Kidney Disease Patients Research Articles

Trajectory of GFR Decline and Fluctuation in Albuminuria Leading to End-Stage Kidney Disease in Patients With Biopsy-Confirmed Diabetic Kidney Disease

Data on longitudinal trajectory of kidney function decline and fluctuation in albuminuria leading to end-stage kidney disease (ESKD) is sparse in patients with type 2 diabetes. Using data from an observational study of patients with type 2 diabetes and biopsy-confirmed diabetic kidney disease (DKD), generalized additive mixed models (GAMMs) were performed to quantify patterns of longitudinal trajectory of estimated glomerular filtration rate (eGFR) decline to ESKD associated with repeated measures of urine albumin-to-creatinine ratio (ACR). Over a median follow-up period of 3.3 years, 155 of 319 patients progressed to ESKD. Among these patients, 91.6% exhibited a curvilinear pattern in their eGFR trajectory. The median coefficient of variation for ACR, representing the variability in ACR measurements, was 48.9 (interquartile range: 36.9, 68.2). The median compound annual growth rate (CAGR) for ACR, reflecting the variation in ACR progression over time, was 43.6% (interquartile range: 0.0, 102.5); and 84.5% of patients developed nephrotic-range albuminuria, with a majority remaining nephrotic and subsequently progressing to ESKD. There was a positive association between the instantaneous speed of eGFR decline and ACR. The observed curvilinear pattern in eGFR trajectory, high variability in ACR progression over time, and positive correlation between the speed of eGFR decline and ACR highlight the complex dynamics of disease progression and emphasize close monitoring of ACR fluctuation over time in patients with DKD.

Diastolic dysfunction and its association to renal outcomes in patients with chronic kidney disease

Abstract Background Left ventricular diastolic dysfunction is frequent in chronic kidney disease (CKD) and is suspected to be linked to a worse renal prognosis. Purpose To investigate the association between the ratio of early mitral inflow velocity to early diastolic tissue velocity (E/e') measured by Doppler echocardiography and development of end-stage kidney disease in patients with non-dialysis-dependent CKD. Methods This prospective cohort study included individuals with non-dialysis-dependent CKD with previous nephrology-related hospital contact. All participants underwent thorough, protocolized echocardiographic examination. Exclusion criteria were inadequate image quality for E/e'-assessment and prevalent heart failure at baseline. The primary endpoint was the composite outcome of time to dialysis treatment and/or kidney transplantation. The association between E/e' and the composite outcome was assessed with multivariable Cox proportional hazards regression models adjusted for age, sex, estimated glomerular filtration rate (eGFR), diabetes, Body Mass Index, albuminuria, systolic blood pressure, heart rate, coronary artery disease, and left ventricular ejection fraction. Results A total of 731 participants were included in the final study sample. Mean age was 57 ± 13 years and 61% were male. Median E/e' was 7.8 (IQR: 6.4; 9.5), median eGFR was 43 mL/min/1.73 m² (IQR: 28; 62), and 36% had a urine albumin/creatinine ratio >300. During a median follow-up of 3.8 years (IQR: 3.3; 4.5), 102 individuals met the composite outcome. In univariable Cox regression both continuous E/e' and elevated E/e' (E/e' >14) were significantly associated with the outcome (P<0.001). Following multivariable adjustments, increasing E/e' remained significantly associated with the outcome (HR = 1.09, 95% CI [1.03; 1.15], P=0.004, per 1 unit increase) (Figure 1A). Elevated E/e' also remained significantly associated with the outcome following adjustments (HR = 2.95, 95% CI [1.33; 6.53], P=0.008), and more than 40% of patients with E/e' >14 were estimated to have reached the primary endpoint after 4 years (Figure 1B). Conclusion In patients with non-dialysis dependent CKD increasing E/e' and E/e' >14 were both associated with worse renal prognosis.

