RESUMO
Background: No comprehensive meta-analysis has evaluated the efficacy and safety of ertugliflozin compared to a placebo in patients with Type 2 diabetes (T2D) until now. This meta-analysis fills this gap in knowledge. Methods: A systematic search was carried out in electronic databases to identify randomized controlled trials (RCTs) that included patients with T2D receiving ertugliflozin in the treatment group and placebo in the control group. The change in HbA1c from the baseline values was the primary outcome, whereas changes in plasma glucose and other metabolic parameters and adverse events (AEs), including hypoglycemia, were the secondary outcomes. Results: Seven RCTs involving 7283 subjects met the inclusion criteria. Ertugliflozin outperformed placebo in reducing HbA1c in both 5 mg (MD -0.62%, 95% CI [-0.80, -0.44], p < 0.00001, I 2 = 91%) and 15 mg (MD -0.69%, 95% CI [-0.91, -0.47], p < 0.00001, I 2 = 93%) doses. A higher proportion of patients achieved HbA1c < 7.0% with ertugliflozin than with placebo. Ertugliflozin was also superior to placebo in lowering fasting plasma glucose (FPG), body weight, and systolic and diastolic blood pressure (BP). Ertugliflozin and placebo had comparable AE profiles, including urinary tract infection (UTI) and hypoglycemia, except for the greater risk of genital mycotic infections (GMIs) with ertugliflozin. Ertugliflozin 5 and 15 mg have equivalent efficacy and safety profiles except for greater weight reduction with ertugliflozin 15 mg. Conclusion: Ertugliflozin has a good glycemic efficacy and a reassuring safety profile in managing T2D. Trial Registration: Registration number: CRD42023456450.
Assuntos
Glicemia , Compostos Bicíclicos Heterocíclicos com Pontes , Diabetes Mellitus Tipo 2 , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/sangue , Compostos Bicíclicos Heterocíclicos com Pontes/uso terapêutico , Compostos Bicíclicos Heterocíclicos com Pontes/efeitos adversos , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Hemoglobinas Glicadas/metabolismo , Resultado do Tratamento , Hipoglicemiantes/uso terapêutico , Hipoglicemiantes/efeitos adversos , Hipoglicemia/induzido quimicamenteRESUMO
Background: Sulfonylureas have been a longstanding pharmacotherapy in the management of type 2 diabetes, with potential benefits beyond glycemic control. Although sulfonylureas are effective, interindividual variability exists in drug response. Pharmacometabolomics is a potent method for elucidating variations in individual drug response. Identifying unique metabolites associated with treatment response can improve our ability to predict outcomes and optimize treatment strategies for individual patients. Our objective is to identify metabolic signatures associated with good and poor response to sulfonylureas, which could enhance our capability to anticipate treatment outcome. Methods: In this cross-sectional study, clinical and metabolomics data for 137 patients with type 2 diabetes who are taking sulfonylurea as a monotherapy or a combination therapy were obtained from Qatar Biobank. Patients were empirically categorized according to their glycosylated hemoglobin levels into poor and good responders to sulfonylureas. To examine variations in metabolic signatures between the two distinct groups, we have employed orthogonal partial least squares discriminant analysis and linear models while correcting for demographic confounders and metformin usage. Results: Good responders showed increased levels of acylcholines, gamma glutamyl amino acids, sphingomyelins, methionine, and a novel metabolite 6-bromotryptophan. Conversely, poor responders showed increased levels of metabolites of glucose metabolism and branched chain amino acid metabolites. Conclusion: The results of this study have the potential to empower our knowledge of variability in patient response to sulfonylureas, and carry significant implications for advancing precision medicine in type 2 diabetes management.
