College of Optometry, 4401 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Wendy W. Harrison
- University of Houston College of Optometry, 4401 Martin Luther King Blvd, Houston, TX 77204, USA
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Shen E, Chen X. Prediabetes and the risk of lung cancer incidence and mortality: A meta-analysis. J Diabetes Investig 2023; 14:1209-1220. [PMID: 37517054 PMCID: PMC10512911 DOI: 10.1111/jdi.14057] [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: 05/16/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS/INTRODUCTION There has been conflicting evidence regarding the role of prediabetes as a risk factor of lung cancer. A systemic review and meta-analysis was conducted to determine the relationship between prediabetes and lung cancer incidence and mortality in general adult populations. MATERIALS AND METHODS Observational studies relevant to the objective were found in Medline, Embase, Cochrane Library, and Web of Science. By incorporating potential heterogeneity into the model, a randomized-effects model was selected. RESULTS Ten cohort studies were included. People with prediabetes were associated with a mildly increased risk of lung cancer incidence compared with controls with normoglycemia (risk ratio [RR]: 1.09, 95% confidence interval [CI]: 1.01-1.18, P = 0.03; I2 = 79%), which was mainly observed in men rather than in women (RR: 1.07 vs 0.99, P for subgroup difference < 0.001). Prediabetes was related to a higher risk of lung cancer mortality (RR: 1.19, 95% CI: 1.02-1.39, P = 0.03; I2 = 52%), and the results were consistent in both men and women (P for subgroup difference = 0.67). The association between prediabetes and lung cancer incidence or mortality did not appear to be significantly affected by different definitions of prediabetes (P for subgroup difference = 0.27 and 0.37). CONCLUSIONS Prediabetes might be associated with a mildly increased risk of lung cancer incidence in men, but not in women. In addition, prediabetes may be related to a higher risk of lung cancer mortality in the adult population.
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Affiliation(s)
- Enjian Shen
- Department of PathologyTaizhou Municipal HospitalTaizhouChina
| | - Xi Chen
- Department of PathologyTaizhou Municipal HospitalTaizhouChina
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Bennasar-Veny M, Malih N, Galmes-Panades AM, Hernandez-Bermudez IC, Garcia-Coll N, Ricci-Cabello I, Yañez AM. Effect of physical activity and different exercise modalities on glycemic control in people with prediabetes: a systematic review and meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne) 2023; 14:1233312. [PMID: 37842295 PMCID: PMC10569497 DOI: 10.3389/fendo.2023.1233312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Numerous studies have shown the beneficial effects of exercise on glycemic control in people with prediabetes. However, the most effective exercise modality for improving glycemic control remains unclear. We aimed to assess which exercise training modality is most effective in improving glycemic control in a population with prediabetes. Methods We conducted searches in Pubmed/MEDLINE, EMBASE, SPORTDiscus, Web of Science, PEDro, BVS, and the Cochrane Library from inception to June 2022. Included studies reported fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and 2-hour postprandial (2hPP) levels and implemented an exercise program lasting at least 12 weeks in adults with prediabetes. We performed a direct meta-analysis using a random-effects model and a network meta-analysis. Cochran's Q statistic and the inconsistency I2 test were used to assess the heterogenicity between studies. Results Twenty trials were included, with 15 trials (comprising 775 participants with prediabetes) combined in the meta-analysis, and 13 in the network meta-analysis. The meta-analysis results did not show a statistically significant reduction in fasting plasma glucose (FPG) after aerobic training (AT) intervention compared to a control group (mean (95%CI) difference = -5.18 (-13.48; 3.12) mg/dL, Z=1.22, p=0.22). However, a difference of -7.25 (-13.79; -0.71) mg/dL, p=0.03, in FPG after interval training (IT) intervention was detected compared to a control group. After resistance training (RT) intervention, FPG was significantly lower -6.71 (-12.65,-0.77) mg/dL, Z=2.21, p=0.03, and HbA1c by -0.13 (-0.55, 0.29), p=0.54, compared to the control group. The impact of RT compared to no intervention on 2hPP was not statistically significant (p=0.26). The network meta-analysis did not show statistical significance. Most of the studies presented an unclear risk of bias, and a low and very low-quality of evidence. According to the GRADE criteria, the strength of the body of evidence was low. Conclusion Resistance training and IT had demonstrated benefits on glycemic indices, especially on FPG, in a population with prediabetes. Further studies with larger sample sizes and a more robust methodology that compare different types of exercise modalities, frequencies, and durations, are needed to establish a beneficial exercise intervention. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=370688, identifier CRD42022370688.