Hemoglobin Response to Zinc Supplementation in Chronic Kidney Disease in Patients with Zinc Deficiency and Anemia

Background: Chronic anemia has an estimated prevalence of 5.6% within the US, where 25.3% of patients with chronic kidney disease (CKD) 3-5 have anemia of chronic kidney disease according to NHANES. Anemia in CKD has long been attributed to a decrease in EPO production due to their kidney disease. While iron deficiency is treated in anemia of chronic kidney disease, other micronutrients are less commonly tested or supplemented. Zinc may be an additional micronutrient of interest in anemia of chronic kidney disease as zinc has numerous proposed mechanisms in erythropoeisis including acting as a catalyst in the iron metabolism and heme synthesis through the activity of alpha-aminolevulinic acid dehydratase enzyme. Zinc is found in the structure of the growth factor independent 1B (Gfi-1B) Zinc finger protein and GATA-1 Zinz finger transcription factor, which functions as a regulator in erythroid cell growth by modulating gene expression specific to erythroid series including the SMAD pathways and TGF-β signaling. The interaction with zinc in signaling cascades such as the growth hormone and insulin-like growth factor-1 pathways also result in increased erythropoietin transcription and therefore increased erythropoiesis. In addition, zinc is regarded as an important erythroid differentiation factor which progress maturation of erythrocytes. Zinc has also shown to stimulate EPO production in nephrectomized rats and Zinc supplementation increased reticulocyte production in human subjects. This descriptive, retrospective study describes zinc deficient patients with CKD 3-5 and chronic anemia; who underwent oral zinc supplementation, and their changes in hemoglobin (HGB) over a 12 month period in an academic outpatient hematology clinic in California, United States of America. Objectives: Primary endpoints: determine the rate of anemia resolution over 12 months following supplementation of zinc in patients with zinc deficiency, CKD, and anemia of chronic kidney disease. Secondary endpoints: determine if zinc supplementation in zinc deficient patients with chronic anemia and CKD 3-5 will improve HGB by at least 1.0 g.dL by 1, 3, 6, and 12 month time points. Methods: Hematology patients from Loma Linda University Cancer Center over the age of 18 who had CKD 3 or above (GFR <59 ml/min) with chronic anemia (HGB <12 for women, HGB <13 for men for >3 months) were identified to have zinc deficiency (plasma zinc concentration <65 ug/dL). Patients did not start new treatment for their anemia, including initiating new treatments for malignancy 3 months preceding, and within the data collection period. Patients were supplemented with Zinc Sulfate 50 mg daily and their HGB was followed over 12 months. A retrospective analysis was completed for prior medical history, lab data, and hemoglobin was tabulated at the time markers of 1, 3, 6, and 12 months following initiation of zinc supplementation. ANOVA, Wilcoxon rank-sum, and unpaired Students and t tests were performed to determine significant differences. p <0.05 is considered statistically significant. Results Thirty-Four patients were identified to have CKD 3-5 with chronic anemia and zinc deficiency. They were found to have no statistically significant baseline characteristics, hematologic values at time of diagnosis, or micronutrient and hormonal etiologies for anemia. HGB prior to supplementation averaged 9.96 g/dL, WBC averaged 5.8, and PLTS averaged 149. Following supplementation HGB at 1 month average was 10.47 g/dL (p=0.19 n=30), at 3 months average of 10.49 (p=0.12 n=31), at 6 months average of 11.03 (p=0.011 n=27), at 1 year 10.93 (p=0.03, n=17). Primary endpoint of HGB resolution was found in 12 of the 34 patients (35%). Secondary endpoint of HGB improvement by at least 1.0 g/dL was reached in 27% of patients at 1 month, 32% of patients at 3 months, 59% of patients at 6 months and 64% of patients at 12 months. Conclusions: Zinc supplementation improved patients' anemia with resolution of anemia in 35% of patients with incremental improvement in HGB over a 1 year time frame. There was statistically significant improvement from baseline HGB at the 6 and 12 month time markers. Further study is warranted to determine the specific mechanism of zinc deficiency in anemia with chronic kidney disease, as well as clinical studies determining zinc supplementation doses, monitoring, and toxicity.

Adverse effects of sodium-glucose cotransporter-2 inhibitors in patients with heart failure: a systematic review and meta-analysis.