Assuntos
Diabetes Mellitus Tipo 2 , Hipoglicemiantes , Metabolômica , Compostos de Sulfonilureia , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Estudos Transversais , Compostos de Sulfonilureia/uso terapêutico , Masculino , Feminino , Pessoa de Meia-Idade , Hipoglicemiantes/uso terapêutico , Idoso , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismoRESUMO
BACKGROUND: Older adults in the USA have worse health and wider socioeconomic inequalities in health compared with those in Britain. Less is known about how health in the two countries compares in mid-life, a time of emerging health decline, including inequalities in health. METHODS: We compare measures of current regular smoking status, obesity, self-rated health, cholesterol, blood pressure and glycated haemoglobin using population-weighted modified Poisson regression in the 1970 British Cohort Study (BCS70) in Britain (N = 9665) and the National Longitudinal Study of Adolescent to Adult Health (Add Health) in the USA (N = 12â300), when cohort members were aged 34-46 and 33-43, respectively. We test whether associations vary by early- and mid-life socioeconomic position. RESULTS: US adults had higher levels of obesity, high blood pressure and high cholesterol. Prevalence of poor self-rated health and current regular smoking was worse in Britain. We found smaller socioeconomic inequalities in mid-life health in Britain compared with the USA. For some outcomes (e.g. smoking), the most socioeconomically advantaged group in the USA was healthier than the equivalent group in Britain. For other outcomes (hypertension and cholesterol), the most advantaged US group fared equal to or worse than the most disadvantaged groups in Britain. CONCLUSIONS: US adults have worse cardiometabolic health than British counterparts, even in early mid-life. The smaller socioeconomic inequalities and better overall health in Britain may reflect differences in access to health care, welfare systems or other environmental risk factors.
Assuntos
Disparidades nos Níveis de Saúde , Hipertensão , Obesidade , Fumar , Fatores Socioeconômicos , Humanos , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Fumar/epidemiologia , Obesidade/epidemiologia , Hipertensão/epidemiologia , Estudos Longitudinais , Pressão Sanguínea , Colesterol/sangue , Nível de Saúde , Hemoglobinas Glicadas/análise , Estudos de CoortesRESUMO
Introduction: This double-blind, placebo-controlled, randomized (1:1) clinical trial was conducted at the West China Hospital, Sichuan University, from March to September 2017. Methods: Eligible participants included adults aged 18 years and older, living in the community, diagnosed with type 2 Diabetes Mellitus according to ADA guidelines, capable of self-managing their diabetes, and able to visit the study site for follow-up. The intervention group received 25 ml of a probiotic beverage containing with over 10^8 CFU/mL of Lactobacillus, administered four times daily. An equal volume of inactivated Lactobacillus was administered to the control group and the control group was administered the same volume of inactivated Lactobacillus. This study aimed to evaluate the effectiveness of probiotics on glycemic control and other diabetes-related outcomes in patients with type 2 diabetes patients. The primary outcomes were changes in HbA1c and FBG levels post-intervention. Investigators, participants, and study site personnel were blinded to the treatment allocation until the conclusion of the study. This double-blind, randomized, placebo-controlled clinical trial was registered in the Chinese Clinical Trial Registry (ChiCTR-POR-17010850). Results: Of the 490 participants screened, 213 were randomized to either the probiotics group (n = 103) or the placebo group (n = 110). After 16 weeks of follow-up, the probiotic group showed reductions in HbA1c [-0.44 (-0.66 to -0.22)] and FBG [-0.97 (-1.49 to 0.46)] post-intervention, similar to the placebo group with reductions in HbA1c [-0.33 (-0.52 to -0.15)] and FBG [-0.90 (-1.32 to -0.47)], but these changes were not statistically significant in PP and ITT analyses (P>0.05). Adverse events were similarly distributed among groups, indicating comparable safety profiles. Discussion: Overall, 16-week probiotic supplementation showed no beneficial effects on glycemic control, lipid profiles, or weight. Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=18421, identifier ChiCTR-POR-17010850.
