Diabetes In Adults Research Articles

The atherogenic index of plasma is associated with an increased risk of diabetes in non-obese adults: a cohort study

The atherogenic index of plasma is associated with an increased risk of diabetes in non-obese adults: a cohort study

Diabetes visits in paediatric versus adult clinics for young adults (YA) with T1D: Pre-pandemic and pandemic care.

Young adults (YA) with type 1 diabetes mellitus (T1D) are at high risk of worsening glycated haemoglobin (HbA1c) with fewer follow-up visits. We examined the association of demographic and diabetes characteristics with care utilization, including in-person and telehealth visits, pre- (1 April 2019 to 15 March 2020) and during the COVID-19 pandemic (30 March 2020 to 15 March 2021) for YA (ages: 18-30) with T1D, comparing those seen in paediatric versus adult diabetes clinics at a single diabetes centre. Data were obtained from the electronic health record for YA with a pre-pandemic HbA1c. We performed descriptive statistics to describe the sample and paired t-tests to compare visits before and during the pandemic. Data from 1762 YA (54% male; age 24.0 ± 3.6 (M ± SD) years; HbA1c 66 ± 18 mmol/mol (8.2 ± 1.6%) revealed that in the full sample, mean pre-pandemic visit frequency was 3.5 ± 3.4 and mean pandemic visit frequency was 3.1 ± 4.1 (p < 0.0001). Furthermore, the pandemic visit frequency declined in the adult clinic regardless of sex, pump therapy, CGM use, and pre-pandemic HbA1c, whereas in the paediatric clinic, visit frequency was only reduced for those with HbA1c <53 mmol/mol (<7%) but was otherwise maintained. In this diabetes centre, the paediatric clinic maintained diabetes care delivery during the pandemic (30 March 2020 to 15 March 2021) to YA with glycaemic control above target, suggesting that preservation of remote care delivery should be considered in this high-risk group.

Strong Association of Autoantibodies Targeting Deamidated Extracellular Epitopes of Insulinoma Antigen-2 (IA-2) with Clinical Onset of Type 1 Diabetes.

Increasing evidence shows that pathogenic T cells in type 1 diabetes (T1D) that may have evaded negative selection recognize post-translational modified (PTM) epitopes of self-antigens. We have investigated the profiles of autoantibodies specifically targeting the deamidated epitopes of insulinoma antigen-2 extracellular domain (IA-2ec) to explore their relationship with T1D development. We compared the characteristics of autoantibodies targeting the IA-2ec Q>E epitopes (PTM IA-2ecA) as well as those targeting the IA-2ec unmodified epitopes (IA-2ecA) in participants across different stages of T1D development and in individuals with other types of diabetes and other kinds of autoimmunity. In patients with new-onset T1D, the prevalence of PTM IA-2ecA (26.1%) was significantly higher than that of IA-2ecA (19.5%, P<0.0001). In a longitudinal newborn cohort, both IA-2ecAs were present, but rare in preclinical stage 1 T1D, and with much lower positivity in individuals with stage 3 T1D who had been closely followed from birth in a clinical study compared to patients diagnosed in routine clinical settings with overt symptoms. In participants with latent autoimmune diabetes in adults, type 2 diabetes, and celiac disease autoimmunity, we did not observe significant positivity of either IA-2ecAs. These results indicate that PTM and unmodified IA-2ecA are predominantly present in clinical new-onset T1D patients, at late stages of T1D development.

A nationwide registry-based cohort study of the association between childhood dental caries and gingivitis with type 2 diabetes in adulthood.

