Journal of Diabetes最新文献

{"title":"Simplicity: The Ultimate Sophistication in Managing Type 2 Diabetes With Severe Hyperglycemia","authors":"Liehua Liu, Yanbing Li","doi":"10.1111/1753-0407.70042","DOIUrl":"10.1111/1753-0407.70042","url":null,"abstract":"<p>Diabetes mellitus, affecting 537 million people globally [<span>1</span>], is a chronic metabolic disorder with well-documented “legacy effects” of early hyperglycemia on complications that persist for decades [<span>2</span>]. The importance of early intensive glycemic control is evidenced by long-term follow-up data from the United Kingdom Prospective Diabetes Study, demonstrating that it lowers the risks of mortality and both microvascular and macrovascular complications, yielding life-long benefits [<span>3</span>].</p><p>Nevertheless, glycemic control in type 2 diabetes (T2DM) remains inadequate globally, particularly in China, where only fewer than 50% of patients achieve HbA1c < 7% [<span>4</span>]. Moreover, severe hyperglycemia at diagnosis is prevalent. A retrospective study in China showed that 44.5% of newly diagnosed patients present with HbA1c > 9% [<span>5</span>]. This fact poses a substantial challenge for achieving early and sustained glycemic control.</p><p>The traditional stepwise escalation approach, which gradually intensifies treatment in response to worsening hyperglycemia, often fails to achieve optimal glycemic control and prevent progressive β-cell dysfunction. Timely initiation of combination therapy is recommended for marked hyperglycemia. Current guidelines from the American Diabetes Association recommend combination therapy when HbA1c exceeds treatment targets by 1.5% (≥ 8.5%) and insulin for HbA1c > 10%, expecting simplifying treatment after correction of glucotoxicity [<span>6</span>]. However, because high-quality evidence is lacking, no standardized guidance could be provided. Indeed, more potent combination regimens may result in superior glycemic control. As shown in the EDICT study, a triple therapy regimen consisting of metformin, pioglitazone, and exenatide achieved HbA1c < 6.5% in 78% of participants over 3 years [<span>7</span>]. However, real-world challenges, including adherence, tolerability, and cost, limit broader implementation of combination therapy, particularly that with injectable agents [<span>8</span>].</p><p>Simplified treatment regimens have consistently been an urgent need for healthcare providers and patients. Nevertheless, as Leonardo da Vinci famously said, “Simplicity is the ultimate sophistication.” Achieving both optimal glycemic control and treatment simplification requires a shift in strategy to pay more attention to the reversibility of β-cell dysfunction in early T2DM. This requires addressing the major mechanisms of disease progression. In patients with significant hyperglycemia, glucotoxicity plays a central role in β-cell dysfunction, reducing β-cell secretory capacity through mechanisms such as triggering β-cell dedifferentiation and endoplasmic reticulum stress [<span>9, 10</span>]. Our previous studies have shown that short-term intensive insulin therapy (SIIT) effectively alleviates glucotoxicity, significantly improving β-cell function and insulin sensitivit","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-Like Peptide-1 Receptor Agonists and Anesthesia—Are We Clearer on the Correct Approach?","authors":"Zachary Bloomgarden","doi":"10.1111/1753-0407.70041","DOIUrl":"10.1111/1753-0407.70041","url":null,"abstract":"<p>A bit over a year ago, we argued in these pages against a consensus statement recommendation from the American Society of Anesthesiologists that patients taking glucagon-like peptide-1 receptor agonists (GLP-1RA) should not take these agents for 1 week before elective procedures [<span>1</span>]. We pointed out the number of medications potentially interfering with gastric motility, including opiate analgesics, anticholinergics, antidepressants, calcium channel blockers, and gastric acid suppressants, with the lack of specific requirements that such treatments be held in preparation for anesthesia and sedation [<span>1</span>]. Some institutions now require that GLP-1RA be withheld for several weeks before procedures, and indeed evidence based on drug levels suggests that “complete dissipation of the effect” would require 4–5 half-lives, although this would likely be “potentially harmful” by virtue of requiring complete reorganization of diabetes treatment for many patients [<span>2</span>].