January 2025
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4 Reads
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January 2025
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4 Reads
December 2024
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16 Reads
European Journal of Endocrinology
Objective We have shown that men aged 50 years+ at high risk of type 2 diabetes treated with testosterone together with a lifestyle program reduced the risk of type 2 diabetes at two years by 40% compared to a lifestyle program alone. To develop a personalized approach to treatment, we aimed to explore a prognostic model for incident type 2 diabetes at two years and investigate biomarkers predictive of the testosterone effect. Design Model development in 783 men with impaired glucose tolerance but not type 2 diabetes from T4DM; a multicenter, 2-year trial of Testosterone vs placebo. External validation performed in 236 men from the EXamining OuTcomEs in chroNic Disease in the 45 and Up Study (EXTEND-45, n=267,357). Methods Type 2 diabetes at two years defined as 2-hour fasting glucose by oral glucose tolerance test (OGTT) ≥ 11.1mmol/L. Risk factors, including predictive biomarkers of testosterone treatment, were assessed using penalized logistic regression. Results Baseline HbA1c and 2-hour OGTT glucose were dominant predictors, together with Testosterone, age, and an interaction between Testosterone and HbA1c (p=0.035, greater benefit with HbA1c≥5.6%, 38mmol/mol). The final model identified men who developed type 2 diabetes, with C-statistics 0.827 in development and 0.798 in validation. After recalibration, the model accurately predicted a participant’s absolute risk of type 2 diabetes. Conclusions Baseline HbA1c and 2-hour OGTT glucose predict incident type 2 diabetes at 2 years in high-risk men, with risk modified independently by Testosterone treatment. Men with HbA1c≥5.6% (38mmol/mol) benefit most from Testosterone treatment, beyond a lifestyle program.
December 2024
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36 Reads
Introduction This analysis aimed to investigate diabetes-specific psychological outcomes among adults with type 1 diabetes (T1D) using hybrid closed-loop (HCL) versus standard therapy. Research design and methods In this multicenter, open-label, randomized, controlled, parallel-group clinical trial, adults with T1D were allocated to 26 weeks of HCL (MiniMed™ 670G) or standard therapy (insulin pump or multiple daily injections without real-time continuous glucose monitoring). Psychological outcomes (awareness and fear of hypoglycemia; and diabetes-specific positive well-being, diabetes distress, diabetes treatment satisfaction, and diabetes-specific quality of life (QoL)) were measured at enrollment, mid-trial and end-trial. Linear mixed models were conducted, using restricted maximum likelihood estimation, unadjusted and adjusted (for covariates: age, sex, diabetes duration, glycated hemoglobin, recent severe hypoglycemia, pre-trial insulin delivery modality, enrollment and mid-study scores). Results 120 participants (mean age 44±12 years) were randomized to intervention (n=61) or standard therapy (n=59). At 13 weeks, the HCL group had better diabetes-specific positive well-being than the standard therapy group (unadjusted: Δ=1.0, p=0.025; adjusted: Δ=1.1, p=0.01), which was maintained at 26 weeks (unadjusted: Δ=0.9, p=0.042; adjusted: Δ=1.0, p=0.023). At 26 weeks, the HCL group also had less diabetes distress (adjusted: Δ=−6.4, p=0.039), fear of hypoglycemia (“maintain high”: adjusted: Δ=−0.8, p=0.034; and “worry”: adjusted: Δ=−1.8, p=0.048), and perceived “unacceptably high glucose levels” (unadjusted: Δ=−1.1, p<0.001; adjusted: Δ=−1.1, p<0.001). HCL did not improve diabetes treatment satisfaction, diabetes-specific QoL, hypoglycemia awareness, or perceived frequency of unacceptably low glucose levels. Conclusions These findings imply that HCL offers important psychological benefits. In particular, improvement in diabetes-specific positive well-being was observed 13 weeks after HCL initiation and maintained at 26 weeks. Reduction in the perceived frequency of hyperglycemia was also apparent by 26 weeks. Adjusted analyses showed significant reductions in diabetes distress and fear of hypoglycemia at 26 weeks, suggesting these benefits were apparent for people with particular characteristics. Trial registration number Australian New Zealand Clinical Trials Registry: ACTRN12617000520336.
