Standards of medical care in diabetes--2011

First Case in Portugal of a Rare Hemoglobin Variant - Hb Montfermeil: Importance of Laboratory Diagnosis

Hemoglobin A1c (HbA1c) is a clinically useful parameter, considered the standard-of-care for diagnosing and monitoring type 2 diabetes mellitus. However, the presence of Hb variants, including Hb Montfermeil, may interfere with HbA1c assay, affecting the accuracy of the results. Here, we report the first case diagnosed in Portugal of this rare hemoglobin variant.

AIP, fatty liver, and HbA1c as modifiers of the C-index and diabetes risk relationship

BACKGROUND AND AIMS

Recent studies have suggested an interplay between conicity index (C-index)-related diabetes risk and lipid burden. It is plausible that the atherogenic index of plasma (AIP), fatty liver, and HbA1c mediate the association between C-index and diabetes risk, though this has not been fully explored. This study explored whether AIP, fatty liver, and HbA1c mediate the relationship between C-index and diabetes risk, as well as their combined effect.

METHODS

Data from 15,453 participants in the NAGALA Cohort were analyzed (median follow-up 5.39 years). Restricted Cubic Spline (RCS) and univariate Cox regression models adjusted for risk factors were used to assess the role of AIP in modifying the C-index-diabetes relationship. Mediation analysis assessed the contributing factors, and predictive models for diabetes were established.

RESULTS

Among normoglycemic individuals, the AIP and C-index remained significantly and positively associated with diabetes risk. Higher AIP levels strengthened the C-index-diabetes association, particularly in the AIP range of 0.11-≤1.21. In the initial model, hazard ratios (HRs) for those in the fourth quartile of the C-index distribution in this group showed a significant HR of 2.22 (1.37-3.59). As fatty liver and HbA1c levels were progressively adjusted, the HRs gradually decreased, but a significant HR of 1.70 (1.05-2.76) was retained in the fully adjusted model. No significant association was observed in the other AIP strata. Furthermore, AIP, fatty liver, and HbA1c mediated the relationship between C-index and diabetes risk, with mediation effects of 9.8%, 25.0%, and 13.4%, respectively. Notably, the combined model incorporating AIP, fatty liver, HbA1c, and the C-index achieved the highest predictive performance (AUC = 0.86), outperforming the C-index alone (AUC = 0.68).

CONCLUSIONS

C-index was significantly associated with diabetes risk, modified by AIP, fatty liver, and HbA1c. These findings emphas ize the importance of AIP along with the C-index, particularly in the context of fatty liver and HbA1c, for diabetes risk screening and management.

Prognostic value of nighttime blood pressure in patients with chronic kidney disease

The optimal blood pressure (BP) in patients with chronic kidney disease (CKD) remains uncertain. Therefore, this cohort study aimed to investigate the prognostic value of ambulatory blood pressure (ABP) in patients with CKD and to determine the optimal range for ABP. In total, 1051 hospitalized patients with CKD were enrolled. The prognosis of patients with CKD was evaluated in terms of all-cause death, cardiovascular death, cardiovascular events, and renal events. Our results showed that systolic blood pressure (SBP) had a higher predictive value than diastolic blood pressure in the multivariate-adjusted models. Additionally, nighttime SBP was found to be the best predictor of prognosis in patients with CKD. Furthermore, when dividing the nighttime SBP into quartiles (quartile 1: <110 mmHg, quartile 2: 110-124 mmHg, quartile 3:124-139 mmHg, and quartile 4: ≥139 mmHg). Nighttime SBP ≥ 124 mmHg had an impact on prognosis in patients with CKD, nighttime SBP 124-139 mmHg: total mortality (hazard ratio [HR], 3.017 [95% confidence interval (CI): 1.367-6.660]), cardiovascular death (HR, 2.570 [95% CI, 1.744-6.151]), all cardiovascular events (HR, 2.401 [95% CI, 1.288-4.475]), and 110-124 mmHg had an impact on the renal prognosis (HR, 1.975 [95% CI, 1.311-2.976]). Therefore, nighttime SBP is an independent risk factor for CKD and a significant predictor of prognosis in patients with CKD. Furthermore, the prognosis of patients with CKD improved when the nighttime SBP was maintained below 124 mmHg; however, maintaining it below 110 mmHg can further lower the incidence of renal disease.

A cross-sectional study on the association between major dietary pattern and impaired fasting glucose

Background

Impaired fasting glucose (IFG) is a precursor to type 2 diabetes and is influenced by dietary factors. This cross-sectional study assessed the association between major dietary patterns and IFG in the baseline phase of PERSIAN Kavar cohort study (PKCS).

Methods

The study included 3,144 participants aged 35-70 years. After assessing dietary intakes by a food frequency questionnaire, principal component analysis was used to identify dietary patterns. Logistic regression model was applied to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between dietary patterns and IFG.

Results

Three major dietary patterns were identified: healthy, Western-like, and CarnFat (Carnivorous-fat). In the fully adjusted model, individuals in the highest tertile of the healthy dietary pattern had a lower likelihood of IFG compared to those in the lowest tertile (OR = 0.68, 95% CI: 0.53-0.88). The second tertile of the healthy pattern was also associated with lower odds of IFG (OR = 0.77, 95% CI: 0.62-0.96). No significant associations were found for the Western-like and CarnFat dietary patterns.

Conclusion

A healthy dietary pattern characterized by high intakes of fruits, vegetables, low-fat dairy, nuts, seeds, olive oil, legumes, fish, and whole grains was associated with a lower risk of IFG. These findings highlight the importance of promoting healthy dietary patterns for the prevention of prediabetes and type 2 diabetes.

Artificial intelligence in diabetes management: transformative potential, challenges, and opportunities in healthcare

BACKGROUND

Diabetes, a chronic metabolic disorder characterized by ineffective blood sugar regulation, affects millions of people worldwide, with its prevalence projected to more than double in the next 30 years. Diabetes-related complications are severe and sometimes life-threatening, including cardiovascular disease, kidney failure, and blindness, this posing a significant challenge, especially in low- and middle-income countries. This study explored the integration of artificial intelligence (AI) into diabetes management, emphasizing its transformative potential in healthcare.

OBJECTIVES

To evaluate the role of AI in enhancing diabetes management and to identify the challenges and opportunities associated with its implementation.

METHODS

A systematic review following the PRISMA guidelines was conducted by analyzing the literature published from January 2020 to May 2024. This review focused on the application of AI in diabetes diagnosis, personalization of treatment, and predictive analytics.

RESULTS

The ability of AI to analyze large datasets and identify complex patterns shows promise in improving diabetes management. AI-assisted diagnostic tools enhance diagnostic accuracy, enable early detection, and support personalized treatment plans, thereby reducing human error. AI has also facilitated research breakthroughs in genomics and drug discovery. Furthermore, AI-powered predictive analytics enhances clinical decision-making and supports precision medicine. Despite these advancements, challenges remain in such issues as data quality, technical infrastructure, and ethical considerations, emphasizing the need for responsible AI development that focuses on patient privacy and transparency.

CONCLUSIONS

AI has significant potential to revolutionize diabetes management and healthcare delivery. Combining AI's analytical processes with clinical expertise can substantially improve the quality of care. Addressing data, technology, and ethical challenges is crucial for fully harnessing AI's potential, thereby enhancing patient well-being and healthcare outcomes.

Fruit and Vegetable Consumption and Risk of All-Cause and Cause-Specific Mortality in Individuals With Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies

CONTEXT

Controversy exists regarding the association between fruit and vegetable consumption and all-cause and cause-specific mortality among individuals with type 2 diabetes (T2D).

OBJECTIVE

This study aims to inform dietary recommendations and add to the body of evidence by providing a thorough investigation of the association between the consumption of fruits and vegetables and the mortality risk in patients with T2D. The literature on this association was evaluated by a comprehensive systematic review and meta-analysis.

DATA SOURCES

PubMed, Scopus, and Web of Science were searched up to 29 June 2024.

DATA EXTRACTION

Prospective cohort studies involving participants with diabetes aged over 18 years reporting risk estimates for the association between total fruit and vegetable intake and all-cause or cause-specific mortality (including cardiovascular disease [CVD], coronary heart disease, and stroke) were included.

DATA ANALYSIS

A random-effects approach was applied for combining risk estimates, and dose-response relationships were assessed using restricted cubic splines. Overall, 9 studies with 75 082 participants and 7590 deaths were included. Compared with the lowest intake, the highest fruit intake was associated with a decreased risk of all-cause (hazard ratio [HR]: 0.82; 95% CI: 0.75, 0.90; n = 6) and CVD (HR: 0.90; 95% CI: 0.84, 0.97; n = 4) mortality. The highest vegetable intake was also related to reduced all-cause (HR: 0.85; 95% CI: 0.73, 0.98; n = 6) and CVD (HR: 0.97; 95% CI: 0.94, 0.99; n = 2) mortality risk. An additional 200 g/day of fruit and vegetable consumption was associated with a 26% and 14% lower risk of all-cause mortality.

CONCLUSION

This meta-analysis indicates an inverse association between fruit and vegetable intake and mortality from all causes and CVD in T2D patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42024571094.

Measures of Serum Markers HbA1c, HOMA-IR, HOMA-β, QUICKI and G/I Ratio as Predictors of Abnormal Glucose Tolerance Among Thai Women with Polycystic Ovary Syndrome

Background/Objectives: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age. It is associated with glucose intolerance, insulin resistance and diabetes mellitus. The oral glucose tolerance test (OGTT) is commonly employed to detect glucose intolerance, but it can be inconvenient and time-consuming. We aimed to evaluate the precision of haemoglobin A1c (HbA1c) and other serum markers in predicting abnormal glucose tolerance (AGT). Methods: This diagnostic study involved 121 PCOS women who attended the Gynaecologic Endocrinology Unit at Siriraj Hospital. Patients underwent assessments for weight, height, waist circumference, modified Ferriman-Gallwey score and acanthosis nigricans. Blood samples were collected to measure fasting glucose and insulin levels after a 75-gram oral OGTT, fasting insulin level, HbA1c, lipid profile, androgen profile and complete blood count. Homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of beta-cell function (HOMA-β), quantitative insulin sensitivity check index (QUICKI) and fasting glucose-to-insulin ratio (G/I ratio) were calculated. The sensitivity, specificity and accuracy of these serum markers were compared. Results: The prevalence of AGT was 24.8%. The area under the receiver operating characteristic curve for HbA1c in detecting AGT was 0.656, while HOMA-IR, HOMA-β, QUICKI and the G/I ratio had values of 0.817, 0.737, 0.817 and 0.77, respectively. The G/I ratio cut-off point of 6% demonstrated a sensitivity of 73.3%, specificity of 74.7%, positive predictive value of 48.9%, negative predictive value of 89.5% and accuracy of 74.4%. Conclusions: The G/I ratio is the most accurate compared to other serum markers in detecting AGT among Thai women with PCOS.

