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  • Fasting C-peptide is a significant indicator of nonalcoholic fatty liver disease in obese children
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-17
    Xiucui Han; Pengfei Xu; Jianming Zhou; Yongxia Liu; Hui Xu

    Aims Whether fasting C-peptide can be a potential indicator for nonalcoholic fatty liver disease (NAFLD) in obese children is unknown. This study aimed to assess whether fasting C-peptide represented a risk factor for NAFLD. Methods A total of 520 obese children (376 male, 144 female) aged 3.4-17.1 years were divided into two groups, obese with NAFLD and non-NAFLD, according to hepatic ultrasound results. Fasting plasma glucose, fasting C-peptide, hemoglobin A1c, renal function, liver function, blood lipid, fasting insulin and blood routine indices were measured. Insulin resistance by homoeostasis model (HOMA-IR) was calculated. Results Compared with the non-NAFLD group, the obese children with NAFLD had higher fasting C-peptide, fasting insulin and HOMA-IR (P < 0.001). Stepwise multiple logistic regression models showed that fasting C-peptide (odds ratio: OR = 2.367) was independent indicator of the presence of NAFLD in obese children as well as white blood cell (OR = 1.113), albumin (OR = 1.124), alanine aminotransferase(OR=1.030), triglycerides(OR=1.335), and waist circumference (OR=1.047). Furthermore, after adjustment for confounding variables, the prevalence of NAFLD in obese children was significantly higher according to increased serum fasting C-peptide levels. The adjusted OR for NAFLD according to fasting C-peptide tertiles were 1.00(as references), 1.896(1.045-3.436), and 4.169(1.822-9.537). Conclusion Our data suggested that obese children with high level of fasting C-peptide had an increased risk for developing NAFLD.

  • Metformin: an old drug against old age and associated morbidities
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-16
    Teresa Salvatore; Pia Clara Pafundi; Floriana Morgillo; Raimondo Di Liello; Raffaele Galiero; Riccardo Nevola; Raffaele Marfella; Lucio Monaco; Luca Rinaldi; Luigi Elio Adinolfi; Ferdinando Carlo Sasso

    Metformin represents a striking example of a “historical nemesis” of a drug. About 40 years after its marketing in Europe, once demonstrated its efficacy and safety, metformin was registered also in the U.S. A few years later, it has become a mainstay in T2DM treatment, according to all international Scientific Societies guidelines. Today, despite the advent of new innovative drugs, metformin still persists as a first-choice drug in T2DM. This success is largely justified. In fact, over the years, also positive effects on health increased. In particular, evidence has been accumulated on a beneficial impact against many other aging-related morbidities (obesity, metabolic syndrome, cardiovascular disease, cancer, cognitive decline and mortality). This literature review describes preclinical and clinical evidence favoring the “anti-aging” therapeutic potential of metformin outside of T2DM. The rationale to the use of metformin as part of a combined therapy in a variety of clinical settings, allowing for a reduction of the chemotherapy dose in cancer patients, has also been discussed. In particular, the focus was on metformin action on RAS/RAF/MAPK pathway. In the end, the real challenge for metformin could be to fully demonstrate beneficial effects on health even in non-diabetic subjects.

  • Insulin pumps use in Greece: efficacy and safety data from 140 patients with type 1 diabetes mellitus
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-16
    Maria Somali; Stavroula A. Paschou; Zadalla Mouslech

    Objective The aim of this study was to investigate the efficacy and safety of continuous subcutaneous insulin infusion (CSII) regarding glycaemic control and quality of life in patients with type 1 diabetes mellitus (T1DM), who were previously treated with a multiple daily injections (MDI). Patients and Methods 140 patients with T1DM [mean age 33.7±22.1 years; 54 males, 76 females, 10 children; duration of diabetes 19.1±8.4 years; total daily insulin usage while on MDI (IU/kg/day) 57.86±15.32; HbA1c at the beginning of CSII treatment 8.67±1.54%] were included in the study. HbA1c, glucose levels, BMI, severe hypoglycemic and diabetic ketoacidosis (DKA) episodes were recorded and compared to the data prior to CSII introduction. The evaluation of the quality of life was assessed with a self-questionnaire adjusted from the SF-12 and diabetes quality of life (DQoL) questionnaires. Results HbA1c was reduced from 8.67±1.54 to 6.85±0.52% (p<0.001). This reduction was independent of age, gender, body mass index (BMI) and diabetes duration. Daily insulin requirements were lower at the end of the follow-up (36.40±12.20 IU/kg/day) compared with the needs during enrolment (57.86±15.32 IU/kg/day) (p<0.001). BMI presented no significant alterations. Ten (10) severe hypoglycemic episodes were recorded but the overall rate was decreased by 71.5% (p<0.001). Only 3 cases of ketoacidosis were recorded. Quality of life parameters were remarkably improved. Conclusions This study provided evidence that CSII treatment was superior to MDI for patients with T1DM in Greece. CSII offered a safe, effective alternative to MDI schemes, while improving glycaemic control, side-effects and quality of life.

  • Association of dietary glycaemic index, glycaemic load, and total carbohydrates with incidence of type-2 diabetes in adults aged ≥40 years: The Multi-Rural Communities Cohort (MRCohort)
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-15
    Se Young Kim; Hye Won Woo; Young-Hoon Lee; Dong Hoon Shin; Min-Ho Shin; Bo Youl Choi; Mi Kyung Kim

    Aims To examine potential associations between the glycaemic index (GI), glycaemic load (GL), and carbohydrates and the incidence risk of type-2 diabetes (T2D) and the effect modification of obesity among Korean adults aged ≥40 years. Method Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for T2D were estimated in 8,310 participants using a modified Poisson regression model. Dietary indices were averaged using repeated dietary assessments during follow-up. Result After adjusting for potential confounders, a positive association between GI and T2D was found among women (IRR=1.63, 95% CI=1.06-2.51 in the highest tertile (T3) vs. the lowest tertile (T1) for GI, p trend=0.0310), but not for GL and carbohydrate intake. This positive association with GI was stronger in obese women (IRR=1.91, 95% CI: 1.15-3.19 in T3 vs. T1, p trend=0.0137 for body mass index ≥ 23 kg/m2; IRR=2.35, 95% CI: 1.01-5.48, p trend=0.0350 for waist circumference (WC) ≥ 85 cm). In men, there was no association before stratification by obesity, but IRRs of GI (T3 vs. T1) were significant and stronger with increased WCs (IRR=2.26, 95% CI: 1.02-4.98, p trend=0.0439 for WC ≥90). Conclusion GI may be positively associated with the incidence of T2D in women, particularly in obese women. The association of GI with T2D incidence risk may also be positive even in men with high WC.

  • Effectiveness of Multidisciplinary Care Teams in Reducing Major Amputation Rate in Adults with Diabetes: A Systematic Review & Meta-Analysis
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-11
    Rachel H. Albright; Nivethitha B. Manohar; Jennifer F. Murillo; Linda Anael M. Kengne; Juan J. Delgado-Hurtado; Matthew L. Diamond; Alyse L. Acciani; Adam E. Fleischer

    Aims To determine the pooled effectiveness of multidiscipinary care teams (MCTs) in reducing major amputation rates in adults with diabetes. Methods A systematic review and meta-analysis was performed, searching databases MEDLINE, EMBASE, Google Scholar, Cochrane Library, and Clinicaltrials.gov thru October 2018. We included only before-after studies comparing amputation rates before and after the implementation of a MCT for the prevention of major amputation in adults with diabetes. Our primary outcome was relative risk of major amputation. Risk ratios and 95% confidence intervals were calculated using a fixed effects model. Results Twenty studies met the inclusion criteria. Nine studies were included in the meta-analysis, and eleven were included in a qualitative analysis. Exposure to a MCT resulted in a protective effect ranging from a RR of 0.44 [p-value <0.00001 (95% CI 0.38, 0.51) I2 = 67%] to a RR of 0.61 [p-value <0.0001, (95% CI 0.50, 0.75) I2=0%] after sensitivity analysis, and remained robust in qualitative analysis. Conclusions Healthcare systems can expect a 39-56% amputation rate reduction after implementing an MCT amputation prevention program. These findings may justify the use of additional resources needed for program implementation by helping healthcare systems predict the anticipated benefit these teams have on “possible limbs saved”. Funding None

  • Evaluating the 1-h Post-Load Glucose Level to Predict Future Type 2 Diabetes
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-09
    Anni E. Saunajoki; Juha P. Auvinen; Aini H. Bloigu; Markku J. Timonen; Sirkka M. Keinänen-Kiukaanniemi

    Aims To evaluate the predictive ability of 2-h post-load glucose level in addition to fasting and 1-h glucose levels in predicting the risk of type 2 diabetes. Methods We examined a prospective population-based cohort study of 654 subjects without type 2 diabetes at baseline. All subjects underwent an oral glucose tolerance test (OGTT), with measurement of glucose at 0, 60, and 120 min at baseline, and after 12 years in a follow-up survey. We evaluated the predictive properties of fasting, 1- and 2-h post-load glucose levels by comparing the areas under the receiver-operating characteristic (ROC) curve. Results We found that 2-h glucose concentration in the prediction model with fasting and 1-h glucose levels did not significantly increase the predictability of type 2 diabetes compared to a model only including fasting and 1-h glucose levels (AUC 0.83 vs. AUC 0.82, respectively; p=0.23). The area under the ROC curve was the largest for 1-h glucose level (AUC 0.81), compared to fasting (AUC 0.71; p<0.01) and 2-h glucose levels (AUC 0.72; p=0.01). Conclusions Adding 2-h glucose to the model with fasting and 1-h glucose levels did not improve the predictability of new onset type 2 diabetes.

  • Aspirin in the primary prevention of cardiovascular disease in diabetes mellitus: A new perspective
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-08
    Bianca Rocca; Carlo Patrono

    Although the improved control of hyperglycaemia and other cardiovascular risk factors was associated with a parallel decline of atherosclerotic cardiovascular disease (ASCVD) and death in both type 1 (T1) and type 2 (T2) diabetes mellitus (DM), the burden of death and hospitalization for ASCVD remains significantly higher by about 2-fold versus the matched non-DM population. Life style interventions, such as physical activity and healthy diet, and drugs, such as statins and low-dose aspirin, may have beneficial effects by targeting one or multiple pathways responsible for accelerated atherosclerosis and its thrombotic complications. The debate on the benefit-risk balance of primary cardiovascular prevention with aspirin has been especially vivacious over the past two years, following the publication of three large randomized, placebo-controlled, primary prevention trials in different settings, spanning from healthy elderly to DM subjects. The aim of this review is to discuss the pathophysiological, pharmacological and clinical evidence supporting the appropriate use of low-dose aspirin in DM, within the context of the current multifactorial approach to primary cardiovascular prevention.

  • Ethnic differences in the severity and clinical management of type 2 diabetes at time of diagnosis: A cohort study in the UK Clinical Practice Research Datalink
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-07
    R. Mathur; L. Palla; R. Farmer; N. Chaturvedi; L. Smeeth

    Aims To characterize ethnic differences in the severity and clinical management of type 2 diabetes at initial diagnosis. Methods An observational cohort study of 179,886 people with incident type 2 diabetes between 2004 and 2017 in the Clinical Practice Research Datalink was undertaken; 63.4% of the cohort were of white ethnicity, 3.9% south Asian, and 1.6% black. Ethnic differences in clinical profile at diagnosis, consultation rates, and risk factor recording were derived from linear and logistic regression. Cox-proportional hazards regression was used to determine ethnic differences in time to initiation of therapeutic and non-therapeutic management following diagnosis. All analyses adjusted for age, sex, deprivation, and clustering by practice. Results In the 12 months prior to diagnosis, non-white groups had fewer consultations compared to white groups, but risk factor recording was better than or equivalent to white groups for 9/10 risk factors for south Asian groups and 8/10 risk factors for black groups (p<0.002). Blood pressure, BMI, cholesterol, eGFR, and CVD risk levels were more favourable in non-white groups, and prevalence of macrovascular disease was significantly lower (p<0.003). Time to initiation of antidiabetic treatment and first risk assessment was faster in non-white groups relative to white groups, while time to risk factor measurement and diabetes review was slower. Conclusions We find limited evidence of systematic ethnic inequalities around the time of type 2 diabetes diagnosis. Ethnic disparities in downstream consequences may relate to genetic risk factors, or manifest later in the care pathway, potentially in relation to long-term risk factor control.

