[Identification process of time-related bias in pharmacoepidemiologic research based on a scoping review].

Objective: To summarize the characteristics of pharmacoepidemiologic research involving diabetes patients, which were published in recent years, in terms of study design and analysis, and develop an identification process for time-related biases in pharmacoepidemiologic research. Methods: PubMed, Embase, CNKI and Wanfang were used for a systematical literature retrieval of relevant study papers published between January 1,2012 and September 26, 2022. Literature screening and data extraction were performed independently by two reviewers. Based on the mechanisms of different time-related biases and the characteristics of included study papers in terms of study design and analysis methods, an identification process for all types of time-related biases was developed. Results: A total of 281 study papers were included, of which 58 (20.64%) specifically mentioned certain time-related biases considered in the study. Based on the scoping review results, key points to identify time-related biases were summarized, involving data source, study design, control selection, comparator drugs, matching the duration of diabetes, identification of the washout period, identification of the induction/latency period, identification of the initiation of follow-up, identification of time window, statistical analysis methods, sensitivity analysis, and other design and analytical elements, in the identification process for time-related biases in pharmacoepidemiologic research. Conclusions: Time-related biases are common in pharmacoepidemiologic research and might significantly impact the study results. Based on scoping review results, this study further developed an identification process for time-related biases in pharmacoepidemiologic research, which will help researchers identify and avoid time-related biases and improve the reliability of related evidence in pharmacoepidemiologic research.

The glycemic gap as a prognostic indicator in cardiogenic shock: a retrospective cohort study.

BACKGROUND: Stress-induced hyperglycemia (SIH) is associated with poor outcomes in cardiogenic shock (CS), and there have been inconsistent results among patients with or without diabetes mellitus (DM). The glycemic gap (GG) is derived by subtracting A1c-derived average glucose from blood glucose levels; it is a superior indicator of SIH. We aimed to explore the role of GG in the outcomes of patients with CS. METHODS: Data on patients diagnosed with CS were extracted from the MIMIC-IV v2.0 database to investigate the relationship between GG and 30-day mortality (Number of absolute GG subjects = 359; Number of relative GG subjects = 357). CS patients from the Second Affiliated Hospital of Wenzhou Medical University were enrolled to explore the correlation between GG and lactic acid (Number of absolute GG subjects = 252; Number of relative GG subjects = 251). Multivariate analysis, propensity score-matched (PSM) analysis, inverse probability treatment weighting (IPTW), and Pearson correlation analysis were applied. RESULTS: Absolute GG was associated with 30-day all-cause mortality in CS patients (HRadjusted: 1.779 95% CI: 1.137-2.783; HRPSM: 1.954 95% CI: 1.186-3.220; HRIPTW: 1.634 95% CI: 1.213-2.202). The higher the absolute GG level, the higher the lactic acid level (ßadjusted: 1.448 95% CI: 0.474-2.423). A similar trend existed in relative GG (HRadjusted: 1.562 95% CI: 1.003-2.432; HRPSM: 1.790 95% CI: 1.127-2.845; HRIPTW: 1.740 95% CI: 1.287-2.352; ßadjusted:1.294 95% CI: 0.369-2.219). Subgroup analysis showed that the relationship existed irrespective of DM. The area under the curve of GG combined with the Glasgow Coma Scale (GCS) for 30-day all-cause mortality was higher than that of GCS (absolute GG: 0.689 vs. 0.637; relative GG: 0.688 vs. 0.633). GG was positively related to the triglyceride-glucose index. Kaplan-Meier curves revealed that groups of higher GG with DM had the worst outcomes. The outcomes differed among races and GG levels (all P < 0.05). CONCLUSIONS: Among patients with CS, absolute and relative GGs were associated with increased 30-day all-cause mortality, regardless of DM. The relationship was stable after multivariate Cox regression analysis, PSM, and IPTW analysis. Furthermore, they reflect the severity of CS to some extent. Hyperlactatemia and insulin resistance may underlie the relationship between stress-induced hyperglycemia and poor outcomes in CS patients. They both improve the predictive efficacy of the GCS.

