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BMJ Open Quality Jun 2024Pre-diabetes affects one-third of US adults and increases the risk of type 2 diabetes. Effective evidence-based interventions, such as the Diabetes Prevention Program,...
BACKGROUND
Pre-diabetes affects one-third of US adults and increases the risk of type 2 diabetes. Effective evidence-based interventions, such as the Diabetes Prevention Program, are available, but a gap remains in effectively translating and increasing uptake of these interventions into routine care.
METHODS
We applied the Translating Research into Practice (TRiP) framework to guide three phases of intervention design and development for diabetes prevention: (1) summarise the evidence, (2) identify local barriers to implementation and (3) measure performance. In phase 1, we conducted a retrospective cohort analysis of linked electronic health record claims data to evaluate current practices in the management of pre-diabetes. In phase 2, we conducted in-depth interviews of 16 primary care physicians, 7 payor leaders and 31 patients to elicit common barriers and facilitators for diabetes prevention. In phase 3, using findings from phases 1 and 2, we developed the core elements of the intervention and performance measures to evaluate intervention uptake.
RESULTS
In phase 1 (retrospective cohort analysis), we found few patients with pre-diabetes received diabetes prevention interventions. In phase 2 (stakeholder engagement), we identified common barriers to include a lack of knowledge about pre-diabetes among patients and about the Diabetes Prevention Program among clinicians. In phase 3 (intervention development), we developed the START Diabetes Prevention Clinical Pathway as a systematic change package to address barriers and facilitators identified in phases 1 and 2, performance measures and a toolkit of resources to support the intervention components.
CONCLUSIONS
The TRiP framework supported the identification of evidence-based care practices for pre-diabetes and the development of a well-fitted, actionable intervention and implementation plan designed to increase treatment uptake for pre-diabetes in primary care settings. Our change package can be adapted and used by other health systems or clinics to target prevention of diabetes or other related chronic conditions.
Topics: Humans; Primary Health Care; Diabetes Mellitus, Type 2; Male; Female; Retrospective Studies; Middle Aged; Translational Research, Biomedical; Adult; Prediabetic State; Qualitative Research; Aged
PubMed: 38839396
DOI: 10.1136/bmjoq-2024-002752 -
Current Opinion in Clinical Nutrition... Jul 2024This review will summarize recent studies assessing the effect of slowly digestible starch (SDS) and resistant starch (RS) on glucose metabolism in healthy, prediabetic... (Review)
Review
PURPOSE OF REVIEW
This review will summarize recent studies assessing the effect of slowly digestible starch (SDS) and resistant starch (RS) on glucose metabolism in healthy, prediabetic or type 2 diabetic adults.
RECENT FINDINGS
Currently, a particular interest in starch and its digestibility has arisen, with data showing a positive effect of SDS and RS on the glucose homeostasis of healthy, at-risk, prediabetic and type 2 diabetic patients but research is ongoing.
SUMMARY
Carbohydrates (CHO) and especially starch play a major role in the prevention and management of metabolic diseases such as type 2 diabetes (T2D). This largely depends on the quality and the digestibility (rate and extent) of the ingested starchy products, beyond their quantity. SDS have been poorly studied but display a beneficial effect on reducing glucose excursions in healthy and insulin-resistant subjects and a relevant potential to improve glucose control in type 2 diabetic individuals. As for RS, the results appear to be encouraging but remain heterogeneous, depending the nature of the RS and its role on microbiota modulation. Further studies are needed to confirm the present results and investigate the potential complementary beneficial effects of SDS and RS on long-term glucose homeostasis to prevent cardiometabolic diseases.
Topics: Humans; Insulin Resistance; Diabetes Mellitus, Type 2; Starch; Homeostasis; Digestion; Blood Glucose; Prediabetic State; Resistant Starch; Dietary Carbohydrates
PubMed: 38836807
DOI: 10.1097/MCO.0000000000001044 -
BMC Endocrine Disorders Jun 2024Type 2 diabetes (T2D) has become an epidemic. Delays in diagnosis and as a consequent late treatment has resulted in high prevalence of complications and mortality....
