Diabetes Disease Management Research Articles

Clinical Practice Guideline for detection and management of diabetic kidney disease: a consensus report by the Spanish Society of Nephrology

Clinical Practice Guideline for detection and management of diabetic kidney disease: a consensus report by the Spanish Society of Nephrology

Nasal administration of polysaccharides-based nanocarrier combining hemoglobin and diferuloylmethane for managing diabetic kidney disease

The management of diabetic kidney disease (DKD) faces challenges stemming from intricate pathologies and suboptimal biodistributions during drug delivery. Although clinically available anti-inflammatory agents hold considerable promise for treating DKD, their therapeutic effectiveness is limited when utilized in isolation. To address this limitation, we introduced a novel self-oriented nanocarrier termed F-GCS@Hb-DIF, designed to synergistically integrate the therapeutic diferuloylmethane (DIF), the polysaccharide fucoidan/glycol chitosan (F-GCS), and phototherapeutic hemoglobin (Hb). F-GCS@Hb-DIF demonstrated the capability to autonomously navigate toward diseased renal sites and directly release drugs into the cytoplasm of target cells following intranasal administration. This self-directed drug delivery system increased the accumulation of Hb and DIF at the target site by around 2–3 times compared to free drugs alone as per biodistribution data. This enhancement allowed F-GCS@Hb-DIF to adopt a synergistic approach in treating the complex pathologies of DKD during the two-week treatment period. This approach entails modulating immunity, promoting renal functional recovery with a tissue-protective effect, and alleviating renal inflammation. These results underscore the promising therapeutic potential of F-GCS@Hb-DIF in managing DKD and other degenerative diseases associated with diabetes.

Slowing the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes Using Four Pillars of Therapy: The Time to Act is Now.

Chronic kidney disease (CKD) is the most common co-morbidity in patients with type 2 diabetes (T2D) and its presence substantially amplifies the risk for premature death, adverse cardiovascular events, and faster progression of kidney injury to kidney failure. For nearly two decades, the pharmacological blockade of the renin-angiotensin-system (RAS) was the only pillar of therapy to afford cardiorenal protection in these patients. During the last 5 years, newer novel therapies have been added to our therapeutic armamentarium, offering promise for more effective management of diabetic kidney disease in the future. Large phase 3 clinical trials have demonstrated additive cardiorenal protective benefits of sodium-glucose co-transporter type 2 (SGLT-2) inhibitors, the non-steroidal mineralocorticoid-receptor-antagonist (MRA) finerenone, and glucagon-like peptide-1 receptor agonist (GLP-1RA) semaglutide relative to placebo in patients with albuminuric CKD and T2D who are receiving standard-of-care treatment with a RAS-blocker. These therapies are likely much more effective when administered in a combined therapeutic algorithm, but the potential additive effects of combination therapy remain to be established in ongoing clinical trials. In this article, we assemble four pillars of therapy for the attenuation of residual cardiorenal risk in patients with CKD associated with T2D. We provide evidence from recent randomized trials and we discuss the concept of combined treatment for maximal cardiorenal protection in this high-risk patient population.

The Pattern of Practice in the Management of Early Diabetic Kidney Disease.

Background and objectives Diabetes is a leading cause of kidney failure in various regions worldwide. To detect renal disease in individuals with diabetes, screening typically involves evaluating the glomerular filtration rate and measuring albuminuria. Although there are established guidelines for these screenings, adherence to them varies. This study aims to examine the prevalence of albuminuria screening among adults with diabetes mellitus (DM) and to assess the different practices in managing these patients across primary and tertiary care settings. Methods This cross-sectional observational study involved adult patients with DM attending outpatient clinics in both primary and tertiary care settings. Patient data were gathered using a standardized form, excluding those with established chronic kidney disease (CKD) who were under nephrology care. Results The study included 1,010 patients, with 303 (30%) from primary care clinics and 707 (70%) from tertiary care clinics. The cohort comprised 582 (58%) females, with a median age of 62 years (IQR: 55-70), and approximately 990 (98%) had type 2 DM (T2DM). Annual albumin-to-creatinine ratio (ACR) screening was conducted for 498 out of 1,010 patients (49%) (95% confidence interval {CI}: 46%-52%). Screening compliance was notably higher in primary care settings compared to tertiary care clinics. Older patients (over 60 years) and those with hypertension or cardiac conditions were less likely to undergo screening. Among those screened, 185 of 498 patients (37%) (95% CI: 33%-41%) had abnormal albuminuria (ACR > 3). Conclusion Albuminuria is a significant indicator of progressing renal disease and cardiovascular risk. The annual screening rate for albuminuria in diabetic patients is inadequate. Primary care physicians show better adherence to screening guidelines compared to their tertiary care counterparts. Increasing physician awareness about the importance of screening could improve guideline compliance and mitigate the adverse effects of albuminuria.

