Journal of Clinical Medicine

Editorial

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Open AccessEditorial

Special Issue “The Prevention, Treatment, and Complications of Diabetes Mellitus”

by Ana I. Arroba and Manuel Aguilar-Diosdado

J. Clin. Med. 2022, 11(18), 5305; https://doi.org/10.3390/jcm11185305 - 9 Sep 2022

Cited by 1 | Viewed by 1904

Abstract

Diabetes mellitus (DM) is a world health problem of global repercussion [...] Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

Research

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9 pages, 785 KiB

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Neutrophil-to-Lymphocyte Ratio Adds Valuable Information Regarding the Presence of DKA in Children with New-Onset T1DM

by Alexandra-Cristina Scutca, Delia-Maria Nicoară, Monica Mărăzan, Giorgiana-Flavia Brad and Otilia Mărginean

J. Clin. Med. 2023, 12(1), 221; https://doi.org/10.3390/jcm12010221 - 28 Dec 2022

Cited by 5 | Viewed by 3962

Abstract

Diabetic ketoacidosis (DKA) is an acute life-threatening complication occurring mainly at the onset of type 1 diabetes mellitus. The neutrophil-to-lymphocyte ratio (NLR), a marker for systemic inflammation, has recently generated increasing interest in many chronic diseases. The aim of this cross-sectional study was [...] Read more.

Diabetic ketoacidosis (DKA) is an acute life-threatening complication occurring mainly at the onset of type 1 diabetes mellitus. The neutrophil-to-lymphocyte ratio (NLR), a marker for systemic inflammation, has recently generated increasing interest in many chronic diseases. The aim of this cross-sectional study was to determine the value of the neutrophil-to-lymphocyte ratio (NLR) in association with DKA severity across these cases. A total of 155 children with new-onset type 1 DM from one large center were included in the study. Total and differential leukocyte counts were measured upon admission and calculation of the NLR was performed. Patients were classified into four groups: without DKA, mild, moderate, and severe DKA at disease onset. Total WBCs, neutrophils, and monocytes increased with DKA severity (p-value < 0.005), while eosinophiles displayed an inverse relationship (p-value < 0.001). Median NLR scores increased from those without ketoacidosis (1.11) to mild (1.58), moderate (3.71), and severe (5.77) ketoacidosis groups. The statistical threshold value of the NLR in predicting DKA was 1.84, with a sensitivity of 80.2% and a specificity of 80%. Study findings indicate that a higher NLR score adds valuable information regarding the presence of DKA in children with new-onset T1DM. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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7 pages, 1289 KiB

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Increased Presentation of Diabetic Ketoacidosis and Changes in Age and Month of Type 1 Diabetes at Onset during the COVID-19 Pandemic in Spain

by Isabel Leiva-Gea, Cristina Antúnez Fernández, Roque Cardona-Hernandez, Marta Ferrer Lozano, Pilar Bahíllo-Curieses, Javier Arroyo-Díez, María Clemente León, Maria Martín-Frías, Santiago Conde Barreiro, Andrés Mingorance Delgado and Jacobo Pérez Sánchez

J. Clin. Med. 2022, 11(15), 4338; https://doi.org/10.3390/jcm11154338 - 26 Jul 2022

Cited by 11 | Viewed by 1955

Abstract

Objective: To assess the impact of the COVID-19 pandemic and lockdown measures on the presenting characteristics (age at diagnosis, severity, monthly distribution) of newly diagnosed type 1 diabetes in Spanish children. Research Design and Methods: An ambispective observational multicenter study was [...] Read more.

Objective: To assess the impact of the COVID-19 pandemic and lockdown measures on the presenting characteristics (age at diagnosis, severity, monthly distribution) of newly diagnosed type 1 diabetes in Spanish children. Research Design and Methods: An ambispective observational multicenter study was conducted in nine Spanish tertiary-level hospitals between January 2015 and March 2021. Inclusion criteria: new cases of type 1 diabetes in children (0–14 years) recording age, sex, date of diagnosis, presence of diabetic ketoacidosis (DKA) at onset, and severity of DKA. Data were compared before and during the pandemic. Results: We registered 1444 new cases of type 1 diabetes in children: 1085 in the pre-pandemic period (2015–2019) and 359 during the pandemic (2020–March 2021). There was a significant increase in the group aged ≤4 years in the pandemic period (chi-squared = 10.986, df 2, p = 0.0041). In 2020–2021, cases of DKA increased significantly by 12% (95% CI: 7.2–20.4%), with a higher percentage of moderate and severe DKA, although this increase was not significant. In 2020, there was a sharp decrease in the number of cases in March, with a progressive increase from May through November, higher than in the same months of the period 2015–2019, highlighting the increase in the number of cases in June, September, and November. The first three months of 2021 showed a different trend to that observed both in the years 2015–2019 and in 2020, with a marked increase in the number of cases. Conclusions: A change in monthly distribution was described, with an increase in DKA at onset of type 1 diabetes. No differences were found in severity, although there were differences in the age distribution, with an increase in the number of cases in children under 4 years of age. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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8 pages, 581 KiB