BACKGROUND
Type 2 diabetes (T2D) has become an epidemic. Delays in diagnosis and as a consequent late treatment has resulted in high prevalence of complications and mortality. Secreted frizzled-related protein 4 (SFRP4), has been recently identified as a potential early biomarker of T2D related to obesity, due to its association with low grade inflammation in adipose tissue and impaired glucose metabolism. We aimed to evaluate the role of SFRP4 in prediabetes and T2D in a Mexican population.
METHODS
This was a cross-sectional study that included 80 subjects with T2D, 50 subjects with prediabetes and 50 healthy individuals. Fasting SFRP4 and insulin concentrations were measured by ELISA. Human serum IL-10, IL-6, IL-1β and IL-8 levels were quantified by flow cytometry. Genotyping was performed by TaqMan® probes.
RESULTS
Prediabetes and T2D patients had significantly higher SFRP4 levels than controls (P < 0.05). In turn, prediabetes subjects had higher SFRP4 concentrations than control subjects (P < 0.05). Additionally, the prediabetes and T2D groups had higher concentrations of proinflammatory molecules such as IL-6, IL-1β and IL-8, and lower concentrations of IL-10, an anti-inflammatory cytokine, than controls (P < 0.001). The serum SFRP4 concentrations were positively correlated with parameters that are elevated in prediabetes and T2D states, such as, HbA1c and homeostasis model assessment insulin resistance (HOMA-IR), (r = 0.168 and 0.248, respectively, P < 0.05). Also, serum SFRP4 concentrations were positively correlated with concentrations of pro-inflammatory molecules (CRP, IL-6, IL-1β and IL-8) and negatively correlated with the anti-inflammatory molecule IL-10, even after adjusting for body mass index and age (P < 0.001). The genetic variant rs4720265 was correlated with low HDL concentrations in T2D (P < 0.05).
CONCLUSIONS
SFRP4 correlates positively with the stage of prediabetes, suggesting that it may be an early biomarker to predict the risk of developing diabetes in people with high serum concentrations of SFRP4, although further longitudinal studies are required.
Topics: Humans; Prediabetic State; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Male; Female; Middle Aged; Biomarkers; Case-Control Studies; Adult; Prognosis; Proto-Oncogene Proteins
PubMed: 38834984
DOI: 10.1186/s12902-024-01613-5 -
BMJ Open Diabetes Research & Care Jun 2024To assess the prevalence of diabetic retinopathy (DR) in persons with newly diagnosed type 2 diabetes (T2D) to understand the potential need for intensified screening... (Observational Study)
Observational Study
Prevalence and risk factors for diabetic retinopathy at diagnosis of type 2 diabetes: an observational study of 77 681 patients from the Swedish National Diabetes Registry.
INTRODUCTION
To assess the prevalence of diabetic retinopathy (DR) in persons with newly diagnosed type 2 diabetes (T2D) to understand the potential need for intensified screening for early detection of T2D.
RESEARCH DESIGN AND METHODS
Individuals from the Swedish National Diabetes Registry with a retinal photo <2 years after diagnosis of T2D were included. The proportion of patients with retinopathy (simplex or worse) was assessed. Patient characteristics and risk factors at diagnosis were analyzed in relation to DR with logistic regression.
RESULTS
In total, 77 681 individuals with newly diagnosed T2D, mean age 62.6 years, 41.1% females were included. Of these, 13 329 (17.2%) had DR.DR was more common in older persons (adjusted OR 1.03 per 10-year increase, 95% CI 1.01 to 1.05) and men compared with women, OR 1.10 (1.05 to 1.14). Other variables associated with DR were OR (95% CI): lower education 1.08 (1.02 to 1.14); previous stroke 1.18 (1.07 to 1.30); chronic kidney disease 1.29 (1.07 to 1.56); treatment with acetylsalicylic acid 1.14 (1.07 to 1.21); ACE inhibitors 1.12 (1.05 to 1.19); and alpha blockers 1.41 (1.15 to 1.73). DR was more common in individuals born in Asia (OR 1.16, 95% CI 1.08 to 1.25) and European countries other than those born in Sweden (OR 1.11, 95% CI 1.05 to 1.18).