Identification of phase angle and Triglyceride-Glucose index as biomarkers for prediction and management of diabetic foot disease

IntroductionApproximately 25 % of diabetic patients develop diabetic foot ulcers (DFUs), significantly increasing morbidity, mortality, and healthcare costs. Effective control and prevention are crucial. ObjectiveThis study aims to identify easily measurable parameters for predicting DFU risk by assessing the correlation between Phase Angle (PA) and the Triglyceride-Glucose (TyG) index with DFU risk. Materials and methodsA comparative case-control study was conducted at the General Hospital of Elche from March to June 2023 with 70 participants (33 with diabetes, 37 without). Cases had diabetes for over five years and a diabetic foot risk grade of 0, 1, or 2 (IWGDF 2019). Exclusion criteria included inability to walk, prior use of orthoses, and severe complications like edema or wounds. Predictive variables were PA, TyG index, body composition, and biochemical markers. Statistical analyses included Pearson/Spearman tests for correlations, Student's t-test/Mann-Whitney test for group comparisons, and ANOVA/Kruskal-Wallis tests for normally and non-normally distributed variables. ResultsPAand TyG index were strongly linked to diabetic foot risk, supporting their potential as biomarkers. Significant relationships with other relevant biomarkers were also confirmed. ConclusionPA and TyG index are valuable, easily measurable biomarkers for assessing diabetic foot risk, and can be monitored in primary care settings. Implementing these biomarkers in routine practice could enhance the management of diabetic complications, particularly in resource-limited settings, by enabling early detection and intervention, thus improving patient outcomes and reducing the burden of advanced complications.

DIABETES AND PERIODONTAL DISEASE: INTERCONNECTED PATHOPHYSIOLOGY AND CLINICAL IMPLICATIONS: A COMPREHENSIVE REVIEW

The bidirectional relationship between diabetes mellitus (DM) and periodontal disease is well-documented, with poor glycemic control exacerbating periodontal inflammation and vice versa. Novel therapies, including anti-inflammatory agents, antioxidants, and biologics, show promise in reducing systemic inflammation and improving glycemic control. Advances in identifying salivary biomarkers such as miRNAs 146a/b and 155, IL-1β, MMP8, and IL-6 have improved early detection of periodontitis in diabetic patients. Additionally, innovative imaging techniques like Raman spectroscopy and multiplex hand-held biosensors have enhanced diagnostic accuracy. Longitudinal studies and clinical trials remain essential to validate the long-term benefits and safety of new biomarkers and therapies. Recent studies highlight the importance of integrated care and interdisciplinary collaboration between dental and medical professionals to effectively manage these interrelated conditions. Future research should focus on understanding the biological pathways linking DM and periodontal disease, with a particular emphasis on the roles of inflammatory cytokines, oxidative stress, and the microbiome. Public health initiatives should aim to increase awareness of the bidirectional relationship between DM and periodontal disease through educational campaigns and community-based screening programs. Policy recommendations should encourage integrated health services and interdisciplinary training programs. The integration of artificial intelligence and machine learning in diagnostic tools offers potential for early detection and personalized treatment plans, further improving patient outcomes. Addressing these research gaps through continued investigation and technological innovation is crucial for enhancing the prevention, diagnosis, and management of diabetes and periodontal disease. These efforts will ultimately lead to better health outcomes and quality of life for affected individuals.