  • Prevalence of diabetes mellitus at the end of life: an investigation using individually linked cause-of-death and medical register data
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-03
    Marianna Mitratza; Anton E Kunst; Peter PM Harteloh; Markus MJ Nielen; Bart Klijs

    Aims Although diabetes mellitus at the end of life is associated with complex care, its end-of-life prevalence is uncertain. Our aim is to estimate diabetes prevalence in the end-of-life population, to evaluate which medical register has the largest added value to cause-of-death data in detecting diabetes cases, and to assess the extent to which reporting of diabetes as a cause of death is associated with disease severity. Methods Our study population consisted of deaths in the Netherlands (2015-2016) included in Nivel Primary Care Database (Nivel-PCD; N=18,162). The proportion of deaths with diabetes (Type 1 or 2) within the last two years of life was calculated using individually linked cause-of-death, general practice, medication, and hospital discharge data. Severity status of diabetes was defined with dispensed medicines. Results According to all data sources combined, 28.7% of the study population had diabetes at the end of life. The estimated end-of-life prevalence of diabetes was 7.7% using multiple cause-of-death data only. Addition of general practice data increased this estimate the most (19.7%-points). Of the cases added by primary care data, 76.3% had a severe or intermediate status. Conclusions More than one fourth of the Dutch end-of-life population has diabetes. Cause-of-death data are insufficient to monitor this prevalence, even of severe cases of diabetes, but could be enriched particularly with general practice data.

  • Cardiovascular risk following metformin treatment in patients with type 2 diabetes mellitus: results from meta-analysis
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-03
    Kui Zhang; Wenxing Yang; Hao Dai; Zhenhua Deng

    Aim Pharmacologic therapy for T2DM has proven benefits in terms of reducing elevated blood glucose levels and reducing microvascular complications. However, the impact of metformin on adverse cardiovascular outcomes and cardiovascular mortality is less clear. We carried out this meta-analysis on all published studies to estimate the overall cardiovascular risk following metformin treatment in patients with T2DM. Methods We searched the PubMed, Embase and CNKI (China National Knowledge Infrastructure) databases for all articles. The odds ratio (OR) corresponding to the 95% confidence interval (95% CI) was used to assess the cardiovascular risk following metformin treatment in patients with T2DM. The statistical heterogeneity among studies was assessed with the Q-test and I2 statistics. Results we collected 16 studies including 25 comparisons with 1,160,254 patients of type 2 diabetes mellitus and 701,843 patients of T2DM following metformin treatment. Our results found statistical evidence of significantly decreased cardiovascular risk to be associated with following treatment with metformin in patients with type 2 diabetes mellitus (OR = 0.57, 95% CI = 0.48 - 0.68) (shown in Table 1 and figure 2), both with the mortality (OR = 0.44, 95% CI = 0.34 – 0.57) and incidence (OR = 0.73, 95% CI = 0.59 – 0.90). Conclusions our meta-analysis indicated that following metformin treatment in patients with T2DM was associated with decreased cardiovascular risk, both with the mortality and incidence. However, the heterogeneity among studies may potentially affect the final results.

  • Different associations between serum urate and diabetic complications in men and postmenopausal women
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-03
    Heng Wan; Yuying Wang; Yi Chen; Sijie Fang; Wen Zhang; Fangzhen Xia; Ningjian Wang; Yingli Lu

    Aims The objective of this study was to investigate the different associations of the serum urate (SUA) level with cardiovascular and cerebrovascular diseases (CVD), diabetic kidney disease (DKD) and diabetic retinopathy (DR) in Chinese adults. Methods We analyzed 4,767 participants out of 4813 adults with diabetes enrolled from seven communities in a cross-sectional survey. Participants underwent several medical examinations, including the measurement of anthropometric factors, blood pressure, SUA, glucose, lipid profiles, urine albumin/creatinine ratio (ACR) and fundus photographs. Results Compared with the first SUA tertile, the third tertile increased the prevalence of CVD by 22% (OR 1.22; 95% CI 1.01, 1.46) (P for trend <0.05) and increased the prevalence of DKD by 59% (OR 1.59; 95% CI 1.28, 1.97) for KDOQI definition. Compared with the first tertile, the OR (95% CI) of the number of diabetic complications, ranging from 0 to 2, associated with SUA level in ordinal logistic regression was 1.75 (1.44, 2.12) for the third tertile (P for trend< 0.01). These associations were all fully adjusted. No association was found between the prevalence of DR and the SUA level. Conclusions A higher SUA level was associated with an increased prevalence of CVD and DKD and a variety of diabetic complications, other than DR, in men and postmenopausal women with T2DM. However, the causation remains to be demonstrated.

  • Outcomes of a church-based lifestyle intervention among Australian Samoans in Sydney– Le Taeao Afua diabetes prevention program
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-03
    Dorothy W. Ndwiga; Freya MacMillan; Kate A. McBride; Ronda Thompson; Jennifer Reath; Olataga Alofivae-Doorbinia; Penelope Abbott; Charles McCafferty; Marra Aghajani; Elaine Rush; David Simmons

    Aims To evaluate the effectiveness of a culturally adapted, church-based lifestyle intervention among Australian Samoans living in Sydney. Methods This was a prospective, pre-post study of a church-wide education and support programme delivered by Community Coach Facilitators and Peer Support Facilitators to prevent, and promote self-management of, Type 2 diabetes. Participants completed questionnaires, anthropometric and HbA1c measurements before and 3-8 months after the intervention. The primary outcome was HbA1c. Results Overall, 68/107(63.5%) participants completed both before and after intervention data collection (mean age 48.9±14.2years; 57.2% female). HbA1c dropped significantly between baseline and follow-up among participants with known diabetes (8.1±2.4% (65mmol/mol) vs 7.4±1.8% (57mmol/mol); p=0.040) and non-significantly among participants with newly diagnosed diabetes (8.0±2.1% (64mmol/mol) vs 7.1±2.3 (54mmol/mol); p=0.131). Participants with no diabetes increased their weekly moderate and vigorous physical activity (316.1±291.6mins vs 562.4±486.6mins; p=0.007) and their diabetes knowledge also improved post-intervention (42.0±13.5% to 61.3±20.2%; p<0.001). There were no significant reductions in blood pressure, BMI or waist circumference at follow-up. Conclusions A structured, church-based, culturally tailored lifestyle intervention showed a number of improvements in diabetes risk among Samoans in Sydney. The intervention however, requires a more rigorous testing in a larger randomised controlled trial over a longer time period.

  • Pharmacological Intervention for Diabetes After Pregnancy Prevention in Women with Prior Gestational Diabetes: A Scoping Review
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-03
    Jill Pancer; Nancy Wu; Ibtisam Mahmoud; Kaberi Dasgupta

    Women with previous gestational diabetes mellitus (GDM) are at increased risk of developing diabetes after pregnancy (DAP), especially 5 to 10 years postpartum. Two well-known diabetes prevention trials demonstrated a significant reduction in DAP incidence using metformin and troglitazone; however, since their publication, several novel classes of anti-hyperglycemic agents have emerged. This review aimed to conduct a systematic literature search for new evidence in support of pharmacotherapy in DAP prevention and to analyze the results based on special considerations for women of reproductive potential. The only studies whose primary outcome was DAP incidence were those examining metformin, the thiazolidinediones troglitazone and pioglitazone, and the dipeptidyl peptidase-4 inhibitor vildagliptin. Metformin was effective in DAP reduction and was well tolerated, but participants were on average 12 years beyond their GDM pregnancy. Troglitazone was also shown to prevent DAP, but was withdrawn from the market due to hepatotoxicity. There was no comparator arm in the pioglitazone study, which limits its interpretability. The vildagliptin study was underpowered. There are ongoing trials with glucagon-like peptide 1 receptor agonists and sodium-glucose transporter 2 inhibitors, but none with diabetes incidence as a primary outcome. This review highlights the limited evidence base for pharmacological prevention of DAP.

  • Liver fat accumulation assessed by computed tomography is an independent risk factor for diabetes mellitus in a population-based study: SESSA (Shiga Epidemiological Study of Subclinical Atherosclerosis)
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-03
    Keiko Fuse; Aya Kadota; Keiko Kondo; Katsutaro Morino; Akira Fujiyoshi; Takashi Hisamatsu; Sayaka Kadowaki; Itsuko Miyazawa; Satoshi Ugi; Hiroshi Maegawa; Katsuyuki Miura; Hirotsugu Ueshima

    Aims Ectopic fat accumulation is related to insulin resistance and diabetes mellitus (DM). However, the effect of fatty liver on DM in non-obese individuals has not been clarified. We investigated whether liver fat accumulation assessed by computed tomography (CT) is associated with the incidence of DM. Methods In a prospective population-based study, 640 Japanese men were followed up for 5 years. The liver to spleen (L/S) ratio of the CT attenuation value was used as the liver fat accumulation index. We calculated the odds ratio (OR) and 95% confidence interval (CI) for the DM incidence of per 1 standard deviation (SD) lower L/S and those of L/S <1.0 compared with L/S ≥1.0, using logistic regression models. Results Both per 1 SD lower L/S and L/S <1.0 were significantly associated with a risk for DM incidence (1 SD lower L/S: OR=1.57, 95%CI=1.14–2.16; L/S <1.0: OR=2.27, 95%CI=1.00–5.14). The relationship between L/S and incidence of DM was consistent in the obese and non-obese groups, with thresholds of BMI 25 kg/m2, waist circumference 85 cm, or visceral adipose tissue 100 cm2. Conclusions Liver fat accumulation assessed by CT was associated with the incidence of DM.

  • The Functions of microRNA-208 in the Heart
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-03
    Xin Zhao; Yao Wang; Xianglan Sun

    Cardiovascular disease is a major chronic complication of obesity and diabetes. Due to several patients with obesity and diabetes, it is necessary to urgently explore early diagnostic biomarkers and innovative therapeutic strategies to prevent the progression of cardiovascular diseases. Recently, microRNAs (also known as miRNAs) have emerged as important players in heart disease and energy regulation. MiRNAs are a group of small, highly conserved non-coding RNA molecules that regulate gene expression by suppressing the translation of messenger RNA of target genes or by promoting mRNA degradation. These act as a class of potential biomarkers and may provide key information in diagnosing common diseases such as tumors, tissue damage, and autoimmune diseases. Among all the known miRNAs, microRNA-208 (miR-208) is specifically expressed in myocardial cells and showed close association with the development of cardiac diseases, such as myocardial hypertrophy, cardiac fibrosis, myocardial infarction, arrhythmia, and heart failure. However, the functions and underlying mechanisms of miR-208 in heart are still unclear. In this review, we highlighted the novel insights of miR-208 functions and associated mechanisms in the regulation of cardiac diseases.

