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11 pages, 675 KiB

Open AccessFeature PaperArticle

Higher Adiponectin Levels in Children and Adolescents with T1D Probably Contribute to the Osteopenic Phenotype through the RANKL/OPG System Activation

by Charalampos Tsentidis, Dimitrios Gourgiotis, Lydia Kossiva, Antonios Marmarinos, Artemis Doulgeraki and Kyriaki Karavanaki

Endocrines 2023, 4(4), 709-719; https://doi.org/10.3390/endocrines4040051 - 03 Nov 2023

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Abstract

Background: Diabetes mellitus is an increasing global health emergency, with serious complications (including osteoporosis). Leptin and adiponectin are among the least-investigated possible contributing factors of T1D low bone mass. Methods: In this case-control cross-sectional analysis, we evaluated 40 pairs of T1D children and [...] Read more.

Background: Diabetes mellitus is an increasing global health emergency, with serious complications (including osteoporosis). Leptin and adiponectin are among the least-investigated possible contributing factors of T1D low bone mass. Methods: In this case-control cross-sectional analysis, we evaluated 40 pairs of T1D children and adolescents and controls. We evaluated body diameters and skinfolds, leptin, adiponectin, lipids and lipoproteins, bone metabolic markers and DXA parameters of BMD and fat percentage. Results: Leptin levels were comparable between groups and correlated well with body mass parameters. Adiponectin levels were found to be higher in the patient group and correlated with higher levels of HbA1c, triglycerides and s-RANKL. Conclusions: In this study, leptin levels were no different, but adiponectin levels were found to be higher in children and adolescents with T1D and correlated with diabetic metabolic derangement indices and s-RANKL in the patient group. Adiponectin can be considered a surrogate marker of T1D in young patients’ metabolic status and probably contributes to the diabetic low bone mass phenotype via activation of the RANKL/OPG metabolic pathway. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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12 pages, 1167 KiB

Open AccessArticle

Continuous Glucose Monitoring (CGM) and Metabolic Control in a Cohort of Patients with Type 1 Diabetes and Coeliac Disease

by Flavia Amaro, Maria Alessandra Saltarelli, Marina Primavera, Marina Cerruto and Stefano Tumini

Endocrines 2023, 4(3), 595-606; https://doi.org/10.3390/endocrines4030042 - 09 Aug 2023

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Abstract

The association between type 1 diabetes (T1D) and coeliac disease (CD) is well known. Metabolic control of thirty-seven patients aged between 1 and 18 years, with coexisting T1D and CD were evaluated. The control group includes 37 patients affected only by diabetes. All [...] Read more.

The association between type 1 diabetes (T1D) and coeliac disease (CD) is well known. Metabolic control of thirty-seven patients aged between 1 and 18 years, with coexisting T1D and CD were evaluated. The control group includes 37 patients affected only by diabetes. All data relating to the metabolic control of all patients were acquired through examination of medical records and CMG reports available on dedicated online platforms. Glucose variability was expressed as Coefficient of Variation (CV) and Standard Deviation of blood glucose values (SD). The formula used for CV computation is: CV (%) = 100 × SD (daily glycemia)/Mean (daily glycemia). Patients with T1D and CD showed a significant reduction in rapid pre-prandial insulin. The same reduction was present if we consider only patients using CGM. In patients without CGM, there was no difference in the doses of basal, pre-prandial and total insulin. Indicators of metabolic control were overlapping between the two groups in patients who used CGM. On the contrary, diabetic and coeliac patients without CGM had increased levels of glycaemic variability indicators and HbA1c. Finally, the percentage of target glycaemic values and >250 mg/dL glycaemic values were significantly decreased and increased, respectively in T1D and CD patients without CGM. With this study we wanted to demonstrate if CGM could improve metabolic control of patients with coexisting T1D and CD. Our data show a worse metabolic control in patients with T1D and CD who did not use CGM. Instead, patients who use CGM, regardless of the concomitant CD, manage to achieve the same glycaemic targets through an adjustment of titration of pre-prandial insulin doses. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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10 pages, 501 KiB

Open AccessArticle

Effects of Renin–Angiotensin Blockade on the Components of Early Interstitial Expansion in Patients with Type 1 Diabetes

by Zahrah Khan, Michael Mauer and Maria Luiza Caramori

Endocrines 2023, 4(3), 548-557; https://doi.org/10.3390/endocrines4030039 - 28 Jul 2023

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Abstract

Interstitial expansion is associated with glomerular filtration rate (GFR) loss in many renal diseases, including diabetic nephropathy. The Renin–Angiotensin System Study (RASS) tested whether a 5-year renin–angiotensin system (RAS) blockade with enalapril or losartan versus placebo slowed progression of early diabetic nephropathy lesions [...] Read more.