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Comparison of Glycemic Variability and Hypoglycemic Events in Hospitalized Older Adults Treated with Basal Insulin plus Vildagliptin and Basal–Bolus Insulin Regimen: A Prospective Randomized Study

by Sol Batule, Analía Ramos, Alejandra Pérez-Montes de Oca, Natalia Fuentes, Santiago Martínez, Joan Raga, Xoel Pena, Cristina Tural, Pilar Muñoz, Berta Soldevila, Nuria Alonso, Guillermo Umpierrez and Manel Puig-Domingo

J. Clin. Med. 2022, 11(10), 2813; https://doi.org/10.3390/jcm11102813 - 16 May 2022

Cited by 8 | Viewed by 3019

Abstract

Background: The basal–bolus insulin regimen is recommended in hospitalized patients with diabetes mellitus (DM), but has an increased risk of hypoglycemia. We aimed to compare dipeptidyl peptidase 4 inhibitors (DPP4-i) and basal–bolus insulin glycemic outcomes in hospitalized type 2 DM patients. Methods and [...] Read more.

Background: The basal–bolus insulin regimen is recommended in hospitalized patients with diabetes mellitus (DM), but has an increased risk of hypoglycemia. We aimed to compare dipeptidyl peptidase 4 inhibitors (DPP4-i) and basal–bolus insulin glycemic outcomes in hospitalized type 2 DM patients. Methods and patients: Our prospective randomized study included 102 elderly T2DM patients (82 ± 9 years, HbA1c 6.6% ± 1.9). Glycemic control: A variability coefficient assessed by continuous glucose monitoring (Free Style^® sensor), mean insulin dose and hypoglycemia rates obtained with the two treatments were analyzed. Results: No differences were found between groups in glycemic control (mean daily glycemia during the first 10 days: 152.6 ± 38.5 vs. 154.2 ± 26.3 mg/dL; p = 0.8). The total doses Kg/day were 0.40 vs. 0.20, respectively (p < 0.001). A lower number of hypoglycemic events (9% vs. 15%; p < 0.04) and lower glycemic coefficient of variation (22% vs. 28%; p < 0.0002) were observed in the basal–DPP4-i compared to the basal–bolus regimen group. Conclusions: Treatment of inpatient hyperglycemia with basal insulin plus DPP4-i is an effective and safe regimen in old subjects with T2DM, with a similar mean daily glucose concentration, but lower glycemic variability and fewer hypoglycemic episodes compared to the basal bolus insulin regimen. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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8 pages, 1028 KiB

Open AccessArticle

Decreased Need for Correction Boluses with Universal Utilisation of Dual-Wave Boluses in Children with Type 1 Diabetes

by Mari Lukka, Vallo Tillmann and Aleksandr Peet

J. Clin. Med. 2022, 11(6), 1689; https://doi.org/10.3390/jcm11061689 - 18 Mar 2022

Cited by 2 | Viewed by 2647

Abstract

Insulin pumps offer standard (SB), square and dual-wave boluses (DWB). Few recommendations exist on how to use these dosing options. Several studies suggest that the DWB is more effective for high-fat or high-carbohydrate meals. Our objective was to test whether time in range [...] Read more.

Insulin pumps offer standard (SB), square and dual-wave boluses (DWB). Few recommendations exist on how to use these dosing options. Several studies suggest that the DWB is more effective for high-fat or high-carbohydrate meals. Our objective was to test whether time in range (TIR) improves in children with type 1 diabetes (T1D) using the universal utilization of the dual-wave boluses for all evening meals regardless of the composition of the meal. This was a 28-day long prospective randomized open-label single-center crossover study. Twenty-eight children with T1DM using a Medtronic 640G pump and continuous glucose monitoring system were randomly assigned to receive either DWB or SB for all meals starting from 6:00 p.m. based solely on the food carbohydrate count. DWB was set for 50/50% with the second part extended over 2 h. After two weeks patients switched into the alternative treatment arm. TIR (3.9–10 mmol/L), time below range (TBR) (<3.9 mmol/L) and time above range (TAR) (>10 mmol/L) and sensor glucose values were measured and compared between the groups. Twenty-four children aged 7–14 years completed the study according to the study protocol. There were no statistically significant differences in mean TIR (60.9% vs. 58.8%; p = 0.3), TBR (1.6% vs. 1.7%; p = 0.7) or TAR (37.5 vs. 39%; p = 0.5) between DWB and SB groups, respectively. Subjects in the DWB treatment arm administered significantly less correction boluses between 6 p.m. and 6 a.m. compared to those in the SB group (1.2 ± 0.8 vs. 1.7 ± 0.8, respectively; p < 0.01). DWB for evening meals in which insulin is calculated solely on the food carbohydrate content did not improve TIR compared to standard bolus in children with T1D. However, DWB enabled to use significantly less correction boluses to achieve euglycemia by the morning compared to the SB. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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10 pages, 687 KiB

