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Abstract: Objectives To investigate the prevalence of gestational diabetes mellitus (GDM) and its associated factors in Shenzhen, China. Methods For routine prenatal care, women with singleton pregnancy underwent 75-g oral glucose tolerance tests (OGTTs) to make a GDM diagnosis at 24 to 28 weeks of gestation. Data of all OGTT results since March of 2017 and relevant clinical information were obtained from Shenzhen Baoan Women’s and Children’s Hospital, Jinan University. Adjusted odds ratio (aOR) was applied to describe association between pregnant women’s characteristics and GDM. Blood glucose levels grouped by characteristics were compared using t-test or one-way analysis of variance. Results A total of 70,427 pregnant women were included in this study, 17.02% of whom were affected by GDM. The prevalence of GDM was increased in recent years, and was strongly correlated with maternal age (Pearson r = 0.98, p < 0.001). Fasting glucose was highest in winter and lowest in summer, while 2-h post-load glucose was highest in summer and lowest in winter. Multivariate logistic regression indicated that maternal age (aOR = 1.12 per 1-year increase, 95% CI: 1.11–1.13), pre-pregnancy body mass index (aOR = 1.12 per 1 kg/m2 increase, 95% CI: 1.11–1.14), and positive family history of diabetes (aOR = 1.63, 95% CI: 1.47–1.81) were associated with increased GDM risk. Intriguingly, multiparous woman was associated with lower GDM risk (aOR = 0.88, 95% CI: 0.83–0.94). In vitro fertilization and embryo transfer was not significantly associated with GDM prevalence (aOR = 1.78, 95% CI: 0.92–3.46). Conclusions The prevalence of GDM was about 17.02% in Shenzhen, with increase in recent years. There were different alterations across seasons for fasting and post-load blood glucose. Multiparity may be an independent protective factor for GDM. PubDate: 2022-08-13
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Abstract: Background Inflammatory markers like tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hsCRP) have been thought to be associated with diabetes mellitus (DM). But their role in the development of diabetes in young is yet to be established. Aims To compare the concentrations of serum TNF-α and hsCRP between young subjects with normal glucose tolerance (NGT) and DM. Methods This cross-sectional study was performed with young subjects under 30 years of age consisting of 40 newly detected DM cases and an equal number of subjects with NGT diagnosed on the basis of the American Diabetes Association (ADA) criterion-2017 to see TNF-α and hsCRP levels. Glucose was measured by the glucose oxidase method, hsCRP by immunonephelometry, and TNF-α by enzyme-linked immunosorbent assay (ELISA). Results hsCRP was higher in DM than that of NGT [DM vs NGT: 3.41 (1.37–9.98) vs. 1.29 (0.68–2.65) pg/ml, median (IQR); p=0.003] but TNF-α was similar in both the groups (DM vs. NGT: 16.30±12.95 vs. 14.55±9.84 mg/L, mean±SD; p=0.201). Both body mass index (BMI) and waist circumference (WC) were positively correlated with hsCRP (BMI: r=0.501, p=0.001; WC: r=0.409, p=0.009) in NGT but not in DM (BMI: r=0.287, p=0.072; WC: r=0.281, p=0.078). Multiple regression analysis revealed BMI (p=0.020), WC (p=0.022), and hsCRP (p=0.041) as independent predictors for DM. Conclusions This study observed that serum hsCRP but not serum TNF-α was significantly higher in DM in young than that of NGT. PubDate: 2022-08-11
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Abstract: Background Hyperglycemia-associated micro- and macro-vascular complications remain the leading cause of premature morbidity and mortality among the diabetic population worldwide. Poor glycemic control due to clinical inertia towards insulin treatment is a major cause behind the development of diabetic complications. In this paper, we analyze different strategies of insulin treatment initialization and titration practiced in India. Methods The response of 367 healthcare professionals (HCPs) across the country was recorded based on a survey on demographics, treatment regimens, and patient behavior. For analysis, the responses from HCPs were segregated into six regions, north, south, east, west, and central, covering the entire country. Results The survey revealed that 59.1% HCPs preferred using three oral anti-diabetic drugs (OADs) before starting insulin therapy while 12.5% initiated insulin as the last option after trying all available OADs. Besides, 61% HCPs across India considered initiating insulin in type 2 diabetes mellitus (T2DM) patients when the patients (i) failed to achieve glycemic targets with current OADs, or (ii) could not tolerate OADs, or (iii) required a more flexible therapy. In T2DM patients, 52.9% HCPs chose basal only insulin during initiation. In comparison, 63.8% HCPs used basal bolus while initiating insulin in type 1 DM (T1DM) patients. Pan-India, 53.4% HCPs preferred analogue premix while 46.6% HCPs opted for human premix. Next, 98.9% HCPs counselled patients about the risk of hypoglycemia upon initiation of insulin. Conclusion This survey outlines an urgent need of reducing the clinical inertia against insulin initialization in Indian settings. PubDate: 2022-08-09