Evidence suggests a bidirectional relationship between oral health status and type 2 diabetes (T2D) in adults. Studies on associations between childhood oral health and T2D in adulthood are lacking. This is a nationwide Danish registry-based cohort study of individuals born between 1963 and 1972, having at least one registration in the National Child Odontology Registry between 1972 and 1987 (n = 627,758). Follow-up lasted from 1995 to 2018. Main exposure variables were the highest achieved levels of dental caries and gingivitis between 1972 and 1987. The outcome was T2D diagnosis during follow-up. Data was analyzed using Cox-regression, stratified on sex, with age as the underlying timescale and highest achieved level of education between age 25-30years as Cox-strata. Main analyses were conducted with and without age-restrictions (T2D diagnosis before/after age 40). Compared to lowest-level references, high levels of gingivitis associated with increased hazard ratios (HRs) of T2D in both males (HR [95% confidence interval]: 1.59 [1.47; 1.72]) and females (1.87 [1.68; 2.08]), as did severe dental caries (males: (1.15 [1.04; 1.27], in females: 1.19 [1.06; 1.35]). Below age 40, gingivitis associated with increased HRs in males (1.84 ([1.58; 2.15]) and females (1.94 [1.63; 2.30]). Above age 40, both exposures displayed higher HRs in males (high gingivitis: 1.52 [1.39; 1.66] vs. severe caries: 1.23 [1.09; 1.38]) and females (1.83 [1.59; 2.10] vs. 1.37 [1.17; 1.59]). Data suggest an association between childhood dental caries and gingivitis with risk of receiving a T2D diagnosis in adulthood. However, results are affected by residual confounding warranting further studies.

Consequence of War on Diabetic Mellitus patients in Tigray region, Ethiopia: a longitudinal study

BackgroundStudies of the world health organization indicated that Diabetes is on the rise. The occurrence of diabetes is steadily increasing everywhere, most markedly in the world’s middle and low-income countries. The aim of this study is to explore the consequence of war on the sugar level of diabetic mellitus patients.MethodsA retrospective longitudinal study with a sample of 67 diabetic mellitus patients was used. As a result, longitudinal different models, which are generalized linear mixed effects and nonlinear mixed effect models were fitted on the continuous response variable, the Sugar Level of the diabetic patients.ResultsThe results depicted that Blood Sugar Level of the patients increases over time. Moreover, as age, weight, medication, total cholesterol, high density lipoprotein (HDL), creatinine and linear time effect increase, Blood Sugar Level increases significantly, whereas triglyceride and low density lipoprotein increase, Blood Sugar Level of the adult Diabetes mellitus patients decreases.ConclusionThe war has significant effect on the poor control of blood glucose level of the adult diabetic patients in Tigray region, Ethiopia. Due to the war, siege or blockages, in return there were rare of medicine, the patients were not taking their medicines on time, and they did not get enough insulin as well.

Psychosocial factors influencing dietary management in patients with type 2 diabetes and healthy adults: an ecological momentary assessment approach.

Dietary management in diabetic patients is affected by psychosocial factors and the social-environmental context. Ecological momentary assessment (EMA) allows patients to consistently report their experiences in real-time over a certain period and across different contexts. Despite the importance of dietary management, only a few EMA studies have been conducted on dietary management and psychosocial factors in patients with type 2 diabetes; further evidence must be gathered. Therefore, this study examined dietary management and psychosocial factors using EMA, comparing type 2 diabetes patients with healthy adults. A total of 20 patients with type 2 diabetes and 16 healthy adults underwent EMA. Relying on event-contingent recordings, this study evaluated the participants' mood (e.g., anxiety, anger, vigor), appetite (hunger, craving), meal types (e.g., breakfast), location (e.g., eating out), companions (e.g., family), and dietary lapses (e.g., I ate a larger portion of a meal or snack than I intended) before and after meals. Dietary lapse recording after meals was paired with psychosocial data before meals. Only the type 2 diabetes patients used a sensor-based glucose monitoring system (Freestyle Libre Pro, Abbot) and wearable activity monitors (GT3X-BT, ActiGraph). The EMA produced a total of 4,254 responses. Dietary lapse predicted two-hour postprandial glucose through a sensor-based glucose monitoring system. Multilevel logistic regression analyses were performed. For diabetes patients, dietary lapse was affected by vigor, fatigue, and cravings before eating. Meanwhile, for healthy adults, only fatigue before meals affected dietary lapse, and increased vigor from dietary intake was associated with dietary lapse. In both type 2 diabetes patients and healthy adults, eating-out situations were linked to dietary lapse. The results suggest differences in psychosocial factors influencing dietary lapse between patients with type 2 diabetes and healthy adults. EMA is well suited to assess psychosocial factors that drive dietary management in diabetic patients. This study further discussed the possibility of individual approaches using EMA data.

