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Neutrophil Lymphocyte Ratio as a Predictor of Stroke Severity in Type 2 Diabetes Mellitus: A Single-Center Study

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Comparative Study of Semaglutide and Dapagliflozin in Type 2 Diabetes Management

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Exploring the Efficacy of Semaglutide and Dapagliflozin in Type 2 Diabetes Treatment: A Leap Towards Precision Medicine


A Comparative Study of Semaglutide and Dapagliflozin

Recent advances in the field of diabetes treatment have led to a trial comparing the efficacy of two antidiabetic drugs: semaglutide and dapagliflozin. The randomized open-label trial, published in Nature, aimed to understand their effects on patients with type 2 diabetes, particularly those with severe insulin-deficient diabetes (SIDD) or severe insulin-resistant diabetes (SIRD). The study discovered that semaglutide induced a larger reduction in glycated haemoglobin (HbA1c) levels than dapagliflozin, especially in those with SIDD.

Identifying Treatment Response through Continuous Pathophysiological Variables

Interestingly, the study found no significant interaction between the drug assignment and the SIDD or SIRD subgroup. Instead, continuous pathophysiological variables such as baseline HbA1c and insulin secretion were more informative in predicting treatment response. These variables, along with body mass index, blood pressure, and insulin resistance measures, were useful in identifying patients likely to benefit most in terms of glycaemic control and cardiovascular risk factors by adding semagliflozin or dapagliflozin.

Combination Therapy: A New Approach in Type 2 Diabetes Management

Further research in Pharmacological Research evaluated the impact of combining dapagliflozin and oral semaglutide in type 2 diabetes patients. This combination therapy outperformed dapagliflozin alone by reducing glycated hemoglobin by 1.2% while improving body mass index, blood pressure, cholesterol, and glucose levels. The combination achieved 55% glycated hemoglobin near-normalization, suggesting it may induce type 2 diabetes pharmacological remission in over 50% of patients.

Implications for Clinical Practices

A related study on the combination therapy of dapagliflozin and semaglutide in PRECARE2 noted its superior efficacy in managing type 2 diabetes. The more significant reduction in HbA1c levels with the combination therapy suggests a promising approach to type 2 diabetes management, potentially changing clinical practices. This therapy offers an effective avenue for managing type 2 diabetes by significantly reducing blood sugar levels and improving other health indicators.

Cardiovascular Disease Prevention and Type 2 Diabetes Treatment

A population-based cohort study in JAMA Network Open investigated the outcomes of SGLT 2i and GLP 1RA therapy among patients with type 2 diabetes, varied by the presence or absence of NAFLD. The study found that both therapies were associated with a reduced risk of major adverse cardiovascular events in patients with type 2 diabetes, regardless of NAFLD status. Specifically, SGLT 2i therapy was associated with a reduced risk of hospitalization for heart failure, supporting current guidelines that recommend GLP 1RA as the first line of therapy for patients with type 2 diabetes and NAFLD.

Stepping Towards Precision Medicine in Diabetes

The findings of these trials highlight the potential for personalized treatment in diabetes, providing valuable insights for future clinical and scientific work in precision medicine. Continuous pathophysiological variables could be more informative in predicting treatment response than stratified subgroups, suggesting a need for a more nuanced approach in diabetes treatment. As our understanding of the disease deepens, we move closer to a future where each patient’s treatment can be tailored according to their unique physiology, bringing us one step closer to the reality of precision medicine in diabetes care.



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Earlier puberty onset in both girls, boys with diabetes: Study | Health

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Research has discovered earlier puberty onset in both girls and boys with diabetes.

Earlier puberty onset in both girls, boys with diabetes: Study(Freepik)

Puberty in both girls and boys with type 1 diabetes has shifted forward over the last two decades, according to research presented at the 61st Annual European Society for Paediatric Endocrinology Meeting in The Hague.

