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Chen GC, Huang X, Ruan ZB, Zhu L, Wang MX, Lu Y, Tang CC. Fasting blood glucose predicts high risk of in-stent restenosis in patients undergoing primary percutaneous coronary intervention: a cohort study. SCAND CARDIOVASC J 2023; 57:2286885. [PMID: 38010775 DOI: 10.1080/14017431.2023.2286885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Abstract
Objectives. Studies have shown that fasting blood glucose (FBG) is closely associated with poor prognosis in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI), but its association with in-stent restenosis (ISR) is still unclear. Therefore, this study was to explore the association between FBG with ISR in patients with CHD after PCI. Design. In this cohort study, we included 531 patients with CHD who underwent PCI. Logistic regression, receiver operating characteristic (ROC), subgroup analysis and restricted cubic spline (RCS) were used to assess the association between FBG with ISR. Results. A total of 124 (23.4%) patients had ISR. Patients with higher levels of FBG had higher incidence of ISR compared to those with lower levels of FBG (p = 0.002). In multivariable logistic regression analyses, higher levels of FBG remained strongly associated with higher risk of ISR (as a categorical variable, OR: 1.89, 95% CI: 1.21-2.94, p = 0.005; as a continuous variable, OR: 1.12, 95% CI: 1.03-1.23, p = 0.011). ROC analysis also showed that FBG might be associated with the occurrence of ISR (AUC = 0.577, 95% CI: 0.52-0.64, p = 0.013). Subgroup analyses showed the association of FBG with ISR was also stable in several subgroups (< 60 years or ≥ 60 years, male, with or without smoking, without diabetes and without hypertension). And RCS analysis showed that FBG was linearly and positively associated with the risk of ISR. Conclusions. Higher levels of FBG were closely associated with higher risk of ISR in patients with CHD after PCI.
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Affiliation(s)
- Ge-Cai Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, PR China
- Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
| | - Xu Huang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, PR China
| | - Zhong-Bao Ruan
- Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
| | - Li Zhu
- Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
| | - Mei-Xiang Wang
- Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
| | - Yi Lu
- Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
| | - Cheng-Chun Tang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, PR China
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Forray AI, Coman MA, Simonescu-Colan R, Mazga AI, Cherecheș RM, Borzan CM. The Global Burden of Type 2 Diabetes Attributable to Dietary Risks: Insights from the Global Burden of Disease Study 2019. Nutrients 2023; 15:4613. [PMID: 37960266 PMCID: PMC10648266 DOI: 10.3390/nu15214613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
The Global Burden of Disease Study (GBD) 2019 reveals an increasing prevalence of Type 2 Diabetes Mellitus (T2DM) from 1990 to 2019. This study delves into the role of dietary risk factors across different demographic and socioeconomic groups. Utilizing data from the GBD 2019, it analyzes age-adjusted T2DM metrics-death counts, Disability-Adjusted Life Years (DALYs), and Age-Standardized Rates (ASRs)-stratified by age, sex, and region. The study employed Estimated Annual Percentage Changes (EAPCs) to track trends over time. The results show that in 2019, 26.07% of T2DM mortality and 27.08% of T2DM DALYs were attributable to poor diets, particularly those low in fruits and high in red and processed meats. There was a marked increase in both the death rate and DALY rate associated with dietary risks over this period, indicating the significant impact of dietary factors on the global T2DM landscape. Geographic variations in T2DM trends were significant, with regions like Southern Sub-Saharan Africa and Central Asia experiencing the most substantial increases in Age-Standardized Mortality Rate (ASMR) and Age-Standardized DALY Rate (ASDR). A positive correlation was noted between Socio-Demographic Index (SDI) and T2DM burden due to dietary risk factors. The study concludes that targeted public health initiatives promoting dietary changes could substantially reduce the global T2DM burden.
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Affiliation(s)
- Alina Ioana Forray
- Discipline of Public Health and Management, Department of Community Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Victor Babeș 8, 400347 Cluj-Napoca, Romania
| | - Mădălina Adina Coman
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, General Traian Moșoiu 71, 400132 Cluj-Napoca, Romania (R.S.-C.)
| | - Ruxandra Simonescu-Colan
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, General Traian Moșoiu 71, 400132 Cluj-Napoca, Romania (R.S.-C.)
| | - Andreea Isabela Mazga
- Faculty of General Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Răzvan Mircea Cherecheș
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, General Traian Moșoiu 71, 400132 Cluj-Napoca, Romania (R.S.-C.)
| | - Cristina Maria Borzan
- Discipline of Public Health and Management, Department of Community Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Victor Babeș 8, 400347 Cluj-Napoca, Romania
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Burgess AJ, Williams DM, Collins K, Roberts R, Burberry DJ, Stephens JW, Davies EA. Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department. Eur Geriatr Med 2023; 14:1105-1110. [PMID: 37612537 DOI: 10.1007/s41999-023-00848-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2D) is associated with poor health outcomes whilst tight glycaemic targets are questionable in those aged over 70 years with increased frailty. Our aim was to examine whether people with T2D admitted to hospital with a fall, were more likely to have greater frailty, increased mortality and co-morbidity burden, or risk factors for falls than people without T2D, and whether these differences were associated with medications used for the treatment of T2D. METHODS The Older Persons Assessment Service (OPAS) is a local emergency department (ED) service, which accepts patients on frailty criteria. The OPAS accepts patients primarily aged over 70 years who present with frailty and geriatric syndromes such as falls, with retrieval from the ED department directly to the service from triage. The OPAS databank was analysed for people with T2D admitted with a fall between June 2020-September 2022. We examined clinical outcomes relating to medication, age, Charlson co-morbidity index (CCI) and clinical frailty score (CFS). RESULTS 1081 patients were included: 294 (27.2%) with T2D and a mean HbA1c of 53.9 (± 15.8) mmol/mol [7.1%]. People with T2D had a similar mean CFS and age compared to those without T2D, but higher mean CCI (7.0 ± 2.2 vs 5.9 ± 2.1, p < 0.001). Of those people with T2D, 175 (59.5%) and 240 (81.6%) had a HbA1c ≤ 53 mmol/mol [7.0%] and ≤ 64 mmol/mol [8.0%], respectively. In total, 48 (16.3%) people with T2D were identified to have a capillary blood glucose below 4.0 mmol/L on admission to the ED. At 12 months' follow-up, 831 (76.9%) patients were alive and 250 (23.1%) had died. People with T2D treated with insulin and/or gliclazide had a greater 1-year mortality (36.6% vs 23.6%, p < 0.05), greater frequency of hypoglycaemia (35.4% vs 11.8%, p < 0.001), and greater HbA1c (65.5 ± 17.2 mmol/mol [8.2] vs 48.9 ± 12.1 mmol/mol [6.6%]) compared to those who used other agents. Logistic regression confirmed a diagnosis of T2D was associated with 1-year mortality, but mortality was not significantly associated with hypoglycaemic-inducing agents. People with T2D were not more likely to live in deprived areas. CONCLUSIONS A diagnosis of T2D is associated with greater 1-year mortality, and may be influenced by use of hypoglycaemia-inducing diabetes medications. Clinician awareness can support de-prescribing for patients with frailty and HbA1c < 64 mmol/mol.
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Affiliation(s)
- Alexandra J Burgess
- Older Person's Assessment Service (OPAS), Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales.
- Diabetes Research Group, Swansea University Medical School, Swansea, Wales.
| | - David M Williams
- Diabetes Centre, Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales
- Diabetes Research Group, Swansea University Medical School, Swansea, Wales
| | - Kyle Collins
- Older Person's Assessment Service (OPAS), Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales
| | - Richard Roberts
- Diabetes Centre, Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales
- Diabetes Research Group, Swansea University Medical School, Swansea, Wales
| | - David J Burberry
- Older Person's Assessment Service (OPAS), Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales
| | - Jeffrey W Stephens
- Diabetes Centre, Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales
- Diabetes Research Group, Swansea University Medical School, Swansea, Wales
| | - Elizabeth A Davies
- Older Person's Assessment Service (OPAS), Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales
- Diabetes Research Group, Swansea University Medical School, Swansea, Wales
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Vivek S, Crimmins EM, Prizment AE, Meier HCS, Ramasubramanian R, Barcelo H, Faul J, Thyagarajan B. Age-related Differences in T-cell Subsets and Markers of Subclinical Inflammation in Aging Are Independently Associated With Type 2 Diabetes in the Health and Retirement Study. Can J Diabetes 2023; 47:594-602.e6. [PMID: 37269981 PMCID: PMC10592537 DOI: 10.1016/j.jcjd.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Age-related changes in adaptive immunity and subclinical inflammation are both important risk factors for diabetes in older adults. We evaluated the independent association between T-cell subsets, subclinical inflammation, and diabetes risk in the Health and Retirement Study (HRS). METHODS We measured 11 T-cell subsets, 5 pro-inflammatory markers, and 2 anti-inflammatory markers from the 2016 wave of the HRS (baseline). Diabetes/prediabetes status was estimated at the 2016, 2018, and 2020 waves of HRS, based on levels of blood glucose/glycated hemoglobin in plasma or self-reported status. We used survey generalized logit models to evaluate the cross-sectional associations and Cox proportional hazard models to evaluate longitudinal associations. RESULTS Among 8,540 participants (56 to 107 years of age), 27.6% had prevalent type 2 diabetes and 31.1% had prediabetes in the 2016 survey. After adjusting for age, sex, race/ethnicity, education, obesity, smoking, comorbidity index, and cytomegalovirus seropositivity, individuals with type 2 diabetes had lower naive T cells and higher memory and terminal effector T cells as compared with normoglycemic individuals. Among 3,230 normoglycemic participants in the 2016 survey, the incidence of diabetes was 1.8% over 4 years of follow-up. The baseline percentage of CD4+ effector memory T cells was associated with a lower risk of incident diabetes (hazard ratio [HR]=0.63, 95% confidence interval [CI] 0.49 to 0.80, p=0.0003) after adjustment for covariates. Baseline level of interleukin-6 (IL-6) was associated with risk of incident diabetes (HR=1.52, 95% CI 1.18 to 1.97, p=0.002). The associations between age-related changes in CD4+ effector memory T cells and risk of incident diabetes remained unchanged after adjustment for subclinical inflammation, although adjusting for CD4+ effector memory T cells nullified the association between IL-6 and incident diabetes. CONCLUSIONS This study showed that the baseline percentage of CD4+ effector memory T cells was inversely associated with incident diabetes independent of subclinical inflammation, but CD4+ effector memory T-cell subsets affected the relationship between IL-6 and incident diabetes. Further studies are needed to confirm and investigate mechanisms by which T-cell immunity affects diabetes risk.
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Affiliation(s)
- Sithara Vivek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Anna E Prizment
- Division of Hematology, Oncology and Transplantation, Medical School, University of Minnesota, Minneapolis, Minnesota, United States
| | - Helen C S Meier
- Institute for Social Research, Survey Research Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Ramya Ramasubramanian
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States
| | - Helene Barcelo
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Jessica Faul
- Institute for Social Research, Survey Research Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, United States.
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John S, Hester S, Basij M, Paul A, Xavierselvan M, Mehrmohammadi M, Mallidi S. Niche preclinical and clinical applications of photoacoustic imaging with endogenous contrast. PHOTOACOUSTICS 2023; 32:100533. [PMID: 37636547 PMCID: PMC10448345 DOI: 10.1016/j.pacs.2023.100533] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 08/29/2023]
Abstract
In the past decade, photoacoustic (PA) imaging has attracted a great deal of popularity as an emergent diagnostic technology owing to its successful demonstration in both preclinical and clinical arenas by various academic and industrial research groups. Such steady growth of PA imaging can mainly be attributed to its salient features, including being non-ionizing, cost-effective, easily deployable, and having sufficient axial, lateral, and temporal resolutions for resolving various tissue characteristics and assessing the therapeutic efficacy. In addition, PA imaging can easily be integrated with the ultrasound imaging systems, the combination of which confers the ability to co-register and cross-reference various features in the structural, functional, and molecular imaging regimes. PA imaging relies on either an endogenous source of contrast (e.g., hemoglobin) or those of an exogenous nature such as nano-sized tunable optical absorbers or dyes that may boost imaging contrast beyond that provided by the endogenous sources. In this review, we discuss the applications of PA imaging with endogenous contrast as they pertain to clinically relevant niches, including tissue characterization, cancer diagnostics/therapies (termed as theranostics), cardiovascular applications, and surgical applications. We believe that PA imaging's role as a facile indicator of several disease-relevant states will continue to expand and evolve as it is adopted by an increasing number of research laboratories and clinics worldwide.
