Diabetes In Clinical Practice Research Articles

Relation of Change or Substitution of Low Calorie Sweetened Beverages with Cardiometabolic Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Abstract Objectives Low calorie sweetened beverages (LCSBs) are associated with increased cardiometabolic diseases using prevalent exposure of LCSBs. Although this association is at high risk of reverse causality, it has led to concerns that LCSBs may not have the intended benefits, with recommendations to replace sugar-sweetened beverage (SSBs) with water and not LCSBs. To address this issue of reverse causality as part of the update of the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of prospective cohort studies of the relation of LCSBs with cardiometabolic outcomes using change and substitution analyses. Methods MEDLINE, EMBASE, and the Cochrane Library were searched through June 2019. We included prospective cohort studies of ≥1 year assessing change in LCSBs or substitution of LCSBs for SSBs in relation to cardiometabolic outcomes. Independent reviewers extracted data and assessed risk of bias. Data were pooled using random effects models and expressed as mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CI). GRADE assessed the certainty of evidence. Results Nine studies (n = 218,880) inclusive of people at risk for or with diabetes were included. An Increase of 1 serving/day of LCSBs was associated with reduced body weight (MD, −0.07 kg [95% CI, −0.10 to −0.04]) and waist circumference (−1.35 cm [−2.60 to −0.05]) in change analyses. Substitution of LCSBs for SSBs was associated with a reduction in body weight (−0.47 kg [−0.55 to - 0.39]) and risk of diabetes (RR, 0.94 [0.90 to 0.98]), cardiovascular mortality (0.95 [0.90 to 0.99]) and total mortality (0.96 [0.94 to 0.98]), while substitution of LCSBs for water was not associated with any changes. The certainty of evidence was very low for all outcomes. Conclusions Substitution of LCSBs for SSBs is associated with reductions in major cardiometabolic outcomes with similar benefits to water as a replacement strategy for SSBs. The certainty of the available evidence is very low with a high likelihood that more studies will alter our estimates in people at risk for or with diabetes.(ClinicalTrials.gov identifier, NCT04245826) Funding Sources Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes, Canadian Institutes of Health Research, Diabetes Canada.

Nordic Dietary Pattern and Cardiometabolic Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies and Randomized Controlled Trials

Abstract Objectives Nordic dietary patterns may have a role in diabetes management. To inform the update of the European Association for the Study of Diabetes (EASD) clinical practice guidelines, we conducted a systematic review and meta-analysis of Nordic dietary patterns and cardiometabolic outcomes. Methods We searched Cochrane, MEDLINE, and EMBASE through Aug 2019. We included cohort studies of ≥1 y and RCTs of ≥3 wk. Two independent reviewers extracted data and assessed risk of bias. The primary outcome was CVD in cohort studies and LDL-C in RCTs. Secondary outcomes included CHD and stroke in cohort studies and markers of glycemic control, lipids, adiposity, BP and inflammation in RCTs. Data were expressed as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI). GRADE assessed the certainty of evidence. Results We identified 10 cohort studies in people inclusive of diabetes and 6 RCTs in people with ≥1 risk factor (overweight/obesity, metabolic syndrome, dyslipidemia). Nordic dietary patterns were associated with lower risk of the primary outcome, total CVD (RR, 0.93 [95% CI, 0.88, 0.99]) and CVD mortality (0.83 [0.73, 0.94]), as well as stroke (0.88 [0.79, 0.98]) in cohort studies. Although Nordic dietary patterns did not reduce the primary outcome, LDL-C, in RCTs, there were reductions in other established lipid targets, non-HDL-C (MD, −0.49 mmol/L [95% CI, −0.67, −0.30]) and apo B (0.15 g/L [−0.19, −0.11]), as well as weight (2.10 kg [−3.58, −0.63]), BMI (−0.90 kg/m2 [−1.11, −0.69]), waist circumference (2.22 cm [−3.36, −1.09], diastolic BP (1.78 mmHg [−3.21, −0.35]) and insulin (7.23 pmol/L [−11.88, −2.58]). The certainty of evidence was moderate for the reductions in CVD mortality, established lipid targets, adiposity markers, and insulin and low for all other outcomes. Conclusions Nordic dietary patterns are associated with decreased CVD and reduce cardiometabolic risk factors in people inclusive of or at risk for diabetes. The available data indicate a benefit for people with diabetes with a moderate likelihood that more studies will alter our estimates. (clinicaltrials.gov identifier, NCT04094194) Funding Sources Diabetes and Nutrition Study Group (DNSG) of the EASD, CIHR, Diabetes Canada, Joannah and Brian Lawson Center for Child Nutrition, Connaught Fund, Onassis Foundation.