Assuntos
Glicemia , Diabetes Mellitus Tipo 2 , Controle Glicêmico , Lipídeos , Probióticos , Humanos , Probióticos/uso terapêutico , Probióticos/administração & dosagem , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Masculino , Método Duplo-Cego , Feminino , Pessoa de Meia-Idade , Controle Glicêmico/métodos , Glicemia/metabolismo , Lipídeos/sangue , Idoso , Adulto , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Resultado do TratamentoRESUMO
OBJECTIVE: To characterise the association between risk of poor glycaemic control and self-reported and area-level food insecurity among adult patients with type 2 diabetes. DESIGN: We performed a retrospective, observational analysis of cross-sectional data routinely collected within a health system. Logistic regressions estimated the association between glycaemic control and the dual effect of self-reported and area-level measures of food insecurity. SETTING: The health system included a network of ambulatory primary and speciality care sites and hospitals in Bronx County, NY. PARTICIPANTS: Patients diagnosed with type 2 diabetes who completed a health-related social need (HRSN) assessment between April 2018 and December 2019. RESULTS: 5500 patients with type 2 diabetes were assessed for HRSN with 7·1 % reporting an unmet food need. Patients with self-reported food needs demonstrated higher odds of having poor glycaemic control compared with those without food needs (adjusted OR (aOR): 1·59, 95 % CI: 1·26, 2·00). However, there was no conclusive evidence that area-level food insecurity alone was a significant predictor of glycaemic control (aOR: 1·15, 95 % CI: 0·96, 1·39). Patients with self-reported food needs residing in food-secure (aOR: 1·83, 95 % CI: 1·22, 2·74) and food-insecure (aOR: 1·72, 95 % CI: 1·25, 2·37) areas showed higher odds of poor glycaemic control than those without self-reported food needs residing in food-secure areas. CONCLUSIONS: These findings highlight the importance of utilising patient- and area-level social needs data to identify individuals for targeted interventions with increased risk of adverse health outcomes.
Assuntos
Diabetes Mellitus Tipo 2 , Insegurança Alimentar , Hemoglobinas Glicadas , Controle Glicêmico , Humanos , Feminino , Diabetes Mellitus Tipo 2/sangue , Masculino , Estudos Transversais , Pessoa de Meia-Idade , Hemoglobinas Glicadas/análise , Estudos Retrospectivos , Idoso , Controle Glicêmico/estatística & dados numéricos , Controle Glicêmico/métodos , Cidade de Nova Iorque/epidemiologia , Abastecimento de Alimentos/estatística & dados numéricos , Adulto , AutorrelatoRESUMO
BACKGROUND: The prevalence of Helicobacter pylori (H. pylori) infection and its potential relationship to various diseases is currently a focus of attention. The aim of this study is to investigate the association between current and past H. pylori infections and elevated levels of microalbuminuria in type 2 diabetic patients. METHODS: Two hundred patients with type 2 diabetes mellitus were tested for the presence of H. pylori infection. They were divided into three groups: 52 had a current H. pylori infection, 38 had a past H. pylori infection, and 110 had no H. pylori infection. All study participants underwent assessments of plasma glucose levels, glycated hemoglobin (HbA1c), albuminuria levels, inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), as well as other relevant investigations. RESULTS: The prevalence of H. pylori infection (current and past) was detected in 90 out of 200 diabetic patients (45%). There was no statistically significant difference between the three groups in terms of age, diabetes duration, family history of DM, family history of hypertension, residence, or dyspeptic symptoms, indicating that current or past infection with H. pylori has no association with these variables. The current H. pylori infection group showed the highest levels of inflammatory markers, ESR and CRP, which were significantly different from those in the non-infected group (p = 0.013 and p < 0.001, respectively). The median (IQR) of albuminuria levels in the current H. pylori infection group, the past H. pylori infection group, and the non-infected group were 125 (4.8-290), 7.6 (2.4-271), and 5.1 (1.2-173), respectively. The current H. pylori infection group showed the highest albuminuria level, which was significantly different from that of the non-infected group (p = 0.001). CONCLUSION: There might be an association between microalbuminuria levels, general inflammatory markers (ESR and CRP), and current H. pylori infection in type 2 diabetic patients.
