The Impact of COVID-19 on Diabetic Retinopathy Monitoring and Treatment
AbstractPurpose of ReviewDiabetic retinopathy (DR) is one of the leading causes of vision loss worldwide. Although screening and early treatment guidelines for DR have significantly reduced the disease burden, restrictions related to the COVID-19 pandemic have changed real-world practice patterns in the management of DR. This review summarizes evolving guidelines and outcomes of the treatment of DR in the setting of the pandemic.Recent FindingsIntravitreal injections for DR have decreased significantly globally during the pandemic, ranging from approximately 30 to nearly 100% reduction, compared to corresponding timepoints...
Source: Current Diabetes Reports - September 8, 2021 Category: Endocrinology Source Type: research

Association Between Diabetes, Diabetic Retinopathy, and Glaucoma
AbstractPurpose of ReviewThe strength of the relationship between diabetes, diabetic retinopathy (DR), and glaucoma remains controversial. We review evidence supporting and refuting this association and explore mechanistic pathological and treatment relationships linking these diseases.Recent FindingsWhile studies have shown diabetes/DR may increase the risk for glaucoma, this remains inconsistently demonstrated. Diabetes/DR may contribute toward glaucomatous optic neuropathy indirectly (either by increasing intraocular pressure or vasculopathy) or through direct damage to the optic nerve. However, certain elements of diab...
Source: Current Diabetes Reports - September 8, 2021 Category: Endocrinology Source Type: research

Metformin in Pregnancy for Women with Type 2 Diabetes: a Review
AbstractPurpose of ReviewTo review the current evidence for the use of metformin in pregnancy for women with type 2 diabetes.Recent FindingsA large, multicenter, double-blind randomized controlled trial found that women with type 2 diabetes in pregnancy treated with metformin as an adjunct to insulin therapy had less gestational weight gain, insulin requirements, caesarian sections, macrosomia, and neonatal adiposity, but more neonates were small for gestational age (SGA) compared with insulin alone. It is unclear if the higher number of SGA infants are a direct result of metformin exposure or mediated through other effect...
Source: Current Diabetes Reports - September 8, 2021 Category: Endocrinology Source Type: research

What the Jackson Heart Study Has Taught Us About Diabetes and Cardiovascular Disease in the African American Community: a 20-year Appreciation
AbstractPurpose of ReviewThe burden of cardiometabolic diseases such as cardiovascular disease (CVD) and type 2 diabetes (T2D) is pronounced among African Americans. Research has shown that behavioral, social, metabolic, psychosocial, and genetic risk factors of CVD and T2D are closely interwoven. Approximately 20  years ago, the Jackson Heart Study (JHS) was established to investigate this constellation of risk factors.Recent FindingsFindings from neighborhood studies emphasize the importance of social cohesion and physical environment in the context CVD and T2D risk. Socioeconomic status factors such as income and e...
Source: Current Diabetes Reports - September 8, 2021 Category: Endocrinology Source Type: research

Postpartum Use of Weight Loss and Metformin for the Prevention of Type 2 Diabetes Mellitus: a Review of the Evidence
AbstractPurpose of ReviewAs many as 70% of patients diagnosed with gestational diabetes mellitus (GDM) will go on to develop type 2 diabetes (T2DM) within their lifetimes. Implementing strategies to mitigate this progression in the postpartum period when patients are already connected to care is essential in optimizing lifelong health for our patients. Both lifestyle modification and metformin have been investigated as options to reduce type 2 diabetes risk in patients with a history of GDM.Recent FindingsThe current model for postpartum testing and care of patients with GDM has been shown to have poor uptake rates. Simila...
Source: Current Diabetes Reports - September 8, 2021 Category: Endocrinology Source Type: research

Laser Therapy in the Treatment of Diabetic Retinopathy and Diabetic Macular Edema
AbstractPurpose of ReviewThis review highlights indications and evidence on laser therapy in the management of diabetic retinopathy and diabetic macular edema. Particular focus is placed upon the benefits and limitations of conventional laser photocoagulation versus more modern laser photocoagulation techniques, as well as the role of laser photocoagulation in treatment of diabetic retinopathy and diabetic macular edema with the frequent utilization of pharmacologic, including anti-vascular endothelial growth factor (VEGF), therapy.Recent FindingsLaser photocoagulation remains the gold-standard therapy for the effective, d...
Source: Current Diabetes Reports - September 6, 2021 Category: Endocrinology Source Type: research