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Affiliation(s)
- Samuel John
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Scott Hester
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Maryam Basij
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Avijit Paul
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | | | - Mohammad Mehrmohammadi
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Wilmot Cancer Institute, Rochester, NY, USA
| | - Srivalleesha Mallidi
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
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Cross W, Srivastava S. A Double-Blind, Randomized, Placebo-Controlled Study to Assess the Efficacy of a Nerve Support Formula on Neuropathic Pain in Individuals Suffering from Type II Diabetes Mellitus. J Pain Res 2023; 16:1115-1126. [PMID: 37020664 PMCID: PMC10069439 DOI: 10.2147/jpr.s397777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/01/2023] [Indexed: 03/31/2023] Open
Abstract
Background The primary objective of the present study was to evaluate the effects of a Nerve Support Formula NeuropAWAY® on diabetic neuropathic pain. Methods This double-blind, placebo-controlled, randomized trial was conducted between August 2020 and February 2021. Patients aged ≥40 and ≤65 years with a history of type 2 diabetes (T2D) with a confirmed diagnosis of diabetic neuropathic pain were included in the study. The primary efficacy endpoint was to assess the effect of the 42 days administration of the Nerve Support Formula on the neuropathic pain as assessed by the 11 point Pain Intensity Numeric Rating Scale (PI-NRS). The secondary objectives were to assess the effect on plasma vitamin B12 levels, nerve conduction velocity, blood flow velocity, Brief Pain Inventory, Neuropathy Total Symptom Score, and Insomnia Severity Index. Results The enrolled study population (n=59) was randomized in two study groups; the Investigational Product (IP) group - Nerve Support Formula (n=27) and placebo group (n=32). The mean age of these participants was 52.63 and 53.72 for IP and placebo group, respectively. The mean (SD) HbA1c levels for IP and placebo group were 8.37 (0.85) and 8.16 (0.86), respectively. By the end of the study (Day 42) the decrease in PI-NRS scores for the IP group was maximal (↓61.32%) and highly significant (p<0.001) in comparison to the placebo group (↑2.47%). Significant improvements (p<0.05) were also noted in the secondary efficacy variables after 42 days of IP intake. Conclusion The formula was found to be significantly effective as compared to placebo in reducing pain and other sensory symptoms related to the diabetic peripheral neuropathy.
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Affiliation(s)
| | - Shalini Srivastava
- Clinical Development, Vedic Lifesciences, Thane, India
- Correspondence: Dr Shalini Srivastava, 118, Morya House, Opp. Infinity Mall, Andheri (West), Mumbai, 400053, Maharashtra, India, Email
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7
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Mistry S, Riches NO, Gouripeddi R, Facelli JC. Environmental exposures in machine learning and data mining approaches to diabetes etiology: A scoping review. Artif Intell Med 2023; 135:102461. [PMID: 36628796 PMCID: PMC9834645 DOI: 10.1016/j.artmed.2022.102461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/06/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Environmental exposures are implicated in diabetes etiology, but are poorly understood due to disease heterogeneity, complexity of exposures, and analytical challenges. Machine learning and data mining are artificial intelligence methods that can address these limitations. Despite their increasing adoption in etiology and prediction of diabetes research, the types of methods and exposures analyzed have not been thoroughly reviewed. OBJECTIVE We aimed to review articles that implemented machine learning and data mining methods to understand environmental exposures in diabetes etiology and disease prediction. METHODS We queried PubMed and Scopus databases for machine learning and data mining studies that used environmental exposures to understand diabetes etiology on September 19th, 2022. Exposures were classified into specific external, general external, or internal exposures. We reviewed machine learning and data mining methods and characterized the scope of environmental exposures studied in the etiology of general diabetes, type 1 diabetes, type 2 diabetes, and other types of diabetes. RESULTS We identified 44 articles for inclusion. Specific external exposures were the most common exposures studied, and supervised models were the most common methods used. Well-established specific external exposures of low physical activity, high cholesterol, and high triglycerides were predictive of general diabetes, type 2 diabetes, and prediabetes, while novel metabolic and gut microbiome biomarkers were implicated in type 1 diabetes. DISCUSSION The use of machine learning and data mining methods to elucidate environmental triggers of diabetes was largely limited to well-established risk factors identified using easily explainable and interpretable models. Future studies should seek to leverage machine learning and data mining to explore the temporality and co-occurrence of multiple exposures and further evaluate the role of general external and internal exposures in diabetes etiology.
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Affiliation(s)
- Sejal Mistry
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; Center of Excellence for Exposure Health Informatics, University of Utah, Salt Lake City, UT, USA
| | - Naomi O Riches
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; Center of Excellence for Exposure Health Informatics, University of Utah, Salt Lake City, UT, USA; Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ramkiran Gouripeddi
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; Center of Excellence for Exposure Health Informatics, University of Utah, Salt Lake City, UT, USA; Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA
| | - Julio C Facelli
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; Center of Excellence for Exposure Health Informatics, University of Utah, Salt Lake City, UT, USA; Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA.
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Huber J, Smeikal M, Saely CH, Stingl H, Clodi M, Lechleitner M, Fasching P. [Geriatric aspects for the management of diabetes mellitus (Update 2023)]. Wien Klin Wochenschr 2023; 135:307-318. [PMID: 37101051 PMCID: PMC10133361 DOI: 10.1007/s00508-022-02124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 04/28/2023]
Abstract
There is a high prevalence of diabetes mellitus in the elderly population of industrial countries. The present article provides recommendations for the screening, prevention and treatment of elderly diabetic patients according to current scientific evidence.
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Affiliation(s)
- Joakim Huber
- Abteilung für Innere Medizin mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Landstraßer Hauptstraße 4a, 1030 Wien, Österreich
| | - Michael Smeikal
- Abteilung für Innere Medizin mit allgemeiner Geriatrie und Palliativmedizin, Haus der Barmherzigkeit, Wien, Österreich
| | - Christoph H. Saely
- Abteilung für Innere Medizin und Kardiologie/VIVIT-Institut, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Harald Stingl
- Interne Abteilung, Landesklinikum Melk, Melk, Österreich
| | - Martin Clodi
- ICMR—Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz (JKU Linz), 4040 Linz, Österreich
| | - Monika Lechleitner
- Interne Abteilung, Landeskrankenhaus Hochzirl – Natters, Hochzirl, Österreich
| | - Peter Fasching
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring der Stadt Wien, Wien, Österreich
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Stevens S, Gallagher S, Andrews T, Ashall-Payne L, Humphreys L, Leigh S. The effectiveness of digital health technologies for patients with diabetes mellitus: A systematic review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:936752. [PMID: 36992773 PMCID: PMC10012107 DOI: 10.3389/fcdhc.2022.936752] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
IntroductionDiabetes mellitus (DM) is a leading cause of morbidity and mortality worldwide. At the same time, digital health technologies (DHTs), which include mobile health apps (mHealth) have been rapidly gaining popularity in the self-management of chronic diseases, particularly following the COVID-19 pandemic. However, while a great variety of DM-specific mHealth apps exist on the market, the evidence supporting their clinical effectiveness is still limited.MethodsA systematic review was performed. A systematic search was conducted in a major electronic database to identify randomized controlled trials (RCTs) of mHealth interventions in DM published between June 2010 and June 2020. The studies were categorized by the type of DM and impact of DM-specific mHealth apps on the management of glycated haemoglobin (HbA1c) was analysed.ResultsIn total, 25 studies comprising 3,360 patients were included. The methodological quality of included trials was mixed. Overall, participants diagnosed with T1DM, T2DM and Prediabetes all demonstrated greater improvements in HbA1c as a result of using a DHT compared with those who experienced usual care. The analysis revealed an overall improvement in HbA1c compared with usual care, with a mean difference of –0.56% for T1DM, –0.90% for T2DM and –0.26% for Prediabetes.ConclusionDM-specific mHealth apps may reduce HbA1c levels in patients with T1DM, T2DM and Prediabetes. The review highlights a need for further research on the wider clinical effectiveness of diabetes-specific mHealth specifically within T1DM and Prediabetes. These should include measures which go beyond HbA1c, capturing outcomes including short-term glycemic variability or hypoglycemic events.
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Affiliation(s)
- Sebastian Stevens
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- *Correspondence: Sebastian Stevens,
| | - Susan Gallagher
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
| | - Tim Andrews
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
- Warwick Medical School (WMS), The University of Warwick, Coventry, United Kingdom
| | - Liz Ashall-Payne
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
- Warwick Medical School (WMS), The University of Warwick, Coventry, United Kingdom
| | - Lloyd Humphreys
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
| | - Simon Leigh
- Research Department, Organisation for the Review of Care and Health Applications, Daresbury, United Kingdom
- Warwick Medical School (WMS), The University of Warwick, Coventry, United Kingdom
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Zhou J, Zhang G, Chang C, Chou OHI, Lee S, Leung KSK, Wong WT, Liu T, Wai AKC, Cheng SH, Zhang Q, Tse G. Metformin versus sulphonylureas for new onset atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based study. Acta Diabetol 2022; 59:697-709. [PMID: 35112189 DOI: 10.1007/s00592-021-01841-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/18/2021] [Indexed: 11/01/2022]
Abstract
AIMS To gain insights on the cardiovascular effects of metformin and sulphonylurea, the present study compares the rates of incident atrial fibrillation, stroke, cardiovascular mortality and all-cause mortality between metformin and sulphonylurea users in type 2 diabetes mellitus. METHODS This was a retrospective population-based cohort study of type 2 diabetes mellitus patients receiving either sulphonylurea or metformin monotherapy between January 1, 2000, and December 31, 2019. The primary outcome was new-onset AF or stroke. Secondary outcomes were cardiovascular, non-cardiovascular and all-cause mortality. Propensity score matching (1:2 ratio) between sulphonylurea and metformin users was performed, based on demographics, CHA-DS-VASc score, past comorbidities and medication use. Cox regression was used to identify significant risk factors. Competing risk analysis was conducted using cause-specific and subdistribution hazard models. Sensitivity analyses using propensity score stratification, high-dimensional propensity score and inverse probability of treatment weighting were conducted. Subgroup analyses were conducted for age and gender in the matched cohort. RESULTS A total of 36,228 sulphonylurea users and 72,456 metformin users were included in the propensity score-matched cohort. Multivariable Cox regression showed that sulphonylurea users had higher risks of incident AF (hazard ratio [HR]: 2.89, 95% confidence interval [CI]: 2.75-3.77; P < 0.0001), stroke (HR: 3.23, 95% CI: 3.01-3.45; P < 0.0001), cardiovascular mortality (HR: 3.60, 95% CI: 2.62-4.81; P < 0.0001) and all-cause mortality (HR: 4.35, 95% CI: 3.16-4.75; P < 0.0001) compared to metformin users. Similarly, significant results were observed using cause-specific and subdistribution hazard models. Sensitivity analysis using techniques based on the propensity score also yielded similar results. CONCLUSIONS Sulphonylurea use was associated with higher risks of incident AF, stroke, cardiovascular mortality and all-cause mortality compared to metformin. Males and patients older than 65 years with sulphonylurea use were exposed to the highest risks.
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Affiliation(s)
- Jiandong Zhou
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Guoming Zhang
- Emergency Department, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Carlin Chang
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Oscar Hou In Chou
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
- Diabetes Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China
| | - Sharen Lee
- Diabetes Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China
| | - Keith Sai Kit Leung
- Aston Medical School, Aston University, Birmingham, UK
- Emergency Medicine Unit, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shuk Han Cheng
- School of Biomedical Sciences, City University of Hong Kong, Hong Kong, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Kowloon City, Hong Kong, China.
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
- Kent and Medway Medical School, Canterbury, UK.
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11
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Knowledge about the Risk of Cardiovascular Disease among Adults with Type 2 Diabetes Visiting the Outpatient Clinics at Tertiary Hospital in Riyadh, Saudi Arabia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094996. [PMID: 35564389 PMCID: PMC9103839 DOI: 10.3390/ijerph19094996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/06/2023]
Abstract
Background: One of the primary goals of diabetes management is to prevent cardiovascular events. The rate of cardiovascular diseases (CVDs) is significantly high in the diabetic population. Inadequate knowledge of CVDs risk in diabetes may result in the failure of its early prevention, causing increased morbidity and mortality. The objectives of this study were to assess the CVD risk knowledge and determine the predictors of the knowledge among adults with type 2 diabetes. Methods: A cross-sectional study was conducted to examine the study objectives. Convenience sampling was used to recruit adults with type 2 diabetes mellitus (DM) who visited the King Saud University Medical City (KSUMC) outpatient clinics. Data were collected using the Heart Disease Fact Questionnaire. SPSS software (version 24.0) was used for data analysis. Results: A total of 383 patients were recruited. The level of CVD risk knowledge was high among all participants (19.04 ± 3.47). There were significant differences in knowledge scores between different groups, including age (p = 0.01), marital status (p = 0.01), and type of residence (p = 0.04). Participants who were older than 40 years, married, and lived in traditional houses had higher knowledge scores. Conclusion: The study findings indicated a high level of CVD risk knowledge in our study population. The presence of multidisciplinary intensive education programmes targeting type 2 DM patients, such as that conducted at KSUMC, might be responsible for the higher levels of knowledge among our study population. Thus, increasing the efforts towards the education of patients will improve the level of knowledge, including CVD risk knowledge.
