Chan Soon Park, Jaewon Choi, Soongu Kwak, Seung-Pyo Lee, Hyung-Kwan Kim, Yong-Jin Kim, Soo Heon Kwak, Jun-Bean Park
{"title":"Association between personality, lifestyle behaviors, and cardiovascular diseases in type 2 diabetes mellitus: a population-based cohort study of UK Biobank data","authors":"Chan Soon Park, Jaewon Choi, Soongu Kwak, Seung-Pyo Lee, Hyung-Kwan Kim, Yong-Jin Kim, Soo Heon Kwak, Jun-Bean Park","doi":"10.1136/bmjdrc-2024-004244","DOIUrl":"https://doi.org/10.1136/bmjdrc-2024-004244","url":null,"abstract":"Introduction Various strategies aim to better assess risks and refine prevention for patients with type 2 diabetes mellitus (T2DM), who vary in cardiovascular disease (CVD) risk. However, the prognostic value of personality and its association with lifestyle factors remain elusive. Research design and methods We identified 8794 patients with T2DM from the UK Biobank database between 2006 and 2010 and followed them up until the end of 2021. We assessed personality traits using the Big Five proxies derived from UK Biobank data: sociability, warmth, diligence, curiosity, and nervousness. Healthy lifestyle behaviors were determined from information about obesity, smoking status, and physical activity. The primary outcome was a composite of incident CVD, including myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), and heart failure (HF). Results During a median follow-up of 13.6 years, a total of 2110 patients experienced CVDs. Among personality traits, diligence was significantly associated with a reduced risk of primary and secondary outcomes. The adjusted HRs with 95% CIs were: composite CVD, 0.93 (0.89–0.97); MI 0.90 (0.82–1.00); IS 0.83 (0.74–0.94); AF 0.92 (0.85–0.98); HF 0.84 (0.76–0.91). Healthy lifestyle behaviors significantly reduced the risk of composite CVDs in groups with high and low diligence. The findings of a structural equation model showed that diligence directly affected the risk of the primary outcome or indirectly by modifying lifestyle behaviors. Conclusion This study revealed which personality traits can influence CVD risk during T2DM and how patients might benefit from adopting healthy lifestyle behaviors in relation to personality. Data are available upon reasonable request. The data used in the present research are available via a direct application to the UK Biobank (<http://www.ukbiobank.ac.uk/register-apply/>) and this research was conducted with approved access to UK Biobank data under application ID 91312. All other data supporting the research findings are available within the article and its supplementary information files and from the corresponding author upon reasonable request.","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"59 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pall Karlsson, Marie Balle Sjogaard, Karoline Schousboe, Hatice Isik Mizrak, Huda Kufaishi, Troels Staehelin Jensen, Jens Randel Nyengaard, Christian Stevns Hansen, Knud Bonnet Yderstræde, Christian Selmer Buhl
{"title":"Assessment of neuropathy subtypes in type 1 diabetes.","authors":"Pall Karlsson, Marie Balle Sjogaard, Karoline Schousboe, Hatice Isik Mizrak, Huda Kufaishi, Troels Staehelin Jensen, Jens Randel Nyengaard, Christian Stevns Hansen, Knud Bonnet Yderstræde, Christian Selmer Buhl","doi":"10.1136/bmjdrc-2024-004289","DOIUrl":"10.1136/bmjdrc-2024-004289","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic polyneuropathy (DPN), a common complication of diabetes, can manifest as small, large, or mixed fiber neuropathy (SFN, LFN, and MFN, respectively), depending on the type of fibers involved. Despite evidence indicating small fiber involvement prior to large fiber involvement in type 1 diabetes mellitus (T1DM)-associated DPN, no evidence has been produced to determine the more prevalent subtype. We aim to determine the more prevalent type of nerve fiber damage-SFN, LFN, and MFN-in T1DM-associated DPN, both with and without pain.</p><p><strong>Research design and methods: </strong>In this cross-sectional study, participants (n=216) were divided into controls; T1DM; T1DM with non-painful DPN (NP-DPN); and T1DM with painful DPN (P-DPN). DPN was further subgrouped based on neuropathy severity. The more prevalent type of fiber damage was determined applying small and large fiber-specific tests and three diagnostic models: model 1 (≥1 abnormal test); model 2 (≥2 abnormal tests); and model 3 (≥3 abnormal tests).