Predicting and Preventing Acute Care Re-Utilization by Patients with Diabetes
AbstractPurpose of ReviewAcute care re-utilization, i.e., hospital readmission and post-discharge Emergency Department (ED) use, is a significant driver of healthcare costs and a marker for healthcare quality. Diabetes is a major contributor to acute care re-utilization and associated costs. The goals of this paper are to (1) review the epidemiology of readmissions among patients with diabetes, (2) describe models that predict readmission risk, and (3) address various strategies for reducing the risk of acute care re-utilization.Recent FindingsHospital readmissions and ED visits by diabetes patients are common and costly. ...
Source: Current Diabetes Reports - September 4, 2021 Category: Endocrinology Source Type: research

Management of Complications and Vision Loss from Proliferative Diabetic Retinopathy
AbstractPurpose of ReviewDiabetes can be associated with profound visual loss due to several mechanisms. As the duration of diabetes and blood glucose levels increase, these changes become more severe. The proliferation of new blood vessels, vitreous hemorrhage, and tractional retinal detachments may ultimately result and can be devastating to visual function. New advances, including anti-vascular endothelial growth factor (VEGF) medications and innovative microsurgical instruments, have provided additional methods for the management of diabetic retinopathy in the clinic and in the operating room, leading to improved outco...
Source: Current Diabetes Reports - September 3, 2021 Category: Endocrinology Source Type: research

The Role of Ultra-Widefield Fundus Imaging and Fluorescein Angiography in Diagnosis and Treatment of Diabetic Retinopathy
AbstractPurpose of ReviewEarly detection and treatment are important for preventing vision loss from diabetic retinopathy. Historically, the gold standard for grading diabetic retinopathy has been based on 7-field 30-degree color fundus photographs that capture roughly the central third of the retina. Our aim was to review recent literature on the role of ultra-widefield (allowing capture of up to 82% of the retina in one frame) fundus imaging in screening, prognostication, and treatment of diabetic retinopathy.Recent FindingsUltra-widefield fundus imaging can capture peripheral retinal lesions outside the traditional 7-fi...
Source: Current Diabetes Reports - August 27, 2021 Category: Endocrinology Source Type: research

Molecular Aspects in the Potential of Vitamins and Supplements for Treating Diabetic Neuropathy
AbstractPurpose of ReviewTo discuss and provide evidence-based data on dietary supplements as part of treating diabetic neuropathyRecent FindingsFew randomized controlled trials are available, but some have shown beneficial efficacy of various dietary supplements on objective primary endpoints including nerve conduction velocities and axon potentials as well as subjective patient-reported outcomes.SummaryNo medical cure for diabetic neuropathy exists, and prevention is therefore crucial. Tight glucose control slows the progression of nerve damage in diabetes, but an unmet clinical need for effective interventions is warran...
Source: Current Diabetes Reports - August 27, 2021 Category: Endocrinology Source Type: research

Efficacy of Ketogenic Diets on Type 2 Diabetes: a Systematic Review
AbstractPurpose of ReviewTo assess the pleiotropic effects of ketogenic diets (KD) on glucose control, changes in medication, and weight loss in individuals with type 2 diabetes, and to evaluate its practical feasibilityRecent FindingsKD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year. This is associated with a reduction in glucose-lowering medications. The weight loss observed after a short time period seems to be maintained with a long-term diet. Adequate support (supportive psychological counseling, enhancing positive affectivity, reinforcing mindful eating) is necess...
Source: Current Diabetes Reports - August 27, 2021 Category: Endocrinology Source Type: research

Toward a New Staging System for Diabetic Retinopathy Using Wide Field Swept-Source Optical Coherence Tomography Angiography
AbstractPurpose of ReviewFor over 50 years, diabetic retinopathy (DR) has been classified by pathologic features seen on clinical examination and conventional retinal photographs. However, newer technology such as optical coherence tomography angiography (OCTA) now enables rapid acquisition of retinal structural and vascular information in a reliable, non-invasive, high-resolution fashion. Here, we highlight recent studies that have explored wide field swept-source OCTA (WF SS-OCTA) for the diagnosis and management of DR.Recent FindingsMultiple studies have demonstrated the utility of WF SS-OCTA for detection of all clinic...
Source: Current Diabetes Reports - August 26, 2021 Category: Endocrinology Source Type: research

