To systematically evaluate qualitative studies on the transition from paediatric to adult care during adolescence among patients with type 1 diabetes.

Qualitative meta synthesis.

The search terms included four main categories: diabetes, transition, experience and qualitative studies. A total of 1214 studies were identified through the database search, and a total of 9 studies met all of the inclusion criteria for this review. Some studies included participants who were young or emerging adults at the time of interview; however, their accounts reflected retrospective experiences of transitioning from paediatric to adult care during adolescence.

The following nine electronic databases were searched: PubMed, Web of Science (Core Collection), The Cochrane Library, Embase, CINAHL, PsycINFO and CNKI, WanFang and Vip. The search period included material published up to July 2024.

A total of nine studies revealed nine subthemes and three descriptive themes: difficulties and challenges, needs in transition, growing through adversity.

Adolescents living with type 1 diabetes navigate complex experiences during the transition to adult healthcare. Healthcare professionals should be attentive to their feelings, encourage them to actively engage with challenges and provide adequate information and combined parental and peer support to facilitate a smooth transition.

CRD42024560173.

Melatonin supplementation has shown potential benefits in the management of diabetes in clinical trials; however, prior meta-analyses have not specifically focused on individuals with type 2 diabetes mellitus (T2DM). This study investigates the efficacy of melatonin supplementation in improving glycemic control among patients with T2DM by systematically reviewing and analyzing data from randomized controlled trials (RCTs).

A comprehensive literature search was conducted in PubMed, Cochrane Library, Scopus, Web of Science, and Embase from their inception to September 2024. RCTs evaluating the effects of melatonin supplementation in adults diagnosed with T2DM were included. The methodological quality of the studies was assessed using the Cochrane Risk of Bias Tool. Data were synthesized and analyzed using RevMan version 5.3.

A total of nine RCTs were included in the meta-analysis (n=9). These studies collectively involved 427 participants. Melatonin supplementation was associated with a statistically significant reduction in glycated hemoglobin (HbA1c) levels compared to placebo [mean difference [MD]: -0.65; 95% CI: -1.28, -0.02; P = 0.04], However, no significant effect was observed on fasting plasma glucose (FPG) levels [mean difference: -6.40; 95% CI: -15.79, 2.99; P = 0.18].

This meta-analysis suggests that melatonin supplementation significantly reduces HbA1c levels in patients with type 2 diabetes mellitus compared to placebo, indicating potential benefits for long-term glycemic control. However, no significant effect was observed on FPG levels.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024629557.

Background Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder often associated with obesity. Despite conventional management strategies, many patients fail to achieve sustained remission. Objective This study aimed to investigate the role of metabolic bariatric surgery (MBS), specifically Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), in achieving remission of T2DM and evaluating the effects on glycemic control and overall metabolic health in patients with obesity. Methods This retrospective study was conducted at Shalamar Hospital, Lahore, Pakistan from January 2021 to December 2024. Data for this study were collected from electronic medical records. It included glycated hemoglobin (HbA1c) levels at baseline and subsequent intervals of three, six, and 12 months. Comparative analyses between the RYGB and SG groups were performed. Fasting blood glucose levels, use of antidiabetic medications (including both oral hypoglycemic agents and insulin), and anthropometric measurements such as weight and BMI were also tracked over time. To identify independent predictors of complete diabetes remission at 12 months, multivariate logistic regression analysis was performed. Results were reported as ORs with 95% CIs and Wald chi-square statistics. A p-value of <0.05 was considered statistically significant for all tests. Results At baseline, the mean age was 47.2 years, and the mean BMI was 42.6 kg/m². At three months, 38 of 81 (46.9%) patients achieved early glycemic response of T2DM. At six months, 21 of 81 (25.9%) showed partial response. By 12 months, complete remission was observed in 29 of 81 patients (35.8%). RYGB patients had higher rates than SG patients at both three months (25/43 (58.1%) vs. 13/38 (34.2%)) and 12 months (20/43 (46.5%) vs. 9/38 (23.7%)). Conclusions MBS, particularly RYGB, offers a highly effective treatment for T2DM in patients with obesity, with significant and sustained improvements in glycemic control and metabolic health. Early intervention, particularly in patients with shorter diabetes duration and lower preoperative HbA1c, maximizes the likelihood of achieving remission.

Microvascular changes induced by diabetes mellitus (DM) are the primary cause of diabetic retinopathy (DR) and choroidopathy. There is a lack of evidence linking diabetic retinopathy (DR) to changes in choroidal thickness (CT), so we designed this study to investigate this relationship. The choroidal thickness of DM patients, with or without DR, was compared to that of controls (subjects without diabetes) using spectral domain optical coherence tomography (SD-OCT).

We recruited 132 participants for a prospective observational study. Choroidal thickness at five points: subfoveal and at 500 and 1000 µm, both temporally and nasally to the fovea, was measured. OCT measurements, insulin use, lipid profiles, age, gender, fundus examination, and glycaemic control were recorded. The inferential and descriptive statistics were applied.