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Abstract: Background Type 2 diabetes mellitus has risen to one of the most common chronic diseases worldwide, which puts heavy pressure on patients and the health-care system. Self-management is an important treatment for type 2 diabetes. New self-management treatments have been making great progress with the development of the advanced telemedicine. Objective The purpose of this study is to gauge and examine the blood glucose control of various self-management strategies through a network meta-analysis. Methods We search the articles through PubMed, Cochrane library, MEDLINE, and EMBASE databases to seek out randomized controlled trials, and the primary outcome was the change in HbA1c from baseline. This meta-analysis was conducted to compare different kinds of self-management methods, applying Revman 5.3, Stata 14.0 software, and GeMTC 0.14.3. Results Thirty-five studies were included, consisting of 5554 type 2 diabetes mellitus patients and 4 interventions including computer-based self-management, telephone-based self-management, telemonitoring self-management, and usual care of clinic. In addition to performance bias, the risk of bias of included studies was low. In network meta-analysis, the computer-based self-management has the highest probability to be the most effective way in diabetes self-management treatments. Conclusion In conclusion, computer-based, telephone-based, and telemonitoring self-management methods are effective self-management methods for type 2 diabetes mellitus. The computer-based self-management method was the most effective compared to the other two self-management methods. Clinical trial registration The detailed protocol was registered in PROSPERO (https://www.crd.york.ac.uk/PROSPERO). Registration number was CRD42020186839. PubDate: 2022-08-09
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Abstract: Background As a clinical and non-invasive tool, the AGE Reader measures skin autofluorescence (SAF) to estimate the accumulation of advanced glycation end products (AGEs) in the skin. Accumulation of AGEs has been implicated in several inflammation-associated diseases, including diabetes and cardio-metabolic diseases. This study aimed to assess SAF in subjects with and without cardiovascular risk (CVR) factors and examine the association between SAF and various bio-clinical parameters. Methods In a cross-sectional study, we included 250 participants between 19 and 86 years of age divided into two groups: a healthy group (n = 88) and subjects with CVR factors (n = 162 in total, diabetes n = 48, hypertension n = 62, and both n = 52). We assessed skin AGE measures and biological and clinical data. Results SAF was significantly higher in subjects with CVR factors than in healthy participants (2.42 ± 0.38 vs 1.90 ± 0.29 respectively; p < 0.001). SAF was associated with age, gender, BMI, duration of diabetes, HbA1c, triglyceride, and obesity. Multivariate analysis showed that age and duration of diabetes were the independent determinants of SAF. The ROC analysis indicated that a SAF > 2.25 AU was the optimal cut-off point to predict the presence of diabetes and/or hypertension and dyslipidemia (p < 0.001). Conclusion This Tunisian population-based study shows an increased SAF level in subjects with diabetes and/or hypertension and dyslipidemia compared to healthy subjects. The AGE Reader device is a rapid and non-invasive tool in clinical practice to evaluate and screen CVR factors in Tunisia with a North African phototype. PubDate: 2022-08-02