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12
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Ghosh AK, Robinson WL, Gulliver J, Simpson HM. Convergent synthesis of (+)-carambolaflavone A, an antidiabetic agent using a bismuth triflate-catalyzed C-aryl glycosylation. Org Biomol Chem 2022; 20:2822-2830. [PMID: 35156978 PMCID: PMC8986597 DOI: 10.1039/d2ob00038e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We describe a convergent total synthesis of carambolaflavone A, a natural flavonoid C-aryl glycoside with significant antihyperglycemic properties. The synthesis features a bismuth triflate-catalyzed stereoselective C-aryl glycosylation of a flavan derivative and an appropriately protected D-fucose derivative as the key step. Inexpensive and non-toxic bismuth triflate provided the best results among various other Lewis acids screened for this C-aryl glycosylation. The method can be utilized for the synthesis of other bioactive C-glycosyl flavonoids. The glycosylation partners were synthesized from commercially available (±)-naringenin and D-(+)-galactose, respectively. An oxidative bromination and elimination reaction sequence was utilized to construct the flavone. The natural product is obtained in 13 steps (longest linear sequence) from D-(+)-galactose.
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Affiliation(s)
- Arun K Ghosh
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, 560 Oval Drive, West Lafayette, Indiana 47907, USA.
| | - William L Robinson
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, 560 Oval Drive, West Lafayette, Indiana 47907, USA.
| | - John Gulliver
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, 560 Oval Drive, West Lafayette, Indiana 47907, USA.
| | - Hannah M Simpson
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, 560 Oval Drive, West Lafayette, Indiana 47907, USA.
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13
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Leite NJC, Raimundo AMM, Mendes RDC, Marmeleira JFF. Impact of COVID-19 Pandemic on Daily Life, Physical Exercise, and General Health among Older People with Type 2 Diabetes: A Qualitative Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3986. [PMID: 35409672 PMCID: PMC8998106 DOI: 10.3390/ijerph19073986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic has resulted in significant alterations to and implications for the lives of millions of people, and especially for those with pre-existing medical conditions. The aim of this study was to explore the lived experience of older people with type 2 diabetes mellitus (T2DM) throughout the first 9 months of the pandemic, with emphasis on the habits of physical exercise. We conducted a qualitative study using semi-structured interviews. The data consist of telephone interviews of seventeen older people with T2DM (10 women and 7 men, aged 62-76 years). Using thematic analysis, five themes were generated: (1) an altered social and relational life; (2) changes in routine and attitude regarding physical activity behaviour; (3) home-related activities gained relevance; (4) health and well-being impact and management; and (5) thoughts about the post-pandemic period. The increase in the number of cases and the fear of becoming infected with COVID-19 limited the social (i.e., contact with family and/or friends) and functional (i.e., daily routine, the habit of exercising) lives of these people, reverberating negatively on their health and well-being. Feelings of isolation, loneliness, anxiety were common. The findings of this study help to better understand the impact of the pandemic and determine areas of need for future interventions. A multidisciplinary approach is necessary to provide support for older people with T2DM and tackle the negative effect of the pandemic, including the reduction in physical activity.
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Affiliation(s)
- Nilton João Chantre Leite
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7000-727 Évora, Portugal; (A.M.M.R.); (J.F.F.M.)
- Comprehensive Health Research Centre (CHRC), 7000-727 Évora, Portugal
| | - Armando Manuel Mendonça Raimundo
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7000-727 Évora, Portugal; (A.M.M.R.); (J.F.F.M.)
- Comprehensive Health Research Centre (CHRC), 7000-727 Évora, Portugal
| | - Romeu Duarte Carneiro Mendes
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal;
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
- Northern Region Health Administration, 4000-447 Porto, Portugal
| | - José Francisco Filipe Marmeleira
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7000-727 Évora, Portugal; (A.M.M.R.); (J.F.F.M.)
- Comprehensive Health Research Centre (CHRC), 7000-727 Évora, Portugal
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14
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Grammes J, Kubiak T. Diabetes im Alter – Unterstützung Pflegebedürftiger und ihres Umfeldes. DIABETOLOGE 2022. [DOI: 10.1007/s11428-022-00873-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungPflegende An- und Zugehörige leisten einen erheblichen Anteil der häuslichen Pflege von älteren Menschen in Deutschland. Die Pflegesituation geht nicht selten mit biopsychosozialen Belastungen sowohl auf Seiten der Pflegenden als auch der Gepflegten einher. Um eine Gefährdung der Pflegesituation zu vermeiden, sollten Belastungen frühzeitig identifiziert werden. Essenziell ist eine rechtzeitige Aufklärung über Unterstützungs- und Hilfsangebote. Im Kontext der Pflege von Menschen mit Diabetes existieren verschiedene diabetesspezifische Unterstützungsmöglichkeiten (z. B. diabetesorientiertes Pflegeassessment), über die Pflegende informiert werden sollten. Die empathische Würdigung der Belastungen und die Wertschätzung für die Pflegetätigkeit sowie das Hervorheben möglicher positiver Aspekte derselben können entlastend wirken. Im Sinne des Empowerment-Ansatzes sollten sowohl die Bedürfnisse der Pflegenden als auch die der pflegebedürftigen Menschen mit Diabetes in Alltags- und Therapieentscheidungen – falls möglich – miteinbezogen werden.
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15
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Wake AD. Protective effects of physical activity against health risks associated with type 1 diabetes: "Health benefits outweigh the risks". World J Diabetes 2022; 13:161-184. [PMID: 35432757 PMCID: PMC8984568 DOI: 10.4239/wjd.v13.i3.161] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/08/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
The magnitude of diabetes mellitus (DM) has increased in recent decades, where the number of cases and the proportion of the disease have been gradually increasing over the past few decades. The chronic complications of DM affect many organ systems and account for the majority of morbidity and mortality associated with the disease. The prevalence of type 1 DM (T1DM) is increasing globally, and it has a very significant burden on countries and at an individual level. T1DM is a chronic illness that requires ongoing medical care and patient self-management to prevent complications. This study aims to discuss the health benefits of physical activity (PA) in T1DM patients. The present review article was performed following a comprehensive literature search. The search was conducted using the following electronic databases: "Cochrane Library", Web of Science, PubMed, HINARI, EMBASE, Google for grey literature, Scopus, African journals Online, and Google Scholar for articles published up to June 21, 2021. The present review focused on the effects of PA on many outcomes such as blood glucose (BG) control, physical fitness, endothelial function, insulin sensitivity, well-being, the body defense system, blood lipid profile, insulin resistance, cardiovascular diseases (CVDs), insulin requirements, blood pressure (BP), and mortality. It was found that many studies recommended the use of PA for the effective management of T1DM. PA is a component of comprehensive lifestyle modifications, which is a significant approach for the management of T1DM. It provides several health benefits, such as improving BG control, physical fitness, endothelial function, insulin sensitivity, well-being, and the body defense system. Besides this, it reduces the blood lipid profile, insulin resistance, CVDs, insulin requirements, BP, and mortality. Overall, PA has significant and essential protective effects against the health risks associated with T1DM. Even though PA has several health benefits for patients with T1DM, these patients are not well engaged in PA due to barriers such as a fear of exercise-induced hypoglycemia in particular. However, several effective strategies have been identified to control exercise-induced hypoglycemia in these patients. Finally, the present review concludes that PA should be recommended for the management of patients with T1DM due to its significant health benefits and protective effects against associated health risks. It also provides suggestions for the future direction of research in this field.
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Affiliation(s)
- Addisu Dabi Wake
- Department of Nursing, College of Health Sciences, Arsi University, Asella 193/4, Ethiopia
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16
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Maida CD, Daidone M, Pacinella G, Norrito RL, Pinto A, Tuttolomondo A. Diabetes and Ischemic Stroke: An Old and New Relationship an Overview of the Close Interaction between These Diseases. Int J Mol Sci 2022; 23:ijms23042397. [PMID: 35216512 PMCID: PMC8877605 DOI: 10.3390/ijms23042397] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is a comprehensive expression to identify a condition of chronic hyperglycemia whose causes derive from different metabolic disorders characterized by altered insulin secretion or faulty insulin effect on its targets or often both mechanisms. Diabetes and atherosclerosis are, from the point of view of cardio- and cerebrovascular risk, two complementary diseases. Beyond shared aspects such as inflammation and oxidative stress, there are multiple molecular mechanisms by which they feed off each other: chronic hyperglycemia and advanced glycosylation end-products (AGE) promote ‘accelerated atherosclerosis’ through the induction of endothelial damage and cellular dysfunction. These diseases impact the vascular system and, therefore, the risk of developing cardio- and cerebrovascular events is now evident, but the observation of this significant correlation has its roots in past decades. Cerebrovascular complications make diabetic patients 2–6 times more susceptible to a stroke event and this risk is magnified in younger individuals and in patients with hypertension and complications in other vascular beds. In addition, when patients with diabetes and hyperglycemia experience an acute ischemic stroke, they are more likely to die or be severely disabled and less likely to benefit from the one FDA-approved therapy, intravenous tissue plasminogen activator. Experimental stroke models have revealed that chronic hyperglycemia leads to deficits in cerebrovascular structure and function that may explain some of the clinical observations. Increased edema, neovascularization, and protease expression as well as altered vascular reactivity and tone may be involved and point to potential therapeutic targets. Further study is needed to fully understand this complex disease state and the breadth of its manifestation in the cerebrovasculature.
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Affiliation(s)
- Carlo Domenico Maida
- Molecular and Clinical Medicine PhD Programme, University of Palermo, 90127 Palermo, Italy; (C.D.M.); (A.T.)
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Mario Daidone
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
- Correspondence:
| | - Gaetano Pacinella
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Rosario Luca Norrito
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Antonio Pinto
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Antonino Tuttolomondo
- Molecular and Clinical Medicine PhD Programme, University of Palermo, 90127 Palermo, Italy; (C.D.M.); (A.T.)
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
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17
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Wilson S, Mone P, Kansakar U, Jankauskas SS, Donkor K, Adebayo A, Varzideh F, Eacobacci M, Gambardella J, Lombardi A, Santulli G. Diabetes and restenosis. Cardiovasc Diabetol 2022; 21:23. [PMID: 35164744 PMCID: PMC8845371 DOI: 10.1186/s12933-022-01460-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/21/2022] [Indexed: 01/05/2023] Open
Abstract
Restenosis, defined as the re-narrowing of an arterial lumen after revascularization, represents an increasingly important issue in clinical practice. Indeed, as the number of stent placements has risen to an estimate that exceeds 3 million annually worldwide, revascularization procedures have become much more common. Several investigators have demonstrated that vessels in patients with diabetes mellitus have an increased risk restenosis. Here we present a systematic overview of the effects of diabetes on in-stent restenosis. Current classification and updated epidemiology of restenosis are discussed, alongside the main mechanisms underlying the pathophysiology of this event. Then, we summarize the clinical presentation of restenosis, emphasizing the importance of glycemic control in diabetic patients. Indeed, in diabetic patients who underwent revascularization procedures a proper glycemic control remains imperative.
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Affiliation(s)
- Scott Wilson
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Pasquale Mone
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Urna Kansakar
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Stanislovas S Jankauskas
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Kwame Donkor
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Ayobami Adebayo
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Fahimeh Varzideh
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Michael Eacobacci
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Jessica Gambardella
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
- International Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Angela Lombardi
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Gaetano Santulli
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA.
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA.
- International Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
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18
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Oyenihi OR, Cerf ME, Matsabisa MG, Brooks NL, Oguntibeju OO. Effect of kolaviron on islet dynamics in diabetic rats. Saudi J Biol Sci 2022; 29:324-330. [PMID: 35002425 PMCID: PMC8716911 DOI: 10.1016/j.sjbs.2021.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 10/25/2022] Open
Abstract
Kolaviron, a biflavonoid isolated from the edible seeds of Garcinia kola, lowers blood glucose in experimental models of diabetes; however, the underlying mechanisms are not yet fully elucidated. The objective of the current study was to assess the effects of kolaviron on islet dynamics in streptozotocin-induced diabetic rats. Using double immunolabeling of glucagon and insulin, we identified insulin-producing β- and glucagon-producing α-cells in the islets of diabetic and control rats and determined the fractional β-cell area, α-cell area and islet number. STZ challenged rats presented with islet hypoplasia and reduced β-cell area concomitant with an increase in α-cell area. Kolaviron restored some islet architecture in diabetic rats through the increased β-cell area. Overall, kolaviron-treated diabetic rats presented a significant (p < 0.05) increase in the number of large and very large islets compared to diabetic control but no difference in islet number and α-cell area. The β-cell replenishment potential of kolaviron and its overall positive effects on glycemic control suggest that it may be a viable target for diabetes treatment.
