Recent Diagnosis Of Type Research Articles

Een 54-jarige man met onverklaard gewichtsverlies

A 54-year-old male patient with unexplained weight loss Unfortunately, a common form of autoimmune diabetes in adults remains ill-recognized in daily clinical practice. This articles describes a case of a 54-year-old male patient with a recent diagnosis of type 2 diabetes mellitus, who was referred to the internal medicine service with unexplained weight loss. Thorough analysis led to the diagnosis of latent autoimmune diabetes in adults (LADA). Remarkably, unexplained weight loss and a moderate response to the initial treatment were the only clinical manifestations of this autoimmune form of diabetes. First, the article briefly describes the analysis of unexplained weight loss and then discusses this still poorly recognized form of diabetes. Taking into account the worldwide acknowledgment of the heterogeneity of both type 1 and 2, an exact diabetes classification is becoming increasingly compelling, considering its (therapeutic) consequences. Furthermore, in the context of unexplained weight loss and regardless of a pre-existing diagnosis of diabetes, this form of autoimmune diabetes should be considered.

Weight Loss Versus Glycemic Control as the Primary Treatment Target in Newly Diagnosed Type 2 Diabetes: Why Choose When You Can Have Both?

Weight loss has been associated with significant improvements in glycemic control, quality of life, and comorbidities in people with type 2 diabetes. Furthermore, achieving diabetes remission can reduce the risk of microvascular complications and mitigate the burden of diabetes on healthcare systems. However, preventing weight regain is challenging in the long term. Strict glycemic control, particularly in the early stages of the disease, can reduce the subsequent risk of microvascular complications and specific macrovascular endpoints in the long run; however, its impact on cardiovascular and all-cause mortality remains controversial. New classes of antidiabetic agents, namely glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, have been shown to reduce cardiorenal risk and induce weight loss, in addition to effectively lowering blood glucose with a minimal risk of hypoglycemia. Recently, it has been debated whether weight loss or glycemic control should be the first priority in people with a recent diagnosis of type 2 diabetes. This article aims to discuss the debate from a clinical perspective, evaluate the advantages and disadvantages of each therapeutic strategy, and assess the impact of both approaches on the future risk of diabetic complications, based on the latest evidence. Given that both goals are equally important, the authors suggest that merging the two strategies, with the early and aggressive use of combination therapies consisting of glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, will confer maximum benefits in terms of weight loss and glycemic control, and will reduce the future risk of complications from diabetes. A personalized approach that takes into account specific patient characteristics, including age, sex, race, frailty, and cognitive status, among others, can lead to more effective diabetes care.

Lifestyle medicine approach in managing pemphigus vulgaris: A case report

A 58-year-old female presented to a lifestyle medicine clinic in 2019 with a one-year history of pemphigus vulgaris (PV) and having itching, burning sensations, and bulla formation all over her body. She further had a recent diagnosis of type 2 diabetes mellitus and also complained of malaise, indigestion, and anxiety due to her skin condition. She was on methyl prednisolone, metformin, and other herbal supplements for 1 year to control her PV and diabetes. Laboratory investigations revealed the presence of autoantibodies Desmoglein 1 and 3 with titers of 3.26 and 3.5, respectively.The patient underwent a yoga & naturopathy-based lifestyle modification program for a period of 53 days in 2019, followed by 10 days in 2020 and 15 days in 2021, and subsequent follow-up measures. This included hydrotherapy, yoga, a vegetarian diet, herbal preparations, massage, etc. By the end of 2020, the patient was tapered from all medications, and there was complete remission from PV. Given the multidimensional impact of PV, a holistic, patient-centered lifestyle approach as described in this case may be beneficial in managing PV. Further research is warranted in this area.

Association of Netrin 1 with hsCRP in Subjects with Obesity and Recent Diagnosis of Type 2 Diabetes.

