People with type 2 diabetes (T2D) have increased cancer risk. Liver cancer (LC) has a high prevalence in East Asia and is one of the leading causes of cancer death globally. Diagnosis of LC at early ...stage carries good prognosis. We used stored serum from patients of Hong Kong Diabetes Register before cancer diagnosis to extract RNA to screen for microRNA markers for early detection of LC in T2D. After screening with Affymetrix GeneChip microarray with serum RNA from 19 incident T2D LC (T2D-LC), 20 T2D cancer free (T2D-CF) and 20 non-T2D non-cancer patients, top signals were validated in a 3-group comparison including 1888 T2D-CF, 127 T2D-LC, and 487 T2D patients with non-liver cancer patients using qPCR. We detected 2.55-fold increase in miR-122-5p and 9.21-fold increase in miR-455-3p in the T2D-LC group. Using ROC analysis, miR-122-5p and miR-455-3p jointly predicted LC with an area under the curve of 0.770. After adjustment for confounders, each unit increase of miR-455-3p increased the odds ratio for liver cancer by 1.022. Increased serum levels of miR-122-5p and miR-455-3p were independently associated with increased risk of incident LC in T2D and may serve as potential biomarkers for early detection of LC in T2D.
To evaluate the effect of a team-based multi-component intervention care (MIC) program in obese patients with type 2 diabetes (T2D) and poor glycemic control.
Patients with T2D and HbA
≥ 8 % and ...body mass index (BMI) ≥ 27 kg/m
and/or waist circumference ≥ 80 cm in women and ≥90 cm in men were recruited. The intervention in Diabetes Centre included 1) nurse-led, group-based workshops; 2) review by endocrinologists; 3) telephone reminders by healthcare assistants and 4) peer support during visits. The usual care (UC) group received consultations at outpatient clinic without workshops or peer support. The MIC group received UC after 1-year of intervention. The primary outcome was change of HbA
from baseline at 1- and 3-year.
Of 207 eligible patients age (mean ± standard deviation): 56.9 ± 8.8 years, 47.4 % men, disease duration: 13.5 ± 8.2 years, HbA
: 9.6 ± 1.3 %, BMI: 28.8 ± 4.3 kg/m
, waist circumference: 101.5 ± 9.9 cm (men), 95.3 ± 9.8 cm (women), 104 received MIC and 103 received UC. 95 % patients had repeat assessments at 1- and 3-year. After adjustment for confounders, MIC had greater HbA
reduction (β -0.51, 95 % confidence interval CI -1.00 to -0.01; P = 0.045) than UC at 1-year, with sustained improvement at 3-year (β -0.56, CI -1.10 to -0.02; P = 0.044).
Team-based MIC for 1 year improved glycemic control in obese T2D which was sustained at 3-year.
Despite the popularity of dietary supplements, their effectiveness and safety in patients with diabetes remain controversial. Furthermore, evidence from clinical trials may not be generalizable to ...real-world settings. This study examined the association between dietary supplement use and mortality outcomes among patients with diabetes based on a nationally representative sample of US adults.
This study analyzed data from National Health and Nutrition Examination Survey (NHANES) 1999-2018. Supplement users referred to adults with diabetes who reported the use of any dietary supplements in the last 30 days, and with a cumulative duration of ≥ 90 days. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between supplement use and all-cause mortality, and mortality from cardiovascular diseases (CVD), diabetes, and cancer. Subgroup analysis of different supplement classes (vitamins, minerals, botanicals, amino acids, fatty acids, probiotics and glucosamine) were also conducted.
We included 8,122 adults with diabetes (mean age: 59.4 years; 48.7% female), of whom 3,997 (54.0%) reported using supplements regularly. Vitamins (87.3%), minerals (75.3%) and botanicals (51.8%) were the most popular supplements. At a median follow-up of 6.9 years, 2447 all-cause deaths had occurred. Overall supplement use was not associated with risk of all-cause mortality among patients with diabetes (HR = 0.97, 95% CI: 0.87 to 1.08, P = 0.56). Subgroup analyses suggested that amino acid use was associated with a lower all-cause mortality (HR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028), while the use of fatty acids (HR = 0.62, 95% CI: 0.42 to 0.92, P = 0.018) and glucosamine (HR = 0.69, 95% CI: 0.51 to 0.95, P = 0.022) supplements were significantly associated with lower CVD mortality.