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The Diabetes Transition of Hospital Care (DiaTOHC) Pilot Study: A Randomized Controlled Trial of an Intervention Designed to Reduce Readmission Risk of Adults with Diabetes

by Daniel J. Rubin, Preethi Gogineni, Andrew Deak, Cherie Vaz, Samantha Watts, Dominic Recco, Felicia Dillard, Jingwei Wu, Abhijana Karunakaran, Neil Kondamuri, Huaqing Zhao, Mary D. Naylor, Sherita H. Golden and Shaneisha Allen

J. Clin. Med. 2022, 11(6), 1471; https://doi.org/10.3390/jcm11061471 - 8 Mar 2022

Cited by 4 | Viewed by 2480

Abstract

Hospital readmission within 30 days of discharge (30-day readmission) is a high-priority quality measure and cost target. The purpose of this study was to explore the feasibility and efficacy of the Diabetes Transition of Hospital Care (DiaTOHC) Program on readmission risk in high-risk [...] Read more.

Hospital readmission within 30 days of discharge (30-day readmission) is a high-priority quality measure and cost target. The purpose of this study was to explore the feasibility and efficacy of the Diabetes Transition of Hospital Care (DiaTOHC) Program on readmission risk in high-risk adults with diabetes. This was a non-blinded pilot randomized controlled trial (RCT) that compared usual care (UC) to DiaTOHC at a safety-net hospital. The primary outcome was all-cause 30-day readmission. Between 16 October 2017 and 30 May 2019, 93 patients were randomized. In the intention-to-treat (ITT) population, 14 (31.1%) of 45 DiaTOHC subjects and 15 (32.6%) of 46 UC subjects had a 30-day readmission, while 35.6% DiaTOHC and 39.1% UC subjects had a 30-day readmission or ED visit. The Intervention–UC cost ratio was 0.33 (0.13–0.79) 95%CI. At least 93% of subjects were satisfied with key intervention components. Among the 69 subjects with baseline HbA1c >7.0% (53 mmol/mol), 30-day readmission rates were 23.5% (DiaTOHC) and 31.4% (UC) and composite 30-day readmission/ED visit rates were 26.5% (DiaTOHC) and 40.0% (UC). In this subgroup, the Intervention–UC cost ratio was 0.21 (0.08–0.58) 95%CI. The DiaTOHC Program may be feasible and may decrease combined 30-day readmission/ED visit risk as well as healthcare costs among patients with HbA1c levels >7.0% (53 mmol/mol). Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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12 pages, 928 KiB

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Blood Pressure Monitoring and Perinatal Outcomes in Normotensive Women with Gestational Diabetes Mellitus

by Almudena Lara-Barea, Begoña Sánchez-Lechuga, Álvaro Vidal-Suárez, Ana I. Arroba, Fernando Bugatto and Cristina López-Tinoco

J. Clin. Med. 2022, 11(5), 1435; https://doi.org/10.3390/jcm11051435 - 5 Mar 2022

Cited by 2 | Viewed by 2083

Abstract

Alterations in ambulatory blood pressure detected by monitoring (ABPM) have been associated with perinatal complications in hypertensive pregnant women. Aim: To establish the relationships between the blood pressure (BP) profiles detected by ABPM and adverse perinatal outcomes in normotensive women with gestational diabetes [...] Read more.

Alterations in ambulatory blood pressure detected by monitoring (ABPM) have been associated with perinatal complications in hypertensive pregnant women. Aim: To establish the relationships between the blood pressure (BP) profiles detected by ABPM and adverse perinatal outcomes in normotensive women with gestational diabetes mellitus (GDM). Methods: A prospective study of normotensive women in whom 24 h ABPM was performed at 28–32 weeks of pregnancy. The obstetric and perinatal outcomes were evaluated. Results: Two hundred patients were included. Thirty-seven women with GDM and obesity had significantly higher mean systolic BP (SBP) and nocturnal SBP and diastolic BP (DBP) compared to women with only GDM (n = 86). Nocturnal SBP (OR = 1.077; p = 0.015) and obesity (OR = 1.131; p = 0.035) were risk factors for the development of hypertensive disorders of pregnancy (HDPs). Mothers of newborns with neonatal complications (n = 27) had higher nocturnal SBP (103.8 vs. 100 mmHg; p = 0.047) and DBP (62.7 vs. 59.4; p = 0.016). Women who delivered preterm (n = 10) had higher BP and a non-dipper pattern (p = 0.005). Conclusions: Nocturnal SBP was a predictor of HDPs in normotensive women with obesity or GDM. Alterations in ABPM in these patients were associated with poor obstetric and perinatal outcomes. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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11 pages, 447 KiB

