Disorders in glucose metabolism can be divided into three separate but interrelated domains,namely hyperglycemia,hypoglycemia,and glycemic variability.Intensive glycemic control in patients with diabetes might increas...Disorders in glucose metabolism can be divided into three separate but interrelated domains,namely hyperglycemia,hypoglycemia,and glycemic variability.Intensive glycemic control in patients with diabetes might increase the risk of hypoglycemic incidents and glucose fluctuations.These three dysglycemic states occur not only amongst patients with diabetes,but are frequently present in other clinical settings,such as during critically ill.A growing body of evidence has focused on the relationships between these dysglycemic domains with cardiac arrhythmias,including supraventricular arrhythmias(primarily atrial fibrillation),ventricular arrhythmias(malignant ventricular arrhythmias and QT interval prolongation),and bradyarrhythmias(bradycardia and heart block).Different mechanisms by which these dysglycemic states might provoke cardiac arrhythmias have been identified in experimental studies.A customized glycemic control strategy to minimize the risk of hyperglycemia,hypoglycemia and glucose variability is of the utmost importance in order to mitigate the risk of cardiac arrhythmias.展开更多
BACKGROUND The prevalence of older individuals with type 2 diabetes mellitus (T2DM) is increasing due to the aging population and improved medical care. These patients are very susceptible to disease and treatment-rel...BACKGROUND The prevalence of older individuals with type 2 diabetes mellitus (T2DM) is increasing due to the aging population and improved medical care. These patients are very susceptible to disease and treatment-related hospitalizations, resulting in higher health care costs, morbidity, and decreased quality of life. However, data of treatment-related complications, especially dysglycemiarelated hospitalizations, are lacking. AIM To assess the prevalence and associated factors for dysglycemia-related hospitalizations among elderly diabetic patients in Thailand using nationwide patient sample. METHODS T2DM patients aged ≥ 65 years who received medical care at public hospitals in Thailand in the year 2014 were included. The prevalence of hospitalization due to dysglycemia within one year was examined. Multivariable logistic regression was performed to assess the independent factors associated with hospitalization due to hypoglycemia and hyperglycemia RESULTS A total of 11404 elderly T2DM patients were enrolled in this study. The mean age was 72.9 ± 5.5 years. The prevalence of hospital admissions due to diabetic ketoacidosis, hyperosmolar hyperglycemic state, hyperglycemic dehydration syndrome, and hypoglycemia among elderly T2DM patients in the year 2014 was 0.1%, 0.1%, 1.7% and 3.1%, respectively. Increased hospitalization due to hypoglycemia was associated with older age, female sex, had hypertension, dementia, lower body mass index, elevated hemoglobin A1C (HbA1C), decreased kidney function, insulin use. Increased hospitalization due to hyperglycemia was associated with dementia, depression, lower body mass index, elevated HbA1C, and insulin use. CONCLUSION The prevalence of dysglycemia-related hospitalization in elderly T2DM patients in Thailand was 4.9%. Close monitoring of blood glucose should be provided in high-risk patients for prevention and early detection for these complications.展开更多
Bone is an endocrine organ involved in modulating glucose homeostasis. The role of the bone formation marker osteocalcin （OCN） in predicting diabetes was reported, but with conflicting results. No study has explored...Bone is an endocrine organ involved in modulating glucose homeostasis. The role of the bone formation marker osteocalcin （OCN） in predicting diabetes was reported, but with conflicting results. No study has explored the association between baseline bone resorption activity and incident diabetes or prediabetes during follow-up. Our objective was to examine the relationship between the baseline bone resorption marker crosslinked C-telopeptide of type I collagen （CTX） and glycemic dysregulation after 4 years. This longitudinal study was conducted in a university teaching hospital. A total of 195 normal glucose tolerant （NGT） women at baseline were invited for follow-up. The incidence of diabetes and prediabetes （collectively defined as dysglycemia） was recorded. A total of 128 individuals completed the 4-year study. The overall conversion rate from NGT to dysglycemia was 31.3%. The incidence of dysglycemia was lowest in the middle tertile [16.3% （95% confidence interval （CI）, 6.8%-30.70/0）] compared with the lower [31.0% （95% CI, 17.2%-46.1%）] and upper [46.5% （95% CI, 31.2%-62.6%）] tertiles of CTX, with a significant difference seen between the middle and upper tertiles （P = 0.002 5）. After adjusting for multiple confounding variables, the upper tertile of baseline CTX was associated with an increased risk of incident dysglycemia, with an odds ratio of 7.09 （95% CI, 1.73-28.99） when the middle tertile was the reference. Osteoclasts actively regulate glucose homeostasis in a biphasic model that moderately enhanced bone resorption marker CTX at baseline provides protective effects against the deterioration of glucose metabolism, whereas an overactive osteoclastic function contributes to an increased risk of subsequent dysglycemia.展开更多
People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.