Chinese medicine Linggui Zhugan formula protects against diabetic kidney disease in close association with inhibition of proteinase 3-mediated podocyte apoptosis in mice

Ethnopharmacological relevanceLinggui-Zhugan (LGZG) comprises four herbs and is a classic formula in traditional Chinese medicine. There is strong clinical evidence of its pleiotropic effects in the prevention of diabetes and its related complications. Although several classes of drugs are currently available for clinical management of diabetic kidney disease (DKD), tight glycemic and/or hypertension control may not prevent disease progression. This study evaluated the therapeutic effect of the ethnopharmacological agent LGZG on DKD. Aim of the studyThis study aimed to investigate the effects of LGZG formula with standard quality control on experimental DKD and its related metabolic disorders in animal model. Meanwhile, the present study aimed to investigate regulatory effects of LGZG on renal proteinase 3 (PR3) to reveal mechanisms underlying renoprotective benefits of LGZG. Materials and methodsLGZG decoction was fingerprinted by high-performance liquid chromatography for quality control. An experimental model of DKD was induced in C57 BL/6J mice by a combination of high-fat diet feeding, uninephrectomy, and intraperitoneal injection of streptozocin. The LGZG decoction was administrated by daily oral gavage. ResultsTreatment with LGZG formula significantly attenuated DKD-like traits (including severe albuminuria, mesangial matrix expansion, and podocyte loss) and metabolic dysfunction (disordered body composition and dyslipidemia) in mice. RNA sequencing data revealed a close association of LGZG treatment with marked modulation of signaling pathways related to podocyte injury and cell apoptosis. Mechanistically, LGZG suppressed the DKD-triggered increase in renal PR3 and podocyte apoptosis. In-vitro incubation of mouse immortalized podocytes with LGZG-medicated serum attenuated PR3-mediated apoptosis. ConclusionOur data demonstrated that the LGZG formula protected against DKD in mice and was closely associated with its inhibitory effects on PR3-mediated podocyte apoptosis.

Challenges of EHR "Meaningful Use" in Rural Health Centers.

The Centers for Disease Control and Prevention (CDC) continues to promote the utilization of electronic health records (EHRs) to support population health management and reduce disparities. However, access to EHRs with capabilities to disaggregate data or generate digital dashboards is not always readily available in rural areas. With funding from CDC's DP-18-1815, the Division of Diabetes and Heart Disease Management (Division) at the South Carolina Department of Health and Environmental Control designed a quality improvement initiative to reduce health disparities for people with hypertension and high blood cholesterol in rural areas. With support from a nonprofit partner, the Division used qualitative evaluation methods to evaluate the extent to which practices were able to disaggregate data and report quality measures.

Corneal endothelium and central corneal thickness changes in patients with type 2 diabetes mellitus

Background Understanding the effect of diabetes mellitus on the corneal endothelium is essential for developing effective strategies for early detection, monitoring, and management of diabetic eye disease. Aim The aim of this study was to investigate the changes in corneal endothelium and central corneal thickness (CCT) in patients with type 2 diabetes mellitus. Patients and methods This is a prospective, nonrandomized, comparative study that included 500 eyes of 500 participants that were divided into two groups: group A: 250 eyes of type 2 diabetic patients and group B: 250 eyes of healthy controls. The diabetic group was further subdivided into two subgroups based on the duration of diabetes (<10 years and >10 years) and glycemic control (uncontrolled diabetes and controlled diabetes). Specular microscopy was performed in all eyes. Results The CCT was significantly higher in the diabetic group (516.93±36.43 μm) than in the control group (503.47±41.89 μm) (P=0.001). However, the two groups were relatively similar in cell density (CD) (cells/mm2), coefficient of variation (%), and hexagonality, with no statistically significant differences (P>0.05 for all). The CD was significantly higher in the patients with a duration of diabetes less than 10 years than those with a duration more than 10 years (2834.04±268.54 vs. 2277.13±244.54 cells/mm2, respectively, P=0.001). In addition, the hexagonality was significantly less in those with the duration of diabetes of more than 10 years (P=0.005). The CD was significantly less in the uncontrolled group than in the controlled group (2292.27±263.4 vs. 2644.69±370.88 cells/mm2, respectively, P=0.001). Conclusion Diabetic patients may exhibit alterations in their corneal parameters, particularly the CCT and endothelial CD. These changes are more in diabetic patients with a disease duration of more than 10 years and those with poor glycemic control.