Interstitial expansion is associated with glomerular filtration rate (GFR) loss in many renal diseases, including diabetic nephropathy. The Renin–Angiotensin System Study (RASS) tested whether a 5-year renin–angiotensin system (RAS) blockade with enalapril or losartan versus placebo slowed progression of early diabetic nephropathy lesions in 285 normoalbuminuric, normotensive, normal/high GFR patients with type 1 diabetes. RASS found no benefit to the RAS blockade on diabetic glomerular lesions but observed an unexpected 50% increase in the fractional volume of the renal cortex which is the interstitium. The effects of the RAS blockade on individual interstitial components––striated collagen, interstitial cells, and peritubular capillaries––were not assessed. We evaluated by electron microscopy changes in fractional volume of each component in seven patients from each group between baseline and five years. At baseline, 49% of the interstitium was collagen, 12% cells, 26% peritubular capillaries, 7% space, and 2% artifact. There was no overall change in the interstitial composition during the RASS. There were no statistically significant effects of treatment group on any interstitial components. Renal volume remained stable in all groups. The RAS blockade affected neither the approximately 50% increase in interstitium fractional volume per cortex nor the parallel increase in all interstitial components that occurred over the five years of the RASS. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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14 pages, 1680 KiB

Open AccessArticle

Identification of Glucagon Secretion Patterns during an Oral Glucose Tolerance Test

by Andrew Shahidehpour, Mudassir Rashid, Mohammad Reza Askari, Mohammad Ahmadasas and Ali Cinar

Endocrines 2023, 4(3), 488-501; https://doi.org/10.3390/endocrines4030035 - 06 Jul 2023

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Abstract

Impaired glucagon secretion is a major component of glucose intolerance in type 2 diabetes mellitus (T2D). Glucagon secretion exhibits heterogenous patterns in individuals and across glucose tolerance diagnoses. Characterization of the range of glucagon secretion patterns can help clinicians personalize diabetes care based [...] Read more.

Impaired glucagon secretion is a major component of glucose intolerance in type 2 diabetes mellitus (T2D). Glucagon secretion exhibits heterogenous patterns in individuals and across glucose tolerance diagnoses. Characterization of the range of glucagon secretion patterns can help clinicians personalize diabetes care based on glucagon characteristics in addition to glucose and insulin profiles. A total of 102 subjects with normal glucose tolerance, impaired glucose tolerance, and T2D had their glucagon profiles recorded in response to an oral glucose tolerance test. Shapelet analysis was used to identify the most descriptive patterns of early glucagon secretion, and spectral biclustering was employed to identify biclusters of associated subjects and shapelets. The dynamics of glucose, insulin, and glucagon secretion in each cluster were evaluated to identify overall patterns, and the characteristics of the subjects in each cluster were compared. Three clusters were chosen to represent the glucagon patterns. Membership in these three clusters was interpreted based on the presence or lack of extrema in the first 30 min after oral carbohydrate intake. Cluster 1 (n = 23) had a minimum at 30 min and only negative trends. Cluster 2 had a minimum at 10 min and a maximum at 20 min (n = 25). Cluster 3 (n = 40) had a maximum at 10 min and a minimum at 20 min. Subjects in cluster 1 had the lowest average fasting plasma glucose (90.17 mg/dL) and average age (41.39 years) and the highest HOMA-beta score (87.5%), while subjects in cluster 2 had the highest average fasting plasma glucose (102.56 mg/dL) and average age (53.16 years) and the lowest HOMA-beta score (55.77%). Characterization of glucagon dynamics, in addition to glucose and insulin, can aid in personalized treatment approaches and provide greater insight about the underlying dysfunction in glucose regulation. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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12 pages, 610 KiB