</p><p>The imposition of these guidelines on people with diabetes has burdened them with the dilemma of not using important glucose-lowering and appetite-suppressing treatments with evidence of cardiovascular, renal, hepatic, and pulmonary benefits. Has there been interim progress?</p><p>In a study of 133 patients with type 2 diabetes undergoing 192 upper endoscopies, gastric contents were present in 19% of those taking versus 5% of those not taking a GLP-1RA [<span>3</span>]. Another study of 124 patients with type 2 diabetes undergoing endoscopy found residual gastric contents in 56% versus 19% of those taking versus not taking a GLP-1RA [<span>4</span>]. A study comparing 24 824 GLP-1RA users with 18 541 sodium-glucose cotransporter-2 inhibitor users undergoing upper endoscopy, however, found similar pulmonary aspiration risks of 4.2 versus 4.3 per 1000, respectively, although endoscopy discontinuation rates were 9.8 versus 4.9 per 1000, respectively, the significantly greater risk with GLP-1RA seen only among those with BMI ≥ 30 kg/m<sup>2</sup>, which the authors speculated might be related to retained gastric contents [<span>5</span>]. A study of 274 211 outpatient upper endoscopy procedures among individuals aged 18–64 with type 2 diabetes from 2005 to 2021 compared claims for aspiration and associated pulmonary adverse events in the 14 days following upper endoscopy, highlighting the infrequency of such events, with aspiration, aspiration pneumonia, and respiratory failure occurring with frequencies of 6.8, 7.6, and 25.6 cases per 10 000 endoscopies, respectively; there was no significant difference in event rates between users of GLP1-RA and those of dipeptidyl peptidase 4 inhibitors (DPP4i), and significantly lower rates of pneumonia, respiratory failure, and hospitalization and ER visits among those using GLP-1RA compared with individuals using chronic opioids, albeit without significant changes in documented aspiration or aspiration pneumonia [<","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142851807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of associated renal risk in type 2 diabetes mellitus in the United Arab Emirates","authors":"Mustafa Jamal Ahmed, Omer Ali, Saf Naqvi, Aisha Ahmed, Waseem Omar","doi":"10.1111/1753-0407.70038","DOIUrl":"https://doi.org/10.1111/1753-0407.70038","url":null,"abstract":"<p>Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder and has become a global health challenge, projected to affect approximately 780 million people by 2045.<span><sup>1, 2</sup></span> T2DM is linked to several micro and macrovascular complications.<span><sup>3, 4</sup></span> A high prevalence of chronic kidney disease (CKD, 4%–20%) and cardiovascular disease (CVD, 6%–27%) has been observed in patients with T2DM.<span><sup>5-8</sup></span> The pathophysiological interactions among diabetes, CKD, and CVD are defined as cardiovascular–kidney–metabolic (CKM) syndrome by the American Health Association (AHA).<span><sup>9</sup></span> Managing CKM syndrome involves addressing several risk factors glycated hemoglobin (HbA1c), BP, higher low-density lipoprotein (LDL) cholesterol, body mass index (BMI), low estimated glomerular filtration rate (eGFR) and high albumin creatinine ratio (ACR).<span><sup>9-11</sup></span> Guidelines from Kidney Disease: Improving Global Outcomes (KDIGO, 2024) help in assessing the stage and severity of CKD based on eGFR and ACR.<span><sup>12</sup></span></p><p>In recent years, United Arab Emirates (UAE) has experienced an increased risk of metabolic syndromes due to a shift toward less healthy lifestyle habits.<span><sup>13, 14</sup></span> The present study aimed to explore the prevalence of T2DM-associated renal risk in UAE population. The risk factors and T2DM treatment modalities were also evaluated in high and very high-risk patients. This cross-sectional study collected data from 33 524 T2DM patients aged ≥18 years registered at the Imperial College Diabetic Center across the seven Emirates. Critical parameters such as age, sex, BMI, systolic and diastolic BP, eGFR, ACR, Hb1Ac, and LDL were collected from the patients. Additionally, data on treatment modalities, SGLT-2, GLP-1, RASi, and Finerenone, for treating T2DM were recorded. Statistical analyses were performed to understand the stage of CKD based on KDIGO heat map to find frequency and percentage of patients at high and very high-risk of CKD.