T2DM

T2DM
  • 文章类型: Journal Article
    背景:男性肥胖是睾酮水平不达标的最相关因素之一。然而,越来越多的证据表明睾酮水平低与胰岛素抵抗和糖尿病并发症有关.我们旨在研究糖尿病对睾丸激素水平的影响,并评估各种临床和生化因素与性腺机能减退的相关性。
    方法:这项病例对照研究是对160名成年男性进行的,分为四个相等组(每组40人);A组:患有T2DM的瘦弱男性,B组:肥胖合并T2DM,C组:瘦,血糖正常,D组:肥胖,血糖正常。血清总睾酮(TT),已经测量了SHBG和HbA1c。计算游离睾酮(cFT)和HOMA-IR。
    结果:血清TT和cFT与BMI(分别为r-0.16,p0.04/r-0.26,p<0.001)和腰围(WC)(分别为r-0.23,p0.003和r-0.3,p<0.001)呈显着负相关。与非糖尿病组相比,糖尿病组的TT和cFT显着降低(两者的p<0.001)。糖尿病瘦肉组的TT水平明显低于非糖尿病瘦肉组(p<0.001),甚至显著低于非糖尿病性肥胖者(p<0.001)。糖尿病肥胖组的TT水平低于非糖尿病肥胖组(p<0.001)。cFT级别也一样,糖尿病瘦肉组低于非糖尿病瘦肉组(p<0.001),糖尿病肥胖组低于非糖尿病肥胖组(p<0.001).糖尿病组SHBG伴随显著降低(p<0.001)。线性回归分析显示TT与HOMA-IR显著相关。HOMA-IR与WC,年龄和糖尿病病程与cFT显著相关。在我们的模型中,HOMA-IR和HbA1c约占TT变异性的51.3%(校正R平方0.513)。
    结论:T2DM对血清睾酮水平的影响比肥胖更显著。我们的研究表明,糖尿病组的SHBG和cFT一起降低。性腺功能减退与胰岛素抵抗和血糖控制不良显著相关,这暗示了另一种观点,即血糖控制欠佳对性腺功能减退症发展的影响。
    BACKGROUND: Male obesity is one of the most associated factors with substandard testosterone levels. However, there is growing evidence linking low testosterone levels to insulin resistance and diabetic complications. We aimed to study the impact of diabetes mellitus on testosterone levels and to assess the correlation of various clinical and biochemical factors with hypogonadism.
    METHODS: This case-control study was conducted on 160 adult males categorized into four equal groups (40 each); Group A: lean men with T2DM, Group B: obese with T2DM, Group C: lean with normal glycemic profile, Group D: obese with normal glycemic profile. Serum total testosterone (TT), SHBG and HbA1c have been measured. Free testosterone (cFT) and HOMA-IR were calculated.
    RESULTS: A significant negative correlation of serum TT and cFTwith BMI (r -0.16, p 0.04/ r -0.26, p < 0.001, respectively) and with waist circumference (WC) (r -0.23, p 0.003 and r -0.3, p < 0.001, respectively). A significant decrease in TT and cFT in the diabetes group versus the non-diabetes one (p < 0.001 for both). TT level was significantly lower in the diabetic lean group than in the non-diabetic lean (p < 0.001), and even significantly lower than in the non-diabetic obese (p < 0.001). TT level in the diabetic obese group was lower than in the non-diabetic obese (p < 0.001). The same for cFT level, lower in the diabetic lean group than in non-diabetic lean (p < 0.001) and lower in the diabetic obese than in the non-diabetic obese (p < 0.001). Concomitant significant reduction in SHBG in the diabetes group (p < 0.001). Linear regression analysis revealed that TT significantly correlated with HOMA-IR. HOMA-IR with WC, age and the duration of diabetes correlated significantly with cFT. In our model, HOMA-IR and HbA1c accounted for approximately 51.3% of TT variability (adjusted R-squared 0.513).
    CONCLUSIONS: The impact of T2DM on serum testosterone levels was more significant than that of obesity. Our study showed a decrease in SHBG together with cFT among the diabetes group. Hypogonadism is significantly correlated to insulin resistance and poor glycemic control, which implies another perspective on the impact of suboptimal glycemic control on the development of hypogonadism.
