Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 444
Filtrar
1.
Front Immunol ; 12: 748787, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34603337

RESUMO

T cell Ig and mucin domain (Tim) protein family members were identified to be important regulators of the immune response. As their name indicates, Tim proteins were originally considered a T cell-specific markers, and they mainly regulate the responses of T helper cells. However, accumulating evidence indicates that Tims are also expressed on antigen-presenting cells (APCs), such as monocytes, macrophages, dendritic cells (DCs) and B cells, and even plays various roles in natural killer cells (NKs) and mast cells. In recent years, the expression and function of Tims on different cells and the identification of new ligands for the Tim family have suggested that the Tim family plays a crucial role in immune regulation. In addition, the relationship between Tim family gene polymorphisms and susceptibility to several autoimmune diseases has expanded our knowledge of the role of Tim proteins in immune regulation. In this review, we discuss how the Tim family affects immunomodulatory function and the potential role of the Tim family in typical autoimmune diseases, including multiple sclerosis (MS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and type 1 diabetes (T1D). A deeper understanding of the immunoregulatory mechanism of the Tim family might provide new insights into the clinical diagnosis and treatment of autoimmune diseases.

2.
Diabetes Metab Res Rev ; : e3501, 2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34614535

RESUMO

OBJECTIVES: Fulminant type 1 diabetes (FT1D) could present diabetes ketoacidosis (DKA) at early onset. It is crucial to identify FT1D from DKA manifestations in time at clinical practice. This study was aimed at investigating whether the fulminant index (FI), encompassing plasma glucose (PG) to glycated hemoglobin (HbA1c) ratio (PG/HbA1c), serum potassium ion (K+ ) to HbA1c ratio (K+ /HbA1c), and serum sodium ion (Na+ ) multiplied by HbA1c (Na+ *HbA1c), is a feasible indicator for early FT1D diagnosis. METHODS: A total of 78 subjects were enrolled, including 40 FT1D patients and 38 non-FT1D patients with DKA. We utilized receiver operating characteristic (ROC) curve analysis to determine the FI cut-off values between FT1D and non-FT1D groups and examined efficacies of FI based on statistics. RESULTS: ROC curve analyses showed that the maximum Youden's index for PG/HbA1c bonding to a cut-off value of 4.389, with the sensitivity of 75.0% and specificity of 81.6% in identifying FT1D from DKA. And optimal K+ /HbA1c cut-off value was 0.728 with a sensitivity of 90.0% and specificity of 84.2%. For Na+ *HbA1c, the best cut-off value was 923.65, and its sensitivity and specificity were 85% and 73.7%, respectively. CONCLUSIONS: These results suggested FI could work as a valid and convenient indicator for differentiating FT1D from initial DKA patients. FI (K+ /HbA1c) presented the best efficacy as an independent index. This article is protected by copyright. All rights reserved.

3.
J Diabetes ; 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34617682

RESUMO

BACKGROUND: We aimed to report the pregnancy outcomes of women with type 1 diabetes (T1D) in China, on which data was sparse. METHODS: This is a nationwide retrospective study conducted in 11 general medical centers in eight cities across China. We investigated the clinical data of all women who attended these centers with a singleton pregnancy and whose pregnancy ended between January 1st , 2004, and December 31st , 2014. Pregnancies of women with pregestational T1D were ascertained and compared with those of women without T1D. RESULTS: From over 300,000 pregnancies over the 11-year study period, we identified 265 singleton pregnancies of women with T1D. One out of 265 (0.37%) maternal death was documented among women with T1D, and 83 out of 318,486 (0.03%) in those without T1D. Women with T1D suffered from higher rates of pregnancy loss(13.21% vs 2.92%, crude risk ratio [cRR] 5.08, 95% confidence interval [CI] 3.56-7.26) and pre-eclampsia(17.74% vs 4.20%, cRR 4.94, 95% CI 3.60-6.77) compared with those without T1D. Infants of these women with T1D had elevated rates of neonatal death(5.65% vs 0.16%, cRR 37.36, 95% CI 21.21-65.82) and congenital malformation(s)(8.26% vs 3.53%, cRR 2.46, 95% CI 1.54-3.93), compared with those of women without T1D. No significant improvement in pregnancy outcomes in women with T1D was observed over 2004-2014. CONCLUSION: Pregnancy outcomes were persistently poor in women with T1D during 2004-2014 in China. Pregnancy care needs improving to reduce adverse pregnancy outcomes among Chinese women with T1D.