Cardiovascular Risk Management in Type 1 Diabetes
AbstractPurpose of reviewType 1 diabetes mellitus (T1DM) is associated with increased mortality, with premature cardiovascular disease (CVD) a major factor. To date, research has identified multiple risk factors for this excess CVD liability. However, gaps remain in our understanding of the underlying mechanisms.Recent findingsT1DM is generally diagnosed at a young age. Since cardiovascular complications often only manifest at a later stage of life, there is generally less focus in earlier years on reducing CVD risk for affected individuals. This is an area that requires improvement as risk factors might be managed from ea...
Source: Current Diabetes Reports - August 26, 2021 Category: Endocrinology Source Type: research

The Role of Hexokinase Domain Containing Protein-1 in Glucose Regulation During Pregnancy
AbstractPurpose of ReviewGestational diabetes mellitus (GDM) is a common pregnancy complication conferring an increased risk to the individual of developing type 2 diabetes. As such, a thorough understanding of the pathophysiology of GDM is warranted. Hexokinase domain containing protein-1 (HKDC1) is a recently discovered protein containing hexokinase activity which has been shown to be associated with glucose metabolism during pregnancy. Here, we discuss recent evidence suggesting roles for the novel HKDC1 in gestational glucose homeostasis and the development of GDM and overt diabetes.Recent FindingsGenome-wide associati...
Source: Current Diabetes Reports - July 7, 2021 Category: Endocrinology Source Type: research

Metagenomics to Identify Pathogens in Diabetic Foot Ulcers and the Potential Impact for Clinical Care
AbstractPurpose of ReviewDiabetes mellitus may affect every third adult American by 2050, and about one-third will develop a diabetic foot ulcer (DFU) during their lifetime. The current standard of care results in healing of less than 50% of all DFUs. Many individuals with DFU develop limb-threatening infection which place them at risk for additional morbidity and mortality. We review research associated with culture-independent next-generation sequencing techniques pertaining to diabetic foot ulcers and their potential for clinical application.Recent FindingsDiabetic foot ulcers are a growing problem and clinicians are li...
Source: Current Diabetes Reports - June 21, 2021 Category: Endocrinology Source Type: research

The Value of Measuring Diabetes Burnout
AbstractPurpose of ReviewDiabetes represents a chronic illness with significant physical and psychological morbidities. This review aims to summarize current conceptualizations of diabetes burnout in individuals with diabetes and describe its associated adverse outcomes in this population while proposing possible mechanisms of action and targets of intervention.Recent Findings“Diabetes burnout” may result in adverse long-term outcomes including poor treatment compliance, diabetes complications, and depression. Diabetes burnout may impact not only individuals, but also providers, and caregivers and family member...
Source: Current Diabetes Reports - June 16, 2021 Category: Endocrinology Source Type: research

Maternal Diabetes and Infant Sex Ratio
AbstractPurpose of ReviewEvolutionary hypotheses on the ratio of males to females at birth posit that women terminate pregnancies with low likelihood of surviving and producing grandchildren. Thus, females are preferred to males under unfavorable conditions. Much of this literature has focused on catastrophic disruptions that induce maternal stress and result in fewer males. Diabetes may similarly affect the sex ratio.Recent FindingsA male bias at birth among infants born to women with GDM is widely recognized; mild hyperglycemia experienced early in pregnancy may signal favorable conditions and warrant investment in males...
Source: Current Diabetes Reports - June 10, 2021 Category: Endocrinology Source Type: research

Lifestyle Interventions for Diabetes Prevention in South Asians: Current Evidence and Opportunities
AbstractPurpose of ReviewThis review summarizes the burden of diabetes in South Asian populations and reviews recent evidence for diabetes prevention through lifestyle modification among South Asians worldwide. We indicate important gaps in the current literature and point to opportunities for additional research in this area.Recent FindingsRandomized, controlled, efficacy studies and implementation research show that lifestyle intervention can be an effective, cost-effective, and feasible method for reducing diabetes risk, improving cardiometabolic health, and improving lifestyle behaviors in South Asian populations, a po...
Source: Current Diabetes Reports - June 7, 2021 Category: Endocrinology Source Type: research

Advances, Challenges, and Cost Associated with Continuous Glucose Monitor Use in Adolescents and Young Adults with Type 1 Diabetes
AbstractPurpose of ReviewContinuous glucose monitors (CGM) are transforming diabetes management, yet adolescents and young adults (AYA) with type 1 diabetes (T1D) do not experience the same benefits seen with CGM use in adults. The purpose of this review is to explore advances, challenges, and the financial impact of CGM use in AYA with T1D.Recent FindingsCGM studies in young adults highlight challenges and suggest unique barriers to CGM use in this population. Recent studies also demonstrate differences in CGM use related to race and ethnicity, raising questions about potential bias and emphasizing the importance of patie...
Source: Current Diabetes Reports - May 15, 2021 Category: Endocrinology Source Type: research