Our results derived from real-world data suggested that overall supplement use was not associated with any mortality benefit in patients with diabetes. However, there is preliminary evidence that suggests a protective effect of amino acid use on all-cause mortality, and a benefit of fatty acids and glucosamine supplement use on CVD mortality. Future large-scale longitudinal studies are needed to investigate the association between dietary supplement use and other intermediate diabetes-related outcomes, such as glucose control and reducing diabetes-related complications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background
Patients with type 2 diabetes (T2D) are at high risk of developing multiple complications, affecting their health‐related quality of life (HRQoL). Existing studies only considered impact ...of complication on HRQoL in the year of occurrence but not its residual impacts in subsequent years. We investigated temporal impacts of diabetes‐related complications on HRQoL in a 12‐year prospective cohort of ambulatory Chinese patients with T2D enrolled in the clinic‐based Joint Asia Diabetes Evaluation (JADE) Register.
Methods
HRQoL utility measures were derived from EuroQol five‐dimensional three‐level questionnaire (EQ‐5D‐3L) questionnaires completed by 19 322 patients with T2D in Hong Kong (2007–2018). Temporal EQ‐5D utility decrements associated with subtypes of cardiovascular‐renal events were estimated using generalized linear regression model after stepwise selection of covariates with p < .01 as cutoff.
Results
In this cohort (mean ± SD age:61.2 ± 11.5 years, 55.3% men, median interquartile range duration of diabetes:10.1 3.0–15.0 years, glycated hemoglobin HbA1C 7.5 ± 1.5%), EQ‐5D utility was 0.860 ± 0.163. The largest HRQoL decrements were observed in year of occurrence of hemorrhagic stroke (−0.230), followed by ischemic stroke (−0.165), peripheral vascular disease (−0.117), lower extremity amputation (−0.093), chronic kidney disease (CKD) G5 without renal replacement therapy (RRT) (−0.079), congestive heart failure (CHF) (−0.061), and CKD G3–G4 without RRT (−0.042). Residual impacts on HRQoL persisted for 2 years after occurrence of CHF or ischemic stroke and 1 year after hemorrhagic stroke or CKD G3–G4 without RRT.
Conclusion
This is the first comprehensive report on temporal associations of HRQoL decrements with subtypes of diabetes‐related complications in ambulatory Asian patients with T2D. These data will improve the accuracy of cost‐effectiveness analysis of diabetes interventions at an individual level in an Asian setting.
Highlights
This is the first report on health‐related quality‐of‐life (HRQoL) decrements associated with subtypes of diabetes‐related cardiovascular‐renal complications in the year of occurrence and their residual impacts in subsequent years amongst 19 322 ambulatory Asian patients with type 2 diabetes (T2D) enrolled in the clinic‐based Joint Asia Diabetes Evaluation (JADE) Register (2007–2018)
The largest HRQoL decrements expressed as EuroQol five‐dimensional questionnaire utility scores were observed in the year of occurrence of hemorrhagic stroke (−0.230), followed by ischemic stroke (−0.165), peripheral vascular disease (−0.117), lower extremity amputation (−0.093), chronic kidney disease (CKD) G5 without renal replacement therapy (RRT) (−0.079), congestive heart failure (−0.061) and CKD G3–G4 without RRT (−0.042)
Residual impacts on HRQoL persisted for 2 years after occurrence of CHF or ischemic stroke, and 1 year after hemorrhagic stroke or CKD G3–G4 without RRT
HRQoL estimates considering residual impacts of diabetes complications would improve accuracy of evaluation of cost‐effectiveness of novel diabetes interventions at an individual level in an Asian setting
To ascertain the risk of progression to diabetes among Chinese women with PCOS.
Women with PCOS (n = 3978) were identified from the Hong Kong Diabetes Surveillance Database based on the ICD-9 code ...for PCOS diagnosis and women without PCOS served as controls (n = 39780), matched 1:10 by age.