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Abstract: Background The aim of this study is to assess for the change in progression of inflammatory, adiposity, and atherosclerotic markers in first degree relatives of type 2 diabetes mellitus patients. Methods Normal glucose tolerant (NGT) individuals (20–40 years) who had positive family history of T2DM (FHP) were enrolled in this prospective study based on ADA 2015 criteria. Age, sex, and BMI matched controls without any history of diabetes in their parents referred as family history negative (FHN) were taken for comparison. At baseline, detailed clinical assessment and requisite blood/imaging investigations were done. All the available subjects from the original cohort (FHN-32 and FHP-46) were studied after 2 years with recording of the clinical, biochemical and imaging parameters. Results A total of 64 cases (FHP) and 42 controls (FHN) were enrolled at baseline. FHP group had significantly higher hsCRP (p = 0.039) and cIMT (p = 0.003) than that of FHN group. No significant difference in the rate of conversion of NGT to prediabetes (using multiple criteria) was found after 2 years between the two groups. cIMT was increased significantly from baseline in FHP group than FHN group at the end of the study(0.02 ± 0.03 vs. 0.01 ± 0.02 mm, p = 0.002). But there was no significant difference for changes in glycemic status, lipid parameters, HOMA IR, hsCRP, and adiposity markers between the two groups at the end of the study. Conclusion Despite no significant differences in change in glycemic parameters or rates of conversion from NGT to pre diabetes, cIMT increased significantly in the normoglycemic offspring of T2DM subjects than those without history of T2DM in their parents. PubDate: 2022-08-02
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Abstract: Introduction Skeletal muscles respond heterogenically under various stresses and conditions like diabetes mellitus and cancer. Various imaging techniques like radiographs, ultrasonography, and MRI have been used to find out the muscle mass and cross-sectional area of foot muscles. Objective To summarize the findings of various imaging techniques to draw inference of presence of foot muscle atrophy in diabetic patients. Methodology Articles from databases-PubMed, Science Direct, Taylor & Francis, and Springer Link were retrieved. Results The imaging techniques confirm the presence of atrophy of foot muscles. Conclusion Based on the findings of study, it can be concluded that foot muscle atrophy is present in diabetics, with intrinsic muscles affected first in terms of decreased cross-sectional area, reduced plantar tissue and skin thickness, and a decrease in total foot muscle volume. PubDate: 2022-08-02
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Abstract: Objectives The aim of this study is to evaluate the prevalence, associated factors, and time for diabetic retinopathy (DR) development in Ecuadorian patients with type 2 diabetes (DM2) followed for 10 years. Methods A retrospective cohort study between 2007 and 2017 included 487 patients with DM2 who had at least one dilated fundus eye examination in Diabetes Center in a primary-health-care level followed up for ten years. Data was collected from clinical records. Sociodemographic and laboratory variables were analysed, determining their association (mean difference and bivariate logistic regression) with DR. Survival time was calculated through life tables and Kaplan-Meier analysis. Results The prevalence of DR was 19.95% during the 10-year follow-up period. The median time for developing DR was 28.53 (95% CI: 26.89–27.05), showing that 50% of patients have the risk (HR: 4.57) to develop DR in the third decade of DM disease diagnosis. The significant risk factors for progression of DR were duration of DM2, high glycosylated hemoglobin level > 7% (HbA1c Expβ: 1.709, 95% CI: 1.00–2.89), systemic hypertension (HNT Expβ: 2.348 Expβ: 2.348 95% CI: 1.17–4.70%) 95% CI: 1.17–4.70%), low glomerular filtration rate (Expβ: 1.805, GFR, < 60 ml/min/sc1.73) (95% CI: 1.10–2.94) and albuminuria (Expβ: 2.48 Expβ: 2.48 95% CI: 1.49–4.13). Conclusions Half of the patients with DM2 treated in a primary level of care will develop DR in the third decade of the disease. There are risk factors related to development of DR, such as low GFR, high HbA1c, albuminuria and HTN. Low GFR, high HbA1c, albuminuria and high blood pressure are related with the presence of retinopathy in diabetes patients. PubDate: 2022-07-28