Investigation and study on the epidemiology of gestational diabetes mellitus in Guizhou

BACKGROUND

Gestational diabetes mellitus (GDM) is a growing public health concern, particularly in regions with diverse ethnic populations. Understanding the incidence and risk factors of GDM is crucial for early prevention and management, especially in underrepresented areas like Guizhou Province, China, where geographic and ethnic diversity may influence the disease's prevalence and risk profiles.

AIM

To investigate the incidence of GDM and identify its associated risk and protective factors among different ethnic groups in Guizhou Province, providing essential data for early prevention strategies.

METHODS

A multi-center retrospective study was conducted, dividing participants into GDM and non-GDM groups according to standardized diagnostic criteria. Data were collected from 103629 deliveries across 40 hospitals in Guizhou. Various demographic, clinical, and laboratory parameters were analyzed using logistic regression to identify risk and protective factors for GDM.

RESULTS

Among the 103629 deliveries, 18957 cases of GDM were identified, with an incidence of approximately 18.3%. The risk of GDM was higher in the Han ethnic group compared to minority ethnic groups. The Dong ethnic group had the lowest incidence among the minorities. Key risk factors identified included older age (especially > 35 years), higher pre-pregnancy body mass index (BMI), light physical activity, gravidity, family history of diabetes, hemoglobin, aspartate aminotransferase, alanine aminotransferase, and direct bilirubin. Protective factors included higher education level, total protein, and albumin. There were also differences based on blood type, with type A associated with higher risk.

CONCLUSION

The incidence rate in Guizhou is 18.3%. Older age (especially > 35 years), Han ethnicity, lower education level, higher pre-pregnancy BMI, light physical activity, and higher gravidity are the main risk factors for GDM. Laboratory findings indicate that higher hemoglobin, higher liver function parameters (alanine aminotransferase, aspartate aminotransferase, and direct bilirubin), and lower total protein and albumin are associated with a higher risk of GDM. Blood type A has a higher risk of GDM compared to blood types AB and O.

Endocrine and metabolic comorbidities in juvenile-onset systemic lupus erythematosus

Background and aims

Juvenile-onset systemic lupus erythematosus (JSLE) is a chronic autoimmune disease affecting individuals under 18, causing multi-system impairment. Patients with JSLE exhibit more severe disease when compared to patients with adult-onset SLE. This study aimed to evaluate the prevalence of endocrine and metabolic comorbidities in patients with JSLE, and analyze the factors associated with each comorbidity.

Methods

Anthropometric, clinical, laboratory data, and the details of glucocorticoids and disease-modifying anti-rheumatic drugs use were collected.

Results

A total of 57 patients with JSLE (48 girls and 9 boys) were included in this study. Endocrine and metabolic comorbidities were observed in 64.9% of the patients. The most prevalent comorbidities were dyslipidemia (40.4%), being overweight or obese (26.3%), subclinical hypothyroidism (24.6%), autoimmune thyroid disease (AITD) (21.1%), and low bone mass (20.9%). The risk of dyslipidemia and AITD increased in patients who were overweight or obese. The risk of being overweight or obese was associated with skin involvement at diagnosis and rheumatoid factor positivity. Younger age at diagnosis and longer duration of glucocorticoid exposure increased the risk of low bone mass. The overall prevalence of endocrine and metabolic comorbidities was associated with short stature at diagnosis, being overweight or obese at follow-up, skin involvement at diagnosis, and rheumatoid factor positivity.

Conclusion

Patients with JSLE have higher burdens of endocrine and metabolic comorbidities and should be routinely monitored. Prevention of obesity may be helpful in lowering the risk of comorbidities.

Prevalence and Association of Thyroid Dysfunction With Diabetes Mellitus in a Tertiary Care Hospital: A Retrospective Study

BACKGROUND

Thyroid dysfunction and diabetes mellitus are endocrine disorders that are closely associated with insulin resistance. Thyroid dysfunction has been found to be more common in patients with diabetes compared to those without. In India, thyroid dysfunction is common among patients with diabetes, with a high prevalence found in Tamil Nadu, where subclinical hypothyroidism also contributes significantly.

AIM

This study aims to determine the prevalence and association of thyroid dysfunction among patients with type 2 diabetes mellitus.

METHODOLOGY

A retrospective cross-sectional study was conducted from August 2023 to August 2024. A total of 91 patients with diabetes were screened for thyroid dysfunction. Data on demographics, comorbidities, duration of diabetes, glycated hemoglobin (HbA1c), and thyroid function (triiodothyronine, thyroxine, and thyroid-stimulating hormone) were collected. Statistical analysis was performed to identify the association among thyroid dysfunction, glycemic control, and diabetes mellitus duration.

RESULTS

Thyroid dysfunction was identified in 21 (23.1%) of the study population, with 19 (20.9%) patients experiencing hypothyroidism and two (2.2%) patients experiencing hyperthyroidism. The prevalence was found to be high in women. Subjects with diabetes for more than five years had a high prevalence of thyroid dysfunction. HbA1c did not show any significant correlation (p = 0.327).

CONCLUSION

This study shows the prevalence of thyroid dysfunction, especially hypothyroidism, among patients with diabetes. It also highlights the importance of screening for thyroid function in patients who have had diabetes for more than five years. Early identification and management of thyroid dysfunction may improve glycemic control and reduce the risk of long-term complications.

Association between insurance status and prevalence of diabetic retinopathy in patients with diabetes in the United States from 2011 to 2020

AIM

To determine whether an association exists between health insurance and diabetic retinopathy (DR) prevalence in adults with diabetes.

METHODS

An analytical cross-sectional study was conducted utilizing the National Health and Nutrition Examination Survey database. 4530 Patients aged ≥ 18 with diabetes from 2011 to 2020 with various insurance types (no insurance, private, Medicare, Medicaid, or other) were evaluated for prevalence of DR, including covariates. Unadjusted and adjusted logistic regression analysis were conducted to calculate odds ratios (OR) and 95 % confidence intervals (CI).

RESULTS

There was no significant association between insurance status and DR prevalence when adjusting for confounders. OR for DR in patients without insurance, Medicare, Medicaid, or other insurance compared to those with private insurance were 1.13 (95 % CI 0.74-1.71), 0.78 (95 % CI 0.54-1.13), 1.20 (95 % CI 0.80-1.81), and 0.81 (95 % CI 0.47-1.37) respectively. However, factors like age ≥ 65 and use of diabetes medication were associated with reduced DR prevalence.

CONCLUSION

Although insurance status alone does not have an association with the prevalence of DR, this study highlights several confounding variables that potentially influence previously reported associations between insurance status and DR.

Gestational Diabetes Mellitus: New Thinking on Diagnostic Criteria

Currently, there is a lack of standardized diagnostic criteria for gestational diabetes mellitus (GDM), making it a subject of ongoing debate. The optimal diagnostic method and screening strategy for GDM remain contentious. In this review, we summarize the criteria and methods for diagnosing GDM, and perform a comparison between universal and selective screening strategies. Therefore, this review aims to highlight the following: (1) The most widely adopted criteria for GDM are those established by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). (2) Evidence from cohort studies suggests that the one-step diagnostic method is associated with improved pregnancy outcomes and appears more cost-effective compared to the two-step method. (3) Universal screening is more cost-effective than selective screening, which may overlook a significant number of women with GDM. Additionally, various methods have been proposed for early pregnancy screening (before 14 weeks). Finally, an outlook is presented for the diagnosis of GDM, emphasizing the importance of large-scale randomized controlled trials (RCTs) to provide stronger evidence for future support.

Glucose Metabolism Disorders and Parkinson's Disease: Coincidence or Indicator of Dysautonomia?

Background: Parkinson's disease (PD) and type 2 diabetes mellitus (T2DM) are both age-related diseases. Evidence from recent studies suggests a link between them. The existence of an interaction between autonomic nervous system dysfunction and the dysregulation of glucose metabolism is one of the proposed mechanisms to explain the complicated relationship between these diseases. The aims of this study are to assess the incidence of glycemic dysregulation in people with PD and to identify clinical factors that may predispose patients with PD to the occurrence of metabolic disturbances. Methods: In total, 35 individuals diagnosed with PD and 20 healthy control subjects matched in terms of age and gender participated in a study consisting of clinical and biometric assessments along with 14 days of continuous glucose monitoring (CGM) using the Freestyle Libre system. In the group of patients with PD, a comparative analysis was performed between patients with and without autonomic dysfunction. The severity of autonomic dysfunction was assessed using the SCOPA-AUT. Results: Participants diagnosed with PD demonstrated a trend toward lower morning glucose levels compared to the control group. PD patients with autonomic symptoms had greater glucose variability and a deeper trend toward lower glucose levels in the mornings. The presence of autonomic dysfunction, especially orthostatic hypotension and micturition disturbance, and the severity of autonomic symptoms were associated with greater glycemic variability. Conclusions: The occurrence of autonomic disorders in the course of Parkinson's disease predisposes patients to more profound glycemic dysregulation.

Chronic Intestinal Failure and Short Bowel Syndrome in Adults: The State of the Art

Background

Short bowel syndrome (SBS) is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). During the intestinal rehabilitation process, patients may need parenteral support for months or years, parenteral nutrition (PN), or hydration/electrolyte supplementation, as a bridge for the desired enteral autonomy.

Summary

Several classification criteria have been highlighted to reflect different perspectives in CIF. The management of CIF-SBS in adults is a multidisciplinary process that aims to reduce gastrointestinal secretions, slow transit, correct/prevent malnutrition, dehydration, and specific nutrient deficiencies, and prevent refeeding syndrome. The nutritional support team should have the expertise to take care of these complex patients: fluid support; oral, enteral, and PN; disease/PN-related complications; pharmacologic treatment; and surgical prevention/treatment.

Key Messages

CIF-SBS is a complex disease with undesired consequences, if not adequately identified and managed. A comprehensive approach performed by a multidisciplinary team is essential to reduce PN dependence, promote enteral independence, and improve quality of life.