Effect of Non-Nutritive Sweetened Beverages (NSBs) on Cardiometabolic Risk: A Network Meta-Analysis of Randomized Controlled Trials

Abstract Objectives Concerns exist that NSBs do not have established benefits, with major dietary guidelines recommending that water and not NSBs replace sugar-sweetened beverages (SSBs). Whether NSBs improve cardiometabolic risk factors similar to water in their intended substitution for SSBs is unclear. To inform the update of the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a systematic review and network meta-analysis to assess the effect of substituting NSBs for SSBs, water for SSBs and NSBs for water on cardiometabolic risk factors in people with and without diabetes. Methods We searched MEDLINE, Embase and the Cochrane Library through March 2019. Randomized controlled trials (RCTs) ≥ 1 week comparing NSBs, SSBs, and/or water were included. Outcomes were measures of adiposity, glycemic control, lipids, blood pressure, nonalcoholic fatty liver disease and uric acid. Two independent reviewers extracted data and assessed risk of bias. A frequentist network meta-analysis was performed for the substitution of NSBs for SSBs, water for SSBs and NSBs for water. Data were expressed as mean (MD) or standardized mean (SMD) differences with 95% confidence intervals (CI). GRADE assessed certainty of evidence. Results We identified 14 RCTs (n = 1530) substituting NSBs for SSBs (7 trials, N = 483), NSBs for water (7 trials, n = 852) and water for SSBs (2 trials, n = 285) mostly in people at risk for or with diabetes. Substitution of NSBs for SSBs reduced body weight (MD, −1.11 kg [95% CI, −1.90 to –0.32]), BMI (−0.32 kg/m2 [−0.58 to –0.07]), body fat (−0.60% [−1.03 to –0.18]), triglycerides (−0.24 mmol/L [−0.45 to −0.02]), and liver fat (SMD, −0.44 [95% CI, −0.69 to –0.19]). Substitution of water for SSBs reduced only uric acid (–0.05 mmol/L [–0.08 to −0.01]). There was no effect of substituting NSBs for water on any outcome except HbA1c (0.21% [0.02 to 0.40]). The certainty of the evidence ranged from low to high. Conclusions The intended substitution of NSBs for SSBs improves cardiometabolic risk factors, showing similar benefits to water. The available evidence supports the use of NSBs as an alternative replacement strategy for SSBs. There is a need for more high-quality RCTs. (ClinicalTrials.gov identifier, NCT02879500) Funding Sources Diabetes and Nutrition Study Group of the EASD, CIHR, Diabetes Canada.

Hemoglobin structure at higher levels of hemoglobin A1C in type 2 diabetes and associated complications.

Background:Fourier transform infrared (FTIR) spectroscopy technique has not been used as a diagnostic tool for diabetes in clinical practice. This study was linked to structural changes in hemoglobin (Hb) in type 2 diabetes patients at higher levels of HbA1C using FTIR spectroscopy.Methods:Fifty-three diabetic patients from the Bahawal Victoria Hospital, Bahawalpur, Pakistan were categorized as group A (6% < HbA1C < 7%; n = 25) and group B (HbA1C ≥9%; n = 28). Another group (group N) of twenty blood samples was taken from healthy people from the Islamia University Bahawalpur, Pakistan. Data from all groups were collected from January 1, 2018 to March 31, 2019. The structure of Hb was studied by FTIR spectroscopy and impact of glucose on the fine structure of HbA1C was estimated.Results:Hb secondary structure erythrocyte parameters were altered by changing glucose concentrations. From FTIR spectra of all three groups it was found that Hb structure was slightly altered in group A, but significantly changed in group B (P < 0.05). There was an increase in β-sheet structure and a reduction in α-helix structure at elevated levels of HbA1C (group B) in type 2 diabetes.Conclusion:We suggest that higher level of glycation reflected by increased HbA1C might be a contributing factor to structural changes in Hb in type 2 diabetic patients. FTIR spectroscopy can be a novel technique to find pathogenesis in type 2 diabetes.