</p><p>The study highlighted prevalence of T2DM (53.43%) in the Emirati population and was found to be concurrent with earlier studies.<span><sup>15-17</sup></span> Among these patients, the overall prevalence of renal risk was segregated based on eGFR and ACR values (KDIGO heat map). As per eGFR values, 24.25% of population had eGFR values between 60 and 89, while 7.74% T2DM patients exhibited eGFR values less than 60, indicating increased renal risk (Figure 1A). These results are consistent with earlier studies in China, Italy, and United States.<span><sup>18-20</sup></span> The Albuminuria (ACR values between 3.5 and 30) was observed in approximately 18% of T2DM patients while severely increased albuminuria (ACR between 30 and 1000) was observed in 5.23% of T2DM patients (Figure 1B). Similar percentage of albuminuria patients has been reported in earlier studies.<span><sup>21, 22</sup></span> The patients at","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142851290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autophagy modulators in type 2 diabetes: A new perspective","authors":"Ayah Talal Zaidalkilani,&nbsp;Hayder M. Al-kuraishy,&nbsp;Esraa H. Fahad,&nbsp;Ali I. Al-Gareeb,&nbsp;Yaser Hosny Ali Elewa,&nbsp;Mahmoud Hosny Zahran,&nbsp;Athanasios Alexiou,&nbsp;Marios Papadakis,&nbsp;Ammar AL-Farga,&nbsp;Gaber El-Saber Batiha","doi":"10.1111/1753-0407.70010","DOIUrl":"10.1111/1753-0407.70010","url":null,"abstract":"<p>Type 2 diabetes (T2D) is a chronic metabolic disorder caused by defective insulin signaling, insulin resistance, and impairment of insulin secretion. Autophagy is a conserved lysosomal-dependent catabolic cellular pathway involved in the pathogenesis of T2D and its complications. Basal autophagy regulates pancreatic β-cell function by enhancing insulin release and peripheral insulin sensitivity. Therefore, defective autophagy is associated with impairment of pancreatic β-cell function and the development of insulin rersistance (IR). However, over-activated autophagy increases apoptosis of pancreatic β-cells leading to pancreatic β-cell dysfunction. Hence, autophagy plays a double-edged sword role in T2D. Therefore, the use of autophagy modulators including inhibitors and activators may affect the pathogenesis of T2D. Hence, this review aims to clarify the potential role of autophagy inhibitors and activators in T2D.</p><p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142826526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"November 11, 2024, T1DX-QI Learning Session, Journal of Diabetes Abstracts","authors":"","doi":"10.1111/1753-0407.70032","DOIUrl":"10.1111/1753-0407.70032","url":null,"abstract":"","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 S1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to “Commentary on factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real-world data from the German/Austrian DPV registry”","authors":"Alexander J. Eckert,&nbsp;Stefan Zimny,&nbsp;Marcus Altmeier,&nbsp;Ana Dugic,&nbsp;Anton Gillessen,&nbsp;Latife Bozkurt,&nbsp;Gabriele Götz,&nbsp;Wolfram Karges,&nbsp;Frank J. Wosch,&nbsp;Stephan Kress,&nbsp;Reinhard W. Holl,&nbsp;for the DPV-Wiss-Initiative","doi":"10.1111/1753-0407.70036","DOIUrl":"https://doi.org/10.1111/1753-0407.70036","url":null,"abstract":"&lt;p&gt;We thank the authors for this commentary and for considering our manuscript a valuable contribution to the topic of diabetic foot ulcers and lower limb amputations in adults with type 1 or type 2 diabetes.