Racial and Ethnic Differences in the Prevalence and Treatment Patterns for Neovascular Glaucoma in the American Academy of Ophthalmology IRIS® Registry

PurposeTo examine racial and ethnic differences in the prevalence and treatment patterns for neovascular glaucoma (NVG) in at-risk individuals in the American Academy of Ophthalmology (Academy) IRIS® Registry (Intelligent Research in Sight). ParticipantsEyes in the IRIS Registry with a retinal ischemia based on a history of proliferative diabetic retinopathy (PDR), retinal vein occlusion (RVO), and/or ocular ischemic syndrome (OIS). MethodsRace and ethnicity was defined as Asian, Black, Hispanic/Latino, Non-Hispanic White, and Other/Unknown. In eyes with retinal ischemia, the outcome was neovascular glaucoma (NVG). In eyes with NVG, outcomes included treatment of retinal ischemia with pan-retinal photocoagulation (PRP), and surgery to lower intraocular pressure (IOP) with trabeculectomy, tube shunt, and cyclophotocoagulation (CPC). Covariates included age, sex, region of residence, insurance type, smoking status, and systemic and ocular comorbidities. Cox proportional hazards regression was used to examine adjusted associations between race and ethnicity and NVG and each type of NVG treatment. Main Outcome MeasuresIncidence of NVG, PRP, trabeculectomy, tube shunt, CPC, and any IOP-lowering surgery ResultsOf 312,106 eyes with retinal ischemia, there were 5,885 (1.9%) with NVG. Compared to eyes of individuals who identified as Non-Hispanic White, eyes of individuals who were Black and Hispanic/Latino had higher hazards of NVG in adjusted analyses (hazards ratio [HR]=1.28, 95% confidence interval [CI]=1.15, 1.43 for Black; HR=1.32, 95% CI=1.17, 1.47 for Hispanic/Latino). Compared to eyes of individuals who were Non-Hispanic White, there was higher hazards of trabeculectomy in eyes of individuals who were Hispanic/Latino (adjusted HR=1.91, 95% CI=1.08, 3.39) and higher hazards of tube shunt (adjusted HR=1.35, 95% CI=1.07, 1.69) and of any IOP-lowering surgery (adjusted HR=1.29, 95% CI=1.09, 1.53) in eyes of individuals who were Black. There were no statistically significant differences in the hazards of PRP or CPC. ConclusionsEyes of Black and Hispanic/Latino individuals with retinal ischemia in the IRIS Registry had higher likelihood of NVG and of IOP-lowering surgery for NVG. Further study is needed to examine the medical and social factors that preclude optimal management of diabetic eye disease, in order to prevent its blinding complications.

Role of hydrosurgery in the management of diabetic foot disease- new application of an age-old technique

Role of hydrosurgery in the management of diabetic foot disease- new application of an age-old technique

Antibiotic Stewardship in the Management of Infected Diabetic Foot Ulcer Disease in Less Developed Countries.

Diabetic foot ulcers in developing countries often become infected. The healthcare systems are often not equipped to conduct the culture and the sensitivity tests required for prescribing a targeted antibiotic treatment for diabetic foot infection (DFI). We evaluate antibiotic stewardship programmes for DFIs, at every level of health care, with an emphasis on resource-poor settings such as in Africa. The management of DFI very often is adapted to the financial and practical realities of the resource-poor regions. The application of the point-of-care Gram stain of deep tissue samples is efficient, rapid, low cost and ubiquitously available. Upon the identification of the predominant pathogen in the Gram stain, a semi-quantitative preemptive antibiotic treatment can be started in accordance with the World Health Organization Aware, Watch and Restrict Essential Medicine List. This list is catered to every country and is a powerful tool. However, some basic knowledge of the local microbiological epidemiology is necessary to choose the most appropriate agent. We report our experience on using the rapidly available Gram stain for narrowing the preemptive choice of listed antibiotic agents, as an economic tool for antibiotic stewardship in DFIs. In the practical and resource-saving management of DFI, the 'therapeutic' use of Gram stains is not common in resource-rich countries but should be added to the arsenal of the general efforts for antibiotic stewardship.

Tadalafil versus pentoxifylline in the management of diabetic kidney disease: a randomized clinical trial