5.
Eur J Endocrinol ; 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34519671

RESUMO

BACKGROUND: Obesity is associated with impaired immune function and chronic low-grade inflammation. Metabolic surgery is one of the most effective therapies for treating obesity and related metabolic disorders. We aimed to explore the pathophysiological roles of peripheral DCs and T lymphocytes in metabolic surgery. METHOD: In this observational cohort study, a total of 106 individuals, including obese participants with or without T2DM, overweight subjects and normal controls, were recruited. All obese participants underwent laparoscopic sleeve gastrectomy surgery and returned for evaluation of the clinical indicators after surgery. We evaluated the frequencies of circulating DCs subsets (mDCs and pDCs), the pro-inflammatory (Th1 and Th17) and antiinflammatory (Th2 and Treg) T cell subsets by flow cytometry. RESULTS: Compared with the normal controls, the frequencies of mDCs, Th1 and Th17 cells increased, while Treg and Th2 cells decreased in the obese participants. The frequency of mDCs and Th1 cells consistently declined after surgery compared with baseline in the obese patients and were restored to the levels observed in the normal controls after surgery. Moreover, the frequency of Treg cells was increased at 6 months after surgery in the obese patients with T2DM, and Th17 cells declined at 6 months after surgery in the severely obese patients without T2DM. CONCLUSION: This study indicates that metabolic surgery can effectively improve imbalanced immune cells in peripheral blood and restore the proportion of immune cells to a normal range during a 12-month follow-up.

6.
JMIR Mhealth Uhealth ; 9(9): e29498, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34499047

RESUMO

BACKGROUND: Diabetes has placed heavy social and economic burdens on society and families worldwide. Insufficient knowledge and training of frontline medical staff, such as nurses, interns, and residents, may lead to an increase in acute and chronic complications among patients with diabetes. However, interns have insufficient knowledge about diabetes management. The factors that affect interns' current level of diabetes-related knowledge are still unclear. Therefore, understanding the behavioral intentions of interns is essential to supporting the development and promotion of the use of virtual simulation teaching applications. OBJECTIVE: This study aimed to identify the determinants of nursing interns' intentions to use simulation-based education applications. METHODS: From December 1, 2020, to February 28, 2021, the web-based survey tool Sojump (Changsha Xingxin Information Technology Co) was used to survey nursing interns in hospitals across China. Two survey links were sent to 37 partner schools in 23 major cities in China, and they were disseminated through participants' WeChat networks. Multiple regression analysis was used to determine the association between demographic information and basic disease information and the use of the application for treating adult patients. RESULTS: Overall, 883 nursing interns from 23 provinces in China responded to the survey. Among them, the virtual simulation utilization rate was 35.6% (314/883) and the awareness rate was 10.2% (90/883). In addition, among the interns, only 10.2% (90/883) correctly understood the concept of virtual simulation, and most of them (793/883, 89.8%) believed that scenario-simulation training or the use of models for teaching are all the same. Multiple regression analysis showed that the educational level, independent learning ability, and professional identity of the interns were related to use of the application (P<.05). Skills and knowledge that the interns most wanted to acquire included the treatment of hypoglycemia (626/883, 70.9%), functional test simulation (610/883, 69.1%), and blood glucose monitoring technology (485/883, 54.9%). A total of 60.5% (534/883) of the interns wanted to acquire clinical thinking skills, while 16.0% (141/883) wanted to acquire operational skills. Nursing trainees believed that the greatest obstacles to virtual simulation included limited time (280/883, 31.7%), the degree of simulation (129/883, 14.6%), the demand for satisfaction (108/883, 12.2%), and test scores (66/883, 7.5%). CONCLUSIONS: The understanding and usage rate of diabetes virtual simulation teaching applications by Chinese nursing interns is very low. However, they have high requirements regarding this teaching method. Conducting high-quality randomized controlled trials and designing applications that are suitable for the needs of different nurse trainees will increase students' interest in learning and help improve diabetes knowledge among nursing interns.