Netrin 1 (Ntn1) is a cell migration protein with an anti-inflammatory effect, which may play a key role in the pathological development of type 2 diabetes (T2D). In this study, we evaluate the relationships between the serum concentrations of Ntn1, glucose, and high-sensitivity C-reactive Protein (hsCRP). We carried out a cross-sectional study including 90 individuals divided into three groups (n = 30): healthy subjects, individuals with obesity without glucose alterations, and individuals with newly diagnosed T2D. Serum concentrations of Ntn1 and hs-CRP were determined by enzyme-linked immunosorbent assay (ELISA). The serum concentration of Ntn1 was higher in individuals with newly diagnosed T2D (0.33 ± 0.22 ng/mL), in comparison to healthy subjects and individuals with obesity (0.13 ± 0.06 and 0.15 ± 0.07 ng/mL, respectively). In addition, we observed a positive association between the levels of Ntn1 and hsCRP (rho = 0.443; p < 0.001) as well as with serum glucose (rho = -0.110; p = 0.05). The serum concentration of Ntn1 was higher in individuals with T2D, in comparison with the other groups in this study, and presented a positive correlation with hsCRP. Therefore, Ntn1 can be considered a promising risk biomarker and a potential therapeutic target for T2D.

Analyze the Efficacy of Silymarin in Treating Newly Diagnosed Cases of Type 2 Diabetes Mellitus by Contrasting its Effects on Glycemic Control and Insulin Resistance

Objective: The purpose of this research was to examine the efficacy of Silymarin in treating newly diagnosed cases of type II diabetes mellitus (T2DM), specifically with regard to glycemic control and insulin resistance. Study design: An observational, randomized, placebo- controlled study. Place and duration: Medicine department of Dr. Akbar Niazi Teaching Hospital (ANTH), Islamabad for the duration from August 2021 to January 2022. Methods: The sixty individuals with a recent diagnosis of type 2 diabetes were chosen at random. There were a total of 60 patients, split evenly between 2 groups of 30. For 90 days, those in Group A took a silymarin capsule containing 200 mg, whereas those in Group B had a placebo capsule looking very similar to the real thing. Fasting blood glucose (FBG), random blood glucose (RBG), glycated haemoglobin A1C (A1C), fasting insulin (FI), and homeostasis model assessment of insulin resistance (HOMA-IR) were measured before and after therapy. The data was examined after 90 days. Statistical analysis was performed using SPSS-20.0. If the probability value was less than 0.05, it was considered significant. The Chi-squared test was employed for statistical analysis. Results: Mean age of the patients of group A (silymarin) was 50.5 years while mean age of group B (controlled) patients was 51.0 years. In both the groups, females were more in numbers as 80% in silymarin group and 70% in controlled group. There was no significant difference showed on the basis of age, gender, BMI, education, family history and employment. Silymarin therapy for 12weeks improved the levels of RBG, RBG, HbA1c, FSI and HOMA-IR. A significant difference p-value<0.001 was showed in these variables between the two groups at baseline and after 90days treatment. Conclusion: The treatment of Silymarin supplementation of 200mg three time a day for newly diagnosed type II diabetic patients had a beneficial effect on improving the blood glucose levels and decreased insulin resistance as compared to standard treatment alone.

Comorbidity Between Recent Diagnosis of Type 2 Diabetes and Non-Psychotic Psychiatric Disorders: Metabolic Characteristics and Clinical Correlates.

PurposeTo describe the metabolic status and clinical characteristics associated with NPPD in patients with less than five years of T2D diagnosis and explore the role of age in the presentation of psychiatric comorbidities.Patients and MethodsThis was a cross-sectional study of subjects who attended a comprehensive care program. Patients were assessed using the Mini-International Neuropsychiatric Interview, and clinical and metabolic characteristics were registered. Multivariate logistic regression analyses were conducted to identify risk and protective factors for psychiatric disorders. We performed an analysis to further explore age’s influence on our results.ResultsWe included 1953 patients, and 40.1% had any psychiatric disorder. Younger age, female sex, and personal psychiatric history were associated with NPPD. The use of insulin was reported as a protective factor for eating disorders. Body mass index was associated with any psychiatric disorders and eating disorders. The analysis of age reported that patients younger than 45 years had the worst metabolic parameters and increased odds for NPPD, while patients older than 65 years had the best metabolic measures and decreased odds for psychiatric comorbidity.ConclusionNPPD were frequent comorbidities in our sample; younger age, female sex, and personal psychiatric history were the most important factors associated with psychiatric comorbidities. Younger subjects experience a higher risk for psychiatric disorders and worst metabolic control.