AimsTo investigate the efficacy and safety of tadalafil (TAD) versus pentoxifylline (PTX) in the management of diabetic kidney disease (DKD). Some animal studies and clinical trials reported that tadalafil and pentoxifylline have a reducing effect on different blood glucose parameters and lipid profiles which contribute to progress the patients with diabetes mellitus (DM) to DKD.MethodsFrom February 2022 to March 2023, 90 patients with type 2 DM and DKD (micro-albuminuria) were enrolled in this randomized-controlled study. The patients were randomized into three equal groups: control group, TAD group, and PTX group. The three groups received traditional blood glucose lowering therapy + ramipril 10 mg PO. The TAD group also received tadalafil 20 mg PO every other day. The PTX group also received pentoxifylline 400 mg PO twice daily.ResultsBoth TAD and PTX groups produced statistically significant improvement in the primary outcomes by a significant reduction in Urinary albumin/creatinine ratio (UACR) which was pronounced by a reduction percentage of—47.47%, −53.73% respectively. In addition to a significant decrease in Hemoglobin A1C (HbA1c) (mmol/mol), Fasting blood glucose (FBG), 2-h postprandial blood glucose (2-h PPG) (p < 0.001). Only the PTX group showed a significant increase in Cr Cl and a significant decrease in S. Cr (p < 0.001). Only the TAD group showed a significant increase in high-density lipoprotein—cholesterol (HDL-C) (p < 0.001), while the PTX group showed a significant decrease in low-density lipoprotein—cholesterol (LDL-C) (p-value 0.011), and triglyceride (p-value 0.002). Both TAD and PTX groups showed a decrease in tumor necrosis factor-α (TNF-α) which was significant only in the PTX group (p < 0.001). There was a significant increase in malondialdehyde (MDA) (p < 0.001), and an increase in urinary neutrophil gelatinase-associated Lipocalin (uNGAL) (p-value 0.850, 0.014 respectively) which was significant only in the PTX group.ConclusionsThe use of tadalafil or pentoxifylline may serve as an effective adjuvant therapy for patients with diabetic kidney disease.Trial Registration: ClinicalTrials.gov identifier NCT05487755, July 25, 2022.

Preparing to Address Social Determinants of Health (SDOH): Approaches to Clinic Transformation.

Pennsylvanians' health is influenced by numerous social determinants of health (SDOH). Integrating SDOH data into electronic health records (EHRs) is critical to identifying health disparities, informing public health policies, and devising interventions. Nevertheless, challenges remain in its implementation within clinical settings. In 2018, the Pennsylvania Department of Health (PADOH) received the Centers for Disease Control and Prevention's DP18-1815 "Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke" grant to strengthen SDOH data integration in Pennsylvania practices. Quality Insights was contracted by PADOH to provide training tailored to each practice's readiness, an International Classification of Diseases, Tenth Revision (ICD-10) guide for SDOH, Continuing Medical Education on SDOH topics, and introduced the PRAPARE toolkit to streamline SDOH data integration and address disparities. Dissemination efforts included a podcast highlighting success stories and lessons learned from practices. From 2019 to 2022, Quality Insights and the University of Pittsburgh Evaluation Institute for Public Health (Pitt evaluation team) executed a mixed-methods evaluation. During 2019-2022, Quality Insights supported 100 Pennsylvania practices in integrating SDOH data into EHR systems. Before COVID-19, 82.8% actively collected SDOH data, predominantly using PRAPARE tool (62.7%) and SDOH ICD-10 codes (80.4%). Amidst COVID-19, these statistics shifted to 65.1%, 45.2%, and 42.7%, respectively. Notably, the pandemic highlighted the importance of SDOH assessment and catalyzed some practices' utilization of SDOH data. Progress was evident among practices, with additional contribution to other DP18-1815 objectives. The main challenge was the variable understanding, utilization, and capability of handling SDOH data across practices. Effective strategies involved adaptable EHR systems, persistent efforts by Quality Insights, and the presence of change champions within practices. The COVID-19 pandemic strained staffing in many practices, impeding SDOH data integration into EHRs. Addressing the diverse understanding and use of SDOH data requires standardized training and procedures. Customized support and sustained engagement by facilitating organizations are paramount in ensuring practices' efficient SDOH data collection and integration.

“If it all goes digital, we’ll have to learn”: facilitators and barriers to uptake of digital health in British South Asians with cardiometabolic disease