CONCLUSIONS
Intensified focus on screening of T2D may be needed in Sweden in clinical practice since nearly one-fifth of persons have retinopathy at diagnosis of T2D. The prevalence of DR was higher in men, birthplace outside of Sweden, and those with a history of stroke, kidney disease, and hypertension.
Topics: Humans; Female; Male; Diabetic Retinopathy; Diabetes Mellitus, Type 2; Sweden; Middle Aged; Prevalence; Risk Factors; Registries; Aged; Follow-Up Studies; Prognosis
PubMed: 38834333
DOI: 10.1136/bmjdrc-2023-003976 -
Expert Review of Endocrinology &... Jun 2024Determining the relationship between cardiovascular risks, carbohydrate metabolism disorders, and renal dysfunction can help in creating new tools for their management...
Functional state of the kidneys in patients with acute coronary syndrome against the background of newly identified disorders of carbohydrate metabolism: a multidisciplinary problem.
BACKGROUND
Determining the relationship between cardiovascular risks, carbohydrate metabolism disorders, and renal dysfunction can help in creating new tools for their management and for better interaction of specialists in a multidisciplinary team. The purpose of this study was to determine the functional state of the kidneys and carbohydrate metabolism in patients with acute coronary syndrome without a history of such disorders.
METHODS
200 patients of the cardiology department of the City Clinical Hospital No. 7 in Almaty were examined using laboratory diagnostics and subsequent statistical data processing.
RESULTS
Acute coronary syndrome develops in 63% of cases against the background of previous disorders of carbohydrate metabolism - prediabetes (45.5%) and type 2 diabetes mellitus (17.5%). In this group of patients, in the presence of disorders of carbohydrate metabolism, in all cases, it is accompanied by acute renal damage. It was noted that diabetes mellitus in newly diagnosed patients actually had a certain duration and occurred much earlier than cardiovascular complications - this was evidenced by an increased level of glycated hemoglobin.
CONCLUSIONS
Such results indicate the need for early diagnosis of cardio-reno-metabolic syndrome in patients with cardiovascular complications, as well as timely administration of drugs that simultaneously have antidiabetic, cardio- and nephroprotective effects.
PubMed: 38831703
DOI: 10.1080/17446651.2024.2363543 -
Medical Science Monitor : International... Jun 2024BACKGROUND Diabetes-related foot disease (DFD) is a serious complication of diabetes, increasing the risk of amputation. Coimplications are preventable, but most...
BACKGROUND Diabetes-related foot disease (DFD) is a serious complication of diabetes, increasing the risk of amputation. Coimplications are preventable, but most diabetics do not receive proper screening and treatment, despite indications. This study was a pilot screening of diabetes-related foot disease in a group of people with glycemic disorders. MATERIAL AND METHODS We recruited 143 volunteers over 40 years of age. In the final analysis, we included 85 people diagnosed with glycemic disorders (diabetes or prediabetes), for whom we performed a total of 170 foot measurements. We screened for peripheral artery disease using: foot pulse, ankle-brachial index (manual and automatic), toe-brachial index, and transcutaneous oxygen pressure (TcPO2). To screen for diabetic peripheral neuropathy, we used indicators of loss of protective sensation: pressure perception and temperature perception, and plantar pressure distribution. RESULTS A history of diabetes was reported by 26 (30.6%) of the subjects. Disorders of at least 1 foot occurred in 20 (66.7%) subjects with diagnosed diabetes and in 10 (17%) subjects declaring no diabetes. Higher risk and DFD category were correlated with duration of diabetes (r=0.68, p=0.007), glycemic levels (r=0.56, p=0.001), age (r=0.57, p=0.007), and the presence of other diabetes complications. The best predictor of risk in DFD was manual ABI, p=0.001; followed by automatic ABI, p=0.006. CONCLUSIONS Our results showed that peripheral complications of diabetes, such as DFD, often remain undiagnosed and untreated despite the high risk of developing ulcers. There is a need for multi-center screening studies.