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Prediabetes Is Associated with Increased Prevalence of Sleep-Disordered Breathing

by Enric Sánchez, Esther Sapiña-Beltrán, Ricard Gavaldà, Ferran Barbé, Gerard Torres, Ariadna Sauret, Mireia Dalmases, Carolina López-Cano, Liliana Gutiérrez-Carrasquilla, Marcelino Bermúdez-López, Elvira Fernández, Francisco Purroy, Eva Castro-Boqué, Cristina Farràs-Sallés, Reinald Pamplona, Dídac Mauricio, Cristina Hernández, Rafael Simó, Albert Lecube and on behalf of the ILERVAS Project Collaborators

J. Clin. Med. 2022, 11(5), 1413; https://doi.org/10.3390/jcm11051413 - 4 Mar 2022

Cited by 8 | Viewed by 2667

Abstract

Type 2 diabetes leads to severe nocturnal hypoxemia, with an increase in apnea events and daytime sleepiness. Hence, we assessed sleep breathing parameters in the prediabetes stage. A cross-sectional study conducted on 966 middle-aged subjects without known pulmonary disease (311 patients with prediabetes [...] Read more.

Type 2 diabetes leads to severe nocturnal hypoxemia, with an increase in apnea events and daytime sleepiness. Hence, we assessed sleep breathing parameters in the prediabetes stage. A cross-sectional study conducted on 966 middle-aged subjects without known pulmonary disease (311 patients with prediabetes and 655 controls with normal glucose metabolism) was conducted. Prediabetes was defined by glycated hemoglobin (HbA1c), and a nonattended overnight home sleep study was performed. Participants with prediabetes (n = 311) displayed a higher apnea–hypopnea index (AHI: 12.7 (6.1;24.3) vs. 9.5 (4.2;19.6) events/h, p < 0.001) and hypopnea index (HI: 8.4 (4.0;14.9) vs. 6.0 (2.7;12.6) events/h, p < 0.001) than controls, without differences in the apnea index. Altogether, the prevalence of obstructive sleep apnea was higher in subjects with prediabetes than in controls (78.1 vs. 69.9%, p = 0.007). Additionally, subjects with prediabetes presented impaired measurements of the median and minimum nocturnal oxygen saturation, the percentage of time spent with oxygen saturations below 90%, and the 4% oxygen desaturation index in comparison with individuals without prediabetes (p < 0.001 for all). After adjusting for age, sex, and the presence of obesity, HbA1c correlated with the HI in the entire population (r = 0.141, p < 0.001), and the presence of prediabetes was independently associated with the AHI (B = 2.20 (0.10 to 4.31), p = 0.040) as well as the HI (B = 1.87 (0.61 to 3.14), p = 0.004) in the multiple linear regression model. We conclude that prediabetes is an independent risk factor for an increased AHI after adjusting for age, sex, and obesity. The enhanced AHI is mainly associated with increments in the hypopnea events. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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14 pages, 661 KiB

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A New Approach to Overcome Insulin Resistance in Patients with Impaired Glucose Tolerance: The Results of a Multicenter, Double-Blind, Placebo-Controlled, Randomized Clinical Trial of Efficacy and Safety of Subetta

by Ashot Mkrtumyan, Alexander Ametov, Tatiana Demidova, Anna Volkova, Ekaterina Dudinskaya, Arkady Vertkin and Sergei Vorobiev

J. Clin. Med. 2022, 11(5), 1390; https://doi.org/10.3390/jcm11051390 - 3 Mar 2022

Cited by 9 | Viewed by 2494

Abstract

Impaired glucose tolerance (IGT) is a common carbohydrate metabolism disorder world-wide. To evaluate the efficacy and safety of 12-week Subetta therapy in correcting 2-h plasma glucose in patients with IGT, a multicenter, double-blind, placebo-controlled, randomized clinical trial was performed. Derived by technological treatment [...] Read more.

