Prediabetes and deprivation: A couple at high risk of diabetes

AimThe higher prevalence of diabetes in deprived populations is well documented but little is known about the risk of diabetes associated with deprivation among pre-diabetic subjects. The aim of the study was to evaluate the risk of diabetes in a population of deprived pre-diabetic patients.Methods2743 pre-diabetic subjects identified using the American Diabetes Association (ADA) criteria, 16 to 85 years old, 1656 non-deprived and 1087 deprived, had at least two health check-ups at an interval of 4.95 (2.04) vs 3.20 (1.71) years, P < 0.0001, respectively. At the first visit, socioeconomic status was assessed using the EPICES score to differentiate deprived and non-deprived subjects.ResultsAt the second visit, the prevalence of overt diabetes was 9.5% among deprived vs 5.1% in the non-deprived group (P < 0.001). After adjustment on confounding factors, deprivation was found independently associated with occurrence of diabetes [1.70 (1.15–2.51), P = 0.01]. Beyond social deprivation, Fasting Plasma Glucose and waist circumference were the main independent predictors of new-onset diabetes.ConclusionAfter 4 years of follow-up, among subjects with prediabetes, prevalence of diabetes was twice as high among deprived compared with non-deprived subjects. Deprived populations with pre-diabetes may require specific public health approaches to avoid the occurrence of overt diabetes.     

Determining the risk of diabulimia and its relationship with diet quality and nutritional status of adolescents with type 1 diabetes

IntroductionDiabulimia is known as an eating disorder specific to individuals with diabetes.ObjectivesIn this study, it was aimed to determine the diabulimia risk and to evaluate the possible relationships between diabulimia risk and diet quality, anthropometric measurements, and biochemical parameters of adolescents with type 1 diabetes.Material and methodsIn total, 110 adolescents (male: 51.8%, female: 48.2%) with type 1 diabetes between 10–19 years were included in the study. Sociodemographic characteristics and information about diabetes of adolescents were collected using a questionnaire prepared by the researchers through face-to-face interview technique. Anthropometric measurements and 3-day food consumption records were obtained to evaluate their nutritional status, and their biochemical parameters were obtained from hospital files to evaluate their metabolic status. The diet quality was evaluated using the Healthy Eating Index-2015. Diabetes Eating Problem Survey was administered to individuals and it was accepted that diabetics with a total score of ≥ 20 were at risk of diabetes-related eating disorders.Results/ConclusionAmong the 110 adolescents included in this study, 31.8% were found to be at risk of diabulimia. There was a significant relationship between the groups with and without diabulimia risk in terms of diet quality scores (P < 0.05). All individuals with a risk of diabulimia as well as 86.8% of individuals without a risk of diabulimia had high HbA1c levels (P < 0.05). Diet quality, some anthropometric measurements and biochemical parameters of adolescents at risk of diabulimia should be improved. It is important to periodically evaluate the risk of diabulimia, the diet quality, and the nutritional status of adolescents with type 1 diabetes to reduce the occurrence of short and long-term complications.     

Hand grip strength: A reliable assessment tool of frailty status on the person with type 2 diabetes mellitus

ObjectiveThe aim was to assess the influence of specific type 2 diabetes Mellitus-related features on the hand grip strength in a diabetic outpatient-based population.Material and methodsA cross-sectional population-based study was conducted. Seventy-three individuals were included after excluding cases of refusal to participate or medical concerns that had potential to affect dominant hand strength. A calibrated dynamometer was used to assess dominant hand grip strength. Two multiple linear regression models were used to predict mean hand grip strength values. Spearman and Pearson correlations were calculated for all possible pairwise combinations of significant independent continuous variables and mean hand grip strength values.ResultsReduced hand grip strength prevalence was 54.8%, from which 70.8% people had ≥ 65 years. Twenty four percent of individuals aged < 65 years showed decreased hand grip strength. Increasing age, female gender and type 2 diabetes Mellitus duration were significantly associated with reduced hand grip strength (P < 0.001; P = 0.017; P = 0.001, respectively). For each 10 years of disease duration, individual mean hand grip strength decreased around 3 kg (P = 0.001).ConclusionsReduced hand grip strength prevalence was substantial in the geriatric subgroup and not negligible in younger patients with a contribution long-term Diabetes, increasing age and female gender as risk factors. This study displays a unique, practical and reliable approach to select at-risk patients who need close screening programs and clinical surveillance concerning frailty status.     