STUDY OF EARLY RETINAL CHANGES IN PATIENTS WITH NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS

Objective: Retina and endothelium constitute fields in which the hyperglycemia’s pathological effects of type 2 diabetes mellitus (T2DM) can be detected. However, the precise time of these lesions’ appearance and factors contributing to it are still under investigation. Thus, we studied the early retinal lesions and endothelial function in patients with a recent diagnosis of T2DM (<6 months) and their association with adverse prognostic factors. Design and method: Patients with a recent diagnosis of T2DM receiving no other diabetic medication except from Metformin, and volunteers matched for age and blood pressure (BP) participated in the study. Somatometric data, BP measurements (ambulatory and office) and hematological parameters (lipids, renal function, fasting glucose, glycosylated hemoglobin) were recorded. Endothelial function was assessed by Asymmetric Dimethylarginine (ADMA). Retinal vessel diameters (central retinal arteriolar equivalent-CRAE / central retinal venular equivalent-CRVE) and their ratio (arteriovenous ratio-AVR) were assessed with a non-mydriatic fundus camera using special software. Results: We studied 165 participants, 81 T2DM patients and 84 non-T2DM volunteers. No differences were found between the 2 groups in retinopathy and ADMA measurements. ADMA was associated with female sex (p = 0.037), Body Mass Index (p = 0.033) and AVR (p = 0.047). AVR was significantly associated with age, male sex, ADMA, estimated Glomerular Filtration Rate (eGFR), smoking, office, day and nighttime diastolic, 24-hour, and nighttime systolic BP. Linear regression analysis showed the independent correlation of AVR with nighttime systolic blood pressure (p = 0.002) and age (p = 0.019) taking into consideration gender, smoking, eGFR, ADMA and T2DM. Conclusions: In patients with a very recent diagnosis of Type 2 Diabetes Mellitus, the retinal vessels diameters do not differ compared with individuals of similar age and blood pressure. However, the AVR index correlates with age and nighttime BP, highlighting the important contribution of the latter in early target organ damage in this population.

Results of Two Strategies for Peer-Support in Patients with Recently Diagnosed Type 2 Diabetes

Authors: Ana Cristina García-Ulloa, Jorge Alberto Ramírez-García, Michelle Díaz-Pineda, Christa Nadine Ovalle-Escalera, Rodrigo Eduardo Arizmendi-Rodríguez, María Luisa Velasco-Pérez, Sergio Hernández-Jiménez. Objective: To investigate whether a peer-support (PS) program at-distance (PSAD) helps maintain metabolic and mental health in patients with a recent diagnosis of type 2 diabetes (T2DM) after a multidisciplinary intervention. Methods: Patients were randomized in PSAD and PS face-to-face groups (PSFF). Leaders were selected if they accomplished the eligibility criteria such as metabolic control and mental health department approval. Results: We included 133 patients divided into three groups, at-distance (n=62), face-to-face (n=59), and leaders (n=12). Patients in the PSFF had higher odds of reaching glycemic targets at three months than PSAD (OR 2.52 95%CI 1.18-5.38, p=0.01) and improved scores in Diabetes Quality of Life Measure (DQoL) and empowerment. Conclusion: PS increases long-term empowerment and decreases problem areas in T2DM, which increases the likelihood of achieving HbA1c target goals, LDL-C control, and promotes weight loss.

Results of Two Strategies for Peer-Support in Patients with Recently Diagnosed Type 2 Diabetes

Authors: Ana Cristina García-Ulloa, Jorge Alberto Ramírez-García, Michelle Díaz-Pineda, Christa Nadine Ovalle-Escalera, Rodrigo Eduardo Arizmendi-Rodríguez, María Luisa Velasco-Pérez, Sergio Hernández-Jiménez. Objective: To investigate whether a peer-support (PS) program at-distance (PSAD) helps maintain metabolic and mental health in patients with a recent diagnosis of type 2 diabetes (T2DM) after a multidisciplinary intervention. Methods: Patients were randomized in PSAD and PS face-to-face groups (PSFF). Leaders were selected if they accomplished the eligibility criteria such as metabolic control and mental health department approval. Results: We included 133 patients divided into three groups, at-distance (n=62), face-to-face (n=59), and leaders (n=12). Patients in the PSFF had higher odds of reaching glycemic targets at three months than PSAD (OR 2.52 95%CI 1.18-5.38, p=0.01) and improved scores in Diabetes Quality of Life Measure (DQoL) and empowerment. Conclusion: PS increases long-term empowerment and decreases problem areas in T2DM, which increases the likelihood of achieving HbA1c target goals, LDL-C control, and promotes weight loss.

