BMJ Open Diabetes Research & Care最新文献

{"title":"Effect of flexor tendon tenotomy of the diabetic hammertoe on plantar pressure: a randomized controlled trial.","authors":"Jonas Askø Andersen, Anne Rasmussen, Susanne Engberg, Jesper Bencke, Marie Frimodt-Møller, Klaus Kirketerp-Møller, Peter Rossing","doi":"10.1136/bmjdrc-2024-004398","DOIUrl":"10.1136/bmjdrc-2024-004398","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to evaluate the effects of flexor tendon tenotomy treatment of the diabetic hammertoe deformity on plantar pressure.</p><p><strong>Research design and methods: </strong>The study was a substudy including participants from a randomized study on tenotomy treatment of diabetic hammertoes. This study was conducted between December 20, 2019 and June 22, 2021. Participants were randomized to tenotomy and standard non-surgical treatment <i>or</i> standard non-surgical treatment alone. Barefoot plantar pressure measurement was performed pre-intervention and 3 months post-intervention. Primary outcome was change in peak plantar pressure post tenotomy treatment.</p><p><strong>Results: </strong>Of the 95 participants screened in the original study, 45 (57.8% male) were included andcompleted this substudy. Of the 45 participants, 22 were randomized to intervention. The average age of participants was 65.6 ((SD±) 9.5) years and 30 (66.7%) had type 2 diabetes.The average peak plantar pressure (PPP) in toe regions of the participants in the intervention group was significantly (p<0.0001) reduced from 205.6 kPa ((Q1-Q3) 152.0-289.1) pre-intervention to 61.3 kPa (39.1-100.5) post-intervention. The average reduction in PPP of toe regions for participants in the intervention group (-145.3 kPa (-225.9 to -56.2)) was significantly (p=0.00017) higher than what was observed for participants in the control group (-1.6 kPa (-30.2 to 27.9)).</p><p><strong>Conclusion: </strong>This study found that tenotomies of the diabetic hammertoe reduces plantar pressure affecting the treated toes. This likely explains the positive effects of tenotomy treatment on diabetic foot ulcers.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 6","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779541","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":"Association between glycosuria and albuminuria in patients with type 2 diabetes from the CREDENCE trial: a mechanistic link?","authors":"Ele Ferrannini, Anna Solini, Andrea Natali","doi":"10.1136/bmjdrc-2024-004654","DOIUrl":"10.1136/bmjdrc-2024-004654","url":null,"abstract":"","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 6","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779556","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}

{"title":"Effects of concurrent aerobic and strength training in patients with type 2 diabetes: Bayesian pairwise and dose-response meta-analysis.","authors":"Han Xue, Yuehui Zou, Shijie Zhang","doi":"10.1136/bmjdrc-2024-004400","DOIUrl":"10.1136/bmjdrc-2024-004400","url":null,"abstract":"<p><p>This study aimed to investigate the effects of concurrent aerobic and strength training (CT) in patients with type 2 diabetes and determine the most effective dose of CT. From the inception of the databases to March 2024, we conducted a systematic search of four electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) to identify randomized controlled trials (RCTs) on CT intervention in patients with type 2 diabetes. Two independent authors assessed the risk of bias of the study using the Cochrane Risk of Bias Assessment Tools. Results analyzed included glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), body mass index, body fat percentage, blood pressure, and VO₂max. Pairwise and dose-response meta-analyses using Bayesian hierarchical random-effects modeling were performed to analyze the effects of CT in patients with type 2 diabetes. From the inception of the databases to March 2024, we conducted a systematic search of four electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) to identify randomized controlled trials (RCTs) on CT intervention in patients with type 2 diabetes. Two independent authors assessed the risk of bias of the study using the Cochrane Risk of Bias Assessment Tools. Results analyzed included glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), body mass index, body fat percentage, blood pressure, and VO₂max. Pairwise and dose-response meta-analyses using Bayesian