Tombolini, BeatriceSacconi, RiccardoBandello, FrancescoQuerques, Giuseppe...
9页查看更多>>摘要：Aim Since its relevance on diagnosis and prognosis of diabetic retinopathy (DR)， this review will examine a multimodal imaging approach to detect diabetic macular ischemia (DMI)。 Methods A PubMed engine search was carried out using the term "macular ischemia" paired with "diabetes，" and "diabetic macular ischemia" paired to "fluorescein angiography，" "ultra-wide field fluorescein angiography，" "optical coherence tomography angiography，" "octa，" "2D octa，" "ultra-wide field octa，" "3D octa，" "visual acuity。" All studies published in English up to October 2021 irrespective of their publication status were reviewed， and relevant publications were included in this review。 Results Recently， new technologies have been proposed as an alternative to fluorescein angiography (FA)， which is an actual diagnostic gold standard technique。 Nowadays， optical coherence tomography angiography (OCTA) has emerged as the most promising and reliable procedure able to provide a qualitative and quantitative description of DMI。 Newer three-dimensional (3D) OCTA approach will be discussed too。 Moreover， we will discuss how OCTA might identify preclinical alterations before the onset of DR and allow prediction about the progression of disease。 Conclusion OCTA has significantly expanded our knowledge on diabetic macular ischemia。
原文链接:
NSTL
Springer Nature
Ahmadi, Shilan SeyedPivodic, AldinaSvensson, Ann-MarieWedel, Hans...
12页查看更多>>摘要：Aims Albuminuria is strongly associated with risk of renal dysfunction， cardiovascular disease and mortality。 However， clinical guidelines diverge， and evidence is sparse on what risk factor levels regarding blood pressure， blood lipids and BMI are needed to prevent albuminuria in adolescents and young adults with type 1 diabetes。 Methods A total of 9347 children and adults with type 1 diabetes [mean age 15。3 years and mean diabetes duration 1。4 years at start of follow-up] from The Swedish National Diabetes Registry were followed from first registration until end of 2017。 Levels for risk factors for a risk increase in nephropathy were evaluated， and the gradient of risk per 1 SD (standard deviation) was estimated to compare the impact of each risk factor。 Results During the follow-up period， 8610 (92。1%) remained normoalbuminuric， 737 (7。9%) individuals developed micro- or macroalbuminuria at any time period of whom 132 (17。9% of 737) individuals developed macroalbuminuria。 Blood pressure >= 140/80 mmHg was associated with increased risk of albuminuria (p <= 0。0001)， as were triglycerides >= 1。0 mmol/L (p = 0。039)， total cholesterol >= 5。0 mmol/L (p = 0。0003)， HDL < 1。0 mmol/L (p = 0。013)， LDL 3。5- < 4。0 mmol/L (p = 0。020)， and BMI >= 30 kg/m(2) (p = 0。033)。 HbA1c was the strongest risk factor for any albuminuria estimated by the measure gradient of risk per 1 SD， followed by diastolic blood pressure， triglycerides， systolic blood pressure， cholesterol and LDL。 In patients with HbA1c > 65 mmol/mol (> 8。1%)， blood pressure > 140/70 mmHg was associated with increased risk of albuminuria。 Conclusions Preventing renal complications in adolescents and young adults with type 1 diabetes need avoidance at relatively high levels of blood pressure， blood lipids and BMI， whereas very tight control is not associated with further risk reduction。 For patients with long-term poor glycaemic control， stricter blood pressure control is advocated。
原文链接:- NSTL
- Springer Nature
Torn, CarinaVaziri-Sani, FaribaRamelius, AnitaLarsson, Helena Elding...
