RESUMO
Background: This study investigates the burden of chronic kidney disease attributed to type 2 diabetes (CKD-T2D) across different geographical locations and time periods from 1990 to 2019. A total of 204 countries and regions are included in the analysis, with consideration given to their socio-demographic indexes (SDI). The aim is to examine both spatial and temporal variations in CKD-T2D burden. Methods: This research utilized data from the 2019 Global Burden of Diseases Study to evaluate the age-standardized incidence rates (ASIR), Disability-Adjusted Life Years (DALYs), and Estimated Annual Percentage Change (EAPC) associated with CKD-T2D. Results: Since 1990, there has been a noticeable increase of CKD age-standardized rates due to T2D, with an EAPCs of 0.65 (95% confidence interval [CI]: 0.63 to 0.66) for ASIR and an EAPC of 0.92 (95% CI: 0.8 to 1.05) for age-standardized DALYs rate. Among these regions, Andean Latin America showed a significant increase in CKD-T2D incidence [EAPC: 2.23 (95% CI: 2.11 to 2.34) and North America showed a significant increase in CKD-T2D DALYs [EAPC: 2.73 (95% CI: 2.39 to 3.07)]. The burden was higher in male and increased across all age groups, peaking at 60-79 years. Furthermore, there was a clear correlation between SDI and age-standardized rates, with regions categorized as middle SDI and High SDI experiencing a significant rise in burden. Conclusion: The global burden of CKD-T2D has significantly risen since 1990, especially among males aged 60-79 years and in regions with middle SDI. It is imperative to implement strategic interventions to effectively address this escalating health challenge.
Assuntos
Diabetes Mellitus Tipo 2, Insuficiência Renal Crônica, Humanos, Diabetes Mellitus Tipo 2/epidemiologia, Diabetes Mellitus Tipo 2/complicações, Insuficiência Renal Crônica/epidemiologia, Masculino, Feminino, Incidência, Pessoa de Meia-Idade, Idoso, Carga Global da Doença/tendências, Adulto, Anos de Vida Ajustados por Deficiência/tendências, Saúde Global/tendênciasRESUMO
Background: We explore the effect of suboptimal glycemic control on the incidence of diabetic peripheral neuropathy (DPN) in both non-elderly and elderly patients with type 2 diabetes mellitus (T2DM). Methods: A 6-year follow-up study (2013-2019) enrolled T2DM patients aged >20 without DPN. Participants were classified into two groups: those below 65 years (non-elderly) and those 65 years or older (elderly). Biochemical measurements, including glycated hemoglobin (HbA1C), were recorded regularly. DPN was diagnosed using the Michigan Neuropathy Screening Instrument examination. The outcome was DPN occurrence in 2019. Results: In 552 enrollments (69% non-elderly), DPN occurred in 8.4% non-elderly and 24.0% elderly patients. A higher initial HbA1C level was significantly linked with a higher risk of future DPN in the non-elderly group (adjusted odds ratio [AOR] 1.46, 95% CI 1.13-1.89, p=0.004). In comparison, HbA1c at the end of the study period was not associated with DPN in the non-elderly group (AOR 1.17, 95% CI 0.72-1.90, p=0.526). In the elderly group, no statistical relationship was found between HbA1C levels and DPN, either in 2013 or in 2019. Conclusion: Suboptimal glycemic control at baseline, rather than at the end of the study period, predicts an increased risk of future DPN in individuals with T2DM under age 65. This correlation is not seen in elderly patients. Therefore, we recommend implementing enhanced glycemic control early in middle-aged T2DM patients and propose individualized therapeutic strategies for diabetes in different age groups.
Assuntos
Diabetes Mellitus Tipo 2, Neuropatias Diabéticas, Hemoglobinas Glicadas, Controle Glicêmico, Humanos, Neuropatias Diabéticas/sangue, Neuropatias Diabéticas/epidemiologia, Neuropatias Diabéticas/etiologia, Masculino, Feminino, Diabetes Mellitus Tipo 2/sangue, Diabetes Mellitus Tipo 2/complicações, Diabetes Mellitus Tipo 2/epidemiologia, Pessoa de Meia-Idade, Idoso, Hemoglobinas Glicadas/análise, Hemoglobinas Glicadas/metabolismo, Seguimentos, Fatores Etários, Glicemia/análise, Glicemia/metabolismo, Adulto, Incidência, Fatores de RiscoRESUMO
Background and aims: Diabetes-related foot ulcers (DFU) are a persistent healthcare challenge, impacting both patients and healthcare systems, with adverse effects on quality of life and productivity. Our primary aim was to examine the trends in lifetime prevalence of DFU, as well as other micro- and macrovascular complications in the Trøndelag Health Study (HUNT) in Norway. Methods: This study consists of individuals ≥20 years with diabetes participating in the population-based cross-sectional HUNT surveys (1995-2019). Prevalence ratios, comparing the lifetime prevalence of DFU and other relevant micro- and macrovascular complications between the HUNT surveys, were calculated using Poisson regression. Results: The lifetime prevalence (95% confidence interval (CI)) of a DFU requiring three or more weeks to heal was 11.0% (9.5-12.7) in HUNT2, 7.5% (6.3-8.8) in HUNT3 and 5.3% (4.4-6.3) in HUNT4. The decrease in DFU prevalence from 1995 to 2019 was observed in both men and women, for all age groups, and for both type 1 and type 2 diabetes. The highest lifetime prevalence of DFU was found among those with type 1 diabetes. The decrease in HbA1c from HUNT2 to HUNT4 did not differ between those with and without a DFU. The prevalence of chronic kidney disease (eGFR <60 mL/min/1.73 m2 (eGFR categories G3-G5)) increased in both individuals with and without a DFU. Conclusion: Results from the HUNT surveys show a substantial decline in the lifetime prevalence of DFU from 1995 to 2019.