Preconception diabetes remission, a viable approach to reduce pregnancy risks in women with recent diagnosis of Type 2 diabetes: Case report and clinical discussion

The prevalence of women diagnosed with Type 2 diabetes (T2D) at fertile age has been increasing over the last few decades, and pregnancy with T2D is associated with increased maternal and foetal risks. In the last few years, studies have shown that focusing on aggressive weight loss in individuals recently diagnosed with T2D can lead to diabetes remission. Here, we present a case report of a woman who achieved diabetes remission after massive weight loss and had an uncomplicated pregnancy. Diabetes remission before pregnancy could be offered to motivated women with T2D as a safe way to reduce the risks of pregnancy. As a plausible hypothesis, dedicated studies are warranted to demonstrate if this approach can lead to reduced adverse maternal and foetal outcomes.

Incident Type 2 Diabetes and Risk of Fracture: A Comparative Cohort Analysis Using U.K. Primary Care Records.

To estimate risk of fracture in men and women with recent diagnosis of type 2 diabetes compared with individuals without diabetes. In this cohort study, we used routinely collected U.K. primary care data from The Health Improvement Network. In adults (>35 years) diagnosed with type 2 diabetes between 2004 and 2013, fractures sustained until 2019 were identified and compared with fractures sustained in individuals without diabetes. Multivariable models estimated time to first fracture following diagnosis of diabetes. Annual prevalence rates included at least one fracture in a given year. Among 174,244 individuals with incident type 2 diabetes and 747,290 without diabetes, there was no increased risk of fracture among males with diabetes (adjusted hazard ratio [aHR] 0.97 [95% CI 0.94, 1.00]) and a small reduced risk among females (aHR 0.94 [95% CI 0.92, 0.96]). In those aged ≥85 years, those in the diabetes cohort were at significantly lower risk of incident fracture (males: aHR 0.85 [95% CI 0.71, 1.00]; females: aHR 0.85 [95% CI 0.78, 0.94]). For those in the most deprived areas, aHRs were 0.90 (95% CI 0.83, 0.98) for males and 0.91 (95% CI 0.85, 0.97) for females. Annual fracture prevalence rates, by sex, were similar for those with and without type 2 diabetes. We found no evidence to suggest a higher risk of fracture following diagnosis of type 2 diabetes. After a diagnosis of type 2 diabetes, individuals should be encouraged to make positive lifestyle changes, including undertaking weight-bearing physical activities that improve bone health.

Clinical and cost-effectiveness of a diabetes education and behavioural weight management programme versus a diabetes education programme in adults with a recent diagnosis of type 2 diabetes: study protocol for the Glucose Lowering through Weight management (GLoW) randomised controlled trial

IntroductionPeople with type 2 diabetes (T2D) can improve glycaemic control or even achieve remission through weight loss and reduce their use of medication and risk of cardiovascular disease. The Glucose...

Neighbourhood greenspace and physical activity and sedentary behaviour among older adults with a recent diagnosis of type 2 diabetes: a prospective analysis

ObjectivesGreenspace is one of the important factors that can promote an active lifestyle. Thus, greener surroundings may be a motivating factor for people with newly diagnosed diabetes to engage in...

