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Agur T, Steinmetz T, Goldman S, Zingerman B, Bielopolski D, Nesher E, Fattal I, Meisel E, Rozen-Zvi B. The impact of metformin on kidney disease progression and mortality in diabetic patients using SGLT2 inhibitors: a real-world cohort study. Cardiovasc Diabetol 2025; 24:97. [PMID: 40022102 PMCID: PMC11871758 DOI: 10.1186/s12933-025-02643-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Accepted: 02/11/2025] [Indexed: 03/03/2025] Open
Abstract
BACKGROUND Selecting the optimal first-line therapy for type 2 diabetes is essential for achieving glycemic control and providing cardio-renal protection, though the combined benefits of metformin with SGLT2 inhibitors, remain uncertain. METHODS This retrospective cohort study analyzed data from Clalit Health Services (2016-2021), to compare outcome in adults with type 2 diabetes treated with SGLT2 inhibitors alone versus in combination with metformin. Propensity score matching was applied to balance baseline characteristics between groups. Primary outcomes were a composite kidney outcome (40% decline in eGFR, or progression to ESRD), and all-cause mortality. Safety outcomes included hospitalizations, acute kidney injury and metabolic acidosis. RESULTS The study included 45,545 patients, with 6774 patients in each group following propensity score matching. The median follow-up time was 1166 days. Combination therapy with metformin and SGLT2 inhibitors was associated with significantly reduced risk of all-cause mortality (aHR 0.74, 95% CI 0.64-0.84), and composite kidney outcomes (aHR 0.65 95% CI 0.48-0.87) even after accounting for mortality as a competing risk (aHR 0.67; 95% CI 0.5-0.9). Furthermore, combination therapy was associated with reduced risks of hospitalization (aHR 0.93 95% CI 0.87-0.99), severe acute kidney injury events (aHR 0.72 95% CI 0.54-0.96) and metabolic acidosis events (aHR 0.58 95% CI 0.4-0.83), compared with SGLT2 inhibitors alone. CONCLUSIONS Patients receiving combination therapy with metformin and SGLT2 inhibitors showed significantly reduced risks of kidney disease progression and mortality compared to those treated with SGLT2 inhibitors alone. These findings support the use of metformin with SGLT2 inhibitors as a first-line treatment strategy for type 2 diabetes irrespective of glycemic control or cardio-renal risk factors.
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Affiliation(s)
- Timna Agur
- Department of Nephrology and Hypertension, Rabin Medical Center, Ze'ev Jabotinsky St 39, Petah Tikva, Israel.
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
| | - Tali Steinmetz
- Department of Nephrology and Hypertension, Rabin Medical Center, Ze'ev Jabotinsky St 39, Petah Tikva, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Shira Goldman
- Department of Nephrology and Hypertension, Rabin Medical Center, Ze'ev Jabotinsky St 39, Petah Tikva, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Boris Zingerman
- Department of Nephrology and Hypertension, Rabin Medical Center, Ze'ev Jabotinsky St 39, Petah Tikva, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana Bielopolski
- Department of Nephrology and Hypertension, Rabin Medical Center, Ze'ev Jabotinsky St 39, Petah Tikva, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Eviatar Nesher
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Department of Transplantation, Rabin Medical Center, Petah Tikva, Israel
| | - Ittai Fattal
- Department of Nephrology and Hypertension, Rabin Medical Center, Ze'ev Jabotinsky St 39, Petah Tikva, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Eshcar Meisel
- Department of Nephrology and Hypertension, Rabin Medical Center, Ze'ev Jabotinsky St 39, Petah Tikva, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Benaya Rozen-Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center, Ze'ev Jabotinsky St 39, Petah Tikva, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
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Kato T, Watanabe Y, Baba Y, Oshima Y, Takase K, Watanabe Y, Okada K, Aikawa M, Okamoto K, Koyama I. Preoperative risk-stratified analysis: External versus internal pancreatic stents in pancreatoduodenectomy. Surgery 2025; 178:108845. [PMID: 39384476 DOI: 10.1016/j.surg.2024.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/08/2024] [Accepted: 09/09/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND Several risk-stratified studies have compared the outcomes of external and internal pancreatic stents in pancreatoduodenectomy (PD), but no resolute standard for a fistula-mitigation strategy exists. The study investigated the efficacy of these stents in a preoperative risk-stratified setting. METHODS Data from 285 patients who underwent PD with pancreaticojejunostomy using an external or internal stent from 2015 to 2023 were analyzed. The preoperative pancreatic fistula score (preFRS) was used to classify patients into low-risk (preFRS: 0-5) and high-risk (preFRS: 6-8) groups. RESULTS PreFRS accurately predicted the risk of clinically relevant postoperative pancreatic fistula (CR-POPF) as 0% and >40% in patients with preFRS ≤1 and ≥7, respectively. Although no significant difference was observed in postoperative outcomes in low-risk patients, the external stent significantly reduced CR-POPF (21% vs 44%, P = .024) and postpancreatectomy hemorrhage (PPH, 0% vs 19%, P = .02) in high-risk patients, leading to the superiority of the external stent in the entire cohort in terms of CR-POPF (12% vs 24%, P = .033) and PPH (1% vs 11%, P = .013). There were no significant differences in stent-related complications or pancreatic dysfunction. External stent malfunction occurred in 14% and significantly affected CR-POPF development in both low- (20% vs 0%, P < .01) and high-risk groups (60% vs 14%, P = .021). CONCLUSION The external pancreatic stent showed a more beneficial effect on CR-POPF and PPH, especially in high-risk patients, without increasing other complications. Risk-stratified strategy and improving stent management might enhance postoperative outcomes.
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Affiliation(s)
- Tomotaka Kato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yuichiro Watanabe
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yuhei Oshima
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kenichiro Takase
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yukihiro Watanabe
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Katsuya Okada
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Masayasu Aikawa
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kojun Okamoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Isamu Koyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Liu Y, Yang Q, Zhang M, Lin J. J-shaped relationship of serum neurofilament light chain with urinary albumin excretion in US adults: NHANES 2013-2014. Ren Fail 2024; 46:2391955. [PMID: 39165224 PMCID: PMC11340232 DOI: 10.1080/0886022x.2024.2391955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/13/2024] [Accepted: 08/08/2024] [Indexed: 08/22/2024] Open
Abstract
INTRODUCTION This study focuses on investigating the relationship between serum neurofilament light chain (sNfL) and urinary albumin-to-creatinine ratio (uACR) among American adults aged 25-75. METHODS An analysis was conducted on information gathered from 1741 individuals aged between 25 and 75 who participated in the National Health and Nutrition Examination Survey (NHANES) during the years 2013-2014. Generalized linear models were utilized, and restricted cubic spline (RCS) analysis was conducted to assess a non-linear relationship. RESULTS Upon adjusting for multiple variables, a non-linear inverse J-shaped relationship was observed between sNfL and uACR. Compared with individuals in quartile 1 (Q1) of sNfL (2.8-8.3), those with quartile 4 (Q4) (≥19.1) had an adjusted β for uACR of 51.57. CONCLUSIONS The study found a J-shaped curve linking sNfL and uACR in American adults, with a turning point around log(sNfL) 2.928 pg/mL.
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Affiliation(s)
- Yanting Liu
- Tianjin Union Medical Center, Tianjin Medical University, Tianjin, China
| | - Qian Yang
- Tianjin Union Medical Center, Tianjin Medical University, Tianjin, China
| | - Meiyun Zhang
- Department of Neurology, Tianjin Union Medical Center, Tianjin, China
| | - Jingna Lin
- Department of Endocrinology, Tianjin Union Medical Center, Tianjin, China
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Leong R, Vosoughi A, Sivakumar G, Micieli JA. The Use of Non-Person-First Language in Consecutive General Ophthalmology Referrals. Am J Ophthalmol 2024; 267:1-7. [PMID: 38901721 DOI: 10.1016/j.ajo.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To investigate the prevalence of non-person-first language (PFL) in consecutive general ophthalmology referrals to a single tertiary ophthalmology clinic. DESIGN Retrospective cross-sectional study. METHODS Participants included Ophthalmology patients seen for their initial visit to a single tertiary ophthalmology clinic from July 2018 to December 2022. Ten randomly selected referrals from each day were screened for non-PFL as per the American Medical Association and American Psychological Association guidelines. Non-PFL was further categorized into general, diabetes, stigma, obesity, or ageism subcategories. The Chi-square test was used to evaluate associations between non-PFL use and referring provider gender and specialty, length of referral, and patient age and gender. RESULTS A total of 2625 referrals were included in the study and 136 (5.2%) used non-PFL, such as referring to a person with diabetes as a "diabetic". Error types included Diabetes (38.2%), Stigma (30.9%), General (23.5%), Disability (8.8%), and Obesity (4.4%). Year of referral was predictive of non-PFL (P = .0016), with most occurring in 2020 (9.5%). Non-PFL was significantly more likely to occur in long length referrals compared to medium and short length referrals (16.2% vs. 5.1% vs. 3.5%, P < .001). Referring provider specialty was also predictive of non-PFL (P < .001) with most received by Family Medicine (8.3%), Optometry (4.4%), Emergency Medicine (0.62%), Ophthalmology (4.2%), Others (2.9%). Patient gender (P = .5563), patient age (P = .3466), and referring provider gender (P = .9057) were not predictive of non-PFL. CONCLUSIONS Non-PFL use was most prevalent in 2020, with the most common referral sources being Family Medicine and Optometry. The highest proportions of non-PFL errors made were diabetes and stigma errors. Increased use of PFL in physician-physician communication can decrease intersectional stigma and promote inclusive patient care for ophthalmology patients.
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Affiliation(s)
- Rachel Leong
- Faculty of Health Sciences, McMaster University (R.L.), Hamilton, Ontario, Canada
| | - Amir Vosoughi
- Health Sciences Centre Winnipeg (A.V.), Winnipeg, Manitoba, Canada
| | - Guhan Sivakumar
- Faculty of Health, University of Waterloo (G.S.), Waterloo, Ontario, Canada
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Abiodun OO, Anya T, Adekanmbi VT, Ojji D. Family History of Hypertension and Echocardiographic Left Ventricular Hypertrophy in Hypertensive Nigerians. Glob Health Epidemiol Genom 2024; 2024:7858899. [PMID: 39345991 PMCID: PMC11438504 DOI: 10.1155/2024/7858899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 09/02/2024] [Accepted: 09/09/2024] [Indexed: 10/01/2024] Open
Abstract
Introduction Studies on the relationship between a family history of hypertension and left ventricular hypertrophy are sparse. We evaluated this relationship in patients with essential hypertension. Methods A total of 1668 patients with essential hypertension were consecutively enrolled in the prospective Federal Medical Centre Abuja Hypertension Registry. First-degree family history was defined by the presence of a known history of hypertension in any or both parents, siblings, and children. Echocardiographic left ventricular hypertrophy was diagnosed using the criteria of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Results The prevalence of a family history of hypertension, echocardiographic, and electrocardiographic left ventricular hypertrophy were 61.7%, 46.8%, and 30.8%, respectively. After multivariable adjustment, paternal history of hypertension [OR: 1.56, CI: 1.20-2.05, p=0.001] was associated with an increased risk of echocardiographic left ventricular hypertrophy, while maternal history of hypertension [OR: 0.72, CI 0.58-0.91, p=0.006] was associated with a reduced risk. Age ≥50 years (p=0.026), duration of hypertension ≥1 year (p=0.047), and heart failure (p < 0.001) were associated with an increased risk of left ventricular hypertrophy, while male sex (p < 0.001) was associated with a reduced risk. Conclusion Our study showed that a paternal history of hypertension is associated with an increased left ventricular hypertrophy risk among patients with essential hypertension, while maternal history is protective.
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Affiliation(s)
| | - Tina Anya
- Department of Internal MedicineFederal Medical Centre, Abuja, Nigeria
| | - Victor Tunde Adekanmbi
- Department of Obstetrics and GynecologyUniversity of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Dike Ojji
- Department of Internal MedicineUniversity of AbujaUniversity of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
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Yang Y, Huang J, Xie L, Wang Y, Guo S, Wang M, Shao X, Liu W, Wang Y, Li Q, Wu X, Zhang Z, Zeng F, Gong W. Nicotinamide protects against diabetic kidney disease through regulation of Sirt1. Endocrine 2024; 85:638-648. [PMID: 38446387 PMCID: PMC11291543 DOI: 10.1007/s12020-024-03721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To investigate the effect of nicotinamide (Nam) on diabetic kidney disease (DKD) in mice and explore its mechanism. METHODS Thirty DBA/2 J mice were randomly assigned to three groups. After 8 weeks of hyperglycemia induced by streptozocin (STZ), Nam and saline were administrated to STZ + Nam and STZ + NS mice, respectively, for 8 weeks. Non-diabetic mice (NDM) were used as control group. Twenty In2-/- Akita mice were randomly divided into two groups. After 8 weeks of hyperglycemia, Nam and saline were administered to Akita + Nam and Akita + NS mice, respectively, for 6 weeks. Wild-type littermates were used as control group. Markers of renal injury were analyzed, and the molecular mechanisms were explored in human proximal tubular HK2 cells. RESULTS Urinary albumin-to-creatinine ratio (UACR) and kidney injury molecule 1 (KIM-1) decreased in the STZ + Nam and Akita + Nam groups. Pathological analysis showed that Nam improved the structure of glomerular basement membrane, ameliorated glomerular sclerosis, and decreased the accumulation of extracellular matrix and collagen. Compared to the diabetic control group, renal fibrosis, inflammation, and oxidative stress were reduced in the Nam-treated mice. The expression of sirtuin 1 (Sirt1) in human proximal tubular HK2 cells was inhibited by high glucose and Nam treatment enhanced its expression. However, in HK2 cells with Sirt1 knockdown, the protective effect of Nam was abolished, indicating that the beneficial effect of Nam was partially dependent on Sirt1. CONCLUSIONS Nam has a renoprotective effect against renal injury caused by hyperglycemia and may be a potential target for the treatment of DKD.