Assuntos
Albuminúria , Diabetes Mellitus Tipo 2 , Infecções por Helicobacter , Helicobacter pylori , Humanos , Diabetes Mellitus Tipo 2/complicações , Infecções por Helicobacter/complicações , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Proteína C-Reativa/análise , Idoso , Adulto , Prevalência , Hemoglobinas Glicadas/análise , Glicemia/análise , Sedimentação SanguíneaRESUMO
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by insulin resistance and impaired insulin production, leading to elevated blood glucose levels. Curcumin, a polyphenolic compound from Curcuma longa, has shown potential in improving insulin sensitivity and reducing blood glucose levels, which may help mitigate type 2 diabetes progression. OBJECTIVE: To assess the efficacy of improving type 2 diabetes (T2DM). STUDY DESIGN: This randomized, double-blind, placebo-controlled trial included subjects (n = 272) with criteria for type 2 diabetes. METHODS: All subjects were randomly assigned to receive curcumin (1500 mg/day) or placebo with blind labels for 12 months. To assess the improvement of T2DM after curcumin treatments body weight and body mass index, fasting plasma glucose, glycosylated hemoglobin A1c, ß-cell function (homeostasis model assessment [HOMA-ß]), insulin resistance (HOMA-IR), insulin, adiponectin, and leptin were monitored at the baseline and at 3-, 6-, 9-, and 12-month visits during the course of intervention. RESULTS: After 12 months of treatment, the curcumin-treated group showed a significant decrease in fasting blood glucose (115.49 vs.130.71; P < 0.05), HbA1c (6.12 vs. 6.47; P < 0.05). In addition, the curcumin-treated group showed a better overall function of ß-cells, with higher HOMA-ß (136.20 vs. 105.19; P < 0.01) The curcumin-treated group showed a lower level of HOMA-IR (4.86 vs. 6.04; P < 0.001) and higher adiponectin (14.51 vs. 10.36; P < 0.001) when compared to the placebo group. The curcumin-treated group also showed a lower level of leptin (9.42 vs. 20.66; P < 0.001). Additionally, body mass index was lowered (25.9 4 vs.29.34), with a P value of 0.001. CONCLUSIONS: A 12-month curcumin intervention in type 2 diabetes patients shows a significant glucose-lowering effect. Curcumin treatment appeared to improve the overall function of ß-cells and reduce both insulin resistance and body weight, with very minor adverse effects. Curcumin intervention in obese patients with type 2 diabetes may be beneficial. TRIAL REGISTRATION: Thai clinical trials regentrify no.20140303003.
Assuntos
Glicemia , Índice de Massa Corporal , Curcumina , Diabetes Mellitus Tipo 2 , Hemoglobinas Glicadas , Resistência à Insulina , Células Secretoras de Insulina , Insulina , Obesidade , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Curcumina/farmacologia , Curcumina/administração & dosagem , Masculino , Feminino , Método Duplo-Cego , Pessoa de Meia-Idade , Células Secretoras de Insulina/efeitos dos fármacos , Células Secretoras de Insulina/metabolismo , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Obesidade/tratamento farmacológico , Obesidade/complicações , Insulina/sangue , Adiponectina/sangue , Extratos Vegetais/farmacologia , Extratos Vegetais/administração & dosagem , Leptina/sangue , Adulto , Curcuma , Peso Corporal/efeitos dos fármacosRESUMO
BACKGROUND: Diabetes is a chronic devastating disease characterized by remarkable tissue damage. AIM: This prospective study conducted in Tikrit City aimed to investigate the role of myonectin and glycemic control parameters in type 2 diabetes (T2DM). METHODS: The study enrolled 60 patients with T2DM and 30 controls participants. Blood withdrawn, serum separated, serum myonectin and glycemic control parameters were quantified using Cobas C 111 analyzer. The mean serum level FBS (263.60±130.83) and HbA1C (97.56±15.54%) in T2DM patients compared with the control group (p≤0.0001). Myonectin level (pg/ml) significantly reduced (p>0.005) in T2DM (292.78±110.32) compared with the control group (379.72±140.64). CONCLUSIONS: Circulating myonectin levels were decreased in T2DM patients. Moreover, serum myonectin levels were correlated with metabolic markers of T2DM. These data suggest that myonectin may be a useful marker in predicting the development of T2DM.
Assuntos
Biomarcadores , Diabetes Mellitus Tipo 2 , Hemoglobinas Glicadas , Humanos , Diabetes Mellitus Tipo 2/sangue , Pessoa de Meia-Idade , Masculino , Feminino , Biomarcadores/sangue , Estudos Prospectivos , Glicemia , Estudos de Casos e Controles , Idoso , AdultoRESUMO
BACKGROUND: Gestational diabetes mellitus (GDM) traditionally refers to abnormal glucose tolerance with onset or first recognition during pregnancy. The objectives: The study is designed to measure vaspin in the serum of women with GDM and estimate its association with insulin resistance, HbA1c, HDL, LDL, triglyceride and total cholesterol. METHODS: This study was a case-control study conducted on 90 pregnant women (26 weeks and more), 60 of them patients with GDM, and 30 normal pregnant women as the control group, The blood sample was taken from participating women, and an interview was carried out with them using questionnaire form. vaspin and insulin were measured by ELISA technique, HbA1c was measured by ichroma™, lipid profile, and fasting blood glucose was measured by colourimetric method. RESULT: Vaspin was increased significantly in the patient group in comparison to control (268.98±154.02) ng/ml. Insulin level increased significantly in the patient group (27.88±19.69) ng/ml, HbA1c and blood glucose also increased significantly in the patient group in comparison to the control respectively (5.08±0.613) (126.47±29.05) mg/dl. However, there was no significant difference in insulin resistance, HDL, LDL, TG, and TC. CONCLUSION: The study shows that vaspin was increased in GDM but there is no negative correlation with HbA1c, insulin resistance, and lipid profile.