9页查看更多>>摘要：Aim The study aim was to evaluate the RSR 3 Screen ICA (TM) and 2 Screen ICA (TM) for detection of islet cell autoimmunity in healthy Swedish subjects and patients with newly diagnosed type 1 diabetes (T1D)。 Methods 3 Screen is designed for combined detection of autoantibodies to glutamic acid decarboxylase (GADA)， to the islet antigen IA-2 (IA-2A) and to zinc transporter 8 (ZnT8A)， while 2 Screen detects GADA and IA-2A。 Serum samples from 100 T1D patients at onset and 200 healthy controls were studied。 Results 3 Screen achieved 93% assay sensitivity and 97。5% specificity， while 2 Screen achieved 91% assay sensitivity and 98。5% specificity。 Samples were also tested in assays for individual autoantibodies。 There was only one 3 Screen positive healthy control sample (0。5%) that was positive for multiple autoantibodies (IA-2A and ZnT8A)。 In contrast， most of the 93 3 Screen positive patients were positive for multiple autoantibodies with 72% (67/93) positive for both GADA and IA-2A and 57% (53/93) positive for three autoantibodies (GADA， IA-2A and ZnT8A)。 Insulin autoantibodies (IAA， measured by radioimmunoassay) were positive in 13 patients and two healthy controls。 Conclusion 3 Screen achieved high sensitivity and specificity， suitable for islet cell autoimmunity screening in a healthy population。 In the case of 3 Screen positivity， further assays for GADA， IA-2A and ZnT8A are required to check for multiple autoantibody positivity， a hallmark for progression to T1D。 In addition， testing for IAA in children below two years of age is warranted。
原文链接:- NSTL
- Springer Nature
Banerjee, MainakPal, RimeshMukhopadhyay, Satinath
9页查看更多>>摘要：Purpose To collate the effect of SGLT2 inhibitors (SGLT2i) on adverse gout events in people with type 2 diabetes mellitus (T2DM)。 Methods PubMed/MEDLINE， Embase， and Web of Science databases were systematically searched using appropriate keywords/MeSH/Emtree terms till January 25， 2022， to identify observational studies， randomized controlled trials (RCTs) or post hoc analysis reporting incident gout events and/or commencement of anti-gout drug in people with T2DM receiving SGLT2i versus those not receiving SGLT2i。 Subgroup analyses were performed using comparators as placebo/other antidiabetic drugs and presence/absence of baseline hyperuricemia (uric acid >= 7 or < 7 mg/dl)。 Hazard ratios (HR) with 95% confidence intervals (CI) were calculated。 Results We identified 5 studies (3 observational， 2 post hoc analysis of RCTs) pooling data retrieved from 568，010 people with T2DM。 Pooled analysis showed that SGLT2i use was associated with 30% reduction in incident gout events/gout flares (HR 0。70， 95% CI: 0。59， 0。84， p < 0。001， I-2 = 84%)。 Sensitivity analysis after excluding the retrospective observational study showed similar estimates (HR 0。65， 95% CI: 0。60， 0。70， p < 0。001， I-2 = 0%)。 Subgroup analysis of data retrieved only from RCTs also showed significant benefits (HR 0。74， 95% CI: 0。55， 0。98， p = 0。03， I-2 = 0%)。 Pooled analysis of data from 2 studies showed that SGLT2i use led to a significant reduction in the need for commencement of new anti-gout drug (pooled HR 0。58， 95% CI: 0。48， 0。71， p < 0。001， I-2 = 0%)。 Consistent benefits were also observed for subgroup without baseline hyperuricemia (pooled HR 0。65， 95% CI: 0。47， 0。89， p < 0。01， I-2 = 0%)。 Conclusions SGLT2i may potentially prevent gout-related adverse events in people with T2DM。
原文链接:- NSTL
- Springer Nature
Nakayama, IzumiHayashino, YasuakiSuzuki, HikariYamazaki, Katsuya...