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Affiliation(s)
- Miquel Bennasar-Veny
- Global Health and Lifestyles Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
| | - Narges Malih
- Research Group on Global Health, University of the Balearic Islands (UIB), Palma, Spain
| | - Aina M. Galmes-Panades
- Global Health and Lifestyles Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Research Group on Global Health, University of the Balearic Islands (UIB), Palma, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Physical Activity and Sport Sciences Research Group (GICAFE), Institute for Educational Research and Innovation (IRIE), University of the Balearic Islands, Palma, Spain
| | | | - Natalia Garcia-Coll
- Research Group on Global Health, University of the Balearic Islands (UIB), Palma, Spain
| | - Ignacio Ricci-Cabello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Research Group in Primary Care and Promotion—Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, Palma de Mallorca, Spain
| | - Aina M. Yañez
- Global Health and Lifestyles Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
- Research Group on Global Health, University of the Balearic Islands (UIB), Palma, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Madrid, Spain
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Lin J, Tu R, Lu Z. Prediabetes and the risk of breast cancer: a meta-analysis. Front Oncol 2023; 13:1238845. [PMID: 37790752 PMCID: PMC10544966 DOI: 10.3389/fonc.2023.1238845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Background Diabetes has been related to a higher risk of breast cancer (BC) in women. However, it remains unknown whether the incidence of BC is increased in women with prediabetes. A systematic review and meta-analysis was therefore performed to evaluate the relationship between prediabetes and risk of BC. Methods Observational studies with longitudinal follow-up relevant to the objective were found via searching Medline, Embase, Cochrane Library, and Web of Science. A fixed- or random-effects model was used to pool the results depending on heterogeneity. Results Eight prospective cohort studies and two nest case-control studies were included. A total of 1069079 community women were involved, and 72136 (6.7%) of them had prediabetes at baseline. During a mean duration follow-up of 9.6 years, 9960 (0.93%) patients were diagnosed as BC. Pooled results with a fixed-effects model showed that women with prediabetes were not associated with a higher incidence of BC as compared to those with normoglycemia (risk ratio: 0.99, 95% confidence interval: 0.93 to 1.05, p = 0.72) with mild heterogeneity (p for Cochrane Q test = 0.42, I2 = 3%). Subgroup analyses showed that study characteristics such as study design, menopausal status of the women, follow-up duration, diagnostic criteria for prediabetes, methods for validation of BC cases, and study quality scores did not significantly affect the results (p for subgroup analyses all > 0.05). Conclusion Women with prediabetes may not be associated with an increased risk of BC as compared to women with normoglycemia.