Роль ингибиторов натрий-глюкозного котранспортера 2 типа в лечении сахарного диабета 2 типа в клинической практике

Роль ингибиторов натрий-глюкозного котранспортера 2 типа в лечении сахарного диабета 2 типа в клинической практике

Снижение гипогликемических явлений на фоне применения инсулина гларгин 300 ЕД/мл у пациентов с сахарным диабетом 2 типа в клинической практике

Снижение гипогликемических явлений на фоне применения инсулина гларгин 300 ЕД/мл у пациентов с сахарным диабетом 2 типа в клинической практике

A convenient diagnostic tool for discriminating adult-onset glutamic acid decarboxylase antibody-positive autoimmune diabetes from type 2 diabetes: a retrospective study.

BackgroundThe glutamic acid decarboxylase antibody (GADA) test, commonly used to diagnose autoimmune diabetes, is not cost-effective in areas of low prevalence. The aim of this study was to develop a convenient tool to discriminate adult-onset GADA-positive autoimmune diabetes from type 2 diabetes (T2DM) in patients with newly diagnosed diabetes.MethodsThis retrospective cross-sectional study, conducted at Changhua Christian Hospital in Taiwan, collected electronic medical record data from January 2009 to December 2018. Patients were divided into a case group (GADA+, n = 152) and a reference group (T2DM, n = 358). Variables that differed significantly between the groups were subjected to receiver operator characteristic analysis to establish cutoff values. Discriminant function analysis was then employed to discriminate the two groups.ResultsAt the onset of diabetes, the GADA+ group was younger, with lower body mass index (BMI), higher hemoglobin A1c (HbA1c), higher high-density lipoprotein cholesterol (HDL-C), and lower total cholesterol and triglycerides (TG). Five major factors were identified to form the linear discriminant functions: BMI, age at onset, TG, HDL-C, and HbA1c. BMI < 23 kg/m2 was the most important factor, followed by TG < 98 mg/dL, HDL-C ≥ 46 mg/dL, age at onset < 30 years, and HbA1c ≥ 8.6%. The overall accuracy of the linear discriminant functions was 87.1%, with 84.2% sensitivity and 88.3% specificity.ConclusionsRoutine tests in diabetes care were used to establish a convenient, low-cost tool that may assist in the early identification of adult-onset GAD+ autoimmune diabetes in clinical practice.

Impact of the 2019 European Guidelines on Diabetes in Clinical Practice: Real and Simulated Analyses of Lipid Goals.

Background: Recent European guidelines on diabetes, prediabetes, and cardiovascular disease developed for the European Society of Cardiology (ESC) in collaboration with the European Association for the Study of Diabetes (EASD) significantly changed some concepts on risk stratification, lipid goals, and recommendations for the use of lipid-lowering drugs. The objectives of this work were to describe the lipid-lowering treatment prescribed for patients with diabetes and to determine the percentage of patients that achieved the lipid goals recommended by the 2019 ESC/EASD Guidelines on Diabetes in real and simulated scenarios. Methods: A multicenter, cross-sectional study was performed. Subjects >18 years with type 2 diabetes were included. The recommendations of the 2019 ESC/EASD Guidelines were followed. The real and simulated (ideal setting using adequate doses of statins ± ezetimibe) scenarios were analyzed. Results: Overall, 528 patients were included. In total, 62.5% of patients received statins (17.1% high intensity). Most patients were stratified as “very high risk” (54.2%) or “high risk” (43.4%). Only 13.3% achieved the double lipid goal (LDL-C and non-HDL-C goals according to the risk categories). In the simulation analysis, the proportion of subjects that did not reach the therapeutic objective decreased in all risk strata, although a considerable proportion of subjects persisted outside the target. Conclusion: The difficulty of achieving lipid goals in diabetic patients was considerable when applying the new guidelines. The situation would improve if we optimized treatment, but the prescription of new lipid-lowering drugs could be limited by their high cost.

Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis.