Furthermore, longer diabetes duration, larger waistlines, and lower blood sugar levels were linked to even earlier puberty development.

The most frequent type of diabetes in children is type 1 diabetes. Puberty causes hormonal changes that can have an impact on metabolic regulation in diabetes. For example, the body can grow more resistant to insulin, raising blood sugar levels. Many studies have found earlier puberty onset around the world in recent years, notably in healthy girls. Diabetes, on the other hand, has been linked to a delay in pubertal onset in children.

ALSO READ: 5 reasons sleeping late at night is increasing your diabetes risk

Researchers from Germany examined data from the German DPV registry on the onset of puberty and pubic hair development of 65,518 children aged 6 to 18 years who were all diagnosed with type 1 diabetes between 2000 and 2021.

In this study, researchers from Germany analysed data on the onset of puberty and pubic hair development of 65,518 children aged 6-18 years, all diagnosed with type 1 diabetes between 2000 and 2021, from the German DPV registry.

They discovered that over the last two decades, both girls and boys have reached puberty six months earlier than before. This outcome was more pronounced in children who had diabetes for a longer period of time, were overweight, or had lower blood sugar levels.

“While the findings for girls align with previous research, our study is groundbreaking in revealing a similar trend in boys with type 1 diabetes for the first time,” said lead researcher Dr Felix Reschke from the Children’s Hospital Auf Der Bult in Hanover.

“As a result, we now anticipate that the average onset of puberty in boys with diabetes will occur just before the age of 12 (11.98 years).”

He added: “Our study demonstrates that children with diabetes are also experiencing this trend towards earlier puberty, which is already known in healthy girls, but not evident in boys yet. It’s also important to note that previous research indicated that type 1 diabetes may lead to delayed pubertal onset, thus our study provides new insights into the complex relationship between type 1 diabetes and puberty onset.”

Many factors that alter puberty in children, such as healthy girls, have been associated with early puberty. However, early puberty often does not have an obvious cause.

“Our research not only sheds light on the evolving landscape of puberty timing in children with type 1 diabetes but also underscores the intricate interplay between metabolic factors, hormones, and environmental influences,” said Dr Reschke. “Further investigations are warranted to explore these dynamics comprehensively and inform targeted interventions for this vulnerable population.”

This story has been published from a wire agency feed without modifications to the text. Only the headline has been changed.



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Night owls have a higher risk of Type 2 diabetes, says study. How can night-shifters control blood sugar? | Health and Wellness News

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If you are at a desk job, move around or take a small walk every two hours during the shift. Don’t go near the vending machine and slot an exercise schedule in your functional cycle, says Dr Anoop Misra, Chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences

diabetes night owlsNight owls may need to pay more attention to their lifestyle because their chronotype may increase the risk for Type-2 diabetes (Source: Getty Images)

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Are you a night owl? Then you are likely to have a higher risk of developing Type-2 diabetes. A recently published study from the US shows that people with “evening chronotype” or those who prefer to be active in the evening, sleep and wake up late are 19 per cent more likely to develop diabetes, even after the researchers accounted for lifestyle factors. This means that unhealthy habits may explain away a large proportion of the risk but not all of it.

“Night owls may need to pay more attention to their lifestyle because their chronotype may increase the risk for Type-2 diabetes,” say the study’s corresponding author and associate epidemiologist from Brigham and Women’s Hospital, Boston, Tianyi Huang. Chronotype refers to a person’s preferred timing of sleeping and waking up, which is partly determined by genetics, and cannot be changed easily. The study, based on data from over 63,000 women nurses, found that those who prefer to stay up and work at night are more likely to consume alcohol in higher quantities, have low-quality diet, smoke and have less physical activity.

Why does the evening chronotype increase the risk of diabetes?