hierarchical random-effects modeling were performed to analyze the effects of CT in patients with type 2 diabetes. A total of 1948 participants (935 males) were included in 23 RCTs. The male/female ratio of participants was 52/48; the mean age range was 50-65 years. The results show that CT significantly reduced HbA1c levels (MD=-0.48%, 95% CrI: -0.55 to -0.40), with some heterogeneity among different levels (SD=0.31, 95% CrI: 0.17 to 0.51), and the model converged well. Similarly, FBG levels were also significantly improved (MD=-0.48 mmol/L, 95% CrI: -0.55 to -0.40), with greater heterogeneity (SD=17.73, 95% CrI: 11.23 to 28.09). Additionally, we found a non-linear dose-response relationship between CT and HbA1c levels, with an optimal dose of 1030 METs-min/week (MD=-0.47%, 95% CrI: -0.68 to -0.26, SE=0.11). CT significantly improves several health indicators in patients with type 2 diabetes. A non-linear dose-response relationship was observed between the training dose of CT and HbA1c, and it is recommended that 270 min of moderate-intensity CT or 160 min of vigorous-intensity CT be performed weekly.PROSPERO registration number: CRD42024547119.<b>Keywords:</b> meta-analysis; concurrent aerobic and strength training.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 6","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749963","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":"Clinical utility of novel diabetes subgroups in predicting vascular complications and mortality: up to 25 years of follow-up of the HUNT Study.","authors":"Vera Vik Bjarkø, Eirin Beate Haug, Arnulf Langhammer, Paz Lopez-Doriga Ruiz, Sofia Carlsson, Kare I Birkeland, Tore Julsrud Berg, Elin Pettersen Sørgjerd, Valeriya Lyssenko, Bjørn Olav Åsvold","doi":"10.1136/bmjdrc-2024-004493","DOIUrl":"10.1136/bmjdrc-2024-004493","url":null,"abstract":"<p><strong>Introduction: </strong>Cluster analysis has previously revealed five reproducible subgroups of diabetes, differing in risks of diabetic complications. We aimed to examine the clusters' predictive ability for vascular complications as compared with established risk factors in a general adult diabetes population.</p><p><strong>Research design and methods: </strong>Participants from the second (HUNT2, 1995-1997) and third (HUNT3, 2006-2008) surveys of the Norwegian population-based Trøndelag Health Study (HUNT Study) with adult-onset diabetes were included (n=1899). To identify diabetes subgroups, we used the same variables (age at diagnosis, body mass index, HbA1c, homeostasis model assessment estimates of beta cell function and insulin resistance, and glutamic acid decarboxylase antibodies) and the same data-driven clustering technique as in previous studies. We used Cox proportional hazards models to investigate associations between clusters and risks of vascular complications and mortality. We estimated the C-index and R² to compare predictive abilities of the clusters to those of established risk factors as continuous variables. All models included adjustment for age, sex, diabetes duration and time of inclusion.</p><p><strong>Results: </strong>We reproduced five subgroups with similar key characteristics as identified in previous studies. During median follow-up of 9-13 years (differing between outcomes), the clusters were associated with different risks of vascular complications and all-cause mortality. However, in prediction models, individual established risk factors were at least as good predictors as cluster assignment for all outcomes. For example, for retinopathy, the C-index for the model including clusters (0.65 (95% CI 0.63 to 0.68)) was similar to that of HbA1c (0.65 (95% CI 0.63 to 0.68)) or fasting C-peptide (0.66 (95% CI 0.63 to 0.68)) alone. For chronic kidney disease, the C-index for clusters (0.74 (95% CI 0.72 to 0.76)) was similar to that of triglyceride/high-density lipoprotein ratio (0.74 (95% CI 0.71 to 0.76)) or fasting C-peptide (0.74 (95% CI 0.72 to 0.76)), and baseline estimated glomerular filtration rate yielded a C-index of 0.76 (95% CI 0.74 to 0.78).</p><p><strong>Conclusions: </strong>Cluster assignment did not provide better prediction of vascular complications or all-cause mortality compared with established risk factors.