Objective To our knowledge, no definitive conclusion has been reached regarding the relationship between glucocorticoids and hypertension. Here, we aimed to explore the characteristics of glucocorticoids in participan...Objective To our knowledge, no definitive conclusion has been reached regarding the relationship between glucocorticoids and hypertension. Here, we aimed to explore the characteristics of glucocorticoids in participants with dysglycemia and hypertension, and to analyze their association with blood pressure indicators.Methods The participants of this study were from the Henan Rural Cohort study. A total of 1,688 patients 18–79 years of age were included in the matched case control study after application of the inclusion and exclusion criteria. Statistical methods were used to analyze the association between glucocorticoids and various indices of blood pressure, through approaches such as logistic regression analysis, trend tests, linear regression, and restricted cubic regression.Results The study population consisted of 552 patients with dysglycemia and hypertension(32.7%).The patients with co-morbidities had higher levels of serum cortisol(P = 0.009) and deoxycortisol(P <0.001). The adjusted odds ratios(and 95% confidence intervals) for dysglycemia with hypertension were1.55(1.18, 2.04) for the highest tertile of Ln-cortisol compared with the lowest tertile. Additionally, the highest Ln-deoxycortisol levels were associated with increased prevalence of dysglycemia with hypertension by 159%(95% confidence interval: 122%, 207%).Conclusions Serum deoxycortisol was positively correlated with systolic blood pressure, pulse pressure, mean arterial pressure, mean blood pressure, and mean proportional arterial pressure.Glucocorticoids(deoxycortisol and cortisol) increase the risk of hypertension in people with dysglycemia, particularly in those with T2 DM.展开更多
Atrial fibrillation(AF)and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role.The resultant vicious cycle which sets in culminates in a higher ather...Atrial fibrillation(AF)and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role.The resultant vicious cycle which sets in culminates in a higher atherogenicity and thermogenicity of the vascular system resulting in increased major adverse cardiac or cerebrovascular event(MACCE)events.However,the same has not convincingly been verified in real-world settings.In the recent retrospective study by Desai et al amongst AF patients being admitted to hospitals following MACCE,prediabetes emerged as an independent risk factor for MACCE after adjusting for all confounding variables.However,certain questions like the role of metformin,quantifying the risk for MACCE amongst prediabetes compared to diabetes,the positive impact of reversion to normoglycemia remain unanswered.We provide our insights and give future directions for dedicated research in this area to clarify the exact relationship between the two.展开更多
Background/Purpose: Hispanic/Latinos in the US are at increased risk for type 2 diabetes (T2D). Data suggest that avocado intake is associated with better glycemic control, but whether this translates to protection fr...Background/Purpose: Hispanic/Latinos in the US are at increased risk for type 2 diabetes (T2D). Data suggest that avocado intake is associated with better glycemic control, but whether this translates to protection from T2D has not been studied. The goal of the current analyses was to examine whether consuming avocados at baseline is associated with lower incident T2D over a six-year period, compared to not consuming avocados at baseline. Subjects/Methods: Using data from a large population of US adults with Hispanic ancestry, without known or unknown T2D at baseline (N = 6159), participants were classified as avocado consumers (N = 983) or non-consumers (N = 5176) based on the mean of two 24-hour dietary recalls. Cox proportional hazard models estimated the association of avocado consumption with incident T2D (N = 656 cases) over a six-year follow-up period, in the population as a whole, and separately in those with normoglycemia vs. prediabetes at baseline. A set of three sequential models were run: the first controlling only for sociodemographic factors (“minimally adjusted” models), the second for these and