Sodium-glucose cotransoporter-2 inhibitors (SGLT-2Is) improve prognosis in heart failure (HF) patients both with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). However, these drugs can have some side effects. To estimate the relative risk of side effects in HF patients treated with SGLT-2Is irrespective from left ventricular EF and setting (chronic and non-chronic HF). Five randomized controlled trials (RCTs) enrolling patients with HFrEF, 4 RCTs enrolling non-chronic HF, and 3 RCTs enrolling HFpEF were included. Among side effects, urinary infection, genital infection, acute kidney injury, diabetic ketoacidosis, hypoglycemia, hyperkalemia, hypokalemia, bone fractures, and amputations were considered in the analysis. Overall, 24,055 patients were included in the analysis: 9020 (38%) patients with HFrEF, 12,562 (52%) with HFpEF, and 2473 (10%) with non-chronic HF. There were no differences between SGLT-2Is and placebo in the risk to develop diabetic ketoacidosis, hypoglycemia, hyperkalemia, hypokalemia, bone fractures, and amputations. HFrEF patients treated with SGLT-2Is had a significant reduction of acute kidney injury (RR = 0.54 (95% CI 0.33-0.87), p = 0.011), whereas no differences have been reported in the HFpEF group (RR = 0.94 (95% CI 0.83-1.07), p = 0.348) and non-chronic HF setting (RR = 0.79 (95% CI 0.55-1.15), p = 0.214). A higher risk to develop genital infection (overall 2.57 (95% CI 1.82-3.63), p < 0.001) was found among patients treated with SGLT-2Is irrespective from EF (HFrEF: RR = 1.96 (95% CI 1.17-3.29), p = 0.011; HFpEF: RR = 3.04 (95% CI 1.88-4.90), p < 0.001). The risk to develop urinary infections was increased among SGLT-2I users in the overall population (RR = 1.13 (95% CI 1.00-1.28), p = 0.046) and in the HFpEF setting (RR = 1.19 (95% CI 1.02-1.38), p = 0.029), whereas no differences have been reported in HFrEF (RR = 1.05 (95% CI 0.81-1.36), p = 0.725) and in non-chronic HF setting (RR = 1.04 (95% CI 0.75-1.46), p = 0.806). SGLT-2Is increase the risk of urinary and genital infections in HF patients. In HFpEF patients, the treatment increases the risk of urinary infections compared to placebo, whereas SGLT-2Is reduce the risk of acute kidney disease in patients with HFrEF.

Characterization of Monogenic Kidney Disease in Patients over 60 Years of Age

Characterization of Monogenic Kidney Disease in Patients over 60 Years of Age

Factors Associated with Chronic Kidney Disease in Jigawa State, Nigeria: A Mixed Methods Study

Abstract Background: Chronic kidney disease (CKD) is becoming an increasing public health problem. A study that reviewed patients receiving treatment in hemodialysis centers reported 79.2% of patients from Jigawa State to be managed for CKD. This study aimed to find the factors associated with CKD among adults from high-burden kidney disease areas of Jigawa State. Materials and Methods: A cross-sectional descriptive study design that utilized mixed methods (quantitative and qualitative) of data collection (sequential explanatory) was used to study eligible respondents from the four local government areas (LGAs) reported to have a high burden of kidney disease. The modified WHO STEPS questionnaire, key informant interview, and in-depth interview guides were employed to collect information from the eligible selected community members. Multistage and purposive sampling techniques were used, and data were analyzed using IBM SPSS version 22.0 with a statistical significance set at P ≤ 0.05. Thematic analysis was used to analyze the qualitative interviews. Results: The age of the respondents ranged from 18 to 102 years, with a median of 45 (interquartile range = 30–80) years. The period prevalence over the past five years (2018–2023) of having kidney disease in the family was 67 (18.6%), while the point prevalence (currently having a patient with kidney disease) was 51 (14.1%). In terms of the distribution of cases by LGAs, Jahun reported more cases, 33.3% in the family within the last five years, followed by Hadejia 18.7%. In the same vein, respondents from Jahun 28.9% and Hadejia 16.5% reported more current cases of kidney disease in the family. The prevalence of ever had patient with chronic kidney disease in the family was significantly higher among those with systolic hypertension (BP) ≥140 mmHg (29.3%, P &lt; 0.001). Elevated systolic BP was significantly associated with currently having a kidney disease patient (23.3%, P = 0.001). The interviews revealed late presentation and noncompliance to medications among those with risk factors as the perceived facilitators of kidney disease. Conclusions: The prevalence of kidney disease was alarming in the high-burden kidney disease areas. The government should develop a sustainable model for mass community screening of risk factors and community-based health insurance to effectively manage all identified cases.

Enhancing On-Skin Analysis: A Microfluidic Device and Smartphone Imaging Module for Real-Time Quantitative Detection of Multianalytes in Sweat.