  • Effect of obstructive sleep apnea syndrome on glycolipid metabolism and early atherosclerosis in diabetics
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2020-01-02
    Wang Jue; Hu Liye; Wang Zhenxian; Yang Shaoling; Wu Shan

    Objective To study the changes in glucose and lipid metabolism indexes and the condition of early atherosclerosis in patients with diabetes with and without obstructive sleep apnea syndrome (OSAS). Methods Patients with type 2 diabetes mellitus (DM) aged 32 to 50 years who did not have significant complications were included. A total of 42 patients with DM with OSAS and 46 patients with DM without OSAS were chosen according to their sleep monitoring indexes. Height and weight were measured, and fasting blood glucose, postprandial blood glucose, endothelin (ET), nitric oxide (NO) and lipid profile were tested. Then, all the subjects were subjected to the pulse wave velocity (PWV) test. Results The levels of glycated haemoglobin and triglycerides were significantly higher in patients with DM with OSAS than those in patients with DM without OSAS. ET, NO and PWV changed significantly. Conclusion Patients with diabetes with OSAS are more likely to have complications related to arteriosclerosis and aggravation of glycolipid metabolism disorder. Early intervention is recommended.

  • Similar cardiovascular and autonomic responses in trained type 1 diabetes mellitus and healthy participants in response to half marathon
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-31
    Laurent Mourot; Alessandro Fornasiero; Mark Rakobowchuk; Spyros Skafidas; Alfredo Brighenti; Federico Stella; Andrea Zignoli; Aldo Savoldelli; Barbara Pellegrini; Elisa Danese; Giuseppe Lippi; Cantor Tarperi; Federico Schena

    Aims This field experiment examined whether trained people with type 1 diabetes mellitus (T1D) have similar cardiovascular and baroreflex alterations after a 21-km running race when compared to healthy people. Methods Nine T1D (39.0±11.1 yr; 175.0±10.2 cm; 70.8±8.7 kg) were matched with 9 healthy participants (42.4±5.8 yr; 175.7±6.7 cm; 72.1±8.5 kg) who ran an official half-marathon. Before and 1-hour after the race, cardiovascular variables, sympathetic activity (catecholamines), parasympathetic (heart rate variability analysis) modulation and cardiac baroreflex function (transfer function analysis) were assessed during supine rest and a squat stand test (forced blood pressure change). Results Performance time and weight loss [104.0±13.2 and 111.0±18.7 min; -2.57±1.05 kg (-1.88±0.88%) and -2.29±1.15 kg (-1.59±0.59%] for healthy and T1D participants, respectively) were similar. Before running, no significant differences in any cardiovascular or autonomic variables were noted between the groups. After 1 hour of recovery, both groups exhibited post-exercise hypotension, accompanied by increased sympathetic activity, decreased parasympathetic modulation, and reduced cardiac baroreflex sensitivity. Conclusions Our results showed that the pattern of change in cardiovascular and autonomic nervous activity to strenuous exercise are well maintained in T1D participants with a training history of at least 5 years.

  • Risk of diabetes among related and unrelated family members
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-31
    Kristian Aasbjerg; Caroline Holm Nørgaard; Nanna Vestergaard; Peter Søgaard; Lars Køber; Peter Weeke; Gunnar Gislason; Christian Torp-Pedersen

    Aims The aim was to explore familial aggregation of diabetes in genetically related and unrelated individuals. Methods We included citizens from Danish nationwide registries between 1995-2018 and calculated rate ratios (RR) of diabetes based on family relation using Poisson regression. Results Of 7.3 million individuals eligible for inclusion, we identified 343,237 (4.7%) with diabetes. The RR of diabetes was 2.02 (95% CI: 1.99–2.05; p<0.0001) if any relative had diabetes, 1.79 (95% CI: 1.76–1.83) if a father had diabetes, and 2.06 (95% CI: 2.02–2.10) if a mother had diabetes. If both parents had diabetes, the RR was 3.40 (95% CI: 3.24–3.56). Among full siblings, the RR for developing diabetes was 2.77 (95% CI: 2.71–2.84) and 5.76 (95% CI: 5.00–6.63) for twins. For second-degree relatives, half siblings with a common mother had a RR of 2.35 (95% CI: 2.15–2.56), and with a common father 1.99 (95% CI: 1.81–2.17). Furthermore, the RR was 1.60 (95% CI: 1.56–1.64) if a wife had diabetes, and 1.41 (95% CI: 1.38–1.44) if a husband had diabetes. A subgroup analysis of individuals receiving insulin only treatment (N=23,054) demonstrated a similar risk pattern, although with slightly higher risk estimates. Conclusions/interpretation Family aggregation of diabetes is associated with genetic disposition with maternal status being the predominant factor. Furthermore, we observed increased risk of diabetes in second-degree relatives, and between unrelated spouses, indicating that environmental factors influence diabetes risk substantially.

  • Effects of prediabetes on long-term clinical outcomes of patients with acute myocardial infarction who underwent PCI using new-generation drug-eluting stents
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-24
    Yong Hoon Kim; Ae-Young Her; Myung Ho Jeong; Byeong-Keuk Kim; Sung-Jin Hong; Seunghwan Kim; Chul-Min Ahn; Jung-Sun Kim; Young-Guk Ko; Donghoon Choi; Myeong-Ki Hong; Yangsoo Jang

    Aims We investigated the 2-year clinical outcomes of patients with acute myocardial infarction (AMI) and prediabetes after new-generation drug-eluting stents implantation. Methods A total of 11,962 patients with AMI were classified into normoglycemia (group A; 3,080), prediabetes (group B; 3,709), and diabetes (group C; 5,173) groups. The primary outcomes were the patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any repeat revascularization. Secondary outcomes were the individual components of POCOs and stent thrombosis (ST). Results POCOs in groups B and C were significantly higher than those in group A. Cardiac death (adjusted hazard ratio [aHR]: 1.957, 95% confidence interval [CI]: 1.126–3.402; p = 0.017) and any repeat revascularization (aHR: 1.597, 95% CI: 1.052–2.424; p = 0.028) rates were significantly higher in group B than in group A. Re-MI (aHR: 1.884, 95% CI: 1.201–2.954; p = 0.006) and death or MI (aHR: 1.438, 95% CI: 1.098–1.884; p = 0.008) were significantly higher in group C than in group B. Conclusions In this study, prediabetes showed bad clinical outcomes post AMI. However, larger randomized controlled studies including ethnically diverse population are needed to confirm these harmful cardiovascular effects of prediabetes in the future.

  • Prevalence, incidence, mortality, and quality of care of diagnosed diabetes in Greenland
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-23
    MB. Backe; ML. Pedersen

    Aims To estimate prevalence, incidence, and mortality of diagnosed diabetes in Greenland, and to evaluate quality of diabetes care among men and women, and patients living in towns and settlements. Methods This study was designed as an observational cross-sectional study based on review of data obtained from the electronic medical record (EMR) in Greenland. All permanent residents of Greenland registered with a diabetes diagnosis in the EMR (N=1498) were included. Results The age-standardized prevalence of diabetes was 2.19% as of Nov 30 2018.The age-standardized incidence was 147 per 100,000 per year and the age-standardized mortality was 62 per 10,000 person-year among people aged ≥0 years old (Dec 1 2017 to Nov 30 2018). Quality of diabetes care was slightly higher among women compared to men concerning proportion with annual measurement of glycated haemoglobin (HbA1c) (89.9% vs. 85.8%; p<0.015), blood pressure (83.7% vs. 76.7%; p<0.001).The only difference observed in quality of care among settlements and towns was lower proportion tested for microalbuminuria within one year in settlements (50.3% vs. 40.1%; p<0.001). Conclusions The age-standardized prevalence of diagnosed diabetes in Greenland was 2.19% and the prevalence of diagnosed diabetes among adults aged ≥20 years was 3.7%. Only minor differences in quality of care related to gender and place of residence were observed. Further improvements in quality of care are warranted.

  • Reduced Pancreatic polypeptide Response is associated with early alteration of glycemic control in chronic pancreatitis
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-23
    Mohsin Aslam; K. Vijayasarathy; Rupjyothi Talukdar; M. Sasikala; D. Nageshwar Reddy

    Aim To study the incidence of glucose intolerance in CP patients without diabetes by performing oral glucose tolerance test (OGTT). Methods We screened consecutive Indian CP patients without diabetes over 6 months by performing OGTT and correlated with physical characteristics and glycated hemoglobin (HbA1c). We also compared c-peptide and pancreatic polypeptide response in different groups based on OGTT. Relevant statistical tests were performed. P<0.05 was considered significant. Results Total of 171 pateints were screened. Mean duration of CP was 5.03 ± 4.32 years. 55 were detected to have prediabetes and 40 DM on OGTT. CP patients with diabetes and prediabetes had significantly dilated pancreatic duct compared to non-diabetic CP (4.2 ± 2.7mm, 3.6 ± 2.7mm, 2.84 ± 2.25mm; p=0.018). Fasting blood glucose (FBS) and 2-hour OGTT were 109.35 ± 19.06, 97.47 ± 11.94, 85.24 ± 9.95 and 236.13 ± 31.42, 154.65 ± 19.53, 112.89 ± 16.32 in patients with DM, prediabetes and CP patients without diabetes (p<0.0001). There was a good c-peptide response (p=0.001) and reduced pancreatic polypeptide response (p=0.003) in CP patients compared to controls. Conclusion Early in the course of disease reduced pancreatic polypeptide response in the presence of good c-peptide response may result in development of DM.

  • Pancreatitis and pancreatic cancer in patientes treated with dipeptidyl peptidase-4 inhibitors: an extensive and updated meta-analysis of randomized controlled trials
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-20
    Ilaria Dicembrini; Chiara Montereggi; Besmir Nreu; Edoardo Mannucci; Matteo Monami

    Aim Observational studies and metanalyses of randomized trials on Dipeptidyl Peptidase-4 inhibitors (DPP4i) reported discordant results on the risk of pancreatitis and pancreatic cancer with this class of drugs. Aim of the present meta-analysis is the assessment of the effect of DPP4i treatment on the incidence of pancreatitis and pancreatic cancer, collecting all available evidence from randomized controlled trials. Methods Data Sources: an extensive Medline, Embase and Cochrane Database search for sitagliptin or vildagliptin or omarigliptin or saxagliptin or alogliptin or trelagliptin or anagliptin or linagliptin or gemigliptin or evogliptin or teneligliptin was performed up to up to September 30th, 2019. All trials performed on type 2 diabetes, with duration ≥24 weeks, and comparing of DPP4i with placebo or active drugs were collected. The study has been registered on PROSPERO (#153344). Mantel-Haenszel odds ratio (MH-OR) with 95% Confidence Interval (95% CI) was calculated for all outcomes defined above. Results A total of 165 eligible trials were identified. DPP-4 inhibitors were not associated with an increased risk of pancreatitis (MH-OR 1.13 [0.86, 1.47]) or pancreatic cancer (MH-OR 0.86 [0.60, 1.24]) with no significant differences across individual molecules of the class. Conclusions: available data do not support the hypothesis of an association of DPP4i treatment with pancreatitis. Present data do not suggest any association of DPP4i with pancreatic cancer, although they are insufficient to draw definitive conclusions.