Assuntos
Glicemia , Diabetes Gestacional , Hemoglobinas Glicadas , Resistência à Insulina , Insulina , Serpinas , Humanos , Diabetes Gestacional/sangue , Feminino , Gravidez , Serpinas/sangue , Adulto , Iraque , Estudos de Casos e Controles , Hemoglobinas Glicadas/análise , Glicemia/análise , Insulina/sangue , Triglicerídeos/sangueRESUMO
Purpose: The aim of this study was to explore the relationship between hemoglobin levels, anemia and diabetic lower extremity ulcers in adult outpatient clinics in the United States. Methods: A retrospective cross-sectional study was conducted on 1673 participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Three logistic regression models were developed to evaluate the relationship between anemia and diabetic lower extremity ulcers. Model 1 adjusted for demographic and socioeconomic variables (age, sex, race and ethnicity, educational level, family income, and marital status). Model 2 included additional health-related factors (BMI, cardiovascular disease, stroke, family history of diabetes, hyperlipidemia, alcohol and smoking status). Model 3 further included clinical and laboratory variables (HbA1c, CRP, total cholesterol, and serum ferritin levels). Stratified analyses were also conducted based on age, sex, HbA1c level, body mass index (BMI), and serum ferritin level. Results: The study included 1673 adults aged 40 years and older, with a mean age of 64.7 ± 11.8 years, of whom 52.6% were male. The prevalence of diabetic lower extremity ulcers (DLEU) was 8.0% (136 participants). Anemia was found in 239 participants, accounting for 14% of the study group. Model 1 showed an OR of 2.02 (95% CI=1.28~3.19) for anemia, while Model 2 showed an OR of 1.8 (95% CI=1.13~2.87). In Model 3, the OR for DFU in patients with anemia was 1.79 (95% CI=1.11~2.87). Furthermore, when serum ferritin was converted to a categorical variable, there was evidence of an interaction between DLEU status and serum ferritin in increasing the prevalence of DLEU. Conclusion: After adjusting for confounding variables, higher levels of anemia were proportionally associated with an increased risk of incident DLEU. These results suggest that monitoring T2DM patients during follow-up to prevent the development of DLEU may be important. However, further prospective studies are needed to provide additional evidence.