BackgroundAlthough availability and utilisation of digital health interventions (DHIs) for management of diabetes and cardiovascular disease (“cardiometabolic disease”) have increased, they may exacerbate health inequalities. South Asians have increased cardiometabolic risk, but their experiences of DHIs are poorly investigated and characterised.ObjectiveTo explore facilitators and barriers to DHI uptake and use in South Asian individuals in the UK with cardiometabolic disease.MethodsMixed-methods approach encompassing online/face-to-face/individual interviews (n = 45) and survey (n = 100). After informed consent, transcription and coding, we conducted a thematic analysis informed by a guide for understanding inequalities in DHIs to examine perceptions at the individual, healthcare professional, societal and intervention level.ResultsParticipants described an intersection of factors resulting in varied digital skills and confidence within the community, including individual characteristics, awareness, and support. COVID-19 restrictions acted as both a positive (use of online shopping and social media increasing digital confidence) and negative (lack of access to health services) drivers to DHI uptake. Participants made recommendations for improving DHI uptake in the health service and policy area, such as promotion and upskilling through culturally and language-appropriate avenues such as community organisations and outlets. Participants suggested DHI design improvements should focus on literacy, numeracy, accessibility, and cultural appropriateness.ConclusionsDHIs have the potential to support South Asian populations in the UK to prevent and manage cardiometabolic disease. To improve their uptake, approaches to their implementation should consider community diversity to provide appropriate promotion, education, and support.

Advancements in diabetic kidney disease management: integrating innovative therapies and targeted drug development.

Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease and affects approximately 40% of individuals with diabetes . Cases of DKD continue to rise globally as the prevalence of diabetes mellitus increases, with an estimated 415 million people living with diabetes in 2015 and a projected 642 million by 2040. DKD is associated with significant morbidity and mortality, representing 34% and 36% of all chronic kidney disease deaths in men and women, respectively. Common comorbidities including hypertension and ageing-related nephron loss further complicate disease diagnosis and progression. The progression of DKD involves several mechanisms including glomerular endothelial cell dysfunction, inflammation, and fibrosis. Targeting these mechanisms has formed the basis of several therapeutic agents. Renin-angiotensin-aldosterone system (RAAS) blockers, specifically angiotensin receptor blockers (ARBs), demonstrate significant reductions in macroalbuminuria. Sodium-glucose transporter type 2 (SGLT-2) inhibitors demonstrate kidney protection independent of diabetes control while also decreasing the incidence of cardiovascular events. Emerging agents including glucagon-like peptide 1 (GLP-1) agonists, anti-inflammatory agents like bardoxolone, and mineralocorticoid receptor antagonists show promise in mitigating DKD progression. Many novel therapies including monoclonal antibodies CSL346, lixudebart, and tozorakimab; mesenchymal stem/stromal cell infusion; and cannabinoid-1 receptor inverse agonism via INV-202 are currently in clinical trials and present opportunities for further drug development.

Predictors of operative management in diabetic foot ulcers.

Surgery plays a key role in the management of complicated diabetic foot disease (DFD). Currently, indications for medical versus surgical management are poorly defined. Prompt identification of patients who require surgery may reduce morbidities and length of hospital stay. This study aims to analyse factors in DFD that necessitate early surgical interventions. All patients admitted under a multi-disciplinary diabetic foot team in a tertiary institution over 2years were included in a retrospective case-control study comparing patients who received medical management and patients who received surgical management. Logistic regression was performed to identify factors associated with surgical management of diabetic foot complications. Three hundred and forty patients were included. 49% of patients required surgical management. Toe ulceration, elevated C-reactive protein (CRP), and the presence of osteomyelitis were associated with surgical management. Multivariate analysis calculated an odds ratio (OR) of 1.01 for CRP (p<0.001), OR 2.19 (p<0.019) favouring surgical management for forefoot ulcers, and OR 2.2 (p<0.019) if osteomyelitis was present. Patients with elevated CRP levels, a forefoot diabetic ulcer and established osteomyelitis were more likely to undergo surgical management. Prompt recognition of these patients has the potential benefit of earlier decision making in definitive surgical interventions.

Lipids as potential mediators linking body mass index to diabetes: evidence from a mediation analysis based on the NAGALA cohort