health behaviors (“fully adjusted” models), and a third for both sets of covariates and also body mass index (BMI;“fully adjusted + BMI” models). Results: In the population as a whole, avocado intake at baseline was associated with reduced incident T2D in both the minimally adjusted (hazard ratio [HR] (±95% confidence intervals [CIs]): 0.70 (0.52 - 0.94), P = 0.04) and the fully adjusted models (HR: 0.72 (0.54 - 0.97), P = 0.03). This association was observed in both those with prediabetes and with normoglycemia at baseline, but only reached significance in those with prediabetes (minimally adjusted model: HR: 0.68 (0.48 - 0.97), P = 0.03;fully adjusted model: HR: 0.69 (0.48 - 0.98), P = 0.04), not in those with normoglycemia (minimally adjusted model: HR: 0.86 (0.45 - 1.65), P = 0.65;fully adjusted model: HR: 0.80 (0.41 - 1.55), P = 0.50). In models which additionally controlled for BMI (“fully adjusted + BMI model”), the associations were slightly attenuated (overall population: HR: 0.79 (0.59 - 1.06), P = 0.60;normoglycemia: HR: 0.83 (0.42 - 1.64), P = 0.60;prediabetes: HR = 0.75 (0.54 - 1.05), P = 0.09). Conclusions: In our longitudinal analyses, adults with Hispanic/Latino ancestry who consumed avocado were less likely to develop T2D than those who did not consume avocado at baseline, especially if they had prediabetes at baseline.展开更多
Diabetes mellitus is a common chronic disease.With the improvement of living standards,the prevalence of diabetes mellitus in China is increasing.There are now more people with diabetes in China(>100 million)than i...Diabetes mellitus is a common chronic disease.With the improvement of living standards,the prevalence of diabetes mellitus in China is increasing.There are now more people with diabetes in China(>100 million)than in any other country.About half of these people with diabetes need to undergo at least one procedure in their lifetime.Diabetic patients have a much higher probability of perioperative dysglycemia than the normal population,which has a great impact on their prognosis.In addition,non-diabetic patients may also have abnormal blood glucose levels due to various reasons during the perioperative period,which will also lead to a series of adverse consequences.This ar ticle reviews the perioperative blood glucose management of patients to provide a reference for improving their health status.展开更多
Polycystic ovary syndrome(PCOS)often coexists with a wide spectrum of dysglycemic conditions,ranging from impaired glucose tolerance to type 2 diabetes mellitus(T2D),which occur to a greater extent compared to healthy...Polycystic ovary syndrome(PCOS)often coexists with a wide spectrum of dysglycemic conditions,ranging from impaired glucose tolerance to type 2 diabetes mellitus(T2D),which occur to a greater extent compared to healthy body mass index-matched women.This concurrence of disorders is mainly attributed to common pathogenetic pathways linking the two entities,such as insulin resistance.However,due to methodological flaws in the available studies and the multifaceted nature of the syndrome,there has been substantial controversy as to the exact association between T2D and PCOS which has not yet been elucidated.The aim of this review is to present the best available evidence regarding the epidemiology of dysglycemia in PCOS,the unique pathophysiological mechanisms underlying the progression of dysglycemia,the most appropriate methods for assessing glycemic status and the risk factors for T2D development in this population,as well as T2D risk after transition to menopause.Proposals for application of a holistic approach to enable optimal management of T2D risk in PCOS are also provided.Specifically,adoption of a healthy lifestyle with adherence to improved dietary patterns,such the Mediterranean diet,avoidance of consumption of endocrine-disrupting foods and beverages,regular exercise,and the effect of certain medications,such as metformin and glucagon-like peptide 1 receptor agonists,are discussed.Furthermore,the maintenance of a healthy weight is highlighted as a key factor in achievement of a significant reduction of T2D risk in women with PCOS.展开更多
基金the National Natural Science Foundation of China,No.81970270,No.81570298,and No.81270245Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-029A.