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Affiliation(s)
- Omolola R Oyenihi
- Phytomedicine and Phytochemistry Group, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville 7535, South Africa
| | - Marlon E Cerf
- Grants, Innovation and Product Development, South African Medical Research Council, Tygerberg, South Africa.,Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, South Africa
| | - Motlalepula G Matsabisa
- Pharmacology Department, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Nicole L Brooks
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Oluwafemi O Oguntibeju
- Phytomedicine and Phytochemistry Group, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville 7535, South Africa
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19
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Chou MY, Huang ST, Liang CK, Peng LN, Lin YT, Hsiao FY, Chen LK. All-cause mortality, cardiovascular mortality, major cardiovascular events and hypoglycaemia of patients with diabetes onset at an older age: results from the 10-year nationwide cohort study. Age Ageing 2021; 50:2094-2104. [PMID: 34628489 DOI: 10.1093/ageing/afab183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Longitudinal adverse outcomes are unclear among adults with diabetes according to the age of onset. OBJECTIVE To investigate the longitudinal diabetes-related outcomes in adults with new-onset diabetes stratified by age. DESIGN Retrospective cohort study. SETTING Taiwan National Health Insurance Research Database claims data from 2000 to 2015. SUBJECTS In total, 115,751 participants aged ≥40 years with new-onset diabetes in 2003 were recruited and stratified by the ages 40-64 (64.3%), 65-74 (21.2%), 75-84 (11.8%) and ≥85 years (2.7%) at the time of diagnosis. METHODS Time-varying multivariate Cox proportional hazards model adjusted for covariates was used to examine the associations between the ages of the patients at diabetes onset and the outcomes of interest [all-cause mortality, cardiovascular (CV) mortality, major cardiovascular events (MACE) and hypoglycaemia] during a 10-year follow-up period. RESULTS The results showed that compared with those patients aged 40-64 at diagnosis, patients with older-onset diabetes had significantly higher comorbidities (P < 0.01) and a higher diabetes severity (P < 0.01). Patients with older-onset diabetes had a higher risk of all-cause mortality [adjusted hazard ratio (aHR) 2.28, 4.48 and 10.07 in 65-74, 75-84 and ≥85 years old, respectively], CV mortality (aHR = 2.82, 6.06 and 15.91), MACE (aHR = 2.19, 3.01 and 4.15) and hypoglycaemia (aHR = 2.41, 3.59 and 4.62) than patients aged 40-64 during a 10-year follow-up period. CONCLUSIONS Patients with diabetes onset at an older age was associated with increased risks of all-cause mortality, CV mortality, MACE and hypoglycaemia after adjusting for the severity of diabetes and anti-diabetic treatment.
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Affiliation(s)
- Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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20
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Lauritzen ES, Kampmann U, Smedegaard SB, Støy J. Effects of daily administration of melatonin before bedtime on fasting insulin, glucose and insulin sensitivity in healthy adults and patients with metabolic diseases. A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2021; 95:691-701. [PMID: 34370338 DOI: 10.1111/cen.14576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/09/2021] [Accepted: 07/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Melatonin is increasingly used as a pharmacological sleep aid but it is also emerging as a regulator of glucose homoeostasis. Yet, previous research has been ambiguous with reports of both positive and negative effects of melatonin on glucose metabolism. OBJECTIVES To assess the effect of daily treatment with melatonin on fasting glucose, insulin, insulin sensitivity and haemoglobin A1c (HbA1c) levels. DATA SOURCES MEDLINE, EMBASE, CENTRAL, clinicaltrials.gov and clinicaltrialsregister.eu were systematically searched. ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS All randomized, placebo-controlled studies with melatonin treatment were assessed. We included studies with daily melatonin treatment (≥2 weeks) of healthy adults or patients with metabolic diseases. METHODS Hedges' g differences were calculated for the metabolic parameters of the included studies, heterogeneity was assessed with χ2 and I2 tests and meta-analyses were performed with the random-effects model. RESULTS Long-term treatment with melatonin did not change fasting glucose significantly compared with placebo (g: -0.07 [-0.22 to 0.08], n = 603) but it reduced fasting insulin levels slightly (g: -0.27 [-0.50 to -0.04], n = 278) and trended towards reduced insulin resistance (HOMA-IR) (g: -0.20 [-0.44 to 0.03], n = 278). HbA1c levels were largely unaffected by melatonin treatment compared with placebo (g: 0.14 [-0.19 to 0.46], n = 142). CONCLUSIONS With the available literature, melatonin seems to be a glucose-metabolic safe sleep aid in patients with metabolic diseases and in healthy adults. It may even have beneficial glucose-metabolic effects as fasting insulin levels were reduced in this meta-analysis, but the confidence intervals of the meta-analyses are wide, underscoring the need for further research within this field.
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Affiliation(s)
- Esben S Lauritzen
- The Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Medical/Steno Research Laboratory, Aarhus University, Aarhus, Denmark
| | - Ulla Kampmann
- The Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Stine B Smedegaard
- The Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Julie Støy
- The Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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21
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Vivek S, Carnethon MR, Prizment A, Carson AP, Bancks MP, Jacobs DR, Thyagarajan B. Association of the extent of return to fasting state 2-hours after a glucose challenge with incident prediabetes and type 2 diabetes: The CARDIA study. Diabetes Res Clin Pract 2021; 180:109004. [PMID: 34391830 PMCID: PMC8655852 DOI: 10.1016/j.diabres.2021.109004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/24/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
AIM To evaluate whether the extent of return to fasting state 2-hours after a glucose challenge among normoglycemic individuals is associated with lower risk of incident prediabetes/ type 2 diabetes in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. METHODS We evaluated this association among 1879 normoglycemic adults who were categorized into three groups: 'Low post load' (2hPG < FPG); 'Medium post load' (2hPG ≥ FPG and < 75th percentile of the difference); and 'High post load' (2hPG > FPG and ≥ 75th percentile of the difference). We used Cox proportional hazards regression to evaluate the association of the difference in 2hPG and FPG with incident diabetes/prediabetes after adjustment for demographic and clinical covariates. RESULTS During 20 years of follow-up, 8% developed type 2 diabetes and 35% developed prediabetes. Compared to those with 'Low post load', the risk of type 2 diabetes was higher for participants with 'High post load' [HR: 1.56, 95% CI (1.03, 2.37)] and similar for participants with 'Medium post load' [HR: 0.99, 95% CI (0.64, 1.52)]. However, HRs for incident prediabetes among participants with 'High post load' [HR = 1.2, 95 %CI = (0.98, 1.46)] was not significantly different compared to participants with 'Low post load'. CONCLUSION Among normoglycemic individuals, a difference between 2hPG and FPG concentration > 0.9 mmol/L can be used to stratify individuals at higher risk for developing type 2 diabetes.
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Affiliation(s)
- Sithara Vivek
- University of Minnesota, School of Medicine, Department of Laboratory Medicine and Pathology, United States
| | - Mercedes R Carnethon
- Northwestern University, Chicago, Department of Preventive Medicine, United States
| | - Anna Prizment
- University of Minnesota, Division of Hematology, Oncology and Transplantation, United States
| | - April P Carson
- University of Alabama at Birmingham, School of Public Health, Department of Epidemiology, United States
| | - Michael P Bancks
- Wake Forest, School of Medicine, Department of Epidemiology and Prevention, United States
| | - David R Jacobs
- University of Minnesota, Division of Epidemiology and Community Health, United States
| | - Bharat Thyagarajan
- University of Minnesota, School of Medicine, Department of Laboratory Medicine and Pathology, United States.
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22
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Lim HY, Lui B, Tacey M, Kwok A, Varadarajan S, Donnan G, Nandurkar H, Ho P. Global coagulation assays in patients with diabetes mellitus. Res Pract Thromb Haemost 2021; 5:e12611. [PMID: 34765860 PMCID: PMC8576266 DOI: 10.1002/rth2.12611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is significant heterogeneity in the incidence and severity of diabetes-associated vascular complications and there is no routine biomarker that accurately predicts these outcomes. This pilot study investigates the role of global coagulation assays in patients with diabetes mellitus. METHODS In this cross-sectional study, patients with diabetes not on anticoagulation or dialysis and without active malignancy were recruited from endocrinology clinics. Blood samples were collected for global coagulation assays including thromboelastography (TEG), thrombin generation using calibrated automated thrombogram (CAT), and fibrin generation and fibrinolysis using the overall hemostatic potential (OHP) assay. The results were compared with healthy controls. RESULTS A total of 147 adult patients including 19 with type 1 diabetes (T1DM), 120 with type 2 diabetes (T2DM), and eight with latent autoimmune diabetes were recruited. Compared with 153 healthy controls, patients with diabetes demonstrated higher maximum amplitude (68.6 vs 60.2 mm, p < 0.001) on TEG, and higher OHP (9.3 vs 6.4, p < 0.001) with comparable CAT parameters. Patients with T2DM were more hypercoagulable than those with T1DM on most biomarkers. Higher maximum amplitude, velocity index, and OHP were associated with increased risk of complications (C-stat 0.82). Patients with history of microvascular complications appear to have more hypercoagulable thrombin and fibrin generation than those without. CONCLUSION Patients with diabetes have more hypercoagulable profiles on global coagulation assays, particularly patients with T2DM and those with microvascular complications. Further studies with longitudinal follow-up are ongoing to evaluate the utility of global coagulation assays in predicting long-term patient outcomes.
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Affiliation(s)
- Hui Yin Lim
- Department of HematologyNorthern Pathology VictoriaNorthern HospitalEppingVic.Australia
- Australian Centre for Blood DiseasesMonash UniversityMelbourneVic.Australia
- Department of MedicineNorthern HealthUniversity of MelbourneHeidelbergVic.Australia
| | - Brandon Lui
- Department of HematologyNorthern Pathology VictoriaNorthern HospitalEppingVic.Australia
| | - Mark Tacey
- Office of ResearchNorthern Centre for Health Education and ResearchNorthern HealthEppingVic.Australia
- Melbourne School of Population and Global HealthUniversity of MelbourneCarltonVic.Australia
| | - Anna Kwok
- Department of HematologyNorthern Pathology VictoriaNorthern HospitalEppingVic.Australia
| | | | - Geoffrey Donnan
- The Melbourne Brain CentreRoyal Melbourne HospitalUniversity of MelbourneParkvilleVic.Australia
| | - Harshal Nandurkar
- Australian Centre for Blood DiseasesMonash UniversityMelbourneVic.Australia
| | - Prahlad Ho
- Department of HematologyNorthern Pathology VictoriaNorthern HospitalEppingVic.Australia
- Australian Centre for Blood DiseasesMonash UniversityMelbourneVic.Australia
- Department of MedicineNorthern HealthUniversity of MelbourneHeidelbergVic.Australia
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23
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Hefner M, Baliga V, Amphay K, Ramos D, Hegde V. Cardiometabolic Modification of Amyloid Beta in Alzheimer's Disease Pathology. Front Aging Neurosci 2021; 13:721858. [PMID: 34497507 PMCID: PMC8419421 DOI: 10.3389/fnagi.2021.721858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
In recent years, several studies have suggested that cardiometabolic disorders, such as diabetes, obesity, hypertension, and dyslipidemia, share strong connections with the onset of neurodegenerative disorders such as Parkinson's and Alzheimer's disease (AD). However, establishing a definitive link between medical disorders with coincident pathophysiologies is difficult due to etiological heterogeneity and underlying comorbidities. For this reason, amyloid β (Aβ), a physiological peptide derived from the sequential proteolysis of amyloid precursor protein (APP), serves as a crucial link that bridges the gap between cardiometabolic and neurodegenerative disorders. Aβ normally regulates neuronal synaptic function and repair; however, the intracellular accumulation of Aβ within the brain has been observed to play a critical role in AD pathology. A portion of Aβ is believed to originate from the brain itself and can readily cross the blood-brain barrier, while the rest resides in peripheral tissues that express APP required for Aβ generation such as the liver, pancreas, kidney, spleen, skin, and lungs. Consequently, numerous organs contribute to the body pool of total circulating Aβ, which can accumulate in the brain and facilitate neurodegeneration. Although the accumulation of Aβ corresponds with the onset of neurodegenerative disorders, the direct function of periphery born Aβ in AD pathophysiology is currently unknown. This review will highlight the contributions of individual cardiometabolic diseases including cardiovascular disease (CVD), type 2 diabetes (T2D), obesity, and non-alcoholic fatty liver disease (NAFLD) in elevating concentrations of circulating Aβ within the brain, as well as discuss the comorbid association of Aβ with AD pathology.
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Affiliation(s)
- Marleigh Hefner
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Vineet Baliga
- College of Arts and Sciences, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - Kailinn Amphay
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Daniela Ramos
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Vijay Hegde
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
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24
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Meagher P, Civitarese R, Lee X, Gordon M, Bugyei-Twum A, Desjardins JF, Kabir G, Zhang Y, Kosanam H, Visram A, Leong-Poi H, Advani A, Connelly KA. The Goto Kakizaki rat: Impact of age upon changes in cardiac and renal structure, function. PLoS One 2021; 16:e0252711. [PMID: 34166385 PMCID: PMC8224913 DOI: 10.1371/journal.pone.0252711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/20/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patients with diabetes are at a high risk for developing cardiac dysfunction in the absence of coronary artery disease or hypertension, a condition known as diabetic cardiomyopathy. Contributing to heart failure is the presence of diabetic kidney disease. The Goto-Kakizaki (GK) rat is a non-obese, non-hypertensive model of type 2 diabetes that, like humans, shares a susceptibility locus on chromosome 10. Herein, we perform a detailed analysis of cardio-renal remodeling and response to renin angiotensin system blockade in GK rats to ascertain the validity of this model for further insights into disease pathogenesis. METHODS Study 1: Male GK rats along with age matched Wistar control animals underwent longitudinal assessment of cardiac and renal function for 32 weeks (total age 48 weeks). Animals underwent regular echocardiography every 4 weeks and at sacrifice, early (~24 weeks) and late (~48 weeks) timepoints, along with pressure volume loop analysis. Histological and molecular characteristics were determined using standard techniques. Study 2: the effect of renin angiotensin system (RAS) blockade upon cardiac and renal function was assessed in GK rats. Finally, proteomic studies were conducted in vivo and in vitro to identify novel pathways involved in remodeling responses. RESULTS GK rats developed hyperglycaemia by 12 weeks of age (p<0.01 c/w Wistar controls). Echocardiographic assessment of cardiac function demonstrated preserved systolic function by 48 weeks of age. Invasive studies demonstrated left ventricular hypertrophy, pulmonary congestion and impaired diastolic function. Renal function was preserved with evidence of hyperfiltration. Cardiac histological analysis demonstrated myocyte hypertrophy (p<0.05) with evidence of significant interstitial fibrosis (p<0.05). RT qPCR demonstrated activation of the fetal gene program, consistent with cellular hypertrophy. RAS blockade resulted in a reduction blood pressure(P<0.05) cardiac interstitial fibrosis (p<0.05) and activation of fetal gene program. No significant change on either systolic or diastolic function was observed, along with minimal impact upon renal structure or function. Proteomic studies demonstrated significant changes in proteins involved in oxidative phosp4horylation, mitochondrial dysfunction, beta-oxidation, and PI3K/Akt signalling (all p<0.05). Further, similar changes were observed in both LV samples from GK rats and H9C2 cells incubated in high glucose media. CONCLUSION By 48 weeks of age, the diabetic GK rat demonstrates evidence of preserved systolic function and impaired relaxation, along with cardiac hypertrophy, in the presence of hyperfiltration and elevated protein excretion. These findings suggest the GK rat demonstrates some, but not all features of diabetes induced "cardiorenal" syndrome. This has implications for the use of this model to assess preclinical strategies to treat cardiorenal disease.