Exploring the clinical connections between epilepsy and diabetes mellitus: Promising therapeutic strategies utilizing agmatine and metformin

PURPOSE

Diabetes mellitus (DM) and epilepsy and the psychological and socio-economic implications that are associated with their treatments can be quite perplexing. Metformin is an antihyperglycemic medication that is used to treat type 2 DM. In addition, metformin elicits protective actions against multiple diseases, including neurodegeneration and epilepsy. Recent studies indicate that metformin alters the resident gut microbiota in favor of species producing agmatine, an arginine metabolite which, in addition to beneficially altering metabolic pathways, is a potent neuroprotectant and neuromodulant.

METHODS

We first examine the literature for epidemiological and clinical evidences linking DM and epilepsy. Next, basing our analyses on published literature, we propose the possible complementarity of agmatine and metformin in the treatment of DM and epilepsy.

RESULTS

Our analyses of the clinical data suggest a significant association between pathogeneses of epilepsy and DM. Further, both agmatine and metformin appear to be multimodal therapeutic agents and have robust antiepileptogenic and antidiabetic properties. Data from animal and clinical studies largely support the use of metformin/agmatine as a double-edged pharmacotherapeutic agent against DM and epilepsy, particularly in their concurrent pathological occurrences.

CONCLUSION

The present review explores the evidences and available data on possible uses of metformin/agmatine as pertinent antidiabetic and antiepileptic agents. Our hope is that this will stimulate further research on the therapeutic actions of these multimodal agents, particularly for subject-specific clinical outcomes.

Assessing the validity of METS-IR for predicting the future onset of diabetes: an analysis using time-dependent receiver operating characteristics

BACKGROUND

The Metabolic Insulin Resistance Score (METS-IR) is a non-invasive proxy for insulin resistance (IR) that has been newly developed in recent years and has been shown to be associated with diabetes risk. Our aim was to assess the predictive value of METS-IR for the future development of diabetes and its temporal differences in people of different sex, age, and body mass index (BMI).

METHODS

The current study included 15,453 baseline non-diabetic subjects in the NAGALA cohort and then grouped according to the World Health Organization's (WHO) recommended criteria for age and BMI. Multivariate Cox regression and time-dependent receiver operator characteristics (ROC) curves were used to analyze the value of METS-IR in assessing and predicting the risk of diabetes in people of different sexes, ages, and BMIs.

RESULTS

373 individuals developed diabetes during the observation period. By multivariate COX regression analysis, the development of future diabetes was significantly associated with increased METS-IR, and this positive association was stronger in women than in men and in individuals < 45 years than in individuals ≥ 45 years; while no significant differences were observed between non-obese and overweight/obesity individuals. Using time-dependent ROC analysis we also assessed the predictive value of METS-IR for future diabetes at a total of 11-time points between 2 and 12 years. The results showed that METS-IR had a higher predictive value for the future development of diabetes in women or individuals < 45 years of age compared to men or individuals ≥ 45 years of age for almost the entire follow-up period. Furthermore, across different BMI categories, we also found that in the short term (3-5 years), METS-IR had a higher predictive value for the development of diabetes in individuals with overweight/obesity, while in the medium to long term (6-12 years), METS-IR was more accurate in predicting the development of diabetes in non-obese individuals.

CONCLUSIONS

Our study showed that METS-IR was independently associated with the development of future diabetes in a non-diabetic population. METS-IR was a good predictor of diabetes, especially for women and individuals < 45 years old for predicting the future risk of developing diabetes at all times.

Association between lipid accumulation products and stress urinary incontinence: a cross-sectional study from NHANES 2005 to 2018

BACKGROUND

Stress urinary incontinence (SUI), a common disorder of the pelvic floor, often results in anxiety, poor quality of life, and psychological issues among its sufferers. The relationship between lipid accumulation products (LAP) and stress-related urine incontinence remains unclear. This research aimed to investigate any possible correlation between the risk of SUI and the level of lipid accumulation products.

METHODS

For this cross-sectional research, people with SUI who were 20 years of age or older were recruited using information from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. A weighted multivariate logistic regression model was used to evaluate the findings. As a potential biomarker, lipid accumulation product levels were sorted among individuals in ascending order and subjected to a trend test (P for trend). Additionally, a nonlinear analysis was conducted using smooth curve-fitting methods. Lipid accumulation products' effectiveness in predicting SUI was evaluated using receiver operating characteristic (ROC) curves. Finally, a subgroup analysis was performed to confirm that the connection between SUI and lipid accumulation products was consistent across all demographic groups.

RESULTS

A thorough survey performed on 14,945 participants indicated that 23.61% of the respondents had SUI. A noteworthy association was observed between higher lipid accumulation product values and a greater probability of SUI in multivariate logistic regression analysis. Specifically, the stratification of lipid accumulation products into quartiles demonstrated a substantial positive correlation between the upper and lower quartiles, as evidenced by an elevated odds ratio for SUI (OR = 1.92; 95%CI 1.51-2.44; P < 0.0001). The subgroup analysis supported link consistency across all cohorts under investigation. Finally, the ROC curve indicated that lipid accumulation products (AUC = 0.67, 95%CI 0.654-0.690) had a superior predictive effect on the likelihood of SUI.

CONCLUSIONS

Increased lipid accumulation product values are associated with a higher chance of SUI in adult participants. This suggests that lipid accumulation products could be a valuable marker for detecting SUI, offering new perspectives for its evaluation and treatment.

Low carbohydrate diets, glycaemic control, enablers, and barriers in the management of type 1 diabetes: a mixed methods systematic review

BACKGROUND

Medical nutrition therapy is fundamental for diabetes management, however there is a lack of evidence supporting an ideal recommended carbohydrate intake for maintaining optimal glycaemia in individuals living with type 1 diabetes (T1D). Adults with T1D are increasingly drawn to very low carbohydrate (≤ 50 g/day or < 10% total energy intake) and low carbohydrate diets (< 130 g/day or < 26% total energy intake) because of the reported positive impact on both physical health and psychological well-being. Current evidence regarding the effectiveness on glycaemia and the lived experience by adults with T1D when using these diets is limited. This mixed methods systematic review was undertaken to examine the effectiveness of very low and low carbohydrate diets on HbA1c and explore the lived experience of adults with T1D who have followed these dietary regimens.

METHODS

Seven databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Informit Health Collection, Web of Science, and PsycInfo) were searched from inception to 1 October 2023. Quality assessment of the included studies was undertaken using the JBI's critical appraisal checklists. Separate quantitative and qualitative synthesis was performed, and findings were integrated for the purpose of comparison and complementarity.

RESULTS

Seventeen studies of varying methodologies were included. Findings from quantitative research were inconclusive in determining the effectiveness of very low and low carbohydrate diets on HbA1c levels. Qualitative data synthesis identified four themes [1) Motivation to follow the diet, 2) Health benefits of the diet, 3) Challenges of the diet, and 4) Limited information (participants knowledge, information sources) about the diet] that influenced adherence to very low and low carbohydrate diets. Through the integration of results from selected studies, it was evident that there were conflicting outcomes between quantitative and qualitative studies.

CONCLUSIONS

There is little evidence to indicate that very low and low carbohydrate diets improve HbA1c in adults with T1D. However, this goes against the reported lived experiences of participants. This review highlights the insufficiency of robust evidence on this topic. Future research involving larger participant samples over longer durations are needed to provide more definitive evidence in relation to the efficacy of these diets and into the enablers and barriers experienced when using a very low or low carbohydrate diet in order to provide support to adults with T1D. Systematic review registration PROSPERO CRD42023482800.

A peptide derived from the amino terminus of leptin improves glucose metabolism and energy homeostasis in myotubes and db/db mice

Leptin is an adipokine, which plays key roles in regulation of glucose metabolism and energy homeostasis. Therefore, identification of a short peptide from leptin which improves glucose-metabolism and energy-homeostasis could be of significant therapeutic importance. Mutational studies demonstrated that N-terminal of human leptin hormone is crucial for activation of leptin-receptor while its C-terminal seems to have lesser effects in it. Thus, for finding a metabolically active peptide and complimenting the mutational studies on leptin, we have identified a 17-mer (leptin-1) and a 16-mer (leptin-2) segment from its N-terminal and C-terminal, respectively. Consistent with the mutational studies, leptin-1 improved glucose-metabolism by increasing glucose-uptake, GLUT4 expression and its translocation to the plasma membrane in L6-myotubes, while leptin-2 was mostly inactive. Leptin-1-induced glucose-uptake is mediated through activation of AMPK, PI3K, and AKT proteins since inhibitors of these proteins inhibited the event. Leptin-1 activated leptin-receptor immediate downstream target protein, JAK2 reflecting its possible interaction with leptin-receptor while leptin-2 was less active. Furthermore, leptin-1 increased mitochondrial-biogenesis and ATP-production, and increased expression of PGC1α, NRF1, and Tfam proteins, that are important regulators of mitochondrial biogenesis. The results suggested that leptin-1 improved energy-homeostasis in L6-myotubes, whereas, leptin-2 showed much lesser effects. In diabetic, db/db mice, leptin-1 significantly decreased blood glucose level and improved glucose-tolerance. Leptin-1 also increased serum adiponectin and decreased serum TNF-α and IL-6 level signifying the improvement in insulin-sensitivity and decrease in insulin-resistance, respectively in db/db mice. Overall, the results show the identification of a short peptide from the N-terminal of human leptin hormone which significantly improves glucose-metabolism and energy-homeostasis.

Lipids as the link between central obesity and diabetes: perspectives from mediation analysis

BACKGROUND

Central obesity is a well-recognized risk factor for diabetes, yet the potential role of lipids in the diabetes risk associated with central obesity remains unclear. This study aimed to explore the possible mediating role of 11 lipid parameters [high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), non-high-density lipoprotein cholesterol (Non-HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), remnant cholesterol (RC), and ratios of Non-HDL-C/HDL-C, RC/HDL-C, LDL/HDL-C, TG/HDL-C, TC/HDL-C] in the association of central obesity with diabetes risk.

METHODS

We utilized data from 15,453 participants in the NAGALA longitudinal cohort to assess the association of baseline central obesity indicators [waist-height ratio (WHtR), waist circumference (WC)] and the 11 lipid parameters with diabetes risk. Mediation analysis models were constructed to explore the mediating role of lipid parameters in the association of WC/WHtR with diabetes.