Prevention of type 2 diabetes (T2D) is a great challenge worldwide. The aim of this evidence synthesis was to summarize the available evidence in order to update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy. We conducted a systematic review and, where appropriate, meta-analyses of randomized controlled trials (RCTs) carried out in people with impaired glucose tolerance (IGT) (six studies) or dysmetabolism (one study) to answer the following questions: What is the evidence that T2D is preventable by lifestyle changes? What is the optimal diet (with a particular focus on diet quality) for prevention, and does the prevention of T2D result in a lower risk of late complications of T2D? The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess the certainty of the trial evidence. Altogether seven RCTs (N = 4090) fulfilled the eligibility criteria and were included in the meta-analysis. The diagnosis of incident diabetes was based on an oral glucose tolerance test (OGTT). The overall risk reduction of T2D by the lifestyle interventions was 0.53 (95% CI 0.41; 0.67). Most of the trials aimed to reduce weight, increase physical activity, and apply a diet relatively low in saturated fat and high in fiber. The PREDIMED trial that did not meet eligibility criteria for inclusion in the meta-analysis was used in the final assessment of diet quality. We conclude that T2D is preventable by changing lifestyle and the risk reduction is sustained for many years after the active intervention (high certainty of evidence). Healthy dietary changes based on the current recommendations and the Mediterranean dietary pattern can be recommended for the long-term prevention of diabetes. There is limited or insufficient data to show that prevention of T2D by lifestyle changes results in a lower risk of cardiovascular and microvascular complications.

Associations between Dietary Pulses Alone or with Other Legumes and Cardiometabolic Disease Outcomes: An Umbrella Review and Updated Systematic Review and Meta-analysis of Prospective Cohort Studies

ABSTRACTTo update the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy, we conducted an umbrella review and updated systematic review and meta-analysis (SRMA) of prospective cohort studies of the association between dietary pulses with or without other legumes and cardiometabolic disease outcomes. We searched the PubMed, MEDLINE, EMBASE, and Cochrane databases through March 2019. We included the most recent SRMAs of prospective cohort studies and new prospective cohort studies published after the census dates of the included SRMAs assessing the relation between dietary pulses with or without other legumes and incidence and mortality of cardiovascular diseases (CVDs) [including coronary heart disease (CHD), myocardial infarction (MI), and stroke], diabetes, hypertension, and/or obesity. Two independent reviewers extracted data and assessed risk of bias. Risk estimates were pooled using the generic inverse variance method and expressed as risk ratios (RRs) with 95% CIs. The overall certainty of the evidence was assessed using the GRADE approach. Six SRMAs were identified and updated to include 28 unique prospective cohort studies with the following number of cases for each outcome: CVD incidence, 10,261; CVD mortality, 16,168; CHD incidence, 7786; CHD mortality, 3331; MI incidence, 2585; stroke incidence, 8570; stroke mortality, 2384; diabetes incidence, 10,457; hypertension incidence, 83,284; obesity incidence, 8125. Comparing the highest with the lowest level of intake, dietary pulses with or without other legumes were associated with significant decreases in CVD (RR: 0.92; 95% CI: 0.85, 0.99), CHD (RR: 0.90; 95% CI: 0.83, 0.99), hypertension (RR: 0.91; 95% CI: 0.86, 0.97), and obesity (RR: 0.87; 95% CI: 0.81, 0.94) incidence. There was no association with MI, stroke, and diabetes incidence or CVD, CHD, and stroke mortality. The overall certainty of the evidence was graded as “low” for CVD incidence and “very low” for all other outcomes. Current evidence shows that dietary pulses with or without other legumes are associated with reduced CVD incidence with low certainty and reduced CHD, hypertension, and obesity incidence with very low certainty. More research is needed to improve our estimates. This trial was registered at clinicaltrials.gov as NCT03555734.

Introducing article numbering to Diabetes Research and Clinical Practice

Introducing article numbering to Diabetes Research and Clinical Practice

Incorporating and interpreting regulatory guidance on estimands in diabetes clinical trials: The PIONEER 1 randomized clinical trial as an example.