BackgroundBody mass index (BMI) and lipid disorders are both known to be strongly associated with the development of diabetes, however, the indirect effect of lipid parameters in the BMI-related diabetes risk is currently unknown. This study aimed to investigate the mediating role of lipid parameters in the association of BMI with diabetes risk.MethodsWe assessed the association of diabetes risk with BMI, as well as lipid parameters including high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-CF and LDL-CS), triglycerides(TG), total cholesterol(TC), remnant cholesterol(RC), non-HDL-C, and combined indices of lipid parameters with HDL-C (RC/HDL-C ratio, TG/HDL-C ratio, TC/HDL-C ratio, non-HDL/HDL-C ratio, LDL/HDL-C ratio) using data from 15,453 subjects in the NAGALA project. Mediation models were used to explore the mediating role of lipid parameters in the association of BMI with diabetes risk, and mediation percentages were calculated for quantifying the strength of the indirect effects. Finally, receiver operating characteristic curve (ROC) analysis was used to compare the accuracy of BMI and BMI combined with lipid parameters in predicting incident diabetes.ResultsMultivariate regression models, adjusted for confounding factors, demonstrated robust associations of lipid parameters, BMI, with diabetes risk, with the exception of TC, LDL-CF, LDL-CS, and non-HDL-C. Mediation analysis showed that lipid parameters except TC, LDL-CF, LDL-CS, and Non-HDL-C were involved in and mediated the association of BMI with diabetes risk, with the largest mediation percentage being the RC/HDL-C ratio, which was as high as 40%; it is worth mentioning that HDL-C and HDL-C-related lipid ratio parameters also play an important mediating role in the association between BMI and diabetes, with the mediator proportion being greater than 30%. Finally, based on the ROC results, we found that the prediction performance of all lipid parameters in the current study except TC was significantly improved when combined with BMI.ConclusionOur fresh findings suggested that lipid parameters partially mediated the association of BMI with diabetes risk; this result indicated that in the context of diabetes risk screening and disease management, it is important to not only monitor BMI but also pay attention to lipid parameters, particularly HDL-C and HDL-C-related lipid ratio parameters.

Chinese Healthcare Workers' Knowledge, Attitudes, and Practices in Diabetic Kidney Management: A Multi-Centered Cross-Sectional Study.

Given the importance of diabetic kidney disease (DKD) management, this study aims to explore the knowledge, attitudes, and practices in disease management demonstrated by healthcare workers from the nephrology department. This study is a multi-centered cross-sectional study, and adopts snowball sampling, with 530 healthcare workers being recruited to complete a questionnaire covering areas such as demographic characteristics, knowledge, attitude, and practices (KAP) of DKD management. This data was analyzed using descriptive statistics and binary logistics analysis. In this study, 530 healthcare workers were studied, including 94 doctors and 436 nurses. The participants were mainly from general tertiary hospitals in 14 provinces. For Chinese nurse, the results indicate that both poor knowledge level (Odds Ratio (OR) =0.63, 95% Confidence Interval (CI): 0.42-0.94) and having experience in further medical training in nephrology (OR=1.92, 95% CI: 1.20-3.08) are associated with the practice levels. For Chinese doctors, having not experience in further medical training in nephrology (OR=0.36, 95% CI: 0.15-0.83) are associated with their practice levels. In summary, Chinese doctors and nurses in this study showed positive attitudes towards DKD management, but their knowledge and practical skills were lacking. This underscores a notable gap in achieving optimal DKD care. Notably, nurses' knowledge influenced their management practices, and additional nephrology training correlated with better engagement. To improve patient care, enhancing nephrology healthcare professional training and addressing knowledge-practice disparities are recommended.

Development of diabetes complications within coordinated and structured primary health care: a 10-year retrospective cohort study in Germany.

Diabetes mellitus is a growing, costly, and potentially preventable public health issue. In 2004, Germany introduced the GP-centred healthcare programme to strengthen primary care. To assess the hazards of the most common diabetes-related complications in patients enrolled in GP-centred health care in comparison with usual primary care. A retrospective cohort study based on German claims data (4 million members) from 2011-2020. In total, 217 964 patients with diabetes were monitored from 2011-2020. Endpoints were blindness, amputation, myocardial infarction, stroke, coronary heart disease, dialysis, hypoglycaemia, and all-cause mortality. Cox proportional-hazards regression models were used for multivariable analysis and adjusted for sociodemographic, practice, and disease-specific characteristics. Compared with usual care (n = 98 609 patients), GP-centred health care (n = 119 355 patients) showed a relative risk reduction of blindness of 12%, and amputation of 20% over 10 years. The estimated impact of GP-centred health care on myocardial infarction, stroke, coronary artery disease, dialysis, and all-cause mortality is significantly favourable in comparison with usual care. However, the proportional risk of hypoglycaemia (+1.2%) in the interventional group is higher than in usual care. Enrolment in GP-centred health care appears to result in a consistent reduction of the relative risk of diabetes-related complications over 10 years. The significant difference in contrast to usual care may be explained by robust, structured primary care provision, including the diabetes disease management programme, and improved coordination and networking of care within primary and secondary care.