SUN-161 Association between Anthropometric Parameters and Recent Diagnosis of Type 2 Diabetes Mellitus in Adult Patients Attended at a General Hospital in Peru

Type 2 Diabetes mellitus (T2DM) is a major public health problem worldwide and its early diagnosis is a challenge, because it’s usually asymptomatic. Therefore, the possibility of using anthropometric parameters (AP) for detection of patients at risk is considered, because are simple to measure and cost effective. The objective was to determine whether the AP: Body Mass Index (BMI), Waist Circumference (WC), Neck Circumference (NC) and Waist-Length Index (WLI) are factors associated with the recent diagnosis of T2DM and determine the cut points for each AP, according to sex. This is a cross-sectional, analytical study, which included 18-70 years old patients, both sexes, who attended for the first time at the endocrinology department for general evaluation during the period January 2016 - January 2017. Were made anthropometric measurements and biochemical studies (oral glucose tolerance test-75g and glycosylated hemoglobin) to diagnose T2DM, according to American Diabetes Association criteria. Were excluded: pregnant, prediabetes or T2DM previous, in hyperglycemic crisis, any thyroid disease including goiter, renal failure, chronic liver disease, heart failure or hypoalbuminemia and lost weight in the last 3 months. For anthropometric measurements, standard stipulated methods were used. To determine association between the AP and the diagnosis of T2DM, the prevalence ratio (PR) of each AP was calculated with CI 95% using Poisson regressions. ROC curve analysis was performed to establish the cut-off points with the best balance of (S) and (E) estimating the youden index. Statistical package Stata version 14.0 was used. We evaluated data from 698 patients: 411 women and 287 men. The average age was 40.9 years old in women and 43.1 years old in men. 10.2% of women and 18.1% of men were diagnosed with T2DM. NC (PR: 1.23 CI95%: 1.15 – 1.31 in women, PR: 1.12 CI95%: 1.06 - 1.19 in men), BMI (PR: 1.13 CI95%: 1.09 - 1.17 in women, PR: 1.06 CI95%: 1.02 - 1.11 in men) and WC (PR: 1.07 CI95%: 1.05 - 1.09 in women, PR: 1.03 CI95%: 1.02 - 1.05 in men) were associated with T2DM diagnosis; whereas WLI was not associated (PR: 1.02 CI95%: 0.99 - 1.06 in women, PR: 0.93 CI95%: 0.94 - 1.00 in men). In ROC curves analysis, the AUC was higher for NC and WC, intermediate for BMI, and lower for WLI; in both sexes. For NC, the cutoff point found was 38cm (S: 0.63 E: 0.70) and 42cm (S: 0.73 E: 0.59), for WC it was 101cm (S: 0.68 E: 0.73) and 108cm (S: 0.59 E: 0.70), for BMI it was 30.2 kg/m2 (S: 0.69 E: 0.66) and 32.4kg/m2 (S: 0.44 E: 0.75), for WLI it was 0.63 (S: 0.55 E: 0.60) and 0.66 (S: 0.90 E: 0.25) in women and men respectively. Finally we conclude that AP associated with the recent diagnosis of T2DM were: NC, BMI and WC, with the NC and WC being the parameters with the highest detection capacity for both sexes. Therefore NC constitutes a tool to be considered in the identification of patients at risk of T2DM, taking into account that it is easier to measure.

MON-LB068 Incidental Finding of a Functioning Corticomedullary Mixed Adrenal Tumor

Background: Incidental adrenal adenoma prevalence ranges from 0.4-4% and reaches up to 10% in older patients, but only 10-15% secrete excess amounts of hormones. Functioning adrenal tumors composed of corticomedullary mixed cells are very rare. Clinical Case: A 78-year-old female patient with a 2-year history of slowly progressive involuntary weight-loss (20kg), recent diagnosis of type 2 diabetes, and incidental finding upon abdominal ultrasound of a right adrenal mass, is admitted to our hospital due to a left hip fracture. She denied hypertension. Physical examination revealed no signs of hypercortisolism and/or catecholamine excess other than tachycardia (120bpm). Abdominal CT Scan showed an enlarged right adrenal mass, 2.7x3.3cm, 40UH. Institutional laboratory results were consistent with a pheochromocytoma: Metanephrines: 180pg/mL (n<65 pg/mL), Normetanephrines: 356 pg/mL (n<196 pg/mL), and an ACTH-independent Cushing Syndrome: elevated 24-hour urinary cortisol: 628.3nmol/L (n<110nmol/L), abnormal 1mg overnight Dexamethasone test: Cortisol 8am: 14.4mcg/dL (positive >1.8mcg/dL), normal ACTH: 19.97pg/mL (n:7-62pg/mL) and DHEASO4: 161.21mcg/dL (n:25-460mcg/dL). Fasting glycemia: 142mg/dL. Laparoscopic right adrenalectomy is performed. Postoperative results: normal Cortisol 8am: 18.6mcg/dL (n:4.46-22.1mcg/dL), fasting glycemia: 94mg/dL. Histological and immunohistochemistry results showed a mixed corticomedullary adrenal tumor with pheochromocytoma (chromogranin A+++, synaptophysin+++), ganglioneuroma (S100+++, synaptophysin ++) and cortical adenoma ((inhibin +++, Melan A +++) components, capsular invasion but no evident angioinvasion. Conclusion: This case is one of the very few reports of a functioning mixed cell tumor with adrenal cortical, medullary and neural lineage in a single gland confirmed by immunohistochemistry. Key words: corticomedullary tumor, mixed adrenal tumor, pheochromocytoma, Cushing’s syndrome