Regulatory guidelines describe the use of estimands in designing and conducting clinical trials. Estimands ensure alignment of the objectives with the design, conduct and analysis of a trial. An estimand is defined by four inter‐related attributes: the population of interest, the variable (endpoint) of interest, the way intercurrent events are handled and the population level summary. A trial may employ multiple estimands to evaluate treatment effects from different perspectives in order to address different scientific questions. As estimands may be an unfamiliar concept for many clinicians treating diabetes, this paper reviews the estimand concept and uses the PIONEER 1 phase 3a clinical trial, which investigated the efficacy and safety of oral semaglutide vs placebo, as an example of the way in which estimands can be implemented and interpreted. In the PIONEER 1 trial, two estimands were employed for each efficacy endpoint and were labelled as: (a) the treatment policy estimand, used to assess the treatment effect regardless of use of rescue medication or discontinuation of trial product, and provides a broad perspective of the treatment effect in the population of patients with type 2 diabetes in clinical practice; and (b) the trial product estimand, used to assess the treatment effect if all patients had continued to use trial product for the planned duration of the trial without rescue medication, thereby providing information on the anticipated treatment effect of the medication. Both approaches are complementary to understanding the effect of the studied treatments.

Genotyping Method and Frequency of ADRB3-rs4994 Single Nucleotide Polymorphism Genotypes in Hanoi 3-5 Years Old Chidren

Genotyping Method and Frequency of ADRB3-rs4994 Single Nucleotide Polymorphism Genotypes in Hanoi 3-5 Years Old Chidren

Cardiovascular Disease in Patients with Type 2 Diabetes and in Patients Starting Empagliflozin Treatment: Nationwide Survey.

IntroductionWere the participants of the EMPA-REG OUTCOME trial representative of patients receiving empagliflozin in clinical practice? The aim of the present study was to examine the prevalence of cardiovascular disease (CVD) in type 2 diabetes patients starting empagliflozin treatment in routine clinical practice in Sweden.MethodsWe used nationwide data from the Swedish National Diabetes Register (NDR), the Swedish Prescribed Drug Register, and the Swedish National Patient Register to provide clinical characteristics and ongoing treatments.ResultsThe total study cohort included 460,558 patients, of whom 130,508 (28.3%) had a history of CVD. The number of patients starting empagliflozin during the study period was 16,985. Among these, 1952 (11.5%) had a history of CVD. The patients starting empagliflozin were younger than the total cohort and were more likely to have retinopathy despite having a similar duration of diabetes to the overall cohort. They also exhibited higher BMI, HbA1c, and eGFR, and were more likely to be treated with insulin and lipid-lowering and blood-pressure-lowering medications. The patients with CVD who were starting empagliflozin were slightly older and had been diabetic for slightly longer than the patients without CVD who were starting empagliflozin, but they also had lower eGFR. Among the patients with CVD who were starting empagliflozin, 87% had coronary heart disease, 8% had suffered a stroke, 13% had peripheral artery disease, 16% had atrial fibrillation, and 20% had congestive heart failure.ConclusionThe prevalence of CVD in patients with type 2 diabetes in clinical practice in Sweden was 28.3% during the study period, and it was 11.5% in the patients starting empagliflozin treatment. Patients of the latter cohort were, however, younger, more obese, and more likely to have unsatisfactory glycemic control, requiring additional treatment. Overall, a large proportion of type 2 diabetes patients should be considered at high cardiovascular risk.FundingBoehringer Ingelheim AB, Sweden.Electronic supplementary materialThe online version of this article (10.1007/s13300-019-0632-4) contains supplementary material, which is available to authorized users.

Implementation and Evaluation of Diabetes Clinical Practice Guidelines in a Primary Care Clinic Serving a Hispanic Community.

Diabetes is a major health concern in the United States. Poor quality diabetes care leads to negative outcomes affecting patients and healthcare systems. Research shows evidence-based clinical practice guidelines from the American Diabetes Association, Standards of Medical Care in Diabetes-2017, have improved outcomes in management of diabetes. The aim of this improvement project was to improve diabetes care and outcomes in a primary care clinic serving a Hispanic community in Miami-Dade, Florida. Specific objectives of the project were to improve primary care provider attitudes and knowledge of American Diabetes Association guidelines and outcomes in patients with diabetes. This two-phase quality improvement project used a pre- and post-test study design. In Phase I, the Diabetes Attitude Survey was administered to determine primary care provider attitudes and knowledge of guidelines. Based on survey results, a 2-hr educational intervention was developed to inform providers regarding the American Diabetes Association clinical practice guidelines. In Phase II, data were collected for 19 clinical quality diabetes outcome measures from agency reports. Guidelines were implemented into practice, and intervention effectiveness was evaluated. Statistical analysis (paired-sample t-test) revealed postintervention improvement in provider knowledge and attitudes, and patient outcomes. Findings suggest the intervention led to improvements in the quality of diabetes care in this Hispanic clinic. Project success supports the importance of evidence-based clinical practice guideline use to achieve better diabetes outcomes. Implementation of the American Diabetes Association Standards of Medical Care in Diabetes to improve patient outcomes is strongly recommended. It is equally important that clinical agencies educate and update primary care providers to achieve best practice and best patient diabetes outcomes. Other healthcare professionals can use this project design to provide culturally competent care to patients with diabetes.