7.
Psychosom Med ; 83(8): 906-912, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34334732

RESUMO

OBJECTIVE: This study aimed to investigate whether patients with juvenile-onset type 1 diabetes mellitus (T1DM) have poorer sustained attention than their counterparts with adult-onset T1DM, and whether there is a relationship between diabetes-related variables and sustained attention. METHODS: This study included 76 participants with juvenile-onset T1DM, 68 participants with adult-onset T1DM, and 85 healthy controls (HCs). All participants completed the Sustained Attention to Response Task, Beck Depression Inventory-II, and the Chinese version of the Wechsler Adult Intelligence Scale. RESULTS: The juvenile-onset group showed more omission errors (p = .007) than the adult-onset group and shorter reaction time (p = .005) than HCs, whereas the adult-onset group showed no significant differences compared with HCs. Hierarchical linear regression analysis revealed that the age of onset was associated with omission errors in T1DM participants (ß = -0.275, t = -2.002, p = .047). In the juvenile-onset group, the omission error rate were associated with the history of severe hypoglycemia (ß = 0.225, t = 1.996, p = .050), whereas reaction time was associated with the age of onset (ß = -0.251, t = -2.271, p = .026). Fasting blood glucose levels were significantly associated with reaction time in both the juvenile-onset and adult-onset groups (ß = -0.236, t = -2.117, p = .038, and ß = 0.259, t = 2.041, p = .046, respectively). CONCLUSIONS: Adults with juvenile-onset T1DM have sustained attention deficits in contrast to their adult-onset counterparts, suggesting that the disease adversely affects the developing brain. Both the history of severe hypoglycemia and fasting blood glucose levels are factors associated with sustained attention impairment. Early diagnosis and treatment in juvenile patients are required to prevent the detrimental effects of diabetes.

8.
Immunity ; 54(9): 2042-2056.e8, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34407391

RESUMO

Recruitment of immune cells to the site of inflammation by the chemokine CCL1 is important in the pathology of inflammatory diseases. Here, we examined the role of CCL1 in pulmonary fibrosis (PF). Bronchoalveolar lavage fluid from PF mouse models contained high amounts of CCL1, as did lung biopsies from PF patients. Immunofluorescence analyses revealed that alveolar macrophages and CD4+ T cells were major producers of CCL1 and targeted deletion of Ccl1 in these cells blunted pathology. Deletion of the CCL1 receptor Ccr8 in fibroblasts limited migration, but not activation, in response to CCL1. Mass spectrometry analyses of CCL1 complexes identified AMFR as a CCL1 receptor, and deletion of Amfr impaired fibroblast activation. Mechanistically, CCL1 binding triggered ubiquitination of the ERK inhibitor Spry1 by AMFR, thus activating Ras-mediated profibrotic protein synthesis. Antibody blockade of CCL1 ameliorated PF pathology, supporting the therapeutic potential of targeting this pathway for treating fibroproliferative lung diseases.

9.
Metabolism ; 123: 154863, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34375645

RESUMO

Reduced ß-cell mass and impaired ß-cell function are primary causes of all types of diabetes. However, the intrinsic molecular mechanism that regulates ß-cell growth and function remains elusive. Here, we demonstrate that the small GTPase Rheb1 is a critical regulator of glucose-stimulated insulin secretion (GSIS) in ß-cells. Rheb1 was highly expressed in mouse and human islets. In addition, ß-cell-specific knockout of Rheb1 reduced the ß-cell size and mass by suppressing ß-cell proliferation and increasing ß-cell apoptosis. However, tamoxifen-induced deletion of Rheb1 in ß-cells had no significant effect on ß-cell mass and size but significantly impaired GSIS. Rheb1 facilitates GSIS in human or mouse islets by upregulating GLUT1 or GLUT2 expression, respectively, in a mTORC1 signaling pathway-dependent manner. Our findings reveal a critical role of Rheb1 in regulating GSIS in ß-cells and identified a new target for the therapeutic treatment of diabetes mellitus.