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  • 文章类型: Journal Article
    糖尿病[DM],是一种多方面的代谢疾病,这已经成为对人类健康的全球性威胁。在过去的几十年里,大量的注意力已经致力于理解microRNAs[miRNAs],一类在转录后水平的基因表达的小的非编码RNA调节因子,与DM病理学有关。已经证明miRNAs控制胰岛素合成,分泌,和活动。本综述旨在评估miR-143和miR-145作为糖尿病诊断和预后的生物标志物。
    已经研究了使用miR-143和miR-145作为糖尿病诊断和预后的生物标志物,研究这种联系的研究在文献中得到了追捧。此外,我们将讨论通过miR-143/145表达调节胰岛素分泌的细胞和分子途径,最后讨论它们在糖尿病中的作用。
    在当前的评论中,我们强调了miR-143/145表达谱在临床研究和动物模型中作为新型DM生物标志物的最新发现,并强调了miR-143/145表达在DM中的复杂调节作用和功能作用的最新发现.
    一种改变miR-143/miR-145的表达和活性的新型临床治疗方法可能能够使细胞恢复其自然状态的葡萄糖稳态。证明了使用全面的miRNA谱预测糖尿病开始的价值。
    在线版本包含补充材料,可在10.1007/s40200-023-01317-y获得。
    UNASSIGNED: Diabetes mellitus [DM], is a multifaceted metabolic disease, which has become a worldwide threat to human wellness. Over the past decades, an enormous amount of attention has been devoted to understanding how microRNAs [miRNAs], a class of small non-coding RNA regulators of gene expression at the post-transcriptional level, are tied to DM pathology. It has been demonstrated that miRNAs control insulin synthesis, secretion, and activity. This review aims to provide an evaluation of the use of miR-143 and miR-145 as biomarkers for the diagnosis and prognosis of diabetes.
    UNASSIGNED: The use of miR-143 and miR-145 as biomarkers for the diagnosis and prognosis of diabetes has been studied, and research that examined this link was sought after in the literature. In addition, we will discuss the cellular and molecular pathways of insulin secretion regulation by miR-143/145 expression and finally their role in diabetes.
    UNASSIGNED: In the current review, we emphasize recent findings on the miR-143/145 expression profiles as novel DM biomarkers in clinical studies and animal models and highlight recent discoveries on the complex regulatory effect and functional role of miR-143/145 expression in DM.
    UNASSIGNED: A novel clinical treatment that alters the expression and activity of miR-143/miR-145 may be able to return cells to their natural state of glucose homeostasis, demonstrating the value of using comprehensive miRNA profiles to predict the beginning of diabetes.
    UNASSIGNED: The online version contains supplementary material available at 10.1007/s40200-023-01317-y.
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  • 文章类型: Journal Article
    2型糖尿病(T2DM)是一种与各种微血管并发症相关的慢性疾病,包括神经病,视网膜病变,和肾病。最近的研究表明,血清网膜素水平与T2DM患者发生微血管并发症的风险之间存在潜在关联。然而,现有的证据仍然没有定论。因此,我们进行了系统评价和荟萃分析,以研究2型糖尿病患者血清网膜素水平与微血管并发症之间的关系.
    在PubMed中进行了全面搜索,Scopus,和谷歌学者数据库检索截至2023年5月发表的相关文章。纳入了观察性研究,调查了T2DM患者中网膜素水平与微血管并发症的相关性。数据被提取并因此被分析。
    共有七篇横断面文章符合纳入标准,共有1587名参与者。荟萃分析显示血清网膜素水平与T2DM患者微血管并发症之间存在显著关联。微血管并发症患者的血清网膜素水平低于无并发症患者(平均差异,95%置信区间:-1.31[-2.50,-0.13],I2=99.62%)。
    本系统综述和荟萃分析提供了支持T2DM患者血清网膜素水平与微血管并发症之间关联的证据。提示Omentin在T2DM患者微血管并发症中可能较低。需要进一步的研究来阐明潜在的机制并探索这些发现的临床意义。
    在线版本包含补充材料,可在10.1007/s40200-023-01359-2获得。
    UNASSIGNED: Type 2 diabetes mellitus (T2DM) is a chronic condition associated with various microvascular complications, including neuropathy, retinopathy, and nephropathy. Recent studies have suggested a potential association between serum omentin levels and the risk of developing microvascular complications in patients with T2DM. However, the existing evidence remains inconclusive. Therefore, we conducted a systematic review and meta-analysis to examine the association between serum omentin levels and microvascular complications in T2DM patients.