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Affiliation(s)
- Yeping Yang
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jinya Huang
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Lijie Xie
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yilin Wang
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Shizhe Guo
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Meng Wang
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiaoqing Shao
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Wenjuan Liu
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yi Wang
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Qin Li
- Division of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Xia Wu
- Department of Endocrinology and Metabolism, Jing'an District Center Hospital of Shanghai, Shanghai, 200040, China
| | - Zhaoyun Zhang
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Institute of Endocrinology and Diabetology, Fudan University, Shanghai, 200040, China
| | - Fangfang Zeng
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Wei Gong
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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Prasad M, Bhardwaj N, Gupta E, Thomas SS. Prevalence and Predictors for Lean Fatty Liver Disease in General Population Attending a COVID-19 Vaccination Center in a Tertiary Care Hospital in India. Euroasian J Hepatogastroenterol 2024; 14:145-150. [PMID: 39802862 PMCID: PMC11714107 DOI: 10.5005/jp-journals-10018-1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/29/2024] [Indexed: 01/16/2025] Open
Abstract
Background There is an international consensus among experts advocating for the classification of fatty liver disease as a metabolic condition. However, some authors have raised concerns that this metabolic-centric framing may result in the underdiagnosis of metabolicdysfunction-associated steatotic liver disease (MASLD) in lean individuals. The present study was carried out with the objective of describing metabolic characteristics in MASLD and the prevalence of lean MASLD in the general population. Methods We carried out a hospital-based cross-sectional study. A pre-tested proforma was used to collect data on socio-demographic factors, lifestyle factors, and medical history. Transient elastography and blood investigations were carried out in all patients. The identification of independent predictors for MASLD and liver fibrosis was carried out using multivariable logistic regression. A test of interaction was conducted for studying effect modification in the association of diabetes and MASLD by subgroups of body mass index (BMI). Results A total of 1,243 participants were interviewed and screened for MASLD. The overall prevalence of MASLD was 43.7% (n = 543), with the prevalence of lean MASLD being 4.3% (n = 53). The prevalence of MASLD in lean vs non-lean subjects differed (21.3 vs 66.7%, p < 0.001). Of the total MASLD cases, lean MASLD constituted 9.7% of cases. The association of diabetes and MASLD did not differ in subgroups by BMI. The test for interaction to detect effect modification was not statistically significant (p = 0.673). Conclusion The results support laying emphasis on metabolic dysfunction as a key criterion when defining fatty liver disease. The findings emphasize the shared metabolic underpinnings between lean and non-lean MASLD and advocate for inclusive approaches in diagnosis, management, and public health initiatives. How to cite this article Prasad M, Bhardwaj N, Gupta E, et al. Prevalence and Predictors for Lean Fatty Liver Disease in General Population Attending a COVID-19 Vaccination Center in a Tertiary Care Hospital in India. Euroasian J Hepato-Gastroenterol 2024;14(2):145-150.
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Affiliation(s)
- Manya Prasad
- Department of Clinical Research and Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Neha Bhardwaj
- Division of Human Resources for Health, National Health Systems Resource Centre, New Delhi, India
| | - Ekta Gupta
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sherin S Thomas
- Department of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India
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Montesanto A, Lagani V, Spazzafumo L, Tortato E, Rosati S, Corsonello A, Soraci L, Sabbatinelli J, Cherubini A, Conte M, Capri M, Capalbo M, Lattanzio F, Olivieri F, Bonfigli AR. Physical performance strongly predicts all-cause mortality risk in a real-world population of older diabetic patients: machine learning approach for mortality risk stratification. Front Endocrinol (Lausanne) 2024; 15:1359482. [PMID: 38745954 PMCID: PMC11091327 DOI: 10.3389/fendo.2024.1359482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Background Prognostic risk stratification in older adults with type 2 diabetes (T2D) is important for guiding decisions concerning advance care planning. Materials and methods A retrospective longitudinal study was conducted in a real-world sample of older diabetic patients afferent to the outpatient facilities of the Diabetology Unit of the IRCCS INRCA Hospital of Ancona (Italy). A total of 1,001 T2D patients aged more than 70 years were consecutively evaluated by a multidimensional geriatric assessment, including physical performance evaluated using the Short Physical Performance Battery (SPPB). The mortality was assessed during a 5-year follow-up. We used the automatic machine-learning (AutoML) JADBio platform to identify parsimonious mathematical models for risk stratification. Results Of 977 subjects included in the T2D cohort, the mean age was 76.5 (SD: 4.5) years and 454 (46.5%) were men. The mean follow-up time was 53.3 (SD:15.8) months, and 209 (21.4%) patients died by the end of the follow-up. The JADBio AutoML final model included age, sex, SPPB, chronic kidney disease, myocardial ischemia, peripheral artery disease, neuropathy, and myocardial infarction. The bootstrap-corrected concordance index (c-index) for the final model was 0.726 (95% CI: 0.687-0.763) with SPPB ranked as the most important predictor. Based on the penalized Cox regression model, the risk of death per unit of time for a subject with an SPPB score lower than five points was 3.35 times that for a subject with a score higher than eight points (P-value <0.001). Conclusion Assessment of physical performance needs to be implemented in clinical practice for risk stratification of T2D older patients.
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Affiliation(s)
- Alberto Montesanto
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy
| | - Vincenzo Lagani
- Biological and Environmental Sciences and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- SDAIA-KAUST Center of Excellence in Data Science and Artificial Intelligence, Thuwal, Saudi Arabia
- Institute of Chemical Biology, Ilia State University, Tbilisi, Georgia
| | | | | | | | - Andrea Corsonello
- Unit of Geriatric Medicine, IRCCS INRCA, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, IRCCS INRCA, Cosenza, Italy
| | - Jacopo Sabbatinelli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
- Laboratory Medicine Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Maria Conte
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Miriam Capri
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | | | | | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
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Guzmán-García JM, Romero-Saldaña M, Molina-Recio G, Fonseca-Del Pozo FJ, Raya-Cano E, Molina-Luque R. Diagnostic accuracy of anthropometric indices for metabolically healthy obesity in child and adolescent population. Pediatr Res 2023; 94:1824-1831. [PMID: 37308682 DOI: 10.1038/s41390-023-02693-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/17/2023] [Accepted: 04/20/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND A variable percentage of children and adolescents with obesity do not have cardiometabolic comorbidities. A phenotype called metabolically healthy obese (MHO) has emerged to describe this population subgroup. Early identification of this condition may prevent the progression to metabolically unhealthy obesity (MUO). MATERIAL AND METHODS A cross-sectional descriptive study of 265 children and adolescents from Cordoba (Spain) conducted in 2018. The outcome variables were MHO, established based on three criteria: International Criterion, HOMA-IR, and a combination of the previous two. RESULTS The prevalence of MHO ranged from 9.4% to 12.8% of the study population, between 41% and 55.7% of the sample with obesity. The highest agreement was reached between the HOMA-IR definitions and the combined criteria. The waist-to-height ratio (WHtR) was the indicator with the highest discriminant capacity for MHO in 2 of the three criteria, with its best cut-off point at 0.47 for both. CONCLUSION The prevalence of MHO in children and adolescents differed according to the criteria used for diagnosis. The anthropometric variable with the most remarkable discriminating capacity for MHO was WHtR, with the same cut-off point in the three criteria analysed. IMPACT STATEMENT This research work defines the existence of metabolically healthy obesity through anthropometric indicators in children and adolescents. Definitions that combine cardiometabolic criteria and insulin resistance are used to identify metabolically healthy obesity, as well as the prediction of this phenomenon through anthropometric variables. The present investigation helps to identify metabolically healthy obesity before metabolic abnormalities begin.
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Affiliation(s)
- José-Miguel Guzmán-García
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004, Cordoba, Spain
| | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004, Cordoba, Spain.
- Lifestyles, Innovation and Health Research Associate Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain.
| | - Guillermo Molina-Recio
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004, Cordoba, Spain
- Lifestyles, Innovation and Health Research Associate Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain
| | - Francisco-Javier Fonseca-Del Pozo
- Córdoba and Guadalquivir Health District, Reina Sofia University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), 14004, Cordoba, Spain
| | - Elena Raya-Cano
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004, Cordoba, Spain
| | - Rafael Molina-Luque
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004, Cordoba, Spain
- Lifestyles, Innovation and Health Research Associate Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Cordoba, Spain
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10
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Usman NUB, Winson T, Basu Roy P, Tejani VN, Dhillon SS, Damarlapally N, Panjiyar BK. The Impact of Statin Therapy on Cardiovascular Outcomes in Patients With Diabetes: A Systematic Review. Cureus 2023; 15:e47294. [PMID: 38021726 PMCID: PMC10656369 DOI: 10.7759/cureus.47294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Cardiovascular disease (CVD) is the primary cause of death all over the world, especially due to myocardial ischemia caused by atherosclerosis that blocks cardiac arteries and leads to arrhythmia and other cardiac diseases. Meanwhile, diabetes mellitus (DM) and elevated cholesterol level are the risk factors for cardiovascular (CV) disease. This noncommunicable disease has become a main concern for us as cardiovascular disease develops in a slow manner without any symptoms in the early stage. Early prevention and intervention have a major impact on improving the outcome of cardiovascular health in diabetic patients. Controlling cholesterol level by administering statin has shown some beneficial impacts in reducing the risk of cardiovascular disease in patients with DM. This study used a systematic literature review (SLR) approach to give an overview of the current literature and to analyze the effects of statin therapy on cardiovascular outcomes in patients with DM. The literature search was conducted in PubMed and Google Scholar databases. The total number of articles included in the present review is six, obtained from reputable journals published between 2013 and 2023, and we only focused on reviewing six articles for in-depth analysis. The evidence we collected showed a positive outcome in terms of cardiovascular health in persons with DM after statin therapy. However, there are several risk factors that interfere with the effectiveness of statin in diabetic patients.
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Affiliation(s)
| | - Tanusha Winson
- Internal Medicine, Asian Institute of Medicine, Science and Technology (AIMST) University, Sungai Petani, MYS
| | - Prithvi Basu Roy
- Cardiology, Kali Pradip Chaudhuri (KPC) Medical College and Hospital, Kolkata, IND
| | - Vitrag N Tejani
- Pharmacology, Dr. N. D. Desai Faculty of Medical Science and Research, Dharmsinh Desai University, Nadiad, IND
- Internal Medicine, Parul Institute of Medical Sciences and Research, Parul Sevashram Hospital, Parul University, Vadodara, IND
| | - Sukhmeet S Dhillon
- Internal Medicine, Baba Farid University of Health Sciences, Patiala, IND
| | | | - Binay K Panjiyar
- Internal Medicine, Harvard Medical School, Boston, USA
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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11
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Spierling Bagsic SR, Savin KL, Soriano EC, San Diego ERN, Orendain N, Clark T, Sandoval H, Chichmarenko M, Perez-Ramirez P, Farcas E, Godino J, Gallo LC, Philis-Tsimikas A, Fortmann AL. Process evaluation of Dulce Digital-Me: an adaptive mobile health (mHealth) intervention for underserved Hispanics with diabetes. Transl Behav Med 2023; 13:635-644. [PMID: 37011033 PMCID: PMC10496430 DOI: 10.1093/tbm/ibad020] [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] [Indexed: 04/04/2023] Open
Abstract
Type 2 diabetes disproportionately impacts ethnic minorities and individuals from low socioeconomic status. Diabetes self-management education and support has been shown to improve clinical outcomes in these populations, and mobile health (mHealth) interventions can reduce barriers to access. Dulce Digital-Me (DD-Me) was developed to integrate adaptive mHealth technologies to enhance self-management and reduce disparities in the high-risk, underserved Hispanic population. The objective of the present study was to evaluate reach, adoption, and implementation of an mHealth diabetes self-management education and support intervention in this underrepresented population. The present analysis is a multimethod process evaluation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The study was effective in reaching a sample that was representative of the intended population; only modest but significant differences were observed in sex and age. The DD-Me health coach (HC) cited several important facilitators of intervention adoption, including outreach frequency and personalization, and the automated HC report. Implementation fidelity was high, with participants receiving >90% of intended interventions. Participants who received DD-Me with support from a HC were most engaged, suggesting utility and acceptability of integrating HCs with mHealth interventions. Perceptions of implementation among study participants were positive and consistent across study arms. This evaluation revealed the target population was successfully reached and engaged in the digital health interventions, which was implemented with high fidelity. Further studies should evaluate the efficacy and maintenance of the study following the RE-AIM model to determine whether this intervention warrants expansion to additional settings and populations.
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Affiliation(s)
| | - Kimberly L Savin
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | | | - Natalia Orendain
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Taylor Clark
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | | | - Perla Perez-Ramirez
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emilia Farcas
- Qualcomm Institute, University of California San Diego, La Jolla, CA, USA
| | - Job Godino
- Qualcomm Institute, University of California San Diego, La Jolla, CA, USA
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | | | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
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12
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Totaganti M, Kant R, Yadav RK, Khapre M. Static and Dynamic Foot Pressure Changes Among Diabetic Patients With and Without Neuropathy: A Comparative Cross-Sectional Study. Cureus 2023; 15:e45338. [PMID: 37849575 PMCID: PMC10577608 DOI: 10.7759/cureus.45338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Foot ulceration is a frequent diabetic complication with potentially fatal consequences. The pathophysiology of neuropathic ulcers in the diabetic foot is thought to be influenced by abnormal plantar pressures. AIM This study aimed to compare the maximum peak pressures among diabetic patients with and without neuropathy. The secondary aim was to evaluate the effect of glycemic control on pressure changes in both feet. MATERIALS AND METHODS The study used 62 diabetic individuals as participants. BMI was calculated, as well as illness duration, hemoglobin A1c, and the existence of neuropathy. Plantar pressure was measured in static (standing) and dynamic (walking/taking a step on the mat) settings for all patients using the BTS P-Walk system. The plantar pressures (kPa) at the five metatarsal regions, the midfoot region, and the medial and lateral heel regions were measured. RESULTS We found that the dynamic maximum pressures were significantly higher in patients with diabetic neuropathy (DN) compared to diabetics without neuropathy at the first metatarsal and mid-foot area in both feet (p<0.05). We also found significantly elevated plantar pressure in patients with poor glycemic control under the second metatarsal head in the right foot (p<0.05). CONCLUSION Persons with DN have higher maximum plantar pressures compared to diabetics without neuropathy. Patients with poor glycemic control also have a higher maximum pressure.