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Abstract: Background/purpose Many studies suggest that insulin resistance in obese patients bridges mental illness. Our objective was to identify the association between levels of depression and anxiety with insulin resistance, and its relationship with obesity and abdominal obesity Methods A cross-sectional analytical study was carried out in Honduras. Sociodemographic variables, anthropometric parameters, HOMA index, and level of severity of anxiety and depression were collected, and a descriptive, bivariate, and multivariate were performed. Results In a sample of 381 adult patients, the bivariate analysis showed a statistic association of insulin resistance with all remaining variables. However, multivariate analysis showed a significative association of anxiety with BMI, depression, waist circumference, and insulinemia, while depression was associated with HOMA, anxiety, insulinemia, glycemia, and waist circumference. Conclusions Our results provide important evidence of a direct and growing association between HOMA-IR and the severity of depression, and indirectly with anxiety. Secondarily, also with anthropometric factors (BMI and WC), traditionally associated with cardiovascular risk. This finding has important implications both for the early diagnosis of these mental pathologies, taking into account HOMA-IR values, and for preventive interventions focused on maintaining blood insulin levels. PubDate: 2022-07-28
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Abstract: Background The significance of insulin antibody (IA) detection in type 2 diabetes mellitus (T2DM) has received scant attention from county hospitals in China. We aimed to introduce exogenous IA positive rate and its relative factors in T2DM treated with insulin in Xiangshan County of Ningbo City, analyzing the immunogenicity of different kinds of insulin. Methods Patients who were residents from the Danxi community and six towns (Dongchen, Xizhou, Maoyang, Sizhoutou, Juexi, and Qiangtou) in Xiangshan County and diagnosed with T2DM and treated with insulins at Xiangshan Hospital of TCM Medical and Health Group between August 2019 and June 2020 were identified. Those who met the eligibility criteria were included and assigned to the IA-positive or IA-negative group. The immunogenicity of different insulins was compared between the two groups. Results Among 992 patients, 781 were eligible for IA detection, and 40.2% of them were IA positive. Blood IA was closely associated with fasting and 2-h glucose, insulin, and C peptide levels and higher insulin dosage. Patients receiving basal insulin treatment showed significantly lower blood IA than those treated with mixed human insulin, premixed human insulins, rapid-acting analogs, or a combination of basal and rapid-acting analogs. PubDate: 2022-07-27
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Abstract: Background Lifestyle modification is an integral aspect for the management of type 2 diabetes (T2D). However, it is difficult to ensure the accuracy of personalized lifestyle advice. The study aims to analyse the real-world effectiveness of personalized glycemic response based Diabefly-Pro digital therapeutics for better glycemic control. Methods Data from continuous glucose monitoring (CGM) of 64 participants with T2D was analysed. All participants were provided with modified lifestyle plan based on their personalized glycemic response. The CGM data was analysed for a period of 7 days, before and after the introduction of modified lifestyle plan. Primary outcome of the study was change in time in range (TIR). Secondary outcomes of the study were change in mean blood glucose, time above range (TAR), time below range (TBR) and glucose management indicator (GMI). Results Significant improvement in glycemic control was observed after the introduction of personalized lifestyle plan. Median reduction in mean blood glucose was from 139.5 (118.3 to 169.3) mg/dL to 122.0 (101.5 to 148.8) mg/dL (p < 0.0001). TIR and GMI improved from 70.50 (50.75 to 83.50) % to 75.00 (58.25 to 89.00) % (p = 0.0001) and 6.64 (6.13 to 7.35) % to 6.23 (5.74 to 6.86) % (p < 0.0001) respectively. TAR reduced significantly from 17.00 (4.25 to 38.0) % to 6.00 (1.25 to 26.0) % (p < 0.0001). No significant increase in TBR was observed (p = 0.198). Conclusion Personalized glycemic response-based Diabefly-Pro digital therapeutics program was effective in achieving better glycemic control in people with T2D. PubDate: 2022-07-22
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Abstract: Purpose Dietary fibers and hypoglycemic drugs can be used concomitantly in the treatment of diabetes mellitus. We aimed to perform this review in order to evaluate whether scientific evidence is available regarding the interaction between these components and whether these interactions alter drug absorption. Methods We conducted a search of the literature for controlled clinical trials that evaluated the occurrence and clinical relevance of interactions between dietary fibers and hypoglycemic drugs. Six databases were searched from inception to April 20, 2020 and trials were eligible for inclusion if they measured changes in drug absorption parameters. Results In three studies, there were interactions between dietary fibers and hypoglycemic drugs, causing alterations in drug absorption. The other two studies had no significant changes in absorption pharmacokinetic parameters. Conclusions The physicochemical characteristics of the dietary fiber used, the chemical structure of the drug, and the pharmaceutical form administered are determining factors for the occurrence of alterations in drug absorption. PubDate: 2022-07-21