Harnessing Metabolomics to Describe the Pathophysiology Underlying Progression in Diabetic Kidney Disease
AbstractPurpose of ReviewDiabetic kidney disease (DKD), a leading cause of end-stage kidney disease, is the result of metabolic network alterations in the kidney. Therefore, metabolomics is an effective tool for understanding its pathophysiology, finding key biomarkers, and developing a new treatment strategy. In this review, we summarize the application of metabolomics to DKD research.Recent FindingsAlterations in renal energy metabolism including the accumulation of tricarboxylic acid cycle and glucose metabolites are observed in the early stage of DKD, and they finally lead to mitochondrial dysfunction in advanced DKD. ...
Source: Current Diabetes Reports - May 11, 2021 Category: Endocrinology Source Type: research

The Role of Programmed Death-1 in Type 1 Diabetes
AbstractPurpose of ReviewProgrammed death-1 (PD-1) is an inhibitory receptor that controls T and B cell proliferation and function through interacting with its ligand PD-L1 or PD-L2. PD-1/PD-L1 blockade reboots anti-tumor immunity and is currently used to treat> 15 different types of cancer. However, the response rate is not at 100% and some patients relapse. Importantly, up to 37% of patients treated with PD-1/PD-L1 blocking antibodies develop immune-related adverse events, including overt autoimmunity, such as type 1 diabetes (T1D). Herein, we discuss the role of PD-1, PD-L1, and PD-L2 signaling in pre-clinical models...
Source: Current Diabetes Reports - May 6, 2021 Category: Endocrinology Source Type: research

Immunological Monitoring in Beta Cell Replacement: Towards a Pathophysiology-Guided Implementation of Biomarkers
AbstractPurpose of reviewGrafted beta cells are lost because of recurrence of T1D and/or allograft rejection, two conditions diagnosed with pancreas graft biopsy, which is invasive and impossible in case of islet transplantation. This review synthetizes the current pathophysiological knowledge and discusses the interest of available immune biomarkers.Recent findingsDespite the central role of auto-(recurrence of T1D) and allo-(T-cell mediated rejection) immune cellular responses, the latter are not directly monitored in routine. In striking contrast, there have been undisputable progresses in monitoring of auto and alloant...
Source: Current Diabetes Reports - April 25, 2021 Category: Endocrinology Source Type: research

PPAR γ and Diabetes: Beyond the Genome and Towards Personalized Medicine
AbstractPurpose of ReviewFull and partial synthetic agonists targeting the transcription factor PPAR γ are contained in FDA-approved insulin-sensitizing drugs and used for the treatment of metabolic syndrome-related dysfunctions. Here, we discuss the association betweenPPARG genetic variants and drug efficacy, as well as the role of alternative splicing and post-translational modifications as contributors to the complexity of PPAR γ signaling and to the effects of synthetic PPARγ ligands.Recent FindingsPPAR γ regulates the transcription of several target genes governing adipocyte differentiation and...
Source: Current Diabetes Reports - April 18, 2021 Category: Endocrinology Source Type: research

Progress in Defining the Genetic Contribution to Type 2 Diabetes in Individuals of East Asian Ancestry
AbstractPurpose of ReviewPrevalence of type 2 diabetes (T2D) and progression of complications differ between worldwide populations. While obesity is a major contributing risk factor, variations in physiological manifestations, e.g., developing T2D at lower body mass index in some populations, suggest other contributing factors. Early T2D genetic associations were mostly discovered in European ancestry populations. This review describes the progression of genetic discoveries associated with T2D in individuals of East Asian ancestry in the last 10 years and highlights the shared genetic susceptibility between the population ...
Source: Current Diabetes Reports - April 13, 2021 Category: Endocrinology Source Type: research

The Prevalence of Diabetic Microvascular Complications in China and the USA
AbstractPurpose of ReviewDiabetes can lead to development of devastating microvascular complications, such as nephropathy, retinopathy, and peripheral sensory and autonomic neuropathy. While China and the USA both face the threat of this major public health challenge, the literature is limited in describing similarities and differences in the prevalence, and risk factors for the development, of diabetic microvascular complications between these two countries.Recent FindingsThe current review discusses the following: (1) the most recent evidence on prevalence of diabetic microvascular complications in China and the USA (inc...
Source: Current Diabetes Reports - April 9, 2021 Category: Endocrinology Source Type: research