[Prevalence and influencing factors of patients with comorbidity of hypertension, diabetes and dyslipidemia in residents aged 35-75 years in Tianjin].

Objective: To investigate the current comorbidity status among hypertension, diabetes, and dyslipidemia in residents aged 35-75 years in Tianjin and to explore the main influencing factors to provide a scientific basis for the prevention and treatment of chronic disease comorbidity. Methods: From June 2019 to November 2023, 10 districts (Hedong, Hexi, Dongli, Beichen, Nankai, Xiqing, Wuqing, Baodi, Jizhou, and Binhai New District) in Tianjin were selected as the project sites. The community and natural village was used as the primary sampling unit, and each project site selected the screening sites by cluster random sampling method. Residents aged 35-75 who lived in the screening sites for 6 months and above were surveyed by questionnaire, physical examination, and biochemical tests. The chi-square test, analysis of variance, and multivariate unconditional logistic regression analysis were used for statistical analysis. Age-standardized prevalence was based on the data of the sixth national census. Results: A total of 146 832 participants were included in this study, including 61 994 males (42.22%) and 84 838 females (57.78%), with an age of (56.83±8.84) years. The number of people with only one disease was 55 485 (37.79%), the number of people with two diseases was 36 942 (25.16%), and the number of people with three diseases was 9 683 (6.59%). The prevalence of hypertension combined with dyslipidemia was the highest (17.23%), and the standardized prevalence were 14.44%. The prevalence rates of three diseases and hypertension combined with diabetes was 6.59% and 4.98%, respectively, and the standardized prevalence was 5.42% and 4.11%, respectively. The prevalence of diabetes combined with dyslipidemia was 2.95%, and the standardized prevalence was 2.45%. Multivariate unconditional logistic regression analysis showed that advanced age (65- 75 years old: OR=2.69, 95%CI: 2.28-3.18), overweight/obesity (overweight: OR=2.21, 95%CI: 2.02-2.41; obesity: OR=4.50, 95%CI: 4.03-5.02), daily smoking (OR=1.96, 95%CI: 1.72-2.24), regular and heavy drinking (OR=1.63, 95%CI: 1.18-2.27), family history of hypertension/diabetes/hyperlipidemia (family history of hypertension: OR=81.17, 95%CI: 74.68-88.22; family history of diabetes: OR=15.26, 95%CI: 13.71-16.99; family history of hyperlipidemia: OR=7.13, 95%CI: 5.92-8.59), tea drinking (occasional tea drinking group: OR=1.74, 95%CI: 1.52-2.00; frequent tea drinking group: OR=2.23, 95%CI: 1.92-2.59) were risk factors for the comorbidity of hypertension, diabetes and dyslipidemia (all P<0.05), while higher education level was a protective factor (senior high school/technical secondary school: OR=0.79, 95%CI: 0.72-0.86; college/bachelor's degree and above: OR=0.60, 95%CI: 0.53-0.68, all P<0.001). Conclusions: The comorbidity rate of hypertension, diabetes, and dyslipidemia is high in residents aged 35-75 years in Tianjin. It is necessary to strengthen the co-management of blood pressure, blood glucose, and blood lipid in key populations with old age, overweight/obesity, junior high school education or below, daily smoking, daily drinking, occasional or frequent tea drinking, and family history of hypertension/diabetes/dyslipidemia, and promote a healthy lifestyle.

Does multifactorial inspiratory muscle training improve postural stability and quality of life of patients with diabetes in Pakistan? A randomised controlled trial.