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Abstract: Background Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM). It is characterized by hyperglycemia, metabolic acidosis, and ketonemia. Fortunately, drug-induced hyperglycemias are usually mild and not life-threatening. However, rarely some cases may present with ketoacidosis. In this case report, we aimed to present a brentuximab vedotin (BV) associated with DKA. Case presentation A 23-year-old Caucasian man presented with abdominal pain, nausea, and vomiting for 1–2 weeks. The patient had a previous diagnosis of Hodgkin’s lymphoma and primer hypothyroidism. He is using levothyroxine 150 μg per day and received BV treatment for Hodgkin lymphoma (HL) 10 days ago. No steroid treatment was administered for premedication before BV. Except for obesity, all system examinations are normal. There were no signs of any infection. Laboratory data revealed hyperglycemia, metabolic acidosis, and ketonemia. The patient was admitted to the service with a diagnosis of DKA. After the patient was admitted to our clinic, insulin treatment and hydration started immediately. Despite the insulin infusion reaching 1700 units per day, the patient’s diabetic ketoacidosis extended to 1 week. Anti-insulin, anti-glutamic acid decarboxylase, and islet cell autoantibodies were negative, which were checked to exclude type 1 DM. Fasting C-peptide was 28 ng/mL (normal range, 0.9–7.1 ng/mL). With all these, the diabetic ketoacidosis status of the patient was evaluated as a BV side effect. Conclusion This patient is a rare case of BV-associated DKA. It is very important to know this relationship since BV treatment has turned into a standard treatment for relapsed Hodgkin lymphoma. Our case highlights that this diagnosis should be kept in mind as a complication of each dose of BV administration. PubDate: 2022-07-16
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Abstract: Purpose of the study Although insulin resistance is the pathogenic basis of type 2 diabetes mellitus (T2DM), it can also affect patients with type 1 diabetes mellitus (T1DM). In this clinical study, we investigated the relationship between insulin resistance grade and daily insulin dosage in order to clarify whether the approach to improving insulin resistance along with insulin therapy should be considered to treat T1DM and T2DM. Methods As the means of insulin resistance estimation, we selected the insulin resistance score because patients use insulin therapy and homeostatic model assessment insulin resistance (HOMA-IR) is not appropriate for those patients. The insulin resistance score was calculated as 24.31 – (12.22 × WHR) – (3.29 × HT) – (0.57 × HbA1c), where WHR is the waist-to-hip ratio, HT is hypertension, and HbA1c is glycated hemoglobin (%). Results The insulin resistance score was negatively correlated with the body mass index (BMI; r = –0.511) and the WHR (r = –0.773). The total insulin dosage was positively correlated with the BMI (r = 0.734) but negatively correlated with the insulin resistance score (r = –0.540). Conclusion Insulin resistance estimation is necessary for T1DM treatment, and the insulin resistance score is a useful tool for estimating insulin resistance in patients with T1DM accompanied with insulin resistance. PubDate: 2022-07-16
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Abstract: Background Glycemic control reduces the risk of cardiovascular complications among people with diabetes. However, the current status of glycemic control is uncertain among Iranian people with diabetes. This study aims to systematically review the studies on the status of glycemic control among people with type 2 diabetes in Iran. Methods A systematic literature search was conducted in international databases including Medline database (PubMed), Web of Science, Google Scholar, and Scopus, as well as domestic databases such as Iran Medex, SID, Magiran, Irandoc, and Medlib, up to end of 2020. All observational studies (cross-sectional, case-control, and cohort) were included. Studies that reported the status of glycemic control among people with type 2 diabetes in Iran were selected. Good glycemic control was defined as glycated hemoglobin A1c (HbA1c) less than 7%. Results A total of 23 eligible studies (15,358 patients) were included in the quantitative analysis. Of 15,358 patients, 5882 had good glycemic control. The pooled prevalence of good glycemic control was 33.1% (95% CI, 25.6–41.1%). Meta-regression showed no significant improvement in glycemic control rate by year. Conclusion Despite the importance of good glycemic control in the prevention of micro- and macrovascular diabetic complications, the high proportion of Iranian people with type 2 diabetes remains poorly controlled. The result of this meta-analysis indicates the need for better approaches to diabetes management in Iran. PubDate: 2022-07-15