10.
Front Immunol ; 12: 702955, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34394099

RESUMO

Type 1 diabetes is an autoimmune disease caused by T cell-mediated destruction of insulin-producing ß cells. BDC2.5 T cells in BDC2.5 CD4+ T cell receptor transgenic Non-Obese Diabetic (NOD) mice (BDC2.5 + NOD mice) can abruptly invade the pancreatic islets resulting in severe insulitis that progresses rapidly but rarely leads to spontaneous diabetes. This prevention of diabetes is mediated by T regulatory (Treg) cells in these mice. In this study, we investigated the role of interleukin 10 (IL-10) in the inhibition of diabetes in BDC2.5 + NOD mice by generating Il-10-deficient BDC2.5 + NOD mice (BDC2.5 + Il-10 -/- NOD mice). Our results showed that BDC2.5 + Il-10 -/- NOD mice displayed robust and accelerated diabetes development. Il-10 deficiency in BDC2.5 + NOD mice promoted the generation of neutrophils in the bone marrow and increased the proportions of neutrophils in the periphery (blood, spleen, and islets), accompanied by altered intestinal immunity and gut microbiota composition. In vitro studies showed that the gut microbiota from BDC2.5 + Il-10 -/- NOD mice can expand neutrophil populations. Moreover, in vivo studies demonstrated that the depletion of endogenous gut microbiota by antibiotic treatment decreased the proportion of neutrophils. Although Il-10 deficiency in BDC2.5 + NOD mice had no obvious effects on the proportion and function of Treg cells, it affected the immune response and activation of CD4+ T cells. Moreover, the pathogenicity of CD4+ T cells was much increased, and this significantly accelerated the development of diabetes when these CD4+ T cells were transferred into immune-deficient NOD mice. Our study provides novel insights into the role of IL-10 in the modulation of neutrophils and CD4+ T cells in BDC2.5 + NOD mice, and suggests important crosstalk between gut microbiota and neutrophils in type 1 diabetes development.

11.
Artigo em Inglês | MEDLINE | ID: mdl-34390338

RESUMO

CONTEXT: Partial remission (PR) is a specific stage in type 1 diabetes (T1D). Although human leukocyte antigen (HLA) class II loci are the strongest genetic determinants in T1D, the relationship between PR and HLA remains unclear. OBJECTIVE: To investigate the association between PR status and HLA genotypes in T1D patients. METHODS: A total of 237 T1D patients were included. PR was defined according to C-peptide ≥300 pmol/L. The frequency of PR and peak C-peptide levels during remission phase were compared according to HLA status. Clinical characteristics including age of onset and diabetes autoantibodies were collected. All analyses were duplicated when subjects were divided into childhood- and adult-onset T1D. RESULTS: The median follow-up time was 24 months, 65.8% (156/237) of T1D patients went into PR. DR9/DR9 carriers had lower PR rate (44.2% vs. 70.6%, P=0.001) and less likely to enter PR (OR=0.218, 95% CI: 0.098-0.487, P<0.001) than the non-DR9/DR9 carriers, observed in both childhood- and adult-onset T1D. Besides, the peak C-peptide during PR phase was also lower in DR9/DR9 carriers, more notable in adult-onset T1D. When compared with non-DR9/DR9 carriers, T1D with DR9/DR9 genotype presented an older age of onset and a lower positivity of zinc transporter 8 antibody (ZnT8A), and the lower trend of ZnT8A was only found in adult-onset T1D (P=0.049). CONCLUSIONS: T1D carrying susceptible DR9/DR9 are less prone to undergo PR. Additionally, the recovery extent of ß-cell function during the PR phase tends to be lower in adults carrying DR9/DR9, which might be associated with ZnT8A.