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Affiliation(s)
| | - Ravi Kant
- General Medicine, All India Institute of Medical Sciences, Rishikesh, IND
- Nursing, All India Institute of Medical Sciences, Rishikesh, IND
| | - Raj Kumar Yadav
- Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Rishikesh, IND
| | - Meenakshi Khapre
- Social Preventive Medicine, All India Institute of Medical Sciences, Rishikesh, IND
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13
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Wahab MA, Alhabibi AM, Sakr AK, Zakaria MY, Saleh OI, Ahmad IH, Abdelrahman EK, Taha RSE, Ahmed FKAA, Ismail B, Azel LH, Hassan AS, El Sayed HME, Kasim SA, Elsharkawy SA. The Correlation Between C-Peptide and Severity of Peripheral Atherosclerosis in Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2023; 16:2617-2625. [PMID: 37663202 PMCID: PMC10474844 DOI: 10.2147/dmso.s426956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background One of the major issues affecting global health is Diabetes mellitus (DM), not only in terms of the disease itself but also its complications. Macrovascular complications are both common and serious, affecting many patients. This study aimed to assess fasting C-peptide levels and correlate them with the severity of the peripheral arterial disease complicating type 2 DM (T2DM). Patients and Methods This study included 200 participants who were categorized into two groups: Group I (n=100, patients with T2DM complicated by femoropopliteal arterial atherosclerosis) and Group II (n=100, healthy age- and sex-matched individuals serving as controls). Fasting C-peptide levels were estimated using an immunochemiluminometric assay. Results Fasting C-peptide levels were significantly higher in Group I than in the control group. Fasting C-peptide levels were positively correlated with the severity of atherosclerosis. In addition, the receiver operating characteristic (ROC) curve analysis revealed that fasting C-peptide levels served as a specific and sensitive marker for detecting the severity of this disease. Conclusion Fasting C-peptide levels can be used as a sensitive and specific indicator of the severity of femoropopliteal arteriosclerosis that complicates T2DM.
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Affiliation(s)
- Maisa A Wahab
- Department of Vascular Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Alshaymaa M Alhabibi
- Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Ahmed Khairy Sakr
- Department of Vascular Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mohamed Yahia Zakaria
- Department of Vascular and Endovascular Surgery, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Ola I Saleh
- Department of Radio-Diagnosis, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Inass Hassan Ahmad
- Department of Endocrinology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Eman Kamel Abdelrahman
- Department of Internal Medicine, Faculty of Medicine, Port Said University, Port Said, Egypt
| | | | | | - Bothayna Ismail
- Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Lamiaa Hosney Azel
- Department of Endocrinology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Asmaa S Hassan
- Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | - Sammar Ahmed Kasim
- Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Safaa Abdelfattah Elsharkawy
- Department of Community Medicine and Occupational Health, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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14
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Ivanova Y, Gramatiuk S, Kryvoruchko I, Tymchenko M, Goltsev K, Sargsyan K. Investigating the joint application of negative pressure wound treatment and tissue therapy for chronic wounds in patients with diabetes. J Med Life 2023; 16:1098-1104. [PMID: 37900068 PMCID: PMC10600680 DOI: 10.25122/jml-2023-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/19/2023] [Indexed: 10/31/2023] Open
Abstract
This study aimed to investigate the effectiveness of combined negative pressure wound therapy (NPWT) and human amniotic membrane in patients with chronic wounds associated with diabetes. A total of five patients with type 2 diabetes, including ischemic and mixed forms of diabetic foot syndrome, presenting with ischemic wounds of the lower extremities were included in this study. Patients with uncorrected limb ischemia were excluded. The treatment protocol included diabetes compensation (treatment with fractional insulin therapy), anticoagulant, metabolic therapy and angiotropic therapy, physical treatment methods, osteoporosis therapy with calcium preparations, and wound-specific interventions. The primary treatment approach involved the application of a vacuum bandage to the transplanted human amniotic membrane, which improved the adaptation of the flap to the wound surface, allowed the removal of excess wound exudate, and stimulated angiogenesis and reparative properties. The combined approach of NPWT and biotherapy was a safe and effective cure for diabetic wounds, promoting faster wound healing, reducing the need for autodermoplasty, and possibly reducing the necessity for high-level amputations.
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Affiliation(s)
- Yulia Ivanova
- Institute of Bio-Stem Cell Rehabilitation, Ukraine Association of Biobank, Kharkiv, Ukraine
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Svitlana Gramatiuk
- Institute of Bio-Stem Cell Rehabilitation, Ukraine Association of Biobank, Kharkiv, Ukraine
- International Biobanking and Education, Medical University of Graz, Graz, Austria
| | - Igor Kryvoruchko
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Mykhailo Tymchenko
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
- Zaytsev V.T. Institute of General and Urgent Surgery, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Kyrylo Goltsev
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Karine Sargsyan
- International Biobanking and Education, Medical University of Graz, Graz, Austria
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15
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Goyal S, Rani J, Bhat MA, Vanita V. Genetics of diabetes. World J Diabetes 2023; 14:656-679. [PMID: 37383588 PMCID: PMC10294065 DOI: 10.4239/wjd.v14.i6.656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/13/2023] [Accepted: 04/17/2023] [Indexed: 06/14/2023] Open
Abstract
Diabetes mellitus is a complicated disease characterized by a complex interplay of genetic, epigenetic, and environmental variables. It is one of the world's fastest-growing diseases, with 783 million adults expected to be affected by 2045. Devastating macrovascular consequences (cerebrovascular disease, cardiovascular disease, and peripheral vascular disease) and microvascular complications (like retinopathy, nephropathy, and neuropathy) increase mortality, blindness, kidney failure, and overall quality of life in individuals with diabetes. Clinical risk factors and glycemic management alone cannot predict the development of vascular problems; multiple genetic investigations have revealed a clear hereditary component to both diabetes and its related complications. In the twenty-first century, technological advancements (genome-wide association studies, next-generation sequencing, and exome-sequencing) have led to the identification of genetic variants associated with diabetes, however, these variants can only explain a small proportion of the total heritability of the condition. In this review, we address some of the likely explanations for this "missing heritability", for diabetes such as the significance of uncommon variants, gene-environment interactions, and epigenetics. Current discoveries clinical value, management of diabetes, and future research directions are also discussed.
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Affiliation(s)
- Shiwali Goyal
- Department of Ophthalmic Genetics and Visual Function Branch, National Eye Institute, Rockville, MD 20852, United States
| | - Jyoti Rani
- Department of Human Genetics, Guru Nanak Dev University, Amritsar 143005, Punjab, India
| | - Mohd Akbar Bhat
- Department of Ophthalmology, Georgetown University Medical Center, Washington DC, DC 20057, United States
| | - Vanita Vanita
- Department of Human Genetics, Guru Nanak Dev University, Amritsar 143005, Punjab, India
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16
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Ramezani Tehrani F, Farzadfar F, Hosseinpanah F, Rahmati M, Firouzi F, Abedini M, Hadaegh F, Valizadeh M, Torkestani F, Khalili D, Solaymani-Dodaran M, Bidhendi-Yarandi R, Bakhshandeh M, Ostovar A, Dovom MR, Amiri M, Azizi F, Behboudi-Gandevani S. Does fasting plasma glucose values 5.1-5.6 mmol/l in the first trimester of gestation a matter? Front Endocrinol (Lausanne) 2023; 14:1155007. [PMID: 37334302 PMCID: PMC10273274 DOI: 10.3389/fendo.2023.1155007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives The aim of the study was to investigate the effect of treatment on pregnancy outcomes among women who had fasting plasma glucose (FPG) 5.1-5.6 mmol/l in the first trimester of pregnancy. Methods We performed a secondary-analysis of a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. All pregnant women with FPG values range 5.1-5.6 mmol/l in the first trimester of gestation were included in the present study (n=3297) and classified to either the (i) intervention group who received treatment for GDM along with usual prenatal care (n=1,198), (ii) control group who received usual-prenatal-care (n=2,099). Macrosomia/large for gestational age (LGA) and primary cesarean-section (C-S) were considered as primary-outcomes. A modified-Poisson-regression for binary outcome data with a log link function and robust error variance was used to RR (95%CI) for the associations between GDM status and incidence of pregnancy outcomes. Results The mean maternal age and BMI of pregnant women in both study groups were similar. There were no statistically significant differences in the adjusted risks of adverse pregnancy outcomes, including macrosomia, primary C-S, preterm birth, hyperbilirubinemia, preeclampsia, NICU-admission, birth trauma, and LBW both groups. Conclusions It is found that treating women with first-trimester FPG values of 5.1-5.6 mmol/l could not improve adverse pregnancy outcomes including macrosomia, Primary C-S, Preterm birth, hypoglycemia, hypocalcemia, preeclampsia, NICU admission, Birth trauma and LBW. Therefore, extrapolating the FPG cut-off point of the second trimester to the first -which has been proposed by the IADPSG, might therefore not be appropriate. Clinical Trial Registration https://www.irct.ir/trial/518, identifier IRCT138707081281N1.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faegheh Firouzi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and Cell Therapy Office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Marzieh Bakhshandeh
- Family Health Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Rostami Dovom
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Huang PF, Zhang YJ, Lou XZ, Ma D, Wu YY, Zhao YB. Predictive value of admission CO 2 combining power combined with serum sodium for the prognosis in acute Stanford type A aortic dissection patients. Sci Rep 2023; 13:1048. [PMID: 36658204 PMCID: PMC9852255 DOI: 10.1038/s41598-022-27099-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/26/2022] [Indexed: 01/20/2023] Open
Abstract
Acute Stanford type A aortic dissection (ATAAD) with sudden onset and high mortality requiries a standard Bentall operation and a accurate prognosis in common, together with alteration of CO2 combining power (CO2CP) and serum sodium rase concern, hence, we evaluated the prognostic value of CO2CP combined with serum sodium in ATAAD patients. This retrospective study included 183 patients who underwent Bentall operation for ATAAD from 2015 to 2021 in the Fourth Hospital of Hebei Medical University, subsequently followed grouping by the levels of CO2CP and serum sodium. The study endpoint was 30-day all-cause mortality, and the prognostic value of CO2CP combined with serum sodium levels in ATAAD patients were evaluated with multivariate logistic regression method. The postoperative incidence of in-hospital death and adverse events in patients with ATAAD were 18% and 25.7%, respectively. Combination of CO2CP and serum sodium for predicting ATAAD death and adverse events presented a higher predictive value than each single indicator with ROC curve analysis (the AUC of CO2CP combined with serum sodium was 0.786, 95% CI 0.706-0.869, P < 0.001), along with CO2CP < 22.5 mmol/L + serum sodium > 138.5 mmol/L group had the worst prognostic. Multivariate regression analyse showed that CO2CP < 22.5 mmol/L combined with serum sodium > 138.5 mmol/L preferably predicted the prognosis of ATAAD (OR =6.073, 95% CI 2.557-14.425, P < 0.001). Consistently, the cumulative 30-day survival after surgery in ATAAD patients with the low CO2CP and high serum sodium simultaneously was the worst (log-rank P < 0.05). The combination of CO2CP and serum sodium increases the predictive value of prognosis, which is conducive to risk stratification of patients with ATAAD.
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Affiliation(s)
- Peng-Fei Huang
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Yun-Jing Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Xian-Zhe Lou
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Dong Ma
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China. .,Department of Biochemistry and Molecular Biology, Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.
| | - Yun-Yan Wu
- Cardiac Surgery Department, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Yong-Bo Zhao
- Cardiac Surgery Department, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.
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18
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Dzodzomenyo S, Narain KDC. Exploring the relationship between self-employment and women’s cardiovascular health. BMC Womens Health 2022; 22:307. [PMID: 35870911 PMCID: PMC9308471 DOI: 10.1186/s12905-022-01893-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/16/2022] [Indexed: 12/19/2022] Open
Abstract
Background Compared with wage and salary work, self-employment has been linked to more favorable cardiovascular health outcomes within the general population. Women comprise a significant proportion of the self-employed workforce and are disproportionately affected by cardiovascular disease. Self-employed women represent a unique population in that their cardiovascular health outcomes may be related to gender-specific advantages of non-traditional employment. To date, no studies have comprehensively explored the association between self-employment and risk factors for cardiovascular disease among women. Methods We conducted a weighted cross-sectional analysis using data from the University of Michigan Health and Retirement Study (HRS). Our study sample consisted of 4624 working women (employed for wages and self-employed) enrolled in the 2016 HRS cohort. Multivariable linear and logistic regression were used to examine the relationship between self-employment and several self-reported physical and mental health risk factors for cardiovascular disease, controlling for healthcare access. Results Among working women, self-employment was associated with a 34% decrease in the odds of reporting obesity, a 43% decrease in the odds of reporting hypertension, a 30% decrease in the odds of reporting diabetes, and a 68% increase in the odds of reporting participation in at least twice-weekly physical activity (p < 0.05). BMI for self-employed women was on average 1.79 units lower than it was for women working for wages (p < 0.01). Conclusions Employment structure may have important implications for cardiovascular health among women, and future studies should explore the causal relationship between self-employment and cardiovascular health outcomes in this population. Trial Registration: Not applicable.