Impaired glucose tolerance (IGT) is a common carbohydrate metabolism disorder world-wide. To evaluate the efficacy and safety of 12-week Subetta therapy in correcting 2-h plasma glucose in patients with IGT, a multicenter, double-blind, placebo-controlled, randomized clinical trial was performed. Derived by technological treatment of antibodies to insulin receptor β-subunit and endothelial NO synthase, Subetta increases the sensitivity of insulin receptors by activating the insulin signaling pathway. Oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were examined at screening, after 4 and 12 weeks. In Per Protocol population, 2-h plasma glucose in the Subetta group decreased by 2.05 ± 2.11 mmol/L (versus 0.56 ± 2.55 mmol/L in the Placebo group) after 12 weeks. The difference between the two groups was 1.49 ± 2.33 mmol/L (p < 0.0001). After 12 weeks, 65.2% of patients had 2-h plasma glucose <7.8 mmol/L. FPG remained almost unchanged. HbA1c tended to decrease. The number of adverse events did not differ in both groups. Subetta treatment is beneficial for patients with IGT; it also prevents progression of carbohydrate metabolism disorders. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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7 pages, 417 KiB

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Metabolic Control of the FreeStyle Libre System in the Pediatric Population with Type 1 Diabetes Dependent on Sensor Adherence

by Isabel Leiva-Gea, Maria F. Martos-Lirio, Ana Gómez-Perea, Ana-Belen Ariza-Jiménez, Leopoldo Tapia-Ceballos, Jose Manuel Jiménez-Hinojosa and Juan Pedro Lopez-Siguero

J. Clin. Med. 2022, 11(2), 286; https://doi.org/10.3390/jcm11020286 - 6 Jan 2022

Cited by 4 | Viewed by 2190

Abstract

Aims: To evaluate the relationship between daily sensor scan rates and changes in HbA1c and hypoglycemia in children. Methods: We enrolled 145 paediatric T1D patients into a prospective, interventional study of the impact of the FreeStyle Libre 1 system on measures of glycemic [...] Read more.

Aims: To evaluate the relationship between daily sensor scan rates and changes in HbA1c and hypoglycemia in children. Methods: We enrolled 145 paediatric T1D patients into a prospective, interventional study of the impact of the FreeStyle Libre 1 system on measures of glycemic control. Results: HbA1c was higher at lower scan rates, and decreased as the scan rate increased to 15–20 scans, after which it rose at higher scan rates. An analysis of the change in hypoglycemia, based on the number of daily sensor scans, showed there was a significant correlation between daily scan rates and hypoglycemia. Subjects with higher daily scan rates reduced all levels of hypoglycaemia. Conclusions: HbA1c is higher at lower scan rates, and decreases as scan rate increases. Reductions in hypoglycemia were evident in subjects with higher daily scan rates. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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16 pages, 1194 KiB

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Validation of an Automated Screening System for Diabetic Retinopathy Operating under Real Clinical Conditions

by Soledad Jimenez-Carmona, Pedro Alemany-Marquez, Pablo Alvarez-Ramos, Eduardo Mayoral and Manuel Aguilar-Diosdado

J. Clin. Med. 2022, 11(1), 14; https://doi.org/10.3390/jcm11010014 - 21 Dec 2021

Cited by 4 | Viewed by 2549

Abstract

Background. Retinopathy is the most common microvascular complication of diabetes mellitus. It is the leading cause of blindness among working-aged people in developed countries. The use of telemedicine in the screening system has enabled the application of large-scale population-based programs for early retinopathy [...] Read more.

Background. Retinopathy is the most common microvascular complication of diabetes mellitus. It is the leading cause of blindness among working-aged people in developed countries. The use of telemedicine in the screening system has enabled the application of large-scale population-based programs for early retinopathy detection in diabetic patients. However, the need to support ophthalmologists with other trained personnel remains a barrier to broadening its implementation. Methods. Automatic diagnosis of diabetic retinopathy was carried out through the analysis of retinal photographs using the 2iRetinex software. We compared the categorical diagnoses of absence/presence of retinopathy issued by family physicians (PCP) with the same categories provided by the algorithm (ALG). The agreed diagnosis of three specialist ophthalmologists is used as the reference standard (OPH). Results. There were 653 of 3520 patients diagnosed with diabetic retinopathy (DR). Diabetic retinopathy threatening to vision (STDR) was found in 82 patients (2.3%). Diagnostic sensitivity for STDR was 94% (ALG) and 95% (PCP). No patient with proliferating or severe DR was misdiagnosed in both strategies. The k-value of the agreement between the ALG and OPH was 0.5462, while between PCP and OPH was 0.5251 (p = 0.4291). Conclusions. The diagnostic capacity of 2iRetinex operating under normal clinical conditions is comparable to screening physicians. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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7 pages, 492 KiB

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Good Metabolic Control in Children with Type 1 Diabetes Mellitus: Does Glycated Hemoglobin Correlate with Interstitial Glucose Monitoring Using FreeStyle Libre?

by Rocio Porcel-Chacón, Cristina Antúnez-Fernández, Maria Mora Loro, Ana-Belen Ariza-Jimenez, Leopoldo Tapia Ceballos, Jose Manuel Jimenez Hinojosa, Juan Pedro Lopez-Siguero and Isabel Leiva Gea

J. Clin. Med. 2021, 10(21), 4913; https://doi.org/10.3390/jcm10214913 - 24 Oct 2021

Cited by 3 | Viewed by 3568

Abstract

Background: Good metabolic control of Type 1 diabetes (T1D) leads to a reduction in complications. The only validated parameter for establishing the degree of control is glycated hemoglobin (HbA1c). We examined the relationship between HbA1c and a continuous glucose monitoring (CGM) system. Materials [...] Read more.