The Standard of Care in Type 2 Diabetes: Re-evaluating the Treatment Paradigm.

There is currently a worldwide epidemic of type 2 diabetes (T2D) that is predicted to increase substantially in the next few years. With 80% of the global T2D population living in low to middle-income countries, there are issues with cost and of access to appropriate medicines. The objective of this symposium was to provide an overview of the efficacy and safety of glucose-lowering drugs, focussing in particular on sulfonylureas (SUs) in patients with T2D using data taken from both randomised controlled trials (RCTs) and real-world studies, the application of strategies to ensure optimal patient adherence and clinical outcomes, and the optimal use of SUs in terms of dose adjustment and agent choice to ensure the best clinical outcome. The symposium began by exploring a profile of the typical patient seen in diabetes clinical practice and the appropriate management of such a patient in the real world, before moving on to an overview of the risks associated with T2D and how the currently available agents, including newer antidiabetic medications, mitigate or exacerbate those risks. The final presentation provided an overview of real-world studies, the gap between RCTs and the real world, and the use of available glucose-lowering agents in daily clinical practice. Clinical evidence was presented demonstrating that tight glucose control improved both microvascular and macrovascular outcomes, but that aggressive treatment in patients with a very high cardiovascular risk could lead to adverse outcomes. Real-world data suggest that older agents such as SUs and metformin are being used in a large proportion of patients with T2D with demonstrable effectiveness, indicating that they still have a place in modern T2D management. The symposium, while acknowledging the need for newer antidiabetic drugs in specific situations and patient groups, recommended the continuation of SUs and metformin as the primary oral antidiabetic agents in resource-constrained regions of the world.Funding:Servier.

The Possibility of Urinary Liver-Type Fatty Acid-Binding Protein as a Biomarker of Renal Hypoxia in Spontaneously Diabetic Torii Fatty Rats

Background: Renal hypoxia is an aggravating factor for tubulointerstitial damage, which is strongly associated with renal prognosis in diabetic kidney disease (DKD). Therefore, urinary markers that can detect renal hypoxia are useful for monitoring DKD. Objective: To determine the correlation between urinary liver-type fatty acid-binding protein (L-FABP) and renal hypoxia using a novel animal model of type 2 diabetes. Methods: Male spontaneously diabetic Torii (SDT) fatty rats (n = 6) were used as an animal model of type 2 diabetes. Age- and sex-matched Sprague-Dawley (SD) rats (n = 8) were used as controls. Body weight, systolic blood pressure, and blood glucose levels were measured at 8, 12, 16, and 24 weeks of age. Urine samples and serum and kidney tissues were collected at 24 weeks of age. Microvascular blood flow index (BFI) was measured using diffuse correlation spectroscopy before sampling both the serum and kidneys for the evaluation of renal microcirculation at the corticomedullary junction. Results: Obesity, hyperglycemia, and hypertension were observed in the SDT fatty rats. Focal glomerular sclerosis, moderate interstitial inflammation, and fibrosis were significantly more frequent in SDT fatty rats than in SD rats. While the frequency of peritubular endothelial cells and phosphoendothelial nitric oxide synthase levels were similar in both types of rats, the degree of renal hypoxia-inducible factor-1α (HIF-1α) expression was significantly higher (and with no change in renal vascular endothelial growth factor expression levels) in the SDT fatty rats. Urinary L-FABP levels were significantly higher and renal microvascular BFI was significantly lower in the SDT fatty rats than in the SD rats. Urinary L-FABP levels exhibited a significant positive correlation with renal HIF-1α expression and a significant negative correlation with renal microvascular BFI. Conclusions: Urinary L-FABP levels reflect the degree of renal hypoxia in DKD in a type 2 diabetic animal model. Urinary L-FABP may thus prove useful as a renal hypoxia marker for monitoring DKD in patients with type 2 diabetes in clinical practice.