Open AccessArticle

Detection of Metabolic Syndrome Using Insulin Resistance Indexes: A Cross-Sectional Observational Cohort Study

by Lucas Fornari Laurindo, Giulia Minniti, Ricardo José Tofano, Karina Quesada, Eduardo Federighi Baisi Chagas and Sandra Maria Barbalho

Endocrines 2023, 4(2), 257-268; https://doi.org/10.3390/endocrines4020021 - 03 Apr 2023

Cited by 1 | Viewed by 1656

Abstract

Insulin resistance (IR) is considered cardinal to the pathophysiology of metabolic syndrome (MetS). Previously, several simple indexes of IR calculated from biochemical and anthropometric variables have been proposed. However, these indexes are population-dependent; therefore, further studies on a global scale are necessary. The [...] Read more.

Insulin resistance (IR) is considered cardinal to the pathophysiology of metabolic syndrome (MetS). Previously, several simple indexes of IR calculated from biochemical and anthropometric variables have been proposed. However, these indexes are population-dependent; therefore, further studies on a global scale are necessary. The present study assessed the diagnostic accuracy of eight IR indicators, namely, METS-IR, TG-HDL-c, TyG, TyG-BMI, TyG-NC, TyG-NHtR, TyG-WC, and TyG-WHtR, in indicating MetS among a Brazilian population. For this, 268 patients (152 men and 116 women, 53–59 years of age) were included in the study, out of which 111 were diagnosed with MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). All indexes achieved significant accuracy, with TyG-WC (0.849 (0.800–0.889)), TyG (0.837 (0.787–0.879)), and TG-HDL-c (0.817 (0.765–0.861)) having the highest area under the curve (AUC). Further, the most heightened diagnostic sensitivities were observed for TG-HDL-c (90.99%), TyG-WC (89.19%), and TyG-NC (84.68%), whereas the highest diagnostic specificities were noted for TyG (73.89%), TyG-WHtR (72.61%), and TyG-WC (66.88%). Thus, TyG-WC, TyG, and TG-HDL-c reached the greatest AUC values in our analyses, making them useful diagnostic indicators of MetS, and crucial for patients’ clinical management. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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9 pages, 245 KiB

Open AccessArticle

Oral Health Professionals’ and Patients’ Opinions of Type-2 Diabetes Screenings in an Oral Healthcare Setting

by Rodrigo Mariño, Andre Priede, Michelle King, Geoffrey G. Adams, Maria Sicari and Mike Morgan

Endocrines 2023, 4(1), 57-65; https://doi.org/10.3390/endocrines4010005 - 20 Jan 2023

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Abstract

Objectives: As part of an evaluation of an oral healthcare practice-based model that identifies patients with prediabetes or type-2 diabetes (T2D), this study reports on the experiences and opinions of oral health professionals and patients on the screening program. Methodology: Urban and rural [...] Read more.

Objectives: As part of an evaluation of an oral healthcare practice-based model that identifies patients with prediabetes or type-2 diabetes (T2D), this study reports on the experiences and opinions of oral health professionals and patients on the screening program. Methodology: Urban and rural oral healthcare practices were invited to participate. Participating practices invited eligible patients to participate in the screening program. Patients were categorised as low, intermediate, or high-risk for prediabetes/T2D. Patients in the intermediate or high-risk category were referred to their general practitioner (GP) for further investigation. Post-screening surveys were used to assess acceptability, barriers and facilitators of the screening program among participating oral health professionals (OHP) and patients. Results: The post-screening survey was completed by 135 patient, and 38 OHPs (i.e., dentists, dental hygienists, oral health therapists). the majority of OHPs (94.6%) who delivered the protocol were satisfied with the approach. Most patients reported satisfaction with the approach (73.2%) and would recommend it to others. Several barriers for implementation were identified by OHPs and patients. Conclusion: OHPs feedback indicated that the screening model was generally acceptable. The feedback from patients following their participation in this study was overwhelmingly positive, indicating that the screening protocols were accepted by patients. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

12 pages, 1522 KiB

Open AccessArticle

Cost-Effectiveness of Screening to Identify Pre-Diabetes and Diabetes in the Oral Healthcare Setting

by Lan Gao, Elise Tan, Rodrigo Mariño, Michelle King, Andre Priede, Geoff Adams, Maria Sicari and Marj Moodie

Endocrines 2022, 3(4), 753-764; https://doi.org/10.3390/endocrines3040062 - 01 Dec 2022

Viewed by 1646

Abstract

Background: This study assesses the long-term cost-effectiveness of this screening protocol from a healthcare system perspective. Methods: Australians presenting to private oral healthcare practices recruited to the iDENTify study were included as the study population. A Markov model preceded by a decision tree [...] Read more.