OBJECTIVE: To determine the effects of multifactorial inspiratory muscle training (IMT) combined with Otago Exercise Programme (OEP) on balance and quality of life (QoL) in patients with diabetes. METHODS: Pretest-post-test randomised controlled trial. SETTING: Rehabilitation Department of Pakistan Railway General Hospital. PARTICIPANTS: 70 patients with diabetes were randomly assigned to experimental or placebo groups, out of which 59 patients completed the intervention. INTERVENTION: Patients in the experimental group performed OEP+IMT (at 50% of baseline maximum inspiratory pressure (MIP)) whereas the placebo group performed OEP+sham IMT (at 15% of MIP). Both groups exercised for 12 consecutive weeks. OUTCOME MEASURES: Outcome measures included nine variables: the Berg Balance Scale (BBS), the Biodex Postural Stability System (including postural stability test (Overall Stability Index, Anterior-Posterior Index and Mediolateral Index), fall risk test (FRT), Limits of Stability (LOS) test (time to complete test and direction control), Clinical Test of Sensory Interaction and Balance (CTSIB)) and the Audit of Diabetes Dependent Quality of Life questionnaire. RESULTS: Out of 59 patients who completed treatment, 37.1% were men and 62.9% were women with a mean age of 58.37±5.91 years. Results show significant interaction effects on BBS scores with the mean score improving from 41.87±2.61 to 49.16±2.50 in IMT versus sham IMT group with scores improving from 41.58±2.51 to 45.74±2.30. The IMT group significantly improved in dynamic balance tested through BBS (p=0.003), anticipatory balance through LOS test (p=0.003), reactive balance tested through FRT (p=0.04), direction control (p=0.03) and sensory integration through CTSIB test (p=0.04) when compared with the sham IMT group. While no significant changes (p>0.05) between groups were observed in QoL and static balance; significant changes (p<0.05) within group were observed in both groups in QoL and static balance. CONCLUSION: Additional research is necessary to understand the association between inspiratory muscle strength and balance, however, we demonstrated that a multifactorial IMT intervention should be used with patients with diabetes to improve balance, postural control and reduce fall risks. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT#04947163.

Lived experiences of diabetes self-management among persons with disabilities in rural Tamil Nadu - a case study approach.

BACKGROUND: People with disabilities have numerous challenges in diabetes self-management. Poor self-management leads to the worsening of disability and secondary complications of diabetes. This study was conducted to explore the challenges in diabetes self-management and the factors influencing diabetes self-management among people with disabilities. METHODS: We conducted 16 case studies among people with physical, neurological, visual, hearing, and multiple disabilities who were affected by diabetes. We adopted a thematic content analysis approach to analyse the data. RESULTS: People with disabilities have challenges in adopting healthy diets as they are unable to purchase and consume fruits and vegetables which are costly, unavailable, and inaccessible. They have difficulty in doing physical activity due to lack of inclusive public spaces which are inaccessible, lack of motivation, and dependence on others for their mobility. Irregular drug supply in the public health system and unaffordable cost of drugs hamper adherence to medications. Laboratories are inaccessible to people with disabilities thus preventing monitoring of blood sugars. They have poor quality of life, life with pain and mental health issues, which prevent adoption of self-management behaviors. The intersectionality of age and gender with disability worsens self-management behaviors. Inaccessible health system, poor quality of health care and insensitive health care providers further complicate self-management. CONCLUSION: This study documents the challenges faced by persons with disabilities in practicing diabetes self management. There is a need for public health policy and planning that is inclusive of persons with disabilities to make access to diabetes care universal.

N6-methyladenine RNA methylation epigenetic modification and diabetic microvascular complications.

N6-methyladensine (m6A) has been identified as the best-characterized and the most abundant mRNA modification in eukaryotes. It can be dynamically regulated, removed, and recognized by its specific cellular components (respectively called "writers," "erasers," "readers") and have become a hot research field in a variety of biological processes and diseases. Currently, the underlying molecular mechanisms of m6A epigenetic modification in diabetes mellitus (DM) and diabetic microvascular complications have not been extensively clarified. In this review, we focus on the effects and possible mechanisms of m6A as possible potential biomarkers and therapeutic targets in the treatment of DM and diabetic microvascular complications.

Risk factors for cardiometabolic health in Ghana: Cardiometabolic Risks Study Protocol-APTI Project.

