Diabetology & Metabolic Syndrome

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ISSN / EISSN : 1758-5996 / 1758-5996
Current Publisher: Springer Science and Business Media LLC (10.1186)
Total articles ≅ 1,265
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Wanwan Luo, Lingmin Zhang, Lingling Sheng, Zhencheng Zhang, Zaixing Yang
Diabetology & Metabolic Syndrome, Volume 13, pp 1-9; doi:10.1186/s13098-021-00624-9

Background Diabetes mellitus (DM) could be classified as type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), gestational diabetes mellitus (GDM) and others according to etiology and pathology. Diabetic nephropathy (DN) is one of the most serious complications of DM. YKL-40 is a marker of inflammation and some studies have indicated that DM was related with inflammation. The objective of our study is to perform a systematic review and meta-analysis to confirm the relationship between YKL-40 and DM as well as DN. Methods Pubmed, Embase, CNKI and Chinese wanfang databases were searched for eligible studies by two independent authors. Studies were included in this meta-analysis if they fulfilled the following inclusion criteria: (1) a study involving the role of YKL-40 in DM (or DN) designed as a case–control study or cohort study; (2) the data of serum YKL-40 levels were available; (3) studies were published in English or Chinese. Finally, twenty-five studies were included in this meta-analysis. Results Compared with healthy controls, DM patients had significantly higher levels of YKL-40 (DM: SMD = 1.62, 95% CI 1.08 to 2.25, P = 0.000; GDM: SMD = 2.85, 95% CI 1.01 to 4.70, P = 0.002). Additionally, DM patients with different degree of albuminuria had significantly higher levels of YKL-40 compared with healthy controls (normoalbuminuria: SMD = 1.58, 95% CI 0.59 to 2.56, P = 0.002; microalbuminuria: SMD = 2.57, 95% CI 0.92 to 4.22, P = 0.002; macroalbuminuria: SMD = 2.69, 95% CI 1.40 to 3.98, P = 0.000) and serum YKL-40 levels increased with increasing severity of albuminuria among DM patients (microalbuminuria vs normoalbuminuria: SMD = 1.49, 95% CI 0.28 to 2.71, P = 0.016; macroalbuminuria vs microalbuminuria: SMD = 0.93, 95% CI 0.34 to 1.52, P = 0.002). Conclusions Our current meta-analysis demonstrates that serum level of YKL-40 is increased in DM and positively associated with the severe degree of albuminuria. Therefore, we suggest that YKL-40 could be considered to be detected, along with other inflammatory markers, if DM, especially DN, is suspected.
Dafeng Liu, Yong Wang, Bennan Zhao, Lijuan Lan, Yaling Liu, Lei Bao, Hong Chen, Min Yang, Qingfeng Li, Yilan Zeng
Published: 12 January 2021
Diabetology & Metabolic Syndrome, Volume 13, pp 1-12; doi:10.1186/s13098-020-00622-3

Background A dysregulated host immune response is common in patients with COVID-19. Aim In this study, we aimed to define the characteristics of lymphocyte subsets and their relationship with disease progression in COVID-19 patients with or without diabetes mellitus (DM). Methods The baseline peripheral lymphocyte subsets were compared between 55 healthy controls and 95 patients with confirmed COVID-19, and between severe and non-severe COVID-19 patients with or without DM. Results The prevalence of DM in the COVID-19 group was 20%, and patients with severe COVID-19 had a higher prevalence of DM than those with non-severe disease (P = 0.006). Moreover, a significantly poor prognosis and a higher rate of severity were found in those with DM relative to those without DM (P = 0.001, 0.003). Generally, all lymphocytes and subsets of lymphocytes, especially B and T cells, were significant reduced in COVID-19 patients, particularly in those with DM. Patients with severe COVID-19 and DM had the lowest lymphocyte counts compared with those with severe COVID-19 without DM, and those with non-severe COVID-19 with or without DM. Partially decreased lymphocyte subsets, age and DM were closely related to disease progression and prognosis. Conclusions These findings provide a reference for clinicians that immunomodulatory treatment may improve disease progression and prognosis of COVID-19 patients, especially those with severe disease with DM. Trial registration Chinese Clinical Trial Register ChiCTR2000034563
Yeo Jin Kim, Sang Mi Kim, Dae Hyun Jeong, Sang-Kyu Lee, Moo-Eob Ahn, Ohk-Hyun Ryu
Diabetology & Metabolic Syndrome, Volume 13, pp 1-12; doi:10.1186/s13098-020-00620-5