12.
JCI Insight ; 6(17)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34264867

RESUMO

A dynamically regulated microenvironment, which is mediated by crosstalk between adipocytes and neighboring cells, is critical for adipose tissue homeostasis and function. However, information on key molecules and/or signaling pathways regulating the crosstalk remains limited. In this study, we identify adipocyte miRNA-182-5p (miR-182-5p) as a crucial antiobesity molecule that stimulated beige fat thermogenesis by promoting the crosstalk between adipocytes and macrophages. miR-182-5p was highly enriched in thermogenic adipocytes, and its expression was markedly stimulated by cold exposure in mice. In contrast, miR-182-5p expression was significantly reduced in adipose tissues of obese humans and mice. Knockout of miR-185-5p decreased cold-induced beige fat thermogenesis whereas overexpression of miR-185-5p increased beiging and thermogenesis in mice. Mechanistically, miR-182-5p promoted FGF21 expression and secretion in adipocytes by suppressing nuclear receptor subfamily 1 group D member 1 (Nr1d1) at 5'-UTR, which in turn stimulates acetylcholine synthesis and release in macrophages. Increased acetylcholine expression activated the nicotine acetylcholine receptor in adipocytes, which stimulated PKA signaling and consequent thermogenic gene expression. Our study reveals a key role of the miR-182-5p/FGF21/acetylcholine/acetylcholine receptor axis that mediates the crosstalk between adipocytes and macrophages to promote beige fat thermogenesis. Activation of the miR-182-5p-induced signaling pathway in adipose tissue may be an effective approach to ameliorate obesity and associated metabolic diseases.

13.
Artigo em Inglês | MEDLINE | ID: mdl-34244734

RESUMO

AIMS: Continuous glucose monitoring (CGM) overcomes the limitations of glycated hemoglobin (HbA1c). This study was to investigate the relationship between CGM metrics and laboratory HbA1c in pregnant women with type 1 diabetes. METHODS: An observational study enrolled pregnant women with type 1 diabetes who wore CGM devices during pregnancy and postpartum from 11 hospitals in China from January 2015 to June 2019. CGM data were collected to calculate time-in-range (TIR), time above range (TAR), time below range (TBR), and glycemic variability parameters. Relationships between the CGM metrics and HbA1c were explored. Linear and curvilinear regressions were conducted to investigate the best-fitting model to clarify the influence of HbA1c on the TIR-HbA1c relationship during pregnancy. RESULTS: A total of 272 CGM data and corresponding HbA1c from 98 pregnant women with type 1 diabetes and their clinical characteristics were analyzed in this study. Mean HbA1c and TIR were 6.49±1.29% and 76.16±17.97% during pregnancy, respectively. HbA1c was moderately correlated with TIR 3.5-7.8(R= -0.429, P=0.001), mean glucose (R= 0.405, P=0.001) and TAR 7.8 (R=0.435, P=0.001), but was weakly correlated with TBR 3.5 (R=0.034, P=0.001) during pregnancy. On average, a 1% (11 mmol/mol) decrease in HbA1c corresponded to an 8.5% increase in TIR 3.5-7.8. During pregnancy, HbA1c of 6.0%, 6.5% and 7.0% were equivalent to a TIR 3.5-7.8 of 78%, 74%, and 69%, respectively. CONCLUSIONS: We found that there was a moderate correlation between HbA1c and TIR 3.5-7.8 during pregnancy. To achieve the HbA1c target <6.0%, pregnant women with type 1 diabetes should strive for TIR 3.5-7.8 >78% (18h 43min) during pregnancy.

14.
Diabetes Ther ; 12(8): 2195-2206, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34236576

RESUMO

INTRODUCTION: Diabetes mellitus (DM) has a serious impact on people's lives in the world. Interventions that affect risk factors for prediabetes can prevent and reduce diabetes occurrence. Proinsulin (PI), true insulin (TI), and proinsulin to insulin ratio (PI/TI) are risk factors for diabetes. The roles of these indicators in prediabetes are unclear. This study aimed to evaluate the impact of PI, TI, PI/TI, 2-h proinsulin (2hPI), 2-h true insulin (2hTI), and 2hPI/2hTI on the risk of prediabetes among the Chinese Han population. METHODS: This cross-sectional study recruited 1688 subjects including 718 prediabetes cases and 970 non-prediabetes controls from Hainan Affiliated Hospital of Hainan Medical University. The cases involved 292 men and 426 women. The controls involved 324 men and 646 women. The mean age was 53.62 ± 12.43 years in the prediabetes group and 44.24 ± 12.87 years in the non-prediabetes group. RESULTS: Our results showed that PI, TI, PI/TI, 2hPI, 2hTI, and 2hPI/2hTI were significantly correlated with prediabetes (all p < 0.05). Logistic regression analysis revealed that PI (OR 1.022, 95% CI 1.014-1.031, p = 0.00011), TI (OR 1.005, 95% CI 1.003-1.007, p = 0.00012), PI/TI (OR 1.517, 95% CI 1.080-2.131, p = 0.016), and 2hTI (OR 1.000, 95% CI 1.000-1.001, p = 0.002) were significantly associated with an increased risk of prediabetes. Receiver operating characteristic curve (ROC) analysis indicated that the area under the ROC curve (AUC) of the combination (PI + TI + PI/TI + 2hPI + 2hTI + 2hPI/2hTI) in diagnosing prediabetes was 0.627, which was larger than the diagnostic value of HOMA-IR (AUC 0.614) and HOMA-ß (AUC 0.387). CONCLUSIONS: Our study showed that PI, TI, PI/TI, and 2hTI could significantly enhance the risk of prediabetes in the Chinese Han population, which suggested that PI, TI, PI/TI, and 2hTI might be available risk factors for prediabetes.