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 6","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692372","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":"Widening the phenotypic spectrum caused by pathogenic <i>PDX1</i> variants in individuals with neonatal diabetes.","authors":"Nicola Jeffery, Omar Al Nimri, Jayne A L Houghton, Evgenia Globa, Matthew N Wakeling, Sarah E Flanagan, Andrew T Hattersley, Kashyap Amratlal Patel, Elisa De Franco","doi":"10.1136/bmjdrc-2024-004439","DOIUrl":"10.1136/bmjdrc-2024-004439","url":null,"abstract":"<p><strong>Introduction: </strong>Biallelic <i>PDX1</i> variants are a rare cause of isolated pancreatic agenesis and neonatal diabetes (NDM) without exocrine pancreatic insufficiency, with 17 cases reported in the literature.</p><p><strong>Research design and methods: </strong>To determine the phenotypic variability caused by this rare genetic aetiology, we investigated 19 individuals with NDM resulting from biallelic disease-causing <i>PDX1</i> variants.</p><p><strong>Results: </strong>Of the 19 individuals, 8 (42%) were confirmed to have exocrine insufficiency requiring replacement therapy. Twelve individuals (63.2%) had extrapancreatic features, including 8 (42%) with conditions affecting the duodenum and/or hepatobiliary tract. Defects in duodenum development are consistent with previous <i>Pdx1</i> ablation studies in mice which showed abnormal rostral duodenum development.</p><p><strong>Conclusions: </strong>Our findings show that recessive <i>PDX1</i> variants can cause a syndromic form of NDM, highlighting the need for clinical assessment of extrapancreatic features in individuals with NDM caused by <i>PDX1</i> variants.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 6","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614520","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":"Association between RDW-SD and prognosis across glycemic status in patients with dilated cardiomyopathy.","authors":"Jiayu Feng, Yani Huang, Liyan Huang, Xuemei Zhao, Xinqing Li, Anran Xin, Chengyi Wang, Yuhui Zhang, Jian Zhang","doi":"10.1136/bmjdrc-2024-004478","DOIUrl":"10.1136/bmjdrc-2024-004478","url":null,"abstract":"<p><strong>Introduction: </strong>The prognostic significance of red cell distribution width-SD (RDW-SD) as a promising inflammatory biomarker in individuals with non-ischemic dilated cardiomyopathy (DCM) and varying glycemic status remains unexplored.</p><p><strong>Research design and methods: </strong>Patients hospitalized for DCM in Fuwai Hospital from 2006 to 2021 were retrospectively included. The primary outcome encompassed all-cause mortality and heart transplantations. The multivariable Cox regression was used to evaluate the association between RDW-SD and outcomes in the overall DCM population, and among patients with normoglycemia (NG), pre-diabetes mellitus (pre-DM) and DM.</p><p><strong>Results: </strong>Among 1,102 patients with DCM, the median age was 48 years and 23.5% were women. In the overall DCM cohort, the RDW-SD was independently associated with the primary outcome (adjusted HR 1.29, 95% CI 1.15 to 1.45, p<0.001, per SD increase). When stratifying patients with glycemic status, the RDW-SD exhibited an independent association with outcome in patients with DCM with pre-DM and DM, the adjusted HRs were 1.48 (95% CI 1.21 to 1.79, p<0.001) and 1.30 (95% CI 1.06 to 1.60, p=0.011) per SD increase, respectively. However, in patients with DCM and NG, the prognostic value of RDW-SD was insignificant, with an adjusted HR of 1.20 per SD increase (95% CI: 0.97 to 1.48, p=0.101).</p><p><strong>Conclusions: </strong>RDW-SD was independently associated with the outcome in patients with DCM with pre-DM and DM, suggesting potential individualized therapeutic targets for this subset of patients with DCM.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 6","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614464","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":"Identification of atypical pediatric diabetes mellitus cases using electronic medical records.","authors":"Marcela F Astudillo, William E Winter, Liana K Billings, Raymond Kreienkamp, Ashok Balasubramanyam, Maria J Redondo, Mustafa Tosur","doi":"10.1136/bmjdrc-2024-004471","DOIUrl":"10.1136/bmjdrc-2024-004471","url":null,"abstract":"<p><strong>Introduction: </strong>There are no established methods to identify children with atypical diabetes for further study. We aimed to develop strategies to systematically ascertain cases of atypical pediatric diabetes using electronic medical records (EMR).