  • Sulfonylurea and fracture risk in patients with type 2 diabetes mellitus: A meta‐analysis
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-19
    Zhen Zhang; Yang Cao; Yujia Tao; E. Meng; Jiahao Tang; Yongcui Liu; Fangping Li

    Aims This meta‐analysis was conducted to investigate the fracture risk among patients with T2DM treated with sulfonylurea. Methods The PubMed and other databases were searched for eligible studies. Both randomized controlled trials and observational studies that compared the fracture risk of sulfonylurea to other hypoglycemic agents were included. Pooled risk ratios and 95% confidence intervals were calculated. Subgroup analysis and meta-regression analyses were conducted to explore the source of heterogeneity. Results A total of 11 studies involving 255644 individuals were included in our meta-analysis. In comparing sulfonylurea users with patients who had not taken sulfonylurea, the pooled risk ratio for developing fracture was 1.14 (95% confifidence interval, 1.08-1.19). In subgroup analyses, the pooled risk ratio of bone fracture in patients receiving sulfonylurea versus thiazolidinedione, metformin and insulin was 0.90 (95% CI, 0.76‐1.06), 1.25 (95% CI, 1.18‐1.32) and 0.81 (95% CI, 0.74‐0.89) respectively. Meta regression showed that age and gender were not related to the effect of sulfonylurea on fracture. Conclusions Sulfonylurea use was associated with 14% increase in the risk of developing fracture in T2DM. The risk of fracture caused by sulfonylurea was similar to thiazolidinedione, higher than metformin and lower than insulin.

  • Increased parathyroid hormone is associated with higher fasting glucose in individuals with normocalcemic primary hyperparathyroidism and prediabetes: A pilot study
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-19
    Spyridon N. Karras; Theocharis Koufakis; Xanthippi Tsekmekidou; Vassiliki Antonopoulou; Pantelis Zebekakis; Kalliopi Kotsa

    Aims This pilot study aimed to evaluate differences in glycemic parameters between patients with prediabetes and normocalcemic primary hyperparathyroidism (NPHPT) and controls with prediabetes and normal parathyroid hormone (PTH) and calcium concentrations. Methods 20 patients with NPHPT and prediabetes and 42 age-, gender-, and body mass index-matched controls with prediabetes were included. Glycemic parameters [fasting glucose (fGlu), glycosylated hemoglobin (HbA1c), fasting insulin (fIns)] were evaluated. Homeostasis Model Assessment was used for estimating insulin secretion (HOMA-B) and resistance (HOMA-IR). Participants underwent a 75-g oral glucose tolerance test. Results HbA1c (5.9 ± 0.0 vs 5.9 ± 0.0 %, p=0.44), HOMA-IR (3.7 ± 1.2 vs 2.9 ± 0.2, p=0.48), HOMA-B (117.8 ± 31.8 vs 146.9 ± 22.0 %, p=0.14), fIns (14.0 ± 4.3 vs 12.2 ± 1.1 μIU/ml, p=0.53) and 2-hour post-load glucose concentrations (157.2 ± 2.2 vs 152.2 ± 2.0 mg/dl, p=0.07), were nondifferent in the two groups. Higher fGlu levels were evident in the NPHPT, compared to the control group (105.6 ± 2.8 vs 98.2 ± 1.8 mg/dl, p=0.01). fGlu demonstrated a positive correlation with PTH concentrations (rho=0.374, p=0.005). Conclusions Individuals with NPHPT and prediabetes present an unfavorable glycemic profile compared to age-matched people with prediabetes, suggesting a direct adverse effect of elevated PTH on glucose homeostasis.

  • Effect of frequency of sensor use on glycaemic control in individuals on sensor-augmented pump therapy with and without Predictive Low Glucose Management System
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-19
    Mary B. Abraham; Grant J Smith; Jennifer A Nicholas; Janice M. Fairchild; Bruce R. King; Geoffrey R. Ambler; Fergus J Cameron; Elizabeth A. Davis; Timothy W. Jones

    Improved frequency of sensor use improves glycaemic control. Furthermore, there is no deterioration of glycaemic control with increased sensor use in individuals on Predictive Low Glucose Management (PLGM) system. Younger children are more likely to have better sensor uptake than older children.

  • Glycemic Variability and Subsequent Malignancies among the Population without Diabetes
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-19
    Daiki Kobayashi; Hiroshi Noto; Osamu Takahashi; Takuro Shimbo

    Background Glycemic variability has been suggested to be related to some unfavorable outcomes, but malignancy development has not been evaluated. The aim of this study was to evaluate the association of glycemic variability with malignancy development among the population without diabetes. Methods We conducted a retrospective cohort study at a large teaching hospital in Tokyo, Japan, from 2005 to 2016. We included all participants without diabetes who underwent voluntary health check-ups. Our outcome was the development of any malignancy. As a measure of glycemic variability, we calculated the quotient of CV in HbA1c and categorized subjects into quartile groups. A Cox proportional hazard model was applied, adjusting for patient demographics and social and family histories. Results A total of 42,731 participants were included in this study; the mean age was 53.8 and 48.3% were male. During the median follow up of 2,639(interquartile range (IQR):1,787–3,662) days, 2,435 participants (5.7%) developed malignancies. Participants who had larger glycemic variability (CV in HbA1c; hazard ratio(HR) 1.15, 95%confidence interval(CI):1.02– .31 for the second quartile group; HR 2.20, 95%CI:1.95–2.48 for the third quartile group, HR 4.66, 95%CI:4.16–5.21 for the fourth quartile group, compared to first quartile group) had a significantly higher risk of malignancies. Conclusion We found an association between large glycemic variability and a high risk of future malignancies in a dose-dependent manner among people without diabetes. This finding suggests that maintaining a constant level of glucose may have favorable effects on cancer prevention in people without diabetes.

  • Study of the diacylglycerol composition in the liver and serum of mice with prediabetes and diabetes using MeV TOF-SIMS
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-19
    Marijana Popović Hadžija; Zdravko Siketić; Mirko Hadžija; Marko Barac; Iva Bogdanović Radović

    Aims Hepatic insulin resistance, induced by fat, occurs before peripheral resistance and leads to prediabetes and diabetes. If insulin resistance is detected earlier, lifestyle changes could prevent or delay disease development. Therefore, we analysed lipids in the liver and serum of prediabetic and diabetic mice by MeV TOF-SIMS with a focus on diacylglycerols (DAGs) as the best predictor of (liver) resistance. Methods Glucose impairment was spontaneously developed or induced by HFD in NOD/LtJ mice, and prediabetic and diabetic mice were selected according to their glucose levels. MeV TOF-SIMS was applied to image the lipid distribution in the liver and to relatively quantify lipids related to insulin resistance in both the liver and serum. Results The same lipids were detected in the liver and serum but with different intensities between mice. The intensity of DAGs and fatty acids was higher in the diabetic than that in the prediabetic liver. Imaging of liver tissue showed a more compact density of prediabetic (non-fatty) than diabetic liver with DAG remodelling in diabetes. DAGs, which are greatly increased in diabetic serum, were successfully detected and quantified already in prediabetes. Conclusion MeV TOF-SIMS applied to the serum presents an excellent tool for in vivo monitoring of disease development over time.

  • Association between sleep disturbances, fear of hypoglycemia and psychological well-being in adults with type 1 diabetes mellitus, data from cross-sectional VARDIA Study
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-19
    V. Suteau; P.J. Saulnier; M. Wargny; L. Gonder-Frederick; E. Gand; L. Chaillous; I. Allix; S. Dubois; F. Bonnet; A-M. Leguerrier; G. Fradet; I. Delcourt Crespin; V. Kerlan; D. Gouet; C. Perlemoine; P.H. Ducluzeau; M. Pichelin; S. Ragot; C. Briet

    Aim To assess the relationship between sleep quality, fear of hypoglycemia, glycemic variability and psychological well-being in type 1 diabetes mellitus. Methods Our data were provided by the VARDIA Study, a multicentric cross-sectional study conducted between June and December 2015. Sleep characteristics were assessed by the Pittsburgh Sleep Quality Index (PSQI). Fear of hypoglycemia and psychological well-being were measured with the Hypoglycemia Fear Survey version II (HFS-II) and the Hospital Anxiety and Depression Scale (HADS), respectively. Glycemic variability (GV) was determined using the CV of three 7-point self-monitoring blood glucose profiles and the mean amplitude of glycemic excursion (MAGE). Results 315 patients were eligible for PSQI questionnaire analysis: 54% women, mean age 47±15, mean diabetes duration of 24±13 years, HbA1c of 7.6±0.9 % (60±7,5mmol/mol). Average PSQI score was 6.0±3.3 and 59.8% of the patients had a PSQI score >5. HFS-II score and HADS were significantly higher among “poor” sleepers (p<0.0001) and PSQI score was positively associated with HADS (β=0.22; 95% CI=0.08;0.35). GV evaluated by CV or MAGE did not differ between “poor” and “good” sleepers (p=0.28 and 0.54, respectively). Conclusions Adult patients with type 1 diabetes have sleep disturbances which correlate with psychological well-being. This study suggests that psychological management can be a target to improve sleep quality in adults with type 1 diabetes mellitus.

  • Alcohol Consumption Patterns in Young Adults with Type 1 Diabetes: the SEARCH for Diabetes in Youth Study
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-16
    Alissa J. Roberts; Jennifer R. Law; Cynthia K. Suerken; Beth A. Reboussin; Jean M. Lawrence; Craig E. Taplin; Elizabeth J. Mayer-Davis; Catherine Pihoker

    Aims The objective of this study is to describe alcohol consumption behaviors of young adults with T1D and to examine associations between alcohol consumption and diabetes-related clinical markers Methods Data from 602 SEARCH for Diabetes in Youth Study participants age ≥18 yrs. with T1D were collected from 12/2011 to 6/2015 (50% female, mean age 21.3(SD 2.4), 22% race/ethnic minority). Participants were characterized as alcohol non-drinkers (n=269), drinkers but non-binge drinkers (n=167), or binge drinkers (n=166) based on reported consumption in the past 30 days. Analyses were conducted using one-way ANOVAs, chi-square tests, and logistic regression modeling to examine associations between drinking and clinical markers. Results Fifty-five percent of participants reported alcohol consumption; 27.6% of participants reported binge drinking. After adjusting for demographic characteristics, neither binge drinking nor non-binge drinking were associated with HbA1c or severe hypoglycemic events relative to non-drinkers. Binge drinking was associated with higher HDL (p=0.008), lower systolic blood pressure (p-=0.011), and a lower waist:height ratio compared to non-drinkers (p=0.013). Conclusions Young adults with T1D in the SEARCH cohort reported similar alcohol use but higher rates of binge drinking compared to the general United States population and previously reported rates in adults with T1D.

  • Disparities in Diabetes-related Multiple Chronic Conditions and Mortality: The Influence of Race
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-15
    John M. Clements; Brady T. West; Zachary Yaker; Breanna Lauinger; Deven McCullers; James Haubert; Mohammad Ali Tahboub; Gregory J. Everett

    Aims The aims of this study are to confirm disparities in diabetes mortality rates based on race, determine if race predicts combinations of diabetes and multiple chronic conditions (MCC) that are leading causes of death (LCD), and determine if combinations of diabetes plus MCC mediate the relationship between race and mortality. Methods We performed a retrospective cohort study of 443,932 Medicare beneficiaries in the State of Michigan with type 2 diabetes mellitus and MCC. We applied Cox proportional hazards regression to determine predictors of mortality. We applied multinomial logistic regression to determine predictors of MCC combinations. Results We found that race influences mortality in Medicare beneficiaries with Type 2 diabetes mellitus and MCC. Prior to adjusting for MCC combinations, we observed that Blacks and American Indian/Alaska Natives have increased risk of mortality compared to Whites, while there is no difference in mortality between Hispanics and Whites. Regarding MCC combinations, Black/African American beneficiaries experience increased odds for most MCC combinations while Asian/Pacific Islanders and Hispanics experience lower odds for MCC combinations, compared to Whites. When adjusting for MCC, mortality disparities observed between Whites, Black/African Americans, and American Indians/Alaska Natives persist. Conclusions Compared to Whites, Black/African Americans in our cohort had increased odds of most MCC combinations, and an increased risk of mortality that persisted even after adjusting for MCC combinations.

