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König A, Outeiro TF. Diabetes and Parkinson's Disease: Understanding Shared Molecular Mechanisms. JOURNAL OF PARKINSON'S DISEASE 2024; 14:917-924. [PMID: 38995799 PMCID: PMC11307096 DOI: 10.3233/jpd-230104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 07/14/2024]
Abstract
Aging is a major risk factor for Parkinson's disease (PD). Genetic mutations account for a small percentage of cases and the majority appears to be sporadic, with yet unclear causes. However, various environmental factors have been linked to an increased risk of developing PD and, therefore, understanding the complex interplay between genetic and environmental factors is crucial for developing effective disease-modifying therapies. Several studies identified a connection between type 2 diabetes (T2DM) and PD. T2DM is characterized by insulin resistance and failure of β-cells to compensate, leading to hyperglycemia and serious comorbidities. Both PD and T2DM share misregulated processes, including mitochondrial dysfunction, oxidative stress, chronic inflammation, altered proteostasis, protein aggregation, and misregulation of glucose metabolism. Chronic or recurring hyperglycemia is a T2DM hallmark and can lead to increased methylglyoxal (MGO) production, which is responsible for protein glycation. Glycation of alpha-synuclein (aSyn), a central player in PD pathogenesis, accelerates the deleterious aSyn effects. Interestingly, MGO blood plasma levels and aSyn glycation are significantly elevated in T2DM patients, suggesting a molecular mechanism underlying the T2DM - PD link. Compared to high constant glucose levels, glycemic variability (fluctuations in blood glucose levels), can be more detrimental for diabetic patients, causing oxidative stress, inflammation, and endothelial damage. Accordingly, it is imperative for future research to prioritize the exploration of glucose variability's influence on PD development and progression. This involves moving beyond the binary classification of patients as diabetic or non-diabetic, aiming to pave the way for the development of enhanced therapeutic interventions.
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Affiliation(s)
- Annekatrin König
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen, Germany
| | - Tiago F. Outeiro
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen, Germany
- Max Planck Institute for Multidisciplinary Science, Göttingen, Germany
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK
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Rogol AD, Laffel LM, Bode B, Sperling MA. Celebration of a century of insulin therapy in children with type 1 diabetes. Arch Dis Child 2023; 108:3-10. [PMID: 35725290 PMCID: PMC9763182 DOI: 10.1136/archdischild-2022-323975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023]
Abstract
Insulin is the key anabolic hormone of metabolism, with clear effects on glycaemia. Near-complete insulin deficiency occurs in type 1 diabetes (T1D), the predominant form affecting children, and uniformly fatal until the discovery of insulin. By the early 20th century, it was known that T1D was caused by the lack of a factor from pancreatic islets, but isolation of this substance proved elusive. In 1921, an unusual team in Toronto comprising a surgeon, a medical student, a physiologist and a biochemist successfully isolated a glucose-lowering pancreatic endocrine secretion. They treated an emaciated 14-year-old boy in 1922, restoring his health and allowing him to live for another 13 years. Thus began an era of remarkable progress and partnership between academia and the pharmaceutical industry to produce drugs that benefit sick people. The Toronto team received the 1923 Nobel Prize, and more Nobel Prizes for work with insulin followed: for elucidation of its amino acid sequence and crystalline structure, and for its role in the development of radioimmunoassays to measure circulating hormone concentrations. Human insulin was the first hormone synthesised by recombinant methods, permitting modifications to enable improved absorption rates and alterations in duration of action. Coupled with delivery via insulin pens, programmable pumps and continuous glucose monitors, metabolic control and quality of life vastly improved and T1D in children was converted from uniformly fatal to a manageable chronic condition. We describe this remarkable ongoing story as insulin remains a paradigm for human ingenuity to heal nature's maladies.
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Affiliation(s)
- Alan D Rogol
- Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Lori M Laffel
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
| | - Mark A Sperling
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Piersanti A, Giurato F, Göbl C, Burattini L, Tura A, Morettini M. Software Packages and Tools for the Analysis of Continuous Glucose Monitoring Data. Diabetes Technol Ther 2023; 25:69-85. [PMID: 36223198 DOI: 10.1089/dia.2022.0237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The advancement of technology in the field of glycemic control has led to the widespread use of continuous glucose monitoring (CGM), which can be nowadays obtained from wearable devices equipped with a minimally invasive sensor, that is, transcutaneous needle type or implantable, and a transmitter that sends information to a receiver or smart device for data storage and display. This work aims to review the currently available software packages and tools for the analysis of CGM data. Based on the purposes of this work, 12 software packages have been identified from the literature, published until December 2021, namely: GlyCulator, EasyGV (Easy Glycemic Variability), CGM-GUIDE© (Continuous Glucose Monitoring Graphical User Interface for Diabetes Evaluation), GVAP (Glycemic Variability Analyzer Program), Tidepool, CGManalyzer, cgmanalysis, GLU, CGMStatsAnalyser, iglu, rGV, and cgmquantify. Comparison of available software packages and tools has been done in terms of main characteristics (i.e., publication year, presence of a graphical user interface, availability, open-source code, number of citations, programming language, supported devices, supported data format and organization of the data structure, documentation, presence of a toy example, video tutorial, data upload and download, measurement-units conversion), preprocessing procedures, data display options, and computed metrics; also, each of the computed metrics has been analyzed in terms of its adherence to the American Diabetes Association (ADA) 2017 international consensus on CGM data analysis and the ADA 2019 international consensus on time in range. Eventually, the agreement between metrics computed by different software and tools has been investigated. Based on such comparison, usability and complexity of data management, as well as the possibility to perform customized or patients-group analyses, have been discussed by highlighting limitations and strengths, also in relation to possible different user categories (i.e., patients, clinicians, researchers). The information provided could be useful to researchers interested in working in the diabetic research field as to clinicians and endocrinologists who need tools capable of handling CGM data effectively.