</p><p><strong>Research design and methods: </strong>We tested two strategies in a large pediatric hospital in the USA. Strategy 1: we designed a questionnaire to rule out typical diabetes and applied it to the EMR of 100 youth with diabetes. Strategy 2: we built three electronic queries to generate reports of three atypical pediatric diabetes phenotypes: unknown type, type 2 diabetes (T2D) diagnosed <10 years old and autoantibody-negative type 1 diabetes (AbNegT1D).</p><p><strong>Results: </strong>Strategy 1 identified six cases (6%) of atypical diabetes (mean diagnosis age=11±2.6 years, 16.6% men, 33% non-Hispanic white (NHW) and 66.6% Hispanic). Strategy 2: unknown diabetes type: n=68 (1%) out of 6676 patients with diabetes; mean diagnosis age=12.6±3.3 years, 32.8% men, 23.8% NHW, 47.6% Hispanic, 25.4% African American (AA), 3.2% other. T2D <10 years old: n=64 (6.6%) out of 1142 patients with T2D; mean diagnosis age=8.6±1.6 years, 20.3% men, 4.7% NHW, 65.6% Hispanic, 28.1% AA, 1.6% other. AbNegT1D: n=38 (5.6%) out of 680 patients with new onset T1D; mean diagnosis age=11.3±3.8 years; 57.9% men, 50% NHW, 19.4% Hispanic, 22.3% AA, 8.3% other.</p><p><strong>Conclusions: </strong>In sum, we identified 1%-6.6% of atypical diabetes cases in a pediatric diabetes population with high racial and ethnic diversity using systematic review of the EMR. Better identification of these cases using unbiased approaches may advance precision diabetes.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 6","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603419","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":"Type 2 diabetes complications in ethnic minority compared with European host populations: a systematic review and meta-analysis.","authors":"Joline W J Beulens, Felix Reichelt, Sharon Remmelzwaal, Femke Rutters, Bianca Strooij, Peter Harms, Ralph de Vries, Marieke T Blom, Karien Stronks, Mirthe Muilwijk","doi":"10.1136/bmjdrc-2024-004345","DOIUrl":"10.1136/bmjdrc-2024-004345","url":null,"abstract":"<p><p>This systematic review and meta-analysis aimed to quantify differences in type 2 diabetes (T2D) complications between ethnic minority populations and European host populations, in both cross-sectional and prospective studies. Following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, we searched multiple databases for studies (until July 1, 2024) with T2D complications as outcome. Studies were included if they compared ethnic minority populations to the host population and were conducted in Europe. T2D complications included mortality, macrovascular and microvascular complications and mental disorders. Risk of bias was assessed with the assessment tool for observational cohort and cross-sectional studies. Risk estimates were pooled using random effects models. From a total of 2901 references, 58 studies were included, comprising 805 to 1 230 410 individuals for the meta-analyzed complications. Compared with the host population, ethnic minority populations generally had a lower risk of all-cause mortality (RR 0.70 (95% CI 0.63; 0.77); I²=87%)) and macrovascular complications (RR 0.72 (95% CI 0.58; 0.88); I²=88%). South Asians, however, showed comparable risks for most macrovascular complications and a slighthly higher risk of major adverse cardiovascular events. Increased risks for microvascular complications, nephropathy and retinopathy were observed (eg, in prospective studies RR 1.50 (95% CI 1.14; 1.96); I²=86% for nephropathy). No ethnic differences were observed for mental disorders. Ethnic minority populations with T2D in Europe are generally at reduced risk of all-cause mortality and macrovascular complications, but at higher risk of nephropathy and retinopathy. Our findings may help to further identify high-risk populations and to develop guidelines and future interventions. PROSPERO registration number:PROSPERO 2022 CRD42022366854.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 6","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614478","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":"National health and economic impact of a lifestyle program to prevent type 2 diabetes mellitus in Germany: a simulation study.","authors":"Katherine Ogurtsova, Michael Laxy, Karl Emmert-Fees, Charalabos-Markos Dintsios, Ping Zhang, Andrea Icks","doi":"10.1136/bmjdrc-2024-004382","DOIUrl":"10.1136/bmjdrc-2024-004382","url":null,"abstract":"<p><strong>Introduction: </strong>To examine the long-term health and economic impact of a lifestyle diabetes prevention program in people with high risk of developing type 2 diabetes in Germany.