9页查看更多>>摘要：Aims Workplace demands， support， and relationships differ according to employment status (e。g。， employment that is full-time， part-time， or self-employed) and may lead to unequal opportunities to keep diabetic appointments。 We investigated the association between employment status and outpatient diabetic appointment non-attendance among working-age adults with type 2 diabetes。 Methods This was a secondary analysis of a cluster-randomized trial (the Japan diabetes outcome intervention trial 2 large-scale trial)。 The analysis included 2010 trial participants (40-65 years old) with type 2 diabetes who were regularly followed by primary care physicians (PCPs)。 The outcome measure was the first non-attendance (defined as a failure to visit a PCP within 2 months of the original appointment) during the one-year follow-up。 The association between baseline employment status and non-attendance was examined using Cox proportional hazard model in men and women。 Results During the 1279 and 789 person-year follow-up periods， 90 men and 34 women， respectively， experienced their first appointment non-attendance。 Among men， self-employed participants had a higher risk of non-attendance compared with full-time employees (adjusted HR， 1。84; 95% CI， 1。15， 2。95)。 The trial intervention (attendance promotion) was associated with a significantly reduced risk of non-attendance among self-employed participants (HR， 0。51; 95% CI， 0。26， 0。99)。 Among women， a significant association between employment status and non-attendance was not observed。 Conclusions Self-employed men with type 2 diabetes had a twofold increased risk of non-attendance than did full-time employees。 Our study suggests that self-employed men with type 2 diabetes should be targeted for interventions promoting appointment adherence。
原文链接:- NSTL
- Springer Nature
Ciardullo, StefanoPerseghin, Gianluca
7页查看更多>>摘要：Aims Soluble Klotho (s-Klotho) is associated with chronic kidney disease (CKD) and aging， but little is known on its relationship with chronic micro- and macro-vascular complications of type 2 diabetes and glycemic control。 Here， we evaluate the association between s-Klotho levels， glycemic control and renal function in patients with type 2 diabetes (T2D)。 Methods This is a cross-sectional study including 2989 patients with T2D and available s-Klotho measurements from the 2007-2016 cycles of the National Health and Nutrition Examination Survey (mean +/- SE， age: 60。0 +/- 0。2 years， BMI 33。3 +/- 0。2 kg/m(2)， 46。7 +/- 1。3% female)。 Determination of s-Klotho concentrations was performed with a sandwich ELISA test。 Results Patients with higher s-Klotho levels were younger， more frequently female and had a lower prevalence of CKD and higher HbA1c levels。 In multivariable linear regression models adjusting for age， race-ethnicity and BMI， both estimated glomerular filtration rate (B = 2。21， 95% CI 1。41-3。01， p < 0。001) and hemoglobin A1c (B = 37。38， 95% CI 28。91-45。86， p < 0。001) were positively associated with s-Klotho， while no significant association was found with cardiovascular disease。 Results were confirmed when analyses were performed in men and women separately。 No significant differences were identified between patients with an albuminuric or non-albuminuric CKD phenotype。 Conclusions s-Klotho levels are dependent on kidney function and glycemic control in patients with T2D。 Additional studies elucidating the mechanisms linking glycemic control and s-Klotho levels and exploring their predictive ability of clinically meaningful outcomes in patients with diabetes are needed。
原文链接:- NSTL
- Springer Nature
Pinto, ClaraDores, JorgePereira, TeresaMonteiro, Silvia Santos...
8页查看更多>>摘要：Aim To compare fetomaternal outcomes between GDM pregnant women with twin versus singleton pregnancies and then between women with GDM versus non-GDM twin pregnancies。 Methods We performed a retrospective study including GDM pregnant women with both twin and singleton pregnancies followed in our tertiary center between 2011 and 2018。 The fetomaternal characteristics of each group were compared。 We then compared women with GDM twin pregnancy followed at our institution between 2011 and 2018 to non-GDM twin pregnant women giving childbirth in 2018。 Results A total of 1127 GDM pregnant women were evaluated: 42 with twin pregnancy and 1085 with singleton pregnancy。 Preeclampsia (14。3% vs。 3。3%， p < 0。001) and cesarean delivery (76。2% vs。 36。9%， p < 0。001) were more frequent among women with twin pregnancy。 Neonatal morbidity was also more common among neonates delivered from twin pregnant women， including preterm labor (73。8% vs。 7。8%， p < 0。001)， hypoglycemia (6% vs。 4。8%， p = 0。043)， hyperbilirubinemia (33。3% vs。 9。0%， p < 0。001)， RDS (28。6% vs。 2。7%， p < 0。001)， admission in NICU (32。1% vs。 4。5%， p < 0。001) and SGA (19。0% vs。 11。0%， p = 0。001)。 Overall there were no significant differences in fetomaternal morbidity parameters between GDM (n = 42) versus non-GDM (n = 83) twin pregnancies， although SGA infants were more frequent in the latter group (33。9% vs。 19。0%， p = 0。014)。 Conclusions In GDM pregnant women， twin pregnancy seems to be associated with an increased prevalence of neonatal morbidity when compared to singleton pregnancy。 On the other hand， in twin pregnancy， diagnosis of GDM does not seem to be associated with poorer fetomaternal outcomes。 GDM seems to be protective for the occurrence of SGA neonates in twin pregnancies。
原文链接:- NSTL
- Springer Nature
de Abreu, Isabel RalhaBaia, CatarinaSilva, Jorge ManuelSantos, Ana Matos...