Background: Good metabolic control of Type 1 diabetes (T1D) leads to a reduction in complications. The only validated parameter for establishing the degree of control is glycated hemoglobin (HbA1c). We examined the relationship between HbA1c and a continuous glucose monitoring (CGM) system. Materials and methods: A cohort prospective study with 191 pediatric patients with T1D was conducted. Time in range (TIR), time below range (TBR), coefficient of variation (CV), number of capillary blood glucose tests, and HbA1c before sensor insertion and at one year of use were collected. Results: Patients were classified into five groups according to HbA1c at one year of using CGM. They performed fewer capillary blood glucose test at one year using CGM (−6 +/− 2, p < 0.0001). We found statistically significant differences in TIR between categories. Although groups with HbA1c < 6.5% and HbA1c 6.5–7% had the highest TIR (62.214 and 50.462%), their values were highly below optimal control according to CGM consensus. Groups with TBR < 5% were those with HbA1c between 6.5% and 8%. Conclusions: In our study, groups classified as well-controlled by guidelines were not consistent with good control according to the CGM consensus criteria. HbA1c should not be considered as the only parameter for metabolic control. CGM parameters allow individualized targets. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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7 pages, 229 KiB

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Effects of Weight Gain after 20 Years of Age and Incidence of Hyper-Low-Density Lipoprotein Cholesterolemia: The Iki Epidemiological Study of Atherosclerosis and Chronic Kidney Disease (ISSA-CKD)

by Shota Okutsu, Yoshifumi Kato, Shunsuke Funakoshi, Toshiki Maeda, Chikara Yoshimura, Miki Kawazoe, Atsushi Satoh, Soichiro Yokota, Kazuhiro Tada, Koji Takahashi, Kenji Ito, Tetsuhiko Yasuno, Hideyuki Fujii, Shigeaki Mukoubara, Hitoshi Nakashima, Daiji Kawanami, Kosuke Masutani, Hisatomi Arima and Shigeki Nabeshima

J. Clin. Med. 2021, 10(14), 3098; https://doi.org/10.3390/jcm10143098 - 14 Jul 2021

Cited by 4 | Viewed by 2543

Abstract

The aim of this study was to investigate the effects of long-term weight gain from the age of 20 on incidence of hyper-low-density-lipoprotein (LDL) cholesterolemia in the general population of Japanese people. Methods: We conducted a population-based retrospective cohort study using annual health [...] Read more.

The aim of this study was to investigate the effects of long-term weight gain from the age of 20 on incidence of hyper-low-density-lipoprotein (LDL) cholesterolemia in the general population of Japanese people. Methods: We conducted a population-based retrospective cohort study using annual health checkup data for residents of Iki City, Nagasaki Prefecture, Japan. A total of 3179 adult (≥30 years old) men and women without hyper-LDL cholesterolemia at baseline, who underwent two or more health checkups were included in the analysis. Information on weight gain (≥10 kg) after 20 years of age was obtained using questionnaire. The outcome of this study was development of hyper-LDL cholesterolemia defined as LDL-cholesterol level ≥3.62 mmol/L and/or initiation of lipid-lowering medications. Results: During a mean follow-up period of 4.53 years, 665 of the 3179 participants developed hyper-LDL cholesterolemia (46.5/1000 person-years). The incidence of hyper-LDL cholesterolemia was higher in participants with a weight gain of ≥10 kg (55.3/1000 person-years) than among those with a weight gain of <10 kg (41.8/1000 person-years). This association remained statistically significant even after adjustment for age, sex, smoking, daily drinking, exercise, obesity, hypertension, and diabetes (multivariable hazard ratio 1.31, 95% confidence interval 1.08–1.58, p = 0.006). Conclusion: A weight gain of ≥10 after 20 years of age affected the development of hyper-LDL cholesterol regardless of age, sex, and obesity in a general population of Japanese. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

9 pages, 242 KiB

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Eating Speed and Incidence of Diabetes in a Japanese General Population: ISSA-CKD

by Hideyuki Fujii, Shunsuke Funakoshi, Toshiki Maeda, Atsushi Satoh, Miki Kawazoe, Shintaro Ishida, Chikara Yoshimura, Soichiro Yokota, Kazuhiro Tada, Koji Takahashi, Kenji Ito, Tetsuhiko Yasuno, Shota Okutsu, Shigeaki Mukoubara, Hitoshi Nakashima, Shigeki Nabeshima, Seiji Kondo, Masaki Fujita, Kosuke Masutani, Hisatomi Arima and Daiji Kawanami Show full author list Hide full author list

J. Clin. Med. 2021, 10(9), 1949; https://doi.org/10.3390/jcm10091949 - 1 May 2021

Cited by 15 | Viewed by 3661

Abstract

Background: We investigated whether eating speed was associated with the incidence of diabetes in a Japanese general population. Methods: A total of 4853 Japanese individuals without diabetes at baseline were analyzed. Self-reported eating speed was categorized as slow, medium, and fast on the [...] Read more.