文摘Disorders in glucose metabolism can be divided into three separate but interrelated domains,namely hyperglycemia,hypoglycemia,and glycemic variability.Intensive glycemic control in patients with diabetes might increase the risk of hypoglycemic incidents and glucose fluctuations.These three dysglycemic states occur not only amongst patients with diabetes,but are frequently present in other clinical settings,such as during critically ill.A growing body of evidence has focused on the relationships between these dysglycemic domains with cardiac arrhythmias,including supraventricular arrhythmias(primarily atrial fibrillation),ventricular arrhythmias(malignant ventricular arrhythmias and QT interval prolongation),and bradyarrhythmias(bradycardia and heart block).Different mechanisms by which these dysglycemic states might provoke cardiac arrhythmias have been identified in experimental studies.A customized glycemic control strategy to minimize the risk of hyperglycemia,hypoglycemia and glucose variability is of the utmost importance in order to mitigate the risk of cardiac arrhythmias.
文摘BACKGROUND The prevalence of older individuals with type 2 diabetes mellitus (T2DM) is increasing due to the aging population and improved medical care. These patients are very susceptible to disease and treatment-related hospitalizations, resulting in higher health care costs, morbidity, and decreased quality of life. However, data of treatment-related complications, especially dysglycemiarelated hospitalizations, are lacking. AIM To assess the prevalence and associated factors for dysglycemia-related hospitalizations among elderly diabetic patients in Thailand using nationwide patient sample. METHODS T2DM patients aged ≥ 65 years who received medical care at public hospitals in Thailand in the year 2014 were included. The prevalence of hospitalization due to dysglycemia within one year was examined. Multivariable logistic regression was performed to assess the independent factors associated with hospitalization due to hypoglycemia and hyperglycemia RESULTS A total of 11404 elderly T2DM patients were enrolled in this study. The mean age was 72.9 ± 5.5 years. The prevalence of hospital admissions due to diabetic ketoacidosis, hyperosmolar hyperglycemic state, hyperglycemic dehydration syndrome, and hypoglycemia among elderly T2DM patients in the year 2014 was 0.1%, 0.1%, 1.7% and 3.1%, respectively. Increased hospitalization due to hypoglycemia was associated with older age, female sex, had hypertension, dementia, lower body mass index, elevated hemoglobin A1C (HbA1C), decreased kidney function, insulin use. Increased hospitalization due to hyperglycemia was associated with dementia, depression, lower body mass index, elevated HbA1C, and insulin use. CONCLUSION The prevalence of dysglycemia-related hospitalization in elderly T2DM patients in Thailand was 4.9%. Close monitoring of blood glucose should be provided in high-risk patients for prevention and early detection for these complications.
基金supported by projects from the National Natural Science Foundation of China(81370977,81570796 and 81370018)by the Shanghai Science and Technology Committee(14411960900)
文摘Bone is an endocrine organ involved in modulating glucose homeostasis. The role of the bone formation marker osteocalcin （OCN） in predicting diabetes was reported, but with conflicting results. No study has explored the association between baseline bone resorption activity and incident diabetes or prediabetes during follow-up. Our objective was to examine the relationship between the baseline bone resorption marker crosslinked C-telopeptide of type I collagen （CTX） and glycemic dysregulation after 4 years. This longitudinal study was conducted in a university teaching hospital. A total of 195 normal glucose tolerant （NGT） women at baseline were invited for follow-up. The incidence of diabetes and prediabetes （collectively defined as dysglycemia） was recorded. A total of 128 individuals completed the 4-year study. The overall conversion rate from NGT to dysglycemia was 31.3%. The incidence of dysglycemia was lowest in the middle tertile [16.3% （95% confidence interval （CI）, 6.8%-30.70/0）] compared with the lower [31.0% （95% CI, 17.2%-46.1%）] and upper [46.5% （95% CI, 31.2%-62.6%）] tertiles of CTX, with a significant difference seen between the middle and upper tertiles （P = 0.002 5）. After adjusting for multiple confounding variables, the upper tertile of baseline CTX was associated with an increased risk of incident dysglycemia, with an odds ratio of 7.09 （95% CI, 1.73-28.99） when the middle tertile was the reference. Osteoclasts actively regulate glucose homeostasis in a biphasic model that moderately enhanced bone resorption marker CTX at baseline provides protective effects against the deterioration of glucose metabolism, whereas an overactive osteoclastic function contributes to an increased risk of subsequent dysglycemia.