First, the evening chronotype is likely to develop more unhealthy lifestyle habits. “Those who go to bed late at night are much more likely to snack after dinner. When they wake up, they are unlikely to have time for exercise before heading out for work or through afternoons and evenings when they are at work,” says Dr Anoop Misra, Chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences. Those with evening chronotype are also much more likely to have an irregular sleep pattern that leads to increased glucose intolerance.

The chronotype can also impact hormones. As Dr Misra explains, “The secretion of melatonin depends on the light. Exposure to a lot of light during the night is likely to reduce melatonin secretion, which is known to regulate insulin secretion. The sleep-wake cycle also affects the cortisol levels in the body, which in turn leads to insulin resistance and obesity.”

How can I protect myself?

Dr Misra says even those with evening chronotype can reduce their risk of diabetes by following a good routine and remaining disciplined. “If a person makes time for a workout in the evening, if they do not snack at night and follow a proper routine within their functional cycle, they can have a reduced risk of diabetes.” Those with evening chronotype may also try to retrain themselves by waking up and going to bed 15 to 30 minutes earlier each day, experts say.

The US researchers found the increased risk associated with evening chronotype in nurses who worked day shifts, not those who worked overnight shifts. “When chronotype was not matched with work hours, we saw an increase in Type 2 diabetes risk. That was another very interesting finding, suggesting that more personalised work scheduling could be beneficial,” say researchers.

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What can I do if I work on a night shift?

If you cannot avoid a night shift, Dr Misra suggests some practical ways you can remain healthy. If you are at a desk job, you should move around or take a small walk every two hours during the shift. He advises that people consume healthy snacks at night and avoid going to vending machines. People must avoid colas that may be more readily available at night than healthier beverages. Most importantly, those working night shifts should also make time for regular exercise in their routine.

“The good thing about the current study is that it has a big sample size. However, the study is based on a single questionnaire. Multiple questionnaires over a period of time would have given more details on whether the participants stuck to a particular lifestyle,” says Dr Misra.

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First published on: 14-09-2023 at 12:42 IST



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Prevalence of Vitamin D Deficiency in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

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New Study of Chicago ER Patients Reveals Troubling Findings on Diabetes – NBC Chicago

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A new study published in the JAMA Network by UI Health staff found hundreds of unsuspecting patients had diabetes and prediabetes, that left untreated could lead to major complications down the road.

“What’s novel about this is that we’re conducting a preventative health screening within our emergency department. So most people that are coming to the emergency department are not coming in because they want to be screened. But we also know that diabetes is of high prevalence within our community,” Dr. Janet Lin said, an ER physician who helped implement the diabetes screenings.

For three months starting in February 2021, UI Health randomly screened more than 2,000 ER patients who met criteria for a diabetes screening.

Of the 2,074 screened, 52.3% had an abnormal A1C result. A stunning number, but that isn’t what shocked doctors the most.

“70% of the people that basically had an abnormal test, in aggregate, did not know that they were either prediabetic, or diabetic,” Dr. Lin said.

Of those 1,085 patients with abnormal results, 69.9% were prediabetic and 30.1% were diabetic. Among those patients, 62 had severe diabetes, which could be life-threatening.

“If it goes uncontrolled, it will lead to a lot of complications that include stroke, heart attacks, kidney failure, loss of limbs, loss of vision,” Dr. Lin said.

Dr. Lin and the study authors say this should be a wake up call that diabetes screenings are important, and often consist of a simple blood test.

The American Diabetes Association recommends anyone over the age of 45 be screened for diabetes every three years. People between the ages of 18-44, with a BMI greater than 25, which is an indication of obesity, should also be screened every three years as well.

UI Health has continued the diabetes screening beyond the pilot study that lasted three months and they’re seeing similar results. On average, they are diagnosing 300 people every month with prediabetes or diabetes, through the emergency room screenings.

When coordinators called one of the first patients who was found to have prediabetes, Dr. Janet Lin said he answered the phone right away and was very surprised by the results.