&lt;/p&gt;&lt;p&gt;Regarding the capturing of biomarkers and inflammatory markers, we want to point out that the listed parameters, namely, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), the systemic inflammation response index (SIRI), and the systemic immune-inflammation index (SII) are subject to a wide range of fluctuation. A blood sedimentation rate is nowadays rarely used in everyday practice, especially in outpatient care, as this marker is very unspecific. Of the above mentioned parameters, CRP alone is an acceptable predictor of systemic inflammation. The other indices or blood parameters from the differential blood count are not used clinically, neither in outpatient foot clinics nor in private practice, their relevance for treatment decisions is questionable. Further, not all of the included clinics and praxes in this study are specialized foot centres, and this is meaningful, since we want to provide data from everyday clinical practice in a real-world setting. CRP might have been available in some, but not in all individuals included. The strength of our study on registry data is not to provide information on inconsistently raised parameters, but rather to provide well-documented parameters and comorbidities that are available is most of the treated individuals as it is reflected in the real-world care of these people. We agree, that some comorbidities might have been additionally investigated, but we wanted to focus on the most relevant and best captured information, in order to include as many individuals as possible in our analysis.&lt;/p&gt;&lt;p&gt;We agree, that there are some limitations in our study regarding wound classification. Again, we could only use what is routinely captured and documented in representative German-speaking clinics and practices. Nevertheless, the Wagner wound classification is internationally accepted and widely used in Germany and in other countries.&lt;/p&gt;&lt;p&gt;Regarding the duration of DFU, we want to point out, that this consideration was the main reason, why we did not use regression models solely, but additionally did longitudinal Kaplan–Meyer analysis and calculated hazard ratios for amputations in order to include this time factor in the analysis. We also excluded individuals with amputations within a very short time (100 days) after the initial documentation of DFU for this specific analysis.&lt;/p&gt;&lt;p&gt;Lastly, we totally agree that Charcot foot is a risk factor for DFU, but the incidence of Charcot foot is below 1% in people with diabetes&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and would therefore be an independent topic for analysis.&lt;/p&gt;&lt;p&gt;In conclusion, we want to thank the authors for the critical and valuable response to our manuscript, and we w","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142764159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on “Factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real-world data from the German/Austrian DPV registry”","authors":"Mostafa Javanian,&nbsp;Mohammad Barary,&nbsp;Soheil Ebrahimpour","doi":"10.1111/1753-0407.70035","DOIUrl":"https://doi.org/10.1111/1753-0407.70035","url":null,"abstract":"&lt;p&gt;We read with great interest the article “Factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real-world data from the German/Austrian DPV registry”,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; published in your esteemed journal. The study provides an essential contribution to understanding the risk factors for diabetic foot ulcers (DFUs) and lower limb amputations, using real-world data from a significant cohort of adults with type 1 (T1D) and type 2 diabetes (T2D). The authors rightly highlight that sex, body height, and complications related to diabetes are associated with an elevated risk of DFUs in both T1D and T2D. Additionally, the potential for improved glycemic control and lipid management in T1D, alongside reduced smoking and alcohol consumption in T2D, is suggested as an intervention to mitigate these risks.&lt;/p&gt;&lt;p&gt;We commend the authors' comprehensive investigation. However, several methodological limitations warrant further discussion and consideration.&lt;/p&gt;&lt;p&gt;First, while the study incorporates key laboratory factors, selecting biomarkers appears somewhat restricted. Expanding the scope to include additional inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), the systemic inflammation response index (SIRI), and the systemic immune-inflammation index (SII) would provide a more nuanced understanding of systemic inflammation's role in the development of DFUs and subsequent amputations.