文摘People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.
基金supported by the National Key Research and Development Program Precision Medicine Initiative of China[grant number:2016YFC0900803]National Natural Science Foundation of China[grant number:81872626,82003454]+2 种基金Chinese Nutrition Society-Bright Moon Seaweed Group Nutrition and Health Research Fund[grant number:CNS-BMSG2020A63]Chinese Nutrition Society-Zhendong National Physical Fitness and Health Research Fund[grant number:CNS-ZD2019066]Key R&D and promotion projects in Henan Province[grant number:212102310219]。
文摘Objective To our knowledge, no definitive conclusion has been reached regarding the relationship between glucocorticoids and hypertension. Here, we aimed to explore the characteristics of glucocorticoids in participants with dysglycemia and hypertension, and to analyze their association with blood pressure indicators.Methods The participants of this study were from the Henan Rural Cohort study. A total of 1,688 patients 18–79 years of age were included in the matched case control study after application of the inclusion and exclusion criteria. Statistical methods were used to analyze the association between glucocorticoids and various indices of blood pressure, through approaches such as logistic regression analysis, trend tests, linear regression, and restricted cubic regression.Results The study population consisted of 552 patients with dysglycemia and hypertension(32.7%).The patients with co-morbidities had higher levels of serum cortisol(P = 0.009) and deoxycortisol(P <0.001). The adjusted odds ratios(and 95% confidence intervals) for dysglycemia with hypertension were1.55(1.18, 2.04) for the highest tertile of Ln-cortisol compared with the lowest tertile. Additionally, the highest Ln-deoxycortisol levels were associated with increased prevalence of dysglycemia with hypertension by 159%(95% confidence interval: 122%, 207%).Conclusions Serum deoxycortisol was positively correlated with systolic blood pressure, pulse pressure, mean arterial pressure, mean blood pressure, and mean proportional arterial pressure.Glucocorticoids(deoxycortisol and cortisol) increase the risk of hypertension in people with dysglycemia, particularly in those with T2 DM.
文摘Atrial fibrillation(AF)and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role.The resultant vicious cycle which sets in culminates in a higher atherogenicity and thermogenicity of the vascular system resulting in increased major adverse cardiac or cerebrovascular event(MACCE)events.However,the same has not convincingly been verified in real-world settings.In the recent retrospective study by Desai et al amongst AF patients being admitted to hospitals following MACCE,prediabetes emerged as an independent risk factor for MACCE after adjusting for all confounding variables.However,certain questions like the role of metformin,quantifying the risk for MACCE amongst prediabetes compared to diabetes,the positive impact of reversion to normoglycemia remain unanswered.We provide our insights and give future directions for dedicated research in this area to clarify the exact relationship between the two.