Background: This study assesses the long-term cost-effectiveness of this screening protocol from a healthcare system perspective. Methods: Australians presenting to private oral healthcare practices recruited to the iDENTify study were included as the study population. A Markov model preceded by a decision tree was developed to assess the intervention’s long-term cost-effectiveness when rolled out to all eligible Australians, and measured against ‘no-intervention’ current practice. The model consisted of four health states: normoglycaemia; pre-diabetes; type 2 diabetes and death. Intervention reach of various levels (10%, 20%, 30%, and 40%) were assessed. The model adopted a 30-year lifetime horizon and a 2020 reference year. Costs and benefits were discounted at 5% per annum. Results: If the intervention reached a minimum of 10% of the target population, over the lifetime time horizon, each screened participant would incur a cost of $38,462 and a gain of 10.564 QALYs, compared to $38,469 and 10.561 QALYs for each participant under current practice. Screening was associated with lower costs and higher benefits (a saving of $8 per person and 0.003 QALYs gained), compared to current standard practice without such screening. Between 8 and 34 type 2 diabetes cases would be avoided per 10,000 patients screened if the intervention were taken up by 10% to 40% of private oral healthcare practices. Sensitivity analyses showed consistent results. Conclusions: Implementing type 2 diabetes screening in the private oral healthcare setting using a simple risk assessment tool was demonstrated to be cost-saving. The wider adoption of such screening is recommended. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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Review

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15 pages, 302 KiB

Open AccessReview

Is Tirzepatide the New Game Changer in Type 2 Diabetes?

by Giuseppe Lisco, Olga Eugenia Disoteo, Vincenzo De Geronimo, Anna De Tullio, Vito Angelo Giagulli, Edoardo Guastamacchia, Giovanni De Pergola, Emilio Jirillo and Vincenzo Triggiani

Endocrines 2024, 5(1), 72-86; https://doi.org/10.3390/endocrines5010005 - 01 Feb 2024

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Abstract

Background: Tirzepatide (TZP) is a once-weekly glucagon-like peptide 1 (GLP-1) and glucose-dependent-insulinotropic-polypeptide (GIP) receptor co-agonist approved for T2D. TZP provides promising evidence in improving glucose control and weight loss in T2D and obesity across preclinical and human studies, including data from the SURPASS [...] Read more.

Background: Tirzepatide (TZP) is a once-weekly glucagon-like peptide 1 (GLP-1) and glucose-dependent-insulinotropic-polypeptide (GIP) receptor co-agonist approved for T2D. TZP provides promising evidence in improving glucose control and weight loss in T2D and obesity across preclinical and human studies, including data from the SURPASS program. Aims: The goal of this paper was to review the evidence on TZP in terms of glucose control, body weight, and the progression of chronic diabetes-related complications and comorbidities. Results: The mean change in HbA1c ranged from −1.6% to −2.06% over placebo, from −0.29% to −0.92% over each GLP-1RAs, and from −0.7% to −1.09% over basal insulins. In SURPASS-6, TZP was more effective than insulin lispro U100 added to basal insulin in reducing HbA_1c levels at the study end (−2.1% vs. −1.1%, respectively). Compared to placebo, TZP induces a significant weight loss: 7.5 (5 mg/week); 11 (10 mg/week); and 12 kg (15 mg/week). Compared to GLP-1RAs, TZP reduces body weight from −1.68 kg to −7.16 kg depending on the dose (5 to 15 mg, respectively). Compared to basal insulin alone rigorously titrated, TZP added onto basal-insulin results in the best strategy for the composite endpoint of improvement of glucose control and weight loss. In SURPASS-6, TZP compared to insulin lispro U100 in add-on to insulin glargine U100 reduced body weight by 9 kg in mean (versus weight gain in basal-bolus users: +3.2 kg). TZP has pleiotropic effects potentially dampening the individual cardiovascular risk, including a reduction in systolic arterial pressure by 4 to 6 mmHg and total cholesterol by 4–6% compared to baseline. A post hoc analysis of SURPASS-4 revealed that TZP, compared to glargine U100, delayed the rate of glomerular filtration decline (−1.4 mL/min vs. −3.6 mL/min, respectively), reduced the rate of urinary albumin excretion (−6.8% vs. +36.9%, respectively), and was associated with a lower occurrence of the composite renal endpoint (HR 0.58 [0.43; 0.80]). Conclusions: Consistent evidence indicates that TZP dramatically changes the clinical course of T2D in different clinical scenarios. The efficacy and safety of TZP on chronic diabetes-related comorbidities and complications seem promising, but ongoing trials will clarify the real benefits. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