  • Diabetes as a risk factor for herpes zoster in adults: A synthetic literature review
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-14
    Mitra Saadatian-Elahi; Bernard Bauduceau; Corinne Del-Signore; Philippe Vanhems

    Aim The objective of this review was to evaluate the role of diabetes as a risk factor for herpes zoster (HZ) and to discuss implications of prevention by vaccination with available HZ vaccines. Methods We reviewed studies that investigated the incidence rates of HZ in patients with diabetes. Papers in English or French published between January 2000 and December 2018 have been selected from PubMed and Google Scholarship by using appropriate key words. Results The risk of HZ was significantly higher in patients with diabetes as compared to controls in 11 studies out of 16, although the magnitude of risk associated to diabetes varied across studies from 1.06 to 2.38 (p<0.05). The incidence of HZ in patients with diabetes increased with age and was higher in women than in men. The incidence of the most common complication of HZ, i.e. post-herpetic neuralgia was also higher in patients with diabetes. Conclusions The presence of HZ adds supplementary complications to the pre-existing comorbidity in patients with diabetes. Investigating the impact of preventive measure by HZ vaccination is therefore of paramount importance in patients with diabetes.

  • Distribution of Glycated Haemoglobin and its Determinants in Indian Young Adults
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-14
    Raghuram Nagarathna; Navneet Kaur; Akshay Anand; Kanupriya Sharma; Rima Dada; Palukuru Sridhar; Purnendu Sharma; Amit Kumar Singh; Suchitra Patil; Hongasandra R Nagendra

    Aim The aim of the present study is to understand the distribution of A1c in four different age groups in young adults and its relation to other co-variants. Methods: The countrywide data was collected in 2017 in Individuals with high risk analysed by Indian Diabetes Risk Score (IDRS) and self-declared diabetics were identified after screening a sample of 240,968 individuals from rural (4villagesofabout500adultseach) and urban (4censusenumerationblocksofabout500adultseach) population spanning 65 districts of 29 states/ UTs of Indian subcontinent. Blood tests and other detailed assessments were carried out on this selected group. This study presents the analysis of the A1c values of 2862 young adults (<35 years). Results: In the age group of 31-34 years, the proportion of Diabetes (22.36%) and Prediabetes (9.86%)was higher in comparison with younger age groups. Also, Diabetes (7.3%) and Prediabetes (22%) were highest among those who had parental history of DM in both parents as compared to those with diabetes history in one parent [Diabetes (7.1 %) or Prediabetes (19.0%)] and no Diabetes Parental History (Diabetes (7.3 %) and Prediabetes (18.3%)) cases. BMI was found to play a significant positive correlation with Diabetes and Prediabetes (p<0.001) with range of A1c. Conclusion: Age, BMI and parental history were found to be correlated with A1c levels in IDRS screened high-risk population. With increasing age, the proportion of Diabetics and Prediabetics also increased with positive correlation of age with A1c levels.

  • Qualitative evaluation of A Safer Ramadan, a structured education programme that addresses the safer observance of Ramadan for Muslims with Type 2 diabetes
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-12
    Natalie Darko; Helen Dallosso; Michelle Hadjiconstantinou; Kerry Hulley; Kamlesh Khunti; Melanie Davies

    Aims Muslims can choose to fast during Ramadan. Guidelines exist for providing clinical support for this group, but there is a lack of culturally tailored diabetes management interventions to provide guidance. The study evaluates the implementation of a programme developed to meet this need. Methods A Safer Ramadan is a multi-faceted package comprising a self-management and community awareness programme, and healthcare professional training. Implementation of the programme took place in two cities in the UK, prior to Ramadan 2017. Uptake and attendance were determined, and qualitative interviews and focus groups were completed with people attending the programme, and with various stakeholders involved in implementation and delivery. Results Success of the implementation varied and engagement by primary care was limited. Three central themes emerged from the interviews highlighting barriers and facilitators of the programme implementation. These were the referral pathway, programme content and feedback on the delivery of the programme. Conclusions Provision of interventions that provide support and education for Muslims during Ramadan was implemented in communities and valued by GPs and practice nurses. However, heavy workloads to support delivery made it difficult for practices to engage. Recommendations for future delivery of the programme indicate that greater attention should be given to marketing and its supporting practices. Furthermore, training for practice nurses to support patients prior to Ramadan and provision of funding is required.

  • The Andean Latin-American burden of diabetes attributable to high body mass index: A comparative risk assessment
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-12
    Rodrigo M. Carrillo-Larco; Jonathan Pearson-Stuttard; Antonio Bernabe-Ortiz; Edward W. Gregg

    Background Body mass index (BMI) has increased in Latin-America, but the implications for the diabetes burden have not been quantified. We estimated the proportion and absolute number of diabetes cases attributable to high BMI in Bolivia, Ecuador and Peru (Andean Latin-America), with estimation of region-level indicators in Peru. Methods We estimated the population attributable fraction (PAF) of BMI on diabetes (regardless of type 1 or 2) from 1980 to 2014, including the number of cases attributable to overweight (BMI 25-<30), class I (30-<35), class II (BMI 35-<40) and class III (BMI ≥40) obesity. We used age- and sex-specific prevalence estimates of diabetes and BMI categories (NCD-RisC and Peru’s DHS survey) combined with relative risks from population-based cohorts in Peru. Findings Across Andean Latin-America in 2014, there were 1,258,313 diabetes cases attributable to high BMI: 209,855 in Bolivia, 367,440 in Ecuador and 681,018 in Peru. Between 1980-2010, the absolute proportion of diabetes cases attributable to class I obesity increased the most (from 12.9% to 27.2%) across the region. The second greatest increase was for class II obesity (from 3.6% to 16.5%). There was heterogeneity in the fraction of diabetes cases attributable to high BMI by region in Peru, as coastal regions had the largest fractions, and so did high-income regions. Interpretation Over one million diabetes cases are attributable to high BMI in Andean Latin-America. Public health efforts should focus on implementing population-based interventions to reduce high BMI and to develop focused interventions targeted at those at highest risk of diabetes.

  • Diagnosis and Management of Neonatal Diabetes Mellitus: A Survey of Physicians’ Perceptions and Practices in ASPED countries
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-10
    Abdelhadi M Habeb, Asma Deeb, Nancy Elbarbary, Salem A Beshyah

    Aim To ascertain the awareness and practice of neonatal diabetes mellitus (NDM) among paediatricians in Arab countries. Methods An online questionnaire was distributed to physicians associated with the Arab Society for Paediatric Endocrinology and Diabetes (ASPED). Results we received 126 replies, from 16 countries. All except one classified the survey’s case scenario as NDM and 94% agreed that NDM patients should have detailed assessment to identify extra-pancreatic features. Although 92% felt that genetic testing is necessary, only 72% requesting them routinely and 32% unaware of the availability of free genetic testing. Insulin is considered the initial therapy for 93% and 80% diluted insulin to deliver accurate doses. Basal-bolus regimen was preferred by 36% and similar percentage used insulin pump. The remaining 28% favour long acting insulin alone. Oral sulfonylureas would be tried empirically by 34% and 69% would do so if genetic testing is unavailable. Whilst 70% have no local NDM management guidelines, 41% are unaware of any international guidelines. Conclusions the ASPED surveyed clinicians have good awareness of NDM diagnosis with marked variation in their practice raising the need to establish management guideline for the condition. The survey highlights areas to focus on in developing consensus and educational activities.

  • Age-specific rate of undiagnosed diabetes and prediabetes in acute stroke
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-09
    Paola Forti, Fabiola Maioli, Giorgia Arnone, Valeria Nativio, Marco Zoli, Maura Coveri, Giuseppe Di Pasquale, Gaetano Procaccianti

    Aims We investigated age-specific rates of undiagnosed diabetes and prediabetes among patients with acute stroke. Methods We used data from 2223 patients with acute stroke consecutively admitted to an Italian Stroke Unit (SU) between 2010 and 2015. Information from medical records and glycated hemoglobin (HbA1c) measured on admission was retrospectively used to screen for diabetes and prediabetes defined according to standard criteria. Results Overall rate of diabetes undiagnosed at admission and diabetes still undiagnosed at SU discharge were 9.7% and 6.7% but age-specific prevalence peaked up to 12.0% and 9.0% after age 80. At admission, the proportion of all undiagnosed diabetes on total diabetes cases was one out of every two cases before age 60 and three out of every four cases after age 80. In these same age intervals, one out of every three diabetes cases was still undiagnosed at SU discharge. Regardless of age, about three out of ten patients with acute stroke had prediabetes. Less than 2% of these patients had a prediabetes diagnosis before or after SU admission. Conclusions In patients with acute stroke, diabetes is substantially underdiagnosed before age 60 and after age 80. Prediabetes is highly prevalent but mostly undiagnosed at all ages. (199 words)

  • Low serum amylase, lipase, and trypsin as biomarkers of metabolic disorders: A systematic review and meta-analysis
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-04
    Juyeon Ko, Jaelim Cho, Maxim S. Petrov

    Aims While there is plentiful evidence on elevated serum levels of amylase, lipase, and trypsin in acute illness, low serum levels of these digestive enzymes have been studied infrequently. The aim was to systematically review published studies on the relationship between low serum levels of amylase, lipase, or trypsin and metabolic disorders. Methods The search was conducted in MEDLINE and Scopus databases. Studies in humans were included if they reported on the association between serum levels of amylase, lipase, or trypsin within normal range and metabolic disorders. Random-effects meta-analysis was conducted. Results A total of 20 studies encompassing 20,916 participants were included. Compared with healthy individuals, individuals with type 2 diabetes mellitus (mean difference=-5.3; p<0.001), metabolic syndrome (mean difference=-5.1; p<0.001), and overweight/obesity (mean difference=-0.8; p=0.02) had significantly lower serum levels of amylase. Both individuals with type 1 diabetes mellitus (mean difference=-1.8; p<0.001) and type 2 diabetes mellitus (mean difference=-0.8; p<0.001) had significantly lower serum levels of lipase compared with healthy individuals. Data on serum trypsin were not suitable for meta-analysis. In the pooled analysis, individuals with type 2 diabetes mellitus had 3.1-times lower serum levels of amylase, 2.9-times lower serum levels of lipase, and 2.5-times lower serum levels of trypsin levels compared with the upper limit of normal of the three digestive enzymes. Conclusion Low serum levels of amylase and lipase are significantly associated with type 2 diabetes mellitus, type 1 diabetes mellitus, excess adiposity, and metabolic syndrome. The role of digestive enzymes in the pathogenesis of metabolic disorders warrants further investigations.

  • Title: Development of the Influence, Motivation, and Patient Activation in Diabetes (IMPACT-D™) Measure
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-02
    Marina Arvanitis, Stacy Cooper Bailey, Guisselle Wismer, James W. Griffith, Emily Freeman, Tracy J. Sims, Rosirene Paczkowski, Megan Klopchin, Arlene E. Chung, Delesha M. Carpenter, Michael S. Wolf

    Aims We sought to create a new research and clinical instrument –the Influence and Motivation for Patient ACTivation in Diabetes care (IMPACT-D™) - to measure the degree to which patients with type 2 diabetes (T2DM) value health and believe they can influence it. Methods Candidate items were generated via a literature review, expert opinion, and qualitative interviews and focus groups with T2DM patients in Chicago, IL and Chapel Hill, NC. Psychometric testing guided by item response theory was conducted among an online panel of 500 English-speaking adults with T2DM. Differential item functioning analyses evaluated item performance across key participant characteristics. To determine construct validity, IMPACT-D™ scores were compared to other general measures of personality and patient activation. A second study among 300 patients recruited from two internal medicine clinics further assessed associations between the IMPACT-D™ and health outcomes. Cognitive interviews confirmed patient understanding of IMPACT-D™ items and instructions. Results Exploratory factor analyses revealed a single-factor solution that included 6 items. The IMPACT-D™ demonstrated adequate reliability (α=0.72) and moderate construct validity with patient activation (r=0.51, p<0.001) and personality-conscientiousness subscales (r=0.29, p<0.001). Higher scores on the IMPACT-D™ were associated with better physical health (r=0.17, p=0.003) and lower severity of depressive (r=-0.35, p<0.001) and anxiety (r=-0.28, p<0.001) symptoms. There were no significant differences by blood pressure (r= -0.0021, p=0.9) or haemoglobin A1c (r=-0.069p=0.2). Conclusions The IMPACT-D holds potential for use in both clinical care and research applications. Future studies should evaluate how to best operationalize its use for both settings.