December 2024
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2 Reads
Jama Ophthalmology
November 2024
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32 Reads
Internal Medicine Journal
Less than 20% of Australians with type 1 diabetes (T1D) meet recommended glucose targets. Technology use is associated with better glycaemia, with the most advanced being automated insulin delivery (AID) systems, which are now recommended as gold‐standard T1D care. Our Australian AID trial shows a wide spectrum of adults with T1D can achieve recommended targets. Other studies, including lived experience data, are supportive. Insulin pumps are not subsidised for most Australian adults with T1D. We advocate change.
October 2024
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47 Reads
Nature Reviews Endocrinology
Although type 1 diabetes mellitus (T1DM) is traditionally viewed as a youth-onset disorder, the number of older adults being diagnosed with this disease is growing. Improvements in the average life expectancy of people with T1DM have also contributed to the growing number of older people living with this disease. We summarize the evidence regarding the epidemiology (incidence, prevalence and excess mortality) of T1DM in older adults (ages ≥60 years) as well as the genetics, immunology and diagnostic challenges. Several studies report an incidence peak of T1DM in older adults of a similar size to or exceeding that in children, and population prevalence generally increases with increasing age. Glutamic acid decarboxylase antibody positivity is frequently observed in adult-onset T1DM. Guidelines for differentiating T1DM from type 2 diabetes mellitus in older adults recommend measuring levels of C-peptide and autoantibodies, including glutamic acid decarboxylase antibodies. However, there is no gold standard for differentiating T1DM from type 2 diabetes mellitus in people aged 60 years and over. As such, the global variation observed in T1DM epidemiology might be in part explained by misclassification, which increases with increasing age of diabetes mellitus onset. With a growing global population of older adults with T1DM, improved genetic and immunological evidence is needed to differentiate diabetes mellitus type at older ages so that a clear epidemiological picture can emerge.
September 2024
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23 Reads
Diabetes Obesity and Metabolism
Diabetic ketoacidosis (DKA) is a life‐threatening complication usually affecting people with type 1 diabetes (T1D) and, less commonly, people with type 2 diabetes. Early identification of ketosis is a cornerstone in DKA prevention and management. Current methods for ketone measurement by people with diabetes include capillary blood or urine testing. These approaches have limitations, including the need to carry testing strips that have a limited shelf life and a requirement for the user to initiate a test. Recent studies have shown the feasibility of continuous ketone monitoring (CKM) via interstitial fluid with a sensor inserted subcutaneously employing an enzymatic electrochemical reaction. Ketone readings can be updated every 5 minutes. In the future, one would expect that commercialized devices will incorporate alarms linked with standardized thresholds and trend arrows. Ideally, to minimize the burden on users, CKM functionality should be integrated with other devices used to implement glucose management, including continuous glucose monitors and insulin pumps. We suggest CKM provision to all at risk of DKA and recommend that the devices should be worn continuously. Those who may particularly benefit are individuals who have T1D, are pregnant, on medications such as sodium‐glucose linked transporter (SGLT) inhibitors that increase DKA, people with recurrent DKA, those with T1D undertaking high intensity exercise, are socially or geographically isolated, or those on low carbohydrate diets. The provision of ketone profiles will provide important clinical insights that have previously been unavailable to people living with diabetes and their healthcare professionals.