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Abstract: Objective The aim of this study is to explore the correlation between vitamin D and diabetic nephropathy. Methods Relevant evidences were searched from PubMed, Embase, Web of Science, Ovid and China Knowledge Resource Integrated (CNKI), Wanfang Data Knowledge Service Platform databases (WANFANG), and VIP dating from inception to December 2019 to obtain the randomized controlled trials (RCTs) of vitamin D in the treatment of diabetic nephropathy. According to inclusion and exclusion criteria, two researchers independently screened the literature, extracted data, and evaluated the quality of included studies. Rev Man 5.3 software was used to conduct statistical analysis. Results A total of 10 studies involving 651 patients were identified. These studies were finally included into the meta-analysis. A meta-analysis results showed that vitamin D is the protection factor in diabetic nephropathy, the group treated with vitamin D did better than the traditional drug and the placebo group. After taking vitamin D, the level of vitamin D in the patient’s body increased significantly. Pooled results showed that there was a significant difference for vitamin D (MD = 38.24, 95%CI = 32.69–43.79, p < 0.001.) The patient had a significant decrease in urinary protein; the difference was statistically significant (MD = − 180.92, 95%CI = − 212.67 to − 149.16, p < 0.001). The blood creatinine content decreased obviously (MD = − 17.13, 95%CI = − 27.88 to − 6.37, p < 0.01). However, most of the included studies did not report the quality of life and adverse reactions of patients, making it impossible to analyze these measures. Conclusion This study showed that vitamin D played an active role in the treatment of diabetic nephropathy and can be used in future clinical applications. However, there are still some studies of low quality in the included studies, so it is suggested that clinical and scientific researchers carry out more high-quality, large sample, multi-center randomized controlled trials (RCTS) to provide more evidence-based medical evidence for future studies on vitamin D treatment of diabetic nephropathy. PubDate: 2022-07-14
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Abstract: Background Measurement of venous plasma glucose concentration (P-Glucose) requires preanalytical precautions: rapid cooling, rapid centrifugation, and using tubes with enzyme inhibitors. A special routine for measuring a biomarker that is critical and frequent in metabolic control is logistically demanding and expensive. We revisit and quantify the diagnostic outcome of using venous serum glucose concentration (S-Glucose) to diagnose diabetes mellitus (DM), using glycated hemoglobin (B-HbA1c) as the reference procedure for diagnosis. Methods Data from 301 participants, with simultaneous measurements of B-HbA1c, fasting S-Glucose and P-Glucose, without diabetes medication or established diagnosis were included. The WHO definition of DM as a B-HbA1c value ≥ 47.5 mmol/mol (6.5%) was used to define DM. The optimal concentration cutoff for S-Glucose was identified using the receiver operating characteristic curve and the cumulative data analysis tools. The diagnostic performance was evaluated by the diagnostic sensitivity, specificity, and the positive likelihood ratio of the S-Glucose measurements. Results The correlation between S-Glucose and P-Glucose was 0.999. S-Glucose had a diagnostic sensitivity and specificity of 91% and 99% and P-Glucose of 97% and 95%, respectively, to diagnose DM when a cutoff value of 6.9 mmol/L (125 mg/dL) was used and in relation to the diagnosis established by B-HbA1c. Conclusion The diagnostic sensitivity and specificity of S-Glucose equals those of P-Glucose when compared to the WHO B-HbA1c criteria. In comparison, S-Glucose instead of P-Glucose saves costs, optimizes the use of the patient sample, and improves the logistics of samples and reagents. PubDate: 2022-07-11
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