Assuntos
Pé Diabético, Humanos, Noruega/epidemiologia, Masculino, Feminino, Estudos Transversais, Pessoa de Meia-Idade, Prevalência, Pé Diabético/epidemiologia, Idoso, Adulto, Idoso de 80 Anos ou mais, Adulto Jovem, Diabetes Mellitus Tipo 2/epidemiologia, Diabetes Mellitus Tipo 2/complicaçõesRESUMO
BACKGROUND: Diabetes mellitus (DM) is the most common metabolic disorder in pregnancy. Women with Type 2 DM seems to have no better perinatal outcomes than those with Type 1 DM. METHODS: Single-center prospective cohort observational study. Pregnant women with diabetes (141 with Type 1 DM and 124 with Type 2 DM) that were followed in the university hospital between 2009 and 2021 were included in this study. Clinical data and obstetric and perinatal outcomes were collected. RESULTS: As expected, women with Type 1 DM were younger and had a longer duration of diabetes than women with Type 2 DM. Obesity and chronic hypertension were higher in the group of women with Type 2 DM and their value of HbA1c in the second and third trimesters were lower than in Type 1 DM. No differences in prematurity were found, but more extreme prematurity was observed in Type 2 DM, as well as a higher rate of congenital malformations. The frequency of hypoglycemia and the weight of the newborn was higher in Type 1 DM. The maternal independent factors related to the weight of the newborn were: the glycemic control at the third trimester, the weight gain during pregnancy, and pregestational BMI. CONCLUSIONS: Newborns born to mothers with Type 1 DM were larger and had a higher frequency of hypoglycemia, while congenital malformations and precocious preterm was more associated to Type 2 DM. Metabolic control, weight gain and pregestational weight were important determinants of both obstetric and neonatal complications.
Assuntos
Anormalidades Congênitas, Diabetes Mellitus Tipo 1, Diabetes Mellitus Tipo 2, Gravidez em Diabéticas, Nascimento Prematuro, Humanos, Feminino, Gravidez, Gravidez em Diabéticas/epidemiologia, Diabetes Mellitus Tipo 1/complicações, Diabetes Mellitus Tipo 1/sangue, Diabetes Mellitus Tipo 2/complicações, Diabetes Mellitus Tipo 2/epidemiologia, Adulto, Estudos Prospectivos, Recém-Nascido, Anormalidades Congênitas/epidemiologia, Nascimento Prematuro/epidemiologia, Hipoglicemia/epidemiologia, Hipoglicemia/etiologia, Peso ao Nascer, Índice de Massa Corporal, Hemoglobinas Glicadas/análise, Resultado da Gravidez/epidemiologiaRESUMO
PURPOSE: This study was undertaken to evaluate the potential risk of acute pancreatitis with empagliflozin in patients with type 2 diabetes (T2D) newly initiating empagliflozin. METHODS: Data from two large US claims databases were analyzed in an observational study of patients with T2D receiving metformin who were newly prescribed empagliflozin versus sulfonylurea (SU). Because dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists have been associated with the risk of acute pancreatitis in some studies, patients on these agents were excluded. Using pooled analyses of data from the two databases (2014-2021), patients initiating empagliflozin were matched 1:1 within database to patients initiating SU using propensity scores (PS) that incorporated relevant demographic and clinical characteristics. Prespecified sensitivity analyses were performed for design parameters. RESULTS: The analyses identified 72 661 new users of empagliflozin and 422 018 new users of SUs, with both patient groups on concurrent metformin therapy. Baseline characteristics within treatment groups appeared to be similar across the 72 621 matched pairs. After mean follow-up of ~6 months, incidence rates of acute pancreatitis in the pooled matched cohort were 10.30 (95% confidence interval [CI] 9.29-11.39) events per 1000 patient-years (PY) for empagliflozin and 11.65 (95% CI 10.59-12.77) events per 1000 PY for SUs. On a background of metformin, patients newly initiating empagliflozin did not have an increased risk of acute pancreatitis compared with those initiating an SU (pooled PS matched hazard ratio 0.88 [0.76-1.02]) across 75621.42 PY of follow-up. CONCLUSIONS: The results of this voluntary post-approval safety study provide additional evidence that the use of empagliflozin for the treatment of T2D is not associated with an increased risk of acute pancreatitis.