The Relationship Between Type 2 Diabetes, NAFLD, and Cardiovascular Risk
AbstractPurpose of ReviewNonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are strongly associated. Both also associate with an increased risk of cardiovascular disease (CVD).Recent FindingsSeveral studies have provided evidence that NAFLD could be an independent CVD risk factor. Given the strong association between NAFLD and T2DM, assessing the independent CV effect of these two conditions remains challenging. However, patients with T2DM and NAFLD exhibit higher risk of CVD compared with T2DM without NAFLD suggesting a potential synergistic increase of CV risk in patients with both T2DM and NAFL...
Source: Current Diabetes Reports - March 19, 2021 Category: Endocrinology Source Type: research

Diabetes in People with HIV
AbstractPurpose of ReviewTo discuss the diagnosis, treatment, and complications of diabetes in people with HIV (PWH) and to review HIV-related factors that may contribute to the development of diabetes or alter decisions in the care and treatment of PWH with diabetes.Recent FindingsFor those patients with atherosclerotic cardiovascular disease, heart failure, and/or chronic kidney disease, GLP-1 receptor agonists and SGLT-2 inhibitors should be considered for use. Evidence for this recommendation is, however, based on studies that were not conducted in populations consisting solely of PWH.SummaryDiabetes is a significant c...
Source: Current Diabetes Reports - March 17, 2021 Category: Endocrinology Source Type: research

Body Composition Methods in Adults with Type 2 Diabetes or at Risk for T2D: a Clinical Review
AbstractPurpose of ReviewThe aim of this study is to summarize anthropometric and advanced methods used to assess body composition in adults diagnosed with type 2 diabetes (T2D) or at risk for T2D that provide clinically relevant information about T2D disease-related complications or risk factors.Recent FindingsAnthropometry is commonly used in clinical settings; however, provides unreliable estimates of fat mass, fat-free mass, and body fat distribution for metabolic health assessments compared to advanced techniques such as bioelectrical impedance analysis (BIA), dual-energy x-ray absorptiometry (DXA), computerized tomog...
Source: Current Diabetes Reports - March 17, 2021 Category: Endocrinology Source Type: research

Brain Health in Children with Type 1 Diabetes: Risk and Protective Factors
AbstractPurpose of ReviewTo synthesize findings from studies of neurocognitive complications in children with type 1 diabetes (T1D) and highlight potential risk and protective factors.Recent FindingsEmerging evidence suggests that hyperglycemia and time in range may be more important for brain development than episodes of hypoglycemia. Further, diabetic ketoacidosis (DKA) at the time of T1D diagnosis appears to be a particular risk factor for neurocognitive complications, particularly deficits in executive function skills and memory, with differences in cerebral white matter microstructure seen via advanced magnetic resona...
Source: Current Diabetes Reports - March 14, 2021 Category: Endocrinology Source Type: research

Cell Therapy for Critical Limb Ischemia: Advantages, Limitations, and New Perspectives for Treatment of Patients with Critical Diabetic Vasculopathy
AbstractPurpose of ReviewTo provide a highlight of the current state of cell therapy for the treatment of critical limb ischemia in patients with diabetes.Recent FindingsThe global incidence of diabetes is constantly growing with consequent challenges for healthcare systems worldwide. In the UK only, NHS costs attributed to diabetic complications, such as peripheral vascular disease, amputation, blindness, renal failure, and stroke, average £10 billion each year, with cost pressure being estimated to get worse. Although giant leaps forward have been registered in the scope of early diagnosis and optimal glycaemic con...
Source: Current Diabetes Reports - March 2, 2021 Category: Endocrinology Source Type: research

The Relationship Between Executive Functioning, Type 1 Diabetes Self-Management Behaviors, and Glycemic Control in Adolescents and Young Adults
AbstractPurpose of ReviewUnderstanding barriers to self-management behaviors and glycemic stability may inform specific needs for behavior change in adolescents and young adults with type 1 diabetes (T1D). The current review aims to systematically synthesize the literature on the relationships between executive functioning, self-management, and A1C in adolescents and young adults with T1D. Fifteen studies were retained in the current review. Study quality assessment for the majority of the studies were “Fair” or “Good.”Recent FindingsThis review highlights several advances in research design, includ...
Source: Current Diabetes Reports - February 22, 2021 Category: Endocrinology Source Type: research