The relationship between sociodemographic characteristics, lifestyle, and diet quality with diabetes risk in overweight and obese Turkish adults

BackgroundObesity and certain associated environmental factors increase the risk of type 2 diabetes mellitus (T2DM). This research aims to evaluate the relationship between sociodemographic characteristics, lifestyle, and diet quality with diabetes risk in overweight and obese Turkish adults.MethodsA questionnaire form including sociodemographic characteristics, lifestyle, body weight and height was applied. Finnish Diabetes Risk Score (FINDRISC) tool was used to identify the risk of T2DM. Dietary assessments were made by 24 h dietary recall and diet quality was evaluated by Healthy Eating Index-2015 (HEI-2015).ResultsAccording to FINDRISC score, 38.1% of adults were at mild risk, 21.9% were at moderate risk, and 20.9% were at high risk. In regression model, factors such as low educational level, being married, being employed, smoking, and the presence of comorbidities were found to increase the risk of developing diabetes. Each unit decline in HEI-2015, the risk of diabetes increased by a factor of 0.983.ConclusionsSociodemographic factors, lifestyle, and diet quality significantly contribute to the increased risk of diabetes in overweight and obese Turkish adults. This trial was registered at clinicaltrials.gov with number NCT06614075 and registration date of 26 September 2024, retrospectively registered.

Long-term weight change, incident cardiovascular disease and all-cause mortality among diabetic adults

We aimed to explore the impact of weight change from young to middle adulthood on incident cardiovascular disease (CVD) and all-cause mortality in US diabetic adults. All study subjects aged 40–79 years were from the US National Health and Nutrition Examination Survey (NHANES) 1988–2018, and they were non-pregnant and had complete data on self-reported weight at age 25 and 10 years before baseline enrollment over average 29.4 years. CVD events occurring from 10 years ago to baseline enrollment were recorded. Relative to stable non-obesity group, the strongest association was noted for the weight-losing group, followed by the stable-obesity group and weight-gaining group over following 10 years. Referring to the stable-obesity group identified significance for the stable non-obesity group. If total population had maintained non-obese from young to middle adulthood, 12 % of CVD cases could have been averted. Relative to the stable non-obesity group, subjects who maintained obese between young and middle adulthood had an increased risk of all-cause mortality. Our findings indicated that the risk for incident CVD and all-cause mortality was potentially reinforced in diabetic adults who were obese at age 25 but non-obese at midlife and who remained stable obese vis-à-vis those with stable non-obesity.

Comparison of residual gastric volume using ultrasound in fasting diabetic and non-diabetic older adults undergoing staged-bilateral total knee arthroplasty: a prospective non-randomized comparative study

Comparison of residual gastric volume using ultrasound in fasting diabetic and non-diabetic older adults undergoing staged-bilateral total knee arthroplasty: a prospective non-randomized comparative study

Patterns and Factors Associated with Dyslipidemia Among Patients with Diabetes Mellitus Attending Hoima Regional Referral Hospital, Uganda.

Dyslipidemia in Sub-Saharan Africa has been on the disproportionate rise among diabetes patients across various contextual settings due to its patterns and associated factors. This study determined the patterns and factors associated with dyslipidemia among diabetes patients attending Hoima Regional Referral Hospital (HRRH). This was a hospital-based cross-sectional study conducted at HRRH between October 2022 and January 2023, enrolled 375 adult diabetes patients consecutively from diabetic outpatient clinic. Data on socio-demographic, behavioral, medical history, physical examination, and laboratory diagnoses were collected and summarized using descriptive statistics. Patterns of dyslipidemia were presented as a proportion of each lipid profile either singly or in combination expressed as a percentage. In the bivariate analysis, variables with p-values <0.2, crude odds ratios of ≥2 or ≤0.5, or those with biological plausibility were included in a multiple logistic regression model. Factors with p-values <0.05 were considered statistically significant. All analyses were conducted using Stata version 17. Of the 375 diabetes patients, 260 (69.3%) had abnormal total cholesterol (TC), and 185 (49.3%) had two lipid profile abnormalities. The majority of the patients were female, 235 (62.7%), and 38 (10.1%) had a diagnosis of coronary heart disease (CHD). Additionally, 134 (35.7%) were overweight, and 39 (10.4%) were obese. Female patients had higher odds of dyslipidemia (Adjusted Odds Ratio [AOR] = 2.2, 95% CI: 1.02-4.86, p = 0.045). Those with coronary heart disease (CHD) had increased odds of dyslipidemia (AOR = 4.1, 95% CI: 1.51-11.07, p = 0.006). All diabetes patients who were overweight or obese had dyslipidemia (p < 0.001). The most common pattern of dyslipidemia in patients with diabetes was elevated total cholesterol, followed by high low-density lipoprotein, associated with overweight, obesity, female gender, and CHD. Routine screening of lipid profiles, BMI, and CHD in diabetic clinics is crucial for early intervention and improved outcomes.