“He said, “What?” And he’s like, you know, I’m in line at the McDonald’s. I was just about to buy a Big Mac or some other thing. He’s like, I am not going to get a Big Mac, please tell me how I can actually help change my lifestyle,” Dr. Lin said.

Patients are referred for further care, a win for the medical community that is working hard to fight what is often called a silent disease.

“This is an opportunity for us to be able to screen for people that might not otherwise get screened,” Dr. Lin said.



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Study suggests COVID-19 can cause diabetes

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Study: New-Onset Diabetes and COVID-19: Evidence from a Global Clinical Registry. Image Credit: ADragan / Shutterstock


The authors of a new study under review at Nature Portfolio and currently posted to the Research Square preprint* server showed the clinical possibility that the coronavirus disease 2019 (COVID-19) heightens the risk of developing diabetes mellitus (DM), supporting diabetes screening in those infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 

Study: New-Onset Diabetes and COVID-19: Evidence from a Global Clinical Registry. Image Credit: ADragan / ShutterstockStudy: New-Onset Diabetes and COVID-19: Evidence from a Global Clinical Registry. Image Credit: ADragan / Shutterstock

Background

An increasing body of evidence suggests that COVID-19 is associated with new diabetes diagnoses. However, it is unclear whether COVID-19 detects pre-existing diabetes or induces new-onset diabetes.

Although previous research reported high blood-sugar levels and metabolic consequences resulting from pre-existing diabetes following COVID-19 hospitalization, studies correlating the disease to new-onset DM are scarce.

COVID-19 has been shown to exacerbate pre-existing diabetes. This likely occurs because COVID-19 is associated with low-grade inflammation, which may initiate or worsen insulin resistance. In addition, numerous studies have also demonstrated that SARS-CoV-2 can infest and multiply within insulin-producing pancreatic beta-cells, thus impairing insulin synthesis and secretion. 

However, whether SARS-CoV-2 can cause clinically meaningful changes in glucose metabolism remains unclear. Nevertheless, it may be possible to find an answer by characterizing the clinical symptoms of COVID-19-related diabetes and by determining the period between the onset of hyperglycemia and that of the infection.

It is imperative to establish a causal relationship between COVID-19 and diabetes since both diseases are prevalent throughout the world. Furthermore, establishing a causal relationship will have significant implications for diagnosis, management, public health, and scientific research. Despite this, it remains unclear whether the association between COVID-19 and diabetes results from indirect health consequences of the former, such as – a higher rate of detection of pre-existing diseases, or whether the causative virus (SARS-CoV-2) directly precipitates hyperglycemia. 

Owing to the higher rate of pre-existing disease detection in the COVID era, newly diagnosed diabetes may be explained both during and after an episode of infectious exposure.

The study

This study investigated the possibility that COVID-19 may trigger new-onset diabetes and its associated symptoms by examining average blood-glucose levels at the time of diabetes presentation against a global clinical registry.

A global COVID-19-related diabetes (CoviDIAB) registry was established to determine whether COVID-19 can acutely induce diabetes and its clinical symptoms. The CoviDIAB registry collects information regarding “newly diagnosed diabetes” and “severe metabolic complications associated with pre-existing diabetes” resulting from COVID-19. 

Individuals with a fasting blood glucose of 126 mg/dL or above or non-fasting blood glucose of 200 mg/dL or above, with no prior diabetes history, and those who had never been on glucose-lowering medications, and with their glycated hemoglobin (HbA1c) levels below the diabetic range (< 6.5%) at presentation were categorized as new-onset diabetes. Here, the researchers examined cases of newly diagnosed diabetes that occurred within four weeks of COVID-19 confirmation. In addition, the HbA1c data were evaluated at the time of diabetes detection to rule out pre-existing hyperglycemia and to confirm the association with SARS-CoV-2 infection.

The findings

Data on 537 eligible newly diagnosed diabetes cases was entered from 61 hospitals in 25 countries between 2020-2022. COVID-19 patients with newly diagnosed diabetes at presentation had HbA1c levels above the diagnostic range, suggesting pre-existing hyperglycemia.