    UNASSIGNED: A comprehensive search was conducted in PubMed, Scopus, and Google Scholar databases to retrieve relevant articles published up to May 2023. Observational studies investigating omentin levels association with microvascular complications in T2DM patients were included. Data was extracted and hence analyzed.
    UNASSIGNED: A total of seven cross-sectional articles met the inclusion criteria, with a total population of 1587 participants. The meta-analysis revealed a significant association between serum omentin levels and microvascular complications in patients with T2DM. Serum omentin levels were lower in patients with microvascular complications than in those without complications (Mean difference, 95% confidence interval: -1.31 [-2.50, -0.13], I2 = 99.62%).
    UNASSIGNED: This systematic review and meta-analysis provides evidence supporting an association between serum omentin levels and microvascular complications in patients with T2DM. The findings suggest that Omentin may be lower in T2DM patients with microvascular complications. Further research is warranted to elucidate the underlying mechanisms and explore the clinical implications of these findings.
    UNASSIGNED: The online version contains supplementary material available at 10.1007/s40200-023-01359-2.
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  • 文章类型: Journal Article
    背景:实际上,观察到整个肝病谱与2型糖尿病(T2DM)有关;T2DM现在是美国肝病的最常见原因我们进行了一项初步研究,以探讨微生物易位增加和全身性炎症在T2DM患者肝损伤发展中的相关性。
    方法:T2DM患者(n=17)和非糖尿病对照组(NDC;n=11),年龄25-80岁。参与了这项研究。血清内毒素水平,钙卫蛋白,测量可溶性CD14和CD163以及几种炎性细胞因子。除了标准的肝损伤标志物,ALT和AST,肝损伤的新型血清标志物,角蛋白18(K-18)M30(凋亡相关的半胱天冬酶裂解的角蛋白18),对M65(可溶性角蛋白18)进行评价。使用Mann-Whitney检验进行统计分析以评估研究组之间的差异。使用GraphPadPrism9.5.0软件进行Pearson相关性分析以确定两个变量之间的关联强度。
    结果:T2DM患者的sCD14水平明显高于NDC,表明肠道通透性增加,微生物易位,和单核细胞/巨噬细胞活化。重要的是,与随后的炎症反应有关,T2DM患者中sCD14的升高伴随着sCD163的显著升高,sCD163是肝Kupffer细胞活化和炎症的标志.Further,在T2DM患者中观察到sCD163与内毒素和sCD14之间呈正相关,但在NDC中没有。伴随着这些变化,反映肝细胞死亡的基于角蛋白18(K-18)的血清标志物(M65和M30)在T2DM组中显著升高,提示持续的肝损伤.值得注意的是,M65和M30水平均与sCD14和sCD163相关,提示免疫细胞活化和肝脏炎症可能与T2DM肝损伤的发生有关.
    结论:这些发现表明,肠-肝轴的致病性变化,以增加的微生物易位为标志,可能是T2DM患者肝细胞炎症和损伤病因的主要组成部分。然而,更大的纵向研究,包括组织学证据,需要确认这些观察结果。
    BACKGROUND: Virtually the entire spectrum of liver disease is observed in association with type 2 diabetes mellitus (T2DM); indeed, T2DM is now the most common cause of liver disease in the U.S. We conducted a pilot study to investigate the relevance of increased microbial translocation and systemic inflammation in the development of liver injury in patients with T2DM.
    METHODS: Patients with T2DM (n = 17) and non-diabetic controls (NDC; n = 11) aged 25-80 yrs. participated in this study. Serum levels of endotoxin, calprotectin, soluble CD14 and CD163, and several inflammatory cytokines were measured. In addition to standard liver injury markers, ALT and AST, novel serum markers of liver injury, keratin 18 (K-18) M30 (apoptosis-associated caspase-cleaved keratin 18), and M65 (soluble keratin 18) were evaluated. Statistical analyses were performed using the Mann-Whitney test to assess differences between study groups. Pearson\'s correlation analysis was performed to determine the strength of association between two variables using GraphPad Prism 9.5.0 software.