  • Increased risk of neonatal complications or death among neonates born small for gestational age to mothers with gestational diabetes
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-02
    Beatriz Barquiel, Lucrecia Herranz, Nuria Martínez-Sánchez, Cristina Montes, Natalia Hillman, José Luis Bartha

    Aims To evaluate if neonatal complications or death were poorer for neonates born small for gestational age (SGA) than for those born with adequate weight or large for gestation age (LGA) to women with gestational diabetes mellitus (GDM). Methods Retrospective analysis of the clinical outcomes of neonates born to 3413 women with GDM. The prevalence of neonatal hypoglycaemia, hypocalcaemia, hyperbilirubinemia, polycythaemia, and death was compared among three birthweight groups: SGA, adequate, and LGA. A two-sided chi-squared or Fisher’s exact test was used for between-group comparisons. A forward multiple logistic regression was performed to determine the odds ratio (OR) associated with SGA. Results Neonatal complications were more frequent in the SGA group (20.1%) than in the adequate (9.9%) or LGA (15.2%) groups. There were four deaths (1.6%) in the SGA group compared to one in the LGA (0.4%) and six in the adequate (0.2%) groups (P=0.002). SGA was a risk factor for neonatal complications or death (OR. 2.122; 95% confidence interval, 1.552-2.899), independent of maternal age, weight gain, fasting glucose, glycaemic control, gestational hypertension, pre-eclampsia, smoking, or neonatal prematurity. Conclusion SGA birthweight is an important risk factor for neonatal complications or death among neonates born to mothers with GDM.

  • Adherence to postpartum diabetes mellitus screening, do associated pregnancy complications make a difference?
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-02
    Reut Rotem, Simrit Salem-Yaniv, Hadar Sandler Rahat, David Yohay, Shanny Sade, Lior Yahav, Adi Y. Weintraub

    Aims We aimed to investigate the impact of Gestational Diabetes Mellitus (GDM) complications on compliance with postpartum Diabetes screening. Methods A retrospective cohort study was conducted comparing screening rates of women with and without GDM associated complications who delivered at the Soroka University Medical Center, between 2016-2017. The screening test of choice was a 2-hour 75g oral glucose tolerance test, taken 6-12 weeks after delivery. GDM associated complications included one or more of the following: polyhydramnios, macrosomia, shoulder dystocia or cesarean section. Univariate analysis was used in order to examine if GDM associated complications were associated with postpartum diabetes screening. Results During the study period a 164 women were included, of which, 82 women had suffered from GDM associated complications and comprised the study group and 82 women with GDM but without complications comprised the comparison group. Women in the study group were significantly older with a higher parity order. Induction rates were significantly higher among the comparison group, whereas, cesarean section rates were higher among the study group. No difference was noted with regard to neonatal outcomes. Women in the study group were not found to be more likely to be given screening recommendations at discharge (P=0.50), at their postpartum visit (P=0.36) or to perform DM screening postpartum (P=0.17). Conclusion Women with GDM associated complications had a higher rate of compliance to postpartum DM screening recommendations. However, in the current study this difference did not reach statistical significance.

  • Sarcopenia and Type 2 diabetes mellitus as predictors of 2-year mortality after hospital discharge in a cohort of hospitalized older adults
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-02
    Mileni V Beretta, Fábio F. Dantas Filho, Raquel Eccel Freiberg, Juliane V Feldman, Camila Nery, Ticiana C. Rodrigues

    Introduction: Sarcopenia has been discussed as a possible predictor of mortality in the older people, but there are few studies evaluating the relationship between mortality and sarcopenia in the population of patients with type 2 diabetes (T2D), especially after hospital discharge. Objective: To evaluate whether coexistence of sarcopenia and T2D predicts mortality after two years of hospital discharge in older patients compared to a control group without diabetes. Methodology: A prospective study that included patients hospitalized between July 2015 and December 2017. To assess sarcopenia, a Timed Up and Go (TUG) test was performed, muscle strength was measured by handgrip, and muscle mass was measured across the largest calf circumference region. This project was approved by the HCPA Ethics Committee under number 150068. Results 610 patients were included. The group was stratified according to the presence of diabetes, 306 (51%) patients had TD2. Patients with T2D had lower muscle strength (19.62 ± 7.53 vs. 21.19 ± 7.31 p = 0.009), were slower in TUG test (23 vs. 16 seconds; p <0.001) than those without T2D, 46.3% being classified as sarcopenic. The mortality rate among T2D was 28%. After adjustment, the coexistence of T2D and sarcopenia was independently associated with mortality after hospital discharge (HR: 1.78; 95% CI: 1.06-2.30). Conclusion: Older patients with T2D and sarcopenia had a higher risk of mortality after hospital discharge compared to a control group.

  • The Associations of Objectively Measured Sleep Duration and Sleep Disturbances with Diabetic Retinopathy
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-02
    Merwyn Chew, Nicholas Y.Q. Tan, Ecosse Lamoureux, Ching-Yu Cheng, Tien Yin Wong, Charumathi Sabanayagam

    Aims To assess the associations between objectively measured sleep duration, sleep disturbances and diabetic retinopathy (DR). Methods This cross-sectional study recruited 92 patients with diabetes from retinal clinics. Objective measurements of sleep duration, apnea-hypopnea index (AHI) and minimum oxygen saturations (SaO2) were obtained through polysomnography. The Epworth Sleepiness Scale and Insomnia Severity Index were administered. Retinal photographs were taken and graded according to the modified Airlie House Classification System. Regression analysis used to determine associations with outcomes including moderate DR, vision-threatening DR (VTDR) and diabetic macular edema (DME). Results Mean age of participants was 57.6 ± 8.3 years. 29 (32%) of them had moderate DR, and 17 (18.5%) had VTDR. Higher AHI (Odds Ratio [OR] 1.04; 95% confidence interval [CI] 1.00,1.07) and short sleep duration (OR 3.22; 95%CI 1.18,8.79) were associated with moderate DR. VTDR was associated with moderate obstructive sleep apnea (OSA) (OR 4.73; 95%CI 1.46,15.31), higher AHI (OR 1.06; 95%CI 1.02,1.10) and lower minimum SaO2 (OR 0.89; 95%CI 0.83,0.96). High risk for insomnia was associated with DME (OR 4.01; 95%CI 1.09,14.73). Conclusions Short sleep duration was associated with moderate DR while OSA-related parameters and a high risk for insomnia were associated with moderate DR, VTDR and DME.

  • Validation of the Polish version of WHO-5 as a screening instrument for depression in adults with diabetes
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-02
    Ewelina Cichoń, Andrzej Kiejna, Andrzej Kokoszka, Tomasz Gondek, Beata Rajba, Cathy E. Lloyd, Norman Sartorius

    Aims The aim of this study was to validate and report the factorial analysis of the World Health Organization’s 5-item Well-being Index (WHO-5) among outpatients with type 2 diabetes. We investigated the psychometric properties of the WHO-5 and its suitability for identifying potential depressive symptoms in Polish adults with diabetes. Methods Participants were randomly chosen among Polish diabetes outpatients and invited to participate in the cross-sectional study (N = 216). Participants completed the Polish version of the WHO-5, Problem Areas in Diabetes Scale and Patient Health Questionnaire. Results Factor analyses identified the one-factor structure of the Polish version of the WHO-5. The internal consistency of the Polish version of the WHO-5 is satisfying. With regard to convergent validity, there were significant negative associations between the WHO-5 and PAID, the PHQ-9, HbA1c and the amount of medical complications. The AUC indicates that the WHO-5 is an effective measure for identifying depressive symptoms. The optimal cut off values of ≤12 yielded the best sensitivity/specificity trade-off for identifying depression among people with diabetes. Conclusions The Polish version of the WHO-5 is a reliable, valid outcome measure for outpatients with type 2 diabetes and can be a useful instrument for screening for depression in people with diabetes.

  • Sex and Age Differences in Prevalence and Risk Factors for Prediabetes in Mexican-Americans
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-02
    Kristina P. Vatcheva, Susan P. Fisher-Hoch, Belinda M. Reininger, Joseph B. McCormick

    Aims Over 1/3 of Americans have prediabetes, while 9.4% have type 2 diabetes. The aim of our study was to estimate the prevalence of prediabetes in Mexican Americans, with known 28.2% prevalence of type 2 diabetes, by age and sex and to identify critical socio-demographic and clinical factors associated with prediabetes. Methods Data were collected between 2004 and 2017 from the Cameron County Hispanic Cohort in Texas. Weighted crude and sex- and age- stratified prevalences were calculated. Survey weighted logistic regression analyses were conducted to identify risk factors for prediabetes. Results The prevalence of prediabetes (32%) was slightly higher than the alarmingly high rate of type 2 diabetes (28.2%). Hispanic men had the highest overall (37.8%) and highest age stratified prevalence of prediabetes. Males had higher odds of prediabetes than females 1.56 (1.19, 2.06), controlling for the effect of family history of diabetes, age, BMI, and high-density lipoprotein. Family history of diabetes was a strong independent risk factor for prediabetes in all men, and in men and women in the age group 40-64 years. Elevated triglycerides (p=0.003) was an independent risk factor for men and women in the age group 18-39 years. Conclusions Despite the very high prevalence of type 2 diabetes, prediabetes prevalence among Mexican Americans is only marginally less than national prediabetes rates. This suggests that progression to type 2 diabetes is more rapid and occurs earlier than nationally. Earlier screening and interventions for prediabetes, especially for men, are necessary to slow the transition to diabetes.

  • Characteristics of diabetes diagnosis and control in toddlers and preschoolers from families with limited resources: A single center experience
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-02
    Mona Mamdouh Hassan, Noha Arafa, Marise Abdou, Omar Hussein

    Aim To describe the characteristics of diabetes diagnosis, insulin therapy regarding type, dose and frequency also the degree of glycemic control achieved in toddlers and preschoolers coming from families with limited resources. Methods Over one year, 69 toddlers and preschoolers clinically diagnosed as type 1 diabetes were included. Data related to presentation at diagnosis, insulin therapy and glycemic control was reviewed from patients' care givers and medical records. Results Diabetic ketoacidosis (DKA) was recorded in 71% of the children at initial diagnosis. The mean time since diabetes diagnosis was 2±1 years. Most of children (65/69, 94%) were on basal-bolus regimen while four (6%) were on basal insulin only. NPH and long acting analogues were used as basal insulin in (74%) and (26%). Regular insulin and rapid acting analogues were used as bolus insulin (27%) and (73%).The mean frequency of daily self monitoring of blood glucose was (2.9 ± 1). The arithmetic mean of HbA1c done over past 6 months to one year before inclusion in the study was 8.2± 1.5% (66±12mmol/mol) with 65% having HbA1c ≥ 7.5%(≥58 mmol/mol). Conclusion Toddlers and preschoolers with diabetes coming from families with limited resources frequently present with DKA at diagnosis and have suboptimal self-monitoring of blood glucose and glycemic control. NPH is more commonly used in this age group, combined with postprandial rapid analogues and less commonly preprandial regular insulin and that yields more favorable HbA1c but with a greater risk of hypoglycemia. The most common cause of hospital readmission was ketoacidosis and uncontrolled hyperglycemia.