When compared to DM patients without DR, CT showed a trend toward lower values; however, only CT at 1000 μm temporal to the fovea (300.25 ± 65.37 μm in control group 1, 304.82 ± 76.71 μm in group 2, and 271.84 ± 65.07 μm in DR group 3) reached statistical significance (p = 0.05). Each diabetic subgroup did not differ in sub-foveal choroidal thickness (SFCT) (p = 0.586). Patients without DME (289.53 ± 63.86 μm) and those with DME (289.83 ± 100.99 μm) had comparable SFCTs (p = 0.992).

When comparing diabetic patients with and without diabetic retinopathy to healthy controls, there are differences in CT (increased, decreased, or no change). The atrophy and dropout of the choriocapillaris in eyes with diabetic retinopathy may be the cause of the decrease in CT in DR patients that our study revealed.

DR patients showed a statistically significant decrease in CT at the 1000 μm temporal to fovea choroidal subregion compared to DM patients without DR. These results suggest that diabetes induces pathological changes in the choroid, resulting in retinopathy.

This study aimed to evaluate the effectiveness of statin therapy as an adjunctive treatment to anti-VEGF therapy in type 2 diabetic patients with non-proliferative diabetic retinopathy (NPDR) and clinically significant macular edema (CSME).

In this prospective, randomized interventional study, patients were randomized into two groups: Group A received low-dose atorvastatin (10-20 mg), and Group B received high-dose atorvastatin (30-40 mg). All participants also received three loading doses of intravitreal ranibizumab (0.5 mg) at monthly intervals, followed by pro re nata treatment over a six-month period. Primary outcomes included the number of anti-VEGF injections required, best-corrected visual acuity (BCVA), and central macular thickness (CMT). Serum VEGF levels were measured at baseline and six months.

The mean number of injections over six months was 3.4, with no significant difference between Group A (3.55) and Group B (3.33) (p = 0.24). Group A demonstrated substantial improvement in BCVA at both 3 and 6 months, accompanied by a notable reduction in CMT. In contrast, Group B's BCVA improvement was only significant at 3 months, with less consistent CMT reduction at 6 months. Serum VEGF levels decreased in Group A but increased in Group B, though these changes were not statistically significant.

The findings suggest that low-dose atorvastatin, when used in conjunction with anti-VEGF therapy, may provide superior functional and anatomical outcomes in patients with CSME compared to high-dose statin therapy. The observed reduction in central macular thickness and improvement in visual acuity indicate a potential adjunctive benefit of statins, likely due to their pleiotropic effects, including anti-inflammatory and anti-angiogenic properties. Although the number of injections required was similar between the groups, the better response in the low-dose group highlights the need for further investigation into the dose-dependent effects of statins in managing diabetic macular edema.

Low-dose atorvastatin (10-20 mg) as an adjunct to anti-VEGF therapy resulted in better functional and anatomical outcomes in diabetic patients with CSME compared to high-dose atorvastatin. These findings suggest potential additional benefits of low-dose statins in managing patients with chronic subdural hematoma (CSME).

Objective: The objective of this study is to explore the association between MTHFR DNA methylation and diabetic kidney disease (DKD). Methods: This study involved 120 healthy people, 200 diabetes mellitus (DM) patients, and 200 DKD patients who visited China-Japan Friendship Hospital from 2022 to 2023. We selected four CpG islands for the detection of MTHFR DNA methylation: three located in the promoter region and one in Exon 2. The methylation rate of the MTHFR gene was measured using an enzyme digestion method combined with quantitative PCR. Clinical and biochemical characteristics between the two groups were also collected. Results: The methylation rate of the three CpG islands in the promoter region showed no significant differences between the DM and DKD patients. However, a significant difference in the CpG island methylation rate of the MTHFR gene Exon 2 was observed (25.14% vs. 21.94%, p < 0.001). Logistic regression analysis indicated that the methylation rate of MTHFR Exon2 is negatively associated with the occurrence and progression of DKD (OR = 0.947, 95% CI [0.919, 0.977], p = 0.001), with adjustments for gender, age, BMI, smoking, drinking, CHO, and TG. Significant differences were observed in the methylation ratios in different HCY groups (24.51% vs. 21.99%, p = 0.031). Linear regression showed MTHFR Exon 2 methylation negatively correlated with homocysteine (HCY) levels (p = 0.007). Conclusion: Methylation of the MTHFR gene Exon 2 is a protective factor for DKD and may contribute to its onset and progression through its influence on HCY levels. These findings highlight the potential of MTHFR methylation as a biomarker for DKD.