Association of Albumin-To-Creatinine Ratio With Diabetic Retinopathy Among US Adults (NHANES 2009-2016).

This study investigates the relationship between the albumin-to-creatinine ratio and diabetic retinopathy (DR) in US adults using NHANES data from 2009 to 2016. This study assesses the predictive efficacy of the urinary serum albumin-to-creatinine ratio (UACR/SACR Ratio) against traditional biomarkers such as the serum albumin-to-creatinine ratio (SACR) and urinary albumin-to-creatinine ratio (UACR) for evaluating DR risk. Additionally, the study explores the potential of these biomarkers, both individually and in combination with HbA1c, for early detection and risk stratification of DR. This cross-sectional study analysed data from 2594 diabetic adults in the National Health and Nutrition Examination Survey (NHANES 2009-2016). Multivariate logistic regression models, adjusted for demographic (sex, age, race and education) and clinical factors (WBC, PLT, RDW, HbA1c, HBP and CHD), examined the associations between biomarkers and DR. Biomarkers were analysed both continuously and in quartiles to assess dose-response relationships. Receiver operating characteristic (ROC) curve analysis evaluated the predictive accuracy of individual biomarkers and combined models. Elevated SACR levels were inversely related to DR risk, while UACR showed a positive correlation. The UACR/SACR ratio demonstrated superior predictive capability for DR compared to SACR and UACR alone. The most accurate predictive model combined SACR, UACR, UACR/SACR ratio and HbA1c (AUC = 0.614), highlighting DR development complexity. Subgroup analyses revealed stronger associations in participants aged < 60 years and those with hypertension (both p < 0.05), with more pronounced effects observed in males and Mexican Americans, while lifestyle factors showed no significant modifying effect. The UACR/SACR Ratio emerged as a potentially superior DR predictor, particularly in younger patients and those with hypertension, suggesting its utility in enhancing early detection and risk stratification. Comprehensive evaluation of renal function and glycaemic control biomarkers, considering age- and comorbidity-specific patterns, could improve DR risk prediction and management. Future longitudinal studies should validate these findings, particularly in identified high-risk subgroups, and investigate underlying mechanisms, potentially advancing personalised DR prediction and management strategies.

A reinforcement learning approach to effective forecasting of pediatric hypoglycemia in diabetes I patients using an extended de Bruijn graph

Pediatric diabetes I is an endemic and an especially difficult disease; indeed, at this point, there does not exist a cure, but only careful management that relies on anticipating hypoglycemia. The changing physiology of children producing unique blood glucose signatures, coupled with inconsistent activities, e.g., playing, eating, napping, makes “forecasting” elusive. While work has been done for adult diabetes I, this does not successfully translate for children. In the work presented here, we adopt a reinforcement approach by leveraging the de Bruijn graph that has had success in detecting patterns in sequences of symbols–most notably, genomics and proteomics. We translate a continuous signal of blood glucose levels into an alphabet that then can be used to build a de Bruijn, with some extensions, to determine blood glucose states. The graph allows us to “tune” its efficacy by computationally ignoring edges that provide either no information or are not related to entering a hypoglycemic episode. We can then use paths in the graph to anticipate hypoglycemia in advance of about 30 minutes sufficient for a clinical setting and additionally find actionable rules that accurate and effective. All the code developed for this study can be found at: https://github.com/KurbanIntelligenceLab/dBG-Hypoglycemia-Forecast.