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Affiliation(s)
- Patrick Meagher
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Robert Civitarese
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Xavier Lee
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Mark Gordon
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Antoinette Bugyei-Twum
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Jean-Francois Desjardins
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Golam Kabir
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Yanling Zhang
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Hari Kosanam
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Aylin Visram
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Howard Leong-Poi
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Andrew Advani
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kim A. Connelly
- St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- * E-mail:
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25
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Gölaç H, Atalik G, Türkcan AK, Yilmaz M. Disease related changes in vocal parameters of patients with type 2 diabetes mellitus. LOGOP PHONIATR VOCO 2021; 47:202-208. [PMID: 33970753 DOI: 10.1080/14015439.2021.1917653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND As the duration of diabetes progresses, various disease related complications might occur in patients. The main goal of this paper is to compare acoustic and aerodynamic measures of patients with type 2 diabetes mellitus (T2DM) with a control group of healthy subjects. METHODS A total of 91 subjects, 51 individuals with type 2 diabetes mellitus (DM group) and 40 healthy volunteers (HV group) were participated in the study. Maximum phonation time (MPT) was captured for assessing phonatory mechanics. Acoustic voice parameters, including mean fundamental frequency (mean fo), jitter local (Jlocal), jitter absolute (Jabs), shimmer local (Slocal), shimmer decibel (SdB), and harmonics to noise ratio (HNR) were detected using the Praat software program. RESULTS Only for Jabs, statically significant difference was found between the groups. There were no statically significant differences between any voice parameters of HV versus those with the duration of diabetes ≥10 years and the HbA1c level ≥7%. However, statically significant differences for MPT and Slocal were found between patients with neuropathy versus HV. In addition, a comparison between patients with voice complaint versus HV showed significant differences for Slocal and SdB. CONCLUSIONS The findings of the present study do not provide strong evidence about the possible effect of DM on the human voice. However, diabetic neuropathy is considered to be a factor affecting the voice parameters in the target population. The physicians should pay attention to the acoustic and aerodynamic voice parameters in patients with diabetes, particularly in those with neuropathy or voice complaints.
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Affiliation(s)
- Hakan Gölaç
- Department of Speech and Language Therapy, Gazi University, Ankara, Turkey
| | - Güzide Atalik
- Department of Speech and Language Therapy, Gazi University, Ankara, Turkey
| | | | - Metin Yilmaz
- Department of Otolaryngology, Gazi University, Ankara, Turkey
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26
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Albright RH, Fleischer AE. Association of select preventative services and hospitalization in people with diabetes. J Diabetes Complications 2021; 35:107903. [PMID: 33691987 DOI: 10.1016/j.jdiacomp.2021.107903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to assess the utilization rates and trends of preventative outpatient visits to providers in a population of people with diabetes, and evaluate which preventative services may offer protection against poor outcomes (i.e. all-cause hospitalization). METHODS The National Health and Nutrition Examination Survey (NHANES) was used to examine the relationship between select outpatient services and risk of all-cause hospitalization in people with diabetes. NHANES data from 2011 to 2016 were included. We assessed five outpatient services commonly recommended to prevent future complications in patients with diabetes: (1) routine examination from a physician (2) assessment of hemoglobin A1C (3) eye exam with pupil dilation (4) foot exam and (5) assessment from a diabetes specialist. Logistic regression models were performed to assess the independent association of outpatient services used in the past 1 year, and hospitalization within that same year. RESULTS The prevalence of diabetes within the NHANES population was 10.5% (n = 3054). Hospitalization was significantly more common among diabetics who were older, had lower income levels (i.e. under $20,000) and those who considered themselves in 'fair' or 'poor health'. After adjustment for important covariates, patients who received a preventative foot exam within the last year (i.e. 1-4 times per year) were 33% less likely to be hospitalized within that year (OR 0.67, 95%CI 0.46, 0.96). Those visiting a diabetes specialist were 44% less likely to be hospitalized that year (OR 0.56, 95%CI 0.39, 0.82) if the visit was preventative in nature (i.e. occurred more than one year before the hospitalized event). No other outpatient services displayed an independent association with hospitalization. CONCLUSION Outpatient Services were consistently being used annually by the diabetic population. Receiving a preventative foot exam and visiting a diabetes specialist were associated with protection against hospitalization, resulting in a 33% and 44% decreased risk, respectively. RESEARCH IN CONTEXT Evidence before this study: Current guidelines focus on preventative care measures to avert diabetes complications. In a 2018 national database study of approximately one-third of the Italian population, guidelines for prevention were not consistently being met among the diabetes population, however, patients who regularly received all the recommended preventative measures experienced a 20% risk reduction in hospitalization. The study's preventative measures included periodic lab monitoring including glycated hemoglobin and lipid profiles and dilated eye exams. Added value of this study: In our study, we used a national database representing the United States' non-institutionalized population to identify the prevalence of prevention measures being utilized in adults with diabetes and further examine their relationship with all-cause hospitalization. Logistic regression analysis identified two preventative measures with inconsistent utilization, however, when these measures were used according to guidelines, they contributed to a risk reduction in all-cause hospitalization. Implications of all the available evidence: Current preventative guidelines can contribute to a risk reduction in hospitalization among adults with diabetes. National guidelines and quality improvement initiatives should be aimed at improving the utilization of foot exams as a preventative measure and referral to a diabetes specialist before complications incur.
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Affiliation(s)
- Rachel H Albright
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, 1 Rope Ferry Rd., Hanover, NH 03755, USA.
| | - Adam E Fleischer
- Department of Podiatric Medicine and Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
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Imai C, Li L, Hardie RA, Georgiou A. Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice. BMJ Qual Saf 2021; 30:706-714. [PMID: 33542066 PMCID: PMC8380884 DOI: 10.1136/bmjqs-2020-012026] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/12/2022]
Abstract
Background Clinical practice guidelines emphasise the role of regular monitoring of glycated haemoglobin A1c (HbA1c) for patients with type 2 diabetes, with most recommending 6-monthly testing. Nonetheless, there are few in-depth studies evaluating the clinical impact of the recommended testing frequency for patients to underpin the significance of guideline adherence. Objective This study aimed to examine associations between patient outcomes and adherence to HbA1c testing frequencies recommended by Australian guidelines (6-monthly for patients with adequate glycaemic control and 3-monthly for patients with inadequate glycaemic control). The primary and secondary outcomes of interest were longitudinal changes in HbA1c values and development of ischaemic heart disease (IHD) and chronic kidney disease (CKD). Methods This 5-year retrospective cohort study (July 2013–June 2018) evaluated HbA1c testing frequency in a subset of patients with type 2 diabetes identified within data collected from approximately 250 Australian general practices. The study included patients who were aged ≥18 in 2013 and had a record of HbA1c testing in study practices during the study period. Each patient’s adherence rate was defined by the proportion of HbA1c tests performed within the testing intervals recommended by Australian guidelines. Based on the adherence rate, adherence level was categorised into low (≤33%), moderate (34%–66%) and high (>66%). Generalised additive mixed models were used to examine associations between adherence to the recommended HbA1c testing frequency and patient outcomes. Results In the 6424 patients with diabetes, the overall median HbA1c testing frequency was 1.6 tests per year with an adherence rate of 50%. The estimated HbA1c levels among patients with low adherence gradually increased or remained inadequately controlled, while HbA1c values in patients with high adherence remained controlled or improved over time. The risk of developing CKD for patients with high adherence was significantly lower than for patients with low adherence (OR: 0.42, 95% CI 0.18 to 0.99). No association between IHD and adherence to the recommended HbA1c frequency was observed. Conclusion Better adherence to guideline-recommended HbA1c testing frequency was associated with better glycaemic control and lower risk of CKD. These findings may provide valuable evidence to support the use of clinical guidelines for better patient outcomes in patients with type 2 diabetes.
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Affiliation(s)
- Chisato Imai
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rae-Anne Hardie
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Sigalapalli DK, Yele V, Jupudi S, Shaikh AS, Kadagathur M, Tangellamudi ND, Nagendra Babu B. Insights into the pharmacophore-based 3D-QSAR modeling, molecular dynamics simulation studies of certain dihydroxy pyrrolidine/piperidine and aza-flavanone derivatives as α-glucosidase inhibitors. J Mol Struct 2021. [DOI: 10.1016/j.molstruc.2020.129243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Albright RH, Joseph RM, Wukich DK, Armstrong DG, Fleischer AE. Is Reconstruction of Unstable Midfoot Charcot Neuroarthropathy Cost Effective from a US Payer's Perspective? Clin Orthop Relat Res 2020; 478:2869-2888. [PMID: 32694315 PMCID: PMC7899431 DOI: 10.1097/corr.0000000000001416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/26/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Charcot neuroarthropathy is a morbid and expensive complication of diabetes that can lead to lower extremity amputation. Current treatment of unstable midfoot deformity includes lifetime limb bracing, primary transtibial amputation, or surgical reconstruction of the deformity. In the absence of a widely adopted treatment algorithm, the decision to pursue more costly attempts at reconstruction in the United States continues to be driven by surgeon preference. QUESTIONS/PURPOSES To examine the cost effectiveness (defined by lifetime costs, quality-adjusted life-years [QALYs] and incremental cost-effectiveness ratio [ICER]) of surgical reconstruction and its alternatives (primary transtibial amputation and lifetime bracing) for adults with diabetes and unstable midfoot Charcot neuroarthropathy using previously published cost data. METHODS A Markov model was used to compare Charcot reconstruction and its alternatives in three progressively worsening clinical scenarios: no foot ulcer, uncomplicated (or uninfected) ulcer, and infected ulcer. Our base case scenario was a 50-year-old adult with diabetes and unstable midfoot deformity. Patients were placed into health states based on their disease stage. Transitions between health states occurred annually using probabilities estimated from the evidence obtained after systematic review. The time horizon was 50 cycles. Data regarding costs were obtained from a systematic review. Costs were converted to 2019 USD using the Consumer Price Index. The primary outcomes included the long-term costs and QALYs, which were combined to form ICERs. Willingness-to-pay was set at USD 100,000/QALY. Multiple sensitivity analyses and probabilistic analyses were performed to measure model uncertainty. RESULTS The most effective strategy for patients without foot ulcers was Charcot reconstruction, which resulted in an additional 1.63 QALYs gained and an ICER of USD 14,340 per QALY gained compared with lifetime bracing. Reconstruction was also the most effective strategy for patients with uninfected foot ulcers, resulting in an additional 1.04 QALYs gained, and an ICER of USD 26,220 per QALY gained compared with bracing. On the other hand, bracing was cost effective in all scenarios and was the only cost-effective strategy for patents with infected foot ulcers; it resulted in 6.32 QALYs gained and an ICER of USD 15,010 per QALY gained compared with transtibial amputation. As unstable midfoot Charcot neuroarthropathy progressed to deep infection, reconstruction lost its value (ICER USD 193,240 per QALY gained) compared with bracing. This was driven by the increasing costs associated with staged surgeries, combined with a higher frequency of complications and shorter patient life expectancies in the infected ulcer cohort. The findings in the no ulcer and uncomplicated ulcer cohorts were both unchanged after multiple sensitivity analyses; however, threshold effects were identified in the infected ulcer cohort during the sensitivity analysis. When the cost of surgery dropped below USD 40,000 or the frequency of postoperative complications dropped below 50%, surgical reconstruction became cost effective. CONCLUSIONS Surgeons aiming to offer both clinically effective and cost-effective care would do well to discuss surgical reconstruction early with patients who have unstable midfoot Charcot neuroarthropathy, and they should favor lifetime bracing only after deep infection develops. Future clinical studies should focus on methods of minimizing surgical complications and/or reducing operative costs in patients with infected foot ulcers. LEVEL OF EVIDENCE Level II, economic and decision analysis.
