Diabetes research and clinical practice最新文献

{"title":"Automated insulin delivery systems in elderly patients with brittle type 2 diabetes","authors":"Ozge Telci Caklili ,&nbsp;Ferhat Cetin ,&nbsp;Melike Ozkan ,&nbsp;Elif Sahiner ,&nbsp;Ramazan Cakmak ,&nbsp;Ela Keskin ,&nbsp;Hulya Hacisahinogullari ,&nbsp;Enver Sukru Goncuoglu ,&nbsp;M. Temel Yilmaz","doi":"10.1016/j.diabres.2024.111913","DOIUrl":"10.1016/j.diabres.2024.111913","url":null,"abstract":"<div><h3>Purpose</h3><div>Geriatric diabetes is complicated by the frailty of this population, and hypoglycemia with insulin is not uncommon in these patients. Automated Insulin Delivery (AID) systems may provide better glycemic control in elderly patients with brittle type 2 diabetes.</div></div><div><h3>Methods</h3><div>Thirty-four patients (≥ 60 years) including cancer patients with brittle diabetes were switched to an AID system from multiple-dose insulin (MDI) treatment. HbA1c level, weight, total daily insulin requirement, and C-peptide, creatinine, and lipids were followed for at least six months.</div></div><div><h3>Results</h3><div>There were 34 patients (14 male, 41.2 %) with a median age of 67 (IQR 63.0–75.5). Six patients (17.6 %) were on chemotherapy and/or steroids (Ch/S). The patients’ initial median HbA1c % was 9.3 (IQR 7.6–11.0), c-peptide level was 0.9 (IQR 0.5–2.2) ng/mL, and median total daily insulin dose was 41 IU (IQR 32–53).</div><div>Six months after the patients were switched to an AID system their HbA1c % decreased to 7.1 (IQR 6.5–8.1), p &lt; 0.001 and c-peptide increased to 1.21 (IQR 0.2–1.7) ng/mL, p = 0.878. Total insulin dose decreased with AID systems [32 IU (IQR 23.9–37.8)), p &lt; 0.001].</div><div>There was a decrease in median HbA1c % in patients on Ch/S [8.7 (IQR 7.0–11.5) to 6.9 (IQR 6.3–9.2)] however it didn’t reach statistical significance p = 0.225. Total insulin dose also decreased without statistical significance [33 IU (IQR 41–28) to 28 (IQR 23–35), p = 0.173].</div><div>The mean time in range (TIR) percent of the patients with AID systems were as follows; &lt;54 mg/dL was 0.5 %, 56–70 mg/dL was 1.3 %, 70–180 mg/dL was 64.8 %, &gt;180 mg/dL was 26.7 % and &gt; 250 mg/dL was 6.7 %.</div></div><div><h3>Conclusion</h3><div>Although AID systems are tested mostly in young type 1 patients our results show that elderly patients with brittle type 2 diabetes also benefit from an AID system. Even in very frail patients such as cancer patients, improvement can be seen.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"218 ","pages":"Article 111913"},"PeriodicalIF":6.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin autoimmune syndrome induced by omeprazole in an Asian Male with HLA-DRB1*0406 Subtype: A case report","authors":"Sinan Ai,&nbsp;Zhiyuan Zhang,&nbsp;Xiai Wu","doi":"10.1016/j.diabres.2024.111906","DOIUrl":"10.1016/j.diabres.2024.111906","url":null,"abstract":"<div><div>Insulin autoimmune syndrome (IAS) is characterized by hyperinsulinemic hypoglycemia and elevated anti-insulin antibodies. While thiol-containing drugs commonly induce IAS, cases induced by proton pump inhibitors are rare. We report a case of IAS induced by omeprazole in a 27-year-old Chinese man with the HLA-DRB1*0406 subtype. This patient presented with Whipple’s triad after taking omeprazole without concurrent insulin use. The mixed-meal tolerance test (MMTT) and insulin-C-peptide release tests revealed a rapid surge in insulin levels within one hour, with a non-significant increase in C-peptide and a significant rise in insulin after precipitation. Further examination revealed high-titer positive insulin autoantibodies, leading to a diagnosis of insulin autoimmune syndrome (IAS). Symptoms resolved upon discontinuation of omeprazole and adherence to dietary recommendations, with insulin autoantibody levels decreasing after a 6-month follow-up. This case highlights omeprazole’s potential to induce IAS, underscoring the need for vigilance due to widespread use of proton pump inhibitor.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"218 ","pages":"Article 111906"},"PeriodicalIF":6.