文献精选

糖尿病足患者应该找哪个科看病

原创：十六点五中山二院糖尿病足中心

随着糖尿病患病人数的不断增加，糖尿病足的病人也越来越多，在平时的临床实践中，笔者发现很多糖尿病足病友搞不清楚糖尿病足应该由什么科管？或者说哪个科的医师负责糖尿病足的诊断和治疗。

糖尿病足患者是否一定要用胰岛素控制血糖？

原创：十六点五中山二院糖尿病足中心

控制血糖是预防糖尿病足最重要的措施之一，也是治疗糖尿病足综合治疗的基础之一。当出现严重的并发症糖尿病足的时候，控制血糖最重要的方法目前一般认为是胰岛素治疗，而且最好是胰岛素的强化治疗。但很多患者不是非常理解，往往产生很多问题，对于其中一些有代表性的问题做一些回答。

糖尿病足患者为什么要保足

原创：十六点五中山二院糖尿病足中心

有不少医护人员为了糖尿病足病患者殚精竭虑地工作着，但是也有很多人不理解这种工作的意义，认为糖尿病足患者如果尽快截肢（踝关节以上），可以省去很多医疗资源和社会资源的投入，而且目前各种支具的生产越来越精巧、越来越智能、也越来越便宜，这种劳神费力的工作真有意义吗？

糖尿病足与夏柯氏关节

原创：十六点五中山二院糖尿病足中心

底压力的改变是糖尿病足发病最重要的因素，一般认为这些足底压力的变化是由于糖尿病神经病变所致，而神经病变的极致就是夏柯氏关节的形成。

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Racial/ethnic and gender disparity in the severity of NAFLD among people with diabetes or prediabetes 2026-03-09 00:00

Magda Shaheen1 *, Katrina M. Schrode1 , Marielle Tedlos 1 , Deyu Pan1 , Sonia M. Najjar 2 and Theodore C. Friedman1

1 Charles R. Drew University, Los Angeles, CA, United States, 2 Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States

Aim: Non-alcoholic fatty liver disease (NAFLD) exhibits a racial disparity. We examined the prevalence and the association between race, gender, and NAFLD among prediabetes and diabetes populations among adults in the United States.

Methods: We analyzed data for 3,190 individuals ≥18 years old from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. NAFLD was diagnosed by FibroScan ® using controlled attenuation parameter (CAP) values: S0 (none) < 238, S1 (mild) = 238-259, S2 (moderate) = 260-290, S3 (severe) > 290. Data were analyzed using Chi-square test and multinomial logistic regression, adjusting for confounding variables and considering the design and sample

Results: Of the 3,190 subjects, the prevalence of NAFLD was 82.6%, 56.4%, and 30.5% (p < 0.0001) among diabetes, prediabetes and normoglycemia populations respectively. Mexican American males with prediabetes or diabetes had the highest prevalence of severe NAFLD relative to other racial/ethnic groups (p < 0.05). In the adjusted model, among the total, prediabetes, and diabetes populations, a one unit increase in HbA1c was associated with higher odds of severe NAFLD [adjusted odds ratio (AOR) = 1.8, 95% confidence level (CI) = 1.4-2.3, p < 0.0001; AOR = 2.2, 95% CI = 1.1-4.4, p = 0.033; and AOR = 1.5, 95% CI = 1.1-1.9, p = 0.003 respectively].

Conclusion: We found that prediabetes and diabetes populations had a high prevalence and higher odds of NAFLD relative to the normoglycemic population and HbA1c is an independent predictor of NAFLD severity in prediabetes and diabetes populations. Healthcare providers should screen prediabetes and diabetes populations for early detection of NAFLD and initiate treatments including lifestyle modification to prevent the progression to non-alcoholic steatohepatitis or liver cancer.

KEYWORDS

NAFLD severity, prediabetes, diabetes, NHANES 2017-2018, race/ethnicity, gender
Blood oxygen saturation is lower in persons with pre-diabetes and screen-detected diabetes compared with non-diabetic individuals: A population-based study of the Lolland-Falster Health Study cohort 2026-03-07 00:00

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
Non-invasive type 2 diabetes risk scores do not identify diabetes when the cause is β-cell failure: The Africans in America study 2026-03-05 00:00

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.

KEYWORDS

type 2 diabetes, risk score, African (Black) diaspora, β-cell failure, insulin resistance, diabetes screening

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主任医师、教授、博导，南方医科大学第三附属医院（广东省骨科医院）院长

文献精选

糖尿病足患者应该找哪个科看病

糖尿病足患者是否一定要用胰岛素控制血糖？

糖尿病足患者为什么要保足

糖尿病足与夏柯氏关节

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Custom Mod Mega1

主任医师、教授、博导，南方医科大学第三附属医院（广东省骨科医院）院长

文献精选

糖尿病足患者应该找哪个科看病

糖尿病足患者是否一定要用胰岛素控制血糖？

糖尿病足患者为什么要保足

糖尿病足与夏柯氏关节

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学术会议

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