Identify unmet needs in diabetes care in Shandong, China: a secondary analysis of a cross-sectional study using cascade of care framework

BackgroundThe continuum management of diabetes remains under-evaluated in China. This study aimed to estimate the proportions of diabetes adults at each stage of the cascade of care framework in Shandong, China.MethodsWe conducted a secondary analysis using the 2018 China Adult Chronic Disease and Nutrition Surveillance (CACDNS) data in Shandong. This nationwide cross-sectional survey was conducted between September and November 2018, investigating the major chronic diseases among Chinese adults through interviews, physical examinations, and laboratory tests. We employed the cascade model to examine the proportion of diabetes adults, including both type 1 and type 2, from diabetes screening, diagnosis, pharmaceutical and non-pharmaceutical treatments, to single and comprehensive management targets, and quantified the attrition between each stage. Diabetes screening was defined as participants reported to have ever received a blood glucose test. Diabetes diagnosis was defined as: 1) fasting plasma glucose (FPG) ≥ 126 mg/dL, or 2) 2-h oral glucose tolerance test (2 h-OGTT) ≥ 200 mg/dL, or 3) hemoglobin A1c (HbA1c) ≥ 6.5%, or 4) self-reported diabetes. Diabetes management targets included: 1) single glycemic target of personalized HbA1c level, 2) comprehensive ABC targets of personalized HbA1c level, blood pressure (BP) < 140/80 mm Hg, and low-density lipoprotein cholesterol (LDL-c) level < 2.6 mmol/L, 3) lifestyle target of not currently smoking. The estimated proportion was calculated through self-reported diabetes status and FPG, 2h-OGTT and HbA1c. The number of diabetes cases in Shandong was extrapolated using the 2018 provincial census data for adults aged 18 years and above (N = 80.6 million). The cascade of diabetes care was further examined by age, sex, and Basic Public Health Service (BPHS) enrollment.ResultsThis secondary analysis included 8,462 individuals (47.8% males, median age: 49.0), among whom 12.4% had diabetes (self-reported: 4.2%, newly diagnosed: 8.2%) and 41.1% had prediabetes. In 2018, an estimated 9.2 million adults in Shandong had diabetes, with 6.4 million (69.6%) receiving diabetes screening but 6.2 million (67.7%) remaining unaware of their conditions. Among self-reported diabetes adults, 2.7 million (86.4%) and 2.8 million (89.6%) received pharmaceutical and non-pharmaceutical treatment, respectively. Of those with treatments, 1.2 million (58.2%) met personalized glycemic target. A rapid decline, however, was observed in BP (31.1%) and LDL-c (39.3%) control among diabetes patients with multimorbidity (≥ 2 diseases). Ultimately, 0.1 million self-reported diabetes adults (3.8%) achieved the ABC targets. BPHS Enrollment slightly improved comprehensive management with ABC targets.ConclusionsA significant unmet need exists for diabetes adults from screening to management, particularly the comprehensive management of glycemia, BP and LDL-c levels among those with multimorbidity. Tailored strategies and appropriate allocation of healthcare resource is needed to addressing gaps in care continuum and reduce long-term disease burden.

Intrapatient Changes in CT-Based Body Composition After Initiation of Semaglutide (Glucagon-Like Peptide-1 Receptor Agonist) Therapy.

BACKGROUND. The long-acting glucagon-like peptide-1 receptor agonist semaglutide is used to treat type 2 diabetes or obesity in adults. Clinical trials have observed associations of semaglutide with weight loss, improved control of diabetes, and cardiovascular risk reduction. OBJECTIVE. The purpose of this study was to evaluate intrapatient changes in body composition after initiation of semaglutide therapy by applying an automated suite of CT-based artificial intelligence (AI) body composition tools. METHODS. This retrospective study included adult patients who were receiving semaglutide treatment and who, between January 2016 and November 2023, underwent abdominopelvic CT within both 5 years before and 5 years after initiation of semaglutide. An automated suite of previously validated CT-based AI body composition tools was applied to scans obtained before semaglutide initiation (hereafter, presemaglutide scans) and scans obtained after semaglutide initiation (hereafter, postsemaglutide scans) to quantify visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) area, skeletal muscle area and attenuation, intermuscular adipose tissue (IMAT) area, liver volume and attenuation, and trabecular bone mineral density (BMD). Patients with weight loss of 5 kg or more and those with weight gain of 5 kg or more between the scans were compared. RESULTS. The study included 241 patients (151 women and 90 men; mean age, 60.4 ± 12.4 [SD] years). In the weight-loss group (n = 67), the postsemaglutide scan, compared with the presemaglutide scan, showed a decrease in VAT area (309.4 vs 341.1 cm2, p < .001), SAT area (371.4 vs 410.7 cm2, p < .001), muscle area (179.2 vs 193.0, p < 0.001), and liver volume (2379.0 vs 2578 HU, p = .009) and an increase in liver attenuation (74.5 vs 67.6 HU, p = .03). In the weight-gain group (n = 48), the postsemaglutide scan, compared with the presemaglutide scan, showed an increase in VAT area (334.0 vs 312.8, p = .002), SAT area (485.8 vs 448.8 cm2, p = .01), and IMAT area (48.4 vs 37.6, p = .009) and a decrease in muscle attenuation (5.9 vs 13.1, p < .001). Other comparisons were not statistically significant (p > .05). CONCLUSION. Patients using semaglutide who lost versus gained weight showed distinct patterns of changes in CT-based body composition measures. Those with weight loss had overall favorable shifts in measures related to cardiometabolic risk. A decrease in muscle attenuation in those with weight gain is consistent with decreased muscle quality. CLINICAL IMPACT. Among patients using semaglutide, automated CT-based AI tools provide biomarkers of changes in body composition beyond those that are evident by standard clinical measures.