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case series of using automated insulin delivery to improve glycaemic control in people with type 1 diabetes and end stage kidney disease on haemodialysis","authors":"Khuram Chaudhry ,&nbsp;Rebecca Hyslop ,&nbsp;Thomas Johnston ,&nbsp;Siobhan Pender ,&nbsp;Sufyan Hussain ,&nbsp;Janaka Karalliedde","doi":"10.1016/j.diabres.2024.111800","DOIUrl":"10.1016/j.diabres.2024.111800","url":null,"abstract":"<div><div>Automated insulin delivery (AID) in people with type 1 diabetes (pwT1D) and end-stage kidney disease (ESKD) on haemodialysis (HD) has not been reported previously. We describe practical considerations and our findings in four pwT1D on HD for ESKD where AID was safely implemented, with significant improvements in time in range.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111800"},"PeriodicalIF":6.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time in range and mean glucose cut-off points for reduction of fetal outcomes in pregnant women with type 1 diabetes using automated insulin delivery systems","authors":"Ana María Gómez Medina ,&nbsp;Diana Cristina Henao Carrillo ,&nbsp;María Natalia Serrano Macías ,&nbsp;María Juliana Soto Chávez ,&nbsp;María Alejandra Robledo Gómez ,&nbsp;Dario Parra ,&nbsp;Javier Alberto Gómez González ,&nbsp;Bruno Grassi ,&nbsp;Angélica Imitola ,&nbsp;Alejandro Cob ,&nbsp;Martin Rondón ,&nbsp;Maira García ,&nbsp;Oscar Mauricio Muñoz Velandia","doi":"10.1016/j.diabres.2024.111902","DOIUrl":"10.1016/j.diabres.2024.111902","url":null,"abstract":"<div><h3>Aim</h3><div>In pregnant women with Type 1 Diabetes (T1D), achieving a lower recommended time in range (TIRp,63–140 mg/dl) could have an impact on fetal outcomes. To determine the TIRp and mean glucose cut-off point associated with better fetal outcomes in pregnant women using automated insulin delivery (AID) systems.</div></div><div><h3>Methods</h3><div>A prospective cohort of pregnant women with T1D, using AID systems and followed-up in Latin America was analyzed. Optimal TIRp and mean glucose cut-off points for predicting large for gestational age (LGA) were determined using the Liu method. Fetal outcomes were evaluated for the identified cut-off point and the one recommended by guidelines (TIRp &gt; 70 %).</div></div><div><h3>Results</h3><div>Sixty-two patients were included (mean age 31.9 ± 5.9 years, HbA1c 7.57 %±1.29 %, TIRp 59.8 %±14.6 %). 27.5 % on advanced hybrid closed loop systems (AHCL). LGA (50 vs 17.9 %,p = 0.010) and hyperbilirubinemia (45 % vs 11.8 %,p = 0.016) were more common in patients with TIRp &lt; 59.1 %. Optimal cut-off of TIRp in the second trimester for predicting LGA was &lt; 59.1 % (sensitivity 75 %, specificity 61 %) with an AUC of 0.68(CI 0.48–0.88). Optimal cut-off for mean glucose was 133 mg/dL (sensitivity 69 %, specificity 70 %) with an AUC of 0.70(CI 0.51–0.88) in the same trimester. Better metabolic control during the third trimester was seen in the AHCL users compared to other devices.</div></div><div><h3>Conclusions</h3><div>TIRp &gt; 59.1 % and mean glucose &lt; 133 mg/dl in the second trimester, is associated with lower fetal outcomes of large for gestational age. One of the strategies that would improve TIRp is the early use of AHCL systems. Further studies are needed before a strong recommendation can be made.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111902"},"PeriodicalIF":6.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Let’s put well-being at the heart of diabetes care","authors":"","doi":"10.1016/j.diabres.2024.111908","DOIUrl":"10.1016/j.diabres.2024.111908","url":null,"abstract":"","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111908"},"PeriodicalIF":6.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of continuous glucose monitoring with remote telemonitoring-enabled virtual educator visits in adults with non-insulin dependent type 2 diabetes: A randomized trial","authors":"Darren Lau ,&nbsp;Donna P. Manca ,&nbsp;Pratima Singh ,&nbsp;Tawnya Perry ,&nbsp;Inga Olu-Jordan ,&nbsp;Jiawei Ryan Zhang ,&nbsp;Gulelala Rahim ,&nbsp;Evan M. Hagen ,&nbsp;Roseanne O. Yeung","doi":"10.1016/j.diabres.2024.111899","DOIUrl":"10.1016/j.diabres.2024.111899","url":null,"abstract":"<div><h3>Aims</h3><div>Estimate the effectiveness of continuous glucose monitoring (CGM) with remote telemonitoring-enabled virtual diabetes educator visits for improving glycemic management in adults with type 2 diabetes, <em>not</em> on insulin.