Assuntos
Anemia , Inquéritos Nutricionais , Pacientes Ambulatoriais , Humanos , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Estudos Retrospectivos , Anemia/epidemiologia , Anemia/sangue , Idoso , Estados Unidos/epidemiologia , Adulto , Pacientes Ambulatoriais/estatística & dados numéricos , Pé Diabético/epidemiologia , Pé Diabético/sangue , Prevalência , Hemoglobinas Glicadas/análise , Fatores de Risco , Extremidade Inferior/patologiaAssuntos
Automonitorização da Glicemia , Glicemia , Diabetes Mellitus Tipo 1 , Hemoglobinas Glicadas , Humanos , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Estudos Retrospectivos , Automonitorização da Glicemia/métodos , Glicemia/análise , Glicemia/metabolismo , Adolescente , Masculino , Feminino , Criança , Diabetes Mellitus Tipo 1/sangue , Controle Glicêmico/estatística & dados numéricosRESUMO
BACKGROUND: This study aimed to investigate the effects of hemoglobin A1c (HbA1c), fasting blood glucose (FBG), 2-hours postprandial blood glucose (2hPBG), and fasting insulin (FINS) levels on pregnancy outcomes and their predictive value in patients with gestational diabetes mellitus (GDM). METHODS: A total of 109 pregnant women with GDM (GDM group) were included and assayed for serum FBG, 2hPBG, HbA1c, and FINS levels. The incidence of adverse pregnancy outcomes was recorded. GDM patients were divided into the poor pregnancy outcome group and the favorable pregnancy outcome group and analyzed for HbA1c, FBG, 2hPBG, and FINS. The predictive value of serum index combined detection on GDM pregnancy outcome was assessed, and the effect of serum indices on pregnancy outcome was evaluated in GDM patients with logistic regression. RESULTS: In the GDM group, there were 8 cases of premature membranes breaking (7.34%), 6 cases of premature delivery (5.50%), 3 cases of hyperamniotic fluid (2.75%), 2 cases of neonatal asphyxia (1.83%), 5 cases of fetal growth restriction (4.59%), and 3 cases of low-birth-weight infants (2.75%). The total incidence of adverse preg-nancy outcomes was 24.77% (27/109). HbA1c, FBG, 2hPBG, and FINS in the poor pregnancy outcome group were higher than those in the favorable pregnancy outcome group. The AUC value of blood biochemical indicators combined detection in predicting pregnancy outcome in GDM patients was higher than of HbA1c, FBG, 2hPBG, and FINS alone detection. HbA1c ≥ 6.94%, FBG ≥ 7.18 mmol/L, 2hPBG ≥ 9.36 mmol/L, and FINS ≥ 13.07 U/L were the risk factors affecting pregnancy outcomes in GDM patients. CONCLUSIONS: The changes of HbA1c, FBG, 2hPBG, and FINS levels in GDM patients are associated with adverse pregnancy outcomes, and the combined detection of serum indicators has predictive value for pregnancy outcomes in GDM patients.
Assuntos
Glicemia , Diabetes Gestacional , Hemoglobinas Glicadas , Valor Preditivo dos Testes , Resultado da Gravidez , Humanos , Gravidez , Feminino , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Resultado da Gravidez/epidemiologia , Adulto , Glicemia/análise , Glicemia/metabolismo , Insulina/sangue , Jejum/sangueRESUMO
OBJECTIVE: To establish an optimal preoperative HbA1c threshold that enhances surgical outcomes and minimises postoperative complications in diabetic patients undergoing elective total knee arthroplasty (TKA). STUDY DESIGN: Prospective cohort study. Place and Duration of the Study: Department of Orthopaedics, First People's Hospital of Lianyungang, China, from January 2021 to March 2024. METHODOLOGY: A total of 152 diabetic patients scheduled for elective TKA were included. Data on preoperative HbA1c levels were collected and analysed to assess their impact on postoperative outcomes using the Oxford Knee Score (OKS). Patients were divided into groups based on HbA1c levels and compared for functional and pain recovery one year postoperatively. Statistical analyses included binary and multivariate logistic regression, with an emphasis on the minimum clinically important difference for OKS. RESULTS: Patients with a preoperative HbA1c below 7.35mmol/L exhibited significantly better functional and pain recovery outcomes at one-year post-TKA. The receiver operating characteristic curve (ROC) analysis confirmed the predictive power of HbA1c, with an Area Under the Curve of 0.734 for functional improvement and 0.721 for pain improvement. CONCLUSION: The study identifies 7.35mmol/L as the optimal preoperative HbA1c threshold for diabetic patients undergoing elective TKA, with lower levels associated with improved functional and pain outcomes. Maintaining HbA1c below this level preoperatively can significantly enhance postoperative recovery and patient satisfaction. KEY WORDS: Diabetes mellitus, Total knee arthroplasty, Haemoglobin A1c, Oxford knee score.
