June 27, 2022

Recent review: A Peep in the world of Diabetes.

The medical literature on diabetes research, both in terms of development and management, is intriguing.
There was a recent study published that has an overview of some interesting recent studies, covering
many facets of the field, and might be very useful to physicians around the globe.
Diabetes mellitus (DM) is a metabolic disorder characterized by abnormally high blood glucose levels.
Type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes,
and secondary causes related to endocrinopathies, steroid usage, and other factors are all types of
diabetes.1

Autoimmunity and Diabetes

A one-year pilot trial found that giving 24 newly diagnosed adults with type 1 diabetes (T1D) the calcium
channel blocker verapamil 120–360 mg daily vs placebo maintained C-peptide while lowering insulin
requirements. Two-year follow-up data have recently been published, and individuals who stopped using
verapamil had a lower C-peptide level and a higher insulin demand, whereas those who kept taking it
continued to improve. The beta-cell autoantigen chromogranin A (CgA) is a beta-cell autoantigen with
elevated levels in T1D; CgA showed a negative correlation with C-peptide secretion in the study

Weight Control approaches and Outcomes

Obesity prevalence in the United States increased from 19% to 24% between 1999 and 2018, with
prediabetes prevalence rising from 12% of the entire population and 18% of obese teenagers in
1999–2002 to 28% and 40%, respectively, in 2015–2018

 

In another study, researchers discovered evidence of weight loss benefit in the Look AHEAD (Action for
Health in Diabetes) study’s 16.7-year follow-up; 934 participants randomized to the intensive lifestyle
intervention lost more than or equal to 10% of their body weight in the first year and had a significant 21%
reduction in subsequent mortality, which was not seen in those who lost less than 10% of their body
weight.

Hypoglycemia

End-stage liver illness is linked to a reduction in hepatic capacity for glycogen storage and
gluconeogenesis, resulting in a pattern of fasting hypo- or euglycemia with daytime hyperglycemia.
45135 people with T2D had more than or equal to one episode of severe hypoglycemia (SH) over a
median of 5.2 years, with a 1.29 times greater SH risk in the 10th decile of a non-alcoholic fatty liver
disease (NAFLD) index. SH was, as expected, more common in those with a lower BMI, but it was also
more common in people with a larger waist circumference.

Macrovascular Disease Treatment Approaches

After a few years of follow-up, a study of the dataset found 18.1 and 13.9 major adverse cardiovascular
events (MACE) and heart failure (HF) events per 1000 people among people with T2D who did not have
prior cardiovascular disease or prior HF; 2-3% of people in the data set used either SGLT2i or
glucagon-like peptide 1 receptor agonists (GLP-1RA), and 0.2-0.3% used both. The use of SGLT2i,
GLP-1RA, and their combination was linked to a reduction in MACE of 18%, 7%, and 30%, and a
reduction in HF events of 51%, 18%, and 43%, respectively.
From 2007 to 2016, a Taiwanese study looked at people with T2D who were taking glyburide or glipizide
versus people who were taking gliclazide or glimepiride; the results showed that the former agents were
linked to a 1.2 times higher risk of MACE, as well as a 1.2-fold higher risk of stroke and 2.6-fold higher
risk of cardiovascular death, with a significant 4.7-fold increase in MACE risk appearing during the first 90
days of usage.


Neuropathy, Retinopathy and Nephropathy


The heritability of diabetic kidney disease was 0.29, macroalbuminuria was 0.41, retinal photocoagulation
or vitrectomy was 0.29, and severe vision loss was 0.33, found using single nucleotide polymorphism
analysis of participants in the UK Biobank (UKB) and the ACCORD trial, corroborating the concept that
genetic risk is an important aspect of diabetic microvascular complications.
In a study of 11 638 371 beneficiary-years of US Medicare claims data from 2013 to 2019, 78 716 people,
or 8.3% of those with diabetes, had at least one diabetic foot ulcer (DFU) episode, resulting in a DFU
incidence of 4.6 per 100 person-years among those with diabetes, highlighting the importance of DFU
among older people with diabetes.


Pregnancy and Diabetes


From 1997 to 2016, a total of 5298, 1451, and 647 Danish offspring from a total of 1116779 offsprings,
whose dads were treated with insulin, metformin, and a sulfonylurea, respectively, had birth defect risks of
0.98-, 1.40-, and 1.34-fold higher than the rest of the population.
Women had a 3.9-fold increase in subsequent T2D within 6–15 years, 3.5-fold within 16–25 years, 2-fold
within 26–35 years, and 1.6-fold after 35 years in a study of 1414 women with a history of gestational
diabetes and 46067 women without such a history, with a mean 10.2 year follow-up, beginning from the
6th year after gestational diabetes.

Diabetes control continues to improve.


Diabetes is expected to rise to 10.2% (578 million) by 2030 and 10.9 per cent (700 million) by 2045.
Urban areas (10.8 per cent) have a higher prevalence than rural areas (7.2 %), while high-income
countries (10.4 %) have a higher prevalence than low-income countries (4.0 % ).2
Diabetes is the most common chronic condition that affects a large number of people around the world.
And there is a lot of research being done on diabetes all over the world. With this article, researchers
have tried to compile all recent diabetes-related papers published to provide a comprehensive overview of the various elements of diabetes.

References:

  1. https://www.statpearls.com/ArticleLibrary/viewarticle/20429
  2. https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(19)31230-6/fulltext#:~:text=
    The%20global%20diabetes%20prevalence%20in,%2Dincome%20countries%20(4.0%25).
  3. https://pubmed.ncbi.nlm.nih.gov/35061024/
  4. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2790364
  5. https://onlinelibrary.wiley.com/doi/full/10.1111/1753-0407.1327

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