</div></div><div><h3>Methods</h3><div>Participants with type 2 diabetes, not on insulin, and HbA1c &gt; 7.0 % were enrolled in an open-label randomized trial of 6 weeks of CGM with telemonitoring versus enhanced usual care. Both groups received educator visits. HbA1c was assessed at 12 weeks.</div></div><div><h3>Results</h3><div>Of 105 participants (mean age 57.3 years, 49.5 % females, mean baseline HbA1c 8.0 %), 86 remained at follow-up. Change in HbA1c was −0.69 % (CGM) versus −0.33 % (enhanced usual care). Adjusting for baseline HbA1c, CGM was superior (0.65 % greater HbA1c reduction [95 % CI 0.17–1.12 %], p = 0.008). CGM participants were 92 % (RR = 1.92, 1.19–3.06, p = 0.007) more likely to have an HbA1c reduction ≥ 0.5 %, lost more weight (difference in weight reduction 2.17 kg, 0.22–4.11, p = 0.029) and were more satisfied with their treatment. No treatment-related adverse events were observed.</div></div><div><h3>Conclusions</h3><div>CGM with virtual diabetes educator visits is effective, safe, and acceptable in adults with type 2 diabetes not on insulin and should be considered as an alternative to drug therapy for improving blood glucose.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111899"},"PeriodicalIF":6.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular disease modifies the relationship between systolic blood pressure and outcomes in people with diabetes","authors":"Anping Cai ,&nbsp;Jiabin Wang ,&nbsp;Xiaoxuan Feng ,&nbsp;Gianfranco Parati ,&nbsp;Ji-Guang Wang ,&nbsp;Yingqing Feng ,&nbsp;Zhiqiang Nie","doi":"10.1016/j.diabres.2024.111909","DOIUrl":"10.1016/j.diabres.2024.111909","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to evaluate the influences of cardiovascular disease (CVD) on the relationship between baseline systolic blood pressure (SBP) and outcomes in community populations with diabetes.</div></div><div><h3>Methods</h3><div>This is an observational study of 16,431 community adults with diabetes. The relationship between SBP with major adverse cardiovascular event (MACE) and all-cause death were evaluated using multivariable-adjusted Cox proportional hazard models and restricted cubic spline.</div></div><div><h3>Results</h3><div>After a median follow-up of 3.4 (IQR 2.6, 4.3) years, 2145 (13.1 %) MACE and 1025 (6.2 %) all-cause death occurred. In participants free of CVD, in reference to SBP &lt; 120 mmHg group, the risks for MACE increased as SBP category (120–129, 130–139, and ≥ 140 mmHg) advanced (P-trend &lt; 0.001), and there was a linear relationship (P-nonlinear = 0.75). The risks for all-cause death were lower in SBP of 120–139 mmHg and 140–159 mmHg groups but higher in SBP ≥ 160 mmHg group, and there was a U-shaped relationship (P-nonlinear &lt; 0.001). In participants with existing CVD the relationship between baseline SBP with MACE and all-cause death did not show any specific pattern.</div></div><div><h3>Conclusion</h3><div>Results of the current study suggest that the relationship between baseline SBP with MACE and all-cause death varied significantly by baseline CVD status.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"218 ","pages":"Article 111909"},"PeriodicalIF":6.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world efficacy and safety of open-source automated insulin delivery for people with type 1 diabetes mellitus: Experience from mainland China.","authors":"Yongwen Zhou, Mengyun Lei, Daizhi Yang, Ping Ling, Ying Ni, Hongrong Deng, Wen Xu, Xubin Yang, Jinhua Yan, Benjamin John Wheeler, Jianping Weng","doi":"10.1016/j.diabres.2024.111910","DOIUrl":"https://doi.org/10.1016/j.diabres.2024.111910","url":null,"abstract":"<p><strong>Background: </strong>Open-source automated insulin delivery systems are increasingly adopted yet predominantly discussed outside of Asia. This study aimed to describe efficacy and safety of android artificial pancreas (AAPS) in people with type 1 diabetes mellitus (T1DM) from mainland China.</p><p><strong>Methods: </strong>This real-world study recruited people who initiated AAPS for ≥ 3 months between 2019 and 2024. Key outcomes included glycated hemoglobin A1c (HbA1c) and metrics from continuous glucose monitoring, rates of diabetic ketoacidosis (DKA) and severe hypoglycemia.