Assuntos
Artroplastia do Joelho , Procedimentos Cirúrgicos Eletivos , Hemoglobinas Glicadas , Humanos , Hemoglobinas Glicadas/análise , Feminino , Masculino , Estudos Prospectivos , Idoso , Pessoa de Meia-Idade , Diabetes Mellitus/sangue , Recuperação de Função Fisiológica , Complicações Pós-Operatórias/sangue , Resultado do Tratamento , China , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/sangueRESUMO
Background: Identification of the unknown pathogenic factor driving atherosclerosis not only enhances the development of disease biomarkers but also facilitates the discovery of new therapeutic targets, thus contributing to the improved management of coronary artery disease (CAD). We aimed to identify causative protein biomarkers in CAD etiology based on proteomics and 2-sample Mendelian randomization (MR) design. Methods: Serum samples from 33 first-onset CAD patients and 31 non-CAD controls were collected and detected using protein array. Differentially expressed analyses were used to identify candidate proteins for causal inference. We used 2-sample MR to detect the causal associations between the candidate proteins and CAD. Network MR was performed to explore whether metabolic risk factors for CAD mediated the risk of identified protein. Vascular expression of candidate protein in situ was also detected. Results: Among the differentially expressed proteins identified utilizing proteomics, we found that circulating Golgi protein 73 (GP73) was causally associated with incident CAD and other atherosclerotic events sharing similar etiology. Network MR approach showed low-density lipoprotein cholesterol and glycated hemoglobin serve as mediators in the causal pathway, transmitting 42.1% and 8.7% effects from GP73 to CAD, respectively. Apart from the circulating form of GP73, both mouse model and human specimens imply that vascular GP73 expression was also upregulated in atherosclerotic lesions and concomitant with markers of macrophage and phenotypic switching of vascular smooth muscle cells (VSMCs). Conclusions: Our study supported GP73 as a biomarker and causative for CAD. GP73 may involve in CAD pathogenesis mainly via dyslipidemia and hyperglycemia, which may enrich the etiological information and suggest future research direction on CAD.
Assuntos
Biomarcadores , Doença da Artéria Coronariana , Proteínas de Membrana , Análise da Randomização Mendeliana , Proteômica , Humanos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/genética , Doença da Artéria Coronariana/patologia , Camundongos , Animais , Proteínas de Membrana/genética , Proteínas de Membrana/sangue , Masculino , Feminino , Biomarcadores/sangue , Pessoa de Meia-Idade , LDL-Colesterol/sangue , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Estudos de Casos e Controles , Aterosclerose/sangue , Aterosclerose/genéticaRESUMO
Partial remission (PR) occurs in only half of people with new-onset type 1 diabetes (T1D) and corresponds to a transient period characterized by low daily insulin needs, low glycemic fluctuations and increased endogenous insulin secretion. While identification of people with newly-onset T1D and significant residual beta-cell function may foster patient-specific interventions, reliable predictive biomarkers of PR occurrence currently lack. We analyzed the plasma of children with new-onset T1D to identify biomarkers present at diagnosis that predicted PR at 3 months post-diagnosis. We first performed an extensive shotgun proteomic analysis using Liquid Chromatography-Tandem-Mass-Spectrometry (LCMS/MS) on the plasma of 16 children with new-onset T1D and quantified 98 proteins significantly correlating with Insulin-Dose Adjusted glycated hemoglobin A1c score (IDAA1C). We next applied a series of both qualitative and statistical filters and selected protein candidates that were associated to pathophysiological mechanisms related to T1D. Finally, we translationally verified several of the candidates using single-shot targeted proteomic (PRM method) on raw plasma. Taken together, we identified plasma biomarkers present at diagnosis that may predict the occurrence of PR in a single mass-spectrometry run. We believe that the identification of new predictive biomarkers of PR and ß-cell function is key to stratify people with new-onset T1D for ß-cell preservation therapies.
Assuntos
Biomarcadores , Diabetes Mellitus Tipo 1 , Proteômica , Humanos , Diabetes Mellitus Tipo 1/sangue , Biomarcadores/sangue , Criança , Proteômica/métodos , Masculino , Feminino , Adolescente , Pré-Escolar , Espectrometria de Massas em Tandem , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Cromatografia Líquida , Proteínas Sanguíneas/análise , Proteínas Sanguíneas/metabolismo , Indução de Remissão , Insulina/sangueRESUMO
Objective: To develop a prediction model for the risk of diabetic retinopathy (DR) in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods: Patients with new diagnosis of T2DM recorded in Yinzhou Regional Health Information Platform between January 1, 2015 and December 31, 2022 were included in the study. The predictor variables were selected by using Lasso-Cox proportional hazards regression model. Cox proportional hazards regression models were used to establish the prediction model for the risk of DR. Bootstrap method (500 resamples) was used for internal validation, and the performance of the model was assessed by C-index, the receiver operating characteristic curve and area under the curve (AUC), and calibration curve. Results: The predictor variables included in the final model were age of T2DM onset, education level, fasting plasma glucose, glycated hemoglobin A1c, urinary albumin, estimated glomerular filtration rate, and history of lipid-lowering agent and angiotensin converting enzyme inhibitor uses. The C-index of the final model was 0.622, and the mean corrected C-index was 0.623 (95%CI: 0.607-0.634). The AUC values for predicting the risk of DR after 3, 5, and 7 years were 0.631, 0.620, and 0.624, respectively, with a high degree of overlap of the calibration curves with the ideal curves. Conclusion: In this study, a simple and practical risk prediction model for DR risk prediction was developed, which could be used as a reference for individualized DR screening and intervention in newly diagnosed T2DM patients.
Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Modelos de Riscos Proporcionais , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/diagnóstico , Incidência , Fatores de Risco , Curva ROC , Hemoglobinas Glicadas/análise , Glicemia/análise , Feminino , China/epidemiologia , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To explore the relationship between triglyceride-glucose index(triglyceride-glucose index) and food intake and the comprehensive compliance rate in patients with type 2 diabetes mellitus(T2DM). METHODS: A total of 6683 T2DM patients aged 18 to 75 years entered the National Metabolic Management Center(MMC) in two Yancheng hospitals from August 2020 to November 2023 were selected to analyze the relationship between T2DM standard attainment rate and relevant indicators. Univariate analysis was conducted with χ~2 test, multivariate analysis was conducted with stepwise logistic regression model, and the relationship of TyG to the overall compliance rate of T2DM was analyzed with restricted cubic spline(Restricted Cubic Spline, RCS). RESULTS: T2DM patients with glycated hemoglobin Hemoglobin A1c(HbA1c) reached 9.01%, blood pressure(BP) reached 29.21%, low density lipoprotein cholesterol(LDL-C) reached 28.51%, and the comprehensive standard rate was 1.14%. TyG index was the hindering factor affecting the comprehensive standard rate of T2DM. The higher the TyG value, the lower the standard rate. Comprehensive compliance rate and fresh fruit intake(χ~2=32.946, P<0.001) and salt intake(χ~2=41.917, P<0.001) was closely related, and the fruit intake of 200-400 g helped to improve the comprehensive compliance rate of T2DM patients. CONCLUSION: TyG index, fruit intake and salt intake may be the influencing factors of comprehensive compliance rate.
Assuntos
Glicemia , Diabetes Mellitus Tipo 2 , Triglicerídeos , Humanos , Diabetes Mellitus Tipo 2/sangue , Pessoa de Meia-Idade , Feminino , Masculino , Adulto , Idoso , Triglicerídeos/sangue , Glicemia/análise , Adolescente , Hemoglobinas Glicadas/análise , Adulto Jovem , Ingestão de Alimentos , Cooperação do Paciente/estatística & dados numéricos , ChinaRESUMO
Preventing and managing Type 2 diabetes (T2D) involves adopting healthy lifestyle habits such as balanced nutrition and regular exercise. Maturity Onset Diabetes of The Young (MODY) shares diagnostic characteristics with T2D, but exercise responses in MODY remain unclear. In Greenland, MODY is 4-5 times more common than in other countries. No established exercise regimen exists for either T2D or MODY in Greenland. This study assessed the feasibility of a 12-week supervised exercise programme for MODY and T2D in Greenland, focusing on attendance, satisfaction, and effects on cardiovascular disease (CVD) risk factors and quality of life (QoL). Conducted as an experimental, two-armed, controlled trial, nine participants (4 with MODY) engaged in prescribed training sessions twice weekly for 45-60 minutes, while another nine (4 with MODY) formed the control group. Key outcomes included adherence rates, satisfaction levels, changes in HbA1c, body composition, aerobic fitness, blood pressure, CVD risk factors, and SF-12 scores. Although training adherence was modest at 56%, participant satisfaction remained high. Notable findings included a slight decrease of -0.3 mmol/l in HDL-cholesterol and a 5.7-point increase in the mental component (MCS) of SF-12 within the intervention group. However, the study underscores the need to refine the study design before supervised exercise programmes can be widely implemented in clinical settings in Greenland.