    RESULTS: Patients with T2DM had significantly higher levels of sCD14 in comparison to NDC, suggesting an increase in gut permeability, microbial translocation, and monocyte/macrophage activation. Importantly, relevant to the ensuing inflammatory responses, the increase in sCD14 in patients with T2DM was accompanied by a significant increase in sCD163, a marker of hepatic Kupffer cell activation and inflammation. Further, a positive correlation was observed between sCD163 and endotoxin and sCD14 in T2DM patients but not in NDC. In association with these changes, keratin 18 (K-18)-based serum markers (M65 and M30) that reflect hepatocyte death were significantly higher in the T2DM group indicating ongoing liver injury. Notably, both M65 and M30 levels correlated with sCD14 and sCD163, suggesting that immune cell activation and hepatic inflammation may be linked to the development of liver injury in T2DM.
    CONCLUSIONS: These findings suggest that the pathogenic changes in the gut-liver axis, marked by increased microbial translocation, may be a major component in the etiology of hepatocyte inflammation and injury in patients with T2DM. However, larger longitudinal studies, including histological evidence, are needed to confirm these observations.
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  • 文章类型: Journal Article
    一些研究表明,减肥和代谢手术(BMS)可以降低肥胖个体患心血管疾病(CVD)的风险。然而,在中国人群中,很少有关于使用多种模型评估BMS对CVD风险的影响的报道.
    本研究旨在使用多种CVD风险模型评估BMS对中国肥胖患者CVD风险的功能。
    我们对我院肥胖患者术前和术后的基本数据和糖脂代谢数据进行了回顾性分析。根据不同的手术方式进行亚组分析。然后,使用四个模型评估了BMS对中国人群心血管疾病风险的作用,包括:中国-PAR风险模型,弗雷明汉风险评分(FRS),世界卫生组织(WHO)风险模型,和Globorisk模型。
    我们招募了64名患者,其中24人(37.5%)接受了腹腔镜袖状胃切除术(LSG),而40人(62.5%)接受了Roux-en-Y胃旁路术(RYGB)。使用China-PAR风险模型计算的患者的10年CVD风险从术前的6.3%下降到术后1年的2.0%,差异有统计学意义。同样,使用FRS计算的患者10年CVD风险,WHO,与术前相比,术后1年全球风险模型显着降低。当FRS风险模型用于计算患者术后30年的CVD风险时,与术前相比,手术后1年有显著下降.当采用各种模型评估LSG和RYGB的10年CVD风险时,两组术后1年RRR无统计学差异.
    与术前相比,BMS术后CVD风险显著降低。在改善心血管风险方面,SG和RYGB似乎同样有效。
    UNASSIGNED: Some research have indicated that Bariatric and metabolic surgery (BMS) can reduce the risk of cardiovascular disease (CVD) among individuals with obesity. However, there are few reports available that focuses on assessing effect of BMS on the risk of CVD in Chinese population using multiple models.
    UNASSIGNED: This research aims to assess the function of BMS on the risk of CVD in Chinese patients with obesity using multiple CVD risk models.
    UNASSIGNED: We performed a retrospective analysis of the basic data and glycolipid metabolism data preoperatively and postoperatively from patients with obesity at our hospital. Subgroup analysis was carried out according to different surgical procedures. Then, the function of BMS on the risk of CVD in the Chinese population was assessed using four models, including: China-PAR risk model, Framingham risk score (FRS), World Health Organization (WHO) risk model, and Globorisk model.
    UNASSIGNED: We enrolled 64 patients, 24 (37.5%) of whom underwent laparoscopic sleeve gastrectomy (LSG) while 40 (62.5%) underwent Roux-en-Y gastric bypass (RYGB). The 10-year CVD risk for patients calculated using the China-PAR risk model decreased from 6.3% preoperatively to 2.0% at 1 year postoperatively and was statistically significantly different. Similarly, the 10-year CVD risk of patients calculated using the FRS, WHO, Global risk model decreased significantly at 1 year postoperatively compared to preoperatively. When the FRS risk model was used to calculate the patients\' 30-year postoperative CVD risk, there was a significant decrease at 1 year after surgery compared to the preoperative period. When employing various models to evaluate the 10-year CVD risk for LSG and RYGB, no statistically significant difference was found in the 1-year postoperative RRR between the procedures.
    UNASSIGNED: The CVD risk after BMS was significantly reduced compared to preoperatively. In terms of improving cardiovascular risk, SG and RYGB appear to be equally effective.
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  • 文章类型: Journal Article
    背景:目前的指南建议将2型糖尿病(T2DM)的医师主导治疗(PLC)转变为更有效的多学科医疗保健(MHC)。然而,很少有研究人员研究它在沙特阿拉伯的现实生活中的实施。因此,我们的目的是评估MDC糖尿病管理计划(DMP)的实施情况,并比较综合医院T2DM患者与PLC患者在真实世界实践环境中随访一年后的结局.