The mean follow-up was 6.28 ± 4.20 and 6.95 ± 4.33 years in women with PCOS and controls, respectively. The crude incidence rate of diabetes was 14.25/1000 person-years in women with PCOS compared with 3.45 in controls. The crude hazard ratio of diabetes in women with PCOS was 4.23 (95 % CI: 3.73–4.80, p < 0.001). Further stratified by age group, the risk of developing diabetes decreased with increasing age but it remained significantly higher in women with PCOS across all age groups. It also suggested that the incidence rate of diabetes in women with PCOS aged 20–29 is highly comparable to that in healthy women aged ≥ 40. More than half of the incident diabetes captured during the follow-up in women with PCOS cohort were young-onset diabetes.
Women diagnosed with PCOS at a younger age have the highest relative risk of developing diabetes, suggesting frequent glycemic status screening is required to detect diabetes at an early stage.
Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing DKD phenotype. We compared the risks of adverse outcomes among patients with this phenotype compared with other DKD phenotypes.
...Multicenter prospective cohort study.
19,025 Chinese adults with type 2 diabetes enrolled in the Hong Kong Diabetes Biobank.
DKD phenotypes defined by baseline estimated glomerular filtration rate (eGFR) and albuminuria: no DKD (no decreased eGFR or albuminuria), albuminuria without decreased eGFR, decreased eGFR without albuminuria, and albuminuria with decreased eGFR.
All-cause mortality, cardiovascular disease (CVD) events, hospitalization for heart failure (HF), and chronic kidney disease (CKD) progression (incident kidney failure or sustained eGFR reduction ≥40%).
Multivariable Cox proportional or cause-specific hazards models to estimate the relative risks of death, CVD, hospitalization for HF, and CKD progression. Multiple imputation was used for missing covariates.
Mean participant age was 61.1 years, 58.3% were male, and mean diabetes duration was 11.1 years. During 54,260 person-years of follow-up, 438 deaths, 1,076 CVD events, 298 hospitalizations for HF, and 1,161 episodes of CKD progression occurred. Compared with the no-DKD subgroup, the subgroup with decreased eGFR without albuminuria had higher risks of all-cause mortality (hazard ratio HR, 1.59 95% CI, 1.04-2.44), hospitalization for HF (HR, 3.08 95% CI, 1.82-5.21), and CKD progression (HR, 2.37 95% CI, 1.63-3.43), but the risk of CVD was not significantly greater (HR, 1.14 95% CI, 0.88-1.48). The risks of death, CVD, hospitalization for HF, and CKD progression were higher in the setting of albuminuria with or without decreased eGFR. A sensitivity analysis that excluded participants with baseline eGFR <30 mL/min/1.73 m2 yielded similar findings.
Potential misclassification because of drug use.
Nonalbuminuric DKD was associated with higher risks of hospitalization for HF and of CKD progression than no DKD, regardless of baseline eGFR.
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Diabetes among working population brings to society concerns on productivity and social welfare cost, in addition to healthcare burden. While lower socio‐economic status has been recognised as a risk ...factor of diabetes; occupation, compared with other socio‐economic status indicators (e.g., education and income), has received less attention. There is some evidence from studies conducted in Europe that occupation is associated with diabetes risk, but less is known in Asia, which has different organisational cultures and management styles from the West. This study examines the association between occupation and diabetes risk in a developed Asian setting, which is experiencing an increasing number of young onset of diabetes and aging working population at the same time. This is a cross‐sectional study of working population aged up to 65 with data from a population‐based survey collecting demographic, socio‐economic, behavioural and metabolic data from Hong Kong residents, through both self‐administered questionnaires and clinical health examinations (1,429 participants). Non‐skilled occupation was found to be an independent risk factor for diabetes, with an odds ratio (OR) of 3.38 (p < 0.001) and adjusted OR of 2.59 (p = 0.022) after adjusting for demographic, behavioural and metabolic risk factors. Older age (adjusted OR = 1.08, p < 0.001), higher body mass index (adjusted OR = 1.23, p < 0.001) and having hypertriglyceridemia (adjusted OR = 1.93, p = 0.033) were also independently associated with diabetes. Non‐skilled workers were disproportionately affected by diabetes with the highest age‐standardized prevalence (6.3%) among all occupation groups (4.9%–5.0%). This study provides evidence that non‐skilled occupation is an independent diabetes risk factor in a developed Asian setting. Health education on improving lifestyle practices and diabetes screening should prioritise non‐skilled workers, in particular through company‐based and sector‐based diabetes screening programmes. Diabetes health service should respond to the special needs of non‐skilled workers, including service at non‐office hour and practical health advice in light of their work setting.