Periodontal inflammation correlates with systemic inflammation and insulin resistance in patients with recent diagnosis of type 2 diabetes

Background: diabetes and periodontitis are common comorbidities; however, the clinical implications of this association remain only partially known. This study was aimed to characterize the periodontal status of type 2 diabetic (T2D) patients and its correlation with metabolic and inflammatory parameters. Methods: patients (n = 30) with 5 or less years since the diagnosis of T2D (18 – 65 years old) were recruited. Anthropometric (Body Mass Index, BMI), metabolic (fasting glucose, glycated hemoglobin, insulin, HOMA-IR, HDL, LDL and total cholesterol, triglycerides) and inflammatory parameters (ultrasensitive C reactive protein, usCRP) were quantified. Periodontal evaluation included clinical attachment level (CAL), probing depth (PD), gingival level (GL) and bleeding on probing (BOP) average. Statistical significance was assessed by Mann-Whitney and Spearman correlation tests. Results: mean values of BOP, CAL, PD and GL were 39.3, 2.8, 2.8, and 0.1, respectively. BOP significantly correlated with BMI and HOMA-IR and was higher in patients with elevated usCRP &gt;3 mg/L (p&lt;0.05). Age and duration of T2D directly and inversely correlated with CAL and GL, respectively. BOP correlated with HOMA-IR and usCRP but not with patients´age, duration of T2D or BMI. Conclusions: in patients with recent diagnosis of T2D, BOP is associated with usCRP and HOMA-IR levels, suggesting that periodontal inflammation promotes insulin resistance possibly by increasing systemic inflammation.

Identification of nephropathy predictors in urine from children with a recent diagnosis of type 1 diabetes

Despite research progresses, the chance to accurately predict the risk for diabetic nephropathy (DN) is still poor. So far, the first evidence of DN is micro-albuminuria, which is detected only 10–20 years after the onset of diabetes.Our goal is to develop new predictive tools of nephropathy starting from urine, which can be easily obtained using noninvasive procedures and it is directly related to kidney. Since it is reasonable to suppose that, in predisposed patients, the mechanisms leading to nephropathy start acting since the diabetes onset, urine from children with recent diagnosis of type 1 diabetes was subjected to proteomic analysis in comparison to age-matched controls. Targeted confirmation was performed on children with a longer history of diabetes using Western Blotting and applying a urinary lipidomic approach. To definitively understand whether the observed alterations could be related to diabetic nephropathy, urine from diabetic adults with or without albuminuria was also examined.For the first time, lipid metabolisms of prostaglandin and ceramide, which are significantly and specifically modified in association with DN, are shown to be already altered in children with a recent diabetes diagnosis. Future studies on larger cohorts are needed to improve the validity and generalizability of these findings.Data are available via ProteomeXchange with identifier PXD011183Submission details:Project Name: Urinary proteomics by 2DE and LC-MS/MS.Project accession: PXD011183Project DOI: https://doi.org/10.6019/PXD011183 SignificanceNephropathy is a very common diabetic complication. Once established, its progression can only be slowed down but full control or remission is achieved in very few cases, thus posing a large burden on worldwide health. The first evidence of diabetic nephropathy (DN) is micro-albuminuria, but only 30% of patients with micro-albuminuria progress to proteinuria, while in some patients it spontaneously reverts to normo-albuminuria. Thus, there is clear need for biomarkers that can accurately predict the risk to develop DN. Herein, by applying proteomic and lipidomic approaches on urine samples, we show that alteration of prostaglandin and ceramide metabolisms specifically occurs in association with DN. Interestingly, we demonstrate that the modification of these metabolic pathways is an early event in diabetic patients, suggesting the identified changed proteins as possible predictive biomarkers of diabetes-induced renal function decline.