RESULTS

Confirmatory associative analysis using multivariable Cox regression showed that, except for Non-HDL-C, TC and LD-C, the remaining eight lipid parameters were significantly associated with WC/WHtR and diabetes risk. Mediation analysis indicated that TG, RC, HDL-C, and lipid ratios such as Non-HDL-C/HDL-C ratio, RC/HDL-C ratio, TG/HDL-C ratio, TC/HDL-C ratio and LDL/HDL-C ratio are potential lipids affecting the diabetes risk related to central obesity. Among these, the RC/HDL-C ratio seemed to contribute the most in the WC/WHtR-related diabetes risk association, with a mediation percentage of about 37%. Additionally, lipid ratio parameters appeared to play a more mediating role in the association of central obesity-related diabetes risk than individual lipids.

CONCLUSIONS

In central obesity-related diabetes risk, most lipids, especially lipid ratio parameters, play a significant mediating role. Given these findings, we advocate for increased efforts in multifactorial risk monitoring and joint management of diabetes. The evaluation of lipids, particularly lipid ratio parameters, may be holds substantial value in the prevention and management of diabetes risk under close monitoring of central obesity.

Barriers and facilitators for universal gestational diabetes Mellitus screening in a low resource setting: a cross-sectional study in Sri Lanka

Gestational Diabetes Mellitus (GDM) is associated with adverse maternal and perinatal outcomes and increased risk of developing diabetes in later life. Sri Lanka adopted universal GDM screening at two time points in pregnancy (before 12 weeks and between 24 and 28 weeks) in 2014 and its utilization has not been assessed. This study assessed the utilization of GDM screening services and associated factors among antenatal mothers in Southern Sri Lanka. A cross-sectional study was carried out in a consecutive sample of 420 postpartum mothers who delivered at three major hospitals in Sri Lanka. Data were collected on socio-demographics, pregnancy, availability and utilization of screening services and logistics using an interviewer-administered questionnaire and a data record sheet. Data was analysed using SPSS software. Chi-square test and binary logistic regression was used to assess the association between variables. The coverage of first and second screening tests were 91.4% and 94.5% and timeliness were 72.4% and 59.5%, respectively. The median period of amenorrhoea at the first and second screening were 10.0 (inter-quartile range: 2.5) weeks and 28.0 (inter-quartile range: 1.5) weeks. A higher utilization was associated with higher income (OR = 3.4, 95% CI: 1.1-10.5) and planned pregnancy (OR = 4.9, 95% CI: 2.2-10.7) for the first screening test. Primiparity (OR = 0.3, 95% CI: 0.1-0.9) and proximity of the nearest laboratory (OR = 3.5, 95% CI: 1.0-12.0) were positively associated with the second screening test. The timeliness of both screening tests was associated with planned pregnancy (OR = 2.1, 95% CI: 1.1-4.0 and OR = 2.3, 95% CI: 1.1-4.5) and being non-employed during the pregnancy (OR = 2.5, 95% CI: 1.4-4.3 and OR = 2.3, 95% CI: 1.3-4.1). A high utilization of GDM screening was observed. Timeliness should be ensured through improved availability and accessibility of screening facilities.

The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study

Objectives

The aim of this study was to determine the association between insulin glargine usage and the potential increase in cancer risk among the Lithuanian population diagnosed with type 2 diabetes mellitus (T2DM).

Methods

A retrospective cohort study was conducted. The cohort of insulin users was established by identifying all male and female patients diagnosed with T2DM, as recorded in the National Health Insurance Fund database between 1 January 2000 and 31 December 2012. The risk of cancer among insulin glargine users was compared with the risk in non-glargine insulin users. Cox proportional hazard models were used to estimate hazard ratios (HR) and their 95% confidence intervals (CI).

Results

The overall cancer risk for all sites combined showed no significant difference (HR 0.84, 95% CI 0.67-1.05). Although a general decrease in the risk of cancers was observed at most sites for glargine users, the use of insulin glargine was associated with a non-significant increase in the risk of mouth and pharynx, stomach, non-melanoma skin, breast, cervical, ovarian, and central nervous system cancers. There was a tendency for a lower risk of colon, rectum, rectosigmoid, and anus cancer among glargine users (HR 0.45, 95% CI 0.18-1.12, p = 0.09).

Conclusions

Our research contributes to the growing body of evidence showing that insulin glargine is not associated with an increased risk of all cancers or specific types of cancer.

Efficacy of ultrasonography and color-Doppler for early prediction of hemodialysis arteriovenous fistula unassisted maturation

BACKGROUND

Arteriovenous fistula (AVF) failure is a prevalent concern for patients with end-stage kidney disease on hemodialysis. Recognizing the efficacy of ultrasound Doppler in post-operative AVF evaluation, this study sought to discern the predictive capabilities of various ultrasonographic and color-Doppler metrics for early AVF outcomes.

METHODS

This single-center, prospective cohort study spanned 1 year and, post ethical clearance, included all patients who underwent native AVF creation surgery and were subsequently referred for standard post-operative ultrasound Doppler assessment. Parameters such as fistula size, cephalic vein area and diameter, and AVF flow velocity and rates were assessed on post-operative day 2, week 2, and week 6. These initial findings were juxtaposed with later outcomes to determine unassisted AVF results.

RESULTS

Of the initial cohort of 40 patients, 75% encountered AVF failure, whereas 25% realized successful unassisted AVF maturation. A notable observation was the significant variance in AVF flow rates as early as post-operative day 2. A threshold of >246 ml/min was indicative of successful unassisted AVF maturation, leading to a sensitivity of 80% and a specificity of 70%. Although the cephalic vein diameter on post-operative day 2 lacked a robust association with AVF outcomes, a cut-off of >3.4 mm, when combined with flow rate testing, augmented the cumulative sensitivity to 92%.

CONCLUSION

Ultrasound Doppler stands out as a valuable quantitative imaging modality, adept at prognosticating AVF outcomes from as early as post-operative day 2. In particular, a flow rate exceeding 246 ml/min and a cephalic vein diameter surpassing 3.4 mm are salient indicators for the early prediction of successful AVF outcomes.

Glycated albumin levels are associated with adverse stroke outcomes in patients with acute ischemic stroke in China

BACKGROUND AND AIM

Glycated albumin (GA) is a biomarker monitoring glycemia 2-4 weeks before stroke onset. This study was designed to explore the association between GA levels with poststroke outcomes in patients with acute ischemic stroke or transient ischemic attack (TIA).

METHOD

Participants with ischemic stroke or TIA who had a baseline GA measurement were included in the Third China National Stroke Registry study. The effect of GA on stroke recurrence, poor functional outcomes, and combined vascular events was examined during the 1-year follow-up period. Multivariate Cox and logistic regression models were performed to evaluate the association. Discrimination tests were used to examine the incremental predictive value of GA when incorporating it into the conventional model.

RESULTS

A total of 3861 participants were enrolled. At the 3-month follow-up, the elevated GA level was associated with an increased risk of poor functional outcomes (adjusted odds ratio [OR], 1.45; 95% confidence interval [CI], 1.01-2.09). A similar increase was observed for stroke recurrence (adjusted hazard ratio [HR], 1.56; 95% CI, 1.09-2.24), poor functional outcomes (adjusted OR, 1.62; 95% CI, 1.07-2.45), and combined vascular events (adjusted HR, 1.55; 95% CI, 1.09-2.20) at the 1-year follow-up. In nondiabetic patients, the association between GA and poor functional outcomes was more pronounced (adjusted OR, 1.62; 95% CI, 1.05-2.50). Adding GA into the conventional model resulted in slight improvements in predicting poor functional outcomes (net reclassification improvement [NRI]: 12.30% at 1 year).

CONCLUSION

This study demonstrated that elevated GA levels in serum were associated with stroke adverse outcomes, including stroke recurrence, poor functional outcomes, and combined vascular events, in patients with ischemic stroke or TIA.

Association Between Type 2 Diabetes Mellitus and Alzheimer's Disease: Common Molecular Mechanism and Therapeutic Targets

Diabetes mellitus (DM) and Alzheimer's disease (AD) rates are rising, mirroring the global trend of an aging population. Numerous epidemiological studies have shown that those with Type 2 diabetes (T2DM) have an increased risk of developing dementia. These degenerative and progressive diseases share some risk factors. To a large extent, the amyloid cascade is responsible for AD development. Neurofibrillary tangles induce neurodegeneration and brain atrophy; this chain reaction begins with hyperphosphorylation of tau proteins caused by progressive amyloid beta (Aβ) accumulation. In addition to these processes, it seems that alterations in brain glucose metabolism and insulin signalling lead to cell death and reduced synaptic plasticity in AD, before the onset of symptoms, which may be years away. Due to the substantial evidence linking insulin resistance in the brain with AD, researchers have coined the name "Type 3 diabetes" to characterize the condition. We still know little about the processes involved, even though current animal models have helped illuminate the links between T2DM and AD. This brief overview discusses insulin and IGF-1 signalling disorders and the primary molecular pathways that may connect them. The presence of GSK-3β in AD is intriguing. These proteins' association with T2DM and pancreatic β-cell failure suggests they might be therapeutic targets for both disorders.

Current approaches in CRISPR-Cas systems for diabetes

In the face of advancements in health care and a shift towards healthy lifestyle, diabetes mellitus (DM) still presents as a global health challenge. This chapter explores recent advancements in the areas of genetic and molecular underpinnings of DM, addressing the revolutionary potential of CRISPR-based genome editing technologies. We delve into the multifaceted relationship between genes and molecular pathways contributing to both type1 and type 2 diabetes. We highlight the importance of how improved genetic screening and the identification of susceptibility genes are aiding in early diagnosis and risk stratification. The spotlight then shifts to CRISPR-Cas9, a robust genome editing tool capable of various applications including correcting mutations in type 1 diabetes, enhancing insulin production in T2D, modulating genes associated with metabolism of glucose and insulin sensitivity. Delivery methods for CRISPR to targeted tissues and cells are explored, including viral and non-viral vectors, alongside the exciting possibilities offered by nanocarriers. We conclude by discussing the challenges and ethical considerations surrounding CRISPR-based therapies for DM. These include potential off-target effects, ensuring long-term efficacy and safety, and navigating the ethical implications of human genome modification. This chapter offers a comprehensive perspective on how genetic and molecular insights, coupled with the transformative power of CRISPR, are paving the way for potential cures and novel therapeutic approaches for DM.