There is a positive association between vitamin B12 deficiency and serum total cholesterol in Iranian type 2 diabetic patients on Metformin

Introduction

Considering the low level of vitamin B₁₂ in diabetic patients on Metformin and also the importance of this vitamin in lipid metabolism, the aim of the present study was assessing the possible relationship between vitamin B₁₂ deficiency, lipid profile and atherogenic indices in Iranian diabetic patients.

硒与2型糖尿病关系的流行病学证据

2型糖尿病(T2DM)是全球最常见的代谢性疾病.国际糖尿病联合会预测糖尿病患者将从2011年的3.66亿上升到2030年的5.52亿^[1];我国的T2DM患病率高达9.7%,估计有9240万患者,并有逐年上升趋势^[2].而饮食在糖尿病的形成过程中起着关键作用,因此一级预防显得尤为重要.硒是人体必需微量元素,以往就认识到一些硒蛋白(如谷胱甘肽过氧化物酶GPX1)的抗氧化作用和硒的类胰岛素作用,据此推测补硒可能预防T2DM.然而,硒和T2DM的关系并非如此简单,涉及到的主要机制是胰岛素信号传导的氧化还原矛盾(redox paradox),H2O2等活性氧(ROS)除了具有自由基的攻击性,也是胰岛素信号传导的第二信使,GPX1等硒蛋白能够清除多余的自由基,保护胰岛的正常功能,但其过量表达则可清除第二信使H2O2,导致胰岛素信号传导过程的磷酸化异常,最终血糖调节失控,长期以往可能发生T2DM^[3].笔者总结已往发表的流行病学资料,就血硒水平/补硒与T2DM患病/发病的关系进行复习,以探讨其中的流行病学证据.     

2型糖尿病患者膳食纤维摄入量与肠道菌群的关联——基于一项随机对照试验的数据再分析

目的  分析2型糖尿病患者膳食纤维摄入量与肠道菌群的关联, 发现相关差异菌群, 为改善患者日常饮食, 调节肠道菌群, 促进健康提供依据。方法  采用横断面研究设计, 以参与一项健康素养和体力活动干预随机对照试验的356名2型糖尿病患者为研究对象。总热能和膳食纤维摄入量基于3 d 24 h膳食调查数据和中国食物成分表计算。对粪便菌群DNA进行16S rDNA V4高变区测序, 采用Qiime2软件进行生物信息学分析。多变量线性回归模型(multivariate analysis by linear models, MaAsLin)方法和广义线性模型用于获得与膳食纤维摄入量有关的肠道菌群。结果  研究对象的膳食纤维摄入量处于较低水平, 中位摄入量(四分位间距)仅7.4(5.5, 9.7) g/d。未发现膳食纤维摄入量高低与肠道菌群Alpha多样性有关, 但基于Jaccard距离矩阵(PERMANOVA P=0.016)计算的Beta多样性在两组间差异有统计学意义。低膳食纤维摄入组有较高丰度的梭杆菌属(Fusobacterium)、柯林斯菌属(Collinsella)和普雷沃菌属(Prevotella), 而高膳食纤维摄入组则有较高丰度的黄体链球菌(Streptococcus Luteciae)、脆弱拟杆菌(Fragilis)和双歧杆菌属(Bifidobacterium)。结论  2型糖尿病患者膳食纤维摄入量与肠道菌群组成有关联。较低膳食纤维摄入量与高丰度的有害菌有关, 而较高摄入量与较高的双歧杆菌属丰度有关, 提示增加膳食纤维摄入可能对患者的肠道菌群和健康有积极作用。     

Association between fish and shellfish,and omega-3 PUFAs intake and CVD risk factors in middle-aged female patients with type 2 diabetes

BACKGROUND/OBJECTIVES

This study was performed to investigate the association between the dietary intake of fish and shellfish, and omega-3 polyunsaturated fatty acids (PUFAs) and cardiovascular disease (CVD) risk factors in the middle-aged Korean female patients with Type 2 diabetes (T2D).