    方法:我们通过分析两个私人护理中心的所有T2DM患者的医疗记录,进行了这项比较性患者档案回顾研究。比较了两者在实现两个结果方面的有效性:第一年结束时糖化血红蛋白(HbA1c)<7%和低密度脂蛋白胆固醇(LDL-c)<70mg/dl。此外,我们评估了DMP的实施情况.
    结果:回顾了八百三十四份医疗记录,537来自DMP,和279来自PLC中心。DMP的个人健康协调几乎完成(97.8%),但在营养方面的实施不完整(65.7%),牙科检查(64.8%),和足部护理(58.3%)。两个护理组的年龄相匹配(p=0.056),性别(p=0.085),糖尿病的持续时间(p=0.217),和基础血糖控制(p=0.171)。DMP显示HbA1c显著净降(-0.5[IQR1.47%]vs-0.2[IQR3.05%],p=0.0001)和LDL-c(-10[IQR50]vs-5[IQR60.5]mg/dl,p=0.004)与PLC相比。在DMP中实现血糖控制的患者比例高于PLC(49.4%vs38.7%,p=0.038)。然而,这两个项目在脂质控制方面表现出相似的结果(28.7%vs.30%,p=0.695)。
    结论:尽管在实施方面存在一些差距,与PLC相比,2型糖尿病患者接受DMP治疗1年后的血糖控制更好.两种程序在脂质控制方面具有可比性。进一步的研究发现护理实施方面的差距可以提高可持续性,未来复制,以及类似计划与沙特阿拉伯其他医疗保健系统的普遍性。
    BACKGROUND: Current guidelines recommend shifting physician-led care (PLC) for type 2 diabetes mellitus (T2DM) to more effective multidisciplinary health care (MHC). However, few researchers have studied its real-life implementation in Saudi Arabia. Therefore, we aimed to assess the implementation and compare the outcomes of an MDC diabetes management program (DMP) among T2DM patients to a PLC at a general hospital after one year of follow-up in a real-world practice setting.
    METHODS: We conducted this comparative patient files review study by analyzing medical records of all T2DM patients at two private care centers. Both were compared for their effectiveness in achieving two outcomes: the glycated hemoglobin (HbA1c) <7% and low-density lipoprotein-cholesterol (LDL-c) <70 mg/dl at the end of the first year. Additionally, we assessed the implementation of the DMP.
    RESULTS: Eight hundred thirty-four medical records were reviewed, 537 from DMP, and 279 from the PLC center. The personal health coordination was almost complete (97.8%) in the DMP, but the implementation was incomplete regarding nutrition (65.7%), dental exam (64.8%), and foot care (58.3%). Both care groups were matched for age (p = 0.056), gender (p = 0.085), duration of diabetes (p = 0.217), and basal glycemic control (p = 0.171). The DMP showed a significant net decrease in HbA1c (-0.5 [IQR 1.47%] vs -0.2 [IQR 3.05%], p = 0.0001) and LDL-c (-10 [IQR 50] vs -5 [IQR 60.5] mg/dl, p = 0.004) compared to PLC. A higher percentage of patients achieved glycemic control in the DMP than in the PLC (49.4% vs 38.7%, p = 0.038). However, both programs demonstrated similar outcomes in lipid control (28.7% vs. 30%, p = 0.695).
    CONCLUSIONS: Despite some gaps in implementation, one year of DMP showed better glycemic control among T2DM patients compared to PLC. Both programs were comparable in terms of lipid control. Further studies identifying the gaps in care implementation could improve sustainability, future replication, and generalizability of similar programs to other healthcare systems in Saudi Arabia.
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  • 文章类型: Journal Article
    背景:肠道微生物代谢产物,三甲胺N-氧化物(TMAO),已与2型糖尿病(T2DM)相关。以前很少有前瞻性研究讨论TMAO和T2DM发病率变化之间的关联。
    方法:数据来自阜新县农村地区2019年至2021年的纵向队列研究,辽宁省,中国,纳入了1515名年龄在35岁以上的无糖尿病参与者.在两个时间点测量血清TMAO及其前体的浓度,即2019年和2021年。在逻辑回归模型中分别测试了TMAO和TMAO变化(ΔTMAO)。为了进一步检查,根据TMAO水平和ΔTMAO水平的组合计算T2DM的比值比(OR).