A retrospective cohort study of a community-based primary care program's effects on pharmacotherapy quality in low-income Peruvians with type 2 diabetes and hypertension

Little is known about the effects of the Chronic Care Model (CCM) and community health workers (CHWs) on pharmacotherapy of type 2 diabetes and hypertension in resource-poor settings. This retrospective cohort implementation study evaluated the effects of a community-based program consisting of CCM, CHWs, guidelines-based treatment protocols, and inexpensive freely accessible medications on type 2 diabetes and hypertension pharmacotherapy quality. A door-to-door household survey identified 856 adults 35 years of age and older living in a low-income Peruvian community, of whom 83% participated in screening for diabetes and hypertension. Patients with confirmed type 2 diabetes and/or hypertension participated in the program's weekly to monthly visits for < = 27 months. The program was implemented as two care periods employed sequentially. During home care, CHWs made weekly home visits and a physician made treatment decisions remotely. During subsequent clinic care, a physician attended patients in a centralized clinic. The study compared the effects of program (pre- versus post-) (N = 262 observations), and home versus clinic care periods (N = 211 observations) on standards of treatment with hypoglycemic and antihypertensive agents, angiotensin converting enzyme inhibitors, and low-dose aspirin. During the program, 80% and 50% achieved hypoglycemic and antihypertensive standards, respectively, compared to 35% and 8% prior to the program, RRs 2.29 (1.72-3.04, p <0.001) and 6.64 (3.17-13.9, p<0.001). Achievement of treatment standards was not improved by clinic compared to home care (RRs 1.0 +/- 0.08). In both care periods, longer retention in care (>50% of allowable time) was associated with achievement of all treatment standards. 85% compared to 56% achieved the hypoglycemic treatment standard with longer and shorter retention, respectively, RR 1.52 (1.13-2.06, p<0.001); 56% compared to 27% achieved the antihypertensive standard, RR 2.11 (1.29-3.45, p<0.001). In a dose-dependent manner, the community-based program was associated with improved guidelines-based pharmacotherapy of type 2 diabetes and hypertension.

Relationship between types and levels of free fatty acids, peripheral insulin resistance, and oxidative stress in T2DM: A case-control study

Free Fatty Acids (FFAs) are vital for energy homeostasis and the pathogenesis of a variety of diseases, including diabetes. For the first time, we presumed and investigated the types and levels of FFAs and their links to Insulin Resistance (IR) and Oxidative Stress (OS) in T2DM. A case-control study was conducted on 60 individuals with diabetes, 60 prediabetics with IFG, and 60 control groups. A Gas Chromatography Flame Ionization Detector (GC-FID) was used to estimate FFAs, which were then classified based on length and saturation. Indeed, antioxidant parameters such as TAC, MDA levels, PON-1, SOD-3, and CAT activity were assessed. Higher levels of LCFFA, SFFA, USFFA, and total FFA were found in people with diabetes and prediabetes. These levels were also linked to higher levels of HOMA-IR, BMI, FBS, HbA1C, and MDA, but lower levels of antioxidants. Furthermore, adjusting the above FFAs with age, sex, and antihypertensive medication increased T2DM development. SCFFA and ω3/6 fatty acids had a negative relationship with HOMA-IR, FBS, and insulin and a positive relationship with TAC. Adjusted SCFFA reduces T2DM risk. According to our models, total FFA is utilized to diagnose diabetes (AUC = 83.98, cut-off > 919 μM) and SCFFA for prediabetes (AUC = 82.32, cut-off < 39.56 μM). Total FFA (≥ 776 μM), LCFFA (≥ 613 μM), SFFA (≥ 471 μM), and USFFA (≥ 398 μM) all increase the risk of T2DM by increasing OS, BMI, and HOMA-IR. On the other hand, SCFFAs (≥ 38.7 μM) reduce the risk of T2DM by reducing BMI, HOMA-IR, and OS. SCFFAs and total FFAs can be used for the diagnosis of prediabetes and diabetes, respectively.

Association between physical activity level and diabetes incidence among Chinese middle-aged and older adults: a cross-sectional study from the China health and retirement longitudinal study

Background

It has been shown that diabetes is associated with insufficient physical activity among middle-aged and older adults, but the association between different physical activity levels (PAL) and diabetes incidence needs to be further explored.

Objective

This study aims to explore the correlation and dose-response relationship between different PAL and the diabetes incidence in middle-aged and older adults.

Methods

Utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this cross-sectional analysis included 17,226 middle-aged and older adults aged 45 and above. Binary logistic regression models and restricted cubic spline (RCS) were used to explore the correlation and dose-response relationship between different PAL and the incidence of diabetes in the total middle-aged and older adults population as well as in subgroups. Sensitivity analyses were also performed to verify the robustness of the findings.

Results

In the entire study population, compared with the lowest PAL, participants in the third and fourth quartiles PAL saw diabetes incidence significantly reduced by 16% (p = 0.005) and 33% (p < 0.001), respectively (p for trend < 0.001). In subgroup analyses, the fourth quartile PAL significantly reduced the diabetes incidence among females, individuals aged 60-69, and rural residents by 25% (p = 0.011), 38% (p < 0.001) and 28% (p < 0.001), respectively. For males, middle-aged (45-59 years), and urban residents, the third quartile PAL reduced diabetes incidence by 22% (p = 0.004), 24% (p = 0.012), 21% (p = 0.013), respectively. When the fourth quartile PAL was reached, the diabetes incidence was significantly reduced in these populations by 41% (p < 0.001), 39% (p < 0.001), and 41% (p < 0.001), respectively. There was a negative dose-response relationship between physical activity and diabetes incidence in specific Chinese middle-aged and older adults population. In addition, sensitivity analyses indicated the robustness of the findings.

Conclusion

Higher PAL was associated with lower diabetes incidence in specific Chinese middle-aged and older adults population. It is feasible to use physical activity to predict diabetes incidence in this demographic, and high PAL may be an effective means of preventing and controlling diabetes.

Saliva, Plasma, and Multifluid Metabolomic Signatures of Periodontal Disease, Type 2 Diabetes Progression, and Markers of Glycemia and Dyslipidemia Among Puerto Rican Adults With Overweight and Obesity

BACKGROUND

Evidence from cohort studies indicates a bidirectional relationship between periodontal disease and type 2 diabetes (T2D), but the underlying mechanisms remain unknown. In this study, we aimed to (1) identify saliva, plasma, and multifluid metabolomic signatures associated with periodontal disease and (2) determine if these signatures predict T2D progression and cardiometabolic biomarkers at year 3.

METHODS AND RESULTS

We included participants from the SOALS (San Juan Overweight Adult Longitudinal Study) (n=911). Metabolites from saliva (k=635) and plasma (k=1051) were quantified using liquid chromatography-mass spectrometry. We applied elastic net regression with 10-fold cross-validation to identify baseline metabolomic signatures of periodontal disease. Multivariable Cox proportional hazards regression and linear regression were used to evaluate the association with T2D progression and biomarker concentrations. Metabolomic profiles included highly weighted metabolites related to lysine and pyrimidine metabolism. Periodontal disease or its 3 metabolomic signatures were not associated with T2D progression in 3 years. Prospectively, 1-SD increments in the multifluid and saliva metabolomic signatures were associated with higher low-density lipoprotein (multifluid: 12.9±5.70, P=0.02; saliva: 13.3±5.11, P=0.009). A 1-SD increment in the plasma metabolomic signature was also associated with Homeostatic Model Assessment for Insulin Resistance (2.67±1.14, P=0.02) and triglyceride (0.52±0.18, P=0.002).

CONCLUSIONS

Although metabolomic signatures of periodontal disease could not predict T2D progression, they were associated with low-density lipoprotein, triglyceride, and Homeostatic Model Assessment for Insulin Resistance levels at year 3.

Branched-Chain and Aromatic Amino Acids, Type 2 Diabetes, and Cardiometabolic Risk Factors among Puerto Rican Adults

(1) Background: Branched-chain and aromatic amino acids (BCAAs/AAAs) have been considered as markers of type 2 diabetes (T2D); however, studies on associations between these metabolites and T2D and cardiometabolic traits in Hispanic populations are limited. The aim of this study was to examine the associations between baseline BCAAs (isoleucine, leucine, valine)/AAAs (phenylalanine, tyrosine) and prevalent and incident T2D, as well as baseline and longitudinal (2 year) changes in cardiometabolic traits (measures of glycemia, dyslipidemia, inflammation, and obesity) in two large cohorts of adults of Puerto Rican descent. (2) Methods: We included participants of the Boston Puerto Rican Health Study (BPRHS, n = 670) and San Juan Overweight Adult Longitudinal study (SOALS, n = 999) with available baseline metabolite and covariate data. T2D diagnosis was defined based on American Diabetes Association criteria. Multivariable logistic (for baseline T2D), Poisson (for incident T2D), and linear (for cardiometabolic traits) regression models were used; cohort-specific results were combined in the meta-analysis and adjusted for multiple comparisons. (3) Results: Higher baseline BCAAs were associated with higher odds of prevalent T2D (OR1SD BCAA score = 1.46, 95% CI: 1.34-1.59, p < 0.0001) and higher risk of incident T2D (IRR1SD BCAA score = 1.24, 95% CI: 1.13-1.37, p < 0.0001). In multivariable longitudinal analysis, higher leucine and valine concentrations were associated with 2-year increase in insulin (beta 1SD leucine = 0.37 mcU/mL, 95% CI: 0.11-0.63, p < 0.05; beta 1SD valine = 0.43 mcU/mL, 95% CI: 0.17-0.68, p < 0.01). Tyrosine was a significant predictor of incident T2D (IRR = 1.31, 95% CI: 1.09-1.58, p < 0.05), as well as 2 year increases in HOMA-IR (beta 1SD tyrosine = 0.13, 95% CI: 0.04-0.22, p < 0.05) and insulin concentrations (beta 1SD tyrosine = 0.37 mcU/mL, 95% CI: 0.12-0.61, p < 0.05). (4) Conclusions: Our results confirmed the associations between BCAAs and prevalent and incident T2D, as well as concurrent measures of glycemia, dyslipidemia, and obesity, previously reported in predominantly White and Asian populations. Baseline leucine, valine, and tyrosine were predictors of 2 year increases in insulin, whereas tyrosine was a significant predictor of deteriorating insulin resistance over time. Our study suggests that BCAAs and tyrosine could serve as early markers of future glycemic changes in Puerto Ricans.

Vascular Disease Is Associated With Differences in Brain Structure and Lower Cognitive Functioning in Inflammatory Bowel Disease: A Cross-Sectional Study

BACKGROUND

Vascular disease and cognitive impairment have been increasingly documented in inflammatory bowel disease (IBD), and both have been individually correlated with changes in brain structure. This study aimed to determine if both macro- and microstructural brain changes are prevalent in IBD and whether alterations in brain structure mediate the relationship between vascular disease and cognitive functioning.