Wearable sweat sensors present exciting opportunities for advancing personal health monitoring and noninvasive biomarker measurements. However, existing sensors often fall short in accurate detection of low analyte volumes and concentrations and lack multimodal sensing capabilities. Herein, we present a highly portable four-channel microfluidic device capable of conducting simultaneous sweat sampling and fluorometric sensing of potential biomarkers, such as l-Tyr, l-Trp, Crt, and NH4+, specifically designed for kidney disease monitoring. Our microfluidic device seamlessly integrates with smartphones, facilitating easy data retrieval and analysis. The core of the sensing array is a novel fluorometric solid-state mechanism utilizing carbon polymer dots derived from dopamine, catechol, and o-phenylenediamine monomers embedded in gelatin hydrogels. The sensors exhibit exceptional performance, offering linear ranges of 5-275, 6-170, 4-220, and 5-170 μM, with impressively low detection limits of 1.5, 1.2, 1.3, and 1.4 μM for l-Tyr, l-Trp, Crt, and NH4+, respectively. Through meticulous optimization of operational variables, comprising the temperature, sample volume, and assay time, we achieved the best performance of the device. Furthermore, the sensors exhibited remarkable selectivity, effectively distinguishing between biologically similar species and other potential biological compounds found in sweat. Our evaluation also extended to monitoring kidney diseases in patients and healthy individuals, showcasing the device's utility in world scenarios. Promising results showcase the potential of low-cost, multidiagnostic microfluidic sensor arrays, especially with synthetic skin integration, for enhanced disease detection and healthcare outcomes.

Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion.

Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thrombo-embolism (TE). CKD concomitantly predisposes towards a pro-haemorrhagic state. Our aim was to evaluate the prognostic value of CKD in patients undergoing percutaneous left atrial appendage occlusion (LAAO). A total of 2124 consecutive AF patients undergoing LAAO were categorized into CKD stage 1+2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), and CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary endpoint included cardiovascular (CV) mortality, TE, and major bleeding. The expected annual TE and major bleeding risks were estimated based on the CHA2DS2-VASc and HAS-BLED scores. A non-significant higher incidence of major peri-procedural adverse events (1.7 vs. 2.3 vs. 4.1 vs. 4.3) was observed with worsening CKD (P = 0.14). The mean follow-up period was 13 ± 7 months (2226 patient-years). In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank P-value = 0.04), CKD stage 4 (log-rank P-value = 0.01), and CKD stage 5 (log-rank P-value = 0.001). Left atrial appendage occlusion led to a TE risk reduction (RR) of 72, 66, 62, and 41% in each group. The relative RR of major bleeding was 58, 44, 51, and 52%, respectively. Patients with moderate-to-severe CKD had a higher incidence of the primary composite endpoint. The relative RR in the incidence of TE and major bleeding was consistent across CKD groups.

Factors associated with chronic kidney disease in patients with diabetes in French Guiana.

With over half of the population living under the poverty threshold, the social and health context in French Guiana is more difficult than in mainland France. The prevalence of diabetes is twice as great and end-stage renal failure is 45% higher than in mainland France. Our objective was to describe the profile of diabetic patients with chronic kidney disease in French Guiana and search for possible risk factors. We conducted a multicenter cross-sectional observational study based on the CODIAM cohort (Cohort of Diabetes in French Amazonia). We analyzed 1,287 patients followed up between May 2019 and June 2021 at Cayenne Hospital, Saint Laurent Hospital, and delocalized health centers. In our cohort, chronic kidney disease was present after an average of 12 years of diabetes. Compared with the French population, 41% of diabetic patients had chronic kidney disease (i.e., 12% more), and had an average age of 56 years (i.e., 10 years younger). Forty-eight per cent of these patients were obese (i.e., 7% more). Seventy-four per cent of patients were precarious and 45% were foreigners but neither was associated with chronic kidney disease, contrary to countries where the health system is not universal. Screening of patients with chronic kidney disease among diabetics in French Guiana remains a real challenge. Patients were younger and more obese than in other French territories. In this cohort, precariousness and immigration were not associated with the presence of chronic kidney disease. However, particular attention should be paid to hypertensive patients and those over 65 years of age, which are, with diabetes itself, the two most obvious risk factors for developing chronic kidney disease among diabetic patients in our territory.