    结果:在1.85年的中位随访中,81例T2DM(5.35%)。基线TMAO水平表现出非线性关系,先减少然后增加,仅在最高四分位数与T2DM风险相关。血清TMAO最高四分位数中T2DM的OR为3.35(95CI:1.55-7.26,p=0.002),与最低四分位数相比。至于它的前体,只有胆碱水平与T2DM风险相关,血清胆碱的Q3和Q4中T2DM的OR分别为3.37(95CI:1.41-8.05,p=0.006)和4.72(95CI:1.47-15.13,p=0.009),分别。当考虑基线TMAO水平和ΔTMAO随时间变化时,TMAO水平持续较高的参与者显示T2DM风险显著增加,多变量校正OR为8.68(95CI:1.97,38.34)。
    结论:初始血清TMAO水平和长期血清TMAO变化均与随后的T2DM事件的发生显著相关。旨在使TMAO水平正常化的干预措施,比如采用健康的饮食习惯,可能对预防T2DM特别有益。
    BACKGROUND: A gut-microbial metabolite, trimethylamine N-oxide (TMAO), has been associated with type 2 diabetes mellitus (T2DM). Few previous prospective studies have addressed associations between the changes in TMAO and T2DM incidence.
    METHODS: Data were derived from a longitudinal cohort conducted from 2019 to 2021 in rural areas of Fuxin County, Liaoning Province, China, and 1515 diabetes-free participants aged above 35 years were included. The concentrations of serum TMAO and its precursors were measured at two time points, namely in 2019 and 2021. TMAO and TMAO changes (ΔTMAO) were separately tested in a logistic regression model. For further examination, the odds ratios (ORs) for T2DM were calculated according to a combination of TMAO levels and ΔTMAO levels.
    RESULTS: During a median follow-up of 1.85 years, 81 incident cases of T2DM (5.35%) were identified. Baseline TMAO levels exhibited a nonlinear relationship, first decreasing and then increasing, and only at the highest quartile was it associated with the risk of T2DM. The OR for T2DM in the highest quartile of serum TMAO was 3.35 (95%CI: 1.55-7.26, p = 0.002), compared with the lowest quartile. As for its precursors, only choline level was associated with T2DM risk and the OR for T2DM in the Q3 and Q4 of serum choline was 3.37 (95%CI: 1.41-8.05, p = 0.006) and 4.72 (95%CI: 1.47-15.13, p = 0.009), respectively. When considering both baseline TMAO levels and ΔTMAO over time, participants with sustained high TMAO levels demonstrated a significantly increased risk of T2DM, with a multivariable-adjusted OR of 8.68 (95%CI: 1.97, 38.34).
    CONCLUSIONS: Both initial serum TMAO levels and long-term serum TMAO changes were collectively and significantly associated with the occurrence of subsequent T2DM events. Interventions aimed at normalizing TMAO levels, such as adopting a healthy dietary pattern, may be particularly beneficial in T2DM prevention.
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  • 文章类型: Journal Article
    慢性肾脏病(CKD)是一个重要的公共卫生问题,在2型糖尿病(T2DM)患者中尤其普遍。CKD发生在约20%至40%的成人糖尿病患者中。Sudoscan可能会早期检测到CKD,为依赖血清肌酐和尿白蛋白水平的传统筛查方法提供了一种非侵入性和便捷的替代方法。这项研究涉及来自一个医疗中心的271名患者超过一年,所有参与者提供知情同意。我们组的CKD患病率为26.5%(n=72)。这项研究整合了一个全面的检查,包括人体测量,生化概况,和Sudoscan的电化学皮肤电导测试。通过估计的肾小球滤过率(eGFR)和白蛋白-肌酐比值(ACR)确认CKD诊断。这项研究的目的是探索Sudoscan在检测T2DM患者CKD中的实用性。统计分析揭示了Sudoscan评分与传统CKD标志物如eGFR和蛋白尿之间的中等相关性。在常规测试不易访问的环境中,它是有益的,提示更广泛的CKD筛查计划的潜力。关键发现表明,Sudoscan可以以合理的敏感性和特异性识别早期肾功能不全。在常规CKD筛查中整合Sudoscan可以增强早期检测,及时采取干预措施,防止进展为终末期肾病,减轻与晚期CKD相关的医疗负担.结果有助于持续评估与糖尿病相关的慢性疾病的管理创新技术。
    Chronic kidney disease (CKD) represents a significant public health issue, particularly prevalent among patients with type 2 diabetes mellitus (T2DM). CKD occurs in approximately 20% to 40% of adults with diabetes mellitus. Sudoscan potentially detects CKD early, providing a non-invasive and convenient alternative to traditional screening methods that rely on serum creatinine and urine albumin levels. This research involves 271 patients from a single medical center over one year, with all participants providing informed consent. The prevalence of CKD in our group was 26.5% (n = 72). This study integrates a comprehensive examination, including anthropometric measurements, biochemical profiles, and Sudoscan\'s electrochemical skin conductance testing. CKD diagnosis was confirmed via estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). The aim of this study was to explore the utility of Sudoscan in detecting CKD among patients with T2DM. Statistical analysis reveals moderate correlations between Sudoscan scores and traditional CKD markers like eGFR and albuminuria. It is beneficial in settings where conventional testing is less accessible, suggesting potential for broader CKD screening programs. Key findings suggest that Sudoscan can identify early renal dysfunction with reasonable sensitivity and specificity. Integrating Sudoscan in regular CKD screening could enhance early detection, allowing for timely interventions to prevent progression to end-stage renal disease and reduce healthcare burdens associated with advanced CKD. The results contribute to the ongoing assessment of innovative technologies in managing chronic diseases related to diabetes.