To address these knowledge gaps, we conducted a large register- and population-based cohort study to measure how age at diagnosis affects (1) glycemic exposure, (2) glycemic deterioration, and (3) ...responses to oral glucose-lowering drugs (OGLDs) during the first decade after diagnosis among adults with T2D. The Hong Kong Hospital Authority (HA) provides universal public healthcare modeled after the British National Health Service. Because of the high out-of-pocket cost of private healthcare, 95% of people with diabetes in Hong Kong receive care in HA clinics 20. All participants undergo structured assessment (eyes, feet, blood, urine) by trained nurses every 2–3 years to collect data not routinely captured in the HA EHR, including diabetes type, age at diagnosis, family history, and lifestyle habits. According to HA regulations, these drugs are only indicated for diabetes 24.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In developed countries, diabetes is the leading cause of chronic kidney disease (CKD) and accounts for 50% of incidence of end stage kidney disease. Despite declining prevalence of micro- and ...macrovascular complications, there are rising trends in renal replacement therapy in diabetes. Optimal glycemic control may reduce risk of progression of CKD and related death. However, assessing glycemic control in patients with advanced CKD and on dialysis (G4-5) can be challenging. Laboratory biomarkers, such as glycated haemoglobin (HbA
), may be biased by abnormalities in blood haemoglobin, use of iron therapy and erythropoiesis-stimulating agents and chronic inflammation due to uraemia. Similarly, glycated albumin and fructosamine may be biased by abnormal protein turnover. Patients with advanced CKD exhibited heterogeneity in glycemic control ranging from severe insulin resistance to 'burnt-out' beta-cell function. They also had high risk of hypoglycaemia due to reduced renal gluconeogenesis, frequent use of insulin and dysregulation of counterregulatory hormones. Continuous glucose monitoring (CGM) systems measure glucose in interstitial fluid every few minutes and provide an alternative and more reliable method of glycemic assessment, including asymptomatic hypoglycaemia and hyperglycaemic excursions. Recent international guidelines recommended use of CGM-derived Glucose Management Index (GMI) in patients with advanced CKD although data are scarce in this population. Using CGM, patients with CKD were found to experience marked glycemic fluctuations with hypoglycemia due to loss of glucose and insulin during haemodialysis (HD) followed by hyperglycemia in the post-HD period. On the other hand, during peritoneal dialysis, patients may experience glycemic excursions with influx of glucose from dialysate solutions. These undesirable glucose exposure and variability may accelerate decline of residual renal function. Although CGM may improve the quality of glycemic monitoring and control in populations with CKD, further studies are needed to confirm the accuracy, optimal mode and frequency of CGM as well as their cost-effectiveness and user-acceptability in patients with advanced CKD and dialysis.
Exploring the intricate crosstalk between dietary prebiotics and the specific intestinal microbiome (SIM) is intriguing in explaining the mechanisms of current successful dietary interventions, ...including the Mediterranean diet and high-fiber diet. This knowledge forms a robust basis for developing a new natural food therapy. The SIM diet can be measured and evaluated to establish a reliable basis for the management of metabolic diseases, such as diabetes, metabolic (dysfunction)-associated fatty liver disease (MAFLD), obesity, and metabolic cardiovascular disease. This review aims to delve into the existing body of research to shed light on the promising developments of possible dietary prebiotics in this field and explore the implications for clinical practice. The exciting part is the crosstalk of diet, microbiota, and gut–organ interactions facilitated by producing short-chain fatty acids, bile acids, and subsequent metabolite production. These metabolic-related microorganisms include Butyricicoccus, Akkermansia, and Phascolarctobacterium. The SIM diet, rather than supplementation, holds the promise of significant health consequences via the prolonged reaction with the gut microbiome. Most importantly, the literature consistently reports no adverse effects, providing a strong foundation for the safety of this dietary therapy.
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