7页查看更多>>摘要：Aims Diabetes mellitus (DM) is a common chronic disease with serious individual and socioeconomic consequences。 Low health literacy (HL) has been associated with higher morbimortality。 Health knowledge about DM (HK-DM) may also influence individual health。 We aimed to assess HL and HK-DM in patients with type 2 DM and their associations with metabolic control。 Methods Our sample comprised 194 diabetic patients from a primary care health centre。 We collected clinical and demographic data and applied two validated questionnaires， the Newest Vital Sign (NST) and Diabetes Knowledge Test (DKT)， to assess HL and HK-DM， respectively。 Metabolic control was defined as HbA1c < 7。0%。 Participants were classified according to the NST as having "high likelihood of limited HL" (HLL-HL)， "possibility of limited HL" (PL-HL)， or "adequate HL" (A-HL) and by the DKT as having "low"， "average" and "good" HK。 Statistical analysis included logistic regression models， using p < 0。05 as a cut-off for statistical significance。 Results Overall， 72。7 and 34。7% of participants had HLL-HL and low HK-DM， respectively。 A-HL (OR = 6。02; 95% CI: 1。691-21。450) and PL-HL (OR = 4。78; 95% CI: 1。350-16。899) were significantly associated with better metabolic control than HLL-HL。 We did not find a significant association between HK-DM and metabolic control。 Conclusions HL seems to be associated with better metabolic control。 We also found a high prevalence of illiteracy and scarce knowledge about DM。 Primary care physicians should promote HL to help patients achieve better metabolic control。
原文链接:- NSTL
- Springer Nature
Liu, YuSang, MiaomiaoDu, ZiweiLi, Wei...
9页查看更多>>摘要：Background Cluster analysis may assist in stratifying heterogeneous clinical presentations of type 2 diabetes (T2D)。 However， the association of cluster-based subgroups with diabetes-related outcomes such as diabetic retinopathy remains unclear。 This study was aimed to address this issue with novel clusters of T2D derived from four simple parameters。 Method We developed a k-means clustering model in participants with newly diagnosed T2D (N = 1910) from the SENSIBLE and SENSIBLE-Addition studies， based on body mass index (BMI)， waist circumference (WC)， mean arterial pressure (MAP)， and hemoglobin A1c (HbA1c)。 Diabetic retinopathy was ascertained with the protocol from the Early Treatment of Diabetic Retinopathy Study。 Participants (N = 515) without diabetic retinopathy at baseline were followed-up for 3 years。 Logistic regression analyses were performed to obtain the odds ratios (ORs) and 95% confidence intervals (CIs)。 Results Three clusters were identified， with cluster 0， 1 and 2 accounting for 48。2， 8。9 and 42。9%， respectively。 Participants with T2D were featured by the lowest BMI， WC， MAP， and HbA1c in cluster 0， poor glycemic condition in cluster 1， and the highest BMI， WC， and MAP in cluster 2。 Compared with cluster 0， cluster 1 was associated with increased odds of diabetic retinopathy in both the cross-sectional study (OR 6。25， 95% CI: 3。19-12。23) and the cohort study (OR 9。16， 95% CI: 2。08-40。34)， while cluster 2 was not。 Moreover， most participants remained their clusters unchanged during follow-up。 Conclusions Our cluster-based analysis showed that participants with poor glycemic condition rather than high blood pressure and obesity had higher risk of diabetic retinopathy。
原文链接:- NSTL
- Springer Nature
Rabbone, IvanaSavastio, SilviaCarducci, ChiaraBerioli, Maria Giulia...
6页查看更多>>摘要：Objective To evaluate the six-month impact of the advanced automated functions of a closed-loop control (CLC) system (Control-IQ) and a virtual educational camp (vEC) on emotions and time in range (TIR) of children and adolescents with type 1 diabetes。 Methods Children and their parents participated in a three-day vEC。 Clinical， glucose， and emotion data were evaluated before， just after， and six months after the vEC。 Emotions were evaluated using adapted Plutchik's and Geneva Emotion Wheels。 Results Forty-three children and adolescents (7-16 years) showed significant improvements in positive emotions immediately and six months after the vEC (67% and 65% vs 38%， p < 0。05， respectively)， while mixed emotions were reduced (32% and 15% vs 61%， p < 0。05 and p < 0。001， respectively)。 The median percentage TIR increased from 64% (IQR 54-72) to 75% (IQR 70-82) with Control-IQ (p < 0。001) six months after the vEC。 Conclusions Positive emotions (joy， serenity， and satisfaction) significantly improved while mixed emotions were significantly worse six months after the initiation of a CLC system (Control-IQ) and a vEC。
原文链接:- NSTL
- Springer Nature