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; These markers have been shown to correlate with adverse outcomes in diabetic complications, yet they were not accounted for in this study. Including them would enhance the predictive model and potentially allow for more targeted interventions. Relevant comorbidities were either underexplored or omitted altogether. For example, cerebrovascular disease, malignancies, and psychological factors—each of which can significantly impact wound healing and overall morbidity—were not sufficiently addressed. A deeper exploration of these comorbidities could offer valuable insights into multifactorial risks associated with DFUs and amputations.&lt;/p&gt;&lt;p&gt;Third, a critical factor overlooked in the study is the duration of DFUs and their correlation with the likelihood of amputation. Wound chronicity is a well-established risk for poor outcomes, and incorporating this variable into the analysis would improve the understanding of which ulcers are most likely to lead to amputation. Additionally, the study could benefit from a more detailed classification of wounds based on their anatomical location (e.g., under the metatarsal heads, heel, or malleoli). Certain anatomical regions are more prone to complications, and this granularity could improve the precision of risk stratification.&lt;/p&gt;&lt;p&gt;Lastly, the role of foot deformities, particularly Charcot foot, in increasing the risk for DFUs and amp","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142764191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension approaches and recent SGLT2i studies","authors":"Zachary Bloomgarden","doi":"10.1111/1753-0407.70034","DOIUrl":"https://doi.org/10.1111/1753-0407.70034","url":null,"abstract":"&lt;p&gt;Several recent studies remind us to more fully address hypertension, suggest potentially useful approaches, point out the particular benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2i), and indicate other effects of these agents.&lt;/p&gt;&lt;p&gt;In a randomized controlled trial (RCT) of 12 821 hypertensive persons with type 2 diabetes (T2D) having cardiovascular disease (CVD), or chronic kidney disease (CKD), or with 2 or more CVD risk factors, assigned to systolic blood pressure (SBP) goals of 120 vs 140, SBP at 1 year was 121.6 vs 133.2 mmHg, respectively, with the composite endpoint of stroke, myocardial infarction, heart failure or CV death occurring 21% less frequently in those assigned to the lower SBP target. Stroke and new onset albuminuria were reduced 21% and 13%, respectively, and similar benefit was seen regardless of age, sex, prior CVD or CKD, HbA1c, or duration of diabetes or of hypertension.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In a meta-analysis of seven hypertension (HBP) trials lasting 3.1–4.7 years, comparing SBP goals of &lt;130 versus ≥130 mmHg among 72 138 participants with a mean age of 62–68, achieveing an SBP of &lt;130 mm Hg was associated with a reduction in major CVD risk by 22%, mortality by 11%, stroke by 26%, coronary heart disease (CHD), including myocardial infarction, by 17%, heart failure (HF) by 31%, and CV mortality by 27%. In four trials, randomization to SBP &lt;120 versus &lt;140 reduced CVD 18%, mortality 15%, stroke 19%, CHD 13%, HF 24%, and CV mortality 28%. Rates of hypotension, syncope, injurious falls, electrolyte abnormalities, and acute kidney injury were higher with lower BP targets, but these events remained infrequent, with the number needed to harm 508 for hypotension and 3222 for electrolyte abnormality. Subgroup outcomes were reported inconsistently, so that differences in outcome could not be ascertained by diabetes, age, or CVD risk.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Given these results, it is sobering to look at achieved levels of BP control. In the combined dataset from The National Health and Nutrition Examination Survey (NHANES) of 2017–2018 and 2019–2020, among 7328 persons age ≥18, 3129 had SBP ≥130 or diastolic BP (DBP) ≥80, of whom 58% were unaware of HBP. Only 825 had a history of HBP with SBP &lt;130. Of those with known HBP, 18% had an SBP of 130–139 or DBP of 80–89 with low atherosclerotic cardiovascular disease (ASCVD) risk, meeting the criteria for lifestyle modification, but 82% met criteria for lifestyle plus additional medication, with 26% having a history of CVD, 21% having CVD, and 21% having diabetes. NHANES is designed to allow estimates of the US population, showing 120 million people in the United States with HBP, 35 million of whom meet the criteria for additional antihypertensive medication, which the authors suggest “may reflect the slow adoption of the updated guidelines.”