METHODS

Eighty-four IBD participants underwent multimodal magnetic resonance imaging. Volumetric and mean diffusivity measures of the thalamus, hippocampus, normal-appearing white matter, and white matter lesions were converted to age- and sex-adjusted z scores. Vascular comorbidity was assessed using a modified Framingham Risk Score and cognition was assessed using a battery of neuropsychological tests. Test scores were standardized using local regression-based norms. We generated summary statistics for the magnetic resonance imaging metrics and cognitive tests, and these were examined using canonical correlation analysis and linear regression modeling.

RESULTS

Greater vascular comorbidity was negatively correlated with thalamic, normal-appearing white matter, and white matter lesion volumes. Higher Framingham Risk Score were also correlated with lower processing speed, learning and memory, and verbal fluency. Increased vascular comorbidity was predictive of poorer cognitive functioning, and this effect was almost entirely mediated (94.76%) by differences in brain structure.

CONCLUSIONS

Vascular comorbidity is associated with deleterious effects on brain structure and lower cognitive functioning in IBD. These findings suggest that proper identification and treatment of vascular disease is essential to the overall management of IBD, and that certain brain areas may serve as critical targets for predicting the response to therapeutic interventions.

Clinical characteristics and complication risks in data-driven clusters among Chinese community diabetes populations

BACKGROUND

Novel diabetes phenotypes were proposed by the Europeans through cluster analysis, but Chinese community diabetes populations might exhibit different characteristics. This study aims to explore the clinical characteristics of novel diabetes subgroups under data-driven analysis in Chinese community diabetes populations.

METHODS

We used K-means cluster analysis in 6369 newly diagnosed diabetic patients from eight centers of the REACTION (Risk Evaluation of cAncers in Chinese diabeTic Individuals) study. The cluster analysis was performed based on age, body mass index, glycosylated hemoglobin, homeostatic modeled insulin resistance index, and homeostatic modeled pancreatic β-cell functionality index. The clinical features were evaluated with the analysis of variance (ANOVA) and chi-square test. Logistic regression analysis was done to compare chronic kidney disease and cardiovascular disease risks between subgroups.

RESULTS

Overall, 2063 (32.39%), 658 (10.33%), 1769 (27.78%), and 1879 (29.50%) populations were assigned to severe obesity-related and insulin-resistant diabetes (SOIRD), severe insulin-deficient diabetes (SIDD), mild age-associated diabetes mellitus (MARD), and mild insulin-deficient diabetes (MIDD) subgroups, respectively. Individuals in the MIDD subgroup had a low risk burden equivalent to prediabetes, but with reduced insulin secretion. Individuals in the SOIRD subgroup were obese, had insulin resistance, and a high prevalence of fatty liver, tumors, family history of diabetes, and tumors. Individuals in the SIDD subgroup had severe insulin deficiency, the poorest glycemic control, and the highest prevalence of dyslipidemia and diabetic nephropathy. Individuals in MARD subgroup were the oldest, had moderate metabolic dysregulation and the highest risk of cardiovascular disease.

CONCLUSION

The data-driven approach to differentiating the status of new-onset diabetes in the Chinese community was feasible. Patients in different clusters presented different characteristics and risks of complications.

The Association Between the Triglyceride to High-Density Lipoprotein Cholesterol Ratio and the Incidence of Type 2 Diabetes Mellitus in the Japanese Population

Abstract Aims: To explore whether the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) was independently associated with the risk of incident type 2 diabetes mellitus (T2DM) in a large Japanese cohort. Methods: A secondary analysis was performed using open-access data from a retrospective cohort study. A total of 12,716 eligible participants who had standard medical examinations at the Murakami Memorial Hospital were included in this study. New-onset T2DM was the main outcome during follow-up. The risk of T2DM based on the TG/HDL-C ratio was evaluated using Cox regression analysis and Kaplan-Meier analysis. Subgroup analysis was performed to understand further the significance of the TG/HDL-C ratio in particular populations. To assess the potential of the TG/HDL-C ratio for predicting T2DM, a receiver operating characteristic (ROC) analysis was performed. Results: One hundred fifty new-onset T2DM cases were observed during a median follow-up of 5.39 years. The incidence of T2DM increased with a rise in the TG/HDL-C ratio based on the Kaplan-Meier curves (P < 0.0001). After controlling for potential confounding variables, the TG/HDL-C ratio was positively related to incidence of T2DM (hazard ratio = 1.08, 95% confidence interval: 1.01-1.15, P = 0.0239). In subgroup analysis, those with a body mass index of ≥18.5 and <24 kg/m2 showed a significantly positive relationship. The area under the ROC curve for the TG/HDL-C ratio as a T2DM predictor was 0.684. The optimal TG/HDL-C ratio cutoff value for T2DM was 1.609, with a sensitivity of 54.7% and a specificity of 73.6%. Conclusion: The authors' results showed a significant relationship between the TG/HDL-C ratio and the incidence of T2DM in the Japanese population.

Diabetes mellitus in patients with type 1 autoimmune pancreatitis at diagnosis and after corticosteroid therapy

BACKGROUND

A high prevalence of diabetes mellitus (DM) coexisting with autoimmune pancreatitis (AIP) is observed. However, evidence on the circumstances under which corticosteroid therapy (CST) for AIP improves or worsens DM is scarce. This study aimed to demonstrate and identify predictors of DM control under the influence of CST.

METHODS

Patients diagnosed with type 1 AIP were enrolled from a prospectively maintained cohort and were classified into three groups according to the chronology in which AIP and DM were diagnosed: pre-existing DM (pDM), concurrent DM (cDM), and non-DM (nDM). The responses of DM to CST were assessed when corticosteroid was ceased or tapered to a maintenance dose and classified as 'improvement' and 'non-improvement' (including 'no change' and 'exacerbation').

RESULTS

Among 101 patients with type 1 AIP, 52 (51.5%) patients were complicated with DM at the time of AIP diagnosis, with 36 patients in the cDM group and 16 patients in the pDM group. The incidences of diffuse pancreatic swelling (72.2%) and pancreatic body/tail involvement (91.7%) were significantly higher in the cDM group than in both the pDM and nDM groups. Of the 52 patients with DM, CST was administered in 48 cases. Multivariate logistic analysis identified that elevated serum gamma-glutamyl transferase (GGT) level at AIP diagnosis [odds ratio (OR) = 0.032, 95% confidence interval (CI): 0.003-0.412, P = 0.008] and pancreatic atrophy after CST (OR = 0.027, 95% CI: 0.003-0.295, P = 0.003) were negatively associated with DM control improvement.

CONCLUSIONS

Patients with diffuse pancreatic swelling and pancreatic body/tail involvement in pancreatitis tended to be complicated with cDM at AIP diagnosis. CST exerted a beneficial effect on the clinical course of DM in nearly half of the AIP patients complicated with DM at diagnosis, particularly in those without elevated serum GGT levels at diagnosis and who did not experience pancreatic atrophy after CST.

Longitudinal decline in peak V̇o2 with aging in a healthy population is associated with a reduction in peripheral oxygen utilization but not in cardiac output

Aging is associated with a significant decline in aerobic capacity assessed by maximal exercise oxygen consumption (V̇o2max). The relative contributions of the specific V̇o2 components driving this decline, namely cardiac output (CO) and arteriovenous oxygen difference (A - V)O2, remain unclear. We examined this issue by analyzing data from 99 community-dwelling participants (baseline age: 21-96 yr old; average follow-up: 12.6 yr old) from the Baltimore Longitudinal Study of Aging, free of clinical cardiovascular disease. V̇o2peak, a surrogate of V̇o2max, was used to assess aerobic capacity during upright cycle ergometry. Peak exercise left ventricular volumes, heart rate, and CO were estimated using repeated gated cardiac blood pool scans. The Fick equation was used to calculate (A - V)O2diff,peak from COpeak and V̇o2peak. In unadjusted models, V̇o2peak, (A - V)O2diff,peak, and COpeak declined longitudinally over time at steady rates with advancing age. In multiple linear regression models adjusting for baseline values and peak workload, however, steeper declines in V̇o2peak and (A - V)O2diff,peak were observed with advanced entry age but not in COpeak. The association between the declines in V̇o2peak and (A - V)O2diff,peak was stronger among those ≥50 yr old compared with their younger counterparts, but the difference between the two age groups did not reach statistical significance. These findings suggest that age-associated impairment of peripheral oxygen utilization during maximal exercise poses a stronger limitation on peak V̇o2 than that of CO. Future studies examining interventions targeting the structure and function of peripheral muscles and their vasculature to mitigate age-associated declines in (A - V)O2diff are warranted.NEW & NOTEWORTHY The age-associated decline in aerobic exercise performance over an average of 13 yr in community-dwelling healthy individuals is more closely associated with decreased peripheral oxygen utilization rather than decreased cardiac output. This association was more evident in older than younger individuals. These findings suggest that future studies with larger samples examine whether these associations vary across the age range and whether the decline in cardiac output plays a greater role earlier in life. In addition, studies focused on determinants of peripheral oxygen uptake by exercising muscle may guide the selection of preventive strategies designed to maintain physical fitness with advancing age.

Is pre-diabetes a predictor of events in patients with atrial fibrillation?

BACKGROUND

Diabetes mellitus (DM) increases the probability of presenting atrial fibrillation (AF) and it is a predictor of its ischemic stroke. There is limited information of the association between glycated hemoglobin (HbA1c) levels and ischemic, embolic or bleeding events in patients with pre-DM and AF.

METHODS

To investigate whether the presence of pre-DM in patients with AF predicts ischemic or bleeding events, myocardial infarction or mortality, we performed a retrospective study with a final cohort of 2993 non-diabetic patients with AF and data of glycated hemoglobin (HbA1c). We divided the cohort in two groups: those with normal glucose (n = 1351) and those with pre-diabetes (n = 1642). Incidence rates were calculated as the number of events per 100 person-years and were then compared between groups. Competitive hazard regression analysis for non-fatal events(death as the competing event) and conventional Cox regression for mortality were performed.

RESULTS

There was not difference between groups for incidence rates of the different events per 100 person-years. Even considering HbA1c as continuous variable, the unadjusted analysis showed no relation between levels of HbA1c and more risk of events. This association remained not significant after adjustment for CHA2DS2-VASc score, HAS-BLED score and anticoagulation therapy.

CONCLUSION

In this study of 2993 non-diabetic patients with new-onset AF, we have not found an association between HbA1c and worse prognosis when it is in the range of pre-diabetes.