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19
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Niknam A, Ramezani Tehrani F, Behboudi-Gandevani S, Rahmati M, Hedayati M, Abedini M, Firouzi F, Torkestani F, Zokaee M, Azizi F. Umbilical cord blood concentration of connecting peptide (C-peptide) and pregnancy outcomes. BMC Pregnancy Childbirth 2022; 22:764. [PMID: 36224521 PMCID: PMC9559016 DOI: 10.1186/s12884-022-05081-4] [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: 08/10/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background C-peptide offers potential as a marker to indicate childhood metabolic outcomes. Measuring C-peptide concentration might have better future utility in the risk stratification of neonates born to overweight or diabetic mothers. Prior research has tried to bring this matter into the light; however, the clinical significance of these associations is still far from reach. Here we sought to investigate the associations between fetomaternal metabolic variables and umbilical cord blood C-peptide concentration. Methods For the present study, 858 pregnant women were randomly selected from among a sub-group of 35,430 Iranian pregnant women who participated in a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. Their umbilical cord (UC) blood C-peptide concentrations were measured, and the pregnancy variables of macrosomia/large for gestational age (LGA) and primary cesarean section (CS) delivery were assessed. The variation of C-peptide concentrations among GDM and macrosomia status was plotted. Due to the skewed distribution of C-peptide concentration in the sample, median regression analysis was used to identify potential factors related to UC C-peptide concentration. Results In the univariate model, positive GDM status was associated with a 0.3 (95% CI: 0.06 − 0.54, p = 0.01) increase in the median coefficient of UC blood C-peptide concentration. Moreover, one unit (kg) increase in the birth weight was associated with a 0.25 (95% CI: 0.03 − 0.47, p = 0.03) increase in the median coefficient of UC blood C-peptide concentration. In the multivariate model, after adjusting for maternal age, maternal BMI, and macrosomia status, the positive status of GDM and macrosomia were significantly associated with an increase in the median coefficient of UC blood C-peptide concentration (Coef.= 0.27, 95% CI: 0.13 − 0.42, p < 0.001; and Coef.= 0.34, 95% CI: 0.06 − 0.63, p = 0.02, respectively). Conclusion UC blood concentration of C-peptide is significantly associated with the incidence of maternal GDM and neonatal macrosomia. Using stratification for maternal BMI and gestational weight gain (GWG) and investigating molecular markers like Leptin and IGF-1 in the future might lay the ground to better understand the link between metabolic disturbances of pregnancy and UC blood C-peptide concentration. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05081-4.
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Affiliation(s)
- Atrin Niknam
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and cell therapy office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Faegheh Firouzi
- Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | | | - Mehdi Zokaee
- Senior Executive of Public Health, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Manoharan P, Nadarajah R, Suganthan N. Assessment of Additional Risk Factors for Cardiovascular Disease and Awareness Among Adult Patients With Diabetes Mellitus: A Cross-Sectional Study From Northern Sri Lanka. Cureus 2022; 14:e30047. [DOI: 10.7759/cureus.30047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
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21
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Al Quran TM, Bataineh ZA, Al-Mistarehi AH, Zein Alaabdin AM, Allan H, Al Qura’an A, Weshah SM, Alanazi AA, Khader YS. Prevalence and Pattern of Dyslipidemia and Its Associated Factors Among Patients with Type 2 Diabetes Mellitus in Jordan: A Cross-Sectional Study. Int J Gen Med 2022; 15:7669-7683. [PMID: 36217367 PMCID: PMC9547589 DOI: 10.2147/ijgm.s377463] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background Dyslipidemia and type 2 diabetes mellitus (T2DM) are growing health problems, particularly in developing countries. This study aimed to determine the prevalence and pattern of dyslipidemia and its associated factors among patients with T2DM. Methods A cross-sectional study was conducted among patients with T2DM attending Family Medicine Clinics in Jordan between August 2017 and March 2019. The socio-demographics, clinical features, medications, and laboratory findings were collected. These laboratory findings included high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TGs). Results A total of 870 patients with T2DM were included. The prevalence of dyslipidemia among patients with T2DM was 91.4%. The most common patterns of dyslipidemia were low HDL-C (66.2%), high LDL-C (62.1%), and hypertriglyceridemia (58.2%). Female gender, obesity, and hypertension were associated with diabetic dyslipidemia patterns. T2DM duration and poor glycemic control were associated with high LDL-C and hypercholesterolemia. Hypertriglyceridemia was associated with poor glycemic control and smoking. Conclusion Dyslipidemia is highly prevalent among patients with T2DM. Evidence -based interventions are needed to prevent and control dyslipidemia among patients with T2DM in Jordan.
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Affiliation(s)
- Thekraiat M Al Quran
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad A Bataineh
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anas M Zein Alaabdin
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hadeel Allan
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anood Al Qura’an
- Department of Internal Medicine, Jordanian Royal Medical Services, Amman, Jordan
| | - Shatha M Weshah
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anfal A Alanazi
- Family Medicine Academy, E1-Eastern Health Cluster, Dammam, Saudi Arabia
| | - Yousef S Khader
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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22
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Nouri M, Pourghassem Gargari B, Tajfar P, Tarighat-Esfanjani A. A systematic review of whey protein supplementation effects on human glycemic control: A mechanistic insight. Diabetes Metab Syndr 2022; 16:102540. [PMID: 35772356 DOI: 10.1016/j.dsx.2022.102540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/04/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND/AIMS Some studies showed that dietary factors such as whey protein (WP) are effective on glycemic regulation. Due to the current controversy about WP effects and mechanisms of its action on glycemic control, we conducted this systematic review to shed light on the subject. METHODS Web of Science, Medline (Pubmed), and Scopus online databases were searched from 2012 up to February 2022 using the following keywords: "whey protein" and "glycemic control"/"glycemia"/"glucose"/"insulin". The search included original English articles, human clinical trials with WP supplementation and measurement of glucose or insulin as an outcome, studies on healthy individuals/patients with diabetes mellitus (DM)/impaired fasting glucose (IFG). RESULTS Title/abstract of 1991 studies were reviewed. After excluding studies due to inappropriate full title and duplication, and exercising inclusion criteria, 58 studies were reviewed in detail. Ample evidence showed that WP decreased postprandial glucose incremental area under the curve (iAUC) and increased iAUCs of insulin and incretin hormones. WP affects glycemic control mainly through stimulating insulin and incretins secretion, slowing gastric emptying, and appetite suppression. CONCLUSION Although most of the recent evidence showed beneficial effects of WP supplementation on glycemic response, further long-term clinical trials are required which assess the long-term impact of WP supplementation and its exact mechanisms.
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Affiliation(s)
- Maryam Nouri
- Student Research Committee, Student Research Center, Tabriz University of Medical Sciences, Tabriz, IR, Iran; Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran.
| | - Bahram Pourghassem Gargari
- Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, IR, Iran.
| | - Pedram Tajfar
- Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran.
| | - Ali Tarighat-Esfanjani
- Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, IR, Iran.
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23
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Park SK, Oh CM, Jung JY. The association between insulin resistance and the consumption of nut including peanut, pine nut and almonds in working-aged Korean population. Public Health Nutr 2022; 25:1904-1911. [PMID: 34482855 PMCID: PMC9991658 DOI: 10.1017/s1368980021003803] [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: 01/19/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Studies have reported that nuts intake is potentially beneficial to cardiometabolic health. However, there have been heterogeneous results regarding the association between nut intake/consumption and the risk of diabetes mellitus (DM). Insulin resistance (IR) is a major pathophysiology of DM. Thus, this study was to assess the association between nuts consumption and IR. DESIGN A retrospective cross-sectional study. SETTING Multivariable-adjusted OR and 95 % CI for increased IR (adjusted OR (95 % CI)) were calculated according to the frequency of consuming one serving dose (15 g) of nuts including peanut, pine nut and almond (< 1/month, 1/month-1/week, 1-3/week, 3-5/week, ≥ 5/week). Elevated IR was defined in homoeostasis model assessment-insulin resistance corresponding to the fourth quartile levels within each study group. Subgroup analysis was conducted for gender, glycaemic status (normal, prediabetes and DM) and age (≥ and < 40 years). PARTICIPANTS 379 310 Koreans who received health check-up. RESULTS Compared with nut consumption < 1/month (reference), nuts consumption ≥ 1/month had the lower OR and 95 % CI for elevated IR (1/month-1/week: 0·90 (95 % CI 0·89, 0·92), 1-3/week: 0·90 (95 % CI 0·87, 0·92), 3-5/week: 0·94 (95 % CI 0·89, 0·98) and ≥ 5/week: 0·90 (95 % CI 0·86, 0·94)). This association was more remarkable in women, normal glycaemic group and young age group (< 40 years). However, men, prediabetes, DM and old age group did not show the significant association. CONCLUSION Nuts consumption ≥ 1/month was less associated with elevated IR. Increased nuts consumption may have a favourable effect on IR.
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Affiliation(s)
- Sung Keun Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, The Republic of Korea
| | - Chang-Mo Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, The Republic of Korea
| | - Ju Young Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, The Republic of Korea
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24
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Ramezani Tehrani F, Behboudi-Gandevani S, Farzadfar F, Hosseinpanah F, Hadaegh F, Khalili D, Soleymani-Dodaran M, Valizadeh M, Abedini M, Rahmati M, Bidhendi Yarandi R, Torkestani F, Abdollahi Z, Bakhshandeh M, Zokaee M, Amiri M, Bidarpour F, Javanbakht M, Nabipour I, Nasli Esfahani E, Ostovar A, Azizi F. A Cluster Randomized Noninferiority Field Trial of Gestational Diabetes Mellitus Screening. J Clin Endocrinol Metab 2022; 107:e2906-e2920. [PMID: 35325164 DOI: 10.1210/clinem/dgac181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Although it is well-acknowledged that gestational diabetes mellitus (GDM) is associated with the increased risks of adverse pregnancy outcomes, the optimal strategy for screening and diagnosis of GDM is still a matter of debate. OBJECTIVE This study was conducted to demonstrate the noninferiority of less strict GDM screening criteria compared with the strict International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria with respect to maternal and neonatal outcomes. METHODS A cluster randomized noninferiority field trial was conducted on 35 528 pregnant women; they were scheduled to have 2 phases of GDM screening based on 5 different prespecified protocols including fasting plasma glucose in the first trimester with threshold of 5.1 mmol/L (92 mg/dL) (protocols A, D) or 5.6 mmol/L (100 mg/dL) (protocols B, C, E) and either a 1-step (GDM is defined if one of the plasma glucose values is exceeded [protocol A and C] or 2 or more exceeded values are needed [protocol B]) or 2-step approach (protocols D, E) in the second trimester. Guidelines for treatment of GDM were consistent with all protocols. Primary outcomes of the study were the prevalence of macrosomia and primary cesarean section (CS). The null hypothesis that less strict protocols are inferior to protocol A (IADPSG) was tested with a noninferiority margin effect (odds ratio) of 1.7. RESULTS The percentages of pregnant women diagnosed with GDM and assigned to protocols A, B, C, D, and E were 21.9%, 10.5%, 12.1%, 19.4%, and 8.1%, respectively. Intention-to-treat analyses satisfying the noninferiority of the less strict protocols of B, C, D, and E compared with protocol A. However, noninferiority was not shown for primary CS comparing protocol E with A. The odds ratios (95% CI) for macrosomia and CS were: B (1.01 [0.95-1.08]; 0.85 [0.56-1.28], C (1.03 [0.73-1.47]; 1.16 [0.88-1.51]), D (0.89 [0.68-1.17]; 0.94 [0.61-1.44]), and E (1.05 [0.65-1.69]; 1.33 [0.82-2.00]) vs A. There were no statistically significant differences in the adjusted odds of adverse pregnancy outcomes in the 2-step compared with the 1-step screening approaches, considering multiplicity adjustment. CONCLUSIONS The IADPSG GDM definition significantly increased the prevalence of GDM diagnosis. However, the less strict approaches were not inferior to other criteria in terms of adverse maternal and neonatal outcomes.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | | | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran 1411713139, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1411713139, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Masoud Soleymani-Dodaran
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran 1445613113, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Mehrandokht Abedini
- Infertility and cell therapy office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran 1419943471, Iran
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Razieh Bidhendi Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran
| | | | - Zahra Abdollahi
- Department of Nutrition, Ministry of Health and Medical Education, Tehran 1419943471, UK
| | - Marzieh Bakhshandeh
- Family Health Department, Ministry of Health and Medical Education, Tehran 1419943471, Iran
| | - Mehdi Zokaee
- Population, family and school health Department, Kurdistan University of Medical Sciences, Sanandaj 6618634683, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Farzam Bidarpour
- Kurdistan University of Medical Sciences, Sanandaj 6618634683, Iran
| | | | - Iraj Nabipour
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr 7514763448, Iran
| | - Ensieh Nasli Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1411713139, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1411713139, Iran
| | - Fereidoun Azizi
- Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
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25
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Hsu PC, Huang JC, Tsai WC, Hung WW, Chang WA, Wu LY, Chang CY, Tsai YC, Hsu YL. Tumor Necrosis Factor Receptor Superfamily Member 21 Induces Endothelial-Mesenchymal Transition in Coronary Artery Endothelium of Type 2 Diabetes Mellitus. Biomedicines 2022; 10:biomedicines10061282. [PMID: 35740304 PMCID: PMC9220259 DOI: 10.3390/biomedicines10061282] [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: 04/05/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/02/2022] Open
Abstract
Diabetes mellitus (DM) is an increasing threat to human health and regarded as an important public issue. Coronary artery disease is one of the main causes of death in type 2 DM patients. However, the effect of hyperglycemia on coronary artery endothelial cells (CAECs) and the pathophysiologic mechanisms are still not well-explored. This study aims to explore the signal pathway and novel biomarkers of injury of CAECs in DM in understanding the microenvironment changes and mechanisms of diabetic heart disease. Next-generation sequence (NGS) and bioinformatics analysis to analyze the CAECs of one type 2 DM patient and one normal individual was performed, and it was found that tumor necrosis factor receptor superfamily member 21 (TNFRSF21) was a soluble factor in circulating system. Further experiments confirmed that advanced glycation end products (AGEs), the metabolite derived by hyperglycemia, increased the expression of TNFRSF21 in CAECs. TNFRSF21 induced endothelial–mesenchymal transition (EndoMT) in CAECs, resulting in increased permeability of CAECs. In addition, levels of serum TNFRSF21 were higher in type 2 DM patients with left ventricular hypertrophy (LVH) than those without LVH. Serum TNFRSF21 levels were also positively correlated with the LV mass index and negatively with LV systolic function. Serum TNFRSF21 levels were associated with changes in cardiac structure and function in patients with type 2 DM. In conclusion, TNFRSF21 plays a pathogenic role in heart disease of type 2 DM, and can be used as a biomarker of the impairment of cardiac structure and function in type 2 DM patients.