Assuntos
Compostos Benzidrílicos, Diabetes Mellitus Tipo 2, Glucosídeos, Metformina, Pancreatite, Compostos de Sulfonilureia, Humanos, Compostos Benzidrílicos/efeitos adversos, Diabetes Mellitus Tipo 2/tratamento farmacológico, Diabetes Mellitus Tipo 2/epidemiologia, Pancreatite/induzido quimicamente, Pancreatite/epidemiologia, Glucosídeos/efeitos adversos, Glucosídeos/uso terapêutico, Glucosídeos/administração & dosagem, Compostos de Sulfonilureia/efeitos adversos, Compostos de Sulfonilureia/uso terapêutico, Masculino, Feminino, Pessoa de Meia-Idade, Idoso, Metformina/efeitos adversos, Metformina/administração & dosagem, Metformina/uso terapêutico, Hipoglicemiantes/efeitos adversos, Hipoglicemiantes/administração & dosagem, Bases de Dados Factuais, Incidência, Vigilância de Produtos Comercializados/estatística & dados numéricos, Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos, Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico, Adulto, Estados Unidos/epidemiologia, Pontuação de PropensãoRESUMO
Objective: The activation of platelets in individuals with type 2 diabetes mellitus (T2DM) triggers inflammation and hemodynamic abnormalities, contributing to the development of diabetic kidney disease (DKD). Despite this, research into the relationship between plateletcrit (PCT) levels and DKD is sparse, with inconsistent conclusions drawn regarding the connection between various platelet parameters and DKD. This highlights the necessity for comprehensive, large-scale population studies. Therefore, our objective is to explore the association between PCT levels and various platelet parameters in relation to DKD. Methods: In this cross-sectional study, hematological parameter data were collected from a cohort of 4,302 hospitalized Chinese patients. We analyzed the relationships between PCT, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR), and DKD, along with the urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR). Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic potential of these parameters. Results: DKD patients exhibited significantly higher PCT levels compared to those without DKD. Multivariate regression analysis identified elevated PCT and PLT levels as potential independent risk factors for both DKD and UACR, while lower MPV levels might serve as independent protective factors for eGFR. The areas under the ROC curve for PCT in relation to DKD and UACR (≥30 mg/g) were 0.523 and 0.526, respectively. The area under the ROC curve for PLT in relation to UACR (≥30 mg/g) was 0.523. Conclusion: PCT demonstrates a weak diagnostic value for T2DM patients at risk of developing DKD and experiencing proteinuria, and PLT shows a similarly modest diagnostic utility for detecting proteinuria. These insights contribute to a deeper understanding of the complex dynamics involved in DKD. Additionally, incorporating these markers into routine clinical assessments could enhance risk stratification, facilitating early interventions and personalized management strategies.
Assuntos
Plaquetas, Diabetes Mellitus Tipo 2, Nefropatias Diabéticas, Humanos, Estudos Transversais, Masculino, Feminino, Nefropatias Diabéticas/sangue, Nefropatias Diabéticas/epidemiologia, Nefropatias Diabéticas/etiologia, Pessoa de Meia-Idade, Contagem de Plaquetas, Prevalência, Diabetes Mellitus Tipo 2/complicações, Diabetes Mellitus Tipo 2/sangue, Diabetes Mellitus Tipo 2/epidemiologia, Plaquetas/metabolismo, Plaquetas/patologia, Idoso, Volume Plaquetário Médio, Taxa de Filtração Glomerular, Fatores de Risco, Adulto, Biomarcadores/sangueRESUMO
Epidemiological and clinical studies have indicated a higher risk of nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM), implying a potentially shared genetic etiology, which is still less explored. Genetic links between T2DM and NAFLD were assessed using linkage disequilibrium score regression and pleiotropic analysis under composite null hypothesis. European GWAS data have identified shared genes, whereas SNP-level pleiotropic analysis under composite null hypothesis has explored pleiotropic loci. generalized gene-set analysis of GWAS data determines pleiotropic pathways and tissue enrichment using eQTL mapping to identify associated genes. Mendelian randomization analysis was used to investigate the causal relationship between NAFLD and T2DM. Linkage disequilibrium score regression analysis revealed a strong genetic correlation between T2DM and NAFLD, and identified 24 pleiotropic loci. These single-nucleotide polymorphisms are primarily involved in biosynthetic regulation, RNA biosynthesis, and pancreatic development. generalized gene-set analysis of GWAS data analysis revealed significant enrichment in multiple brain tissues. Gene mapping using these 3 methods led to the identification of numerous pleiotropic genes, with differences observed in liver and kidney tissues. These genes were mainly enriched in pancreas, brain, and liver tissues. The Mendelian randomization method indicated a significantly positive unidirectional causal relationship between T2DM and NAFLD. Our study identified a shared genetic structure between NAFLD and T2DM, providing new insights into the genetic pathogenesis and mechanisms of NAFLD and T2DM comorbidities.
Assuntos
Diabetes Mellitus Tipo 2, Estudo de Associação Genômica Ampla, Análise da Randomização Mendeliana, Hepatopatia Gordurosa não Alcoólica, Polimorfismo de Nucleotídeo Único, Humanos, Diabetes Mellitus Tipo 2/genética, Diabetes Mellitus Tipo 2/epidemiologia, Hepatopatia Gordurosa não Alcoólica/genética, Hepatopatia Gordurosa não Alcoólica/epidemiologia, Predisposição Genética para Doença, Desequilíbrio de Ligação, Pleiotropia Genética, Locos de Características QuantitativasRESUMO
OBJECTIVE: The risk factors of urinary tract infection in elderly patients with type 2 diabetes were investigated. METHODS: A total of 72 elderly patients admitted to our hospital from December 2019 to September 2023 because of with type 2 diabetes were retrospectively included. They were divided into the observation group (n = 35) and control group (n = 37) according to whether they had urinary tract infection. The general clinical data, clinical characteristics and the distribution of pathogenic bacteria in the observation group were collected and analysed. Then, t-tests, chi-square tests, regression analysis and receiver operating characteristic curve analysis were conducted. RESULTS: Escherichia coli (E. coli) accounted for 51.43% of the pathogenic bacteria in the observation group, whereas Klebsiella pneumoniae (K. pneumoniae) accounted for 22.86%. The remaining pathogens accounted for 2.86% each. Differences in gender, course of disease, glycosylated haemoglobin and comorbid urinary calculi were found between the groups (p < 0.05); These factors were all risk factors for concurrent urinary infection, and the odds ratios were all >1. The obtained values for gender, disease course, glycosylated haemoglobin and comorbid urinary calculi were respectively 0.594, 0.654, 0.738 and 0.696 (area under the curve); 0.971, 0.714, 0.800 and 0.743 (sensitivity); 0.216, 0.595, 0.676 and 0.649 (specificity); And 0.188, 0.309, 0.476 and 0.392 (Youden index). CONCLUSIONS: Common pathogens in elderly people with type 2 diabetes and comorbid urinary tract infection are E. coli and K. pneumoniae. Risk factors include gender, disease duration, glycosylated haemoglobin and urinary stones. The prompt identification of pathogens and risk factors facilitates clinical treatment, reducing infection incidence.