26 pages, 601 KiB

Open AccessReview

Exploring SGLT-2 Inhibitors: Benefits beyond the Glucose-Lowering Effect—What Is New in 2023?

by Clipper F. Young, Neeka Farnoudi, Jenny Chen and Jay H. Shubrook

Endocrines 2023, 4(3), 630-655; https://doi.org/10.3390/endocrines4030045 - 04 Sep 2023

Cited by 1 | Viewed by 3247

Abstract

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors were once known as a class of glycemic-lowering agents to treat type 2 diabetes. As the evolving evidence from recent cardiorenal trials on these agents has shown—e.g., EMPA-REG OUTCOME, DECLARE-TIMI 58, CANVAS Program, DAPA-CKD—disclosing their benefits beyond glycemic management, [...] Read more.

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors were once known as a class of glycemic-lowering agents to treat type 2 diabetes. As the evolving evidence from recent cardiorenal trials on these agents has shown—e.g., EMPA-REG OUTCOME, DECLARE-TIMI 58, CANVAS Program, DAPA-CKD—disclosing their benefits beyond glycemic management, SGLT-2 inhibitors have stimulated a shift in the management of T2DM and its comorbidities, specifically preventing cardiovascular events in people with ASCVD, preventing heart failure hospitalizations, and delaying the progression of chronic kidney disease. As a result, their usage beyond glycemic management has been included in clinical practice guidelines. Although SGLT-2 inhibitors have shown promising results in cardiorenal outcomes, patients have not had equal access to these agents, at least in the United States, suggesting a systemic issue of health inequity. This review article explores the mechanisms by which cardiorenal benefits are offered, the results of the landmark clinical trials for these agents, and their place in therapy. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

15 pages, 300 KiB

Open AccessReview

Updates on the Management of Hyperglycemia in Hospitalized Adult Patients

by Laleh Razavi Nematollahi and Caitlin Omoregie

Endocrines 2023, 4(3), 521-535; https://doi.org/10.3390/endocrines4030037 - 20 Jul 2023

Viewed by 2943

Abstract

The prevalence of diabetes is rising globally; currently, 537 million people worldwide and 37.3 million people in the US are affected. Patients with diabetes have a four-times-greater risk of hospitalization with longer hospital stays and a greater chance of readmission compared to patients [...] Read more.

The prevalence of diabetes is rising globally; currently, 537 million people worldwide and 37.3 million people in the US are affected. Patients with diabetes have a four-times-greater risk of hospitalization with longer hospital stays and a greater chance of readmission compared to patients without diabetes. Spending on diabetes care as a proportion of global GDP is also projected to increase from 1.8% in 2015 to 2.2% in 2030. The largest component of this medical expenditure is inpatient care in hospitalized patients, accounting for USD 69.7 billion of the total medical cost. Hospitalized patients can develop hyperglycemia without a history of pre-existing diabetes. It has been shown that hyperglycemia in patients without a history of diabetes is also associated with poor hospital outcome. In this review, we discuss the adverse effects of hyperglycemia and hypoglycemia on hospital outcomes; we review recent glycemic targets, recent guidelines’ recommendations, and landmark trials with a brief review on discharge planning, updates on hyperglycemic emergencies, and the use of newer technologies in hospitalized patients such as continuous glucose monitoring devices. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