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Affiliation(s)
- Rachel H Albright
- R. H. Albright, The Dartmouth Institute, Geisel School of Medicine, Hanover, NH, USA
| | - Robert M Joseph
- R. M. Joseph, A. E. Fleischer, Department of Podiatric Medicine and Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Dane K Wukich
- D. K. Wukich, Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - David G Armstrong
- D. G. Armstrong, Southwestern Academic Limb Salvage Alliance, Department of Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Adam E Fleischer
- R. M. Joseph, A. E. Fleischer, Department of Podiatric Medicine and Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- A. E. Fleischer, Weil Foot and Ankle Institute, Mount Prospect, IL, USA
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Ahmad E, Sargeant JA, Zaccardi F, Khunti K, Webb DR, Davies MJ. Where Does Metformin Stand in Modern Day Management of Type 2 Diabetes? Pharmaceuticals (Basel) 2020; 13:E427. [PMID: 33261058 PMCID: PMC7761522 DOI: 10.3390/ph13120427] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023] Open
Abstract
Metformin is the most commonly used glucose-lowering therapy (GLT) worldwide and remains the first-line therapy for newly diagnosed individuals with type 2 diabetes (T2D) in management algorithms and guidelines after the UK Prospective Diabetes Study (UKPDS) showed cardiovascular mortality benefits in the overweight population using metformin. However, the improved Major Adverse Cardiovascular Events (MACE) realised in some of the recent large cardiovascular outcomes trials (CVOTs) using sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have challenged metformin's position as a first-line agent in the management of T2D. Many experts now advocate revising the existing treatment algorithms to target atherosclerotic cardiovascular disease (ASCVD) and improving glycaemic control as a secondary aim. In this review article, we will revisit the major cardiovascular outcome data for metformin and include a critique of the UKPDS data. We then review additional factors that might be pertinent to metformin's status as a first-line agent and finally answer key questions when considering metformin's role in the modern-day management of T2D.
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Affiliation(s)
- Ehtasham Ahmad
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (J.A.S.); (F.Z.); (K.K.); (D.R.W.); (M.J.D.)
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester LE5 4PW, UK
| | - Jack A. Sargeant
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (J.A.S.); (F.Z.); (K.K.); (D.R.W.); (M.J.D.)
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester LE5 4PW, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (J.A.S.); (F.Z.); (K.K.); (D.R.W.); (M.J.D.)
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (J.A.S.); (F.Z.); (K.K.); (D.R.W.); (M.J.D.)
- NIHR Applied Research Collaborations (ARC), East Midlands, Leicester LE5 4PW, UK
| | - David R. Webb
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (J.A.S.); (F.Z.); (K.K.); (D.R.W.); (M.J.D.)
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester LE5 4PW, UK
| | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (J.A.S.); (F.Z.); (K.K.); (D.R.W.); (M.J.D.)
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester LE5 4PW, UK
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Chen Z, Liang Q, Wu Y, Gao Z, Kobayashi S, Patel J, Li C, Cai F, Zhang Y, Liang C, Chiba H, Hui SP. Comprehensive lipidomic profiling in serum and multiple tissues from a mouse model of diabetes. Metabolomics 2020; 16:115. [PMID: 33067714 DOI: 10.1007/s11306-020-01732-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Diabetes mellitus is a serious metabolic disorder causing multiple organ damage in human. However, the lipidomic profiles in different organs and their associations are rarely studied in either diabetic patients or animals. OBJECTIVES To evaluate and compare the characteristics of lipid species in serum and multiple tissues in a diabetic mouse model. METHODS Semi-quantitative profiling analyses of intact and oxidized lipids were performed in serum and multiple tissues from a diabetic mouse model fed a high fat diet and treated with streptozotocin by using LC/HRMS and MS/MS. The total content of each lipid class, and the tissue-specific lipid species in all tissue samples were determined and compared by multivariate analyses. RESULTS The diabetic mouse model displayed characteristic differences in serum and multiple organs: the brain and heart showed the largest reduction in cardiolipin, while the kidney had more alterations in triacylglycerol. Interestingly, the lipidomic differences also existed between different regions of the same organ: cardiolipin species with highly polyunsaturated fatty acyls decreased only in atrium but not in ventricle, while renal cortex showed longer fatty acyl chains for both increased and decreased triacylglycerol species than renal medulla. Importantly, diabetes caused an accumulation of lipid hydroperoxides, suggesting that oxidative stress was induced in all organs except for the brain during the development of diabetes. CONCLUSIONS These findings provided novel insight into the organ-specific relationship between diabetes and lipid metabolism, which might be useful for evaluating not only diabetic tissue injury but also the effectiveness of diabetic treatments.
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Affiliation(s)
- Zhen Chen
- Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Qiangrong Liang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, 11548, USA
| | - Yue Wu
- Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Zijun Gao
- Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Satoru Kobayashi
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, 11548, USA
| | - Joy Patel
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, 11548, USA
| | - Cairong Li
- Clinical Medical College, Hubei University of Science and Technology, 437100, Xianning, China
| | - Fei Cai
- Hubei Key Laboratory of Diabetes and Angiopathy, Hubei University of Science and Technology, 437100, Xianning, China
| | - Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, 11548, USA
| | - Chongsheng Liang
- Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Hitoshi Chiba
- Department of Nutrition, Sapporo University of Health Sciences, Nakanuma Nishi-4-2-1-15, Higashi, Sapporo, 007-0894, Japan
| | - Shu-Ping Hui
- Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan.
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Avram R, Olgin JE, Kuhar P, Hughes JW, Marcus GM, Pletcher MJ, Aschbacher K, Tison GH. A digital biomarker of diabetes from smartphone-based vascular signals. Nat Med 2020; 26:1576-1582. [PMID: 32807931 PMCID: PMC8483886 DOI: 10.1038/s41591-020-1010-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/06/2020] [Indexed: 12/11/2022]
Abstract
The global burden of diabetes is rapidly increasing, from 451 million people in 2019 to 693 million by 20451. The insidious onset of type 2 diabetes delays diagnosis and increases morbidity2. Given the multifactorial vascular effects of diabetes, we hypothesized that smartphone-based photoplethysmography could provide a widely accessible digital biomarker for diabetes. Here we developed a deep neural network (DNN) to detect prevalent diabetes using smartphone-based photoplethysmography from an initial cohort of 53,870 individuals (the 'primary cohort'), which we then validated in a separate cohort of 7,806 individuals (the 'contemporary cohort') and a cohort of 181 prospectively enrolled individuals from three clinics (the 'clinic cohort'). The DNN achieved an area under the curve for prevalent diabetes of 0.766 in the primary cohort (95% confidence interval: 0.750-0.782; sensitivity 75%, specificity 65%) and 0.740 in the contemporary cohort (95% confidence interval: 0.723-0.758; sensitivity 81%, specificity 54%). When the output of the DNN, called the DNN score, was included in a regression analysis alongside age, gender, race/ethnicity and body mass index, the area under the curve was 0.830 and the DNN score remained independently predictive of diabetes. The performance of the DNN in the clinic cohort was similar to that in other validation datasets. There was a significant and positive association between the continuous DNN score and hemoglobin A1c (P ≤ 0.001) among those with hemoglobin A1c data. These findings demonstrate that smartphone-based photoplethysmography provides a readily attainable, non-invasive digital biomarker of prevalent diabetes.
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Affiliation(s)
- Robert Avram
- Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
| | | | - J Weston Hughes
- Department of Computer Science, University of California, Berkeley, Berkeley, CA, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Kirstin Aschbacher
- Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Geoffrey H Tison
- Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA.
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA.
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Abdul Y, Li W, Vargas JD, Clark E, He L, Jamil S, Ergul A. Diabetes-related sex differences in the brain endothelin system following ischemia in vivo and in human brain endothelial cells in vitro. Can J Physiol Pharmacol 2020; 98:587-595. [PMID: 32496159 PMCID: PMC7508777 DOI: 10.1139/cjpp-2019-0630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The endothelin (ET) system has been implicated to contribute to the pathophysiology of cognitive impairment and stroke in experimental diabetes. Our goals were to test the hypotheses that (1) circulating and (or) periinfarct ET-1 levels are elevated after stroke in both sexes and this increase is greater in diabetes, (2) ET receptors are differentially regulated in the diabetic brain, (3) brain microvascular endothelial cells (BMVEC) of female and male origin express the ETA receptor subtype, and (4) diabetes- and stroke-mimicking conditions increase ET-1 levels in BMVECs of both sexes. Control and diabetic rats were randomized to sham or stroke surgery. BMVECs of male (hBEC5i) and female (hCMEC/D3) origin, cultured under normal and diabetes-mimicking conditions, were exposed to normoxia or hypoxia. Circulating ET-1 levels were higher in diabetic animals and this was more pronounced in the male cohort. Stroke did not further increase plasma ET-1. Tissue ET-1 levels were increased after stroke only in males, whereas periinfarct ET-1 increased in both control and diabetic females. Male BMVECs secreted more ET-1 than female cells and hypoxia increased ET-1 levels in both cell types. There was sexually dimorphic regulation of ET receptors in both tissue and cell culture samples. There are sex differences in the stroke- and diabetes-mediated changes in the brain ET system at the endothelial and tissue levels.
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Affiliation(s)
- Yasir Abdul
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Weiguo Li
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Juan D Vargas
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Emily Clark
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Lianying He
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Sarah Jamil
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Adviye Ergul
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
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Wake AD. Antidiabetic Effects of Physical Activity: How It Helps to Control Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13:2909-2923. [PMID: 32884317 PMCID: PMC7443456 DOI: 10.2147/dmso.s262289] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the improvements in clinical care of the patients, research updates, and public health interventions, there is still an increase in the prevalence, incidence, and mortality because of diabetes mellitus (DM). DM is a public health problem in both developed and developing countries. It has increased alarmingly, putting this disease in the dimension of an epidemic. Diabetes is associated with several complications which increase the risk of many serious health problems on the other side. Therefore, this review was aimed to discuss the antidiabetic effects of physical activity (PA) on type 2 DM (T2DM) by summarizing the significant studies on this topic. This review found that several studies have recommended the utilization of PA for the effective management of T2DM. PA is a non-pharmacologic therapy which is a significant strategy for the management of T2DM and is an appropriate lifestyle modification approach to be practiced by these patients. The studies showed that PA has antidiabetic effects which are evidenced by its substantial role in improving the blood glucose (BG) levels of the individuals with T2DM where it helps them to control their levels of glucose in the blood. It plays a significant role in glycemic control of this disease by lowering the BG levels through possible mechanisms such as decreasing insulin resistance, increasing production of glucose transporter type 4 (GLUT-4), lowering visceral adipose tissue (VAT), increasing pancreatic β-cell functions, using glucose for energy, and so on. In turn, the controlled glycemia helps to prevent the complications associated with uncontrolled T2DM and this would further improve the overall health of the patients and the burden on the health professionals as well. Finally, this review concludes that PA is the cornerstone in the management of T2DM. It also suggests that more attention is needed to its significance in the prevention, glycemic control, and its role in the management of the morbidity and mortality associated with T2DM. Practical PA recommendations and suggestions for the future direction of research in this area are also provided.
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Affiliation(s)
- Addisu Dabi Wake
- Nursing Department, College of Health Sciences, Arsi University, Assela, Oromia, Ethiopia
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Abstract
Diabetes risk increases with age due to changes in β-cell function and increased insulin resistance and is one of the most common chronic medical conditions in the elderly. Diabetes management in this population requires a multidisciplinary, patient-centric approach due to wide heterogeneity in patients' health and functional capacities. Meticulous assessment of each patient before formulating a regimen and thorough patient education are keys to success in achieving glycemic goals, which should be individualized. Lifestyle modification is recommended for every patient.
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Affiliation(s)
- Zehra Tekin
- Endocrinology, Diabetes and Metabolism Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, F-20, Cleveland, OH 44195, USA
| | - Robert S Zimmerman
- Endocrinology, Diabetes and Metabolism Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, F-20, Cleveland, OH 44195, USA.
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Agarwal S, Cappola AR. Continuous Glucose Monitoring in Adolescent, Young Adult, and Older Patients With Type 1 Diabetes. JAMA 2020; 323:2384-2385. [PMID: 32543670 PMCID: PMC7385810 DOI: 10.1001/jama.2020.7058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Division of Endocrinology, Diabetes, and Metabolism, Albert Einstein College of Medicine, Bronx, New York
- NY-Regional Center for Diabetes and Translational Research, Albert Einstein College of Medicine, Bronx, Nork
| | - Anne R Cappola
- Perelman School of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania, Philadelphia
- Associate Editor
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Brown EC, Buchan DS, Madi SA, Gordon BN, Drignei D. Grip Strength Cut Points for Diabetes Risk Among Apparently Healthy U.S. Adults. Am J Prev Med 2020; 58:757-765. [PMID: 32273132 DOI: 10.1016/j.amepre.2020.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Early detection screening tools are needed to aid in preventing vascular complications associated with type 2 diabetes. As low muscular strength is linked to increased diabetes risk, the purpose of this study is to establish muscular strength cut points for determining diabetes risk using a large, nationally representative U.S. METHODS Using the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey data, 5,108 participants aged 20-80 years (68.6% aged 20-50 years; young male participants, n=1,813, mean age=33.43 years; young female participants, n=1,692, mean age=33.39 years; older male participants, n=813, mean age=59.92 years; older female participants, n=790, mean age=60.45 years) and free of common diabetes comorbidities were included. Muscular strength was assessed using a handgrip dynamometer and normalized by adjusting for body weight. A logistic regression for survey data controlling for covariates was used to determine normalized grip strength cut points. Diabetes risk was determined using American Diabetes Association diagnostic criteria. Analyses were conducted in the summer of 2019. RESULTS Normalized grip strength significantly predicted diabetes (p=0.0332), and the cut points for detecting diabetes risk included 0.78 (young male participants), 0.57 (young female participants), 0.68 (older male participants), and 0.49 (older female participants). The risk percentages for diabetes and estimated rates reported for all subgroups were comparable, and the risk percentages included 6.84 (95% CI=5.32, 8.36; younger male participants), 7.49 (95% CI=5.87, 9.10; younger female participants), 5.76 (95% CI=2.34, 9.19, older male participants), and 4.27 (95% CI=2.44, 6.10; older female participants). CONCLUSIONS Normalized grip strength using the cut points proposed in this paper may be a useful screening tool for diabetes risk in apparently healthy, normotensive adults.