Assuntos
Diabetes Mellitus Tipo 2, Infecções Urinárias, Humanos, Infecções Urinárias/epidemiologia, Infecções Urinárias/complicações, Infecções Urinárias/microbiologia, Diabetes Mellitus Tipo 2/complicações, Diabetes Mellitus Tipo 2/epidemiologia, Estudos Retrospectivos, Masculino, Fatores de Risco, Feminino, Idoso, Estudos de Coortes, Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Limited information is available on the effect of ideal cardiovascular health (CVH) and abnormal glucose metabolism in elderly people. We aimed to analyze the prevalence of CVH behaviors, abnormal glucose metabolism, and their correlation in 65 and older people. METHODS: In this study, randomized cluster sampling, multivariate logistic regression, and mediating effects analysis were used. Recruiting was carried out between January 2020 and December 2020, and 1984 participants aged 65 years or older completed the study. RESULTS: The prevalence of abnormal glucose metabolism in this group was 26.7% (n = 529), among which the prevalence of impaired fasting glucose (IFG) was 9.5% (male vs. female: 8.7% vs 10.1%, P = 0.338), and the prevalence of type 2 diabetes mellitus (T2DM) was 19.0% (male vs. female: 17.8 vs. 19.8%, P = 0.256). The ideal CVH rate (number of ideal CVH metrics ≥ 5) was only 21.0%. The risk of IFG and T2DM decreased by 23% and 20% with each increase in one ideal CVH metrics, with OR (95%CI) of 0.77(0.65-0.92) and 0.80(0.71-0.90), respectively (P -trend < 0.001). TyG fully mediated the ideal CVH and the incidence of T2DM, and its mediating effect OR (95%CI) was 0.88(0.84-0.91). CONCLUSIONS: Each increase in an ideal CVH measure may effectively reduce the risk of abnormal glucose metabolism by more than 20%.
Assuntos
Glicemia, Doenças Cardiovasculares, Diabetes Mellitus Tipo 2, Humanos, Feminino, Masculino, Idoso, Diabetes Mellitus Tipo 2/epidemiologia, Diabetes Mellitus Tipo 2/metabolismo, Doenças Cardiovasculares/epidemiologia, Doenças Cardiovasculares/metabolismo, Glicemia/metabolismo, Prevalência, China/epidemiologia, Idoso de 80 Anos ou mais, Fatores de RiscoRESUMO
This two-sample Mendelian randomization (MR) study was conducted to investigate the causal associations between type 2 diabetes mellitus (T2DM) and the risk of pancreatic cancer (PaCa), as this causal relationship remains inconclusive in existing MR studies. The selection of instrumental variables for T2DM was based on two genome-wide association study (GWAS) meta-analyses from European cohorts. Summary-level data for PaCa were extracted from the FinnGen and UK Biobank databases. Inverse variance weighted (IVW) and four other robust methods were employed in our MR analysis. Various sensitivity analyses and multivariable MR approaches were also performed to enhance the robustness of our findings. In the IVW and Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) analyses, the odds ratios (ORs) for each 1-unit increase in genetically predicted log odds of T2DM were approximately 1.13 for PaCa. The sensitivity tests and multivariable MR supported the causal link between T2DM and PaCa without pleiotropic effects. Therefore, our analyses suggest a causal relationship between T2DM and PaCa, shedding light on the potential pathophysiological mechanisms of T2DM's impact on PaCa. This finding underscores the importance of T2DM prevention as a strategy to reduce the risk of PaCa.
Assuntos
Diabetes Mellitus Tipo 2, Estudo de Associação Genômica Ampla, Análise da Randomização Mendeliana, Neoplasias Pancreáticas, Humanos, Diabetes Mellitus Tipo 2/genética, Diabetes Mellitus Tipo 2/epidemiologia, Neoplasias Pancreáticas/genética, Neoplasias Pancreáticas/etiologia, Neoplasias Pancreáticas/epidemiologia, Polimorfismo de Nucleotídeo Único, Predisposição Genética para Doença, Razão de Chances, Fatores de RiscoRESUMO
INTRODUCTION: Research linking type 2 diabetes and depression mostly relied on hospital-based diagnoses or prescription data, overlooking many outpatient diagnoses. We aimed to quantify the risks of depression in individuals newly diagnosed with type 2 diabetes, and type 2 diabetes in those newly diagnosed with depression, while exploring potential risk differences depending on age, sex, and follow-up time. RESEARCH DESIGN AND METHODS: We conducted a matched cohort study using German nationwide outpatient claims data from 2012 to 2022. Participants were individuals newly diagnosed with type 2 diabetes (N=294 642) or depression (N=1 271 537) in 2015, matched in a 1:4 ratio to controls without these conditions by age, sex, and region. The bidirectional risk was evaluated over an 8-year period using mixed-effects Cox proportional hazards models, adjusting for the Charlson Comorbidity Index, urbanicity, and area-level deprivation. RESULTS: New type 2 diabetes diagnosis was associated with higher depression risk over 8 years (N=54 561 with depression, HR=1.23, 99% CI=1.21 to 1.24). Similarly, depression diagnosis was linked to an increased type 2 diabetes risk (N=71 848 with type 2 diabetes, HR=1.15, 99% CI=1.14 to 1.17). The association between depression and type 2 diabetes was stronger in younger age groups, especially under 34 years. Findings held across sex-stratified analyses. Time stratification showed a more pronounced association between type 2 diabetes and depression risk during the earlier follow-up quarters, whereas the risk of developing type 2 diabetes after depression diagnosis remained constant throughout the follow-up period. CONCLUSIONS: Our findings confirm a bidirectional link between type 2 diabetes and depression, particularly in younger individuals. As type 2 diabetes and depression are frequent, future research needs to study whether preventive approaches can reduce the risk of developing this comorbidity.