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Affiliation(s)
- Po-Chao Hsu
- Division of Cardiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-C.T.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (J.-C.H.); (W.-A.C.)
| | - Jiun-Chi Huang
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (J.-C.H.); (W.-A.C.)
- Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wei-Chung Tsai
- Division of Cardiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-C.H.); (W.-C.T.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (J.-C.H.); (W.-A.C.)
| | - Wei-Wen Hung
- Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Wei-An Chang
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (J.-C.H.); (W.-A.C.)
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Medical University, Kaohsiung 807, Taiwan
| | - Ling-Yu Wu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Chao-Yuan Chang
- Department of Anatomy, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Yi-Chun Tsai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (J.-C.H.); (W.-A.C.)
- Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Division of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (Y.-C.T.); (Y.-L.H.); Tel.: +886-7-312-1101-5029 (Y.-C.T.); +886-7-312-1101-2015 (Y.-L.H.)
| | - Ya-Ling Hsu
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (Y.-C.T.); (Y.-L.H.); Tel.: +886-7-312-1101-5029 (Y.-C.T.); +886-7-312-1101-2015 (Y.-L.H.)
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Glucose deprivation-induced glycogen degradation and viability are altered in peripheral blood mononuclear cells of type 2 diabetes patients. UKRAINIAN BIOCHEMICAL JOURNAL 2022. [DOI: 10.15407/ubj94.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Multi-Criteria Usability Evaluation of mHealth Applications on Type 2 Diabetes Mellitus Using Two Hybrid MCDM Models: CODAS-FAHP and MOORA-FAHP. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
People use mHealth applications to help manage and keep track of their health conditions more effectively. With the increase of mHealth applications, it has become more difficult to choose the best applications that are user-friendly and provide user satisfaction. The best techniques for any decision-making challenge are multi-criteria decision-making (MCDM) methodologies. However, traditional MCDM methods cannot provide accurate results in complex situations. Currently, researchers are focusing on the use of hybrid MCDM methods to provide accurate decisions for complex problems. Thus, the authors in this paper proposed two hybrid MCDM methods, CODAS-FAHP and MOORA-FAHP, to assess the usability of the five most familiar mHealth applications that focus on type 2 diabetes mellitus (T2DM), based on ten criteria. The fuzzy Analytic Hierarchy Process (FAHP) is applied for efficient weight estimation by removing the vagueness and ambiguity of expert judgment. The CODAS and MOORA MCDM methods are used to rank the mHealth applications, depending on the usability parameter, and to select the best application. The resulting analysis shows that the ranking from both hybrid models is sufficiently consistent. To assess the proposed framework’s stability and validity, a sensitivity analysis was performed. It showed that the result is consistent with the proposed hybrid model.
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28
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Zou JJ, Wei Q, Shi YY, Wang K, Zhang YH, Shi HJ. Longitudinal Associations Between Maternal Glucose Levels and Ultrasonographic Fetal Biometrics in a Shanghai Cohort. JAMA Netw Open 2022; 5:e226407. [PMID: 35389498 PMCID: PMC8990351 DOI: 10.1001/jamanetworkopen.2022.6407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Evidence on the timing of fetal growth alterations associated with gestational diabetes or on the association of the maternal glycemic trajectory with fetal growth during pregnancy remains lacking. OBJECTIVE To examine the associations between maternal glucose levels and offspring intrauterine growth. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from 4574 eligible pregnant women and their offspring in the Shanghai Maternal-Child Pairs Cohort collected from April 10, 2016, to April 30, 2018. Group-based trajectory modeling was used to classify fasting plasma glucose levels during pregnancy into 3 glycemic trajectories (trajectory 1, consistently normal glucose levels in all 3 trimesters; trajectory 2, hyperglycemia only in late pregnancy; and trajectory 3, hyperglycemia in all 3 trimesters [ie, consistently high glucose levels]). Statistical analysis was performed from April 25, 2020, to October 1, 2021. EXPOSURES Gestational diabetes, which was defined using the results of an oral glucose tolerance test. MAIN OUTCOMES AND MEASURES Longitudinal fetal biometrics during gestational weeks 11 to 40 and birth outcomes were obtained from medical records. Pregnancy was partitioned into 3 periods (<24, 24-34, and >34 weeks' gestational age). The differences in offspring growth (log-transformed) and maternal glucose levels were compared using generalized linear mixed models. RESULTS A total of 4121 pregnant women had oral glucose tolerance test results (mean [SD] age, 28.8 [4.1] years), 3746 of whom had glycemic trajectory data (mean [SD] age, 28.6 [4.1] years); 983 women (23.8%) had gestational diabetes. Throughout the pregnancy period and compared with the women without gestational diabetes or with women in the trajectory 1 group, the fetal biometrics for the women with gestational diabetes or for those in the trajectory 3 group were significantly higher (except for biparietal diameter), with an estimated increase in fetal weight in the group with gestational diabetes (β = 1.82; 95% CI, 1.03-2.61) and in the trajectory 3 group (β = 1.50; 95% CI, 0.54-2.47; P = .002). Fetal biometric alterations among women with gestational diabetes appeared before 24 weeks' gestational age, with neonatal birth weight significantly higher than in the group without gestational diabetes at 40.4 g (95% CI, 9.8-71.1 g) along with an increased risk of large size for gestational age (odds ratio, 1.36; 95% CI, 1.05-1.75) and macrosomia (odds ratio, 1.47; 95% CI, 1.12-1.94). However, pregnant women in the trajectory 2 group manifested significantly reduced fetal biometrics, and abdominal circumference was significantly augmented after 34 weeks' gestational age (increase, β = 1.92; 95% CI, 0.87-2.99). CONCLUSIONS AND RELEVANCE In this cohort study, pregnant women who received a diagnosis of gestational diabetes in midpregnancy or had hyperglycemia during all 3 trimesters showed an association with altered fetal growth patterns, including increased estimated fetal weight that appeared before 24 weeks' gestational age, increased birth weight, and the risk for large size for gestational age and macrosomia.
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Affiliation(s)
- Jiao-jiao Zou
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Qian Wei
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Yu-yang Shi
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Ke Wang
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Yun-hui Zhang
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Hui-jing Shi
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
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Abstract
A literature search was conducted to identify publications addressing the early phases of lipid phenotypes in children and adults with either type 1 diabetes or type 2 diabetes. Medline, EMBASE, and Ovid were searched using the following search terms: clinical remission, partial remission, partial clinical remission, honeymoon phase, C-peptide, type 1 or 2 diabetes, children, pediatric type 1 or 2 diabetes, and paediatrics type 1 or 2 diabetes, adults, adult type 1 or type 2 diabetes. Partial clinical remission (PR) of type 1 diabetes (T1D) is characterized by continued endogenous production of insulin and C-peptide following the diagnosis and the introduction of exogenous insulin therapy. PR is associated with improved glycemic control and reduced prevalence of diabetes complications. The theory of hyperglycemic memory was proposed to explain this concept of improved glycemic outcomes in remitters (those who experienced PR) versus non-remitters (those who did not experience PR). However, this theory is incomplete as it does not explain the dichotomy in early lipid phenotypes in T1D based on PR status, which is an understudied area in diabetology and lipidology. To fill this knowledge gap, we propose the Theory of Hyperlipidemic Memory of T1D. This theory is premised on our 5-year research on early post-diagnostic dichotomy in lipid phenotypes between remitters and non-remitters across the lifespan. It provides a more rigorous explanation for the differences in lifelong atherosclerotic cardiovascular disease (ASCVD) risk between remitters and non-remitters. We conducted 4 clinical studies in pediatric and adult subjects with diabetes mellitus to characterize the particulars of the hyperlipidemic memory. In the first investigation, we explored the impact of the presence or absence of PR on lipid parameters in children and adolescents with T1D. In the second, we investigated whether pubertal maturation influenced our findings in T1D; and whether these findings could be replicated in healthy, non-diabetic children and adolescents. In the third, we leveraged our findings from T1D and controls to investigate the mechanisms of early lipid changes in T2D by comparing the earliest lipid phenotype of subjects with type 2 diabetes (T2D) to those of remitters, non-remitters, and controls. In the fourth, we investigated the impact of PR on the earliest lipid phenotypes in adults with T1D and compared these early lipid data to those of T2D subjects and controls. This body of work across the lifespan in children, adolescents, and adults supports the Theory of Hyperlipidemic Memory. This new theory clarifies why PR largely determines the risks for early-phase dyslipidemia, mid-term microvascular disease risk, and long-term ASCVD risk in subjects with T1D.
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Affiliation(s)
- Benjamin Udoka Nwosu
- Division of Endocrinology, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States
- Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
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Adams EL, Caccavale LJ, LaRose JG, Raynor HA, Bean MK. Home Food Environment Changes and Dietary Intake during an Adolescent Behavioral Weight Loss Intervention Differ by Food Security Status. Nutrients 2022; 14:976. [PMID: 35267951 PMCID: PMC8912871 DOI: 10.3390/nu14050976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
Behavioral weight loss (BWL) for pediatric obesity includes guidance on improving the home food environment and dietary quality; yet food insecurity presents barriers to making these changes. This study examined if home food environment, dietary quality, energy intake, and body weight changes during adolescent obesity treatment differed by food security status, and if changes in the home food environment were associated with changes in dietary quality and energy intake by food security status. Adolescents (n = 82; 13.7 ± 1.2 years) with obesity participated in a 4-month BWL treatment. Food insecurity, home food environment (Home Food Inventory [HFI]), dietary quality (Healthy Eating Index [HEI]), energy intake, and body mass index (BMI) were assessed at baseline and post-treatment. A reduced obesogenic home food environment and improved dietary quality were observed for food secure (ps < 0.01), but not insecure households (ps > 0.05) (mean difference, HFI: −6.6 ± 6.4 vs. −2.4 ± 7.4; HEI: 5.1 ± 14.4 vs. 2.7 ± 17.7). Energy intake and BMI decreased for adolescents in food secure and insecure households (ps < 0.03) (mean difference; energy intake: −287 ± 417 vs. −309 ± 434 kcal/day; BMI: −1.0 ± 1.4 vs. −0.7 ± 1.4). BWL yielded similar reductions in energy intake and body weight yet did not offer the same benefits for improved dietary quality and the home food environment for adolescents with food insecurity.
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Affiliation(s)
- Elizabeth L. Adams
- Department of Exercise Science, University of South Carolina, 921 Assembly St., Columbia, SC 29208, USA;
| | - Laura J. Caccavale
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA 23298, USA;
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Box 980430, Richmond, VA 23298, USA;
| | - Hollie A. Raynor
- Department of Nutrition, University of Tennessee, 1215 W. Cumberland Ave., Knoxville, TN 37996, USA;
| | - Melanie K. Bean
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA 23298, USA;
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Sabi EM, Bin Dahman LS, Mohammed AK, Sumaily KM, Al-Daghri NM. -2548G>A LEP Polymorphism Is Positively Associated with Increased Leptin and Glucose Levels in Obese Saudi Patients Irrespective of Blood Pressure Status. Medicina (B Aires) 2022; 58:346. [DOI: https:/doi.org/10.3390/medicina58030346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Background and Objectives: In this study, we aimed to investigate the link between common -2548G>A (rs7799039) promoter variant of the human leptin gene (LEP) with leptin and serum glucose leptin levels in obese Saudi patients. Materials and Methods: A total of 206 Saudi adults (80 obese normotensive nondiabetics, 76 obese hypertensive with Type 2 Diabetes and 50 normotensive nondiabetic controls) were genotyped for -2548G>A LEP polymorphism using the polymerase chain reaction-restriction fragment-length polymorphism technique. Results: Participants with minor AA genotype had significantly higher blood glucose levels (6.8 ± 0.55 mmol/L vs. 5.8 ± 0.30 mmol/L; p < 0.04) and HOMA-IR (4.1 ± 0.84 vs. 2.6 ± 0.67; p = 0.03) against those carrying major GG genotype. Participants with heterozygous GA genotype had significantly higher serum leptin levels against those carrying major GG genotype (40.0 ± 2.6 ng/mL vs. 29.6 ± 2.6 ng/mL; p = 0.04). Further investigation showed that individuals with AA, GA, GA + AA genotypes are at greater risk of developing hyperglycemia compared to those with GG genotype [OR 3.7(1.6–8.4), p = 0.001; 3.2 (1.2–8.6), p = 0.03; 3.5 (1.6–7.7), p = 0.001, respectively]. Additionally, the -2548AA allele was shown to be a risk factor for hyperglycemia [OR 1.9 (1.2–3.0), p = 0.006]. Our data revealed no relationship between this variant of the LEP gene with systolic and diastolic BP, signifying that this genetic variant is not a significant marker of obesity and hypertension in the Saudi population. Conclusions: AA and GA genotypes and LEP gene -2548AA alleles may signify potent risk factors predisposing healthy individuals to develop T2DM regardless of blood-pressure profile.