</p><p><strong>Results: </strong>MFN showed the highest prevalence in T1DM-associated DPN. No differences in neuropathy subtype were found between NP-DPN and P-DPN. DPN, with prevalent SFN plateaus between models 2 and 3. All models showed increased prevalence of MFN according to DPN severity. Model 3 showed increased DPN with prevalent LFN in early neuropathy. DPN with prevalent SFN demonstrated a similar, but non-significant pattern.</p><p><strong>Conclusions: </strong>DPN primarily manifests as MFN in T1DM, with no differentiation between NP-DPN and P-DPN. Additionally, we propose model 2 as an initial criterion for diagnosing DPN with a more prevalent SFN subtype in T1DM. Lastly, the study suggests that in mild stages of DPN, one type of nerve fiber (either small or large) is more susceptible to damage.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11261698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723068","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}
Xinfang Xiao, Liu Wu, Juan Deng, Junfen Li, Yiqing Zhou, Sicheng He, Faqi Li, Yan Wang
{"title":"Effects of insonification on repairing the renal injury of diabetic nephropathy rats.","authors":"Xinfang Xiao, Liu Wu, Juan Deng, Junfen Li, Yiqing Zhou, Sicheng He, Faqi Li, Yan Wang","doi":"10.1136/bmjdrc-2024-004146","DOIUrl":"10.1136/bmjdrc-2024-004146","url":null,"abstract":"<p><strong>Introduction: </strong>Prolonged hyperglycemia in diabetes mellitus can result in the development of diabetic nephropathy (DN) and increase the susceptibility to kidney failure. Low-intensity pulsed ultrasound (LIPUS) is a non-invasive modality that has demonstrated effective tissue repair capabilities. The objective of this study was to showcase the reparative potential of LIPUS on renal injury at both animal and cellular levels, while also determining the optimal pulse length (PL).</p><p><strong>Research design and methods: </strong>We established a rat model of DN, and subsequently subjected the rats' kidneys to ultrasound irradiation (PL=0.2 ms, 10 ms, 20 ms). Subsequently, we assessed the structural and functional changes in the kidneys. Additionally, we induced podocyte apoptosis and evaluated its occurrence following ultrasound irradiation.</p><p><strong>Results: </strong>Following irradiation, DN rats exhibited improved mesangial expansion and basement membrane thickening. Uric acid expression increased while urinary microalbumin, podocalyxin in urine, blood urea nitrogen, and serum creatinine levels decreased (p<0.05). These results suggest that the optimal PL was 0.2 ms. Using the optimal PL further demonstrated the reparative effect of LIPUS on DN, it was found that LIPUS could reduce podococyte apoptosis and alleviate kidney injury. Metabolomics revealed differences in metabolites including octanoic acid and seven others and western blot results showed a significant decrease in key enzymes related to lipolysis (p<0.05). Additionally, after irradiating podocytes with different PLs, we observed suppressed apoptosis (p<0.05), confirming the optimal PL as 0.2 ms.</p><p><strong>Conclusions: </strong>LIPUS has been demonstrated to effectively restore renal structure and function in DN rats, with an optimal PL of 0.2 ms. The mechanism underlying the alleviation of DN by LIPUS is attributed to its ability to improve lipid metabolism disorder. These findings suggest that LIPUS may provide a novel perspective for future research in this field.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11261688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723069","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}
Martin F Overbeek, Femke Rutters, Max Nieuwdorp, Mark Davids, Irene van Valkengoed, Henrike Galenkamp, Bert-Jan van den Born, Joline W J Beulens, Mirthe Muilwijk