LADA diabetes as an orphan disease and its connection with other autoimmune diseases

BACKGROUND. Latent autoimmune diabetes of adults (LADA) is a type of diabetes that develops after the age of 30 and has signs of type 1 and type 2 diabetes. Its feature is that the destruction of β-cells of the pancreas occurs more slowly and the patient can during do not need insulin therapy for a certain period of time. Autoimmune diseases are a class of diseases in which the immune system perceives its own cells as foreign and attacks them. Although LADA and autoimmune diseases are not directly related, research shows that people with LADA diabetes have an increased risk of developing other autoimmune diseases. OBJECTIVE. To familiarize with the clinical manifestations, aspects of diagnosis and treatment of LADA diabetes with the help of literary sources, as well as to investigate the relationship of LADA with other autoimmune diseases. MATERIALS AND METHODS. Object: LADA diabetes as an orphan disease and its relationship with other autoimmune diseases. Research method: a review of literary sources. RESULTS. The combination of LADA and autoimmune thyroiditis (AIT) is quite common: according to studies, 10-25 % of patients with LADA have AIT. The relationship between LADA and other autoimmune diseases such as rheumatoid arthritis, Sjögren's disease, peripheral T-cell lymphoma, and systemic lupus erythematosus was also revealed. The study of the microbiome is an interesting and promising direction, because there is a deep connection between the intestinal microbiota and the immune system, the dysregulation of which underlies many important diseases. CONCLUSIONS. Each patient with LADA has individual characteristics, which leaves an imprint on the prognosis of the disease and approaches to treatment. The main goal is to maintain a normal level of glucose in the blood to avoid complications. The combination of LADA diabetes with AIT is quite common (10-25 % of cases), so it is advisable for patients with LADA to undergo an examination to confirm or exclude AIT. The combination of LADA diabetes with other autoimmune diseases is quite rare, but it can affect the clinical course of the disease, worsen glycemic control, and require more intensive diabetes treatment.

Implementation of hybrid closed loop therapy in the NHS: experiences from the adult diabetes centre in Derby and Burton

Implementation of hybrid closed loop therapy in the NHS: experiences from the adult diabetes centre in Derby and Burton

Association of early-onset diabetes with socioeconomic, and health factors: a matched case-control study controlling for age, gender, and BMI.

This study examines the link between early-onset diabetes and health factors in South Korean young adults (20-39) using data from the Korea National Health and Nutrition Examination Survey (2010-2020). A matched case-control study was conducted in 2022 with 103 patients with diabetes and 103 controls, matched by age, gender, and BMI. All data, including socioeconomic status (income, education, occupation), health behaviors (smoking, alcohol consumption, physical activity), and medical histories, were extracted from the KNHANES database. We analyzed socioeconomic status, health behaviors, and medical histories using descriptive statistics, chi-square tests, and binary logistic regression. The study revealed that educational attainment and economic status are substantial predictors of diabetes, with those holding only a high school diploma showing a nearly threefold increased risk compared to college graduates (OR = 2.986; 95% CI = 1.334-6.687). Additionally, participants with a higher number of chronic diseases (OR = 3.534; 95% CI: 1.547-8.073) and those who felt unwell in the past two weeks (OR = 4.010; 95% CI: 1.388-11.585) also demonstrated significantly increased odds of diabetes. And having a parent with diabetes was an exceptionally strong predictor, with these participants having a significantly increased risk of diabetes (OR = 47.022; 95% CI = 4.206-525.704). The study emphasizes that improving educational and economic conditions, coupled with targeted screening programs for individuals with a family history of diabetes, may be effective in curbing the tide of early-onset diabetes in South Korea. These strategies may have profound implications for public health policies aimed at mitigating the risk in this increasingly vulnerable group.