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Affiliation(s)
- Elise C Brown
- Department of Public and Environmental Wellness, Oakland University, Rochester, Michigan.
| | - Duncan S Buchan
- Division of Sport and Exercise, Institute for Clinical Exercise and Health Sciences, University of the West of Scotland, Lanarkshire, Scotland
| | - Samar A Madi
- Department of Mathematics and Statistics, Oakland University, Rochester, Michigan
| | - Breanne N Gordon
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan
| | - Dorin Drignei
- Department of Mathematics and Statistics, Oakland University, Rochester, Michigan
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Imai C, Hardie RA, Franco GS, Sezgin G, Tepper K, McLeod A, Pearce C, Westbrook J, Georgiou A. Harnessing the potential of electronic general practice pathology data in Australia: An examination of the quality use of pathology for type 2 diabetes patients. Int J Med Inform 2020; 141:104189. [PMID: 32534436 DOI: 10.1016/j.ijmedinf.2020.104189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite the importance of pathology testing in diagnosis and disease monitoring, there is little in-depth research about pathology test ordering in general practice and how it impacts patient outcomes. This is in part due to the limited availability of high-quality data. With the now-widespread use of electronic software in general practice comes the potential for electronic patient data to be used for research leading to better understanding of general practice activities, including pathology testing. OBJECTIVES This study aimed to examine the usefulness of electronic general practice pathology data to: (1) identify patients' characteristics, (2) monitor quality of care, (3) evaluate intervention effects, (4) identify variations in patient care, and (5) measure patient outcomes. An exemplar study evaluating kidney function testing in type 2 diabetes mellitus (type 2 diabetes) compared to guidelines was used to demonstrate the value of pathology data. MATERIALS AND METHODS De-identified electronic data from approximately 200 general practices in Victoria were extracted using Outcome Health's Population Level Analysis & Reporting (POLAR) Aurora research platform. Our study population included patients ≥18 diagnosed with type 2 diabetes before July 2016. Data from July 2016 to June 2018 were used to i) determine frequency of kidney function tests (KFT), and ii) identify whether antihypertensive medications were prescribed for abnormal KFT results. RESULTS There were 20,514 active patients with type 2 diabetes identified from the data. The age and gender standardised estimate of diabetes prevalence was 4.9%, consistent with Australian estimates (5.2%). Sociodemographic features of prevalence, including higher prevalence in older males, were also consistent with previous Australian estimates. Kidney function testing was performed annually, as recommended by guidelines, in 75.7% of patients, with higher annual testing observed in patients managed under general practice incentive programs (80.1%) than those who were not (72.2%). Antihypertensive medications were prescribed as recommended in 77.4% of patients with suspected microalbuminuria or macroalbuminuria based on KFT results. DISCUSSION Evaluations using data from diabetes patients in this study illustrate the value of electronic data for identifying patients with the condition of interest (e.g. type 2 diabetes) along with sociodemographic characteristics. This allows for the ability to undertake analyses on pathology testing factors and the identification of variation compared to guidelines, which has a potential to ensure quality of care. Its potential to identify associations with incentive programs further demonstrates the advantages of the data's longitudinal nature. These include the ability to assess temporal order and time interval of tests as a marker of quality of monitoring and evaluate intervention effects on a cohort over time. Finally, analyses on antihypertensive medication prescribing in patients with suspected micro/macroalbuminuria exemplified the electronic data's usefulness in monitoring patient outcomes, such as appropriate prescribing based on pathology test results. CONCLUSIONS Electronic general practice data is an important resource which can provide valuable insights about the quality use of pathology. There are clear benefits to patients for better monitoring, and consequent better outcomes, and to inform policymakers about the best ways to channel resources to enhance the quality of care.
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Affiliation(s)
- Chisato Imai
- Australian Institute of Health Innovation, Macquarie University, NSW 2109, Australia.
| | - Rae-Anne Hardie
- Australian Institute of Health Innovation, Macquarie University, NSW 2109, Australia.
| | | | - Gorkem Sezgin
- Australian Institute of Health Innovation, Macquarie University, NSW 2109, Australia.
| | - Kathy Tepper
- Eastern Melbourne Primary Health Network, Box Hill 3128, VIC, Australia.
| | - Adam McLeod
- Outcome Health, Blackburn 3130, VIC, Australia.
| | - Christopher Pearce
- Outcome Health, Blackburn 3130, VIC, Australia; Department of General Practice, Monash University, VIC 3168, Australia.
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, NSW 2109, Australia.
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, NSW 2109, Australia.
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Elnaggar A, Ta Park V, Lee SJ, Bender M, Siegmund LA, Park LG. Patients' Use of Social Media for Diabetes Self-Care: Systematic Review. J Med Internet Res 2020; 22:e14209. [PMID: 32329745 PMCID: PMC7210496 DOI: 10.2196/14209] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 01/08/2020] [Accepted: 01/26/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patient engagement with diabetes self-care is critical to reducing morbidity and mortality. Social media is one form of digital health that is available for diabetes self-care, although its use for peer-to-peer communication has not been systematically described, and its potential to support patient self-care is unclear. OBJECTIVE The primary aim of this systematic review was to describe the use of social media among patients (peer-to-peer) to manage diabetes and cardiovascular disease (CVD). The secondary aim was to assess patients' clinical outcomes, behavioral outcomes, quality of life, and self-efficacy resulting from peer-to-peer social media use. METHODS We conducted a literature search in the following databases: PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO (January 2008 through April 2019). The inclusion criteria were quantitative studies that included peer-to-peer use of social media for self-care of diabetes mellitus (with all subtypes) and CVD, including stroke. RESULTS After an initial yield of 3066 citations, we selected 91 articles for a full-text review and identified 7 papers that met our inclusion criteria. Of these, 4 studies focused on type 1 diabetes, 1 study included both type 1 and 2 diabetes, and 2 studies included multiple chronic conditions (eg, CVD, diabetes, depression, etc). Our search did not yield any individual studies on CVD alone. Among the selected papers, 2 studies used commercial platforms (Facebook and I Seek You), 3 studies used discussion forums developed specifically for each study, and 2 surveyed patients through different platforms or blogs. There was significant heterogeneity in the study designs, methodologies, and outcomes applied, but all studies showed favorable results on either primary or secondary outcomes. The quality of studies was highly variable. CONCLUSIONS The future landscape of social media use for patient self-care is promising. However, current use is nascent. Our extensive search yielded only 7 studies, all of which included diabetes, indicating the most interest and demand for peer-to-peer interaction on diabetes self-care. Future research is needed to establish efficacy and safety in recommending social media use among peers for diabetes self-care and other conditions.
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Affiliation(s)
- Abdelaziz Elnaggar
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Van Ta Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Sei J Lee
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Melinda Bender
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Lee Anne Siegmund
- Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland, OH, United States
| | - Linda G Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
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Wu XW, Yang HB, Yuan R, Long EW, Tong RS. Predictive models of medication non-adherence risks of patients with T2D based on multiple machine learning algorithms. BMJ Open Diabetes Res Care 2020; 8:8/1/e001055. [PMID: 32156739 PMCID: PMC7064141 DOI: 10.1136/bmjdrc-2019-001055] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Medication adherence plays a key role in type 2 diabetes (T2D) care. Identifying patients with high risks of non-compliance helps individualized management, especially for China, where medical resources are relatively insufficient. However, models with good predictive capabilities have not been studied. This study aims to assess multiple machine learning algorithms and screen out a model that can be used to predict patients' non-adherence risks. METHODS A real-world registration study was conducted at Sichuan Provincial People's Hospital from 1 April 2018 to 30 March 2019. Data of patients with T2D on demographics, disease and treatment, diet and exercise, mental status, and treatment adherence were obtained by face-to-face questionnaires. The medication possession ratio was used to evaluate patients' medication adherence status. Fourteen machine learning algorithms were applied for modeling, including Bayesian network, Neural Net, support vector machine, and so on, and balanced sampling, data imputation, binning, and methods of feature selection were evaluated by the area under the receiver operating characteristic curve (AUC). We use two-way cross-validation to ensure the accuracy of model evaluation, and we performed a posteriori test on the sample size based on the trend of AUC as the sample size increase. RESULTS A total of 401 patients out of 630 candidates were investigated, of which 85 were evaluated as poor adherence (21.20%). A total of 16 variables were selected as potential variables for modeling, and 300 models were built based on 30 machine learning algorithms. Among these algorithms, the AUC of the best capable one was 0.866±0.082. Imputing, oversampling and larger sample size will help improve predictive ability. CONCLUSIONS An accurate and sensitive adherence prediction model based on real-world registration data was established after evaluating data filling, balanced sampling, and so on, which may provide a technical tool for individualized diabetes care.
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Affiliation(s)
- Xing-Wei Wu
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Heng-Bo Yang
- School of Pharmacy, Chengdu Medical College, Chengdu, China
| | - Rong Yuan
- Endocrine Department, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - En-Wu Long
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Rong-Sheng Tong
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
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Milky G, Thomas J. Shared decision making, satisfaction with care and medication adherence among patients with diabetes. PATIENT EDUCATION AND COUNSELING 2020; 103:661-669. [PMID: 31676101 DOI: 10.1016/j.pec.2019.10.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We examined factors associated with shared decision making and whether shared decision-making (SDM) was associated with satisfaction with care or with adherence to anti-diabetic medication. METHODS A retrospective study was conducted using 2011-2014 Medical Expenditure Panel Survey (MEPS) data. Inclusion criteria were 18 years or older and visit to a usual source of care during the prior 12 months. Exclusion criteria were reported cognitive limitation, proxy response, less than two prescription fills, or missing data on study variables. SDM was assessed using seven MEPS items. Satisfaction with care was assessed using a single MEPS item 12 months after SDM measurement. Adherence was assessed using Medication Possession Ratio in 12 months after SDM measurement. RESULTS The weighted sample of 797 respondents represented 15.6 million with diabetes. Being older, male, or uninsured were associated with low SDM. High SDM was associated with higher satisfaction (p < 0.0001). SDM was not associated with adherence. CONCLUSIONS Patients with higher SDM were more satisfied with their healthcare. We did not find association between SDM and adherence to antidiabetic medication. PRACTICE IMPLICATIONS Involvement in SDM is encouraged to improve patient satisfaction. Providers may consider age, sex and insurance status in facilitating communications to improve SDM.
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Affiliation(s)
- Gediwon Milky
- Department of Pharmacy Practice, Purdue University, West Lafayette, IN, USA
| | - Joseph Thomas
- Department of Pharmacy Practice, Purdue University, West Lafayette, IN, USA.
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Impact of a supervised multicomponent physical exercise program on cognitive functions in patients with type 2 diabetes. Geriatr Nurs 2020; 41:421-428. [PMID: 32005445 DOI: 10.1016/j.gerinurse.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/28/2022]
Abstract
This study evaluated the impact of a multicomponent exercise program on cognitive functions in participants with Type 2 Diabetes. Participants (n = 70, 65.6 ± 5.9 years) engaged in the program (75 min per session; 3 x week) for 32 weeks. A battery of cognitive tests was performed at baseline and study completion. Two groups were formed according to their attendance rate (low and high attendance), and statistical comparisons were computed on their changes in cognitive performance. Such changes were also associated with the attendance rate for all participants. Results showed no significant differences between groups in their change scores, although there were some within-group differences in both groups. Correlation analysis showed that the attendance rate was not associated with cognitive performance changes, except for one variable. As the exercise program did not improve cognitive function, we discuss the potential of future interventions to incorporate dual-task activities merging physical and cognitive stimulation.