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Affiliation(s)
- Essa M. Sabi
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Lotfi S. Bin Dahman
- Chair for Biomarkers of Chronic Diseases, Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Medical Biochemistry, College of Medicine and Health Sciences, Hadhramout University, Mukalla 50511, Yemen
| | - Abdul Khader Mohammed
- Chair for Biomarkers of Chronic Diseases, Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Khalid M. Sumaily
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Nasser M. Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
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Sabi EM, Bin Dahman LS, Mohammed AK, Sumaily KM, Al-Daghri NM. -2548G>A LEP Polymorphism Is Positively Associated with Increased Leptin and Glucose Levels in Obese Saudi Patients Irrespective of Blood Pressure Status. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:346. [PMID: 35334523 PMCID: PMC8955012 DOI: 10.3390/medicina58030346] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: In this study, we aimed to investigate the link between common -2548G>A (rs7799039) promoter variant of the human leptin gene (LEP) with leptin and serum glucose leptin levels in obese Saudi patients. Materials and Methods: A total of 206 Saudi adults (80 obese normotensive nondiabetics, 76 obese hypertensive with Type 2 Diabetes and 50 normotensive nondiabetic controls) were genotyped for -2548G>A LEP polymorphism using the polymerase chain reaction-restriction fragment-length polymorphism technique. Results: Participants with minor AA genotype had significantly higher blood glucose levels (6.8 ± 0.55 mmol/L vs. 5.8 ± 0.30 mmol/L; p < 0.04) and HOMA-IR (4.1 ± 0.84 vs. 2.6 ± 0.67; p = 0.03) against those carrying major GG genotype. Participants with heterozygous GA genotype had significantly higher serum leptin levels against those carrying major GG genotype (40.0 ± 2.6 ng/mL vs. 29.6 ± 2.6 ng/mL; p = 0.04). Further investigation showed that individuals with AA, GA, GA + AA genotypes are at greater risk of developing hyperglycemia compared to those with GG genotype [OR 3.7(1.6−8.4), p = 0.001; 3.2 (1.2−8.6), p = 0.03; 3.5 (1.6−7.7), p = 0.001, respectively]. Additionally, the -2548AA allele was shown to be a risk factor for hyperglycemia [OR 1.9 (1.2−3.0), p = 0.006]. Our data revealed no relationship between this variant of the LEP gene with systolic and diastolic BP, signifying that this genetic variant is not a significant marker of obesity and hypertension in the Saudi population. Conclusions: AA and GA genotypes and LEP gene -2548AA alleles may signify potent risk factors predisposing healthy individuals to develop T2DM regardless of blood-pressure profile.
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Affiliation(s)
- Essa M. Sabi
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia;
| | - Lotfi S. Bin Dahman
- Chair for Biomarkers of Chronic Diseases, Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (L.S.B.D.); (A.K.M.); (N.M.A.-D.)
- Department of Medical Biochemistry, College of Medicine and Health Sciences, Hadhramout University, Mukalla 50511, Yemen
| | - Abdul Khader Mohammed
- Chair for Biomarkers of Chronic Diseases, Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (L.S.B.D.); (A.K.M.); (N.M.A.-D.)
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Khalid M. Sumaily
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia;
| | - Nasser M. Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (L.S.B.D.); (A.K.M.); (N.M.A.-D.)
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Aravindakshan MR, Maity SK, Paul A, Chakrabarti P, Mandal C, Sarkar J. Distinct pathoclinical clusters among patients with uncontrolled type 2 diabetes: results from a prospective study in rural India. BMJ Open Diabetes Res Care 2022; 10:10/1/e002654. [PMID: 35144941 PMCID: PMC8845217 DOI: 10.1136/bmjdrc-2021-002654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/15/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Inadequate glycemic control among patients with type 2 diabetes mellitus (T2DM) poses an enormous challenge. Whether this uncontrolled T2DM population is a heterogenous mix of disease subtypes remains unknown. Identification of these subtypes would result in a customized T2DM management protocol thereby paving the way toward personalized therapy. RESEARCH DESIGN AND METHODS Electronic health records of 339 patients with uncontrolled T2DM patients followed up for a median period of 14 months were analyzed using Uniform Manifold Approximation and Projection followed by density-based spatial clustering of applications with noise. Baseline clinical features and final diagnoses with drug combinations were selected in the analysis. A 30 min oral glucose tolerance test was next performed for assessing the underlying insulin resistance and β cell dysfunction. RESULTS Three major clusters were identified. The first cluster characterized by recent onset T2DM had moderately preserved β cell function. The second cluster with a longer duration of T2DM and associated hypertension showed the best glycemic control with dual antidiabetic therapy. The third cluster with the longest history of T2DM and no history of hypertension had the worst glycemic control in spite of the highest percentage of patients on triple therapy (34.58%) and quadruple therapy (8.41%). CONCLUSIONS Uncontrolled T2DM comprises a heterogeneous population with respect to disease duration, presence of co-morbidities and β cell function without significant difference in insulin resistance. Stratifying them on the basis of pathoclinical features is the first step toward a personalized management in T2DM.
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Affiliation(s)
| | - Sujay Krishna Maity
- Department of Cell Biology and Physiology, Indian Institute of Chemical Biology CSIR, Kolkata, West Bengal, India
| | - Avishek Paul
- Department of Cell Biology and Physiology, Indian Institute of Chemical Biology CSIR, Kolkata, West Bengal, India
| | - Partha Chakrabarti
- Department of Cell Biology and Physiology, Indian Institute of Chemical Biology CSIR, Kolkata, West Bengal, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Chittaranjan Mandal
- Department of Computer Science & Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Jit Sarkar
- Department of Cell Biology and Physiology, Indian Institute of Chemical Biology CSIR, Kolkata, West Bengal, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
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Garcia TS, Engelholm JL, Vouche M, Leitão CB. Decrease in Pancreatic Perfusion of Patients with Type 2 Diabetes Mellitus Detected by Perfusion Computed Tomography. J Clin Imaging Sci 2022; 11:50. [PMID: 35003832 PMCID: PMC8730536 DOI: 10.25259/jcis_72_2021] [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: 04/09/2021] [Accepted: 09/04/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: The objectives of the study was to compare pancreatic perfusion by computed tomography in type 2 diabetes and non-diabetic subjects. Material and Methods: In this case–control study, 17 patients with type 2 diabetes and 22 non-diabetic controls were examined with a dynamic 192-slices perfusion computed tomography for estimating pancreatic perfusion parameters. Results: Thirty-nine patients were included (22 with Type 2 diabetes mellitus [T2DM]), with a mean age of 64 years. There were significant differences in some pancreatic perfusion parameters in patients with and without type 2 diabetes. Blood volume (BV) was lower in pancreatic head (with T2DM: 14.0 ± 3.4 vs. without T2DM: 16.1 ± 2.4 mL/100 mL; P = 0.033), pancreatic tail (with: 14.4 ± 3.6 vs. without: 16.8 ± 2.5 mL/100 mL; P = 0.023), and in whole pancreas (with: 14.2 ± 3.2 vs. without: 16.2 ± 2.5 mL/100 mL; P = 0.042). Similar behavior was observed with mean transit time (MTT) in pancreatic head (with: 7.0 ± 1.0 vs. without: 7.9 ± 1.2 s; P = 0.018), pancreatic tail (with: 6.6 ± 1.3 vs. without: 7.7 ± 0.9 s; P = 0.005), and in whole pancreas (with: 6.8 ± 1.0 vs. without: 7.7 ± 0.9 s; P = 0.016). BV in head, tail, and whole pancreas had negative correlations with age (head r: –0.352, P = 0.032; tail r: –0.421, P = 0.031; whole pancreas r: –0.439, P = 0.007), and fasting plasma glucose (head r: –0.360, P = 0.031; tail r: –0.483, P = 0.003; whole pancreas r: –0.447, P = 0.006). In a multivariate linear regression model, HbA1c was independently associated with decrease in BV in whole pancreas (β: –0.884; CI95%: –1.750 to –0.017; P = 0.046). Conclusion: Pancreatic BV and MTT were significantly lower in patients with type 2 diabetes. BV was decreased with older age and poorer glycemic control.
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Affiliation(s)
- Tiago Severo Garcia
- Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Michaël Vouche
- Department of Radiology, Institute Jules Bordet, Brussels, Belgium
| | - Cristiane Bauermann Leitão
- Department of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Martínez AD, Mercado E, Barbieri M, Kim SY, Granger DA. The Importance of Biobehavioral Research to Examine the Physiological Effects of Racial and Ethnic Discrimination in the Latinx Population. Front Public Health 2022; 9:762735. [PMID: 35083188 PMCID: PMC8784784 DOI: 10.3389/fpubh.2021.762735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022] Open
Abstract
A growing body of research is documenting how racial and ethnic populations embody social inequalities throughout the life course. Some scholars recommend the integration of biospecimens representing the hypothalamic-pituitary-adrenal axis, neurological and endocrinological processes, and inflammation to capture the embodiment of inequality. However, in comparison to other racial and ethnic groups, there has been little research examining how Hispanic/Latinx persons embody racial and ethnic discrimination, much less resulting from institutional and structural racism. We provide a rationale for expanding biobehavioral research examining the physiological consequences of racism among Latinx persons. We identify gaps and make recommendations for a future research agenda in which biobehavioral research can expand knowledge about chronic disease inequities among Latinx populations and inform behavioral and institutional interventions. We end by cautioning readers to approach the recommendations in this article as a call to expand the embodiment of racism research to include the diverse Latinx population as the United States addresses racial inequity.
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Affiliation(s)
- Airín D. Martínez
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Evelyn Mercado
- Department of Psychological and Brain Sciences, College of Natural Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Marielena Barbieri
- Department of Psychological and Brain Sciences, College of Natural Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Su Yeong Kim
- Department of Human Development and Family Sciences, University of Texas-Austin, Austin, TX, United States
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
- The Johns Hopkins University Bloomberg School of Public Health, School of Nursing, School of Medicine, Baltimore, MD, United States
- Saliva Bioscience Laboratory, University of Nebraska-Lincoln, Lincoln, NE, United States
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OUP accepted manuscript. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:116-128. [DOI: 10.1093/ijpp/riac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/02/2022] [Indexed: 11/12/2022]
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Ramezani Tehrani F, Rahmati M, Farzadfar F, Abedini M, Farahmand M, Hosseinpanah F, Hadaegh F, Torkestani F, Valizadeh M, Azizi F, Behboudi-Gandevani S. One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial. Front Endocrinol (Lausanne) 2022; 13:1039643. [PMID: 36818463 PMCID: PMC9932332 DOI: 10.3389/fendo.2022.1039643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES There is considerable worldwide controversy regarding optimal screening and diagnostic approaches for GDM. This study aimed to compare the prevalence, maternal and neonatal outcomes of a One-step with a Two-step approach for the screening and diagnosis of GDM in a large community sample of pregnant women. METHODS We conducted a secondary analysis of a randomized community non-inferiority trial of GDM screening in Iran. For the current study, all pregnant women who met the inclusion criteria were randomized into two groups for GDM screening. The first group of women (n = 14611) was screened by a One-step screening approach [75-g 2-h oral glucose tolerance test (OGTT)] and the second group (n = 14160) by a Two-step method (the 50-g glucose challenge test followed by the 100-g OGTT). All study participants were followed up until delivery, and the adverse maternal and neonatal outcomes were recorded in detail. RESULTS GDM was diagnosed in 9.3% of the pregnant women who were assigned to the One-step and in 5.4% of those assigned to the Two-step approach with a statistically significant difference between them (p < 0.001). Intention-to-treat analyses showed no significant differences between the One-step and the Two-step group in the unadjusted risks of the adverse pregnancy outcomes of macrosomia, primary cesarean-section, preterm birth, hypoglycemia, hypocalcemia, hyperbilirubinemia, preeclampsia, neonatal intensive care unit admission, birth trauma, low birth weight, and intrauterine fetal death. Results remained unchanged after adjustment for potential confounder variables including gestational age at enrollment and delivery, maternal body mass index, gestational weight gain, type of delivery, treatment modality, and GDM diagnosis in the first trimester. CONCLUSION We found that although the rates of GDM more than doubled with the One-step strategy, the One-step approach was similar to the Two-step approach in terms of maternal and neonatal outcomes. These findings may warn that more caution should be exercised in adopting the One-step method worldwide. Future research is needed to assess the long-term harm and benefits of those approaches to GDM screening for both mothers and their offspring. CLINICAL TRIAL REGISTRATION https://www.irct.ir/trial/518, identifier (IRCT138707081281N1).
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and Cell Therapy Office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Maryam Farahmand
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- *Correspondence: Samira Behboudi-Gandevani,
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Wang X, Wu H, Yang G, Xiang J, Xiong L, Zhao L, Liao T, Zhao X, Kang L, Yang S, Liang Z. REG1A and RUNX3 Are Potential Biomarkers for Predicting the Risk of Diabetic Kidney Disease. Front Endocrinol (Lausanne) 2022; 13:935796. [PMID: 35937821 PMCID: PMC9352862 DOI: 10.3389/fendo.2022.935796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease. Clinical features are traditionally used to predict DKD, yet with low diagnostic efficacy. Most of the recent biomarkers used to predict DKD are based on transcriptomics and metabolomics; however, they also should be used in combination with many other predictive indicators. The purpose of this study was thus to identify a simplified class of blood biomarkers capable of predicting the risk of developing DKD. The Gene Expression Omnibus database was screened for DKD biomarkers, and differentially expressed genes (DEGs) in human blood and kidney were identified via gene expression analysis and the Least Absolute Shrinkage and Selection Operator regression. A comparison of the area under the curve (AUC) profiles on multiple receiver operating characteristic curves of the DEGs in DKD and other renal diseases revealed that REG1A and RUNX3 had the highest specificity for DKD diagnosis. The AUCs of the combined expression of REG1A and RUNX3 in kidney (AUC = 0.929) and blood samples (AUC = 0.917) of DKD patients were similar to each other. The AUC of blood samples from DKD patients and healthy individuals obtained for external validation further demonstrated that REG1A combined with RUNX3 had significant diagnostic efficacy (AUC=0.948). REG1A and RUNX3 expression levels were found to be positively and negatively correlated with urinary albumin creatinine ratio and estimated glomerular filtration rate, respectively. Kaplan-Meier curves also revealed the potential of REG1A and RUNX3 for predicting the risk of DKD. In conclusion, REG1A and RUNX3 may serve as biomarkers for predicting the risk of developing DKD.