September 2024
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44 Reads
Heart, Lung and Circulation
August 2024
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35 Reads
Aims/Hypothesis In diabetes haptoglobin (Hp) 2 vs Hp 1 allelic product is associated with cardiac and renal complications. Few studies report both Hp phenotype and Hp levels. In a Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial substudy we evaluated the Hp phenotype, Hp levels, and fenofibrate effects. Materials and Methods In 480 adults with type 2 diabetes (T2D) the Hp phenotype was assessed and the Hp level quantified (both using ELISAs assays) in plasma from baseline, after 6 weeks of fenofibrate, and (in n = 200) at 2 years post‐randomization to fenofibrate or placebo. Results The Hp phenotypes 1‐1, 2‐1, and 2‐2 frequencies were 15%, 49%, and 36%, respectively. Baseline Hp levels differed by phenotype (P < 0.0001) and decreased (median 21%) after 6 weeks fenofibrate in all phenotypes (adjusted mean (95% CI): −0.27 (−0.32, −0.23) mg/mL in Hp 1‐1, −0.29 (−0.31, −0.27) mg/mL in Hp 2‐1 and −0.05 (−0.07, −0.02) mg/mL in Hp 2‐2 (P = 0.005 and P = 0.055 vs Hp 1‐1 and Hp 2‐1, respectively)). At 2 years post‐randomization the Hp levels in the placebo group had returned to baseline, whilst the fenofibrate‐group levels remained similar to the 6 week levels. Conclusions In type 2 diabetes, Hp levels differ by Hp phenotype and are decreased by fenofibrate in all phenotypes, but the effect is diminished in Hp 2‐2.
July 2024
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29 Reads
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1 Citation
Journal of Diabetes Science and Technology
Background and aim Continuous glucose monitoring systems (CGMs) have been commercially available since 1999. However, automated insulin delivery systems may benefit from real-time inputs in addition to glucose. Continuous multi-analyte sensing platforms will meet this area of potential growth without increasing the burden of additional devices. We aimed to generate pilot data regarding the safety and function of a first-in-human, single-probe glucose/lactate multi-analyte continuous sensor. Methods The investigational glucose/lactate continuous multi-analyte sensor (PercuSense Inc, Valencia, California) was inserted to the upper arms of 16 adults with diabetes, and data were available for analysis from 11 of these participants (seven female; mean [SD] = age 43 years [16]; body mass index [BMI] = 27 kg/m ² [5]). A commercially available Guardian 3 CGM (Medtronic, Northridge, California) was also inserted into the abdomen for comparison. All participants underwent a meal-test followed by an exercise challenge on day 1 and day 4 of wear. Performance was benchmarked against venous blood YSI glucose and lactate values. Results The investigational glucose sensor had an overall mean absolute relative difference (MARD) of 14.5% (median = 11.2%) which improved on day 4 compared with day 1 (13.9% vs 15.2%). The Guardian 3 CGM had an overall MARD of 13.9% (median = 9.4%). The lactate sensor readings within 20/20% and 40/40% of YSI values were 59.7% and 83.1%, respectively. Conclusions Our initial data support safety and functionality of a novel glucose/lactate continuous multi-analyte sensor. Further sensor refinement will improve run-in performance and accuracy.
... Large language models (LLMs) have revolutionized a wide range of applications driven by their remarkable ability to understand and interpret real-world contexts [1,2,3,4,5]. In the medical domain, LLMs have demonstrated significant potential across diverse applications, such as disease management [6], medical document summarization [7,8], clinical workflows optimization [9], and patient-clinical trial matching [10,11]. Despite these advancements, ongoing debates persist regarding the ethical use of LLM technology in healthcare, addressing concerns such as "hallucination"(generating plausible-sounding but inaccurate or misleading content), biases inherent in training data, and broader ethical considerations [12,13,14,15]. ...
July 2024
Nature Medicine
... Furthermore, the study highlights the broader implications of reduced access to these medications, extending beyond glycaemic control to encompass cardiovascular, renal, retinal, and neural health outcomes. 48 Unfortunately, there remains limited empirical evidence regarding the impact of GLP-1 RA shortages on patients with type 2 diabetes. The available literature confirms the existence of shortages during the period under review. ...