Introduction: Cardiometabolic diseases are rapidly becoming primary causes of death in developing countries, including Ghana. However, risk factors for these diseases, including obesity phenotype, and availability of cost-effective diagnostic criteria are poorly documented in an African-ancestry populations in their native locations. The extent to which the environment, occupation, geography, stress, and sleep habits contribute to the development of Cardiometabolic disorders should be examined. Purpose: The overall goal of this study is to determine the prevalence of undiagnosed diabetes, prediabetes, and associated cardiovascular risks using a multi-sampled oral glucose tolerance test. The study will also investigate the phenotype and ocular characteristics of diabetes and prediabetes subgroups, as well as determine if lifestyle changes over a one-year period will impact the progression of diabetes and prediabetes. Methods and analysis: The study employs a community-based quasi-experimental design, making use of pre- and post-intervention data, as well as a questionnaire survey of 1200 individuals residing in the Cape Coast metropolis to ascertain the prevalence and risk factors for undiagnosed diabetes and prediabetes. Physical activity, dietary habits, stress levels, sleep patterns, body image perception, and demographic characteristics will be assessed. Glucose dysregulation will be detected using oral glucose tolerance test, fasting plasma glucose, and glycated hemoglobin. Liver and kidney function will also be assessed. Diabetes and prediabetes will be classified using the American Diabetes Association criteria. Descriptive statistics, including percentages, will be used to determine the prevalence of undiagnosed diabetes and cardiovascular risks. Inferential statistics, including ANOVA, t-tests, chi-square tests, ROC curves, logistic regression, and linear mixed model regression will be used to analyze the phenotypic variations in the population, ocular characteristics, glycemic levels, sensitivity levels of diagnostic tests, etiological cause of diabetes in the population, and effects of lifestyle modifications, respectively. Additionally, t-tests will be used to assess changes in glucose regulation biomarkers after lifestyle modifications. Ethics and dissemination: Ethics approval was granted by the Institutional Review Board of the University of Cape Coast, Ghana (UCCIRB/EXT/2022/27). The findings will be disseminated in community workshops, online learning platforms, academic conferences and submitted to peer-reviewed journals for publication.

Insights to the emerging potential of glucokinase activators as antidiabetic agent.

The glucokinase enzyme (belongs to the hexokinase family) is present in liver cells and ß-cells of the pancreas. Glucokinase acts as a catalyst in the conversion of glucose-6-phosphate from glucose which is rate-limiting step in glucose metabolism. Glucokinase becomes malfunctional or remains inactivated in diabetes. Glucokinase activators are compounds that bind at the allosteric site of the glucokinase enzyme and activate it. This article highlights the patent and recent research papers history with possible SAR from year 2014-2023. The data comprises the discussion of novel chemotypes (GKAs) that are being targeted for drug development and entered into clinical trials. GK activators have attracted massive interest since successful results have been reported from clinical trials data.

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Real-world treatment patterns in patients with systemic lupus erythematosus: associations with comorbidities and damage.

OBJECTIVE: To assess treatment patterns and the association between long-term glucocorticoid (GC) and hydroxychloroquine (HCQ) use and damage accrual in patients with systemic lupus erythematosus (SLE). METHODS: A retrospective study including patients with SLE using the computerised database of a large health maintenance organisation. Patients were matched with subjects from the general population. Multivariable logistic regression models were used to assess the association between GC cumulative daily doses, HCQ and comorbidities: Osteoporosis, cardiovascular disease (CVD), hypertension and diabetes mellitus. Models were adjusted for age, sex, socioeconomic status, smoking, disease duration and HCQ use. RESULTS: A total of 1073 patients with SLE were included, 87.79% were women. The age at first diagnosis was 37.23±14.36 and the SLE disease duration was 12.89±6.23 years. Initiation of HCQ within 12 months of SLE diagnosis increased from 51.02% in 2000 to 83.67% in 2010 and 93.02% in 2018. The annual usage of GC gradually decreased from 45.34% in 2000 to 30.76% in 2020. CVD and osteoporosis were more prevalent in SLE than in the general population. Multivariable logistic regression models revealed increased odds for comorbidities in patients receiving a mean daily dose of prednisone of more than 5 mg/day compared with those receiving 5 mg/day or less. CONCLUSIONS: CVD and osteoporosis were more prevalent in SLE than in the general population. The dose and frequency of GC treatment in patients with SLE have decreased over the years. Prednisone usage in doses exceeding 5 mg/day is associated with significantly increased odds of osteoporosis and CVD.