19 pages, 575 KiB

Open AccessReview

Sleep Characteristics in Adults of African Descent at Risk for and with Cardiometabolic Conditions: A Systematic Review

by Cherlie Magny-Normilus, Stephanie Griggs, Julie Sanders, Youri Hwang and Catrina Longhurst

Endocrines 2023, 4(3), 502-520; https://doi.org/10.3390/endocrines4030036 - 19 Jul 2023

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Abstract

The purpose of this systematic review is to synthesize available studies on sleep health characteristics in adults of African descent with or at risk for cardiometabolic conditions. PubMed, PsycINFO, CINAHL, and Web of Science were searched for original research studies on subgroups of [...] Read more.

The purpose of this systematic review is to synthesize available studies on sleep health characteristics in adults of African descent with or at risk for cardiometabolic conditions. PubMed, PsycINFO, CINAHL, and Web of Science were searched for original research studies on subgroups of African descent with at least one cardiometabolic risk factor. Studies published in English with measured sleep characteristics were included. Studies focused on participants with severe psychiatric illness, night shift workers, or with a pharmacologic sleep treatment focus were excluded. The risk for bias was assessed using the NHLBI 2021 Quality Assessment Tool. Two reviewers independently synthesized the results before reaching a consensus. Out of 340 studies screened, 35 studies were included. There were 631,756 participants with an average age of 44.3 combined (SD = 16.5) (53% female and 22% Black). Disparities in sleep health characteristics and cardiometabolic health among African American adults were found. Markers of poor cardiometabolic health were associated with disordered sleep. While the studies in this review captured key factors, the study measurement methods were inconsistent, and African Caribbean Americans were underrepresented. The studies demonstrated the intersectionality of poor sleep characteristics, cardiometabolic risk factors, and racial/ethnic groupings. Clinicians should consider these findings when providing care. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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20 pages, 2167 KiB

Open AccessReview

The Etiological Diagnosis of Diabetes: Still a Challenge for the Clinician

by Danièle Dubois-Laforgue and José Timsit

Endocrines 2023, 4(2), 437-456; https://doi.org/10.3390/endocrines4020033 - 15 Jun 2023

Viewed by 1846

Abstract

The etiological diagnosis of diabetes conveys many practical consequences for the care of patients, and often of their families. However, a wide heterogeneity in the phenotypes of all diabetes subtypes, including Type 1 diabetes, Type 2 diabetes, and monogenic diabetes, has been reported [...] Read more.

The etiological diagnosis of diabetes conveys many practical consequences for the care of patients, and often of their families. However, a wide heterogeneity in the phenotypes of all diabetes subtypes, including Type 1 diabetes, Type 2 diabetes, and monogenic diabetes, has been reported and contributes to frequent misdiagnoses. The recently revised WHO classification of diabetes mellitus includes two new classes, namely “hybrid forms” and “unclassified diabetes”, which also reflect the difficulties of this etiological diagnosis. During the last years, many studies aiming at identifying homogenous subgroups on refined phenotypes have been reported. Ultimately, such subtyping may improve the diagnosis, prognosis, and treatment of patients on a pathophysiological basis. Here, we discuss the concepts of typical vs. atypical diabetes in the context of autoimmune Type 1 diabetes, Type 2 diabetes, and its monogenic forms. We discuss the contributions of clinical markers, biological tests, particularly islet cell auto-antibodies, and genetics to improving accurate diagnoses. These data support a systematic evaluation of all newly diagnosed diabetes cases. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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12 pages, 544 KiB

Open AccessReview

Pregnancy and Type 2 Diabetes: Unmet Goals

by Maria Grazia Dalfrà, Silvia Burlina and Annunziata Lapolla

Endocrines 2023, 4(2), 366-377; https://doi.org/10.3390/endocrines4020028 - 12 May 2023

Viewed by 1884

Abstract

The increased frequency of type 2 diabetes worldwide has led to a concomitant increase in pregnancies complicated by type 2 diabetes for the past 20 years. This is mainly due to two factors: the earlier age of diabetes onset and the advanced age [...] Read more.

