Jens Christian Laursen1*, Randi Jepsen2 , Neda Esmailzadeh Bruun-Rasmussen2 , Marie Frimodt-Møller1 , Marit Eika Jørgensen3 , Peter Rossing1,4 and Christian Stevns Hansen1
1 Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark,
2Center for Epidemiological Research, Nykøbing Falster Hospital, Nykøbing Falster, Denmark,
3Steno Diabetes Center Greenland, Nuuk, Greenland, 4Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Aims: Low blood oxygen saturation is associated with increased mortality and persons with diabetes have sub-clinical hypoxemia. We aimed to confirm the presence of sub-clinical hypoxemia in pre-diabetes, screen-detected diabetes and known diabetes.
Methods: Pre-diabetes was defined as hemoglobin A1C (HbA1C) ≥ 42 mmol/mol and <48 mmol/mol; known diabetes as history or treatment of diabetes; screen-detected diabetes as no history or treatment of diabetes and HbA1C ≥ 48 mmol/mol. Blood oxygen saturation was measured with pulse oximetry. Urine albumin-to creatinine ratio (UACR) was measured on a single spot urine.
Results: The study included 829 adults (≥18 years) with diabetes (713 (86%) with known diabetes; 116 (14%) with screen-detected diabetes) and 12,747 without diabetes (11,981 (94%) healthy controls; 766 (6%) with pre-diabetes). Mean (95% CI) blood oxygen saturation was 96.3% (96.3% to 96.4%) in diabetes which was lower than in non-diabetes [97.3% (97.2–97.3%)] after adjustment for age, gender, and smoking (p < 0.001), but significance was lost after adjustment for BMI (p = 0.25). Sub-groups with pre-diabetes and screen-detected diabetes had lower blood oxygen saturations than healthy controls (p-values < 0.01). Lower blood oxygen saturation was associated with higher UACR.
Conclusions: Persons with pre-diabetes and screen-detected diabetes have sub-clinical hypoxemia, which is associated with albuminuria.
KEYWORDS
hypoxia, microvascular complications, albuminuria, type 2 diabetes, pre-diabetes
Annemarie Wentzel1,2,3*, Arielle C. Patterson1 , M. Grace Duhuze Karera1,4,5, Zoe C. Waldman1 , Blayne R. Schenk1 , Christopher W. DuBose1 , Anne E. Sumner1,4 and Margrethe F. Horlyck-Romanovsky1,6*
1 Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States,
2 Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa, 3South African Medical Research Council, Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa, 4National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States, 5 Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda, 6Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, New York, NY, United States
Background: Emerging data suggests that in sub-Saharan Africa β-cell-failure in the absence of obesity is a frequent cause of type 2 diabetes (diabetes). Traditional diabetes risk scores assume that obesity-linked insulin resistance is the primary cause of diabetes. Hence, it is unknown whether diabetes risk scores detect undiagnosed diabetes when the cause is β-cell-failure.
Aims: In 528 African-born Blacks living in the United States [age 38 ± 10 (Mean ± SE); 64% male; BMI 28 ± 5 kg/m2 ] we determined the: (1) prevalence of previously undiagnosed diabetes, (2) prevalence of diabetes due to β-cell-failure vs. insulin resistance; and (3) the ability of six diabetes risk scores [Cambridge, Finnish Diabetes Risk Score (FINDRISC), Kuwaiti, Omani, Rotterdam, and SUNSET] to detect previously undiagnosed diabetes due to either β-cell-failure or insulin resistance.
Methods: Diabetes was diagnosed by glucose criteria of the OGTT and/or HbA1c ≥ 6.5%. Insulin resistance was defined by the lowest quartile of the Matsuda index (≤2.04). Diabetes due to β-cell-failure required diagnosis of diabetes in the absence of insulin resistance. Demographics, body mass index (BMI), waist circumference, visceral adipose tissue (VAT), family medical history, smoking status, blood pressure, antihypertensive medication, and blood lipid profiles were obtained. Area under the Receiver Operator Characteristics Curve (AROC) estimated sensitivity and specificity of each continuous score. AROC criteria were: Outstanding: >0.90; Excellent: 0.80–0.89; Acceptable: 0.70–0.79; Poor: 0.50–0.69; and No Discrimination: 0.50.
Results: Prevalence of diabetes was 9% (46/528). Of the diabetes cases, β-cell-failure occurred in 43% (20/46) and insulin resistance in 57% (26/46). The β-cell-failure group had lower BMI (27 ± 4 vs. 31 ± 5 kg/m2 P < 0.001), lower waist circumference (91 ± 10 vs. 101 ± 10cm P < 0.001) and lower VAT (119 ± 65 vs. 183 ± 63 cm3 , P < 0.001). Scores had indiscriminate or poor detection of diabetes due to β-cell-failure (FINDRISC AROC = 0.49 to Cambridge AROC = 0.62). Scores showed poor to excellent detection of diabetes due to insulin resistance, (Cambridge AROC = 0.69, to Kuwaiti AROC = 0.81).
Conclusions: At a prevalence of 43%, β-cell-failure accounted for nearly half of the cases of diabetes. All six diabetes risk scores failed to detect previously undiagnosed diabetes due to β-cell-failure while effectively identifyingdiabetes when the etiology was insulin resistance. Diabetes risk scores whichcorrectly classify diabetes due to B-cell-failure are urgently needed.
type 2 diabetes, risk score, African (Black) diaspora, β-cell failure, insulin resistance, diabetes screening
原创：伤口治疗及造口护理中心
在日常生活中，当我们的机体受到伤害而造成伤口的时候，最希望伤口能够尽快愈合，恢复到未受伤时候的状态。通过观察不难发现，伤口几乎是一天一个样，那么机体是如何让伤口产生这些变化的呢？伤口有时如何进行修复的呢？
今天小编就告诉大家伤口的愈合过程，通过了解这个过程，我们能够更好地了解自己伤口所处在的周期，以及能够大概了解伤口是往好的方向发展还是往坏的方向恶化。话不多说，下面介绍今天的主题！
一旦有伤口出现，往往会有疼痛的症状发生，这些疼痛反复发作，让许多患者困扰不已。实际上导致患者出现伤口疼痛有些是伤口愈合期间的正常症状，有些由于伤口感染等原因导致，我们应该区别对待，区别处理。
伤口的愈合除了需要良好的环境以外，必不可少的就是需要充足的营养物质的提供。今天小编就给大家介绍一下与伤口愈合紧密相关的一些营养素（分为两次课程）。
原创:伤口治疗及造口护理中心
伤口世界平台生态圈，以“关爱人间所有伤口患者”为愿景，连接、整合和拓展线上和线下的管理慢性伤口的资源，倡导远程、就近和居家管理慢性伤口，解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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