</p><p><strong>Findings: </strong>292 (male, 46·9 %) participants aged 25·7 (14·7, 35·0) years were included, with 183 (62·7 %) and 68 (23·3 %) using AAPS for 6 and 12 months. Prior-AAPS HbA1c was 7·6 ± 1·7 % with 44·5 % achieving < 7·0 %. After 3 months, mean HbA1c improved by -1·5 ± 2·0 % to 6·3 ± 0·8 % (P < 0.01), with 82·9 % achieving < 7.0 %. Time in range 3·9-10·0 mmol/L (TIR) improved to 78·8 ± 12·9 %, with 80·5 % achieving > 70 %, followed by time below 3·9 mmol/L of 3·9 (2·1, 6·1) %. After 12 months, HbA1c and TIR remained similar at 6·4 ± 1·0 % and 77·9 ± 12·2 %. No DKA and severe hypoglycemia was observed.</p><p><strong>Interpretation: </strong>Real-world data from mainland China highlights current uptake of open-source AAPS with potential glycemic benefits. No safety signals are seen. More support to enhance access and utilization of all AID systems in this region is warranted.</p>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":" ","pages":"111910"},"PeriodicalIF":6.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproductive factors predict risks of cardiovascular disease and premature death in postmenopausal women with type 2 diabetes: The Fukuoka Diabetes Registry","authors":"Ayaka Oshiro ,&nbsp;Toshiaki Ohkuma ,&nbsp;Masanori Iwase ,&nbsp;Taiki Higashi ,&nbsp;Masahito Yoshinari ,&nbsp;Takanari Kitazono","doi":"10.1016/j.diabres.2024.111907","DOIUrl":"10.1016/j.diabres.2024.111907","url":null,"abstract":"<div><h3>Aims</h3><div>Reproductive factors (reproductive period, age at menarche, and age at menopause) are associated with a risk of cardiovascular disease (CVD) and death in individuals without focusing on comorbid diabetes. However, it remains unclear whether this association also applies to individuals with diabetes. This study investigated the relationship between reproductive factors and the risk of CVD and death in postmenopausal Japanese women with type 2 diabetes.</div></div><div><h3>Methods</h3><div>1,592 postmenopausal women with type 2 diabetes without pre-existing CVD were subclassified based on reproductive period (age at menopause minus age at menarche). The primary outcome was a composite of CVD incidence and all-cause death.</div></div><div><h3>Results</h3><div>The risk of the outcome decreased with a longer reproductive period. Compared with a reproductive period of ≤ 29 years, the multivariable-adjusted hazard ratios (95 % CI) were 0.80 (0.39–1.66), 0.73 (0.37–1.43), and 0.43 (0.19–0.99) for reproductive periods of 30–34, 35–39, and ≥ 40 years, respectively (p for trend = 0.046). Earlier age at menarche and later age at menopause were also associated with a decreased risk of the outcome.</div></div><div><h3>Conclusions</h3><div>Evaluating reproductive factors may help predict the risks of CVD and death in postmenopausal women with type 2 diabetes.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"218 ","pages":"Article 111907"},"PeriodicalIF":6.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling the impaired incretin effect in obesity and type 2 diabetes: Key role of hyperglycemia-induced unscheduled glycolysis and glycolytic overload","authors":"Naila Rabbani ,&nbsp;Paul J. Thornalley","doi":"10.1016/j.diabres.2024.111905","DOIUrl":"10.1016/j.diabres.2024.111905","url":null,"abstract":"<div><div>Glucagon-like peptide-1 (GLP-1) agonists and GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) co-agonists are major treatment options for subjects with obesity and patients with type 2 diabetes mellitus (T2DM). They counter without addressing the mechanistic cause of the impaired incretin effect associated with obesity and T2DM. Incretin effect impairment is characterized by decreased secretion of incretins from enteroendocrine cells and incretin resistance of pancreatic β-cells. It is linked to hyperglycemia. We present evidence that subversion of the gating of glucose entry into glycolysis, mainly by glucokinase (hexokinase-4), during persistent hyperglycemia in enteroendocrine cells, pancreatic β- and α-cells and appetite-regulating neurons contributes to the biochemical mechanism of the impaired incretin effect. Unscheduled glycolysis and glycolytic overload thereby produced decreases cell signalling of incretin secretion to glucose and other secretion stimuli and incretin receptor responses. This mechanism provides a guide for development of alternative therapies targeting recovery of the impaired incretin effect.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111905"},"PeriodicalIF":6.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}