Clinical reaudit on management of diabetic ketoacidosis in Assiut University Children Hospital

Introduction Diabetic ketoacidosis (DKA) is one of the most common causes of admission in emergency unit and pediatric ICU in Assiut University Children Hospital. It is one of the important causes of mortality and morbidity in children with diabetes. DKA is a complex metabolic state of hyperglycemia, ketosis, and acidosis resulting from absolute or relative insulin deficiency. Patients and methods The study includes pediatric patients presented with DKA to emergency unit and pediatric ICU of Assiut University Children Hospital. It was done on 100 pediatric patients over 1 year from March 2017 to February 2018. This reaudit was done to evaluate the degree of compliance of management of DKA in relation to the guidelines in comparison with the previous study on the same topic that applied the same guidelines (International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2014). Results Overall, 63% were females and 39% were in the age group older than 10 to 15 years. Resuscitation fluids were administered in 95% of cases on admission. All cases received insulin therapy with the start of resuscitation fluids. Glucose 5% was correctly added to intravenous fluids when blood glucose had fallen to ~14–17 mmol/l (250–300 mg/dl) in all cases. Conclusion Guidelines have been followed in the management of DKA in the studied cases, but there were some defects that can affect the outcome of management of DKA. The study recommends avoiding these defects.

Basic Anthropometric Indices and Diabetes Mellitus Type 2 in Russian Population

Obesity is one of the main risk factors for type 2 diabetes developing. The question of the advantages and disadvantages of using various anthropometric indices [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR), lipid accumulation product index (LAPI), visceral obesity index (VOI)] has been under discussion lately. Aim . To perform an analysis of anthropometric obesity indicators (BMI, WC, WHR, VOI, LAPI) depending on the presence of type 2 diabetes in the adult population of the Russian Federation. Material and methods . The results of the study Epidemiology of Cardiovascular diseases and their risk factors in the regions of the Russian (ESSE-RF) performed in 2012-2014 in 13 regions of the Russian Federation are included into the analysis. People aged 25-64 years (n=20878; 8058 men and 12820 women) were examined. The following indicators in people with/without type 2 diabetes were analyzed: age; sex; anthropometric indicators: height, weight, WC; smoking status (“never smoked”, “smoked”, “smokes now”); alcohol consumption, which was ranked for “never in the last year” and “a lot” (≥168 g of ethanol per week for men and ≥84 g of ethanol per week for women); the level of systolic (SBP) and diastolic (DBP) blood pressure; heart rate (HR); levels of glucose, total cholesterol (TC), high density lipoproteins cholesterol (HDL-C), triglycerides (TG); WHR; VOI; LAPI, BMI. Results . Levels of TC and glucose, excessive alcohol consumption, BMI were selected in a multifactor regression model in men after adjusting for age, region of residence and IVO. The same factors (SBP instead of alcohol and BMI instead of WHR were included in the model) were selected in women. VOI showed the greatest degree of association with type 2 diabetes regardless of gender after adjusting for age and region of residence (in men odds ratio 1,085; p=0.0001; in women odds ratio 1,136; p=0.0001). Thus, VOI (predictor of type 2 diabetes in population of working age) was common to both sexes. Conclusion . VOI has statistically significant associations with type 2 diabetes. VOI is the best surrogate marker for measuring the degree of abdominal obesity in the Russian population and can be used to determine the presence of type 2 diabetes in clinical practice. Screening for elevated VOI values in healthy individuals and patients with pre-diabetes can serve as a guide for targeted aggressive preventive interventions. Participants of the ESSE-RF Study: Vladivostok: Kulakova N.V., Nevzorova V.A., Shestakova N.V., Mokshina M.V., Rodionova L.V.; Vladikavkaz: Tolparov G.V.; Vologda: Shabunova A.A., Kalashnikov K.N., Kalachikova O.N., Popov A.V.; Volgograd: Nedogoda S.V., Chumachek E.V., Lediaeva A.A.; Voronezh: Chernyih T.M., Furmenko G.I., Ovsyannikova V.V., Bondarcov L.V.; Ivanovo: Belova O.A., Romanchuk S.V., Nazarova O.A., Shutemova O.A.; Kemerovo: Barbarash O.L., Artamonova G.V., Indukaeva E.V., Mulerova T.A., Maksimov S.A., Skripchemko A.E., Cherkass N.V., Tabakaev M.V., Danilchenko Ia.V.; Krasnoyarsk: Grinshtein Yu.I., Petrova M.M., Danilova L.K., Evsiukov A.A., Shabalin V.V., Ruph R.R., Kosinova A.A., Filonenko I.V., Baykova O.A.; Moscow: Gomyranova N.V., Oganov R.G., Oshepkova E.V.; Orenburg: Libis R.A., Basyrova I.R., Lopina E.A.; Samara: Dupliakov D.V., Gudkova S.A., Cherepanova N.A.; St. Petersburg: Konradi A.O., Baranova E.I.; Tomsk: Trubacheva I.A., Kaveshnikov V.S., Karpov R.S., Serebriakova V.N.; Tyumen: Efanov A. Yu., Medvedeva I.V., Storozhok M.A., Shalaev S.V.