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  • 文章类型: Journal Article
    背景:糖尿病是一种常见的慢性代谢性疾病。该疾病的进展促进血管炎症和动脉粥样硬化的形成,导致心血管疾病。基于CCTA的冠状动脉血管周围脂肪组织衰减指数是一种新的非侵入性成像生物标志物,可以反映CCTA图像中血管周围脂肪组织衰减的空间变化和冠状动脉周围的炎症。在这项研究中,提出了一种影像组学方法,以高通量方式从CCTA中提取大量图像特征,并结合临床诊断数据,探索基于CCTA的血管周围脂肪成像数据对糖尿病患者冠心病的预测能力。
    方法:采用R语言进行统计分析,筛选出差异显著的变量。预分离模型用于CCTA血管分割,筛选出冠状动脉周围脂肪区域。PyRadiomics用于计算冠状动脉周围脂肪组织的影像组学特征,和SVM,使用DT和RF对临床数据和影像组学数据进行建模和分析。使用PPV、FPR,AAC,ROC。
    结果:结果表明,年龄存在显着差异,血压,糖尿病患者和无冠心病患者之间的一些生化指标。在1037个计算的放射学参数中,18.3%的人在成像组学特征上表现出显著差异。三种建模方法用于分析不同的临床信息组合,内部血管影像组学信息和冠状动脉血管脂肪影像组学信息。结果表明,在不同的机器学习模型下,完整数据的数据集具有最高的ACC值。支持向量机方法表现出最好的特异性,灵敏度,和这个数据集的准确性。
    结论:在这项研究中,将CCTA的临床数据和冠状动脉影像组学数据进行融合,以预测糖尿病患者冠心病的发生。这为糖尿病患者早期发现冠心病提供了信息,并可以及时进行干预和治疗。
    BACKGROUND: Diabetes is a common chronic metabolic disease. The progression of the disease promotes vascular inflammation and the formation of atherosclerosis, leading to cardiovascular disease. The coronary artery perivascular adipose tissue attenuation index based on CCTA is a new noninvasive imaging biomarker that reflects the spatial changes in perivascular adipose tissue attenuation in CCTA images and the inflammation around the coronary arteries. In this study, a radiomics approach is proposed to extract a large number of image features from CCTA in a high-throughput manner and combined with clinical diagnostic data to explore the predictive ability of vascular perivascular adipose imaging data based on CCTA for coronary heart disease in diabetic patients.
    METHODS: R language was used for statistical analysis to screen the variables with significant differences. A presegmentation model was used for CCTA vessel segmentation, and the pericoronary adipose region was screened out. PyRadiomics was used to calculate the radiomics features of pericoronary adipose tissue, and SVM, DT and RF were used to model and analyze the clinical data and radiomics data. Model performance was evaluated using indicators such as PPV, FPR, AAC, and ROC.
    RESULTS: The results indicate that there are significant differences in age, blood pressure, and some biochemical indicators between diabetes patients with and without coronary heart disease. Among 1037 calculated radiomic parameters, 18.3% showed significant differences in imaging omics features. Three modeling methods were used to analyze different combinations of clinical information, internal vascular radiomics information and pericoronary vascular fat radiomics information. The results showed that the dataset of full data had the highest ACC values under different machine learning models. The support vector machine method showed the best specificity, sensitivity, and accuracy for this dataset.