Assuntos
Depressão, Diabetes Mellitus Tipo 2, Pacientes Ambulatoriais, Humanos, Diabetes Mellitus Tipo 2/epidemiologia, Diabetes Mellitus Tipo 2/complicações, Diabetes Mellitus Tipo 2/psicologia, Masculino, Feminino, Alemanha/epidemiologia, Pessoa de Meia-Idade, Adulto, Pacientes Ambulatoriais/estatística & dados numéricos, Idoso, Depressão/epidemiologia, Seguimentos, Comorbidade, Fatores de Risco, Estudos de Coortes, Adulto JovemRESUMO
Importance: Gestational diabetes is a type 2 diabetes risk indicator, and recurrence further augments risk. In women with a single occurrence across 2 pregnancies, it is unclear whether first- vs second-pregnancy gestational diabetes differ in terms of risk. Objective: To compare the hazards of incident diabetes among those with gestational diabetes in the first, in the second, and in both pregnancies with women without gestational diabetes in either. Design, Setting, and Participants: This was a retrospective cohort study with cohort inception from April 1, 1990, to December 31, 2012. Follow-up was April 1, 1990, to April 1, 2019. Participants were mothers with 2 singleton deliveries between April 1, 1990, and December 31, 2012, without diabetes before or between pregnancies, who were listed in public health care insurance administrative databases and birth, stillbirth, and death registries in Quebec, Canada. Data were analyzed from July to December 2023. Exposure: Gestational diabetes occurrence(s) across 2 pregnancies. Main outcomes and measures: Incident diabetes from the second delivery until a third pregnancy, death, or the end of the follow-up period, whichever occurred first. Results: The 431â¯980 women with 2 singleton deliveries studied had a mean (SD) age of 30.1 (4.5) years at second delivery, with a mean (SD) of 2.8 (1.5) years elapsed between deliveries; 373â¯415 (86.4%) were of European background, and 78â¯770 (18.2%) were at the highest quintile of material deprivation. Overall, 10â¯920 women (2.5%) had gestational diabetes in their first pregnancy, 16â¯145 (3.7%) in their second, and 8255 (1.9%) in both (12â¯205 incident diabetes events; median [IQR] follow-up 11.5 [5.3-19.4] years). First pregnancy-only gestational diabetes increased hazards 4.35-fold (95% CI, 4.06-4.67), second pregnancy-only increased hazards 7.68-fold (95% CI, 7.31-8.07), and gestational diabetes in both pregnancies increased hazards 15.8-fold (95% CI, 15.0-16.6). Compared with first pregnancy-only gestational diabetes, second pregnancy-only gestational diabetes increased hazards by 76% (95% CI, 1.63-1.91), while gestational diabetes in both pregnancies increased it 3.63-fold (95% CI, 3.36-3.93). Conclusions and relevance: In this retrospective cohort study of nearly half a million women with 2 singleton pregnancies, both the number and ordinal pregnancy of any gestational diabetes occurrence increased diabetes risk. These considerations offer greater nuance than an ever or never gestational diabetes dichotomy.
Assuntos
Diabetes Gestacional, Humanos, Feminino, Gravidez, Diabetes Gestacional/epidemiologia, Adulto, Estudos Retrospectivos, Incidência, Quebeque/epidemiologia, Diabetes Mellitus Tipo 2/epidemiologia, Fatores de RiscoRESUMO
Diabetes-related distress (DRD) refers to the psychological distress specific to living with diabetes. DRD can lead to negative clinical consequences such as poor self-management. By knowing the local prevalence and severity of DRD, primary care teams can improve the DRD evaluation in our daily practice. This was a cross-sectional study conducted in 3 General Out-patient Clinics (GOPCs) from 1 December 2021 to 31 May 2022. A random sample of adult Chinese subjects with T2DM, who regularly followed up in the selected clinic in the past 12 months, were included. DRD was measured by the validated 15-item Chinese version of the Diabetes Distress Scale (CDDS-15). An overall mean score ≥ 2.0 was considered clinically significant. The association of DRD with selected clinical and personal factors was investigated. The study recruited 362 subjects (mean age 64.2 years old, S.D. 9.5) with a variable duration of living with T2DM (median duration 7.0 years, IQR 10.0). The response rate was 90.6%. The median HbA1c was 6.9% (IQR 0.9). More than half (59.4%) of the subjects reported a clinically significant DRD. Younger subjects were more likely to have DRD (odds ratio of 0.965, 95% CI 0.937-0.994, p = 0.017). Patients with T2DM in GOPCs commonly experience clinically significant DRD, particularly in the younger age group. The primary care clinicians could consider integrating the evaluation of DRD as a part of comprehensive diabetes care.