SUBJECTS/METHODS

A cross-sectional analysis was performed with 356 female patients (means age: 55.5 years), who were recruited from the Huh''s Diabetes Clinic in Seoul, Korea between 2005 and 2011. The dietary intake was assessed by a validated semi-quantitative food frequency questionnaire and analyzed using the Computer Aided Nutritional Analysis program (CAN-Pro) version 4.0 software.

RESULTS

In a multiple regression analysis after the adjustment for confounding factors such as age, BMI, duration of diagnosed T2D, alcohol consumption, fiber intake, sodium intake, and total energy intake, fish and shellfish intake of the subjects was negatively associated with triglyceride and pulse wave velocity (PWV). Omega-3 PUFAs intake was negatively associated with triglyceride, systolic blood pressures, diastolic blood pressures, and PWV. The multiple logistic regression analysis with the covariates showed a significant inverse relationship between the omega-3 PUFAs consumption and prevalence of hypertriglyceridemia [OR (95% CI) for greater than the median compared to less than the median: 0.395 (0.207-0.753)].

CONCLUSIONS

These results suggest that the consumption of fish and shellfish, good sources of omega-3 PUFAs, may reduce the risk factors for CVD in the middle-aged female patients with T2D.     

膳食红肉摄入与2型糖尿病并发冠心病的相关性研究

目的 探讨2型糖尿病患者（T2DM）膳食红肉摄入量与并发冠心病（CHD）的关系。方法 随机选取深圳市南山区T2DM并发CHD的患者为病例组,以年龄 ± 2岁的原则1∶1配对无CHD的T2DM患者为对照组。采用自制问卷及简化版食物频数问卷对所有参与者进行调查。采用条件Logistic回归对膳食红肉摄入量与T2DM并发CHD进行相关性分析。结果 本研究纳入病例和对照各120例,病例组患者人均红肉摄入量中位数为50.00（21.43,100.00）g/d,对照组为42.86（21.43,50.00）g/d,差异有统计学意义（P<0.05）。条件Logistic回归结果显示,T2DM合并CHD的OR值随着膳食红肉摄入量的增加而增加（P_线性<0.05）。在校正多种混杂变量后,T2DM患者红肉摄入量为25~50、>50 g/d并发CHD的风险分别是膳食红肉摄入量<25 g/d的2.01倍（95%CI：0.77~5.22）和6.76倍（95%CI：1.55~29.50）。结论 T2DM患者膳食红肉摄入量>50 g/d可能是并发CHD的危险因素。     

天津市社区成年肥胖人群糖尿病患病率和危险因素分析

目的 研究天津市社区成年肥胖人群2型糖尿病(T2DM)患病率及其危险因素.方法 2006年在天津市采用分层整群随机抽样方法抽取全市3个城区和3个郊县≥18岁的成年人进行现况调查,从中选取体重指数(BMI)≥28 kg/m2的人群,共2888人作为研究对象.经过考试培训的调查员对抽样人群进行面对面问卷调查和空腹血糖测定,空腹血糖值≥6.1 mmol/L者再进行餐后2 h血糖测定.描述该人群的T2DM患病率及其人群分布特征,分析患T2DM的危险因素.结果 天津市社区成年肥胖人群T2DM患病率为11.74%,女性患病率(13.90%)高于男性(8.75%).肥胖人群按不同人群特征分组后,不同年龄、文化程度、职业、地区和BMI之间T2DM患病率差异有统计学意义.经单因素和多因素的logistic回归分析,年龄(OR=1.383,95%CI:1.254～1.525)、性别(OR=1.591,95%CI:1.230～2.059)是成年肥胖人群患糖尿病的危险因素,食用水果(OR=0.867,95%CI:0.774～0.971)是保护因素.结论 肥胖人群的T2DM患病率较高,T2DM在不同肥胖人群特征的分布和影响因素与全人群有所不同,可能与肥胖者本身存在的危险因素有关.     