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Wong T, Brovman EY, Rao N, Tsai MH, Urman RD. A Dashboard Prototype for Tracking the Impact of Diabetes on Hospital Readmissions Using a National Administrative Database. J Clin Med Res 2020; 12:18-25. [PMID: 32010418 PMCID: PMC6968923 DOI: 10.14740/jocmr4029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/03/2019] [Indexed: 01/05/2023] Open
Abstract
Background Over the past several decades, diabetes mellitus has contributed to a significant disease burden in the general population. Evidence suggests that patients with a coexisting diabetes diagnosis consume more hospital resources, and have higher readmission rates compared to those who do not. Against the backdrop of bundled-payment programs, healthcare systems cannot underestimate the importance of monitoring patient health information at the population level. Methods Using the data from the Centers for Medicare and Medicaid Services (CMS) administrative claims database, we created a dashboard prototype to enable hospitals to examine the impact of diabetes on their all-cause readmission rates and financial implications if diabetes was present at the index hospitalization. The technical design involved loading the relevant 10th revision of International Classification of Diseases (ICD-10) codes provided by the medical team and flagging diabetes patients at the claim. These patients were then tagged for readmissions within the same database. The odds ratios were determined based on data from two groups: those with diabetes at index hospitalization which include type 1 only, type 2 only, and type 1 and type 2 diabetes, plus those without diabetes at index hospitalization. Results The dashboard presents summary data of diabetes readmissions quality metrics at a national level. Users can visualize summary data of each state and compare odds ratios for readmissions as well as raw hospitalization data at their facility. Dashboard users can also view data classified by a diagnosis-related group (DRG) system. In addition to a “national” data view, for users who inquire about data specific to demographic regions, the DRG view can be further stratified at the state level or county level. At the DRG level, users can view data about the cost per readmissions for all index hospitalization with and without diabetes. Conclusions The dashboard prototype offers users a virtual interface which displays visual data for quick interpretation, monitors changes at a population level, and enables administrators to benchmark facility data against local and national trends. This is an important step in using data analytics to drive population level decision making to ultimately improve medical systems.
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Affiliation(s)
- Timothy Wong
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Ethan Y Brovman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mitchell H Tsai
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, VT, USA.,Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT, USA.,Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Secnik J, Schwertner E, Alvarsson M, Hammar N, Fastbom J, Winblad B, Garcia-Ptacek S, Religa D, Eriksdotter M. Cholinesterase inhibitors in patients with diabetes mellitus and dementia: an open-cohort study of ~23 000 patients from the Swedish Dementia Registry. BMJ Open Diabetes Res Care 2020; 8:8/1/e000833. [PMID: 31958305 PMCID: PMC7039592 DOI: 10.1136/bmjdrc-2019-000833] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/24/2019] [Accepted: 11/28/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Cholinesterase inhibitors (ChEIs) and memantine are the only approved pharmacological treatments for Alzheimer's disease (AD). Recent literature suggests reductions in cardiovascular burden and risk of stroke in ChEI users. However, the clinical effectiveness of these drugs in patients with diabetes mellitus (DM) and dementia has not been evaluated. RESEARCH DESIGN AND METHODS We conducted a registry-based open-cohort study of 22 660 patients diagnosed with AD and mixed-pathology dementia registered in the Swedish Dementia Registry until December 2015. Information on drug use, comorbidity and mortality was extracted using the linkage with the National Patient Registry, the Prescribed Drug Registry and the Cause of Death Registry. In total, 3176 (14%) patients with DM and 19 484 patients without DM were identified. Propensity-score matching, Cox-regression and competing-risk regression models were applied to produce HRs with 95% CIs for differences in all-cause, cardiovascular and diabetes-related mortality rates in ChEI users and non-users. RESULTS After matching the ChEI use in patients with DM was associated with 24% all-cause mortality reduction (HR 0.76 (95% CI 0.67 to 0.86)), compared with 20% reduction (0.80 (0.75 to 0.84)) in non-DM users. Donepezil and galantamine use were associated with a reduced mortality in both patients with DM (0.84 (0.74 to 0.96); 0.80 (0.66 to 0.97)) and patients without DM (0.85 (0.80 to 0.90); 0.93 (0.86 to 0.99)). Donepezil was further associated with reduction in cardiovascular mortality, however only in patients without DM (0.84 (0.75 to 0.94)). Rivastigmine lowered mortality only in the whole-cohort analysis and in patients without DM (0.82 (0.75 to 0.89)). Moreover, ChEI use was associated with 48% reduction in diabetes-related mortality (HR 0.52 (0.32 to 0.87)) in the whole-cohort analysis. Last, low and high doses were associated with similar benefit. CONCLUSIONS We found reductions in mortality in patients with DM and AD or mixed-pathology dementia treated with ChEIs, specifically donepezil and galantamine were associated with largest benefit. Future studies should evaluate whether ChEIs help maintain self-management of diabetes in patients with dementia.
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Affiliation(s)
- Juraj Secnik
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Emilia Schwertner
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Michael Alvarsson
- Growth and Metabolism, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Niklas Hammar
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
- Section for Neurology, Department of Internal Medicine, Södersjukhuset - Stockholm South General Hospital, Stockholm, Sweden
| | - Dorota Religa
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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Agofure O, Odjimogho S, Okandeji-Barry O, Efegbere H, Nathan H. Pattern of diabetes mellitus-related complications and mortality rate: Implications for diabetes care in a low-resource setting. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_64_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jackson L, Li W, Abdul Y, Dong G, Baban B, Ergul A. Diabetic Stroke Promotes a Sexually Dimorphic Expansion of T Cells. Neuromolecular Med 2019; 21:445-453. [PMID: 31197651 PMCID: PMC6884673 DOI: 10.1007/s12017-019-08554-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/04/2019] [Indexed: 12/31/2022]
Abstract
We recently reported that diabetes negates the cerebrovascular protection typically seen in adult female rats resulting in cognitive impairment, which is worsened by increased parenchymal bleeding and edema after ischemic stroke. Although women experience more severe diabetes and suffer from a higher rate of diabetic complications, including stroke and cognitive impairment, underlying mechanisms contributing to sex differences are limited. Emerging evidence suggests interleukin (IL)-17 contributes to cerebrovascular pathologies: (1) high salt diet-mediated expansion of IL-17-producing T cells (Th17) in the gut microbiome promotes cerebrovascular dysfunction and cognitive impairment in male mice, (2) increased IL-17-producing γδTCR cells exacerbates stroke injury in male mice, and (3) IL-17 promotes rupture of cerebral aneurysms in female mice. Based on these premises, we investigated the potential involvement of IL-17-producing inflammatory cells in cerebrovascular dysfunction and post-stroke vascular injury in diabetes by measuring intestinal, circulating, or cerebral T cell profiles as well as in plasma IL-17 in both sexes. Cell suspensions prepared from naive or stroked (3 days after stroke) diabetic and control rats were analyzed by flow cytometry, and IL-17 levels were measured in plasma using ELISA. Diabetes deferentially promoted the expansion of cerebral Th17 cells in females. In response to stroke, diabetes had a sexually dimorphic effect on the expansion of numerous T cell profiles. These results suggest that a better understanding of the role of IL-17-producing cells in diabetes may identify potential avenues in which the molecular mechanisms contributing to these sex differences can be further elucidated.
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Affiliation(s)
- Ladonya Jackson
- Program in Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA
| | - Weiguo Li
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Ave. MSC 908, Charleston, SC, 29425, USA
- Ralph Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Yasir Abdul
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Ave. MSC 908, Charleston, SC, 29425, USA
- Ralph Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Guangkuo Dong
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Babak Baban
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Adviye Ergul
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Ave. MSC 908, Charleston, SC, 29425, USA.
- Ralph Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
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Visaria J, Iyer NN, Raval A, Kong S, Hobbs T, Bouchard J, Kern DM, Willey V. Incidence and Prevalence of Microvascular and Macrovascular Diseases and All-cause Mortality in Type 2 Diabetes Mellitus: A 10-year Study in a US Commercially Insured and Medicare Advantage Population. Clin Ther 2019; 41:1522-1536.e1. [PMID: 31196656 DOI: 10.1016/j.clinthera.2019.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE The relationship between type 2 diabetes mellitus (T2DM) and increased microvascular and macrovascular disease and mortality is well established; however, data for the broad US T2DM population, especially by age, are limited. To help address this issue, we conducted a cohort study in a large national US commercially insured/Medicare Advantage population that incorporated a broad range of different age groups, including a large subset of younger individuals, during a 10-year study period. METHODS This longitudinal study combined health plan claims and mortality data to identify incident T2DM patients and 1:1 directly matched non-DM controls. T2DM individuals (n = 13,883) were identified by a medical claim with a T2DM diagnosis or T2DM medication pharmacy claim in 2007; non-DM controls had no DM medical or pharmacy claims over the entire study period (January 1, 2006 to December 31, 2015). The outcomes assessed were incidence, prevalence, time to vascular disease and all-cause mortality, as well as age-stratified incidence and mortality based on Centers of Disease Control and Prevention-defined age strata. FINDINGS Individuals with T2DM developed vascular disease at twice the rate as non-DM controls, 197 versus 98 per 1000 person-years, respectively. Vascular disease (composite) rates increased by age in T2DM/non-DM groups, 107.1/28.2 (18-44 years), 166.3/70.3 (45-64 years), and 391.0/199.7 (≥65 years) per 1000 person-years. The largest rate ratio was observed in younger individuals. All-cause mortality over follow-up was higher in T2DM individuals (27.5%) than in non-DM controls (19.6%). The largest increases in vascular disease prevalence and mortality among T2DM individuals were observed in the first year of follow-up. IMPLICATIONS T2DM has a substantial effect on microvascular and macrovascular disease and all-cause mortality rates in all age groups. These outcomes appear to occur early after T2DM diagnosis, and have more pronounced, nearly fourfold, relative impact on younger individuals with T2DM compared to matched non-DM controls.
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Affiliation(s)
- Jay Visaria
- HealthCore Inc, Wilmington, DE, United States.
| | - Neeraj N Iyer
- Novo Nordisk Inc, Plainsboro Township, NJ, United States
| | - Amit Raval
- HealthCore Inc, Wilmington, DE, United States; Merck and Co., Inc. Kenilworth, NJ, USA
| | - Sheldon Kong
- Novo Nordisk Inc, Plainsboro Township, NJ, United States; Bayer U.S., Whippany, NJ, USA
| | - Todd Hobbs
- Novo Nordisk Inc, Plainsboro Township, NJ, United States
| | - Jonathan Bouchard
- Novo Nordisk Inc, Plainsboro Township, NJ, United States; Sanofi, Inc., Bridgewater Township, NJ, USA
| | - David M Kern
- HealthCore Inc, Wilmington, DE, United States; Janssen Research & Development, Inc., Titusville, NJ, USA
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Trout KK, McCool WF, Homko CJ. Person-Centered Primary Care and Type 2 Diabetes: Beyond Blood Glucose Control. J Midwifery Womens Health 2019; 64:312-323. [PMID: 31066495 DOI: 10.1111/jmwh.12973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022]
Abstract
With an estimated 9% of persons in the United States diagnosed with diabetes, primary care providers such as midwives and nurse practitioners are increasingly working with persons who have diabetes and are seeking primary care services. This article reviews the current literature with regard to the initial evaluation of individuals who are diagnosed with diabetes, and what is entailed in comprehensive continuing management of care. A person-centered interprofessional approach to care of the person with diabetes is presented. Recommendations are given that address dietary habits, activities of daily living, medication regimens, and potential alternative therapies. Social constructs related to effective care of individuals with diabetes also are addressed. Knowledge of current research that has identified effective care practices for individuals with diabetes is imperative to ensuring their well-being, and promoting a person-centered and interprofessional approach is best for offering optimal care to those diagnosed with diabetes.
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Affiliation(s)
- Kimberly K Trout
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - William F McCool
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Carol J Homko
- Division of Endocrinology, Metabolism & Diabetes, Temple University School of Medicine, Philadelphia, Pennsylvania
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Huber J, Smeikal M, Saely CH, Stingl H, Lechleitner M, Fasching P. Geriatrische Aspekte bei Diabetes mellitus (Update 2019). Wien Klin Wochenschr 2019; 131:236-245. [DOI: 10.1007/s00508-019-1463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Local release of rapamycin by microparticles delays islet rejection within the anterior chamber of the eye. Sci Rep 2019; 9:3918. [PMID: 30850640 PMCID: PMC6408557 DOI: 10.1038/s41598-019-40404-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/14/2019] [Indexed: 12/23/2022] Open
Abstract
The anterior chamber of the eye (ACE) has emerged as a promising clinical islet transplantation site because of its multiple advantages over the conventional intra-hepatic portal site. This includes reduced surgical invasiveness and increased islet graft survival rate. It also allows for enhanced accessibility and monitoring of the islets. Although the ACE is initially an immuno-privileged site, this privilege is disrupted once the islet grafts are re-vascularized. Given that the ACE is a confined space, achieving graft immune tolerance through local immunosuppressive drug delivery is therefore feasible. Here, we show that islet rejection in the ACE of mice can be significantly suppressed through local delivery of rapamycin by carefully designed sustained-release microparticles. In this 30-day study, allogeneic islet grafts with blank microparticles were completely rejected 18 days post-transplantation into mice. Importantly, allogeneic islet grafts co-injected with rapamycin releasing microparticles into a different eye of the same recipient were preserved much longer, with some grafts surviving for more than 30 days. Hence, islet allograft survival was enhanced by a localized and prolonged delivery of an immunosuppressive drug. We envisage that this procedure will relieve diabetic transplant recipients from harsh systemic immune suppression, while achieving improved glycemic control and reduced insulin dependence.
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