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： 十六点五 中山二院糖尿病足中心
（4）糖尿病足的感染，不但是局部的问题，而且还是全身的问题，一方面，糖尿病人全身抵抗力的下降，葡萄糖对重要脏器的损害，造成糖尿病足的感染即难控制又对全身脏器的功能影响大，很容易导致心衰、肾衰等，或者加重有关脏器的损伤；
糖尿病足部的慢性溃疡是否存在感染，好像应该是没有多少疑问的，但在所谓的“神经性溃疡”的表面是否存在有临床意义的感染，一直有争议。
对于外周血管病变的介入治疗，较IWGDF指南较有关OFFLOADING的细节描述，有关介入治疗的部分实在是比较粗慥，目前糖尿病外周血管病变介入治疗的热点问题大部分都没有涉及
对于糖尿病外周血管病变的治疗，2019年版IWGDF指南讲的比较少，无论是内科治疗还是介入治疗，这版的指南都讲得比较少（其实之前版本的IWGDF指南有关血管病变方面的内容更少），而国内糖尿病足指南，提到有关糖尿病外周血管病变治疗，一般都会用比较大的篇幅谈到其内科治疗。
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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