{"title":"Plasma sphingolipids mediate the association between gut microbiome composition and type 2 diabetes risk in the HELIUS cohort: a case-cohort study.","authors":"Martin F Overbeek, Femke Rutters, Max Nieuwdorp, Mark Davids, Irene van Valkengoed, Henrike Galenkamp, Bert-Jan van den Born, Joline W J Beulens, Mirthe Muilwijk","doi":"10.1136/bmjdrc-2024-004180","DOIUrl":"10.1136/bmjdrc-2024-004180","url":null,"abstract":"<p><strong>Introduction: </strong>The association between the gut microbiome and incident type 2 diabetes (T2D) is potentially partly mediated through sphingolipids, however these possible mediating mechanisms have not been investigated. We examined whether sphingolipids mediate the association between gut microbiome and T2D, using data from the Healthy Life in an Urban Setting study.</p><p><strong>Research design and methods: </strong>Participants were of Dutch or South-Asian Surinamese ethnicity, aged 18-70 years, and without T2D at baseline. A case-cohort design (subcohort n=176, cases incident T2D n=36) was used. The exposure was measured by 16S rRNA sequencing (gut microbiome) and mediator by targeted metabolomics (sphingolipids). Dimensionality reduction was achieved by principle component analysis and Shannon diversity. Cox regression and procrustes analyses were used to assess the association between gut microbiome and T2D and sphingolipids and T2D, and between gut microbiome and sphingolipids, respectively. Mediation was tested familywise using mediation analysis with permutation testing and Bonferroni correction.</p><p><strong>Results: </strong>Our study confirmed associations between gut microbiome and T2D and sphingolipids and T2D. Additionally, we showed that the gut microbiome was associated with sphingolipids. The association between gut microbiome and T2D was partly mediated by a sphingolipid principal component, which represents a dominance of ceramide species over more complex sphingolipids (HR 1.17; 95% CI 1.08 to 1.28; proportional explained 48%), and by Shannon diversity (HR 0.97; 95% CI 0.95 to 0.99; proportional explained 24.8%).</p><p><strong>Conclusions: </strong>These data suggest that sphingolipids mediate the association between microbiome and T2D risk. Future research is needed to confirm observed findings and elucidate causality on a molecular level.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11261679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723070","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}
Ling Ren, Jiao Xia, Chang Huang, Yun Bai, Jin Yao, Dan Li, Biao Yan
{"title":"Single-cell transcriptomic analysis reveals the antiangiogenic role of Mgarp in diabetic retinopathy.","authors":"Ling Ren, Jiao Xia, Chang Huang, Yun Bai, Jin Yao, Dan Li, Biao Yan","doi":"10.1136/bmjdrc-2024-004189","DOIUrl":"10.1136/bmjdrc-2024-004189","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic retinopathy (DR) is a common vascular complication of diabetes mellitus and a leading cause of vision loss worldwide. Endothelial cell (EC) heterogeneity has been observed in the pathogenesis of DR. Elucidating the underlying mechanisms governing EC heterogeneity may provide novel insights into EC-specific therapies for DR.</p><p><strong>Research design and methods: </strong>We used the single-cell data from the Gene Expression Omnibus database to explore EC heterogeneity between diabetic retinas and non-diabetic retinas and identify the potential genes involved in DR. CCK-8 assays, EdU assays, transwell assays, and tube formation assays were conducted to determine the role of the identified gene in angiogenic effects.</p><p><strong>Results: </strong>Our analysis identified three distinct EC subpopulations in retinas and revealed that Mitochondria-localized glutamic acid-rich protein (<i>Mgarp</i>) gene is potentially involved in the pathogenesis of DR. Silencing of Mgarp significantly suppressed the proliferation, migration, and tube formation capacities in retinal endothelial cells.</p><p><strong>Conclusions: </strong>This study not only offers new insights into transcriptomic heterogeneity and pathological alteration of retinal ECs but also holds the promise to pave the way for antiangiogenic therapy by targeting EC-specific gene.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141625987","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}
Rebecca L Thomson, Helena Oakey, Aveni Haynes, Maria E Craig, Leonard C Harrison, John M Wentworth, Amanda Anderson, Pat Ashwood, Simon Barry, Bek Brittain, James D Brown, Peter G Colman, Elizabeth A Davis, Emma Hamilton-Williams, Dao Huynh, Tony Huynh, Ki-Wook Kim, Kelly J McGorm, Grant Morahan, William Rawlinson, Richard O Sinnott, Georgia Soldatos, Jason A Tye-Din, Peter J Vuillermin, Megan A S Penno, Jennifer J Couper