Background Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of cardiovascular disease. However, the relationship between metabolic syndrome and dementia has remained controversial. Using nationwide population cohort data, we investigated the association between metabolic syndrome and dementia, according to the dementia type. Methods We analyzed data of 84,144 individuals, in the aged group of more than 60 years, between January 1, 2009, to December 31, 2009, at Gangwon province by using the information of the (Korean) National Health Insurance Service. After eight years of gap, in 2017, we investigated the relationship between metabolic syndrome and dementia. We classified Dementia either as dementia of the Alzheimer type (AD) or vascular dementia (VD). AD and VD were defined as per the criteria of International Classification of Disease, Tenth Revision, Clinical Modification codes. Multiple logistic regression analyses examined the associations between metabolic syndrome or five metabolic syndrome components and dementia. Analyses included factors like age, sex, smoking, alcohol, physical inactivity, previous stroke, and previous cardiac disease. Results Metabolic syndrome was associated with AD (OR = 11.48, 95% CI 9.03–14.59), not with VD. Each of five components of metabolic syndrome were also associated with AD. (high serum triglycerides: OR = 1.87, 95% CI 1.60–2.19; high blood pressure: OR = 1.85, 95% CI 1.55–2.21; high glucose: OR = 1.77, 95% CI 1.52–2.06; abdominal obesity: OR = 1.88, 95% CI 1.57–2.25; low serum high-density lipoprotein cholesterol: OR = 1.91, 95% CI 1.63–2.24) However, among components of metabolic syndrome, only the high glucose level was associated with VD. (OR = 1.26, 95% CI 1.01–1.56) body mass index (BMI), fasting glucose, and smoking were also associated with AD. (BMI: OR = 0.951, 95% CI 0.927–0.975; fasting glucose: OR = 1.003, 95% CI 1.001–1.005; smoking: OR = 1.020, 95% CI 1.003–1.039) A history of the previous stroke was associated with both AD and VD. (AD: OR = 1.827, 95% CI 1.263–2.644; VD: OR 2.775, 95% CI 1.747–4.406) Conclusions Metabolic syndrome was associated with AD but not with VD. Patients with metabolic syndrome had an 11.48 times more likeliness to develop AD compared to those without metabolic syndrome. VD was associated only with several risk factors that could affect the vascular state rather than a metabolic syndrome. We suggested that the associations between metabolic syndrome and dementia would vary depending on the type of dementia.
Zahra Yari, Zahra Naser-Nakhaee, Elahe Karimi‐Shahrbabak, Makan Cheraghpour , Mehdi Hedayati, Seyede Marjan Mohaghegh, Shahrzad Ommi, Azita Hekmatdoost
Diabetology & Metabolic Syndrome, Volume 13, pp 1-11; doi:10.1186/s13098-020-00619-y

Background Regarding the increasing prevalence of cardiometabolic abnormalities, and its association with non-communicable chronic diseases, providing preventive and therapeutic strategies is a priority. A randomized placebo-controlled study was conducted to assess the effects of combination therapy of milled brown flaxseed and hesperidin during lifestyle intervention on controlling cardiovascular risk in prediabetes. Methods A total of forty-eight subjects were randomly assigned to receive lifestyle intervention plus combination therapy of brown flaxseed (30 g milled) and hesperidin (two 500 mg capsules) or lifestyle modification alone for 12 weeks. Changes from baseline in anthropometric measures, lipid profile and atherogenic indices, glucose homeostasis parameters, and inflammatory biomarkers was assessed as a primary end point. Results Anthropometric data comparison between the two groups showed a significant reduction in weight (p = 0.048). Waist circumference reduction was about twice that of the control group (− 6.75 cm vs − 3.57 cm), but this difference was not statistically significant. Comparison of blood pressure changes throughout the study indicated a greater reduction in blood pressure in the intervention group rather than control group (− 5.66 vs. − 1.56 mmHg, P = 0.049). Improvements of lipid profile and atherogenic indices, glucose homeostasis parameters, and inflammatory biomarkers in flaxseed-hesperidin group was significantly more than the control group after 12 weeks of intervention (p < 0.05). Conclusion Our results indicate that co-administration of flaxseed and hesperidin as an adjunct to lifestyle modification program is more effective than lifestyle modification alone in the metabolic abnormalities remission of prediabetic patients. Trial registration: The trial was registered with ClinicalTrials.gov, number NCT03737422. Registered 11 November 2018. Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT03737422&cntry=&state=&city=&dist=.
M. Rodacki , L. E. Calliari, A. C. Ramalho, A. G. D. Vianna, D. R. Franco, K. F. S. Melo, L. R. Araujo, M. Krakauer, M. Scharf, W. Minicucci, et al.
Diabetology & Metabolic Syndrome, Volume 13, pp 1-10; doi:10.1186/s13098-020-00607-2