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Affiliation(s)
- Jing Lin
- Health Management Center, Ningbo Women and Children’s Hospital, Ningbo, China
| | - Rongzu Tu
- Department of Internal Medicine, Ningbo Women and Children’s Hospital, Ningbo, China
| | - Zhai’e Lu
- Department of Obstetrics, Ningbo Women and Children’s Hospital, Ningbo, China
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Gravesteijn E, Mensink RP, Plat J. The effects of long-term almond consumption on whole-body insulin sensitivity, postprandial glucose responses, and 48 h continuous glucose concentrations in males and females with prediabetes: a randomized controlled trial. Eur J Nutr 2023; 62:2661-2672. [PMID: 37258943 PMCID: PMC10421771 DOI: 10.1007/s00394-023-03178-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/15/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Findings concerning the effects of almond consumption on glucose metabolism are inconsistent which might relate to body weight gain. The effects of long-term almond consumption on glucose metabolism are investigated in a free-living setting without detailed dietary instructions in males and females with overweight/obesity and prediabetes. METHODS Forty-three participants volunteered in this randomized, cross-over trial with a 5-months control and intervention period and a 2-months wash-out. In the intervention period participants daily consumed 50 g whole almonds. At the end of both periods insulin sensitivity was assessed by a hyperinsulinemic euglycemic clamp, and postprandial glucose responses, and 48 h continuous glucose concentrations were measured. RESULTS Almond consumption significantly decreased insulin sensitivity (P = 0.002), and increased postprandial glucose concentrations (P = 0.019), as well as fasting insulin concentrations (P = 0.003) as compared to the control period. The AUCs for 24 h glucose concentrations were not significantly different between control and intervention (P = 0.066). Almond consumption also significantly increased BMI (P = 0.002), and waist circumference (P = 0.013), supported by the concurrent increased energy intake (P = 0.031). The effects on glucose metabolism could only partly be explained by the observed weight gain as the almond effect remained after correcting for BMI changes. CONCLUSIONS In participants with prediabetes, long-term almond consumption showed adverse effects on insulin sensitivity and glucose metabolism. As almonds seemed not to have fully replaced other food items, it might be necessary to provide more supporting guidelines on how to incorporate energy-dense nuts into healthy diets to prevent type 2 diabetes development. CLINICAL TRIAL REGISTRATION This clinical trial was registered in February 2018 as NCT03419702.
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Affiliation(s)
- Elske Gravesteijn
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+ (MUMC+), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Ronald P Mensink
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+ (MUMC+), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jogchum Plat
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+ (MUMC+), P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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Patil S, Patil N, Hardikar-Bhat P, Dervankar O, Joglekar C, Bhat R, Nandoskar A, Yadav A, Nilawar A. Prediabetes in rural adolescent girls from DERVAN cohort: data from the KONKAN region of the state of Maharashtra, India (DERVAN-4). Front Public Health 2023; 11:1181401. [PMID: 37601212 PMCID: PMC10435731 DOI: 10.3389/fpubh.2023.1181401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Background India is witnessing an epidemic of type 2 diabetes. Overweight/obesity, overnutrition, physical inactivity, and family history are well-known risk factors for diabetes. We investigated the role of undernutrition in the development of diabetes among rural adolescent girls. Methods DERVAN cohort study was set up in the KONKAN region of the western Indian state of Maharashtra. It enrolled 1,520 adolescent girls (16-18 years old at the time of enrollment). We measured glycemic parameters (glucose, insulin, and HbA1C) and body size using anthropometry and body composition using bioimpedance. Prediabetes was diagnosed using the American Diabetic Association (ADA) criteria. We also calculated various HOMA indices for insulin resistance (HOMA-IR), β-cell function (HOMA-β), insulin sensitivity (HOMA-S), and compensatory β-cell response using a homeostasis model. BMI, body fat%, and waist circumferences were treated as exposures and all the glycemic parameters and indices as outcomes. Results The median age of the subjects was 16.6 years. The median weight, height, and BMI were 40.7 kg, 151.7 cm, and 17.5 kg/m2, respectively. Prevalence of underweight was 28.8%, and stunting was observed in 30.4%. Thinness and obesity using BMI were observed in 58.4% and 4.2%, respectively. The median body fat% was 22.5, and excess body fat (>35%) was observed in 5.7%. The prevalence of prediabetes was 39.4%. Fasting insulin concentrations, HOMA-IR, and HOMA-β showed a positive trend across body composition quartiles (p < 0.001). HOMA-S and compensatory β-cell response showed an inverse trend (p < 0.001). Compared with prediabetic girls in the overweight/obese group, girls most undernourished group had lower median insulin concentrations (8.1 μIU/ml vs. 17.1 μIU/ml), lower HOMA-IR (1.1 vs. 2.3), and lower HOMA-β (75.6 vs. 129.2) but higher sensitivity (87.4 vs. 43.7) (p < 0.001) for all. Conclusion We have reported a high prevalence of prediabetes among rural adolescent girls with a very low prevalence of obesity. Prediabetes in obesity is driven by hyperinsulinemia and overworking of the pancreas while poor β-cell function and poor insulin secretion are major drivers in the undernourished group. The high-risk diabetes screening programs are much needed for the undernourished populations. Caution should be exercised for planning the interventions as overfeeding (or overnutrition) is likely to put the populations at risk of development of obesity and insulin resistance.