Background: We investigated whether eating speed was associated with the incidence of diabetes in a Japanese general population. Methods: A total of 4853 Japanese individuals without diabetes at baseline were analyzed. Self-reported eating speed was categorized as slow, medium, and fast on the basis of questionnaire responses. The study outcome was the incidence of diabetes. Results: After an average follow-up period of 5.1 years, 234 individuals developed diabetes. The incidence of diabetes per 1000 person-years was 4.9 in the slow eating speed group, 8.8 in the medium eating speed group, and 12.5 in the fast eating speed group, respectively (*** p < 0.001 for trend). The HRs were 1.69 (95%CI 0.94–3.06) for the medium eating speed and 2.08 (95%CI 1.13–3.84) for the fast eating speed, compared to the slow eating speed (* p = 0.014 for trend) after adjustment for age, gender, smoking status, drinking, exercise, obesity, hypertension, and dyslipidemia. Conclusion: Faster eating speed increased a risk for the incidence of diabetes in a general Japanese population. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

Review

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IL-1β Implications in Type 1 Diabetes Mellitus Progression: Systematic Review and Meta-Analysis

by Fátima Cano-Cano, Laura Gómez-Jaramillo, Pablo Ramos-García, Ana I. Arroba and Manuel Aguilar-Diosdado

J. Clin. Med. 2022, 11(5), 1303; https://doi.org/10.3390/jcm11051303 - 27 Feb 2022

Cited by 23 | Viewed by 4329

Abstract

During Type 1 Diabetes Mellitus (T1DM) progression, there is chronic and low-grade inflammation that could be related to the evolution of the disease. We carried out a systematic review and meta-analysis to evaluate whether peripheral levels of pro-inflammatory markers such as interleukin-1 beta [...] Read more.

During Type 1 Diabetes Mellitus (T1DM) progression, there is chronic and low-grade inflammation that could be related to the evolution of the disease. We carried out a systematic review and meta-analysis to evaluate whether peripheral levels of pro-inflammatory markers such as interleukin-1 beta (IL-1β) is significantly different among patients with or without T1DM, in gender, management of the T1DM, detection in several biological fluids, study design, age range, and glycated hemoglobin. We searched PubMed, Embase, Web of Science, and Scopus databases, and 26 relevant studies (2186 with T1DM, 2047 controls) were included. We evaluated the studies’ quality using the Newcastle–Ottawa scale. Meta-analyses were conducted, and heterogeneity and publication bias were examined. Compared with controls, IL-1β determined by immunoassays (pooled standardized mean difference (SMD): 2.45, 95% CI = 1.73 to 3.17; p < 0.001) was significantly elevated in T1DM. The compared IL-1β levels in patients <18 years (SMD = 2.81, 95% CI = 1.88–3.74) was significantly elevated. The hemoglobin-glycated (Hbg) levels in patients <18 years were compared (Hbg > 7: SMD = 5.43, 95% CI = 3.31–7.56; p = 0.001). Compared with the study design, IL-1β evaluated by ELISA (pooled SMD = 3.29, 95% CI = 2.27 to 4.30, p < 0.001) was significantly elevated in T1DM patients. IL-1β remained significantly higher in patients with a worse management of T1DM and in the early stage of T1DM. IL-1β levels determine the inflammatory environment during T1DM. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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24 pages, 871 KiB

Open AccessReview

State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature

by Miguel Ángel González-Moles and Pablo Ramos-García

J. Clin. Med. 2021, 10(22), 5383; https://doi.org/10.3390/jcm10225383 - 18 Nov 2021

Cited by 19 | Viewed by 5424

Abstract

Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, [...] Read more.

Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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15 pages, 606 KiB

Open AccessReview

Heart Failure in Type 1 Diabetes: A Complication of Concern? A Narrative Review

by Ana María Gómez-Perez, Miguel Damas-Fuentes, Isabel Cornejo-Pareja and Francisco J. Tinahones

J. Clin. Med. 2021, 10(19), 4497; https://doi.org/10.3390/jcm10194497 - 29 Sep 2021

Cited by 11 | Viewed by 3366

Abstract

Heart failure (HF) has been a hot topic in diabetology in the last few years, mainly due to the central role of sodium-glucose cotransporter 2 inhibitors (iSGLT2) in the prevention and treatment of cardiovascular disease and heart failure. It is well known that [...] Read more.