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Affiliation(s)
- Agnese Piersanti
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Giurato
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Christian Göbl
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Laura Burattini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Tura
- CNR Institute of Neuroscience, Padova, Italy
| | - Micaela Morettini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
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HASBULLAH, FARIDAH DN, DEWI FNA, INDRASTI D, ANDARWULAN N. Effect of nutmeg on glycemic status in rat and mice: a systematic review. FOOD SCIENCE AND TECHNOLOGY 2023. [DOI: 10.1590/fst.130122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Brown JVE, Ajjan R, Siddiqi N, Coventry PA. Acceptability and feasibility of continuous glucose monitoring in people with diabetes: protocol for a mixed-methods systematic review of quantitative and qualitative evidence. Syst Rev 2022; 11:263. [PMID: 36494845 PMCID: PMC9733378 DOI: 10.1186/s13643-022-02126-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Good glycaemic control is a crucial part of diabetes management. Traditional assessment methods, including HbA1c checks and self-monitoring of blood glucose, can be unreliable and inaccurate. Continuous glucose monitoring (CGM) offers a non-invasive and more detailed alternative. Availability of this technology is increasing worldwide. However, there is no current comprehensive evidence on the acceptability and feasibility of these devices. This is a protocol for a mixed-methods systematic review of qualitative and quantitative evidence about acceptability and feasibility of CGM in people with diabetes. METHODS We will search MEDLINE, Embase, CINAHL, and CENTRAL for qualitative and quantitative evidence about the feasibility and acceptability of CGM in all populations with diabetes (any type) using search terms for "continuous glucose monitoring" and "diabetes". We will not apply any study-type filters. Searches will be restricted to studies conducted in humans and those published from 2011 onwards. We will not restrict the search by language. Study selection and data extraction will be carried out by two reviewers independently using Rayyan and Eppi-Reviewer, respectively, with disagreements resolved by discussion. Data extraction will include key information about each study, as well as qualitative evidence in the form of participant quotes from primary studies and themes and subthemes based on the authors' analysis. Quantitative data relating to acceptability and feasibility including data loss, adherence, and quantitative ratings of acceptability will be extracted as means and standard deviations or n/N as appropriate. Qualitative evidence will be analysed using framework analysis informed by the Theoretical Framework of Acceptability. Where possible, quantitative evidence will be combined using random-effects meta-analysis; otherwise, a narrative synthesis will be performed. The most appropriate method for integrating qualitative and quantitative findings will be selected based on the data available. DISCUSSION Ongoing assessment of the acceptability of interventions has been identified as crucially important to scale-up and implementation. This review will provide new knowledge with the potential to inform a programme theory of CGM as well as future roll-out to potentially vulnerable populations, including those with severe mental illness. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021255141.
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Affiliation(s)
| | - Ramzi Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, YO10 5DD, UK.,Hull York Medical School, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, YO10 5DD, UK.,York Environmental Sustainability Institute, University of York, York, UK.,Leverhulme Centre for Anthropocene Biodiversity, University of York, York, UK
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The Association of Personality Traits and Parameters of Glycemic Regulation in Type 1 Diabetes Mellitus Patients Using isCGM. Healthcare (Basel) 2022; 10:healthcare10091792. [PMID: 36141404 PMCID: PMC9498785 DOI: 10.3390/healthcare10091792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to examine the impact of personality on glycemic regulation in adult patients with type 1 diabetes mellitus (T1DM). The study group consisted of subjects with T1DM, who were ≥ 18 years of age. The study was conducted in two phases: At baseline, subjects completed the Croatian version of the International Personality Item Pool scale (IPIP50s) and a questionnaire designed to gather socioeconomic data, duration of diabetes, presence of chronic complications, presence of cardiovascular risk factors, frequency, and type of pre-existing hypoglycemic episodes per week. Blood and urine samples were collected and body mass index (BMI) was calculated. Each participant was provided with the intermittently scanned glucose monitoring system (isCGM) Freestyle Libre. During the second visit (3 months from the start of the trial), glycemic parameters were collected from the reports generated from the Freestyle Libre system. Estimated glycated hemoglobin (HbA1c) values were significantly lower after three months compared to baseline HbA1c (Wilcoxon test, p < 0.001). An inverse correlation between the number of daily scans and degree of extraversion among subjects was observed, e.g., higher degrees of extraversion resulted in lower numbers of daily scans, while lower degrees of extraversion, i.e., introvertedness, resulted in higher numbers of daily scans (Rho = −0.238 p = 0.009). There was a positive correlation between emotional stability and time spent in hypoglycemia (Rho = 0.214; p = 0.02). In addition, a shorter duration of diabetes was associated with higher percentages of TIR and vice versa (p = 0.02). Investigating personality traits can be a useful tool for identifying patients predisposed to hypoglycemia and lower scanning frequency. Patients with a longer history of T1DM require closer follow-up and should be re-educated when necessary.