This manuscript reports the Brazilian Diabetes Society Position Statement for insulin adjustments based on trend arrows observed in continuous glucose monitoring systems. The Brazilian Diabetes Society supports the utilization of trend arrows for insulin dose adjustments in patients with diabetes on basal-bolus insulin therapy, both with multiple daily insulin doses or insulin pumps without closed-loop features. For those on insulin pumps with predictive low-glucose suspend feature, we suggest that only upward trend arrows should be used for adjustments. In this paper, tables for insulin adjustment based on sensitivity factors are provided and strategies to optimize the use of trend arrows in clinical practice are discussed.
Golaleh Asghari, Mitra Hasheminia, Abolfazl Heidari, Parvin Mirmiran, Kamran Guity, Mohammad Karim Shahrzad , Fereidoun Azizi, Farzad Hadaegh
Diabetology & Metabolic Syndrome, Volume 13, pp 1-9; doi:10.1186/s13098-020-00608-1

Aim To investigate the association of youth metabolic syndrome (MetS) and its components, individually and in combination with early adulthood incident type 2 diabetes (T2DM). Methods A total of 2798 adolescents aged 11–19 years enrolled in the study. At baseline, MetS, its components including blood pressure (BP), waist circumference (WC), triglycerides (TGs), fasting plasma glucose, and low HDL-C, and different combinations of MetS components were defined. After a mean 11.3 years of follow-up, T2DM was determined. Multivariable Cox proportional hazard regression analysis adjusted for age, sex, family history of T2DM, and adult BMI was used for data analysis. The hazard ratio (HR) and 95% confidence interval (CI) were reported. Results During the follow-up, 44 incidents T2DM were developed. Among different individual components, only high WC [HR = 2.63, 95% CI (1.39–4.97)] and high TGs [HR = 1.82, 95% CI (1.00–3.34)] remained as significant predictors only in the age and sex adjusted model. Regarding combinations of MetS components, ‘high TGs and high WC’ [HR = 2.70, 95% CI (1.27–5.77)], ‘high BP and high WC’ [HR = 2.52, 95% CI (1.00–6.33)], ‘high TGs and high BP’ [HR = 2.27, 95% CI (1.02–5.05)] as well as MetS per se [HR = 2.82, 95% CI (1.41–5.64)] had a significant relationship with incident T2DM in the multivariable adjusted model. Among different confounders, being female and having family history of T2DM were consistently associated with higher risk of T2DM, in different combinations of MetS components. Conclusions Adolescence MetS and some combinations of MetS components predicted early adulthood T2DM. Thus, adolescents, particularly female ones, with combinations of MetS components as well as those with family history of T2DM could be targeted for lifestyle intervention.
Jing Chang, Yanming Yu, Zhan Fang, Haiyan He, Dan Wang, Jian Teng, Lina Yang
Diabetology & Metabolic Syndrome, Volume 12, pp 1-11; doi:10.1186/s13098-020-00618-z

Background Long non-coding RNA cyclin-dependent kinase inhibitor 2B antisense RNA 1 (CDKN2B-AS1) has been reported to be related to diabetic nephropathy (DN) progression. However, the regulatory mechanisms of CDKN2B-AS1 in DN are unclear. Methods High glucose (HG) was used to induce human mesangial cells (HMCs) for establishing the DN model. Expression levels of CDKN2B-AS1, microRNA (miR)-15b-5p, wingless-Type family member 2B (WNT2B) mRNA in serum and HMCs were detected through quantitative real-time polymerase chain reaction (qRT-PCR). The viability and cell cycle progression of HMCs were determined with Cell Counting Kit-8 (CCK-8) or flow cytometry assays. The levels of several proteins and inflammatory factors in HMCs were analyzed by western blotting or enzyme-linked immunosorbent assay (ELISA). The relationship between CDKN2B-AS1 or WNT2B and miR-15b-5p was verified with dual-luciferase reporter assay. Results CDKN2B-AS1 and WNT2B were upregulated while miR-15b-5p was downregulated in serum of DN patients and HG-treated HMCs. CDKN2B-AS1 inhibition reduced HG-induced viability, cell cycle progression, ECM accumulation, and inflammation response in HMCs. CDKN2B-AS1 regulated WNT2B expression via competitively binding to miR-15b-5p. MiR-15b-5p inhibitor reversed CDKN2B-AS1 knockdown-mediated influence on viability, cell cycle progression, ECM accumulation, and inflammation response of HG-treated HMCs. The repressive effect of miR-15b-5p mimic on viability, cell cycle progression, ECM accumulation, and inflammation response of HG-treated HMCs was abolished by WNT2B overexpression. Conclusion CDKN2B-AS1 regulated HG-induced HMC viability, cell cycle progression, ECM accumulation, and inflammation response via regulating the miR-15b-5p/WNT2B axis, provided a new mechanism for understanding the development of DN.
Mostafa Qorbani, Pouria Khashayar, Hadith Rastad, Hanieh-Sadat Ejtahed, Ehsan Shahrestanaki, Ehsan Seif, Seyede Shahrbanoo Daniali, Masoomeh Goudarzi, Mohammad Esmaeil Motlagh, Zeinab Khodaparast, et al.
Published: 7 December 2020
Diabetology & Metabolic Syndrome, Volume 12, pp 1-7; doi:10.1186/s13098-020-00617-0