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Affiliation(s)
- Xinyu Wang
- Department of Geriatrics, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
| | - Han Wu
- Department of Endocrinology, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
| | - Guangyan Yang
- Department of Geriatrics, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
| | - Jiaqing Xiang
- Department of Geriatrics, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
| | - Lijiao Xiong
- Department of Geriatrics, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
| | - Li Zhao
- Department of Health Management, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
| | - Tingfeng Liao
- Department of Geriatrics, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
| | - Xinyue Zhao
- Department of Nephrology, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
| | - Lin Kang
- Department of Geriatrics, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
- The Biobank of National Innovation Center for Advanced Medical Devices, Shenzhen People’s Hospital, Shenzhen, China
- *Correspondence: Zhen Liang, ; Shu Yang, ; Lin Kang,
| | - Shu Yang
- Department of Geriatrics, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
- Shenzhen Clinical Research Center for Aging, Shenzhen, China
- *Correspondence: Zhen Liang, ; Shu Yang, ; Lin Kang,
| | - Zhen Liang
- Department of Geriatrics, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
- Shenzhen Clinical Research Center for Aging, Shenzhen, China
- *Correspondence: Zhen Liang, ; Shu Yang, ; Lin Kang,
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Early Identification of the Maternal, Placental and Fetal Dialog in Gestational Diabetes and Its Prevention. REPRODUCTIVE MEDICINE 2021. [DOI: 10.3390/reprodmed3010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Gestational diabetes mellitus (GDM) complicates between 5 and 12% of pregnancies, with associated maternal, fetal, and neonatal complications. The ideal screening and diagnostic criteria to diagnose and treat GDM have not been established and, currently, diagnostic use with an oral glucose tolerance test occurs late in pregnancy and produces poor reproducibility. Therefore, in recent years, significant research has been undertaken to identify a first-trimester biomarker that can predict GDM later in pregnancy, enable early intervention, and reduce GDM-related adverse pregnancy outcomes. Possible biomarkers include glycemic markers (fasting glucose and hemoglobin A1c), adipocyte-derived markers (adiponectin and leptin), pregnancy-related markers (pregnancy-associated plasma protein-A and the placental growth factor), inflammatory markers (C-reactive protein and tumor necrosis factor-α), insulin resistance markers (sex hormone-binding globulin), and others. This review summarizes current data on first-trimester biomarkers, the advantages, and the limitations. Large multi-ethnic clinical trials and cost-effectiveness analyses are needed not only to build effective prediction models but also to validate their clinical use.
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Riyaphan J, Pham DC, Leong MK, Weng CF. In Silico Approaches to Identify Polyphenol Compounds as α-Glucosidase and α-Amylase Inhibitors against Type-II Diabetes. Biomolecules 2021; 11:1877. [PMID: 34944521 PMCID: PMC8699780 DOI: 10.3390/biom11121877] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 01/01/2023] Open
Abstract
Type-II diabetes mellitus (T2DM) results from a combination of genetic and lifestyle factors, and the prevalence of T2DM is increasing worldwide. Clinically, both α-glucosidase and α-amylase enzymes inhibitors can suppress peaks of postprandial glucose with surplus adverse effects, leading to efforts devoted to urgently seeking new anti-diabetes drugs from natural sources for delayed starch digestion. This review attempts to explore 10 families e.g., Bignoniaceae, Ericaceae, Dryopteridaceae, Campanulaceae, Geraniaceae, Euphorbiaceae, Rubiaceae, Acanthaceae, Rutaceae, and Moraceae as medicinal plants, and folk and herb medicines for lowering blood glucose level, or alternative anti-diabetic natural products. Many natural products have been studied in silico, in vitro, and in vivo assays to restrain hyperglycemia. In addition, natural products, and particularly polyphenols, possess diverse structures for exploring them as inhibitors of α-glucosidase and α-amylase. Interestingly, an in silico discovery approach using natural compounds via virtual screening could directly target α-glucosidase and α-amylase enzymes through Monte Carto molecular modeling. Autodock, MOE-Dock, Biovia Discovery Studio, PyMOL, and Accelrys have been used to discover new candidates as inhibitors or activators. While docking score, binding energy (Kcal/mol), the number of hydrogen bonds, or interactions with critical amino acid residues have been taken into concerning the reliability of software for validation of enzymatic analysis, in vitro cell assay and in vivo animal tests are required to obtain leads, hits, and candidates in drug discovery and development.
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Affiliation(s)
| | - Dinh-Chuong Pham
- Biomaterials and Nanotechnology Research Group, Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City 700000, Vietnam;
| | - Max K. Leong
- Department of Chemistry, National Dong Hwa University, Hualien 97401, Taiwan
| | - Ching-Feng Weng
- Functional Physiology Section, Department of Basic Medical Science, Xiamen Medical College, Xiamen 361023, China
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Fetuin-A as a Marker of Insulin Resistance. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2021-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Fetuin–A is a glycoprotein which helps in the regulation of metabolism. It is an early marker of insulin resistance (IR). The aim of this study was to evaluate the role of Fetuin–A as a predictive biomarker in cases of newly detected type 2 diabetes (NDD). The study involved 60 NDD and 60 Normal Healthy Controls (NHC). All the demographics and anthropological characteristics were noted. Fasting blood samples were drawn and various biochemical parameters were analyzed. The homeostatic model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) score was calculated. Chisquare, student T-test and Mann Whitney U tests were employed to associate and compare the mean and median between the NDD and NHC groups. Pearson's and Spearman’s correlation analysis were employed to examine the relationship of Fetuin–A levels with parametric and nonparametric variables. The independent predictors of Fetuin–A was determined by employing multiple forward linear regression. Fetuin–A was significantly high in NDD compared to NHC (1323 vs. 306.98 mcg/mL; p<0.001). Majority of NDD patients demonstrated IR based on the HOMA-IR (88.33% vs. 66.67%) and QUICKI score (96.67% vs. 85%). The multiple linear regression analysis showed that systolic blood pressure, age and QUICKI score were independently associated with Fetuin–A (p value <0.01). Fetuin–A may be used as a biomarker to detect NDD. Therefore, early detection of Fetuin–A levels in NDD gives an opportunity for suitable patient management.
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Suryakanth S, Shankar HNR, Heralgi MM, Sagar P, Kavitha V, Mahesha S, Babu NS, Tekade P. A study of effect of hemodialysis on macular thickness in patients with end-stage renal disease. Taiwan J Ophthalmol 2021; 11:367-371. [PMID: 35070665 PMCID: PMC8757532 DOI: 10.4103/tjo.tjo_86_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: The purpose was to study the effect of hemodialysis (HD) on macular thickness in patients with diabetic retinopathy (DR) and end-stage renal disease. MATERIALS AND METHODS: In this prospective observational study, patients undergoing HD for diabetic nephropathy were recruited. None of the patients received treatment for DR per se during the study duration. Patients underwent ocular examination and optical coherence tomography before HD and were followed up on day 3 and day 30. At each visit, central subfield macular thickness (CSMT) and total macular volume (TMV) were measured and compared with baseline values using analysis of variance and post hoc test (Wilcoxon's matched-pairs signed-rank test). RESULTS: Thirty-one eyes of 19 patients were recruited in the study. The mean CSMT decreased from baseline value of 278.93 ± 45.01 μ to 239.81 ± 40.54 μ at the end of 30 days (P < 0.005). The mean TMV decreased from baseline value of 8.14 ± 0.68 mm3 to 7.80 ± 0.63 mm3 on day 30 (P < 0.005). CONCLUSION: There was a statistically significant reduction in CSMT and TMV after HD at 30 days as compared to baseline values. HD alone results in reduction of macular thickness over short term.
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Affiliation(s)
- Shwetha Suryakanth
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - H N Ravi Shankar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | | | - Pradeep Sagar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - V Kavitha
- Pediatric Ophthalmology and Strabismus, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - S Mahesha
- Cataract and Trauma, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - N Suresh Babu
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Pradeep Tekade
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
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Miranda JJ, Pesantes MA, Lazo-Porras M, Portocarrero J, Diez-Canseco F, Carrillo-Larco RM, Bernabe-Ortiz A, Trujillo AJ, Aldridge RW. Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review. Wellcome Open Res 2021; 6:163. [PMID: 34595355 PMCID: PMC8447049 DOI: 10.12688/wellcomeopenres.16947.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Financial incentives may improve the initiation and engagement of behaviour change that reduce the negative outcomes associated with non-communicable diseases. There is still a paucity in guidelines or recommendations that help define key aspects of incentive-oriented interventions, including the type of incentive (e.g. cash rewards, vouchers), the frequency and magnitude of the incentive, and its mode of delivery. We aimed to systematically review the literature on financial incentives that promote healthy lifestyle behaviours or improve health profiles, and focused on the methodological approach to define the incentive intervention and its delivery. The protocol was registered at PROSPERO on 26 July 2018 ( CRD42018102556). Methods: We sought studies in which a financial incentive was delivered to improve a health-related lifestyle behaviour (e.g., physical activity) or a health profile (e.g., HbA1c in people with diabetes). The search (which took place on March 3 rd 2018) was conducted using OVID (MEDLINE and Embase), CINAHL and Scopus. Results: The search yielded 7,575 results and 37 were included for synthesis. Of the total, 83.8% (31/37) of the studies were conducted in the US, and 40.5% (15/37) were randomised controlled trials. Only one study reported the background and rationale followed to develop the incentive and conducted a focus group to understand what sort of incentives would be acceptable for their study population. There was a degree of consistency across the studies in terms of the direction, form, certainty, and recipient of the financial incentives used, but the magnitude and immediacy of the incentives were heterogeneous. Conclusions: The available literature on financial incentives to improve health-related lifestyles rarely reports on the rationale or background that defines the incentive approach, the magnitude of the incentive and other relevant details of the intervention, and the reporting of this information is essential to foster its use as potential effective interventions.
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Affiliation(s)
- J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, 15102, Peru
| | - M. Amalia Pesantes
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
| | - María Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Geneva, 1205, Switzerland
| | - Jill Portocarrero
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
| | - Rodrigo M. Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, W2 1UA, UK
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
| | - Antonio J. Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
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Al Hayek AA, Al-Saeed AH, Alzahrani WM, Al Dawish MA. Assessment of Patient Satisfaction with On-Site Point-of-Care Hemoglobin A1c Testing: An Observational Study. Diabetes Ther 2021; 12:2531-2544. [PMID: 34363602 PMCID: PMC8384983 DOI: 10.1007/s13300-021-01126-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Poor glycemic control is a serious challenge in successful diabetes management. Given the low adherence and compliance with HbA1c testing frequency and the corresponding delay in the appropriate medication adjustment, point-of-care testing (POCT) for HbA1c provides an opportunity for better control of diabetes and higher patient satisfaction. The data with this regard are limited in Saudi Arabia. Therefore, we aimed to assess the level of patient satisfaction associated with the POCT service implementation for HbA1c and evaluate the differences between the number of requested and conducted HbA1c tests before and after POCT implementation and its effect on glycemic control in Saudi clinical practice. METHODS We conducted a single-center ambispective descriptive cohort study in Riyadh, Saudi Arabia. This study had two phases: the retrospective phase (January 2017 to December 2017) and the prospective phase (January 2018 to December 2018). Patient satisfaction was assessed using the patient satisfaction questionnaire short form (PSQ-18) and on-site HbA1c point-of-care testing (HbA1c-POCT) satisfaction questionnaire. RESULTS This study included 75 patients with diabetes (37% type 1, 63% type 2) with a mean age of 44.35 (± 17.97) years. The adherence to physician recommendations for HbA1c testing frequency increased from 24% to 85% (before and after POCT implementation, respectively). High levels of satisfaction across seven dimensions of PSQ-18 (77-88%) were reported towards the provided healthcare service after POCT implementation. Furthermore, a high level of agreement on the statements of the on-site HbA1c-POCT satisfaction questionnaire was also observed. Finally, the mean HbA1c level has significantly improved after POCT implementation compared to the traditional HbA1c laboratory testing before POCT implementation [8.34 ± 0.67 and 8.06 ± 0.62, respectively, p < 0.001). CONCLUSION HbA1c testing at POCT improved adherence to recommendations for HbA1c testing frequency for better glycemic control and higher patient satisfaction. POCT reduces turnaround time, improves glycemic control, and facilitates the decision-making process. HbA1c measurement with POC devices is recommended to be implemented in diabetes treatment centers. All of the described benefits of POCT come together to make HbA1c testing the most common procedure for diabetes management at the point of care.
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Affiliation(s)
- Ayman A. Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159 Saudi Arabia
| | - Abdulghani H. Al-Saeed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159 Saudi Arabia
| | - Wael M. Alzahrani
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159 Saudi Arabia
| | - Mohamed A. Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159 Saudi Arabia
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Antoku Y, Takemoto M, Mito T, Shiiyama R, Otsuka-Morisaki H, Tanaka A, Maeda Y, Tsuchihashi T. Impact of Annual Cardiovascular Screening Tests in Patients with Type 2 Diabetes Mellitus without Previous Histories of Cardiovascular Disease: Four-year Clinical Outcomes. Intern Med 2021; 60:2725-2732. [PMID: 33716290 PMCID: PMC8479217 DOI: 10.2169/internalmedicine.6893-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/26/2021] [Indexed: 11/21/2022] Open
Abstract
Objective We previously reported that, among asymptomatic patients with type 2 diabetes mellitus (T2DM) without a history of cardiovascular disease (CVD), up to 19% of the patients with myocardial ischemia were detected by annual cardiovascular screening tests (ACVSTs). Thus, the present study assessed the long-term clinical outcomes of ACVSTs in those patients. Methods Six hundred and fifty-seven outpatients with T2DM who received ACVSTs at least once or not at all from April 2014 to March 2018 were defined as the S and NS groups, respectively. The data were compared between these two groups. Results This study revealed that, among outpatients with T2DM in our hospital over those four years, with the increasing frequency of receiving ACVSTs, 1) the frequency of the internal use of statins, anti-platelets, and renin-angiotensin system inhibitors, which are well-known as medications for preventing CVD, significantly increased; 2) low-density lipoprotein-cholesterol and triglyceride levels significantly improved; 3) levels of highly sensitive C-protein, a strong predictors of CVD, were significantly suppressed; 4) the progression of renal dysfunction was significantly suppressed; 5) the cumulative of four-point major adverse cardiovascular events and admissions due to heart failure significantly decreased; and 6) the cumulative of all-cause mortality was significantly suppressed. Conclusions Given the above, it may be important to continue ACVSTs in outpatients with T2DM without a history of CVD for several years.