The role of canagliflozin in the prevention of stroke and chronic kidney disease in patients with type 2 diabetes mellitus: an expert council resolution

Over the past 10 years of studying the complications of type 2 diabetes mellitus (DM) and ways to deal with them, significant progress has been made in one of the most important areas of treatment — the prevention of cardiovascular and renal complications. Thus, when using inhibitors of type 2 sodium-glucose cotransporter, a significant reduction in the risks of cardiovascular mortality and progression of chronic heart failure, which occupy the main place in the structure of mortality in this cohort of patients, as well as a positive effect on diabetic nephropathy, one of the most common complications of type 2 diabetes, has been proven. However, there are other complications that significantly affect the duration and quality of life of patients. In particular, these include stroke, which occupies the 2nd-3rd place in the frequency of death of people with type 2 diabetes, and albuminuria, a frequent manifestation of diabetic kidney disease, which is associated with an increased risk of cardiovascular complications (including stroke) and chronic renal failure. Recent studies indicate the important role of sodium-glucose cotransporter type 1 in the development of these complications. Canagliflozin has the highest affinity for these transporters among iSGLT-2 registered in the Russian Federation. This article aims to evaluate the mechanisms of action of canagliflozin and its possible role in the prevention of stroke and albuminuria.

Trends in the epidemiology of chronic kidney disease in patients with diabetes in Russian Federation according to the Federal diabetes register (2010–2022)

BACKGROUND: Chronic kidney disease (CKD) in diabetes mellitus (DM) is a supranosological concept that characterizes multifactorial kidney damage associated with increased cardiovascular and mortality risk, which determines the high medical and social significance of this problem in diabetic patients.AIMS: To assess the clinical and epidemiological characteristics of CKD in adult DM patients with type 1(T1) and type 2 (T2) in Russian Federation (RF) in 2010–2022 according to the Federal Register of Diabetes Mellitus (FDR) and to present the capabilities of the register’s analytical tools for assessing organ-protective therapy and predicting the risk of pathology.MATERIALS AND METHODS: We have used the database of FRD (http://diaregistry.ru), 85 regions of the RF. The data are presented as of 01.01.2023 and in dynamics for the period 2010–2022.RESULTS: The CKD prevalence in adult DM patients in RF in dynamics 2010→2022 showed in an increase in the rate for T1 from 21.5 to 27.1% (1.3 times), for T2 from 5.2 to 19.1% (3.7 times). The incidence of new CKD cases was 153.3→106.3/10 000 adult patients in T1, and 64.3→212.8/10 000 adult patients in T2. The analysis of the distribution by CKD stage indicates improved diagnosis of the complication. In the structure of new cases of CKD in the dynamics of 2010→2022. The proportions of patients with low and moderate combined risk of cardiovascular events and end-stage renal failure according to KDIGO criteria increased for T1 63.7→82.4%, for T2 64.5→77.4%. The proportions of patients with very high risk progressively decreased for T1 12.3→4.0%, for T2 13.1→1.6%. The average age of onset of CKD increased by an average of 6 years in persons with type 1 and type 2 diabetes (35.6→42 years, 63.3→69.3 years, respectively), with the dynamics of the average DM duration at the time of CKD development: in T1 11.5→14.8 years, in T2 7.4→7.8 years. The cause of terminal CKD in the structure of mortality in DM patients took only in T1 patients 5.6% and in T2D — 2.0%. A retrospective analysis of factors influencing the fatal outcome of DM patients with COVID-19 showed the significance of a history of CKD in T2DM patients, which increases the risk of death by 1.49 times (95% CI 1.01–2.04). Analysis of the structure of glucose-lowering therapy in T2DM patients and CKD indicates a more frequent prescription of drugs from the group of SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 receptor antagonists compared to the general cohort of T2DM. There is the CKD prognosis calculator in the FRD, which allows assessing the risk of developing of pathology within 5 years in a particular patient based on a set of the most significant predictors, which included 6 factors for T1 and 11 factors for T2. CONCLUSIONS: Epidemiological trends in the prevalence of CKD over a 13-year period indicate the growing importance of this problem in DM patients who are at risk. Along with the positive trends in the development of pathology with a longer duration of diabetes, in clinical practice the problem remains of untimely detection of CKD with impaired renal function at advanced stages. The progressive nature of the course and the negative impact of kidney damage on the risks of premature mortality in patients determine the priority of preventive diagnostic and therapeutic strategies aimed at compliance with the standard of examination, detection of pathology in the early stages and a multifactorial approach to nephroprotection, according to clinical recommendations.