15.
Artigo em Inglês | MEDLINE | ID: mdl-34302736

RESUMO

CONTEXT: Diabetes mellitus (DM) is a systemic disease characterized by chronic hyperglycemia associated with inflammation and oxidative stress, and the lung may be a target organ of diabetic microvascular damage. Several studies have indicated a positive association between idiopathic pulmonary fibrosis (IPF) and diabetes with controversial findings. OBJECTIVE: Primary outcomes were to compare the prevalence of DM among individuals with IPF to non-IPF controls, and the prevalence of IPF among individuals with DM to non-DM controls. DATA SOURCES: PubMed, EMBASE and the Cochrane Library. STUDY SELECTION: Studies contained sufficient data to calculate the prevalence of DM among individuals with and without IPF, or the prevalence of IPF among individuals with and without DM. DATA EXTRACTION: Two investigators independently identified eligible studies and extracted data. Pooled odds ratio (OR) with 95% CIs was the summary effect measure. DATA SYNTHESIS: Eighteen studies including 26,410,623 individuals met eligibility criteria, of which 16 recruited people with IPF and 2 recruited people with DM. The OR of DM in IPF subjects was 1.54 (95% CI: 1.30-1.84; P<0.001) compared to that in non-IPF controls. However, compared with that in non-DM patients, the risk of IPF in DM patients was not found to be significantly reduced (OR: 0.89, 95% CI: 0.64-1.25; P=0.497). CONCLUSION: This meta-analysis suggests that people with IPF have 1.54 times increased odds of diabetes compared to non-IPF controls, while whether patients with DM have an increased risk of IPF is still controversial. Further large, prospective cohort studies investigating the prevalence of IPF in diabetic patients are warranted.

17.
Metabolism ; 121: 154802, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34090869

RESUMO

Diabetes is a noncommunicable widespread disease that poses the risk of severe complications in patients, with certain complications being life-threatening. Hepatitis C is an infectious disease that mainly causes liver damage, which is also a profound threat to human health. Hepatitis C virus (HCV) infection has many extrahepatic manifestations, including diabetes. Multiple mechanisms facilitate the strong association between HCV and diabetes. HCV infection can affect the insulin signaling pathway in liver and pancreatic tissue and change the profiles of circulating microRNAs, which may further influence the occurrence and development of diabetes. This review describes how HCV infection causes diabetes and discusses the current research progress with respect to HCV infection-related diabetes.


Assuntos
Diabetes Mellitus/virologia , Hepacivirus/fisiologia , Hepatite C/complicações , Animais , Diabetes Mellitus/etiologia , Diabetes Mellitus/metabolismo , Hepatite C/metabolismo , Hepatite C/patologia , Hepatite C Crônica/complicações , Hepatite C Crônica/metabolismo , Hepatite C Crônica/patologia , Humanos , Insulina/metabolismo , Resistência à Insulina/fisiologia , Transdução de Sinais/fisiologia
18.
Diabetes Obes Metab ; 23(10): 2226-2233, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34121308