Bariatric surgery significantly improves glycemic control and can lead to type 2 diabetes remission. However, the reliability of glycated hemoglobin (HbA1c) as a type 2 diabetes biomarker post-surgery can be confounded by conditions such as anemia and gastrointestinal complications. Hence, we explored the use of alternative biomarkers such as glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), and insulin-like growth factor binding protein-1 (IGFBP-1) to monitor glycemic control more effectively in post-bariatric surgery patients. Measuring GA and 1,5-AG levels can detect glycemic variability more sensitively than HbA1c, especially under non-fasting conditions. GA shows promise for short-term monitoring post-surgery while 1,5-AG could be useful for real-time glucose monitoring. IGFBP-1 can be used to monitor metabolic improvement and to predict HbA1c normalization. However, challenges in assay standardization and cost remain significant barriers to their clinical adoption. Although these biomarkers could offer a more personalized approach to glucose monitoring (thereby addressing the limitations of utilizing HbA1c in this endeavor in post-bariatric surgery patients), this would require overcoming technical, logistical, and cost-related challenges. While using GA, 1,5-AG, and IGFBP-1 shows promise for glycemic monitoring, further research and validation are crucial for their routine clinical implementation, especially in the context of diabetes management post-bariatric surgery.

Glucose-lowering medication expenditures per user by different payers among patients with diabetes.

Accurate type 1 diabetes prediction is important to facilitate screening for pre-clinical type 1 diabetes to enable potential early disease-modifying interventions and to reduce the risk of severe presentation with diabetic ketoacidosis. We aimed to assess the generalisability of a prediction model developed in children followed from birth. Additionally, we sought to create an application for easy calculation and visualisation of individualised risk prediction.

We developed and internally validated a stratified prediction model combining a genetic risk score, age, islet autoantibodies, and family history using data from children followed since birth by The Environmental Determinants of Diabetes in the Young (TEDDY) study. We tested the validity of the model through external validation in the Type 1 Diabetes TrialNet Pathway to Prevention study, which conducts cross-sectional screening in relatives of people with type 1 diabetes. We recalibrated the model by adjusting for baseline risk and selection criteria in TrialNet using logistic recalibration to improve calibration across all ages.

The study included 7798 TEDDY and 4068 TrialNet participants, with 305 (4%) and 1373 (34%) developing type 1 diabetes, respectively. The stratified model showed similar discriminative ability in autoantibody-positive participants across TEDDY and TrialNet, but inferior calibration in TrialNet (Brier score 0.40 [95% CI 0.38,0.43]). Adjustment for baseline risk and selection criteria in TrialNet using logistic recalibration improved calibration across all ages (Brier score 0.16 [0.14,0.17]; p < 0.001). A web calculator was developed to visualise individual risk estimates ( https://t1dpredictor.diabetesgenes.org ).

A stratified model incorporating the type 1 diabetes genetic risk score, family history, age, and autoantibody status can predict type 1 diabetes risk with improved accuracy, but may need recalibration depending on the screening strategy.

Recent findings suggest remnant cholesterol (RC) may contribute to gestational diabetes mellitus (GDM). This study aimed to explore the link between RC and GDM in early pregnancy to assess RC's risk independently of triglycerides (TG).

We performed a retrospective cohort study involving pregnant women admitted to the Suzhou Ninth Hospital affiliated to Soochow University. Data were obtained from the electronic medical record system. RC (mg/dL) was determined by subtracting high-density lipoprotein cholesterol and low-density lipoprotein cholesterol from total cholesterol. GDM was diagnosed using a 75-g oral glucose tolerance test diagnosed at 24-28 weeks of pregnancy. Various analyses, including logistic regressions, restricted cubic spline (RCS), subgroup, sensitivity, and receiver operating characteristic (ROC) analyses, were performed to evaluate the independent association between RC levels and GDM. We conducted discordance analyses to assess GDM risk in RC versus TG discordant and concordant groups using various cut points. The link between RC and different GDM subtypes was also further examined.

Of the 1,361 women studied, 353 (25.9%) developed GDM. After adjusting for multiple variables, RC was linked to a higher risk of GDM, with an odds ratio (OR) of 1.05 and a 95% confidence interval (CI) of 1.02-1.08. Individuals in the highest RC quartile were more likely to develop GDM (OR: 2.27, 95% CI: 1.37-3.74) than those in the lower quartile. Additionally, the adjusted RCS analysis revealed a significant linear-dose-response link between RC and GDM risk (P for all < 0.001; P for nonlinear = 0.357). Various sensitivity and subgroup analyses confirmed the robustness of our results. The discordant low TG and high RC group revealed an association with GDM, whereas the high TG and low RC group did not when compared with the low TG and low RC group. Even after adjusting for variables, the association remained significant. Similar results were observed using varying clinical cut points. In early pregnancy, RC emerged as the strongest diagnostic marker for GDM, with an ROC curve area of 0.687, surpassing other traditional lipid markers. Further analysis revealed a strong connection between early pregnancy RC levels and GDM subtypes marked solely by high fasting glucose.

Higher RC levels were linked to GDM independently of traditional risk factors, especially TG levels, and may be more useful in diagnosing specific GDM subtypes.