Are Ethiopian health facilities providing diabetes services capable of managing tuberculosis? Policy implications for introducing diabetes and tuberculosis collaborative care.

OBJECTIVE: This study aimed to assess the availability and preparedness of health facilities offering diabetes mellitus (DM) to manage tuberculosis (TB) in Ethiopia. DESIGN: Secondary data analysis of institution-based cross-sectional national survey data. SETTING: Data were obtained from the 2021-2022 Ethiopian Service Provision Assessment (ESPA) survey which includes all active health facilities in Ethiopia. PARTICIPANTS: This study included all health facilities that provide DM services (both diagnosis and treatment) and recently collected DM data during the 2021-2022 ESPA survey. OUTCOME MEASURES: The service availability was computed as the percentage of facilities offering DM services to provide TB management. The preparedness of these facilities for managing TB was measured using three service tracer indicators (staff training and guidelines, diagnostics and essential medicines used in TB management) defined by the WHO Service Availability and Readiness Assessment Manual. The extent of preparedness was categorised as low level (<50%), moderate level (≥50% to 75%) and high level (≥75%). A descriptive statistic was employed to present the study findings. RESULTS: Only 170 out of 338 facilities were reported to provide DM services across the country, with 136 (70%) also offering TB management services. Among these facilities, the majority were health centres (n=82; 60.1%), publicly owned (n=98; 72.0%), rural (n=83; 60.7%) and located in the Oromia region (n=53; 39.0%). Regarding preparedness, facilities offering DM services had an overall moderate to high preparedness for managing TB, with 47 (27.5%), 53 (31.1%) and 70 (41.3%) facilities classified as low-level, moderate-level and high-level preparedness, respectively. Specifically, these facilities were less prepared in the domains of 'trained staff and guidelines' and 'diagnostics', but had better preparedness in providing first-line TB drugs, with an overall score of 79.7%. CONCLUSIONS: Although the percentage availability of TB services in facilities offering DM services and their preparedness was unsatisfactory compared with WHO standards, Ethiopia has a greater capacity to implement WHO strategies to reduce the burden of TB-DM comorbidity. However, given the high epidemiological risk and the high burden of both diseases in the country, our findings emphasise the urgent necessity to establish and implement a collaborative TB-DM care plan to integrate TB services within facilities providing DM care.

Investigation of the knowledge, attitude and practice regarding nutrition in older adults with tuberculosis and diabetes: a cross-sectional study in Eastern China.

OBJECTIVES: Older adults with tuberculosis and diabetes have special needs regarding dietary nutrition. This study aimed to investigate the knowledge, attitude and practice (KAP) regarding dietary nutrition among older adults with those two conditions. DESIGN: Cross-sectional study. SETTING: Three tertiary medical centres in China. PARTICIPANTS: Adults over 60 year old diagnosed with tuberculosis and diabetes. INTERVENTIONS: Between July 2023 and October 2023. PRIMARY AND SECONDARY OUTCOME MEASURES: Demographic characteristics and KAP scores collected by self-designed questionnaire. RESULTS: A total of 456 valid questionnaires were analysed, with 261 (57.24%) participants being over 70 years old. The mean scores were 6.84±3.16 (possible range: 0-24) for knowledge, 23.23±2.23 (possible range: 8-40) for attitude and 22.73±3.14 (possible range: 8-40) for practice, respectively. Correlation analysis revealed significant positive correlations between knowledge and attitude (r=0.287, p<0.001), knowledge and practice (r=0.189, p<0.001) and attitude and practice (r=0.176, p<0.001). Structural equation modelling demonstrated that knowledge significantly influenced attitude (ß=0.343, 95% CI (0.257 to 0.422), p<0.001) and practice (ß=0.245, 95% CI (0.101 to 0.405), p<0.001) and attitude significantly influenced practice (ß=0.274, 95% CI (0.146 to 0.405), p<0.001). CONCLUSIONS: The study highlights a need for improvements in dietary nutrition practices for older adults with tuberculosis and diabetes. Findings emphasise the urgency of enhancing dietary education among this population in China. Implementation of targeted educational programmes is warranted to improve knowledge, foster positive attitudes and encourage healthier dietary practices, ultimately leading to improved patient outcomes and well-being.