Auto-antigen and Immunomodulatory Agent –Based Approaches for Antigen-Specific Tolerance in NOD Mice
AbstractPurpose of ReviewType 1 diabetes (T1D) can be managed by insulin replacement, but it is still associated with an increased risk of microvascular/cardiovascular complications. There is considerable interest in antigen-specific approaches for treating T1D due to their potential for a favorable risk-benefit ratio relative to non-specific immune-based treatments. Here we review recent antigen-specific tolerance approaches using auto-antigen and/or immunomodulatory agents in NOD mice and provide insight into seemingly contradictory findings.Recent FindingsAlthough delivery of auto-antigen alone can prevent T1D in NOD mi...
Source: Current Diabetes Reports - February 6, 2021 Category: Endocrinology Source Type: research

Genetic Contribution to Non-alcoholic Fatty Liver Disease and Prognostic Implications
AbstractPurpose of ReviewNon-alcoholic fatty liver disease (NAFLD) is a major and increasing health burden, with the potential to overwhelm hepatology services. However, only a minority of patients develop advanced liver disease. The challenge is early identification of patients at risk of progression. This review aims to summarize current knowledge on the genetic predisposition to NAFLD, and its implications for prognostication and risk stratification.Recent FindingsPNPLA3-I148M is the most robustly associated genetic variant with NAFLD. Recently, variants inTM6SF2,MBOAT7,GCKR andHSD17B13 have also been implicated. NAFLD ...
Source: Current Diabetes Reports - February 5, 2021 Category: Endocrinology Source Type: research

A Model of Adolescent Sleep Health and Risk for Type 2 Diabetes
AbstractPurpose of ReviewThis paper presents a review of the current literature in support of a model explaining the relationships between sleep health and risk for type 2 diabetes in adolescents.Recent FindingsShort sleep duration is associated with risk of developing obesity in youth. Sleep restriction increases energy expenditure, but also increases hunger, appetite, and food intake, causing positive energy balance, impacting appetite-regulating hormones, and leading to increased eating late at night. Insufficient sleep may lead to reduced physical activity and greater sedentary behaviors. In addition, short sleep durat...
Source: Current Diabetes Reports - January 15, 2021 Category: Endocrinology Source Type: research

Managing Patients with Insulin Pumps and Continuous Glucose Monitors in the Hospital: to Wear or Not to Wear
AbstractPurpose of ReviewAs the prevalence of diabetes mellitus in the USA continues to rise, so does the popularity of diabetes management devices such as continuous glucose monitors (CGMs) and insulin pumps. The use of this technology has been shown to improve outpatient glycemic outcomes and quality of life and oftentimes may be continued in the hospital setting. Our aim is to review the current guidelines and available evidence on the continuation of insulin pumps and CGMs in the inpatient setting.Recent FindingsPatients with diabetes are at higher risk for hospitalizations and complications due to hyper- or hypoglycem...
Source: Current Diabetes Reports - January 15, 2021 Category: Endocrinology Source Type: research

Role of Glucose Metabolism and Mitochondrial Function in Diabetic Kidney Disease
AbstractPurpose of ReviewDiabetic kidney disease (DKD) continues to be the primary cause of chronic kidney disease in the USA and around the world. The numbers of people with DKD also continue to rise despite current treatments. Certain newer hypoglycemic drugs offer a promise of slowing progression, but it remains to be seen how effective these will be over time. Thus, continued exploration of the mechanisms underlying the development and progression of DKD is essential in order to discover new treatments. Hyperglycemia is the main cause of the cellular damage seen in DKD. But, exactly how hyperglycemia leads to the activ...
Source: Current Diabetes Reports - January 15, 2021 Category: Endocrinology Source Type: research

The Financial Impact of an Inpatient Diabetes Management Service
ConclusionIDMS may play an important role in helping both academic and community hospitals to improve the quality of diabetes care and reduce costs. Clinicians and policymakers can utilize existing literature to build a compelling business case for IDMS to hospital administrations and state legislatures in the era of value-based healthcare. (Source: Current Diabetes Reports)
Source: Current Diabetes Reports - January 15, 2021 Category: Endocrinology Source Type: research

Novel Immunomodulatory Approaches for Porcine Islet Xenotransplantation
AbstractPurpose of ReviewPorcine islet xenotransplantation is a promising alternative to overcome the shortage of organ donors. For the successful application of islet xenotransplantation, robust immune/inflammatory responses against porcine islets should be thoroughly controlled. Over the last few decades, there have been numerous attempts to surmount xenogeneic immune barriers. In this review, we summarize the current progress in immunomodulatory therapy for the clinical application of porcine islet xenotransplantation.Recent FindingsLong-term graft survival of porcine islets was achieved by using anti-CD154 Ab-based reg...
Source: Current Diabetes Reports - January 12, 2021 Category: Endocrinology Source Type: research