文摘Background/Purpose: Hispanic/Latinos in the US are at increased risk for type 2 diabetes (T2D). Data suggest that avocado intake is associated with better glycemic control, but whether this translates to protection from T2D has not been studied. The goal of the current analyses was to examine whether consuming avocados at baseline is associated with lower incident T2D over a six-year period, compared to not consuming avocados at baseline. Subjects/Methods: Using data from a large population of US adults with Hispanic ancestry, without known or unknown T2D at baseline (N = 6159), participants were classified as avocado consumers (N = 983) or non-consumers (N = 5176) based on the mean of two 24-hour dietary recalls. Cox proportional hazard models estimated the association of avocado consumption with incident T2D (N = 656 cases) over a six-year follow-up period, in the population as a whole, and separately in those with normoglycemia vs. prediabetes at baseline. A set of three sequential models were run: the first controlling only for sociodemographic factors (“minimally adjusted” models), the second for these and health behaviors (“fully adjusted” models), and a third for both sets of covariates and also body mass index (BMI;“fully adjusted + BMI” models). Results: In the population as a whole, avocado intake at baseline was associated with reduced incident T2D in both the minimally adjusted (hazard ratio [HR] (±95% confidence intervals [CIs]): 0.70 (0.52 - 0.94), P = 0.04) and the fully adjusted models (HR: 0.72 (0.54 - 0.97), P = 0.03). This association was observed in both those with prediabetes and with normoglycemia at baseline, but only reached significance in those with prediabetes (minimally adjusted model: HR: 0.68 (0.48 - 0.97), P = 0.03;fully adjusted model: HR: 0.69 (0.48 - 0.98), P = 0.04), not in those with normoglycemia (minimally adjusted model: HR: 0.86 (0.45 - 1.65), P = 0.65;fully adjusted model: HR: 0.80 (0.41 - 1.55), P = 0.50). In models which additionally controlled for BMI (“fully adjusted + BMI model”), the associations were slightly attenuated (overall population: HR: 0.79 (0.59 - 1.06), P = 0.60;normoglycemia: HR: 0.83 (0.42 - 1.64), P = 0.60;prediabetes: HR = 0.75 (0.54 - 1.05), P = 0.09). Conclusions: In our longitudinal analyses, adults with Hispanic/Latino ancestry who consumed avocado were less likely to develop T2D than those who did not consume avocado at baseline, especially if they had prediabetes at baseline.
基金supported by Emerging Industry Leading Talent Project of Shanxi Province (No.2020587)。
文摘Diabetes mellitus is a common chronic disease.With the improvement of living standards,the prevalence of diabetes mellitus in China is increasing.There are now more people with diabetes in China(>100 million)than in any other country.About half of these people with diabetes need to undergo at least one procedure in their lifetime.Diabetic patients have a much higher probability of perioperative dysglycemia than the normal population,which has a great impact on their prognosis.In addition,non-diabetic patients may also have abnormal blood glucose levels due to various reasons during the perioperative period,which will also lead to a series of adverse consequences.This ar ticle reviews the perioperative blood glucose management of patients to provide a reference for improving their health status.
文摘Polycystic ovary syndrome(PCOS)often coexists with a wide spectrum of dysglycemic conditions,ranging from impaired glucose tolerance to type 2 diabetes mellitus(T2D),which occur to a greater extent compared to healthy body mass index-matched women.This concurrence of disorders is mainly attributed to common pathogenetic pathways linking the two entities,such as insulin resistance.However,due to methodological flaws in the available studies and the multifaceted nature of the syndrome,there has been substantial controversy as to the exact association between T2D and PCOS which has not yet been elucidated.The aim of this review is to present the best available evidence regarding the epidemiology of dysglycemia in PCOS,the unique pathophysiological mechanisms underlying the progression of dysglycemia,the most appropriate methods for assessing glycemic status and the risk factors for T2D development in this population,as well as T2D risk after transition to menopause.Proposals for application of a holistic approach to enable optimal management of T2D risk in PCOS are also provided.Specifically,adoption of a healthy lifestyle with adherence to improved dietary patterns,such the Mediterranean diet,avoidance of consumption of endocrine-disrupting foods and beverages,regular exercise,and the effect of certain medications,such as metformin and glucagon-like peptide 1 receptor agonists,are discussed.Furthermore,the maintenance of a healthy weight is highlighted as a key factor in achievement of a significant reduction of T2D risk in women with PCOS.