Relationship between four visceral obesity indices and prediabetes and diabetes: a cross-sectional study in Dalian, China.

BACKGROUND: In recent times, a number of new indices for measuring visceral obesity have been developed. This research sought to investigate the relationship between four visceral obesity indices and prediabetes and diabetes. METHODS: Conducted in 2011 as a cross-sectional analysis in Dalian, China, this study utilized logistic regression models to explore the relationships between four visceral obesity indices and prediabetes and diabetes. It also assessed the dose-response relationships using restricted cubic splines (RCS), performed subgroup analyses, and conducted interaction tests. The predictive values of four visceral obesity indices were evaluated using receiver operating characteristic (ROC) curves. RESULTS: The study enrolled 10,090 participants, with prediabetes and diabetes prevalence at 80.53%. Multifactorial logistic regression revealed positive relationships between the four visceral obesity indices and prediabetes and diabetes. The results of the RCS analysis revealed a linear relationship between the body roundness index (BRI), cardiometabolic index (CMI) and prediabetes and diabetes. Conversely, a non-linear relationship was observed between Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP) and prediabetes and diabetes. Subgroup analyses demonstrated stronger relationships of CMI, CVAI, and LAP with prediabetes and diabetes among females. ROC curves suggested that LAP could be an effective predictor of these conditions. CONCLUSION: This research confirmed that four visceral obesity indices are linked with a higher risk of prediabetes and diabetes in middle-aged and elderly individuals in Dalian. Importantly, LAP could be an effective predictor of prediabetes and diabetes. Effective weight management significantly reduces the risk of both prediabetes and diabetes.

Health disparities and inequalities in prevalence of diabetes in the Kingdom of Saudi Arabia.

BACKGROUND: Over time, global health systems have witnessed significant improvements in the delivery and coverage of healthcare services. Nevertheless, the increasing prominence of non-communicable diseases remains a persistent challenge. Diabetes is one such non-communicable chronic disease that poses a threat with respect to both mortality and morbidity. This study investigated the socio-economic determinants and inequalities in the prevalence of diabetes in the Kingdom of Saudi Arabia according to data collected from the 2018 Saudi Family Health Survey conducted by the General Authority for Statistics. METHODS: The analysis was limited to a sample of 11,528 respondents aged ≥ 18 years, selected across all 13 regions of Saudi Arabia, with complete responses for all variables of interest. Socio-economic determinants in diabetes prevalence were explored with univariate, bivariate, and multivariate logistic regression analyses. Furthermore, inequalities were visualised and quantitatively estimated according to construction of a concentration curve and calculation of the concentration index. RESULTS: The prevalence of diabetes among the 11,528 respondents was 11.20%. Age, education, income, and residence area were significant determinants of diabetes prevalence, with a greater risk of diabetes found in older participants (odds ratio [OR]: 12.262, 95% confidence interval [CI]: 9.820-15.313, p < 0.01) compared to younger participants. Inequality analysis showed a negative education-based concentration index (-0.235, p < 0.01), indicating that diabetes prevalence is concentrated among people with relatively less formal education. For males, the income-based concentration index was significantly positive, whereas the education-based concentration index was significantly negative, indicating a greater concentration of diabetes among Saudi men with higher incomes and less education. CONCLUSION: These findings emphasize the need to prioritize policies and strategies for diabetes prevention and control with considerations of the socio-economic inequalities in prevalence. Key areas of focus should include improving education levels across all regions, raising awareness about diabetes and implementing nutritional interventions.

The impact of diabetes mellitus on tuberculosis recurrence in Eastern China: a retrospective cohort study.