Topics: Humans; Pilot Projects; Diabetic Foot; Male; Female; Middle Aged; Aged; Adult; Ankle Brachial Index; Risk Factors; Diabetes Mellitus, Type 2; Peripheral Arterial Disease; Prediabetic State; Diabetic Neuropathies; Foot
PubMed: 38829832
DOI: 10.12659/MSM.944239 -
Pakistan Journal of Medical Sciences 2024This study aimed to investigate whether there is a difference in lipid levels between prediabetic individuals with one-hour post-Oral Glucose Tolerance Test (OGTT)...
OBJECTIVE
This study aimed to investigate whether there is a difference in lipid levels between prediabetic individuals with one-hour post-Oral Glucose Tolerance Test (OGTT) plasma glucose (PG) values > 155 mg/dl and those with one-hour PG values ≤ 155 mg/dl.
METHODS
This retrospective cross sectional study was initiated on August 2020 and concluded on June 2021, and conducted with 229 prediabetic patients who presented to the Diabetes Clinic of the Research Hospital. A correlation analysis was performed to investigate the relationship between OGTT values and serum lipid levels. Additionally, the patients were divided into two groups based on the one-hour post-OGTT PG value of 155 mg/dl, and the presence of any difference in serum lipid levels between the two groups was examined using the Mann-Whitney U test. The SPSS 20 software was used for statistical analysis, and a statistical significance level of P < 0.05 was considered.
RESULTS
Out of the 229 prediabetic patients included in the study, 172 were female. The number of patients with one-hour post-OGTT PG ≤ 155 mg/dl was 86, while those with values > 155 mg/dl were 143. A statistically significant difference was found between the group with one-hour post-OGTT PG > 155 mg/dl and the group with ≤ 155 mg/dl in terms of high-density lipoprotein (HDL-C) and triglyceride (TG) levels. There was a statistically significant negative correlation between one-hour PG and HDL-C.
CONCLUSION
The evaluation of HDL-C and TG levels is important in prediabetic patients with a one-hour OGTT PG level greater than 155 mg/dL.
PubMed: 38827857
DOI: 10.12669/pjms.40.5.8292 -
The Lancet. Healthy Longevity Jun 2024
Topics: Humans; Sarcopenia; Prediabetic State; Vitamin D; Adult
PubMed: 38824955
DOI: 10.1016/S2666-7568(24)00090-4 -
The Lancet. Healthy Longevity Jun 2024
Topics: Humans; Sarcopenia; Vitamin D; Prediabetic State; Adult
PubMed: 38824954
DOI: 10.1016/S2666-7568(24)00091-6 -
Journal of Public Health Dentistry May 2024The aim of this study was to assess the knowledge of state dental directors regarding their state's professional practice act, specifically scope of practice laws...
OBJECTIVES
The aim of this study was to assess the knowledge of state dental directors regarding their state's professional practice act, specifically scope of practice laws regarding point-of-care chairside screening for diabetes.
METHODS
A cross-sectional study design was used to examine the 50 state dental directors' knowledge of policy around point-of-care diabetes testing in their state. A five-item survey instrument was designed in a web-based platform and electronically distributed in 2022.
RESULTS
Thirty-seven states (74%) responded to the survey. Regarding whether it was within the scope of practice for dentists to provide chairside point-of-care HbA1c screening, 17 states (46.0%) responded "yes," 5 states (13.5%) responded "no," and 15 states (40.5%) responded "don't know." Of the 17 states who provide diabetes testing, four states (23.5%) reported that dentists were reimbursed, nine states (53.0%) reported they were not reimbursed, and four states (23.5%) reported they did not know regarding reimbursement.
CONCLUSIONS
There is significant state heterogeneity with regard to laws, regulations, and reimbursement for chairside diabetes testing in the United States. This is accompanied by vagueness and lack of specificity in the state education laws. For more widespread promotion and adoption of this evidence-based screening, the entire dental community including clinicians, educators, policymakers, payers, and professional organizations at all levels are encouraged to work together to advocate for clarification and specificity in the language of state education laws as well as reimbursement for this vital service.
PubMed: 38818943
DOI: 10.1111/jphd.12631