In cases with new-onset hyperglycemia after the SARS-CoV-2 infection, individuals displayed glycemic levels above the diagnostic thresholds, although their HbA1c levels remained within the non-diabetic range. The results showed that 22% of newly diagnosed patients with documented HbA1c levels had recently acquired diabetes.

The most common diabetes subtype among adults was type 2 DM (59%), and the “not yet known” subtype (41%). Two newly diagnosed cases of type 1 DM were recorded among children. After COVID-19 resolution, hyperglycemia persisted in 39 of 89 patients (45%) with newly diagnosed diabetes.

For 28 of these individuals, follow-up data beyond three months was collected, demonstrating that five of them were in remission from diabetes, while 23 (82%) remained diabetic. 

The findings suggested that COVID-19 causes clinically significant changes in glucose metabolism. Although this study does not prove that SARS-CoV-2 causes diabetes, it strongly suggests that the virus may impose a diabetogenic aftermath. 

Further, type 2 DM was the predominant subtype among COVID-19 participants with newly diagnosed diabetes. Thus, type 2 DM likely accounts for most newly diagnosed diabetes cases associated with the post-acute phase of the SARS-CoV-2 infection.

This study confirms this phenomenon across diverse geographical locations and ethnicities by incorporating clinical observations from 25 countries. 

Numerous areas for improvement have been identified in this study, including inherent heterogeneity in clinical practice and the judgment of contributing physicians. 

Conclusion

The results of this study suggest that COVID-19 likely has a diabetogenic effect. Thus, individuals exposed to SARS-CoV-2 infection must be screened for diabetes. Further research is necessary to confirm the mechanisms through which the virus interferes with glucose metabolism.

*Important notice

Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.



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Diabetes indicators improve with use of health incentives, CDC study finds –

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Incentivizing patients to follow a lifestyle modification program helps them improve across a range of diabetes-related health measures, a new meta-analysis has found.

Investigators performed what they said is the first systematic review and meta-analysis to examine the effect of incentives on diabetes-related health indicators when patients participate in lifestyle modification programs. 

The researchers analyzed data from 19 randomized controlled trials. Relative to a control group, the incentive group had significant reductions in weight, and both systolic and diastolic blood pressure. One study found a significant reduction in hemoglobin A1c. A reduction in cholesterol level was also noted but was not significant. 

Six incentive-related domains were also studied. These included type of incentive, monetary value, recipient of the incentive (such as individuals, groups or a combination of both), frequency of incentives, certainty of incentive attainment and schedule (how the amount of the incentive was provided to recipients during the study period). 

Incentive effects

When incentives were provided, the meta-analysis showed patients experienced a nearly 2 kg greater weight loss and a significant reduction in BMI compared to no incentive, reported the authors, including researchers from the Centers for Disease Control and Prevention. 

“This finding has important health implications considering that a large study reported a 16% reduction in diabetes risk for every kilogram of weight lost, and others have shown that weight loss in conjunction with a lifestyle modification program can lower the risk for cardiovascular disease,” they wrote.

Incentives were also shown to be effective for reducing systolic and diastolic blood pressure. Those findings suggest a benefit for programs that seek to help participants achieve ideal blood pressure goals, such as less than 140/90 mm Hg, the authors said. This would be especially helpful for programs associated with chronic disease prevention and management, they added. 

Incentive type

Type of incentive did not appear to have an outsized effect on the positive results. “Therefore, it seems reasonable for lifestyle modification programs to use a variety of incentive domain subgroups,” the authors concluded.

Adults aged 65 years and older make up approximately 40% of the adult diabetic population, according to federal data from 2018. In nursing homes, the prevalence of diabetes is estimated to range from 25% to 34%. 

The current study was published in the CDC’s journal Preventing Chronic Diseases.

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