&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Similarly, analysis of NHANES 2021-2023 showed that 47.7% of adults","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 11","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacteriophages and their potential for treatment of metabolic diseases","authors":"Youpeng Deng,&nbsp;Shouwei Jiang,&nbsp;Hanyu Duan,&nbsp;Haonan Shao,&nbsp;Yi Duan","doi":"10.1111/1753-0407.70024","DOIUrl":"https://doi.org/10.1111/1753-0407.70024","url":null,"abstract":"<p>Recent advances highlight the role of gut virome, particularly phageome, in metabolic disorders such as obesity, type 2 diabetes mellitus, metabolic dysfunction-associated fatty liver disease, and cardiovascular diseases, including hypertension, stroke, coronary heart disease, and hyperlipidemia. While alterations in gut bacteria are well-documented, emerging evidence suggests that changes in gut viruses also contribute to these disorders. Bacteriophages, the most abundant gut viruses, influence bacterial populations through their lytic and lysogenic cycles, potentially modulating the gut ecosystem and metabolic pathways. Phage therapy, previously overshadowed by antibiotics, is experiencing renewed interest due to rising antibiotic resistance. It offers a novel approach to precisely edit the gut microbiota, with promising applications in metabolic diseases. In this review, we summarize recent discoveries about gut virome in metabolic disease patients, review preclinical and clinical studies of phage therapy on metabolic diseases as well as the breakthroughs and currently faced problems and concerns.</p><p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 11","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long noncoding RNAs and metabolic memory associated with continued progression of diabetic retinopathy","authors":"Jay Kumar,&nbsp;Pooja Malaviya,&nbsp;Renu A. Kowluru","doi":"10.1111/1753-0407.70009","DOIUrl":"https://doi.org/10.1111/1753-0407.70009","url":null,"abstract":"<p>Progression of diabetic retinopathy resists arrest even after institution of intensive glycemic control, suggesting a “metabolic memory” phenomenon, but the mechanism responsible for this phenomenon is still elusive. Gene expression and biological processes can also be regulated by long noncoding RNAs (LncRNAs), the RNAs with &gt;200 nucleotides and no open reading frame for translation, and several LncRNAs are aberrantly expressed in diabetes. Our aim was to identify retinal LncRNAs that fail to reverse after termination of hyperglycemia. Microarray analysis was performed on retinal RNA from streptozotocin-induced diabetic rats in poor glycemic control for 8 months, followed by in good glycemic control (blood glucose &gt;400 mg/dL), or for 4 months, with four additional months of good glycemic control (blood glucose &lt;150 mg/dL). Differentially expressed LncRNAs and mRNAs were identified through Volcano filtering, and their functions were predicted using gene ontology and pathway enrichment analyses. Compared with age-matched normal rats, rats in continuous poor glycemic control had &gt;1479 differentially expressed LncRNAs (710 downregulated, 769 upregulated), and among those, 511 common LncRNAs had similar expression in Diab and Rev groups (139 downregulated, 372 upregulated). Gene Ontology/pathway analysis identified limited LncRNAs in biological processes, but analysis based on biological processes/molecular function revealed &gt;350 genes with similar expression in Diab and Rev groups; these genes were mainly associated with stress response, cell death, mitochondrial damage and cytokine production. Thus, identifying retinal LncRNAs and their gene targets that do not benefit from termination of hyperglycemia have potential to serve as therapeutic targets to slow down the progression of diabetic retinopathy.</p><p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 11","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}