RESUMO

AIM: To compare the efficacy and safety of LY2963016 insulin glargine (LY IGlar) with the reference product (Lantus®) insulin glargine (IGlar) in Chinese patients with type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS: This phase III, prospective, multicentre, open-label study enrolled patients with T1DM, age ≥18 years, with haemoglobin A1c (HbA1c) ≤11.0%, who were randomized to LY IGlar (n = 137) or IGlar (n = 135) in combination with premeal insulin lispro for 24 weeks. The treatment targets were to achieve HbA1c <7% and preprandial capillary blood glucose 79-126 mg/dl (4.4-7.0 mmol/L), avoiding hypoglycaemia. The primary efficacy endpoint was testing the non-inferiority of LY IGlar to IGlar by a margin of 0.4% using the mixed model repeated measure approach, as measured by changes in HbA1c levels from baseline to 24 weeks. Continuous laboratory measures were analysed using analysis of covariance. For categorical measures, Fisher's exact test was used. RESULTS: The least squares mean difference between treatments (LY IGlar - IGlar) in change from baseline was -0.12% (95% confidence interval -0.32%, 0.08%), meeting the non-inferiority criteria. There were no clinically meaningful differences (p > .05) in other efficacy outcomes, including proportions of patients achieving HbA1c <7.0% and HbA1c ≤6.5%, self-monitored blood glucose and insulin dose at week 24. Weight change, insulin antibodies and all adverse events including allergic reactions and hypoglycaemia, were also similar between the two treatment groups (all p > .05). CONCLUSIONS: LY IGlar and IGlar had equivalent efficacy in glycaemic control and similar safety profiles in Chinese patients with T1DM, when used in combination with mealtime insulin lispro.

19.
Diabetes Metab Res Rev ; : e3480, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34156143

RESUMO

Latent autoimmune diabetes in adults (LADA) is an autoimmune disease that shares some genetic, immunological and clinical features with both type 1 diabetes and type 2 diabetes. Immune cells including CD4+ T cells, CD8+ T cells, B cells, macrophages and dendritic cells (DCs) have been detected in the pancreas of patients with LADA and a rat model of LADA. Therefore, similar to type 1 diabetes, the pathogenesis of LADA may be caused by interactions between islet ß-cells and innate and adaptive immune cells. However, the role of the immunity in the initiation and progression of LADA remains largely unknown. In this review, we have summarized the potential roles of innate immunity and immune-modulators in LADA development. Furthermore, we have examined the evidence and discussed potential innate immunological reasons for the slower development of LADA compared with type 1 diabetes. More in-depth mechanistic studies are needed to fully elucidate the roles of innate immune-associated genes, molecules and cells in their contributions to LADA pathogenesis. Undertaking these studies will greatly enhance the development of new strategies and optimization of current strategies for the diagnosis and treatment of the disease.

20.
Patient Educ Couns ; 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33941419

RESUMO

OBJECTIVE: To examine how physicians implement guidelines to deliver insulin dosing education for type 1 diabetes patients in real-world settings. METHODS: A nationally representative sample of endocrinologists from top tertiary hospitals in China was obtained by a multistage random sampling method (n = 385). Knowledge, perceptions and practices of insulin dosing were assessed by validated questionnaires. Multivariable logistic regression was used to identify independent determinants of clinical practice and knowledge. RESULTS: Only 20.5% of endocrinologists correctly answered> 75% of the items regarding insulin dosing knowledge. Only 37.7% of endocrinologists reported often teaching insulin-to-carbohydrate ratio and insulin sensitivity factor. Practice behaviours were independently associated with guideline familiarity (OR: 5.92, 95% CI: 3.36-10.41), receiving standardized training (OR: 2.00, 95% CI:1.23-3.25), self-reported lack of time (OR: 0.58, 95% CI:0.34-0.99) and insufficient teaching approaches (OR: 0.57, 95% CI:0.33-0.97) CONCLUSIONS: There was a large gap between guidelines and clinical practice in insulin dosing education. Modifiable factors, including self-reported lack of time, unfamiliarity with guidelines, the shortage of medical training and educational tools hinder insulin dosing education. PRACTICE IMPLICATIONS: Sufficient medical training and educational tools are important to optimize insulin dosing education. The current care paradigm should also be modified to relieve the burden of physicians.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...