</p><p><strong>Research design and methods: </strong>We assessed the lifetime cost-effectiveness of a 2-year pragmatic lifestyle program for preventing type 2 diabetes targeting German adults aged 35-54 and 55-74 years old with hemoglobin A1c (HbA1c) from 6.0% to 6.4%. We used the Centers for Disease Control and Prevention RTI Diabetes Cost-Effectiveness Model to run a simulation on the program effectiveness. We estimated incremental health benefits in quality-adjusted life years (QALYs) and costs using an established simulation model adapted to the German context, from a healthcare system and societal perspective. The cost-effectiveness of the program was measured by incremental cost-effectiveness ratios (ICERs) in cost per QALY. We projected the number of type 2 diabetes cases prevented by participation rate if the program was implemented nationwide.</p><p><strong>Results: </strong>The lifestyle program would result to more QALYs and higher costs. The lifetime ICERs were 14 690€ (35-54 years old) and 14 372€ (55-74 years old) from a healthcare system perspective and cost saving (ICER=-3805€) and cost-effective (ICER=4579€), respectively, from a societal perspective. A total of 10 527 diabetes cases would be prevented over lifetime if the program was offered to all eligible people nationwide and 25% of those would participate in the program.</p><p><strong>Conclusions: </strong>Implementing the lifestyle intervention for people with HbA1c from 6.0% to 6.4% could be a cost-effective at standard willingness to pay level strategy for type 2 diabetes prevention. The intervention in the younger cohort could be cost saving from a societal perspective. The successful implementation of a lifestyle-based diabetes prevention program could be an important component of a successful National Diabetes Strategy in Germany.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 5","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458047","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":"Effect of weight-maintaining ketogenic diet on glycemic control and insulin sensitivity in obese T2D subjects.","authors":"Aurora Merovci, Brittany Finley, Andrea Hansis-Diarte, Sivaram Neppala, Muhammad A Abdul-Ghani, Eugenio Cersosimo, Curtis Triplitt, Ralph A DeFronzo","doi":"10.1136/bmjdrc-2024-004199","DOIUrl":"10.1136/bmjdrc-2024-004199","url":null,"abstract":"<p><strong>Introduction: </strong>Low carbohydrate ketogenic diets have received renewed interest for the treatment of obesity and type 2 diabetes. These diets promote weight loss, improve glycemic control, and reduce insulin resistance. However, whether the improvements in glycemic control and insulin sensitivity are secondary to the weight loss or result from a direct effect of hyperketonemia is controversial.</p><p><strong>Research design and methods: </strong>29 overweight obese subjects were randomized to one of three dietary interventions for 10 days: (1) Weight-maintaining standard diet; (2) Weight-maintaining ketogenic diet; (3) Weight-maintaining ketogenic diet plus supplementation with the ketone ester of beta-hydroxybutyrate (β-OH-B), 8 g every 8 hours. At baseline, all subjects had oral glucose tolerance test, 2-step euglycemic insulin clamp (20 mU/m².min and 60 mU/m².min) with titrated glucose and indirect calorimetry.</p><p><strong>Results: </strong>Body weight, fat content, and per cent body fat (DEXA) remained constant over the 10-day dietary intervention period in all three groups. Plasma β-OH-B concentration increased twofold, while carbohydrate oxidation decreased, and lipid oxidation increased demonstrating the expected shifts in substrate metabolism with institution of the ketogenic diet. Glucose tolerance either decreased slightly or remained unchanged in the two ketogenic diet groups. Whole body (muscle), liver, and adipose tissue sensitivity to insulin remained unchanged in all 3 groups, as did the plasma lipid profile and blood pressure.</p><p><strong>Conclusion: </strong>In the absence of weight loss, a low carbohydrate ketogenic diet has no beneficial effect on glucose tolerance, insulin sensitivity, or other metabolic parameters.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 5","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458046","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}