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Affiliation(s)
- Suvarna Patil
- Department of Medicine, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Netaji Patil
- Department of Radiology, BKL Walawalkar Hospital and Rural Medical College, Sawarde, Maharashtra, India
| | - Pallavi Hardikar-Bhat
- Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Omkar Dervankar
- Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Charudatta Joglekar
- Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Rohit Bhat
- Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Ajit Nandoskar
- Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Arvind Yadav
- Department of Biochemistry, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Anup Nilawar
- Department of Biochemistry, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
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Bannerman-Williams E, Hayfron-Benjamin CF, Atiase Y, Bahendeka S, Meeks K, Klipstein-Grobusch K, Addo J, Mockenhaupt F, Schulze MB, Beune E, van den Born BJ, Agyemang C. Macrovascular and renal microvascular complications in West Africans with intermediate hyperglycemia living in West Africa and Europe: The RODAM study. Heliyon 2023; 9:e19334. [PMID: 37664733 PMCID: PMC10469941 DOI: 10.1016/j.heliyon.2023.e19334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
Background Metabolic conditions, including intermediate hyperglycemia (IH), affect migrants to a greater extent than the populations of origin. Evidence suggests that IH increases the risk of vascular complications, but it is unclear whether the differences in IH between the non-migrant and migrant populations translate to differences in vascular complications between the two populations. We compared the prevalence of macrovascular and renal microvascular complications among West Africans with IH living in West Africa and their migrant compatriots in Europe. Methods Data from the multicenter Research on Obesity and Diabetes among African Migrants(RODAM) study were analyzed. Ghanaians with IH(524 non-migrant and 1439 migrants) were included. Logistic regression analyses were used to determine the associations between migrant status and macrovascular [coronary artery disease(CAD) and peripheral artery disease(PAD)] and renal microvascular[nephropathy] complications with adjustment for age, sex, socioeconomic status, smoking, systolic blood pressure, BMI, total cholesterol, HbA1c, C-reactive protein, and serum uric acid. Findings The prevalence of microvascular/macrovascular complications was higher in non-migrants than in migrants(nephropathy 15.3vs.9.7%; PAD 3.1%vs.1.3%; and CAD 15.8% vs. 5.0%). The differences persisted in the fully adjusted model: nephropathy [odds ratio, 2.12; 95% CI(1.46-3.08); PAD, 4.44(1.87-10.51); CAD 2.35(1.64-3.37)]. Non-migrant females had higher odds of nephropathy[2.14(1.34-3.43)], PAD[7.47(2.38-23.40)] and CAD [2.10(1.34-3.27)] compared to migrant females. Non-migrant males had higher odds of nephropathy[2.54(1.30-4.97)] and CAD[2.85(1.48-5.50)], but not PAD[1.81(0.32-10.29)],than their migrant peers. Interpretation Macrovascular and renal microvascular complications were more prevalent in non-migrants than in migrant West Africans with IH. Further studies are needed to identify factors that increase the risk to aid preventive/treatment strategies.
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Affiliation(s)
- Emmanuel Bannerman-Williams
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Surgery, University of Ghana Medical School, Ghana
| | - Charles F. Hayfron-Benjamin
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Physiology, University of Ghana Medical School, Ghana
- Department of Anaesthesia and Critical Care, University of Ghana Medical School, Ghana
| | - Yacoba Atiase
- Department of Medicine and Therapeutics, University of Ghana Medical School, Ghana
| | | | - Karlijn Meeks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliet Addo
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Frank Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute for Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Erik Beune
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Bert-Jan van den Born
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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