Glycemic variability after mechanical thrombectomy for anterior circulation acute ischemic stroke

INTRODUCTION

Morbidity remains high among patients who undergo successful mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO). Stress hyperglycemia worsens the prognosis after acute ischemic stroke (AIS), but aggressively treating hyperglycemia does not improve the outcome. There is no consensus on how to best manage glycemia after AIS. Glycemic variability (GV) reflects glycemic fluctuations over time and could be the culprit. We aimed to elucidate how GV impacts outcome of AIS patients treated with MT.

PATIENTS AND METHODS

This was a single-center retrospective study. We consecutively included AIS patients who received MT for anterior circulation LVO. We recorded discrete blood glucose measurements within the first 24 hours post thrombectomy, from which we calculated two measures of GV: standard deviation (SD) and coefficient of variation. Univariate and multivariate analyses were conducted to identify predictors of poor functional outcome (modified Ranking scale score 3-6) and mortality at 3-month follow-up.

RESULTS

We included 657 patients. Patients with poor functional outcome (42.5%) and patients that died (14.8%) had significantly higher GV as measured by SD. In a multivariable model adjusted for confounders, higher SD was associated with mortality -adjusted odds ratio: 1.020 (95% CI 1.001-1.040)- but not with functional outcome -adjusted odds ratio for modified Ranking scale score 3-6: 1.007 (95% CI 0.990-1.025)-.

CONCLUSIONS

Our results suggest that higher GV after MT for anterior circulation AIS is an independent risk factor for 3-month mortality. Future trials should evaluate the benefit of reducing GV in this setting.

Serum and CSF metabolomics analysis shows Mediterranean Ketogenic Diet mitigates risk factors of Alzheimer's disease

Alzheimer's disease (AD) is influenced by a variety of modifiable risk factors, including a person's dietary habits. While the ketogenic diet (KD) holds promise in reducing metabolic risks and potentially affecting AD progression, only a few studies have explored KD's metabolic impact, especially on blood and cerebrospinal fluid (CSF). Our study involved participants at risk for AD, either cognitively normal or with mild cognitive impairment. The participants consumed both a modified Mediterranean Ketogenic Diet (MMKD) and the American Heart Association diet (AHAD) for 6 weeks each, separated by a 6-week washout period. We employed nuclear magnetic resonance (NMR)-based metabolomics to profile serum and CSF and metagenomics profiling on fecal samples. While the AHAD induced no notable metabolic changes, MMKD led to significant alterations in both serum and CSF. These changes included improved modifiable risk factors, like increased HDL-C and reduced BMI, reversed serum metabolic disturbances linked to AD such as a microbiome-mediated increase in valine levels, and a reduction in systemic inflammation. Additionally, the MMKD was linked to increased amino acid levels in the CSF, a breakdown of branched-chain amino acids (BCAAs), and decreased valine levels. Importantly, we observed a strong correlation between metabolic changes in the CSF and serum, suggesting a systemic regulation of metabolism. Our findings highlight that MMKD can improve AD-related risk factors, reverse some metabolic disturbances associated with AD, and align metabolic changes across the blood-CSF barrier.

Semaglutide mitigates testicular damage in diabetes by inhibiting ferroptosis

Diabetes is linked to male infertility, but the mechanisms and therapeutic options remain unclear. This study investigates the effects of semaglutide on testicular function in a diabetes mouse model. Clinical data shows that diabetes affects blood glucose, lipid levels, and sperm quality. Single-cell and transcriptome analyses reveal changes in testicular tissue cell proportions and activation of ferroptosis pathways in diabetic patients/rats. In the diabetes mouse model, sperm quality decreases significantly. Treatment with semaglutide (Sem) and the ferroptosis inhibitor ferrostatin-1 (Fer-1) alleviates testicular damage, as evidenced by improved lipid peroxidation and ferroptosis markers. Moreover, the diabetes-induced decrease in the TM-3 cell line's vitality, increased lipid peroxidation, ROS, ferrous ions, and mitochondrial membrane potential damage are all improved by semaglutide and ferrostatin-1 intervention. Overall, these findings highlight semaglutide's potential as a therapeutic approach for mitigating diabetes-induced testicular damage through modulation of the ferroptosis pathway.

Does metabolic control of the disease related with bone turnover markers in children with type 1 diabetes mellitus in Turkey?

BACKGROUND

The aim was to evaluate the effect of metabolic control on bone biomarkers in children with type I diabetes.

MATERIALS AND METHODS

The children were divided into two groups according to their glycated hemoglobin (HbA1c) (%) levels: a group with HbA1c levels < 8% (n = 16) and: a group with HbA1c levels > 8% (n = 18). The serum total oxidative status (TOS) (µmol/L), total antioxidant status (TAS) (mmol/L), alkaline phosphatase (ALP) (IU/L), osteocalcin (OC) (ng/ml), procollagen type-1-N-terminal peptide (P1NP) (ng/ml), and vitamin D (IU) levels and food consumption frequencies were determined.

RESULTS

When patients were classified according to HbA1c (%) levels, those with HbA1c levels < 8% were found to have lower TOS (µmol/L) values (8.7 ± 6.16, 9.5 ± 5.60) and higher serum OC (ng/mL) (24.2 ± 16.92, 22.0 ± 6.21) levels than those with HbA1c levels > 8% (p < 0.05). Regardless of the level of metabolic control, there was a statistically significant association between serum TOS (µmol/L) and P1NP (ng/ml) (p < 0.05) levels, with no group-specific relationship (HbA1c levels <%8 or HbA1c levels >%8).

CONCLUSION

HbA1c and serum TOS levels had an effect on bone turnover biomarkers in individuals with type I diabetes.

Changes in the type 2 diabetes gut mycobiome associate with metformin treatment across populations

The human gut teems with a diverse ecosystem of microbes, yet non-bacterial portions of that community are overlooked in studies of metabolic diseases firmly linked to gut bacteria. Type 2 diabetes mellitus (T2D) is associated with compositional shifts in the gut bacterial microbiome and the mycobiome, the fungal portion of the microbiome. However, whether T2D and/or metformin treatment underpins fungal community changes is unresolved. To differentiate these effects, we curated a gut mycobiome cohort spanning 1,000 human samples across five countries and validated our findings in a murine experimental model. We use Bayesian multinomial logistic normal models to show that T2D and metformin both associate with shifts in the relative abundance of distinct gut fungi. T2D is associated with shifts in the Saccharomycetes and Sordariomycetes fungal classes, while the genera Fusarium and Tetrapisipora most consistently associate with metformin treatment. We confirmed the impact of metformin on individual gut fungi by administering metformin to healthy mice. Thus, metformin and T2D account for subtle, but significant and distinct variation in the gut mycobiome across human populations. This work highlights for the first time that metformin can confound associations of gut fungi with T2D and warrants the need to consider pharmaceutical interventions in investigations of linkages between metabolic diseases and gut microbial inhabitants.

IMPORTANCE

This is the largest to-date multi-country cohort characterizing the human gut mycobiome, and the first to investigate potential perturbations in gut fungi from oral pharmaceutical treatment. We demonstrate the reproducible effects of metformin treatment on the human and murine gut mycobiome and highlight a need to consider metformin as a confounding factor in investigations between type 2 diabetes mellitus and the gut microbial ecosystem.

Prevalence of Hypoglycemia and Its Determinants Among Diabetes Patients on Insulin Treatment at Tepi General Hospital, Southwest, Ethiopia

Background

Hypoglycemia occurs when the blood sugar levels are too low. In severe cases, hypoglycemia may give to seizures, coma, and sometimes death. The prevalence of hypoglycemia among patients with diabetes is likely underreported and undocumented.

Methods

An institutional-based cross-sectional study was conducted among 336 study participants at the Tepi General Hospital in Southwest Ethiopia. A binary logistic regression model was used to determine the association between the prevalence of hypoglycemia and the factors associated with it. After a bivariate analysis, variables with a p value of < 0.25 were selected as a candidate for multivariable analysis. An odds ratio with a 95% CI was considered to indicate a significant association.

Results

With 95% CI (52.48-62.25) the prevalence of hypoglycemia was determined as 57.44%. Nearly 11% of the patients encounter severe hypoglycemia. Female patients had three times higher odds of experiencing hypoglycemia (aOR=3, 95% CI: 2.10, 6.39). Those with no formal education had 1.5 times higher odds of experiencing hypoglycemia (aOR = 1.5, 95% CI: 1.08, 5.45). Patients with type 1 diabetes were 3.4 times more likely to experience hypoglycemia (aOR = 3.4, 95% CI: 1.87, 7.50). Those who had been diagnosed before 10 years (aOR = 1.3, 95% CI: 1.02, 3.21) were more likely to have hypoglycemia. Furthermore, patients who consumed alcohol were 3.0 times more likely to have a history of hypoglycemia (aOR = 3.0, 95% CI: 2.03, 6.43).

Conclusion

The magnitude of hypoglycemia among patients with diabetes is determined to be considerable with more than half of the participants encountered hypoglycemia. There is a strong relationship between the occurrence of hypoglycemia and sex, type of diabetes, time since diagnosis, alcohol status, and education status. Therefore, all concerned parties must pay close attention to lessen the prevalence of hypoglycemia and address the problems based on the primary contributing factors.

The Relationship between a High Carbohydrate Diet and Oral Glucose Tolerance Test in Pregnancy

OBJECTIVE

The aim of this study is to examine the impact of carbohydrate ratios in the diet consumed one day prior to the 75-g oral glucose screening test on both the screening test values and the diagnosis of gestational diabetes mellitus in the unselective pregnant population.

MATERIAL-METHOD

83 pregnant women who were under observation in the antenatal clinic of our hospital and underwent glucose tolerance tests were included in the study. The patients were given training by a dietitian to keep nutrition records of the day prior to glucose loading during their previous visits before any glucose loading. A carbohydrate intake of 40-60% was considered as the normal range in terms of the percentage of carbohydrates in the diet. A carbohydrate percentage above 60% was considered to be a high carbohydrate intake. The carbohydrate percentages in their diet over the past 24 hours was compared with the effect on the glucose tolerance test.

RESULTS

Out of the 83 pregnant women included in the study, 40 of them had a high carbohydrate diet (HCD) prior to the oral glucose tolerance test (OGTT), and the average carbohydrate percentage of this diet was found to be 62%. The remaining 43 patients had an average carbohydrate percentage of 49% and belonged to the group that had a normal carbohydrate diet (NCD). Out of the 83 pregnant women, 33 of them were at high risk for gestational diabetes mellitus (GDM). In the high-risk patient group, 16 patients had an NCD intake, while 17 patients had a HCD intake. It was determined that a high carbohydrate diet had no significant effect on fasting, first-hour, and second-hour glucose levels, as well as the diagnosis of gestational diabetes mellitus (GDM), in both the unselective population and the high-risk patient population.