Assuntos
Diabetes Mellitus Tipo 2, Atenção Primária à Saúde, Humanos, Diabetes Mellitus Tipo 2/epidemiologia, Diabetes Mellitus Tipo 2/psicologia, Pessoa de Meia-Idade, Masculino, Feminino, Hong Kong/epidemiologia, Prevalência, Estudos Transversais, Idoso, Angústia Psicológica, Estresse Psicológico/epidemiologia, Fatores de RiscoRESUMO
BACKGROUNDPreclinical studies suggest that cholesterol accumulation leads to insulin resistance. We previously reported that alterations in a monocyte cholesterol metabolism transcriptional network (CMTN) - suggestive of cellular cholesterol accumulation - were cross-sectionally associated with obesity and type 2 diabetes (T2D). Here, we sought to determine whether the CMTN alterations independently predict incident prediabetes/T2D risk, and correlate with cellular cholesterol accumulation.METHODSMonocyte mRNA expression of 11 CMTN genes was quantified among 934 Multi-Ethnic Study of Atherosclerosis (MESA) participants free of prediabetes/T2D; cellular cholesterol was measured in a subset of 24 monocyte samples.RESULTSDuring a median 6-year follow-up, lower expression of 3 highly correlated LXR target genes - ABCG1 and ABCA1 (cholesterol efflux) and MYLIP (cholesterol uptake suppression) - and not other CMTN genes, was significantly associated with higher risk of incident prediabetes/T2D. Lower expression of the LXR target genes correlated with higher cellular cholesterol levels (e.g., 47% of variance in cellular total cholesterol explained by ABCG1 expression). Further, adding the LXR target genes to overweight/obesity and other known predictors significantly improved prediction of incident prediabetes/T2D.CONCLUSIONThese data suggest that the aberrant LXR/ABCG1-ABCA1-MYLIP pathway (LAAMP) is a major T2D risk factor and support a potential role for aberrant LAAMP and cellular cholesterol accumulation in diabetogenesis.FUNDINGThe MESA Epigenomics and Transcriptomics Studies were funded by NIH grants 1R01HL101250, 1RF1AG054474, R01HL126477, R01DK101921, and R01HL135009. This work was supported by funding from NIDDK R01DK103531 and NHLBI R01HL119962.
Assuntos
Colesterol, Diabetes Mellitus Tipo 2, Receptores X do Fígado, Estado Pré-Diabético, Transdução de Sinais, Humanos, Estado Pré-Diabético/genética, Estado Pré-Diabético/metabolismo, Masculino, Feminino, Diabetes Mellitus Tipo 2/genética, Diabetes Mellitus Tipo 2/metabolismo, Diabetes Mellitus Tipo 2/epidemiologia, Pessoa de Meia-Idade, Receptores X do Fígado/genética, Receptores X do Fígado/metabolismo, Colesterol/metabolismo, Idoso, Membro 1 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética, Membro 1 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/metabolismo, Monócitos/metabolismo, Fatores de Risco, Transportador 1 de Cassete de Ligação de ATP/genética, Transportador 1 de Cassete de Ligação de ATP/metabolismo, Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Previous studies on whole grain consumption had inconsistent findings and lacked quantitative assessments of evidence quality. Therefore, we aimed to summarize updated findings using the Burden of Proof analysis (BPRF) to investigate the relationship of whole grain consumption on type 2 diabetes (T2D), colorectal cancer (CRC), stroke, and ischemic heart disease (IHD). METHODS: We conducted a literature search in the Medline and Web of Science up to June 12, 2023, to identify related cohort studies and systematic reviews. The mean RR (relative risk) curve and uncertainty intervals (UIs), BPRF function, risk-outcome score (ROS), and the theoretical minimum risk exposure level (TMREL) were estimated to evaluate the level of four risk-outcome pairs. RESULTS: In total, 27 prospective cohorts were included in our analysis. Consuming whole grain at the range of TMREL (118.5-148.1 g per day) was associated with lower risks: T2D (declined by 37.3%, 95% UI: 5.8 to 59.5), CRC (declined by 17.3%, 6.5 to 27.7), stroke (declined by 21.8%, 7.3 to 35.1), and IHD (declined by 36.9%, 7.1 to 58.0). For all outcomes except stroke, we observed a non-linear, monotonic decrease as whole grain consumption increased; For stroke, it followed a J-shaped curve (the greatest decline in the risk of stroke at consuming 100 g whole grain for a day). The relationships between whole grain consumption and four diseases are all two-star pairs (ROS: 0.087, 0.068, 0.062, 0.095 for T2D, CRC, stroke, and IHD, respectively). CONCLUSION: Consuming 100 g of whole grains per day offers broad protective benefits. However, exceeding this threshold may diminish the protective effects against stroke. Our findings endorse replacing refined grains with whole grains as the main source of daily carbohydrates. REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: We have registered our research in PROSPERO, and the identifier of our meta-analyses is CRD42023447345.
Assuntos
Doenças Cardiovasculares, Neoplasias Colorretais, Diabetes Mellitus Tipo 2, Grãos Integrais, Humanos, Diabetes Mellitus Tipo 2/epidemiologia, Neoplasias Colorretais/epidemiologia, Doenças Cardiovasculares/epidemiologia, Doenças Cardiovasculares/prevenção & controle, Dieta/métodos, Dieta/estatística & dados numéricos, Estudos Prospectivos, Fatores de RiscoRESUMO
This study aimed to explore the potential correlation between atherosclerotic cardiovascular disease (ASCVD) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). We enrolled 6540 patients with T2DM who were receiving chronic disease management for hypertension, hyperglycemia, and hyperlipidemia in Chengyang District of Qingdao. Among them, 730 had ASCVD (ASCVD group), which 5810 did not (N-ASCVD group). The results showed significantly higher levels of age, blood glucose, glycosylated hemoglobin (HbA1c), systolic blood pressure, ASCVD family history, female proportion, and DR incidence in the N-ASCVD group. Additionally, the glomerular filtration rate was significantly lower in the ASCVD group. Logistic regression analysis revealed a positive correlation between DR and ASCVD risk. DR was further categorized into 2 subtypes, nonproliferative DR (NPDR) and proliferative DR (PDR), based on e lesion severity. Interestingly, only the PDR was associated with ASCVD. Even after accounting for traditional ASCVD risk factors such as age, sex, and family history, PDR remained associated with ASCVD, with a staggering 718% increase in the risk for patients with PDR. Therefore, there is a strong association between ASCVD and DR in individuals with T2DM, with PDR particularly exhibiting an independent and positive correlation with increased ASCVD risk.