Background and aims To examine the association of dietary behaviors, lifestyle, and biochemical factors with metabolic phenotypes of obesity among obese Iranian children and adolescents. Methods This cross-sectional study was conducted within the framework of the fifth phase of CASPIAN study. Of 3840 students aged 7–18 years of 30 Iranian provinces, 408 subjects were diagnosed as obese; they were divided into metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) groups. Biochemical factors, anthropometric measures, dietary, and lifestyle habits were compared between groups. Results Of the 408 obese subjects, 68 (16.7%) were the MUO; the remaining 340 (84.3%) fall in the MHO group. The MUO group had significantly higher systolic and diastolic BPs, FBS, TG, ALT, anthropometric measures, and lower HDL levels than MHO groups (all p-value < 0.05). The frequency of high birth weight (> 4000 gr) was significantly higher in the MUO group than the MHO group (p-value: 0.04). A higher percentage of individuals with breastfeeding duration ≥ 6 month was found in the MUO group (95.5% (95% CI 86.1–98.6%)) compared to MHO group (85.7% (95% CI 80.4–89.7%)) (p-value = 0.04). Among dietary and lifestyle-related behaviors, only the frequency of salty snack consumption and eating food according to the parents’ request was significantly higher in the MUO group than the MHO group (p-value < 0.05). Conclusion Dietary habits and lifestyle factors may determine the obesity phenotypes in children and adolescents.
Zahra Aslani, Omid Sadeghi, Motahar Heidari-Beni, Hoda Zahedi, Fereshteh Baygi, Nitin Shivappa, James R. Hébert, Sajjad Moradi, Gity Sotoudeh, Hamid Asayesh, et al.
Diabetology & Metabolic Syndrome, Volume 12, pp 1-1; doi:10.1186/s13098-020-00615-2

An amendment to this paper has been published and can be accessed via the original article.
Lúcia Fadiga , Joana Saraiva, Diana Catarino, João Frade, Miguel Melo, Isabel Paiva
Diabetology & Metabolic Syndrome, Volume 12, pp 1-9; doi:10.1186/s13098-020-00616-1

Introduction Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA. Methods We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed. Results We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR–15) for T1DM and 42 years (IQR–15) for LADA (p = 0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p < 0.001). The mean BMI at diagnosis was 24.1 kg/m2 in T1DM group and 26.1 kg/m2 in LADA group (p = 0.042). In T1DM group, 67.4% of the patients had more than one positive autoantibody, comparing to 41.3% of LADA patients (p = 0.012). There was no statistical difference in what concerns to title of GAD autoantibodies, A1C and C-peptide at diagnosis of autoimmune aetiology. The presence of symptoms at diagnosis was associated with T1DM group (p < 0.001). The median daily insulin dose was 40 IU for T1DM (0.58 IU/kg) and 33.5 IU for LADA (0.57 IU/kg), with no statistical difference. LADA patients were more often under non-insulin antidiabetic drugs (p = 0.001). At 10 years follow up, 21.1% of T1DM patients and 63.3% of LADA patients had microvascular complications (p = 0.004). Diabetic nephropathy was present in 23.5% of T1DM patients and 53.3% of LADA patients (p = 0.047). At the last evaluation, 55.6% of T1DM and 82.6% of LADA patients had metabolic syndrome and this difference was independent of diabetes duration. Conclusion Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process. Patients with LADA developed more frequently microvascular complications for the same disease duration, namely diabetic nephropathy, and had more often metabolic syndrome.
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