Early Screening for Latent Autoimmune Diabetes in Adults to Improve Care—Beyond the Routine

This Teachable Moment describes a man in his 30s who presented with a right diabetic foot ulcer and hyperglycemia and was assumed to have type 2 diabetes and was subsequently diagnosed with latent autoimmune diabetes in adults.

Diabetes and cardiovascular disease in older adults.

An aging population combined with a rapidly increasing prevalence of diabetes foreshadows a global epidemic of cardiovascular and kidney disease that threatens to halt improvements in life and health-span and will have particularly severe consequences in older adults. The management of diabetes has been transformed with the recent development of newer anti-hyperglycemic agents that have demonstrated superior efficacy. However, the utility of these drugs extends beyond glycemic control to benefits for managing obesity, cardiovascular disease (CVD), chronic kidney disease, and heart failure. Numerous cardiovascular and kidney outcomes trials of these drugs have played an instrumental role in shaping current guidelines for the management of diabetes and CVD. Older adults with diabetes are diverse in terms of their comorbidities, diabetic complications, and cognitive and functional status. Therefore, there is an unmet need for personalized management of diabetes and CVD in this population. In this review, we provide an overview of the epidemiological burden and management of diabetes and CVD in older adults. We then focus on randomized cardiovascular and kidney outcome trials with anti-hyperglycemic agents to propose an evidence-based approach to the management of diabetes in older adults with high risk of cardiovascular and kidney disease.

Construction of evidence graph for modifiable risk factors for diabetic retinopathy

Objective: Diabetic retinopathy (DR) has been reported as the leading cause of blindness among diabetic adults, which is closely related to poor quality of life and increased burden of disability. This study aimed to aggregate the optimally available evidence on modifiable risks of DR. Methods: Until June 2023, PubMed, Cochrane Library, CNKI, and Wanfang databases were used to retrieve Meta-analysis about various risk factors for DR, and Meta-analysis were analyzed and summarized. R 4.3.2 software was used for each Meta-analytic association to calculate the effect size, 95%CI, heterogeneity, small-study effects, excess significance bias, and 95% prediction intervals. The credibility of significant evidence was graded. Results: We captured 23 eligible papers (72 associations) covering a wide range of medication use, concomitant diseases, daily intervention, biomarkers, lifestyle, and physical measurement index. Among them, higher HbA1c variability (RR=1.45, 95%CI: 1.26-1.66) and urine microalbumin positive (OR=2.44, 95%CI: 1.99-2.97) were convincing (grade Ⅰ) evidence, and insulin use (RR=3.48, 95%CI: 2.14-5.67) was highly suggestive (grade Ⅱ) evidence. Moreover, hypertension (OR=2.03, 95%CI: 1.06-3.97), poor glycemic control (OR=4.35, 95%CI: 1.47-12.85), positive macroalbuminuria (OR=8.42, 95%CI: 3.52-20.15), long sleep duration (OR=2.05, 95%CI: 1.37-3.05), vitamin D deficiency (OR=2.02, 95%CI: 1.17-3.50), periodontitis (OR=4.51, 95%CI: 1.76-11.55) were the main risk factors for DR. Intensive blood pressure intervention (RR=0.78, 95%CI: 0.65-0.94), dietary control (OR=0.64, 95%CI: 0.47-0.89) and moderate intensity physical activity (RR=0.76, 95%CI: 0.59-0.97) yielded significant protective associations with DR. Conclusions: Intensive blood pressure glycemic control, and a healthy lifestyle pattern could reduce the risk of DR. This study provides the evidence to identify high-risk populations and recommends rational treatment options and healthy living interventions.