Attitudes and barriers to exercise in adults with a recent diagnosis of type 1 diabetes: a qualitative study of participants in the Exercise for Type 1 Diabetes (EXTOD) study

ObjectivesTo explore attitudes and barriers to exercise in adults with new-onset type 1 diabetes mellitus (T1DM).DesignQualitative methodology using focus group (n=1), individual face-to-face (n=4) and telephone interviews (n=8). Thematic analysis...

The Impact of Sleep Debt on Excess Adiposity and Insulin Sensitivity in Patients with Early Type 2 Diabetes Mellitus.

We examined cross-sectional and prospective associations between sleep debt and adiposity measures, as well as homeostatic model assessment-insulin resistance (HOMA-IR) in early type 2 diabetes. Prospective data analysis from participants of a randomized controlled trial based on an intensive lifestyle intervention (usual care, diet, or diet and physical activity). Data were collected at baseline, 6 months, and 12 months post-intervention. The study was performed across five secondary care centers in the United Kingdom. Patients (n = 593) with a recent diagnosis of type 2 diabetes were recruited. Objective height and weight were ascertained for obesity status (body mass index [BMI]; ≥ 30 kg/m(2)), waist circumference (cm) for central adiposity, and fasting blood samples drawn to examine insulin resistance (IR). Seven-day sleep diaries were used to calculate weekday sleep debt at baseline, calculated as average weekend sleep duration minus average weekday sleep duration. At baseline, compared to those without weekday sleep debt, those with weekday sleep debt were 72% more likely to be obese (OR = 1.72 [95% CI:1.03-2.88]). At six months, weekday sleep debt was significantly associated with obesity and IR after adjustment, OR = 1.90 (95% CI:1.10-3.30), OR = 2.07 (95% CI:1.02-4.22), respectively. A further increase at 12 months was observed for sleep debt with obesity and IR: OR = 2.10 (95% CI:1.14-3.87), OR = 3.16 (95% CI:1.38-7.24), respectively. For every 30 minutes of weekday sleep debt, the risk of obesity and IR at 12 months increased by 18% and 41%, respectively. Sleep debt resulted in long-term metabolic disruption, which may promote the progression of type 2 diabetes in newly diagnosed patients. Sleep hygiene/education could be an important factor for future interventions to target early diabetes.

Awaking Blood Pressure Surge and Progression to Microalbuminuria in Type 2 Normotensive Diabetic Patients.

Background. We investigated the predictive value of morning blood pressure surge (MBPS) on the development of microalbuminuria in normotensive adults with a recent diagnosis of type 2 diabetes. Methods. Prospective assessments of 24-hour ambulatory blood pressure monitoring and urinary albumin excretion were performed in 377 adult patients. Multivariate-adjusted Cox regression models were used to assess hazard ratios (HRs) between baseline and changes over follow-up in MBPS and the risk of microalbuminuria. The MBPS was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep BP. Results. After a mean follow-up of 6.5 years, microalbuminuria developed in 102 patients. An increase in MBPB during follow-up was associated with an increased risk of microalbuminuria. Compared to individuals in the lowest tertile (−0.67 ± 1.10 mmHg), the HR and 95% CI for microalbuminuria in those in the highest tertile of change (24.86 ± 6.92 mmHg) during follow-up were 17.41 (95% CI 6.26–48.42); p for trend <0.001. Mean SD MBPS significantly increased in those who developed microalbuminuria from a mean [SD] of 10.6 [1.4] to 36.8 [7.1], p < 0.001. Conclusion. An increase in MBPS is associated with the risk of microalbuminuria in normotensive adult patients with type 2 diabetes.