June 2024
Diabetes Research and Clinical Practice
... Regarding IR, numerous studies have suggested that it is a more pivotal contributor to cardiometabolic complications than hyperglycemia [17]. Even in the absence of diabetes, individuals with IR are predisposed to an increased risk of CVD [18,19], making the measurement of IR in OSA patients vital for predicting CVD events [20]. The homeostatic model assessment for IR (HOMA-IR) index is highly sensitive and specific and is extensively used in both research and clinical practice to estimate the severity of IR [21,22]. ...
May 2024
Cardiovascular Diabetology
... Dopo una mediana di 4 anni si è osservata una riduzione significativa degli eventi nel gruppo trattato con fenofibrato (HR 0.73; IC 95% 0.58 to 0.91; p=0.006) con un NNT di 15 (35). Va sottolineato infine come la terapia con fenofibrato ha anche alcuni spiccati effetti a livello renale (23,(36)(37)(38)(39). Da un lato l'inizio della terapia si caratterizza da un aumento della creatinina e riduzione dell'eGFR, aspetto che tuttavia tende a regredire con un effetto protettivo sulla riduzione dell'eGFR nel lungo termine (ossia con un deep iniziale, che tuttavia può essere fino al 15%, che viene poi recuperato e completamente reversibile alla sospensione della terapia) (40)(41). ...
March 2024
Diabetes Research and Clinical Practice
... Anaemia and cognitive dysfunction. The declining capacity to excrete metabolites via the kidneys together with shifts in the secretome of the intestinal microbiota alter the plasma metabolome of patients with CKD 97 , which contributes to cognitive dysfunction in patients with CKD 98,99 . CKD-related anaemia is another cause of cognitive dysfunction, as well as of fatigue, weakness, low exercise tolerance and major cardiovascular events 100,101 . ...
Reference:
Chronic kidney disease
February 2024
Diabetologia
... Whilst a number of societal statements or summaries have been published outlining gaps in evidence and roadmaps for research in specific areas of basic / translational, clinical or social research [105][106][107][108] , few have provided a broad overview of the gaps in evidence in cardio-oncology. To this end, we summarized the afore-identified gaps in evidence in Table 1 and Fig. 1 . ...
February 2024
Heart, Lung and Circulation
... Employing multivariate statistical models or propensity scores will help control for this potential confounding. Despite the caution we apply to these implications, a large Australian study also confirms that HbA1c disparities across various socioeconomic strata is absent when matched for use of advanced technology (24). Despite serving a population predominantly comprised of ethnic minority groups and experiencing significantly higher levels of social deprivation compared to national data, our centre reported a lower median HbA1c compared to the national average (61 vs. 62 mmol/mol). ...
February 2024
Diabetes Care
... The observed hepatoprotective effects of V. gracilis components may be attributed to their antiinflammatory (Fathy et al., 2023), antioxidant (Januszewski et al., 2024), and anti-apoptotic properties (Xiaobo et al., 2023). These components may scavenge free radicals, modulate inflammatory pathways, and inhibit apoptotic processes, collectively contributing to liver protection (Senavirathna et al., 2024). ...
February 2024
Antioxidants
... Patients should be educated on their condition, symptoms (including exacerbation triggers, tracking, recognition, and management), therapies (including medications and nonpharmacological approaches), and management of possible complications, along with when to contact health care providers for assistance with symptoms, with clinical deterioration, or in case of an emergency [4]. An important challenge is low health literacy, which has been estimated to affect 59% of Australians [5]. The risk factors of low health literacy are older age, multimorbidity, immigrant status, low socioeconomic status, low education levels, and a person's primary language being different from that of the available educational resources. ...
January 2024
Diabetes Research and Clinical Practice
... While the presence of obesity is a well-established risk factor for T2DM [20][21][22], there is mounting evidence that T2DM is increasingly prevalent among lean individuals [23]. Primary preventative studies have also highlighted the "obesity paradox", where communitydwelling individuals with lean T2DM demonstrate a poorer prognosis compared to their counterparts with obesity [15,19,24]. ...
September 2023
Journal of the American College of Cardiology