  • Level of knowledge and evaluation of perceptions regarding pediatric diabetes among Greek teachers
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-12-02
    Panagiota Chatzistougianni, Eleni Tsotridou, Meropi Dimitriadou, Athanasios Christoforidis

    Aim To assess the knowledge and attitudes of nursery school, preschool and primary school Greek teachers regarding pediatric diabetes. Methods Our anonymous questionnaire was comprised of three parts: the first part was regarding sociodemographic characteristics; the second part was assessing basic knowledge about diabetes and the third part was about personal perceptions regarding diabetes management in the school setting. A total of 375 fully completed questionnaires were collected (22,67% from males). Results Males had a higher percentage of correct answers than females (80.71 ± 10.58% versus 80.17 ± 11.77%), but without reaching statistical significance (p= 0.763). Teachers aged over 45 years, tertiary education graduates and teachers in the public sector proved to be more knowledgeable about the disease. Question scoring the lowest percentage of correct answers were those dealing with the management of diabetic emergencies, such as the course of action in case a diabetic pupil is found unconscious. One out of four participants incorrectly declared that a delay in the diagnosis of diabetes mellitus cannot possibly be life-threatening whereas, an embarrassing 7.47% of the participants stated that diabetes is a contagious disease and another 6.67% declared that diabetic children should stop school. Conclusions It is evident that there is an urgent need for providing further information, as well as practical training to schoolteachers with emphasis being placed on the initial symptoms of diabetes and also in the detection and management of diabetic emergencies.

  • The Prevalence of undiagnosed type 2 diabetes and prediabetes in Eastern Mediterranean Region (EMRO): a systematic review and meta-analysis
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-30
    Alireza Mirahmadizadeh, Mohammad Fathalipour, Ali Mohammad Mokhtari, Shahryar Zeighami, Soheil Hassanipour, Alireza Heiran

    Background Previous studies of diabetes in Eastern Mediterranean Region (EMRO) did not assess the prevalence of either unknown diabetes or prediabetes. We conducted a systematic review and meta-analysis to estimate the prevalence of undiagnosed type 2 diabetes and prediabetes as well as variations by region in EMRO, using the relevant publications since 2000. Methods We carried out a comprehensive electronic search on electronic databases from January 1, 2000 to March 1, 2018. We selected cross-sectional and cohort studies reporting the prevalence of undiagnosed type 2 diabetes, prediabetes, or both. Two independent reviewers initially screened the eligible articles; then, synthesized the target data from full papers. Random or fixed effects model, subgroup analysis on Human Development Index (HDI), and publication year and sensitivity analysis to minimize the plausible effect of outliers were used. Results Among 849 identified citations, 55 articles were entered into meta-analysis, involving 567025 individuals. The forest plots estimated 5.46% (confidence intervals [CI]: 4.77-6.14) undiagnosed diabetic and 12.19% (CI: 10.13-14.24) prediabetics in EMRO. Low HDI countries and high HDI countries had the highest (7.25%; CI: 4.59-9.92) and the lowest (3.98%; CI: 3.11-4.85) undiagnosed diabetes prevalence, respectively. Very high HDI countries and low HDI countries had the highest (13.50%; CI: 8.43-18.57) and the lowest (7.45%; 1.20-13.71) prediabetes prevalence, respectively. In addition, meta-regression analysis showed a statistically significant association between publication year and prevalence of prediabetes (Reg Coef = 0.059, P = 0.014). But such finding was not observed for undiagnosed diabetes and publication year (Reg Coef = 0.034, P = 0.124), prediabetes and HDI (Reg Coef = 0.128, P = 0.31) and undiagnosed diabetes and HDI (Reg Coef = - 0.04, P = 0.96). Conclusion The prevalence of undiagnosed diabetes and prediabetes was high and increasing. The notion of universal health coverage is a priority; that is the integration of the primary, secondary and tertiary health levels, as well as employing the available action plans. Therefore, future studies, using identical screening tool and diagnostic criteria, are warranted to make an accurate picture of diabetes in EMRO.

  • Glycated haemoglobin in the first trimester: a predictor of gestational diabetes mellitus in pregnant Asian Indian women
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-30
    John Punnose, Rajeev Kumar Malhotra, Komal Sukhija, Anu Mathew, Asha Sharma, Naimaa Choudhary

    Aim To assess the efficacy of first trimester glycated hemoglobin (HbA1c-FT) to in diagnosinge or predicting gestational diabetes mellitus (GDM) in Asian Indian women. Methods This retrospective cohort study involved 2275 women who underwent both HbA1c -FT estimation and GDM screening by with aone-step 75 g oral glucose tolerance test. Receiver oOperating cCharacteristic (ROC) curve wasstatistics were applied to assess the discriminativeng ability of HbA1c-FTfor inGDM diagnosis. A multivariable logistic regression analysis after adjustment adjustingfor plausible confounders was used to evaluated the independent effect of HbA1c-FT on GDM diagnosis. Results The mMean HbA1c-FT of GDM (n=578) and non-GDM women (n=1697) were 5.04+0.04% and 4.9+0.37%, respectively (p<0.001). Compared to women with a HbA1c-FT <5.2%, the adjusted odds ratioto develop GDM of women with an HbA1c–FT range of 5.2 to 5.5 % and those >5.6 % to develop GDM were 1.627 (p <.004) and 2.6 (p <0.001), respectively. The area under the ROC curve to detect GDM was 0.606 (95% CI:0.519 to 0.633 p <0.001), but the sensitivity and specificity of the HbA1c-FT were not sufficient to diagnose, rule in or rule out GDM. Conclusions HbA1c-FT is an independent GDM predictor in Asian Indian women but lacks sufficient sensitivity or specificity for use as a diagnostic test.

  • Type 1 diabetes incidence in children and adolescents in Mexico: data from a nation-wide institutional register during 2000-2018
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-30
    Niels H. Wacher, Rita A. Gómez-Díaz, Iván de Jesús Ascencio-Montiel, Ramón Alberto Rascón-Pacheco, Carlos A. Aguilar-Salinas, Victor H. Borja-Aburto

    Aims To describe the annual incidence of type 1 diabetes in children and adolescents insured by the Mexican Institute of Social Security, the main health provider in Mexico, during 2000-2018. Methods We conducted a secondary data analyses using the incidence registers from the Epidemiological Surveillance Coordination of the Mexican Institute of Social Security collected during 2000-2018. Incident type 1 diabetes cases (age 19 years old and below) were identified using ICD-10-CM E10 diagnostic codes. Age, sex, and geographical region and seasonal-specific incidence were calculated with their corresponding annual percentage change (APC) as well. Results In the period 2000-2018, the number of incident cases with type 1 diabetes decreased from 3.4 to 2.8 per 100,000 in insured for subjects below 20 years old. We observed an increase in the 2000-2006, followed by a decrease for the 2006-2018 period (APC +16.1 and -8.7 respectively). Females and children <5 years old had a significant decrease in the incidence rate, while inhabitants in Central Mexico showed a significant increase. No difference was found in incidence between seasons. Conclusions Our study describes significant fluctuations of the incidence of type 1 diabetes during the period 2000–2018, which appeared to correspond to influenza outbreaks, among Mexican children and adolescents.

  • Disparities in gastric emptying and postprandial glycaemia between Han Chinese and Caucasians with type 2 diabetes
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-29
    Xuyi Wang, Cong Xie, Chinmay S. Marathe, Charles-Henri Malbert, Michael Horowitz, Karen L. Jones, Christopher K. Rayner, Zilin Sun, Tongzhi Wu

    Aims Gastric emptying is a major determinant of postprandial glycaemia in both health and type 2 diabetes (T2DM); the potential impact of ethnicity on gastric emptying is unclear. We compared the rate of gastric emptying of a standardised meal and the associated glycaemic response in Han Chinese and Caucasian patients with T2DM. Methods 14 Han Chinese and 14 Caucasian T2DM patients, managed by diet and/or metformin monotherapy, underwent concurrent measurements of gastric emptying and blood glucose for 240min after a 99mTc-calcium phytate-labelled mashed potato meal. Results Han Chinese patients were slightly younger (P<0.05), and had a lower BMI (P<0.05), than Caucasians. There were no differences in either HbA1c or fasting blood glucose between them. Gastric half-emptying time (T50) was shorter (P<0.05) and the postprandial blood glucose increment greater (P<0.05) in Han Chinese than Caucasian patients. Both the increment in blood glucose from baseline at 60min and peak blood glucose were related inversely to T50 (P<0.05 each). Conclusions Han Chinese with relatively well-controlled T2DM have more rapid gastric emptying compared to Caucasians, which is associated with a greater postprandial glycaemic excursion. These differences may inform the choice of management, e.g. Han Chinese may particularly benefit from therapies that slow gastric emptying.

  • An observational prospective study to evaluate the outcomes of new onset diabetes after renal transplantation (NODAT) in a tertiary care centre in Eastern India
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-26
    Santosh Kumar, Debmalya Sanyal, Pratik Das, Kingshuk Bhattacharjee, Rohit Rungta

    Aim To analyse post-transplant outcomes of NODAT patients in comparison to the regular cohort (non-NODAT). Objectives: To compare graft survival and rejection rate, patient survival rate, incidence of hospitalization (due to any cause) in between NODAT and non-NODAT groups in cases of renal transplantation. Methods: A single–centred prospective real–world observational study of 100 subjects who underwent renal transplantation over a period of 2 years. All NODAT cases evaluated for graft survival/ rejection, incidence of hospitalisation/infection, mortality from all causes and compared with that of non-NODAT post-transplant recipients. Nominal categorical data between the groups are compared using Chi-square test or Fisher’s exact test as appropriate. p value <0.05 was taken to indicate a significant difference. Results: Mean number of hospital admissions of subjects was 1.38 ± 1.38 and 0.29 ± 0.56 in NODAT and Non-NODAT respectively, p< 0.0001. Nineteen out of 24 NODAT subjects and 72 out of 76 Non-NODAT subjects had graft survival, p = 0.0342. Twenty out of 24 NODAT and 74 out of 76 Non-NODAT subjects had survived, p = 0.0282. Conclusions: NODAT leads to adverse outcomes viz. increased rate of hospitalization, reduced rates of allograft survival and patient survival.

  • The right place for Metformin today
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-26
    Guntram Schernthaner, Gerit-Holger Schernthaner

    Metformin is the most widely used glucose lowering drug worldwide in the treatment of patients with type 2 diabetes, since we have experience with this drug for more than 60 years about the efficacy and safety. Metformin is very effective in HbA1c lowering associated with some weight loss, but does not increase risk for hypoglycemia. At the moment all guidelines in the world recommend to use metformin in monotherapy in patients with newly diagnosed diabetes or in combination with other antidiabetic drugs with documented CV (and renal) benefit in cardiovascular outcome trials (CVOT). Although a randomized placebo controlled CVOT with metformin is lacking, many observational studies in patients with coronary heart disease, heart failure and chronic kidney disease have demonstrated consistent beneficial effects. A recent metanalysis of 26 observational studies including 815 839 patients showed that metformin use was associated with a significantly lower rate of all-cause mortality (HR: 0.74; 95% CI: 0.68-0.81). Whether this very consistent reduction of all-cause mortality is related to the incidence/outcome of several cancers has still to be investigated. In the future early combination therapy of metformin e.g. with SGLT-2 inhibitors should be more often used.