Diabetes Complications in Racial and Ethnic Minority Populations in the USA
AbstractPurpose of ReviewRacial and ethnic minority populations have a higher burden of diabetes-related complications. There have been many epidemiologic studies to better define these racial/ethnic disparities in diabetes outcomes with additional studies offering interventions to mitigate them. This narrative review highlights the epidemiologic trends in diabetes complications specific to racial and ethnic minorities and underscores differences in microvascular and macrovascular complications of diabetes, health care utilization, and diabetes prevention efforts and also reviews interventions aimed to reduce racial/ethnic...
Source: Current Diabetes Reports - January 9, 2021 Category: Endocrinology Source Type: research

The β-Cell Genomic Landscape in T1D: Implications for Disease Pathogenesis
This article reviews the current knowledge on the genetics of T1D with a specific focus on genetic variation in pancreatic islet regulatory networks and its implication to T1D risk and disease development.Recent FindingsAccumulating evidence suggest an active role of β cells in T1D pathogenesis. Based on such observation several studies aimed in mapping T1D risk variants acting at the β cell level. Such studies unravel T1D risk loci shared with type 2 diabetes (T2D) and T1D risk variants potentially interfering with β-cell responses to external stimuli.SummaryThe characterization of regulatory genomics maps ...
Source: Current Diabetes Reports - January 2, 2021 Category: Endocrinology Source Type: research

Periodic and Intermittent Fasting in Diabetes and Cardiovascular Disease
AbstractPurpose of ReviewCardiovascular disease (CVD) is one of the leading causes of death globally. Nutrition plays a central role in CVD risk by affecting aging, adiposity, glycemia, blood pressure, cholesterol, inflammation, and other risk factors and can affect CVD risk not only based on calorie intake and dietary composition but also the timing and range of meals. This review evaluates the effects of fasting, fasting-mimicking diets, and time-restricted eating on the reduction of CVD risk factors and provides initial data on their potential to serve as CVD prevention and treatment therapies.Recent FindingsIntermitten...
Source: Current Diabetes Reports - December 10, 2020 Category: Endocrinology Source Type: research

Cardiometabolic Morbidity and Mortality with Smoking Cessation, Review of Recommendations for People with Diabetes and Obesity
AbstractPurpose of ReviewObesity is closely linked with the pathogenesis of type 2 diabetes (T2DM) and cardiovascular disease (CVD), and whilst smoking cessation is associated with weight gain, there are concerns that this weight gain may offset the benefit of CVD risk reduction especially in those with considerable post-cessation weight gain. The aim of this narrative review is to evaluate recent evidence on smoking cessation and cardiometabolic outcomes and discuss limitations of current knowledge and studies.Recent FindingsNicotine is a key player in modulating energy balance by influencing lipid storage in adipose tiss...
Source: Current Diabetes Reports - December 8, 2020 Category: Endocrinology Source Type: research

Sleep Extension: A Potential Target for Obesity Treatment
AbstractPurpose of ReviewSleep and obesity share a bidirectional relationship, and weight loss has been shown to enhance sleep. Aiming to extend sleep on its own or as part of a lifestyle intervention may attenuate health consequences of short sleep. This review highlights several sleep extension approaches, discusses feasibility of each, and summarizes findings relevant to obesity.Recent FindingsSleep extension in response to experimental sleep restriction demonstrates partial rescue of cardiometabolic dysfunction in some but not all studies. Adequate sleep on a nightly basis may be necessary for optimal health. While ini...
Source: Current Diabetes Reports - December 4, 2020 Category: Endocrinology Source Type: research

Use of Machine Learning Approaches in Clinical Epidemiological Research of Diabetes
AbstractPurpose of ReviewMachine learning approaches —which seek to predict outcomes or classify patient features by recognizing patterns in large datasets—are increasingly applied to clinical epidemiology research on diabetes. Given its novelty and emergence in fields outside of biomedical research, machine learning terminology, techniques, and r esearch findings may be unfamiliar to diabetes researchers. Our aim was to present the use of machine learning approaches in an approachable way, drawing from clinical epidemiological research in diabetes published from 1 Jan 2017 to 1 June 2020.Recent FindingsMachine...
Source: Current Diabetes Reports - December 3, 2020 Category: Endocrinology Source Type: research