Assuntos
Aterosclerose, Diabetes Mellitus Tipo 2, Retinopatia Diabética, Humanos, Diabetes Mellitus Tipo 2/complicações, Diabetes Mellitus Tipo 2/epidemiologia, Feminino, Masculino, Retinopatia Diabética/epidemiologia, Retinopatia Diabética/etiologia, Pessoa de Meia-Idade, Aterosclerose/epidemiologia, Aterosclerose/etiologia, Idoso, Fatores de Risco, China/epidemiologia, Hemoglobinas Glicadas/análise, Doenças Cardiovasculares/epidemiologia, Doenças Cardiovasculares/etiologia, Glicemia/análise, Glicemia/metabolismo, IncidênciaRESUMO
Observational research suggests that the evidence linking dietary nutrient intake (encompassing minerals, vitamins, amino acids, and unsaturated fatty acids) to type 2 diabetes (T2D) is both inconsistent and limited. This study aims to explore the potential causal relationship between dietary nutrients and T2D. Causal estimation utilized Mendelian randomization techniques. Single nucleotide polymorphisms linked to dietary nutrients were identified from existing genome-wide association studies and used as instrumental variables. Genome-wide association studies data pertinent to T2D were sourced from the DIMANTE consortium and the FinnGen database. Techniques including inverse variance weighting (IVW), weighted mode, weighted median, and Mendelian randomization-Egger were employed for causal inference, complemented by sensitivity analysis. Genetically predicted higher phenylalanine (IVW: odds ratioâ =â 1.10 95% confidence interval 1.04-1.17, Pâ =â 1.5â ×â 10-3, q_pvalâ =â 3.4â ×â 10-2) and dihomo-gamma-linolenic acid (IVW: odds ratioâ =â 1.001 95% confidence interval 1.0006-1.003, Pâ =â 3.7â ×â 10-3, q_pvalâ =â 4.1â ×â 10-2) levels were directly associated with T2D risk. Conversely, no causal relationships between other nutrients and T2D were established. We hypothesize that phenylalanine and dihomo-gamma-linolenic acid contribute to the pathogenesis of T2D. Clinically, the use of foods with high phenylalanine content may pose potential risks for patients with a heightened risk of T2D. Our study provides evidence supporting a causal link between dietary nutrient intake and the development of T2D.
Assuntos
Diabetes Mellitus Tipo 2, Estudo de Associação Genômica Ampla, Análise da Randomização Mendeliana, Polimorfismo de Nucleotídeo Único, Humanos, Diabetes Mellitus Tipo 2/genética, Diabetes Mellitus Tipo 2/epidemiologia, Análise da Randomização Mendeliana/métodos, Nutrientes, Dieta/efeitos adversos, Fenilalanina/sangueRESUMO
INTRODUCTION: Despite potential links between diabetes and sensorineural hearing loss (SNHL), routine hearing assessments for diabetic patients are not standard practice. Our study aimed to investigate the prevalence of SNHL and its association with diabetes-related factors among patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS: This cross-sectional study was conducted at the Diabetes Clinic, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from May to September 2021. A total of 396 patients fulfilling the inclusion criteria participated after informed consent. Data collection involved a sociodemographic profile, Michigan Neuropathy Screening Instrument examination followed by pure-tone audiometry and laboratory tests including haemoglobin A1C (HbA1c). HL was defined using better ear four-frequency pure-tone average of ≥26 dB HL and graded as per WHO criteria. Statistical analyses were performed using SPSS. χ2, independent t-test and multinomial logistic regression analyses were applied. P<0.05 at 95% CI was considered significant. RESULTS: Our study revealed a high prevalence of SNHL among patients with T2DM. Mild HL was seen in 55.8%, while 18.7% suffered from moderate HL. Common audiological symptoms included difficulty understanding speech in noisy surroundings (44.2%), balance problems (42.9%), sentence repetition (35.9%), tinnitus (32.3%) and differentiating consonants (31.1%). Hearing impairment predominantly affected low (0.25-0.5 kHz) and high (4-8 kHz) frequencies with a significant difference at 4 kHz among both sexes (t (394)=2.8, p=0.004). Peripheral neuropathy was significantly associated with SNHL on multinomial logistic regression after adjusting with age, sex, body mass index and the presence of any comorbidities. Diabetes duration, HbA1c or family history of diabetes was found unrelated to SNHL severity. CONCLUSIONS: The study highlights the substantial prevalence of SNHL among patients with T2DM and emphasises the importance of targeted audiological care as part of a holistic approach to diabetes management. Addressing HL early may significantly improve communication and overall quality of life.