  • CVOTs: What did the Endocrinologist learn ?
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-26
    Paul Valensi, Gaëtan Prévost

    The recent CVOTs which tested the new glucose-lowering drugs (GLD) show that in patients with type 2 diabetes mellitus (T2DM) it is now possible to reduce cardiovascular complications including ischemic events and hospitalization for heart failure, and mortality, and, to some extent, microvascular complications of diabetes, in particular renal outcomes. Additionally CVOTs provide major informations on safety and metabolic effects for long-term use of these drugs. The benefits with GLP-1 RAs are most likely derived through the reduction of atherosclerosis-related events while SGLT-2is seem mostly to reduce heart failure-related events. Specific mechanisms independent from glucose control are involved. Based on CVOTs results it is time, as stated in the new EASD-ADA and ESC/EASD guidelines, to take into consideration such opportunities in the decision-making process when treating T2DM patients, favoring the use of drugs that have shown clear cardiovascular and renal benefits. The treatment decisions require more expertise in the evaluation of cardiovascular and renal risk which becomes a major determinant for the choice of GLD treatment, the target for lipids, the adjustment of anti-hypertensive treatments and the prescription of aspirin. In this context it is essential that endocrinologists-diabetologists communicate more with cardiologists and nephrologists and with the primary care practitioners.

  • Clinical and epidemiological differences in diabetes: a cross-sectional study of the Brazilian population compared with the French GERODIAB cohort
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-25
    Carina Bandeira Bezerra, Maria Vieira de Lima Saintrain, Ana Ofélia Portela Lima, Marina Arrais Nobre, Rafaela Lais e Silva Pesenti Sandrin, Débora Rosana Alves Braga, Jean Doucet

    Aims This study aimed to compare the sociodemographic and epidemiological profiles between Brazilian and French older people with type 2 diabetes mellitus. Methods Quantitative analytical study of 248 type 2 diabetes patients aged 65+ years receiving care in a center for integrated diabetes and hypertension care. The data were compared with the GERODIAB study conducted in France. Results The participants’ mean age was 73.16 ± 6.4 years, with 162 (65.4%) participants aged less than 75 years and 38 (15.3%) over 80 years old. Almost all the participants (99.2%) lived at home, 35 (14.1%) were uneducated, and 17 (6.9%) had completed higher education. The majority (232 older people) were retired. Most of the median values of the variables differed statistically (p<0.001) between the two populations. Peripheral vascular disease, diabetic neuropathy, foot wound, amputation, hypoglycemia, hyperosmolarity and other intercurrent infections differed statistically (p<0.001) between the two populations. Most of the medication use variables differed significantly (p<0.05) between Brazilians and the French. Conclusions The statistically significant differences between the two populations reveal better conditions among the French participants, which highlights the importance of the scientific evidence found in the French study for developing public health actions targeted at Brazilian diabetic older people.

  • Program completion and glycemic control in a remote patient monitoring program for diabetes management: does gender matter?
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-23
    Tzeyu L. Michaud, Mohammad Siahpush, Keyonna M. King, Athena K. Ramos, Regina E. Robbins, Robert J. Schwab, Martina A. Clarke, Dejun Su

    Aims To examine gender differences in program completion and glycemic outcomes for patients with type 2 diabetes (T2D) in a remote patient monitoring (RPM) program for diabetes management. Methods Based on data from an RPM program that enrolled post-discharge T2D patients (n=1,645) in 2014-2017, logistic regression models were estimated to assess gender difference in the likelihood of completing the three-month RPM program; whereas ordinary least squares (OLS) regression models were used to examine gender difference in post-RPM Hemoglobin A1c (HbA1c), controlling for demographics, baseline health status, including HbA1c, patient activation scores, and physiological data upload frequency for patients who had completed the program. Results Among enrolled participants, men had lower odds of completing the three-month RPM program than women (adjusted odds ratio, 0.61; 95% confidence interval [CI], 0.39-0.95). However, among those who completed the program, men had lower post-RPM HbA1c than women (-0.18; 95% CI, -0.33, -0.03) after controlling for baseline HbA1c and other covariates. Conclusions While female patients with T2D were more likely to complete the RPM program, they showed a higher glycemic level at the end of the program compared to male patients. To close gender disparities in health, interventions through telemedicine tailored towards women’s diabetes outcomes and men’s engagement level are warranted.

  • Standard Mortality Rates and Years of Life Lost for Serologically defined Adult-onset Type 1 and Type 2 Diabetes - A Fifteen Year Follow-Up
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-22
    Maria Thunander, Anna Lindgren, Christer Petersson, Mona Landin-Olsson, Sara Holmberg

    Aims The Diabetes Incidence in Kronoberg (DIK) study of adult-onset diabetes used serological classification. Standard Mortality Rates (SMR) and Years of Life Lost (YLL) 15 years after adult-onset (18-100 years) of diabetes were compared to the population of Kronoberg. Methods Of 1609/1660 (97%) patients, 112 (7%) had type 1 (T1D) (GADA+ and/or ICA+, and/or C-peptide < 0.25 nmol/l), and 1497 (93%) had type 2 diabetes (T2D) (antibody- and C-peptide ≥ 0.25 nmol/l). The National Swedish Mortality Register provided time of death. Results For T1D SMR did not differ from the Kronoberg population in any age group. In T2D SMR was 1.20 (1.12-1.29). After 15 years 26% (29/112) T1D and 52% (785/1497) T2D patients had died, p < 0.0001. In T2D SMR was 5.6 (30-39 years), 2 (40-59 years), 1.4 (60-69 years), and thereafter no difference. There were no significant sex differences in mortality, and no YLL to adult-onset T1D, but five YLL to T2D for onset at ages 20-60 years. Conclusions For adult-onset T1D SMR did not differ from the general population, in contrast to previous findings in childhood-onset (< 30 years of age) T1D. The difference in mortality between persons with diabetes and the general population was due to higher mortality in T2D.

  • Balance, risk of falls, risk factors and fall-related costs in individuals with diabetes
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-16
    Willem D. Rinkel, Shelly van Nieuwkasteele, Manuel Castro Cabezas, Johan W. van Neck, Erwin Birnie, J. Henk Coert

    Aims Sensory loss and impaired balance are considered risk factors of incident falls. The aim of this study was to assess the relationship between degree of foot sensation and balance, risk of falls, incidence of fall-related injuries and costs in a cohort of patients with diabetes. Methods (Non)-neuropathic subjects participating in the Rotterdam Diabetic Foot Study were followed prospectively. Subjects underwent sensory testing of the feet (39 item Rotterdam Diabetic Foot Study Test Battery (RDF-39)); balance was assessed at the second follow-up (Brief-BESTest) as were data on incident falls. Medical records and financial data were abstracted to estimate fall-related morbidity and in-hospital costs. Results A higher RDF-39 score, cerebral artery disease, type 2 diabetes, height and age were predictors of the Brief-BESTest total score. 41/296 patients (13.9%) reported two or more falls during follow-up. Predictors for recurrent falls were a higher RDF-39 score (aOR: 1.124, p<.0005), male gender (aOR: 0.319, p=0.016), age (aOR: 0.938, p=0.003) and type 2 diabetes (aOR: 3.157, p=0.100). Thirty-one patients used medical resources (median € 370 (IQR: 150-977)). Conclusions Degree of sensory loss correlates significantly with an increased imbalance and risk of falls. The RDF-39 may be used as stratification tool in medical decision-making and patient information.

  • Prevention of gestational diabetes mellitus in overweight or obese pregnant women: A network meta-analysis
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-11-15
    Christos Chatzakis, Dimitrios G. Goulis, Evangelia Mareti, Makarios Eleftheriades, Apostolos Zavlanos, Konstantinos Dinas, Alexandros Sotiriadis

    Aims Several interventions have been implemented to prevent the development of gestational diabetes mellitus (GDM) in obese pregnant women, including physical exercise programs, and administration of metformin, vitamin D and probiotics. The aim of this network meta‐analysis was to compare the efficiency of these interventions and identify the optimal. Materials A network meta-analysis of randomized trials was performed comparing the different interventions for the development of GDM in overweight or obese women, either to each other or placebo / no intervention. A search was conducted in four electronic databases and grey literature sources. The primary outcome was the development of GDM; secondary outcomes were other complications of pregnancy. Results The meta-analysis included 23 studies (4237 participants). None of the interventions was superior compared with placebo / no intervention for the prevention of GDM. Metformin and physical exercise were superior to placebo / no intervention for gestational weight gain (MD -1.21, 95% CI -2.14 to -0.28 and MD -0.96, 95% CI -1.69 to -0.22, respectively). Metformin was superior to placebo / no intervention for caesarean sections and admission to NICU. Conclusions Interventions aiming to prevent the development of GDM in overweight / obese women are not effective, when applied during pregnancy.

  • The Estimating effectiveness from efficacy taxonomy (EFFECT): A tool to estimate the real-world impact of health interventions
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-05-29
    Karla I. Galaviz, Mohammed K. Ali, Jeehea Sonya Haw, Matthew James Magee, Alysse Kowalski, Jingkai Wei, Audrey Straus, Mary Beth Weber, Theo Vos, Christopher Murray, K.M.V. Narayan

    Aims To develop and pilot test a taxonomy that empirically estimates health intervention effectiveness from efficacy data. Methods We developed a taxonomy to score health interventions across 11 items on a scale from 0–100. The taxonomy was pilot-tested in efficacy and effectiveness diabetes prevention studies identified in two separate systematic reviews; here, the face validity, inter-rater reliability and factor structure of the taxonomy were established. Random effects meta-analyses were used to obtain weight loss and diabetes incidence pooled effects across studies. These effects and taxonomy scores were used to down calibrate efficacy estimates to effectiveness estimates as follows: Efficacy effect*[Efficacy score/highest possible score]. Results We scored 82 effectiveness lifestyle modification studies (mean score 49.2), 32 efficacy lifestyle modification studies (mean score 69.8) and 20 efficacy studies testing medications (mean score 77.4). The taxonomy had face validity and good inter-rater reliability (ICC = 0.9 [0.87, 0.93]). The between-groups down calibrated weight loss estimate was similar to that observed in the effectiveness meta-analysis (1.7 and 1.8 kg, respectively). The down calibrated diabetes relative risk reduction was also similar to that observed in the effectiveness meta-analysis (30.6% over 2.7 years and 29% over 2 years, respectively). Conclusions The taxonomy is a promising tool to estimate the real-world impact of health interventions.

  • Series: Implications of the recent CVOTs in type 2 diabetes
    Diabetes Res. Clin. Pract. (IF 3.239) Pub Date : 2019-05-18
    André J. Scheen

    The management of type 2 diabetes mellitus (T2DM) essentially consists in controlling hyperglycaemia, together with other vascular risk factors, in order to reduce the incidence and severity of diabetic complications. Whereas glucose control using classical glucose-lowering agents (except perhaps metformin) largely fails to reduce cardiovascular disease (CVD), two new pharmacological classes, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter type 2 inhibitors (SGLT2is), have proven their ability to reduce major cardiovascular events in patients with established CVD. Furthermore, SGLT2is reduced the risk of hospitalisation for heart failure and the progression of renal disease. According to the 2018 ADA-EASD consensus report, the choice of a second agent to be added to metformin should now be driven by the presence or not of atherosclerotic CVD, heart failure or renal disease, all conditions that should promote the use of a SGLT2i or a GLP-1 RA with proven efficacy. Thus endocrinologists have to face a new paradigm in the management of T2DM, with a shift from a primary objective of glucose control without inducing hypoglycaemia and weight gain to a goal of cardiovascular and renal protection, largely independent of glucose control. Of note, however, the latter remains crucial to reduce the risk of microangiopathy.

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