    CONCLUSIONS: In this study, the clinical data and pericoronary radiomics data of CCTA were fused to predict the occurrence of coronary heart disease in diabetic patients. This provides information for the early detection of coronary heart disease in patients with diabetes and allows for timely intervention and treatment.
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  • 文章类型: Clinical Trial Protocol
    背景:代谢功能障碍相关的脂肪变性肝病(MASLD)是全球主要的慢性肝病,与肥胖密切相关,糖尿病,和血脂异常。必需磷脂(EPL)被推荐作为管理肝脏疾病的支持治疗,包括MASLD或代谢功能障碍相关的脂肪性肝炎,肝硬化,和病毒性肝炎。虽然EPL在MASLD治疗中作为辅助治疗的疗效已经较早确立,其使用的某些方面,如护理标准参数的影响,EPL对MASLD患者的生活质量(QoL)和症状评估变化的影响仍未研究。拟议的试验旨在评估EPL的有效性和安全性以及与2型糖尿病(T2DM)和/或高脂血症和/或肥胖相关的MASLD患者的后续QoL。
    方法:这是一个多中心,跨国公司,双盲,随机化,双臂,安慰剂对照,平行组,IV期临床试验。该试验在大约190名患者中进行,这些患者以1:1的比例随机分配到EPL组(Essentiale®1800mg/天口服+标准护理)或安慰剂组(安慰剂+标准护理)。主要结果是评估EPL对肝脏脂肪变性的疗效,通过瞬时弹性成像测量,从基线到6个月。次要结果包括QoL参数的变化,根据慢性肝病问卷-代谢功能障碍相关的脂肪性肝病/代谢功能障碍相关的脂肪性肝炎和症状评估的变化(使用全球总体症状量表)从基线到6个月的症状,包括虚弱,感到沮丧,腹痛/不适,或疲劳。
    结论:当前的方案设计将允许通过评估各种结果指标,全面探索将EPL添加到治疗标准中对肝脏脂肪变性和QoL的疗效及其在患有与T2DM和/或高脂血症和/或肥胖相关的MASLD患者中的安全性。
    背景:欧盟临床试验注册,EudraCT,2021-006069-39。2022年3月13日注册。
    BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a predominant chronic liver condition globally and is strongly associated with obesity, diabetes mellitus, and dyslipidemia. Essential phospholipids (EPL) are recommended as supportive treatment for managing liver conditions, including MASLD or metabolic dysfunction-associated steatohepatitis, cirrhosis, and viral hepatitis. While efficacy of EPL as an adjunctive therapy in MASLD treatment has been established earlier, certain aspects of its usage such as the impact of standard-of-care parameters, effect of EPL on quality of life (QoL) and change in symptoms evaluation in patients with MASLD remain unexplored. The proposed trial aims to assess the efficacy and safety of EPL and the subsequent QoL of patients with MASLD associated with type 2 diabetes mellitus (T2DM) and/or hyperlipidemia and/or obesity.
    METHODS: This is a multicenter, multinational, double-blind, randomized, two-arm, placebo-controlled, parallel-group, phase IV clinical trial. The trial is being conducted in approximately 190 patients who are randomized on a 1:1 basis either to the EPL arm (Essentiale® 1800 mg/day orally + standard of care) or placebo arm (placebo + standard of care). The primary outcome is to assess the efficacy of EPL on hepatic steatosis, as measured by transient elastography, from baseline to 6 months. The secondary outcomes include change in QoL parameters, as measured by the Chronic Liver Disease Questionnaire-metabolic dysfunction-associated steatotic liver disease/ metabolic dysfunction-associated steatohepatitis and change in symptom evaluation (using the Global Overall Symptom scale) from baseline to 6 months for symptoms, including asthenia, feeling depressed, abdominal pain/discomfort, or fatigue.
    CONCLUSIONS: The current protocol design will allow to comprehensively explore the efficacy of EPL added to the standard of care on hepatic steatosis and QoL and its safety in patients with MASLD associated with T2DM and/or hyperlipidemia and/or obesity by assessing various outcome measures.
    BACKGROUND: European Union Clinical Trials Register, EudraCT, 2021-006069-39. Registered on March 13, 2022.
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