Evidence for Mental Health Contributions to Medical Care in Diabetes Management: Economic and Professional Considerations
AbstractPurpose of ReviewThis paper considers the potential contributions of behavioral health providers to interprofessional, collaborative treatment for diabetes. We have the following objectives: (1) review the behavioral health complications, risks, burdens, and costs associated with diabetes management and consider the role of behavioral health providers in treating mental health concerns specific to diabetes; (2) highlight two frameworks for incorporating behavioral health into diabetes treatment, and review the empirical support for each; and (3) consider the financial feasibility of integrating behavioral health se...
Source: Current Diabetes Reports - November 28, 2020 Category: Endocrinology Source Type: research

Impact of Type 2 Diabetes Mellitus and Antidiabetic Medications on Bone Metabolism
AbstractPurpose of ReviewThis review focuses on the complex interactions between hyperglycemia and bone fragility and the effects of antidiabetic medications on bone metabolism.Recent FindingsType 2 diabetes (T2D) is associated with increased risk of bone fracture even in those with increased or normal bone mineral density (BMD). The pathophysiology of diabetic bone disease is not completely understood, but it is thought to be multifactorial and associated with complex cross talk among factors such as AGEs, IGF-1, enteric hormones, and pro-inflammatory cytokines. Treatment for T2D may have an impact on bone metabolism.Summ...
Source: Current Diabetes Reports - November 27, 2020 Category: Endocrinology Source Type: research

Caring for Hospitalized Patients with Diabetes Mellitus, Hyperglycemia, and COVID-19: Bridging the Remaining Knowledge Gaps
AbstractPurpose of ReviewThis review discusses the interplay between coronavirus disease 2019 (COVID-19, caused by SARS-CoV-2 infection), diabetes mellitus, and hyperglycemia in the hospital setting. There are data emerging about diabetes and hyperglycemia, their prevalence, and potential risks in the setting of SARS-CoV-2 infection and COVID-19.Recent FindingsIt is known that viral infections exert effects on beta cell function and insulin resistance. Therefore, much can be learned about SARS-CoV-2/COVID-19 from examining these known relationships. Such pathophysiological underpinnings may unlock greater understanding as ...
Source: Current Diabetes Reports - November 26, 2020 Category: Endocrinology Source Type: research

The Role of Aspirin for Preeclampsia Prevention in Women with Diabetes
AbstractPurpose of ReviewA diagnosis of type I or type 2 diabetes confers heightened risk for virtually every obstetric and perinatal complication, with the incidence of superimposed preeclampsia representing a particularly high-risk scenario. Over the past three decades, studies have investigated the role of aspirin in preeclampsia prevention, yielding some promising results for certain at-risk groups, yet unconvincing evidence of benefit among women with pre-pregnancy diabetes. The purpose of this review is to present the current evidence base for aspirin use in pregnancy as a means of mitigating preeclampsia risk in the...
Source: Current Diabetes Reports - November 24, 2020 Category: Endocrinology Source Type: research

Does Weight Loss Improve Clinical Outcomes in Overweight and Obese Patients with Heart Failure?
AbstractPurpose of ReviewObesity increases the risk of new onset heart failure (HF), and particularly HF with preserved ejection fraction (HFpEF). Despite the observations of favorable clinical outcomes in HF patients with obesity in general, sometimes referred to as the “obesity paradox,” it is important to recognize that severe obesity is associated with worse clinical outcomes. This review summarizes the effects of obesity treatment on cardiovascular health and HF clinical outcomes.Recent FindingsTreatment for obesity utilizes a variety of modalities to achieve purposeful weight loss including lifestyle inte...
Source: Current Diabetes Reports - November 24, 2020 Category: Endocrinology Source Type: research

Sodium-Glucose Cotransporter Type 2 (SGLT-2) Inhibitors and Ketogenesis: the Good and the Bad
AbstractPurpose of ReviewThe micro/macrovascular complications of diabetes cause considerable morbidity and premature mortality. The SGLT2 inhibitors are the first diabetes medications with significant benefits on microvascular disease (nephropathy) and macrovascular cardiovascular disease. In this review, we evaluate one of the potential mechanisms for these cardiorenal benefits —the production of ketones, their benefits, and risks.Recent FindingsIn recent cardiovascular outcome trials (CVOTs), the SGLT2 inhibitors demonstrated significant cardiorenal benefits and they are now approved to reduce CV events/death, hea...
Source: Current Diabetes Reports - November 23, 2020 Category: Endocrinology Source Type: research