Acta Diabetologica

Type 2 diabetes mellitus (T2DM) has a rising prevalence and gut microbiota involvement is increasingly recognized. Diabetic nephropathy (DN) is a major complication of T2DM. The aim of the study was to understand the gut–kidney axis by an analysis of gut microbiota composition among biopsy-proven DN, T2DM without kidney disease, and healthy control. Fecal samples were collected from 14 DNs, 14 age/gender-matched T2DMs without renal diseases (DM), 14 age and gender-matched healthy controls (HC) and household contacts (HH) of DM group. The microbiota composition was analyzed by 16sRNA microbial profiling approach. Substantial differences were found in the richness of gut microbiota and the variation of bacteria population in DM compared to HC, and DN compared to DM, respectively. DM could be accurately distinguished from age/gender-matched healthy controls by the variable of genus g_Prevotella_9 (AUC = 0.9), and DN patients could be accurately distinguished from age/gender-matched DM by the variables of two genera (g_Escherichia-Shigella and g_Prevotella_9, AUC = 0.86). The microbiota composition of HH group was close to that of HC group, and was different from DM group. Under the same diet, DM could be more accurately detected by the same genus (g_Prevotella_9, AUC = 0.92). Gut microbiota composition was explored to be related to the occurrence of biopsy-proven DN from DM. DM could be distinguished from HC by detecting g_Prevotella_9 level in feces, while DN was different from DM by the variables of g_Escherichia-Shigella and g_Prevotella_9, which potentially contributed to the physiopathological diagnosis of DN from DM.

The objective of this study is to ascertain if higher normal fasting glucose levels are also an independent risk of developing diabetes in an Asian population, and we thus analysed data from a cohort of healthy Japanese workers. We used data from the non-randomised trial on health promotion intervention, High-risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) Study. Diabetes cases and those who had fasting blood glucose levels equal to or greater than 100 mg/dl at baseline were excluded, and the Cox proportional-hazards model was used for the analysis. During the four-year follow-up of 2212 participants, we found 37 diabetes cases. In the multivariable model, people with blood glucose levels in the 4th quartile had a higher risk of diabetes than those in the bottom quartile; the multivariable-adjusted odds ratio was 2.52. The risk of diabetes abruptly rose in persons with blood glucose levels higher than 94 mg/dl (fourth quartile). A significant linear trend was not observed in the 1st to 3rd quartiles (p=0.726). In conclusion, higher fasting glucose level was associated with the risk of diabetes, and we found a threshold in the association between fasting blood glucose levels and risk of diabetes in an Asian population.

Diabetes mellitus is one of the largest global health concerns of recent times. Women with diabetes mellitus have a higher excess risk of all-cause mortality and more vascular events than men. Focusing on type 1 diabetes, this could be caused by gender inequalities in delivered diabetes care. This study aims to assess gender differences in type 1 diabetes outpatient care, particularly diagnostics and outcomes. This cross-sectional cohort study included all adult type 1 diabetes patients in the Dutch Pediatric and Adult Registry of Diabetes (DPARD) visiting diabetes outpatient clinics between 2016–2021. The frequency of process measurements, including physical examination and laboratory testing, was assessed among both sexes after adjustment for age and body mass index. Gender differences in eGFR ≥ 60, BMI-, and control in blood pressure and LDL-cholesterol were evaluated. Hospital variation in achieving HbA1c targets of 53 mmol/mol and median HbA1c were assessed. Cardiovascular risk scores were calculated in men and women using the Systematic Coronary Risk Evaluation (SCORE) European low-risk chart. Our study showed a 17% higher odds of reaching weight control and a 23% lower odds of achieving blood pressure targets in men than women. Gender-skewed cardiovascular mortality risk scores were found. Gender disparities in outcomes appear not to be caused by gender-biased attitudes in healthcare professionals since no gender differences were found in the performance of process measurements in type 1 diabetes care. In addition, hospitals appear to vary by extent of gender differences in achieving a target HbA1c of 53 mmol/mol. Gender equality exists in the diagnostic process of diabetes care. However, differences in weight control, blood pressure control, and cardiovascular mortality risk scores remain between both sexes, most likely due to multifactorial causes. Indications for interhospital variation in gender disparities in HbA1c control exist. Further focus on performance of process measurements between hospitals may identify areas for improvement of gender-skewed outcomes to further enhance Dutch diabetes care for both sexes.

The swelling technique evidenced inhibition of Pi transport in isolated mouse liver mitochondria by 1 mM or higher concentration of alloxan, while no effect was found with streptozotocin. Complete or partial protection against alloxan inhibition was found under the following conditions: preincubation at 4 °C, or pretreatment with Pi, glucagon, succinate, malate or pyruvate. Complete protection was observed in isolated mitochondria from mice injected with glucagon. No protection was seen under the following conditions: preincubation at 37 °C, addition of microsomes, or pretreatment with insulin or glucagon in the presence of glucagon antibodies. So-called light and heavy mitochondria were as sensitive to alloxan as those obtained with the routine technique. Alloxanic acid had no effect, and addition of cysteine or glutathione abolished the inhibition by alloxan. Alloxan inhibited Pi transport also in isolated lung mitochondria. The findings suggest a direct action of alloxan on mitochondrial Pi transport which is affected by the energetic state. A relationship seems to exist between protection against alloxan toxicityin vivo and protection under the present experimental conditions.

Các tác giả phân tích 100 ca phẫu thuật trên 75 bệnh nhân được chọn từ tổng số 580 trường hợp tiểu đường trong diện điều trị của họ. Các cuộc phẫu thuật nghiêm trọng ảnh hưởng đáng kể đến quá trình chuyển hóa của bệnh nhân tiểu đường đã được thực hiện ở 52 ca; phần lớn trong số đó là các phẫu thuật thuộc chuyên khoa phụ khoa và phẫu thuật tổng quát. Trong 15 ca, do tác động của phẫu thuật, quá trình dinh dưỡng bình thường đã bị cản trở trong vài ngày. Để khắc phục những khó khăn này, sự hợp tác chặt chẽ giữa bác sĩ phẫu thuật và bác sĩ nội khoa là cần thiết. Người ta đã cố gắng, trong khả năng cho phép, điều chỉnh bệnh nhân một cách thích hợp trước phẫu thuật (insulin được sử dụng theo dạng nhỏ, liều thấp, tác động ngắn, và kiểm soát tuần hoàn tùy theo nhu cầu) và thực hiện điều trị sau phẫu thuật trong khoa nội. Việc kiểm soát các trường hợp phẫu thuật khẩn cấp đã được thực hiện thông qua nhiều can thiệp của bác sĩ nội khoa. Đã có hai trường hợp tử vong sau phẫu thuật (2,66%), với nguyên nhân không liên quan đến bệnh tiểu đường. Sự hợp tác chặt chẽ đã giúp mở rộng chỉ định phẫu thuật (đặc biệt liên quan đến phẫu thuật cắt túi mật).