{"title":"Environmental Determinants of Islet Autoimmunity (ENDIA) longitudinal prospective pregnancy to childhood cohort study of Australian children at risk of type 1 diabetes: parental demographics and birth information.","authors":"Rebecca L Thomson, Helena Oakey, Aveni Haynes, Maria E Craig, Leonard C Harrison, John M Wentworth, Amanda Anderson, Pat Ashwood, Simon Barry, Bek Brittain, James D Brown, Peter G Colman, Elizabeth A Davis, Emma Hamilton-Williams, Dao Huynh, Tony Huynh, Ki-Wook Kim, Kelly J McGorm, Grant Morahan, William Rawlinson, Richard O Sinnott, Georgia Soldatos, Jason A Tye-Din, Peter J Vuillermin, Megan A S Penno, Jennifer J Couper","doi":"10.1136/bmjdrc-2024-004130","DOIUrl":"10.1136/bmjdrc-2024-004130","url":null,"abstract":"<p><strong>Introduction: </strong>The Environmental Determinants of Islet Autoimmunity (ENDIA) Study is an ongoing Australian prospective cohort study investigating how modifiable prenatal and early-life exposures drive the development of islet autoimmunity and type 1 diabetes (T1D) in children. In this profile, we describe the cohort's parental demographics, maternal and neonatal outcomes and human leukocyte antigen (HLA) genotypes.</p><p><strong>Research design and methods: </strong>Inclusion criteria were an unborn child, or infant aged less than 6 months, with a first-degree relative (FDR) with T1D. The primary outcome was persistent islet autoimmunity, with children followed until a T1D diagnosis or 10 years of age. Demographic data were collected at enrollment. Lifestyle, clinical and anthropometric data were collected at each visit during pregnancy and clinical pregnancy and birth data were verified against medical case notes. Data were compared between mothers with and without T1D. HLA genotyping was performed on the ENDIA child and all available FDRs.</p><p><strong>Results: </strong>The final cohort comprised 1473 infants born to 1214 gestational mothers across 1453 pregnancies, with 80% enrolled during pregnancy. The distribution of familial T1D probands was 62% maternal, 28% paternal and 11% sibling. The frequency of high-risk HLA genotypes was highest in T1D probands, followed by ENDIA infants, and lowest among unaffected family members. Mothers with T1D had higher rates of pregnancy complications and perinatal intervention, and larger babies of shorter gestation. Parent demographics were comparable to the Australian population for age, parity and obesity. A greater percentage of ENDIA parents were Australian born, lived in a major city and had higher socioeconomic advantage and education.</p><p><strong>Conclusions: </strong>This comprehensive profile provides the context for understanding ENDIA's scope, methodology, unique strengths and limitations. Now fully recruited, ENDIA will provide unique insights into the roles of early-life factors in the development of islet autoimmunity and T1D in the Australian environment.</p><p><strong>Trial registration number: </strong>ACTRN12613000794707.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141625986","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}
Rebecka Renklint, Youssef Chninou, Martin Heni, Andreas Fritsche, Hans-Ulrich Haering, Robert Wagner, Julia Otten
{"title":"Surrogate measures of first-phase insulin secretion versus reference methods intravenous glucose tolerance test and hyperglycemic clamp: a systematic review and meta-analyses.","authors":"Rebecka Renklint, Youssef Chninou, Martin Heni, Andreas Fritsche, Hans-Ulrich Haering, Robert Wagner, Julia Otten","doi":"10.1136/bmjdrc-2024-004256","DOIUrl":"10.1136/bmjdrc-2024-004256","url":null,"abstract":"<p><strong>Introduction: </strong>In this systematic review, we investigated the diagnostic accuracy of surrogate measures of insulin secretion based on fasting samples and the oral glucose tolerance test (OGTT). The first phase of insulin secretion was calculated using two gold standard methods; the hyperglycemic clamp (HGC) test and intravenous glucose tolerance test (IVGTT).</p><p><strong>Research design and methods: </strong>We conducted searches in the PubMed, Cochrane Central, and Web of Science databases, the last of which was conducted at the end of June 2021. Studies were included that measured first-phase insulin secretion in adults using both a gold-standard reference method (either HGC or IVGTT) and one or more surrogate measures from either fasting samples, OGTT or a meal-tolerance test. QUADAS-2, a revised tool for the quality assessment of diagnostic accuracy studies, was used for quality assessment. Random-effects meta-analyses were performed to examine the correlation between first-phase measured with gold standard and surrogate methods.