Endogenous adenine mediates kidney injury in diabetic models and predicts diabetic kidney disease in patients.

Diabetic kidney disease (DKD) can lead to end-stage kidney disease (ESKD) and mortality; however, few mechanistic biomarkers are available for high-risk patients, especially those without macroalbuminuria. Urine from participants with diabetes from the Chronic Renal Insufficiency Cohort (CRIC) study, the Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes (SMART2D), and the American Indian Study determined whether urine adenine/creatinine ratio (UAdCR) could be a mechanistic biomarker for ESKD. ESKD and mortality were associated with the highest UAdCR tertile in the CRIC study and SMART2D. ESKD was associated with the highest UAdCR tertile in patients without macroalbuminuria in the CRIC study, SMART2D, and the American Indian study. Empagliflozin lowered UAdCR in nonmacroalbuminuric participants. Spatial metabolomics localized adenine to kidney pathology, and single-cell transcriptomics identified ribonucleoprotein biogenesis as a top pathway in proximal tubules of patients without macroalbuminuria, implicating mTOR. Adenine stimulated matrix in tubular cells via mTOR and stimulated mTOR in mouse kidneys. A specific inhibitor of adenine production was found to reduce kidney hypertrophy and kidney injury in diabetic mice. We propose that endogenous adenine may be a causative factor in DKD.

Characteristics of glucose change in diabetes mellitus generalized through continuous wavelet transform processing: A preliminary study.

The continuous glucose monitoring (CGM) system has become a popular evaluation tool for glucose fluctuation, providing a detailed description of glucose change patterns. We hypothesized that glucose fluctuations may contain specific information on differences in glucose change between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), despite similarities in change patterns, because of different etiologies. Unlike Fourier transform, continuous wavelet transform (CWT) is able to simultaneously analyze the time and fre-quency domains of oscillating data. To investigate whether CWT can detect glucose fluctuations in T1DM. The 60-d and 296-d glucose fluctuation data of patients with T1DM (n = 5) and T2DM (n = 25) were evaluated respectively. Glucose data obtained every 15 min for 356 d were analyzed. Data were assessed by CWT with Morlet form (n = 7) as the mother wavelet. This methodology was employed to search for limited frequency glucose fluctuation in the daily glucose change. The frequency and enclosed area (0.02625 scalogram value) of 18 emerged signals were compared. The specificity for T1DM was evaluated through multiple regression analysis using items that demonstrated significant differences between them as explanatory variables. The high frequency at midnight (median: 75 Hz, cycle time: 19 min) and middle frequency at noon (median: 45.5 Hz, cycle time: 32 min) were higher in T1DM vs T2DM (median: 73 and 44 Hz; P = 0.006 and 0.005, respectively). The area of the > 100 Hz zone at midnight to forenoon was more frequent and larger in T1DM vs T2DM. In a day, the lower frequency zone (15-35 Hz) was more frequent and the area was larger in T2DM than in T1DM. The three-dimensional scatter diagrams, which consist of the time of day, frequency, and area of each signal after CWT, revealed that high frequency signals belonging to T1DM at midnight had a loose distribution of wave cycles that were 17-24 min. Multivariate analysis revealed that the high frequency signal at midnight could characterize T1DM (odds ratio: 1.33, 95% confidence interval: 1.08-1.62; P = 0.006). CWT might be a novel tool for differentiate glucose fluctuation of each type of diabetes mellitus using CGM data.

Analysis of influencing factors and interaction of body weight and disease outcome in patients with prediabetes.