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Affiliation(s)
- Yoshibumi Antoku
- Cardiovascular Center, Steel Memorial Yawata Hospital, Japan
- Department of Cardiology, Munakata Suikokai General Hospital, Japan
| | - Masao Takemoto
- Cardiovascular Center, Steel Memorial Yawata Hospital, Japan
- Department of Cardiology, Munakata Suikokai General Hospital, Japan
| | - Takahiro Mito
- Department of Cardiology, Munakata Suikokai General Hospital, Japan
| | - Ryuta Shiiyama
- Department of Cardiology, Munakata Suikokai General Hospital, Japan
| | | | - Atsushi Tanaka
- Department of Cardiology, Munakata Suikokai General Hospital, Japan
| | - Yasutaka Maeda
- Diabetes and Endocrine Center, Munakata Suikokai General Hospital, Japan
- Masae Minami Clinic, Japan
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Alsugair HA, Alshugair IF, Alharbi TJ, Bin Rsheed AM, Tourkmani AM, Al-Madani W. Weekly Semaglutide vs. Liraglutide Efficacy Profile: A Network Meta-Analysis. Healthcare (Basel) 2021; 9:healthcare9091125. [PMID: 34574899 PMCID: PMC8466858 DOI: 10.3390/healthcare9091125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Glucagon-like peptide 1 receptor agonist (GLP-1 RA) is a class of hypoglycemic medications. Semaglutide once-weekly (QW) and liraglutide once-daily (OD) significantly improved glycemic control compared to placebo. To date, no long-term phase III trials directly comparing semaglutide and liraglutide are available. This network meta-analysis (NMA) aims to compare the long-term efficacy of semaglutide and liraglutide. METHODS PubMed, Embase, and Cochrane Library were searched from inception until June 2019 to identify relevant articles. Nine long-term randomized controlled trials comparing once-weekly semaglutide or liraglutide with placebo or other active comparisons were identified. The outcomes of interest were changes in HbA1c and weight after 52 weeks. A Bayesian framework and NMA were used for data synthesis. This is a sub-study of the protocol registered in PROSPERO (number CRD42018091598). RESULTS The data showed significant superiority in HbA1c reduction of semaglutide 1 mg QW over liraglutide 1.2 and 1.8 mg with a treatment difference of 0.47% and 0.3%, respectively. Semaglutide 0.5 mg QW was found to be significantly superior to liraglutide 1.2 mg in HbA1c reduction with a treatment difference of 0.17%. Regarding weight reduction analysis, semaglutide 0.5 and 1 mg QW were significantly associated with a greater reduction than liraglutide 0.6 mg with a treatment difference of 2.42 and 3.06 kg, respectively. However, no significant reduction was found in comparison to liraglutide 1.2 and 1.8 mg. CONCLUSIONS Semaglutide improved the control of blood glucose and body weight. The capacity of long-term glycemic control and body weight control of semaglutide appears to be more effective than other GLP-1 RAs, including liraglutide. However, considering the number of included studies and potential limitations, more large-scale, head-to-head, well-designed randomized-controlled trials (RCTs) are needed to confirm these findings.
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Affiliation(s)
- Hassan A. Alsugair
- Family Medicine Department, Prince Sultan Military Medical City, Riyadh 12624, Saudi Arabia; (A.M.B.R.); (A.M.T.)
- Correspondence: or (H.A.A.); or (T.J.A.); Tel.: +966-114777714-40438 (T.J.A.)
| | - Ibrahim F. Alshugair
- Orthopedic Surgery Department, King Saud Medical City, Riyadh 12746, Saudi Arabia;
| | - Turki J. Alharbi
- Family Medicine Department, Prince Sultan Military Medical City, Riyadh 12624, Saudi Arabia; (A.M.B.R.); (A.M.T.)
- Correspondence: or (H.A.A.); or (T.J.A.); Tel.: +966-114777714-40438 (T.J.A.)
| | - Abdulaziz M. Bin Rsheed
- Family Medicine Department, Prince Sultan Military Medical City, Riyadh 12624, Saudi Arabia; (A.M.B.R.); (A.M.T.)
| | - Ayla M. Tourkmani
- Family Medicine Department, Prince Sultan Military Medical City, Riyadh 12624, Saudi Arabia; (A.M.B.R.); (A.M.T.)
| | - Wedad Al-Madani
- General Authority of Statistics, Riyadh 11481, Saudi Arabia;
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Ghanbari F, Amerizadeh A, Behshood P, Moradi S, Asgary S. Effect of Microalgae Arthrospira on Biomarkers of Glycemic Control and Glucose Metabolism: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2021; 47:100942. [PMID: 34538515 DOI: 10.1016/j.cpcardiol.2021.100942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/04/2021] [Accepted: 07/09/2021] [Indexed: 01/18/2023]
Abstract
Diabetes mellitus and insulin resistance are associated with an increased risk of cardiovascular disease (CVD) incidence and a higher rate of CVD-related death. In this study, the effects of Arthrospira (Spirulina) a blue-green algae supplementation on biomarkers of glycemic control and glucose metabolism has been evaluated. PubMed, Scopus, and ISI Web of Science were searched systematically of English human subjects and PubMed for pre-clinical animal studies (rats and mice) from January 2008 until November 2020. The pooled weighted mean difference (MD) and its 95% confidence interval (CI) were calculated and pooled using a random-effect model. Seven clinical and 27 preclinical studies were included. Pooled results of the clinical studies showed that Arthrospira supplementation significantly reduced the fasting blood sugar (FBS): (0.63- 2.90-) 1.77-, total cholesterol (TC): (0.46- ، 4.61-) 2.54-, triglycerides (TG): (0.89- ، 6.54-) 3.71- and increased the high-density lipoprotein cholesterol (HDL-C): (3.86 ، 0.67) 2.27; however, Arthrospira was not significantly effective in terms of reducing the glycated hemoglobin A1c (HbA1C): (1.04 ، 2.23-) 0.59- and low-density lipoprotein cholesterol (LDL-C). Pooled results of preclinical studies showed that Arthrospira supplementation reduced FBS [-10.31 (-12.49, -8.13)] and HbA1C [-5.12 (-8.06, -2.19)] significantly in diabetic animals. Sub-group analysis of clinical studies showed that intervention duration less than 2 months [-2.52 (-4.37, -0.67)] and the dose less than 2 gram [-3.22 (-5.67, -0.76)] showed significant improvement in terms of reducing the FBS in humans. It can be concluded that Arthrospira can be considered as an effective FBS, TG, TC, and HDL-C adjusting nutraceutical agent for diabetes mellitus. Due to the differences in the results of clinical and animal studies in terms of HbA1c, more studies are needed for a definitive conclusion.
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Affiliation(s)
- Fahimeh Ghanbari
- Student research committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Atefeh Amerizadeh
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Behshood
- Department of Microbiology, Young Researchers and Elite Club, Shahrekord Branch, Islamic Azad University, Isfahan, Iran
| | - Sajjad Moradi
- Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah
| | - Sedigheh Asgary
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
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Li M, Wang G, Xia H, Feng Z, Xiao P, Yuan J. Retinal vascular geometry detection as a biomarker in diabetes mellitus. Eur J Ophthalmol 2021; 32:1710-1719. [PMID: 34284606 DOI: 10.1177/11206721211033488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the vessel geometry characteristics of color fundus photographs in normal control and diabetes mellitus (DM) patients and to find potential biomarkers for early diabetic retinopathy (DR) based on a neural network vessel segmentation system and automated vascular geometry parameter analysis software. METHODS A total of 102 consecutive patients with type 2 DM (T2DM) and 132 healthy controls were recruited. All participants underwent general ophthalmic examinations, and retinal fundus photographs were taken with a digital fundus camera without mydriasis. Color fundus photographs were input into a dense-block generative adversarial network (D-GAN)-assisted retinal vascular segmentation system (http://www.gdcerc.cn:8081/#/login) to obtain binary images. These images were then analyzed by customized software (ocular microvascular analysis system V2.9.1) for automatic processing of vessel geometry parameters, including the monofractal dimension (Dbox), multifractal dimension (D0), vessel area ratio (R), max vessel diameter (dmax), average vessel diameter (dave), arc-chord ratio (A/C), and tortuosity (τn). Geometric differences between the healthy subjects and DM patients were analyzed. Then, regression analysis and receiver operating characteristic (ROC) curve analysis were performed to evaluate the diagnostic efficiency of the vascular geometry parameters. RESULTS No significant differences were observed between the baseline characteristics of each group. DM patients had lower Dbox and D0 values (1.330 ± 0.041; 1.347 ± 0.038) than healthy subjects (1.343 ± 0.048, p < 0.05; 1.362 ± 0.042, p < 0.05) and showed increasing values of dmax, dave, A/C, and τn compared with normal controls, although only the differences in dave and τn between the groups were statistically significant. In the regression analysis, dave and τn showed a good correlation with diabetes (dave, OR 1.765, 95% CI 1.319-2.362, p < 0.001; τn, OR 9.323, 95% CI 1.492-58.262, p < 0.05). CONCLUSIONS We demonstrated the relationship between retinal vascular geometry and the process in DM patients, showing that Dbox, D0, dave, and τn may be indicators of morphological changes in retinal vessels in DM patients and can be early biomarkers of DR.
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Affiliation(s)
- Meng Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Gengyuan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Honghui Xia
- Department of Ophthalmology, Zhaoqing Gaoyao People's Hospital, Zhaoqing, People's Republic of China
| | - Ziqing Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Peng Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
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Razip NNM, Gopalsamy B, Abdul Mutalib MS, Chang SK, Abdullah MMJA, Azlan A, Rejali Z, Khaza’ai H. Correlation between Levels of Vitamins D 3 and E in Type 2 Diabetes Mellitus: A Case-Control Study in Serdang, Selangor, Malaysia. Nutrients 2021; 13:2288. [PMID: 34371798 PMCID: PMC8308395 DOI: 10.3390/nu13072288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
An overview of vitamins D3 and E suggests micronutrient deficiency contributes to type 2 diabetes mellitus (T2DM). A case-control study was conducted to determine the status of plasma vitamins D3 and E isomers amongst diabetic Malaysians. Two groups were recruited for participation, one comprising fifty diabetic subjects (DM) and one comprising fifty non-diabetic (non-DM) subjects, in order to assess their plasma vitamin D3, calcium and vitamin E status. Glycaemic status (haemoglobin A1c, HbA1c; fasting blood glucose, FBG; C-Peptide) and lipid profiles (total cholesterol, TC; triglycerides, TG; low-density lipoprotein-cholesterol, LDL-C; high-density lipoprotein-cholesterol, HDL-C) were assessed, followed by anthropometric measurements. The Mann-Whitney U-test, Kruskal-Wallis and Spearman's correlation coefficient were used to elucidate the association between levels of plasma vitamins D3 and E and T2DM. The vitamin D3 deficiency group (<20 ng/mL) showed a significant correlation (p < 0.05) with glycaemic status (HbA1c and FBG) and lipid profiles (HDL-C, LDL and TC). Spearman's correlation demonstrated that vitamin D3 status is strongly correlated with HDL levels (p < 0.05). Similarly, plasma total vitamin E levels >4.9 μg/mL revealed significantly different FBG, HbA1c, C-Peptide, LDL, HDL and TC levels across both groups. Moreover, family history, smoking, waist circumference and HbA1c levels demonstrated a significant association (p < 0.05) with levels of vitamins D and E but not FBG and lipid profiles. This could be because the pre-diabetic status among the non-DM group influenced the outcomes of this study.
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Affiliation(s)
- Nurliyana Najwa Md Razip
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.N.M.R.); (B.G.)
| | - Banulata Gopalsamy
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.N.M.R.); (B.G.)
| | - Mohd Sokhini Abdul Mutalib
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (M.S.A.M.); (A.A.)
| | - Sui Kiat Chang
- Key Laboratory of Plant Resources Conservation and Sustainable Utilization, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou 510650, China;
| | | | - Azrina Azlan
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (M.S.A.M.); (A.A.)
| | - Zulida Rejali
- Department of Obstetric and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | - Huzwah Khaza’ai
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.N.M.R.); (B.G.)
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50
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Miranda JJ, Pesantes MA, Lazo-Porras M, Portocarrero J, Diez-Canseco F, Carrillo-Larco RM, Bernabe-Ortiz A, Trujillo AJ, Aldridge RW. Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review. Wellcome Open Res 2021; 6:163. [PMID: 34595355 PMCID: PMC8447049 DOI: 10.12688/wellcomeopenres.16947.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Financial incentives may improve the initiation and engagement of behaviour change that reduce the negative outcomes associated with non-communicable diseases. There is still a paucity in guidelines or recommendations that help define key aspects of incentive-oriented interventions, including the type of incentive (e.g. cash rewards, vouchers), the frequency and magnitude of the incentive, and its mode of delivery. We aimed to systematically review the literature on financial incentives that promote healthy lifestyle behaviours or improve health profiles, and focused on the methodological approach to define the incentive intervention and its delivery. The protocol was registered at PROSPERO on 26 July 2018 ( CRD42018102556). Methods: We sought studies in which a financial incentive was delivered to improve a health-related lifestyle behaviour (e.g., physical activity) or a health profile (e.g., HbA1c in people with diabetes). The search (which took place on March 3 rd 2018) was conducted using OVID (MEDLINE and Embase), CINAHL and Scopus. Results: The search yielded 7,575 results and 37 were included for synthesis. Of the total, 83.8% (31/37) of the studies were conducted in the US, and 40.5% (15/37) were randomised controlled trials. Only one study reported the background and rationale followed to develop the incentive and conducted a focus group to understand what sort of incentives would be acceptable for their study population. There was a degree of consistency across the studies in terms of the direction, form, certainty, and recipient of the financial incentives used, but the magnitude and immediacy of the incentives were heterogeneous. Conclusions: The available literature on financial incentives to improve health-related lifestyles rarely reports on the rationale or background that defines the incentive approach, the magnitude of the incentive and other relevant details of the intervention, and the reporting of this information is essential to foster its use as potential effective interventions.
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Affiliation(s)
- J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, 15102, Peru
| | - M. Amalia Pesantes
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
| | - María Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Geneva, 1205, Switzerland
| | - Jill Portocarrero
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
| | - Rodrigo M. Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, W2 1UA, UK
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, 15074, Peru
| | - Antonio J. Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
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