</p><p><strong>Results: </strong>A total of 33 articles, encompassing 5362 individuals with normal glucose tolerance, pre-diabetes or type 2 diabetes, were included in our systematic review. Homeostatic model assessment (HOMA)-beta and Insulinogenic Index 30 (IGI(30)) were the surrogate measures validated in the largest number of studies (17 and 13, respectively). HOMA-beta's pooled correlation to the reference methods was 0.48 (95% CI 0.40 to 0.56) The pooled correlation of IGI to the reference methods was 0.61 (95% CI 0.54 to 0.68). The surrogate measures with the highest correlation to the reference methods were Kadowaki (0.67 (95% CI 0.61 to 0.73)) and Stumvoll's first-phase secretion (0.65 (95% CI 0.58 to 0.71)), both calculated from an OGTT.</p><p><strong>Conclusions: </strong>Surrogate measures from the first 30 min of an OGTT capture the first phase of insulin secretion and are a good choice for epidemiological studies. HOMA-beta has a moderate correlation to the reference methods but is not a measure of the first phase specifically.</p><p><strong>Prospero registration number: </strong>The meta-analysis was registered at PROSPERO (Id: CRD42020169064) before inclusion started.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141625988","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}
Akshata Chaugule, Kyra Howard, Donald C Simonson, Marie E McDonnell, Rajesh Garg, Geetha Gopalakrishnan, Joanna Mitri, Jasmin Lebastchi, Nadine E Palermo, Gregory Westcott, Ruth S Weinstock
{"title":"Predictors of readmission and mortality in adults with diabetes or stress hyperglycemia after initial hospitalization for COVID-19.","authors":"Akshata Chaugule, Kyra Howard, Donald C Simonson, Marie E McDonnell, Rajesh Garg, Geetha Gopalakrishnan, Joanna Mitri, Jasmin Lebastchi, Nadine E Palermo, Gregory Westcott, Ruth S Weinstock","doi":"10.1136/bmjdrc-2024-004167","DOIUrl":"10.1136/bmjdrc-2024-004167","url":null,"abstract":"<p><strong>Introduction: </strong>We previously reported predictors of mortality in 1786 adults with diabetes or stress hyperglycemia (glucose>180 mg/dL twice in 24 hours) admitted with COVID-19 from March 2020 to February 2021 to five university hospitals. Here, we examine predictors of readmission.</p><p><strong>Research design and methods: </strong>Data were collected locally through retrospective reviews of electronic medical records from 1786 adults with diabetes or stress hyperglycemia who had a hemoglobin A1c (HbA1c) test on initial admission with COVID-19 infection or within 3 months prior to initial admission. Data were entered into a Research Electronic Data Capture (REDCap) web-based repository, and de-identified. Descriptive data are shown as mean±SD, per cent (%) or median (IQR). Student's t-test was used for comparing continuous variables with normal distribution and Mann-Whitney U test was used for data not normally distributed. X<sup>2</sup> test was used for categorical variable.</p><p><strong>Results: </strong>Of 1502 patients who were alive after initial hospitalization, 19.4% were readmitted; 90.3% within 30 days (median (IQR) 4 (0-14) days). Older age, lower estimated glomerular filtration rate (eGFR), comorbidities, intensive care unit (ICU) admission, mechanical ventilation, diabetic ketoacidosis (DKA), and longer length of stay (LOS) during the initial hospitalization were associated with readmission. Higher HbA1c, glycemic gap, or body mass index (BMI) were not associated with readmission. Mortality during readmission was 8.0% (n=23). Those who died were older than those who survived (74.9±9.5 vs 65.2±14.4 years, p=0.002) and more likely had DKA during the first hospitalization (p<0.001). Shorter LOS during the initial admission was associated with ICU stay during readmission, suggesting that a subset of patients may have been initially discharged prematurely.</p><p><strong>Conclusions: </strong>Understanding predictors of readmission after initial hospitalization for COVID-19, including older age, lower eGFR, comorbidities, ICU admission, mechanical ventilation, statin use and DKA but not HbA1c, glycemic gap or BMI, can help guide treatment approaches and future research in adults with diabetes.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 3","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466139","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}