Heart failure (HF) has been a hot topic in diabetology in the last few years, mainly due to the central role of sodium-glucose cotransporter 2 inhibitors (iSGLT2) in the prevention and treatment of cardiovascular disease and heart failure. It is well known that HF is a common complication in diabetes. However, most of the knowledge about it and the evidence of cardiovascular safety trials with antidiabetic drugs refer to type 2 diabetes (T2D). The epidemiology, etiology, and pathophysiology of HF in type 1 diabetes (T1D) is still not well studied, though there are emerging data about it since life expectancy for T1D has increased in the last decades and there are more elderly patients with T1D. The association of T1D and HF confers a worse prognosis than in T2D, thus it is important to investigate the characteristics, risk factors, and pathophysiology of this disease in order to effectively design prevention strategies and therapeutic tools. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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15 pages, 3688 KiB

Open AccessReview

A Practical Guide for the Management of Steroid Induced Hyperglycaemia in the Hospital

by Felix Aberer, Daniel A. Hochfellner, Harald Sourij and Julia K. Mader

J. Clin. Med. 2021, 10(10), 2154; https://doi.org/10.3390/jcm10102154 - 16 May 2021

Cited by 44 | Viewed by 17494

Abstract

Glucocorticoids represent frequently recommended and often indispensable immunosuppressant and anti-inflammatory agents prescribed in various medical conditions. Despite their proven efficacy, glucocorticoids bear a wide variety of side effects among which steroid induced hyperglycaemia (SIHG) is among the most important ones. SIHG, potentially causes [...] Read more.

Glucocorticoids represent frequently recommended and often indispensable immunosuppressant and anti-inflammatory agents prescribed in various medical conditions. Despite their proven efficacy, glucocorticoids bear a wide variety of side effects among which steroid induced hyperglycaemia (SIHG) is among the most important ones. SIHG, potentially causes new-onset hyperglycaemia or exacerbation of glucose control in patients with previously known diabetes. Retrospective data showed that similar to general hyperglycaemia in diabetes, SIHG in the hospital and in outpatient settings detrimentally impacts patient outcomes, including mortality. However, recommendations for treatment targets and guidelines for in-hospital as well as outpatient therapeutic management are lacking, partially due to missing evidence from clinical studies. Still, SIHG caused by various types of glucocorticoids is a common challenge in daily routine and clinical guidance is needed. In this review, we aimed to summarize clinical evidence of SIHG in inpatient care impacting clinical outcome, establishment of diagnosis, diagnostic procedures and therapeutic recommendations. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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27 pages, 1074 KiB

Open AccessSystematic Review

Prevention of Peripheral Distal Polyneuropathy in Patients with Diabetes: A Systematic Review

by Lidia Carvajal-Moreno, Manuel Coheña-Jiménez, Irene García-Ventura, Manuel Pabón-Carrasco and Ana Juana Pérez-Belloso

J. Clin. Med. 2022, 11(6), 1723; https://doi.org/10.3390/jcm11061723 - 21 Mar 2022

Cited by 1 | Viewed by 3554

Abstract

Background: Diabetic peripheral neuropathy (DPN) is the most frequent chronic complication and is that which generates the highest disability and mortality in diabetes mellitus (DM). As it is currently the only microvascular complication of DM without a specific treatment, prevention is essential. The [...] Read more.

Background: Diabetic peripheral neuropathy (DPN) is the most frequent chronic complication and is that which generates the highest disability and mortality in diabetes mellitus (DM). As it is currently the only microvascular complication of DM without a specific treatment, prevention is essential. The aim of this study was to determine the most effective preventive strategy to avoid or delay the appearance and/or development of DPN in patients with DM. Methods: A systematic search was carried out in the main health science databases (PubMed, Scopus, CINAHL, PEDro and The Cochrane Library) from 1 January 2010 to 31 August 2020. The study selection was conducted by two independent reviewers and data extraction was performed by the author. The eligibility criteria included randomized clinical trials (RCTs) and cohort studies from RCTs. Results: Eleven studies were selected that included 23,595 participants with DM. The interventions evaluated were intensive or standard glycemic control, the use of drugs to achieve glycemic control, and the promotion of a healthy lifestyle and exercise. Intensive glucose control achieved a significant reduction in the development of DPN in TIDM patients, and lifestyle modifications and exercise achieved it moderately in TIIDM patients. Conclusions: The main preventive strategy for DPN is intensive glycemic control with a target HbA1c < 6% in patients with TIDM and standard control of 7.0–7.9 in patients with TIIDM, incorporating lifestyle modifications. Full article

(This article belongs to the Special Issue The Prevention, Treatment, and Complications of Diabetes Mellitus)

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