The trend of prediabetes progressing to type 2 diabetes mellitus (T2DM) is prominent, and effective intervention can lead to a return to prediabetes. Exploring the factors influencing the outcome of prediabetes is helpful to guide clinical intervention. The weight change in patients with prediabetes has not attracted much attention. To explore the interaction between body weight and the factors affecting the progression of prediabetes to T2DM. We performed a retrospective analysis of 236 patients with prediabetes and 50 with normal glucose tolerance (NGT), and collected clinical data and follow-up results of all patients. Based on natural blood glucose outcomes, we classified 66 patients with progression to T2DM into the disease progression (DP) group, and 170 patients without progression to T2DM into the disease outcome (DO) group. We analyzed the factors that influenced prediabetes outcome and the influence of body weight on prediabetes blood glucose outcome by unconditional logistic regression. A general linear model (univariate) was used to analyze the inter-action between body weight and independent influencing factors. There were 98 cases of impaired fasting glucose (IFG), 90 cases of impaired glucose tolerance (IGT), and 48 cases of coexistent IFG and IGT. The body weight, waist circumference, body mass index, fasting blood glucose, and 2 h plasma glucose of patients with IFG, IGT, and coexistent IFG and IGT were higher than those in patients with NGT (P < 0.05). Logistic regression analysis showed that body weight, glycosylated hemoglobin, uric acid, fasting insulin, and homeostatic model assessment for insulin resistance were independent factors affecting progression of prediabetes to T2DM (P < 0.05). Receiver operating characteristic curve analysis showed that the area under the curve predicted by the above indicators combined was 0.905 [95% confidence interval (CI): 0.863-0.948], which was greater than that predicted by each indicator alone. Logistic regression analysis with baseline body weight as an independent variable showed that compared with body weight 1, the odds ratio (95%CI) of body weight 3 was 1.399 (1.142-2.126) (P = 0.033). There was a multiplicative interaction between body weight and uric acid (β = 1.953, P = 0.005). High body weight in patients with prediabetes is an independent risk factor for progression to T2DM, and the risk of progression is increased when coexisting with high uric acid level.

Accessibility and utilization of healthcare services among diabetic patients: Is diabetes a poor man's ailment?

Diabetes is a non-communicable ailment that has adverse effects on the individual's overall well-being and productivity in society. The main objective of this study was to examine the empirical literature concerning the association between diabetes and poverty and the accessibility and utilization of medical care services among diabetic patients. The diabetes literature was explored using a literature review approach. This review revealed that diabetes is an ailment that affects all individuals irrespective of socioeconomic status; however, its pre-valence is high in low-income countries. Hence, despite the higher prevalence of diabetes in developing countries compared with developed countries, diabetes is not a poor man's ailment because it affects individuals of all incomes. While the number of diabetic patients that access and utilize diabetes medical care services has increased over the years, some personal and institutional factors still limit patients' access to the use of diabetes care. Also, there is a lacuna in the diabetes literature concerning the extent of utilization of available healthcare services by diabetic patients.

Effect of individualized nutrition interventions on clinical outcomes of pregnant women with gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) can lead to excessive pregnancy weight gain (PWG), abnormal glucolipid metabolism, and delayed lactation. Therefore, it is necessary to provide appropriate and effective interventions for pregnant women with GDM. To clarify the effects of individualized nutrition interventions on PWG, glucolipid metabolism, and lactation in pregnant women with GDM. The study population consisted of 410 pregnant women with GDM who received treatment at the Northern Jiangsu People's Hospital of Jiangsu Province and Yangzhou Maternal and Child Health Hospital between December 2020 and December 2022, including 200 who received routine in-terventions [control (Con) group] and 210 who received individualized nutrition interventions [research (Res) group]. Data on PWG, glucolipid metabolism [total cholesterol, (TC); triglycerides (TGs); fasting blood glucose (FPG); glycosylated hemoglobin (HbA1c)], lactation time, perinatal complications (cesarean section, premature rupture of membranes, postpartum hemorrhage, and pregnancy-induced hypertension), and neonatal adverse events (premature infants, fetal macrosomia, hypo-glycemia, and respiratory distress syndrome) were collected for comparative analysis. The data revealed markedly lower PWG in the Res group vs the Con group, as well as markedly reduced TG, TC, FPG and HbA1c levels after the intervention that were lower than those in the Con group. In addition, obviously earlier lactation and statistically lower incidences of perinatal complications and neonatal adverse events were observed in the Res group. Individualized nutrition interventions can reduce PWG in pregnant women with GDM, improve their glucolipid metabolism, and promote early lactation, which deserves clinical promotion.