CONCLUSION

In our study, we concluded that the high carbohydrate ratios in the diets of pregnant women one day prior did not affect the OGTT results or the GDM ratios. This indicates that there is no need for a preparatory diet prior to the OGTT in women with normal dietary habits.

Association of ADIPOQ Gene Polymorphisms with Type 2 Diabetes and Obesity Risk in the Kazakh Population: A Case-Control and Population-Based Study

Type 2 diabetes mellitus (T2DM) is a socially significant disease with increasing prevalence worldwide. It is characterized by heterogeneous metabolic disorders and is associated with various risk factors, including BMI, abnormal lipid levels, hypertension, smoking, dietary preferences, physical inactivity, sedentary lifestyle, family history of diabetes, prediabetes or gestational diabetes, inflammation, intrauterine environment, age, sex, ethnicity, and socioeconomic status. Assessing the genetic risk of developing T2DM in specific populations remains relevant. The ADIPOQ gene, encoding adiponectin, is directly related to the risk of developing T2DM, obesity, and cardiovascular diseases. Our study demonstrated significant associations of ADIPOQ gene polymorphisms with the risk of developing T2DM and obesity, as well as with fasting glucose levels and BMI, in the Kazakh population. Specifically, rs266729 was significantly associated with T2DM and obesity in the Kazakh population, while other studied polymorphisms (rs1501299, rs2241766, and rs17846866) did not show a significant association. These findings suggest that ADIPOQ gene polymorphisms may influence T2DM risk factors and highlight the importance of genetic factors in T2DM development. However, further research in larger cohorts is needed to confirm these associations.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with type 2 diabetes mellitus: recent findings from NHANES 2007-2018

OBJECTIVE

This study aims to assess the relationship between NHHR (non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio) and Type 2 diabetes mellitus (T2DM) in US adults, using National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2018.

METHODS

This study explored the connection between NHHR and T2DM by analyzing a sample reflecting the adult population of the United States (n = 10,420; NHANES 2007-2018). NHHR was characterized as the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol. T2DM was defined based on clinical guidelines. This research used multivariable logistic models to examine the connection between NHHR and T2DM. Additionally, it included subgroup and interaction analyses to assess variations among different groups. Generalized additive models, smooth curve fitting, and threshold effect analysis were also employed to analyze the data further.

RESULTS

The study included 10,420 subjects, with 2160 diagnosed with T2DM and 8260 without. The weighted multivariate logistic regression model indicated an 8% higher probability of T2DM for each unit increase in NHHR (OR: 1.08, 95% CI: 1.01-1.15) after accounting for all covariates. Subgroup analysis outcomes were uniform across various categories, demonstrating a significant positive relationship between NHHR and T2DM. Interaction tests showed that the positive link between NHHR and T2DM remained consistent regardless of age, body mass index, smoking status, moderate recreational activities, hypertension, or stroke history, with all interaction P-values exceeding 0.05. However, participants' sex appeared to affect the magnitude of the connection between NHHR and T2DM (interaction P-value < 0.05). Also, a nonlinear association between NHHR and T2DM was discovered, featuring an inflection point at 1.50.

CONCLUSIONS

Our study suggests that an increase in NHHR may be correlated with a heightened likelihood of developing T2DM. Consequently, NHHR could potentially serve as a marker for estimating the probability of T2DM development.

Lipids as potential mediators linking body mass index to diabetes: evidence from a mediation analysis based on the NAGALA cohort

BACKGROUND

Body mass index (BMI) and lipid disorders are both known to be strongly associated with the development of diabetes, however, the indirect effect of lipid parameters in the BMI-related diabetes risk is currently unknown. This study aimed to investigate the mediating role of lipid parameters in the association of BMI with diabetes risk.

METHODS

We assessed the association of diabetes risk with BMI, as well as lipid parameters including high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-CF and LDL-CS), triglycerides(TG), total cholesterol(TC), remnant cholesterol(RC), non-HDL-C, and combined indices of lipid parameters with HDL-C (RC/HDL-C ratio, TG/HDL-C ratio, TC/HDL-C ratio, non-HDL/HDL-C ratio, LDL/HDL-C ratio) using data from 15,453 subjects in the NAGALA project. Mediation models were used to explore the mediating role of lipid parameters in the association of BMI with diabetes risk, and mediation percentages were calculated for quantifying the strength of the indirect effects. Finally, receiver operating characteristic curve (ROC) analysis was used to compare the accuracy of BMI and BMI combined with lipid parameters in predicting incident diabetes.

RESULTS

Multivariate regression models, adjusted for confounding factors, demonstrated robust associations of lipid parameters, BMI, with diabetes risk, with the exception of TC, LDL-CF, LDL-CS, and non-HDL-C. Mediation analysis showed that lipid parameters except TC, LDL-CF, LDL-CS, and Non-HDL-C were involved in and mediated the association of BMI with diabetes risk, with the largest mediation percentage being the RC/HDL-C ratio, which was as high as 40%; it is worth mentioning that HDL-C and HDL-C-related lipid ratio parameters also play an important mediating role in the association between BMI and diabetes, with the mediator proportion being greater than 30%. Finally, based on the ROC results, we found that the prediction performance of all lipid parameters in the current study except TC was significantly improved when combined with BMI.

CONCLUSION

Our fresh findings suggested that lipid parameters partially mediated the association of BMI with diabetes risk; this result indicated that in the context of diabetes risk screening and disease management, it is important to not only monitor BMI but also pay attention to lipid parameters, particularly HDL-C and HDL-C-related lipid ratio parameters.

Remnant Cholesterol is More Strongly Associated with Arterial Stiffness than Traditional Lipids and Lipid Ratios in the General Chinese Population

AIM

Studies on the relationship between remnant cholesterol (RC) and arterial stiffness (AS) are limited. This study aims to investigate the relationship between RC and AS and to explore RC, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), non-HDL-C, LDL-C/HDL-C, TG/HDL-C, lipoprotein combine index (LCI), and TC/HDL-C, which are lipid parameters most strongly associated with AS.

METHODS

A total of 4653 participants from the REACTION (Risk Evaluation of Cancers in Chinese Diabetic Individuals) study were recruited. AS was defined as a brachial-ankle pulse wave velocity of ≥ 1400 cm/s. Multiple logistic regression analyses were performed to detect its association with lipid parameters (RC, TG, TC, HDL-C, LDL-C, non-HDL-C, LDL-C/HDL-C, TG/HDL-C, LCI, and TC/HDL-C).

RESULTS

Logistic regression analysis showed that compared with other traditional or non-traditional lipid parameters, the association between RC and AS was the strongest (odds ratio (OR) 1.59, 95% confidence interval (CI) 1.30-1.95, P＜0.001). In the stratified analysis, RC was significantly associated with AS in both sexes and at any age, as well as blood glucose, blood pressure, and body mass index levels. Besides, RC and AS were still significantly associated when TG＜1.7 mmol/L (OR:1.58, 95% CI: 1.02-2.45, P=0.04), LDL-C ＜3.4 mmol/L (OR:1.32, 95% CI: 1.01-1.73, P=0.041), HDL-C ≥ 1.0 mmol/L (OR:1.67, 95% CI: 1.34-2.08, P＜0.001), or non-HDL-C＜4.1 mmol/L (OR: 1.42, 95% CI: 1.10-1.82, P=0.007) are controlled within the appropriate range.

CONCLUSION

In conclusion, compared with traditional lipids and lipid ratios, RC is more strongly associated with AS. The association between RC and AS remains significant even when TG, LDL-C, HDL-C, or non-HDL-C levels are controlled within the appropriate range.

The Association between Body Mass Index and Glycohemoglobin (HbA1c) in the US Population's Diabetes Status

Obesity, indicated by Body Mass Index (BMI), is a risk factor for type 2 diabetes. However, its association with glycated hemoglobin (HbA1c), a crucial indicator of blood-sugar control, may vary across different populations and disease statuses. Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 were analyzed. Participants aged 18-79 years with complete information on BMI, diabetes status, and HbA1c were included (n = 4003). Linear regression models were used to assess the association between BMI and HbA1c, adjusting for demographic confounders, smoking status, alcohol consumption, and healthcare access. Among participants without diabetes, BMI was positively associated with HbA1c levels (coefficient: 0.015, 95% CI: 0.01, 0.02; p-value < 0.05), after adjusting for potential confounders. However, this association was not significant among those with diabetes (coefficient: -0.005, 95% CI: -0.05, 0.04; p-value > 0.1). Our findings suggest a differential relationship between BMI and HbA1c in individuals with and without diabetes. While BMI remains a significant predictor of HbA1c in non-diabetic individuals, its significance diminishes in those with diabetes.

Combining diaries and accelerometers to explain change in physical activity during a lifestyle intervention for adults with pre-diabetes: A PREVIEW sub-study

Self-report and device-based measures of physical activity (PA) both have unique strengths and limitations; combining these measures should provide complementary and comprehensive insights to PA behaviours. Therefore, we aim to 1) identify PA clusters and clusters of change in PA based on self-reported daily activities and 2) assess differences in device-based PA between clusters in a lifestyle intervention, the PREVIEW diabetes prevention study. In total, 232 participants with overweight and prediabetes (147 women; 55.9 ± 9.5yrs; BMI ≥25 kg·m-2; impaired fasting glucose and/or impaired glucose tolerance) were clustered using a partitioning around medoids algorithm based on self-reported daily activities before a lifestyle intervention and their changes after 6 and 12 months. Device-assessed PA levels (PAL), sedentary time (SED), light PA (LPA), and moderate-to-vigorous PA (MVPA) were assessed using ActiSleep+ accelerometers and compared between clusters using (multivariate) analyses of covariance. At baseline, the self-reported "walking and housework" cluster had significantly higher PAL, MVPA and LPA, and less SED than the "inactive" cluster. LPA was higher only among the "cycling" cluster. There was no difference in the device-based measures between the "social-sports" and "inactive" clusters. Looking at the changes after 6 months, the "increased walking" cluster showed the greatest increase in PAL while the "increased cycling" cluster accumulated the highest amount of LPA. The "increased housework" and "increased supervised sports" reported least favourable changes in device-based PA. After 12 months, there was only minor change in activities between the "increased walking and cycling", "no change" and "increased supervised sports" clusters, with no significant differences in device-based measures. Combining self-report and device-based measures provides better insights into the behaviours that change during an intervention. Walking and cycling may be suitable activities to increase PA in adults with prediabetes.