ISPAD Clinical Practice Consensus Guidelines 2018: Management of cystic fibrosis-related diabetes in children and adolescents.

Pediatric DiabetesVolume 19, Issue S27 p. 64-74 ISPAD Clinical Practice Consensus Guidelines ISPAD Clinical Practice Consensus Guidelines 2018: Management of cystic fibrosis-related diabetes in children and adolescents Antoinette Moran, Corresponding Author Antoinette Moran moran001@umn.edu orcid.org/0000-0002-2694-5147 Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota Correspondence Antoinette Moran, MD, Professor and Division Chief, Pediatric Endocrinology and Diabetes, University of Minnesota, East Building, Room MB671, 2450 Riverside Avenue, Minneapolis, Minnesota 55455. Email: moran001@umn.eduSearch for more papers by this authorKubendran Pillay, Kubendran Pillay Westville Hospital, Durban, South AfricaSearch for more papers by this authorDorothy Becker, Dorothy Becker orcid.org/0000-0001-8632-3633 Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PennsylvaniaSearch for more papers by this authorAndrea Granados, Andrea Granados Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, MissouriSearch for more papers by this authorShihab Hameed, Shihab Hameed Department of Endocrinology, Sydney Children's Hospital, Randwick, NSW, Australia School of Women's and Children's Health, University of New South Wales, Kensington, NSW, AustraliaSearch for more papers by this authorCarlo L. Acerini, Carlo L. Acerini orcid.org/0000-0003-2121-5871 Department of Paediatrics, University of Cambridge, Cambridge, UKSearch for more papers by this author Antoinette Moran, Corresponding Author Antoinette Moran moran001@umn.edu orcid.org/0000-0002-2694-5147 Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota Correspondence Antoinette Moran, MD, Professor and Division Chief, Pediatric Endocrinology and Diabetes, University of Minnesota, East Building, Room MB671, 2450 Riverside Avenue, Minneapolis, Minnesota 55455. Email: moran001@umn.eduSearch for more papers by this authorKubendran Pillay, Kubendran Pillay Westville Hospital, Durban, South AfricaSearch for more papers by this authorDorothy Becker, Dorothy Becker orcid.org/0000-0001-8632-3633 Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PennsylvaniaSearch for more papers by this authorAndrea Granados, Andrea Granados Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, MissouriSearch for more papers by this authorShihab Hameed, Shihab Hameed Department of Endocrinology, Sydney Children's Hospital, Randwick, NSW, Australia School of Women's and Children's Health, University of New South Wales, Kensington, NSW, AustraliaSearch for more papers by this authorCarlo L. Acerini, Carlo L. Acerini orcid.org/0000-0003-2121-5871 Department of Paediatrics, University of Cambridge, Cambridge, UKSearch for more papers by this author First published: 09 August 2018 https://doi.org/10.1111/pedi.12732Citations: 90Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume19, IssueS27Supplement: International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2018, 11–14 October 2018, Hyderabad, India. Guest Editor: David M. Maahs. Special Guest Editor: Mark SperlingOctober 2018Pages 64-74 RelatedInformation