The increased frequency of type 2 diabetes worldwide has led to a concomitant increase in pregnancies complicated by type 2 diabetes for the past 20 years. This is mainly due to two factors: the earlier age of diabetes onset and the advanced age of pregnancy occurrence. Patients with type 2 diabetes in pregnancy show a high frequency of maternal and fetal complications, posing a series of problems in the follow-up of these women. In this narrative review, changes in epidemiology, maternal and fetal complications, and evidence of critical unmet needs before and during pregnancy complicated by type 2 diabetes are reported and discussed to review the possible approaches. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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12 pages, 822 KiB

Open AccessReview

Diabetic Ketoacidosis Management: Updates and Challenges for Specific Patient Population

by Azza B. El-Remessy

Endocrines 2022, 3(4), 801-812; https://doi.org/10.3390/endocrines3040066 - 08 Dec 2022

Viewed by 20668

Abstract

Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency and causes the greatest risk for death that could be prevented in patients with diabetes mellitus. DKA occurs more commonly among patients with type-1 diabetes with a thirty percent of the cases take place [...] Read more.

Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency and causes the greatest risk for death that could be prevented in patients with diabetes mellitus. DKA occurs more commonly among patients with type-1 diabetes with a thirty percent of the cases take place in patients with type 2 diabetes. DKA is characterized by sever hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive replacement and monitoring of fluids, electrolytes and insulin therapy. Management of DKA has been updated with guidelines, to help standardize care, and reduce mortality and morbidity. The major precipitating factors for DKA include new diagnosis of diabetes, non-adherence to insulin therapy as well as infection in patients with diabetes. Discharge plans should include appropriate selection of insulin dosing and regimens as well as patient education to prevent recurrence of DKA. Further, definition and management of euglycemic DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors are discussed. Special consideration is reviewed for specific patient population including pregnancy, renal replacement, acute pancreatitis, and insulin pump users as well as patients with COVID-19. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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14 pages, 2221 KiB

Open AccessEditor’s ChoiceReview

Looking at Diabetes-Related Distress through a New Lens: The Socio-Ecological Health Model

by Neeka Farnoudi, Mimi Lyang, Kees Vanderwyk, Sarah Vreeburg and Clipper Young

Endocrines 2022, 3(4), 775-788; https://doi.org/10.3390/endocrines3040064 - 06 Dec 2022

Viewed by 2237

Abstract

Diabetes-related distress (DRD) is defined as an emotional state experienced by people with diabetes (PWD) who are worried about their disease management, the emotional burden from the condition, and/or potential difficulties accessing care or support. The psychosocial aspect of diabetes management is a [...] Read more.

Diabetes-related distress (DRD) is defined as an emotional state experienced by people with diabetes (PWD) who are worried about their disease management, the emotional burden from the condition, and/or potential difficulties accessing care or support. The psychosocial aspect of diabetes management is a factor that directly influences patients’ well-being as well as the chronic management of the condition yet is not a primary clinical problem being addressed within the healthcare setting. This review advocates for a re-evaluation and subsequent adjustment of the current DRD screening methodology by implementing the five primary components (Intrapersonal, Interpersonal, Organizational, Community, and Public Policy) of the Socio-Ecological Model of Health (SEMH), bridging the gaps from a public-health perspective. We searched two electronic databases for studies published in the United States from 1995 to 2020 reporting the effects of social determinants of health (SDOH) on DRD. Articles that contained at least one of the five elements of the SEMH and focused on adults aged 18 years or older were included. SDOH, which include circumstances where individuals grow, work, and age, are highly influenced by external factors, such as the distribution of wealth, power, and resources. Current DRD screening tools lack the capacity to account for all major components of SDOH in a comprehensive manner. By applying the SEMH as a theory-based framework, a novel DRD screening tool addressing sex, ethnicity, and socioeconomic background should be implemented to better improve diabetes management outcomes. By exploring the relationships between each level of the SEMH and DRD, healthcare professionals will be better equipped to recognize potential stress-inducing factors for individuals managing diabetes. Further efforts should be invested with the goal of developing a novel screening tool founded on the all-encompassing SEMH in order to perpetuate a more comprehensive diabetes treatment plan to address barriers within the SDOH framework. Full article

(This article belongs to the Special Issue Advances in Diabetes Care)

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