Thiago Fraga Napoli, Ramon V Cortez, Luiz Gustavo Sparvoli, Carla R Taddei, Joao Eduardo Nunes Salles
{"title":"Unveiling contrasts in microbiota response: A1c control improves dysbiosis in low-A1c T2DM, but fails in high-A1c cases-a key to metabolic memory?","authors":"Thiago Fraga Napoli, Ramon V Cortez, Luiz Gustavo Sparvoli, Carla R Taddei, Joao Eduardo Nunes Salles","doi":"10.1136/bmjdrc-2023-003964","DOIUrl":"10.1136/bmjdrc-2023-003964","url":null,"abstract":"<p><strong>Introduction: </strong>Type 2 diabetes mellitus (T2DM) is associated with dysbiosis in the gut microbiota (MB). Individually, each medication appears to partially correct this. However, there are no studies on the response of the MB to changes in A1c. Therefore, we investigated the MB's response to intensive glycemic control.</p><p><strong>Research design and methods: </strong>We studied two groups of patients with uncontrolled T2DM, one group with an A1c <9% (18 patients-G1) and another group with an A1c >9% (13 patients-G2), aiming for at least a 1% reduction in A1c. We collected A1c and fecal samples at baseline, 6, and 12 months. G1 achieved an average A1c reduction of 1.1%, while G2 a reduction of 3.13%.</p><p><strong>Results: </strong>G1's microbiota saw a decrease in Erysipelotrichaceae_UCG_003 and in Mollicutes order (both linked to metabolic syndrome and associated comorbidities). G2, despite having a more significant reduction in A1c, experienced an increase in the proinflammatory bacteria <i>Megasphaera</i> and <i>Acidaminococcus</i>, and only one beneficial genus, <i>Phascolarctobacterium</i>, increased, producer of butyrate.</p><p><strong>Conclusion: </strong>Despite a notable A1c outcome, G2 could not restore its MB. This seeming resistance to change, leading to a persistent inflammation component found in G2, might be part of the \"metabolic memory\" in T2DM.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 3","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466140","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}
Matevž Slivnik, Maja Navodnik Preložnik, Mojca Fir, Janja Jazbar, Nanča Čebron Lipovec, Igor Locatelli, Hélène Liette Lauzon, Vilma Urbančič Rovan
{"title":"A randomized, placebo-controlled study of chitosan gel for the treatment of chronic diabetic foot ulcers (the CHITOWOUND study).","authors":"Matevž Slivnik, Maja Navodnik Preložnik, Mojca Fir, Janja Jazbar, Nanča Čebron Lipovec, Igor Locatelli, Hélène Liette Lauzon, Vilma Urbančič Rovan","doi":"10.1136/bmjdrc-2024-004195","DOIUrl":"10.1136/bmjdrc-2024-004195","url":null,"abstract":"<p><strong>Introduction: </strong>To assess the efficacy of a chitosan-based gel (ChitoCare) for the treatment of non-healing diabetic foot ulcers (DFUs).</p><p><strong>Research design and methods: </strong>Forty-two patients with chronic DFUs were randomized to the ChitoCare or placebo gel for a 10-week treatment period and 4-week follow-up. The primary study end point was the rate of complete wound closure at week 10, presented as relative rate.</p><p><strong>Results: </strong>Thirty patients completed the 10-week treatment and 28 completed the 4-week follow-up. The ChitoCare arm achieved 16.7% complete wound closure at week 10 vs 4.2% in the placebo arm (p=0.297), 92.0% vs 37.0% median relative reduction in wound surface area from baseline at week 10 (p=0.008), and 4.62-fold higher likelihood of achieving 75% wound closure at week 10 (p=0.012). Based on the results of the Bates-Jensen Wound Assessment Tool, the wound state at week 10 and the relative improvement from the baseline were significantly better (median 20 vs 24 points, p=0.018, and median 29.8% vs 3.6%, p=0.010, respectively).</p><p><strong>Conclusions: </strong>ChitoCare gel increased the rate of the DFU healing process. Several secondary end points significantly favored ChitoCare gel.</p><p><strong>Trial registration number: </strong>NCT04178525.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 3","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442130","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}