Effects of insulin aspart and metformin on gestational diabetes mellitus and inflammatory markers

Diabetes mellitus is one of the most common causes of chronic kidney disease. Kidney involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria and kidney failure. The development of kidney disease in diabetes is associated with structural changes in multiple kidney compartments, such as the vascular system and glomeruli. Glomerular alterations include thickening of the glomerular basement membrane, loss of podocytes, and segmental mesangiolysis, which may lead to microaneurysms and the development of pathognomonic Kimmelstiel-Wilson nodules. Beyond lesions directly related to diabetes, awareness of the possible coexistence of nondiabetic kidney disease in patients with diabetes is increasing. These nondiabetic lesions include focal segmental glomerulosclerosis, IgA nephropathy, and other primary or secondary renal disorders. Differential diagnosis of these conditions is crucial in guiding clinical management and therapeutic approaches. However, the relationship between diabetes and the kidney is bidirectional; thus, new-onset diabetes may also occur as a complication of the treatment in patients with renal diseases. Here, we review the complex and multifaceted correlation between diabetes and kidney diseases and discuss clinical presentation and course, differential diagnosis, and therapeutic opportunities offered by novel drugs.

Multifaceted relationship between diabetes and kidney diseases: Beyond diabetes.

Diabetes mellitus is one of the most common causes of chronic kidney disease. Kidney involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria and kidney failure. The development of kidney disease in diabetes is associated with structural changes in multiple kidney compartments, such as the vascular system and glomeruli. Glomerular alterations include thickening of the glomerular basement membrane, loss of podocytes, and segmental mesangiolysis, which may lead to microaneurysms and the development of pathognomonic Kimmelstiel-Wilson nodules. Beyond lesions directly related to diabetes, awareness of the possible coexistence of nondiabetic kidney disease in patients with diabetes is increasing. These nondiabetic lesions include focal segmental glomerulosclerosis, IgA nephropathy, and other primary or secondary renal disorders. Differential diagnosis of these conditions is crucial in guiding clinical management and therapeutic approaches. However, the relationship between diabetes and the kidney is bidirectional; thus, new-onset diabetes may also occur as a complication of the treatment in patients with renal diseases. Here, we review the complex and multifaceted correlation between diabetes and kidney diseases and discuss clinical presentation and course, differential diagnosis, and therapeutic oppor-tunities offered by novel drugs.

Gut microbiome supplementation as therapy for metabolic syndrome.

The gut microbiome is defined as an ecological community of commensal symbiotic and pathogenic microorganisms that exist in our body. Gut microbiome dysbiosis is a condition of dysregulated and disrupted intestinal bacterial homeostasis, and recent evidence has shown that dysbiosis is related to chronic inflammation, insulin resistance, cardiovascular diseases (CVD), type 2 diabetes mellitus (T2DM), and obesity. It is well known that obesity, T2DM and CVD are caused or worsened by multiple factors like genetic predisposition, environmental factors, unhealthy high calorie diets, and sedentary lifestyle. However, recent evidence from human and mouse models suggest that the gut microbiome is also an active player in the modulation of metabolic syndrome, a set of risk factors including obesity, hyperglycemia, and dyslipidemia that increase the risk for CVD, T2DM, and other diseases. Current research aims to identify treatments to increase the number of beneficial microbiota in the gut microbiome in order to modulate metabolic syndrome by reducing chronic inflammation and insulin resistance. There is increasing interest in supplements, classified as prebiotics, probiotics, synbiotics, or postbiotics, and their effect on the gut microbiome and metabolic syndrome. In this review article, we have summarized current research on these supplements that are available to improve the abundance of beneficial gut microbiota and to reduce the harmful ones in patients with metabolic syndrome.

Partners in diabetes epidemic: A global perspective.

There is a recent increase in the worldwide prevalence of both obesity and diabetes. In this review we assessed insulin signaling, genetics, environment, lipid metabolism dysfunction and mitochondria as the major determinants in diabetes and to identify the potential mechanism of gut microbiota in diabetes diseases. We searched relevant articles, which have key information from laboratory experiments, epidemiological evidence, clinical trials, experimental models, meta-analysis and review articles, in PubMed, MEDLINE, EMBASE, Google scholars and Cochrane Controlled Trial Database. We selected 144 full-length articles that met our inclusion and exclusion criteria for complete assessment. We have briefly discussed these associations, challenges, and the need for further research to manage and treat diabetes more efficiently. Diabetes involves the complex network of physiological dysfunction that can be attributed to insulin signaling, genetics, environment, obesity, mitochondria and stress. In recent years, there are intriguing findings regarding gut microbiome as the important regulator of diabetes. Valid approaches are necessary for speeding medical advances but we should find a solution sooner given the burden of the metabolic disorder - What we need is a collaborative venture that may involve laboratories both in academia and industries for the scientific progress and its application for the diabetes control.