Assuntos
Audiometria de Tons Puros, Diabetes Mellitus Tipo 2, Perda Auditiva Neurossensorial, Humanos, Diabetes Mellitus Tipo 2/complicações, Diabetes Mellitus Tipo 2/epidemiologia, Masculino, Feminino, Estudos Transversais, Perda Auditiva Neurossensorial/epidemiologia, Pessoa de Meia-Idade, Paquistão/epidemiologia, Prevalência, Adulto, Idoso, Neuropatias Diabéticas/epidemiologia, Doenças do Sistema Nervoso Periférico/epidemiologia, Hemoglobinas Glicadas/análise, Fatores de RiscoRESUMO
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) and SGLT1 inhibitors may have additional beneficial metabolic effects on circulating metabolites beyond glucose regulation, which could contribute to a reduction in the burden of cerebral small vessel disease (CSVD). Accordingly, we used Mendelian Randomization (MR) to examine the role of circulating metabolites in mediating SGLT2 and SGLT1 inhibition in CSVD. METHODS: Genetic instruments for SGLT1/2 inhibition were identified as genetic variants, which were both associated with the expression of encoding genes of SGLT1/2 inhibitors and glycated hemoglobin A1c (HbA1c) level. A two-sample two-step MR was used to determine the causal effects of SGLT1/2 inhibition on CSVD manifestations and the mediating effects of 1400 circulating metabolites linking SGLT1/2 inhibition with CSVD manifestations. RESULTS: A lower risk of deep cerebral microbleeds (CMBs) and small vessel stroke (SVS) was linked to genetically predicted SGLT2 inhibition. Better white matter structure integrity was also achieved, as evidenced by decreased mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD), as well as lower deep (DWMH) and periventrivular white matter hyperintensity (PWMH) volume. Inhibiting SGLT2 could also lessen the incidence of severe enlarged perivascular spaces (EPVS) located at white matter, basal ganglia (BG) and hippocampus (HIP). SGLT1 inhibition could preserve white matter integrity, shown as decreased MD of white matter and DWMH volume. The effect of SGLT2 inhibition on SVS and MD of white matter through the concentration of 4-acetamidobutanoate and the cholesterol to oleoyl-linoleoyl-glycerol (18:1 to 18:2) ratio, with a mediated proportion of 30.3% and 35.5% of the total effect, respectively. CONCLUSIONS: SGLT2 and SGLT1 inhibition play protective roles in CSVD development. The SGLT2 inhibition could lower the risk of SVS and improve the integrity of white matter microstructure via modulating the level of 4-acetamidobutanoate and cholesterol metabolism. Further mechanistic and clinical studies research are needed to validate our findings.
Assuntos
Biomarcadores, Doenças de Pequenos Vasos Cerebrais, Análise da Randomização Mendeliana, Transportador 1 de Glucose-Sódio, Inibidores do Transportador 2 de Sódio-Glicose, Transportador 2 de Glucose-Sódio, Humanos, Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico, Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos, Transportador 1 de Glucose-Sódio/genética, Transportador 1 de Glucose-Sódio/antagonistas & inibidores, Transportador 1 de Glucose-Sódio/metabolismo, Doenças de Pequenos Vasos Cerebrais/genética, Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem, Doenças de Pequenos Vasos Cerebrais/tratamento farmacológico, Doenças de Pequenos Vasos Cerebrais/sangue, Doenças de Pequenos Vasos Cerebrais/metabolismo, Fatores de Risco, Transportador 2 de Glucose-Sódio/metabolismo, Transportador 2 de Glucose-Sódio/genética, Biomarcadores/sangue, Medição de Risco, Hemoglobinas Glicadas/metabolismo, Variantes Farmacogenômicos, Resultado do Tratamento, Fenótipo, Hemorragia Cerebral/genética, Hemorragia Cerebral/induzido quimicamente, Hemorragia Cerebral/epidemiologia, Fatores de Proteção, Diabetes Mellitus Tipo 2/tratamento farmacológico, Diabetes Mellitus Tipo 2/diagnóstico, Diabetes Mellitus Tipo 2/genética, Diabetes Mellitus Tipo 2/sangue, Diabetes Mellitus Tipo 2/epidemiologia, Predisposição Genética para DoençaRESUMO
OBJECTIVE: Bayesian network (BN) models were developed to explore the specific relationships between influencing factors and type 2 diabetes mellitus (T2DM), coronary heart disease (CAD), and their comorbidities. The aim was to predict disease occurrence and diagnose etiology using these models, thereby informing the development of effective prevention and control strategies for T2DM, CAD, and their comorbidities. METHOD: Employing a case-control design, the study compared individuals with T2DM, CAD, and their comorbidities (case group) with healthy counterparts (control group). Univariate and multivariate Logistic regression analyses were conducted to identify disease-influencing factors. The BN structure was learned using the Tabu search algorithm, with parameter estimation achieved through maximum likelihood estimation. The predictive performance of the BN model was assessed using the confusion matrix, and Netica software was utilized for visual prediction and diagnosis. RESULT: The study involved 3,824 participants, including 1,175 controls, 1,163 T2DM cases, 982 CAD cases, and 504 comorbidity cases. The BN model unveiled factors directly and indirectly impacting T2DM, such as age, region, education level, and family history (FH). Variables like exercise, LDL-C, TC, fruit, and sweet food intake exhibited direct effects, while smoking, alcohol consumption, occupation, heart rate, HDL-C, meat, and staple food intake had indirect effects. Similarly, for CAD, factors with direct and indirect effects included age, smoking, SBP, exercise, meat, and fruit intake, while sleeping time and heart rate showed direct effects. Regarding T2DM and CAD comorbidities, age, FBG, SBP, fruit, and sweet intake demonstrated both direct and indirect effects, whereas exercise and HDL-C exhibited direct effects, and region, education level, DBP, and TC showed indirect effects. CONCLUSION: The BN model constructed using the Tabu search algorithm showcased robust predictive performance, reliability, and applicability in forecasting disease probabilities for T2DM, CAD, and their comorbidities. These findings offer valuable insights for enhancing prevention and control strategies and exploring the application of BN in predicting and diagnosing chronic diseases.