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Yan L, Li Q, Guan Q, Han M, Zhao Y, Fang J, Zhao J. Evaluation of the performance and usability of a novel continuous glucose monitoring system. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Abstract
Background
Continuous glucose monitoring (CGM) can help manage diabetes mellitus (DM) and prevent hypoglycemia. This study aimed to evaluate the performance and usability of a novel SiJoy GS1 CGM system.
Methods
This multicenter trial enrolled participants with DM. Based on the comparison of glucose values measured by SiJoy GS1 CGM and venous blood glucose test, the 20/20% consistency and mean absolute relative difference (MARD%) were calculated, as well as Clarke and consensus error grid analysis. Product usability was evaluated by questionnaire completed by participants. Any occurrence of adverse events (AE) was documented.
Results
Seventy participants were included in the study. The mean age of participants was 41.5 ± 13.2 years, among which 29 (42.0%) were male, with the DM course of 8.6 ± 7.5 years. A total of 39 (56.5%) of them had type 1 DM, 24 (34.8%) had type 2 DM, and 6 (8.7%) were others for DM. The 20/20% consistency achieved 91.82%, which was higher than the target 65%. The percentage of A + B zones of Clarke and consensus error grid was 99.22% and 99.90%, respectively. The MARD value was 8.83% ± 4.03%. The mean score of usability questionnaire was 86.59 ± 5.17 out of 90. AE were observed in only one participant (mild fever), and no severe AEs occurred.
Conclusions
The SiJoy GS1 CGM system achieved satisfactory performance and usability. No severe AEs occurred and mild AE was reported in only one case.
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Possibility of Venous Serum Cl - Concentration ([Cl -] s) as a Marker for Human Metabolic Status: Correlation of [Cl -] s to Age, Fasting Blood Sugar (FBS), and Glycated Hemoglobin (HbA1c). Int J Mol Sci 2021; 22:ijms222011111. [PMID: 34681771 PMCID: PMC8537275 DOI: 10.3390/ijms222011111] [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: 09/17/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
The HCO3− concentration in venous serum ([HCO3−]s) is a factor commonly used for detecting the body pH and metabolic conditions. To exactly detect [HCO3−]s, the venous CO2 pressure should be kept as it is in the vein. The [HCO3−]s measurement is technically complicated to apply for huge numbers of almost heathy persons taking only basic medical examinations. The summation of [HCO3−]s and the venous serum Cl− concentration ([Cl−]s) is approximately constant; therefore, we studied if [Cl−]s could be a marker detecting metabolic conditions instead of [HCO3−]s. Venous blood was obtained from persons taking basic medical examinations (the number of persons = 107,630). Older persons showed higher values of [Cl−]s, fasting blood sugar (FBS), and glycated hemoglobin (HbA1c) than younger ones. [Cl−]s showed positive correlation to age and negative correlation to FBS and HBA1c. The negative correlation of [Cl−]s to FBS/HbA1c was obvious in persons with high FBS/HbA1c, leading us to an idea that persons with high FBS/HbA1c show high [HCO3−]s, which might be caused by low activity of carbonic anhydrase in the lung observed in persons with diabetes mellitus under acidotic conditions. Taken together, an easily measured serum electrolyte, [Cl−]s, could be a useful marker estimating metabolic conditions.
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Timmons JG, Boyle JG, Petrie JR. Time in Range as a Research Outcome Measure. Diabetes Spectr 2021; 34:133-138. [PMID: 34149253 PMCID: PMC8178718 DOI: 10.2337/ds20-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Time in range (TIR) is gaining ground as an outcome measure in type 1 diabetes trials. However, inclusion of TIR raises several issues for trial design. In this article, the authors begin by defining TIR and describing the current international consensus around TIR targets. They then expand on evidence for the validity of TIR as a primary clinical trial outcome before concluding with some practical, ethical, and logistical implications.
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Affiliation(s)
- Joseph G. Timmons
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, U.K
- Department of Endocrinology and Diabetes, Glasgow Royal Infirmary, Glasgow, Scotland, U.K
| | - James G. Boyle
- Department of Endocrinology and Diabetes, Glasgow Royal Infirmary, Glasgow, Scotland, U.K
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, U.K
| | - John R. Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, U.K
- Department of Endocrinology and Diabetes, Glasgow Royal Infirmary, Glasgow, Scotland, U.K
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