Food intake and dietary glycaemic index in free-living adults with and without type 2 diabetes mellitus

A recent Cochrane review concluded that low glycaemic index (GI) diets are beneficial in glycaemic control for patients with type 2 diabetes mellitus (T2DM). There are limited UK data regarding the dietary GI in free-living adults with and without T2DM. We measured the energy and macronutrient intake and the dietary GI in a group (n = 19) of individuals with diet controlled T2DM and a group (n = 19) without diabetes, matched for age, BMI and gender. Subjects completed a three-day weighed dietary record. Patients with T2DM consumed more daily portions of wholegrains (2.3 vs. 1.1, P = 0.003), more dietary fibre (32.1 vs. 20.9 g, P < 0.001) and had a lower diet GI (53.5 vs. 57.7, P = 0.009) than subjects without T2DM. Both groups had elevated fat and salt intake and low fruit and vegetable intake, relative to current UK recommendations. CONCLUSIONS: Patients with T2DM may already consume a lower GI diet than the general population but further efforts are needed to reduce dietary GI and achieve other nutrient targets.     

膳食模式与2型糖尿病

糖尿病已成为一个严重影响人类健康的全球性公共卫生问题,给个人、社会和经济带来了沉重的负担。全球2型糖尿病(type 2 diabetes mellitus,T2DM)的流行是由肥胖率上升驱动的,T2DM的管理显得尤为重要。生活方式和医学营养疗法(medical nutrition therapy,MNT)被认为是T2DM预防和治疗的重点,但是在如何使用这些方法预防和治疗该疾病方面尚未达成明确的共识。就目前流行的五种膳食模式对T2DM的影响展开综述,旨为T2DM的医学营养治疗提供参考。     

2型糖尿病危险因素研究

目的探讨2型糖尿病(T2DM)的危险因素,为确定高危人群及制定防治措施提供依据。方法采用病例对照研究方法,选取北京市海淀区两所综合医院T2DM患者233例和健康对照243例,对研究因素进行糖尿病关联分析。计量资料的差异比较应用t检验,定性资料的差异比较应用χ2检验,各因素与T2DM的关联分析采用logistic回归,P<0.05为差异有统计学意义。结果 T2DM发病的危险因素有:家族史(P=0.001,OR=4.452);嗜甜食(P=0.001,OR=3.146);嗜腌制食物(P=0.002,OR=2.872);高血压病史(P=0.001,OR=2.671);吸烟(P=0.003,OR=2.520)。保护因素有:体育活动(P=0.001,OR=0.406);喜食蔬菜(P=0.001,OR=0.320);牛奶(P=0.001,OR=0.210);酸味食物(P=0.001,OR=0.372);母乳喂养(P=0.004,OR=0.446);正常水平的甘油三酯(P=0.042,OR=0.571)和总胆固醇(P=0.041,OR=0.463)。结论在人群中避免吸烟、嗜甜食及腌制食品等不良生活习惯,加强体育锻炼及合理的饮食习惯,控制血压、血脂,对婴幼儿应提倡母乳喂养。     

2型糖尿病高危人群的早期预测及其评价

目的 采用巢式病例对照研究的方法，建立2型糖尿病及糖耐量损害危险因素的Logistic回归模型。方法 用腰臀围比或腰围指标预测2型糖尿病高危人群，并评价其效果。结果 以空腹血糖结果为标准，在小于40岁人群中，灵敏度均为100％，特异度分别为80．0％和77．0％，约登指数为0．80和0．77，效果满意。在40岁以上人群中，灵敏度为52．0％和40．0％，特异度为62．0％和70．0％，约登指数为0．14和0．10。效果不满意。按照目前推荐的腰臀围比与腰围评价标准，2项指标测量结果一致率为85．0％。结论 在小于40岁人群中，通过常规体检或自身测量腰臀围比或腰围，筛检2型糖尿病的高危人群，是一个简单、有效、经济的方法。