BACKGROUND: The comorbidity of tuberculosis (TB) and diabetes mellitus (DM) is a significant global public health issue. This study aims to explore the recurrence risk and related factors of active pulmonary TB, specifically focusing on the impact of DM. METHODS: A retrospective cohort study was conducted in Lianyungang City, Jiangsu Province, Eastern China by recruiting 12,509 individuals with newly diagnosed pulmonary TB between 2011 and 2019. The Cox proportional hazards models were performed to identify risk factors of recurrence and assess the association between DM and recurrence. The hazard ratio (HR) and 95% confidence interval (CI) were used to estimate the strength of the association. RESULTS: After a median follow-up period of 5.46 years, we observed 439 recurrent cases (incident recurrence rate: 6.62 per 1000 person-years). Males (HR: 1.30, 95% CI: 1.03-1.64), patients aged ≥ 60 years (HR: 1.39, 95% CI: 1.15-1.70), DM (HR: 2.40, 95% CI: 1.68-3.45), and etiologic positivity in the initial episode (HR: 2.42, 95% CI: 2.00-2.92) had a significantly increased risk of recurrence. CONCLUSIONS: Recurrence of pulmonary TB patients who have completed treatment, especially those who also suffer from DM, should be a concern. Enhanced follow-up and targeted surveillance of these high-risk groups are needed.

Signalment and laboratory findings in cats with diabetes mellitus in Germany: a retrospective review of laboratory submissions of 129,505 cats.

OBJECTIVES: The aims of this study were to compare signalment and laboratory parameters between diabetic (D) and non-diabetic (ND) cats and poorly-controlled diabetic (PD) and well-controlled diabetic (WD) cats in Germany. METHODS: Laboratory data from Antech Lab Germany between 2015 and 2018 were retrospectively analysed. Age, sex, red blood cell count (RBC), creatinine (CREA), alkaline phosphatase (AP), alanine aminotransferase (ALT), bilirubin (BILI), cholesterol (CHOL), triglycerides (TRI), glucose (GLU) and total thyroxine (TT4) were compared between D (fructosamine ⩾340 µmol/l) and ND cats, and PD (fructosamine >500 µmol/l) and WD (fructosamine 340-500 µmol/l) cats. The proportion of cats with anaemia (RBC ⩽4.21 ×1012/l), CREA >250 µmol/l, ALT >455 U/l, AP >315 U/l, BILI ⩾35 µmol/l and TT4 > reference interval (RI) was compared between PD and WD cats. Data are presented as median and interquartile range (IQR) and analysed using non-parametric tests. Significance was P<0.05, and effect size was assessed by Cramér V or r. RESULTS: In total, 129,505 cats were included (D: n = 9334 [prevalence 7.2%], WD: n = 5670/9334 [60.7%]). The median age of D and ND cats was 12 years (IQR D 9-14; ND 9-15); there was no difference in sex. A significant difference was found between groups (D vs ND; PD vs WD) for all parameters studied. Considering the effect sizes and medians outside the RI, the only relevant difference was higher CHOL, TRI, AP and GLU in PD compared with WD (CHOL: PD 7.46 [5.85-9.32] vs WD 5.44 [4.32-6.97] mmol/l, P<0.001, r = 0.39; TRI: PD 1.44 [0.84-3.66] vs WD 0.78 [0.5-1.35] mmol/l, P <0.001, r = 0.35; AP: PD 66 [47-92] vs WD 35 [23-59] U/l, P <0.001, r = 0.39; GLU: PD 23.7 [20.15-27.3] vs WD 6.89 [5-11.31] mmol/l, P <0.001, r = 0.69). CONCLUSIONS AND RELEVANCE: Laboratory changes in diabetic cats were mild and mainly associated with lipid derangements.

Decoding the diabetic bone paradox: How AGEs sabotage skeletal integrity.

Diabetes patients often suffer from fractures despite normal or high bone mineral density, a phenomenon known as the diabetic bone paradox. Gao et al.1 identify AGEs as disrupting bone quality and compromising skeletal integrity in diabetic bone disease.

Risk factors for cardiovascular diseases in patients with vitiligo: an analysis of current evidence.

OBJECTIVE: The relationship between vitiligo and cardiovascular diseases remains controversial. This study aimed to systematically review the evidence comparing cardiovascular disease risk factors between patients with vitiligo and controls and to perform a meta-analysis of the results. DATA SOURCES: A comprehensive database search was performed for all studies in PubMed, EMBASE, and Cochrane Central Register databases from inception to November, 2023. The main keywords used were vitiligo, hypertension, diabetes, hyperlipidemia, metabolic syndrome, obesity, smoking, alcohol consumption, C-reactive protein, and homocysteine. STUDY SELECTION: Only observational studies and no randomized controlled trials were included. Of the 1269 studies initially selected, the full texts of 108 were assessed for eligibility, and 74 were ultimately included in the analysis. DATA EXTRACTION AND SYNTHESIS: Three reviewers independently extracted the following data: study design, number and characteristics of participants, inclusion indicators, and disease duration. A meta-analysis of the single-group rates was performed for the diabetes, hypertension, hyperlipidemia, and obesity groups. Random-effects or fixed-effects models were used to calculate the sample-size weighted averages for the indicators included in the studies. MAIN OUTCOMES AND MEASURES: The primary outcomes were co-morbidity analysis and co-morbidity rates of vitiligo with metabolic syndrome, obesity, hyperlipidemia, hypertension, and diabetes mellitus. Secondary outcomes were factors associated with vitiligo and cardiovascular disease. RESULTS: This meta-analysis concluded that comorbidities in patients with vitiligo included metabolic syndrome, diabetes, obesity, hyperlipidemia, and hypertension, with comorbidity rates of 28.3%, 6.0%, 38.5%, 43.0%, and 15.8%, respectively. Simultaneously, we showed that the vitiligo group differed significantly from the control group in the following aspects: fasting blood glucose, insulin, systolic and diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, homocysteine, C-reactive protein, smoking, and alcohol consumption. However, no significant differences were observed between the vitiligo and control groups in terms of waist circumference, body mass index, or phospholipid levels. LIMITATIONS: The vast majority of the studies were from Eastern countries; therefore, extrapolation of these results to Western populations is questionable. The significant heterogeneity may be due to different protocols, doses, durations, center settings, population registries, etc., which severely compromise the validity of the results. CONCLUSION: This study summarized not only the factors associated with, but also those not associated with, cardiovascular disease in patients with vitiligo. This study provides a foundation for the prevention and treatment of cardiovascular disease in patients with vitiligo.

The relationship between vitiligo and cardiovascular diseases remains controversial.This meta-analysis concluded that comorbidities in patients with vitiligo include metabolic syndrome, diabetes, obesity, hyperlipidemia, and hypertension, with comorbidity rates of 28.3%, 6.0%, 38.5%, 43.0%, and 15.8%.Our study identified cardiovascular disease risk factors in patients with vitiligo, including smoking, alcohol consumption, high serum SBP, DBP, FBG, CRP, TC, TG, LDL, insulin, and Hcy, and low serum HDL levels.

Systems Biology of Human Microbiome for the Prediction of Personal Glycaemic Response.

The human gut microbiota is increasingly recognized as a pivotal factor in diabetes management, playing a significant role in the body's response to treatment. However, it is important to understand that long-term usage of medicines like metformin and other diabetic treatments can result in problems, gastrointestinal discomfort, and dysbiosis of the gut flora. Advanced sequencing technologies have improved our understanding of the gut microbiome's role in diabetes, uncovering complex interactions between microbial composition and metabolic health. We explore how the gut microbiota affects glucose metabolism and insulin sensitivity by examining a variety of -omics data, including genomics, transcriptomics, epigenomics, proteomics, metabolomics, and metagenomics. Machine learning algorithms and genome-scale modeling are now being applied to find microbiological biomarkers associated with diabetes risk, predicted disease progression, and guide customized therapy. This study holds promise for specialized diabetic therapy. Despite significant advances, some concerns remain unanswered, including understanding the complex relationship between diabetes etiology and gut microbiota, as well as developing user-friendly technological innovations. This mini-review explores the relationship between multiomics, precision medicine, and machine learning to improve our understanding of the gut microbiome's function in diabetes. In the era of precision medicine, the ultimate goal is to improve patient outcomes through personalized treatments.