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IssueDiabetic Medicine: Volume 31, Issue 11
1279-1477November 2014
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Editor's Selection: This Month's Highlighted Article
Commentary
Review Articles
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Efficacy and safety of dipeptidyl peptidase-4 inhibitors as an add-on to insulin treatment in patients with Type 2 diabetes: a review
- Pages: 1293-1300
- First Published: 12 August 2014
Systematic Review or Meta-Analysis
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Dietary magnesium intake and risk of metabolic syndrome: a meta-analysis
- Pages: 1301-1309
- First Published: 26 June 2014
What's new?
- This is a meta-analysis of original studies on the association of dietary magnesium intake and risk of metabolic syndrome.
- The results of the meta-analysis could inform programmes focusing on the prevention of metabolic syndrome and its complications, including cardiovascular diseases.
Research Articles
Metabolism
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Plasma free fatty acids do not provide the link between obesity and insulin resistance or β-cell dysfunction: results of the Reading, Imperial, Surrey, Cambridge, Kings (RISCK) study
- Pages: 1310-1315
- First Published: 21 July 2014
What's new?
- We investigated the relationship between adiposity and plasma free fatty acid levels and the influence of total plasma free fatty acid levels on insulin sensitivity and β-cell function.
- We observed a modest inverse association between plasma free fatty acid levels and insulin sensitivity and β-cell output.
- We found that free fatty acid levels do not reflect degrees of adiposity.
- These observations add further weight to the emerging literature showing the limited influence that adiposity has on plasma free fatty acid levels in individuals who are at elevated risk of Type 2 diabetes.
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Serum bilirubin concentrations are positively associated with serum C-peptide levels in patients with Type 2 diabetes
- Pages: 1316-1322
- First Published: 09 June 2014
What's new?
- Although several clinical studies have reported an inverse correlation between serum bilirubin levels and the risk of diabetes, the relationship between serum bilirubin levels and serum C-peptide levels in patients with Type 2 diabetes is unknown.
- Our results show that serum total bilirubin concentrations within the physiological range are positively associated with serum C-peptide levels in patients with Type 2 diabetes.
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Metabolic effects of lifestyle intervention in obese pregnant women. Results from the randomized controlled trial ‘Lifestyle in Pregnancy’ (LiP)
- Pages: 1323-1330
- First Published: 02 July 2014
What's new?
- This study is among the largest of the randomized controlled trials in obese pregnant women to investigate the metabolic impact of a lifestyle intervention during pregnancy.
- Lifestyle intervention in obese pregnant women resulted in attenuation of the physiologic pregnancy-induced insulin resistance.
- Despite restricted gestational weight gain in the intervention group, there was no major effect in glucose or lipid metabolism.
Treatment
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Effect of docosahexaenoic acid-enriched fish oil supplementation in pregnant women with Type 2 diabetes on membrane fatty acids and fetal body composition—double-blinded randomized placebo-controlled trial
- Pages: 1331-1340
- First Published: 12 June 2014
What's new?
- This study tested the effectiveness of docosahexaenoic acid-enriched fish oil supplementation on ameliorating red cell membrane fatty acid composition of pregnant women with Type 2 diabetes and their neonates.
- A daily dose of 600 mg docosahexaenoic acid supplementation from early pregnancy in women with Type 2 diabetes resulted in normalizing docosahexaenoic acid levels in red cell membrane phospholipids of women and their neonates.
- The docosahexaenoic acid-enriched fish oil supplementation helped to minimize maternal docosahexaenoic acid depletion in pregnancy with Type 2 diabetes.
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Residual effect of reductions in red blood cell count and haematocrit and haemoglobin levels after 10-month withdrawal of pioglitazone in patients with Type 2 diabetes
- Pages: 1341-1349
- First Published: 05 May 2014
What's new?
- Red blood cell count and haematocrit and haemoglobin levels were found to decrease significantly, while body weight and BMI increased in patients with Type 2 diabetes treated with pioglitazone after 38 months. Reductions in red blood cell count and haemoglobin levels are associated with long-term pioglitazone treatment.
- A reversal of body weight gain but no recoveries in red blood cells, haematocrit and haemoglobin levels were observed after stopping pioglitazone treatment for 10 months. This finding indicates that thiazolidinediones can produce sustained effects on the haematopoietic system in patients with Type 2 diabetes despite thiazolidinedione withdrawal.
Genetics
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A genetic variant in SLC6A20 is associated with Type 2 diabetes in white-European and Chinese populations
- Pages: 1350-1356
- First Published: 23 June 2014
What's new?
- In a previous metabolic study, reduced SLC6A20 activity was shown to be related to Type 2 diabetes in primates and mice.
- In the present prospective follow-up study in a white-European population and in two independent case–control studies in a white-European and a Chinese population, the rs13062383 variant in SLC6A20, was associated with a higher risk of Type 2 diabetes.
- This finding highlights the possible importance of the proline pathway in Type 2 diabetes and could therefore provide new insights into the pathophysiology of Type 2 diabetes.
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Molecular and clinical characterization of glucokinase maturity-onset diabetes of the young (GCK-MODY) in Japanese patients
- Pages: 1357-1362
- First Published: 07 May 2014
What's new?
- Glucokinase maturity-onset diabetes of the young (GCK-MODY) has been believed to be rare in Asian people, and only a few case reports have been published.
- This study describes the molecular and clinical characteristics of the largest series of Japanese patients with GCK-MODY.
- The clinical picture of the Japanese patients was similar to that previously reported for white people, although 25% of the patients showed signs of insulin resistance.
Epidemiology
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Role of sleep duration as a risk factor for Type 2 diabetes among adults of different ages in Japan: the Niigata Wellness Study
- Pages: 1363-1367
- First Published: 30 July 2014
What's new?
- In this cohort of Japanese individuals, habitual short sleep duration of <6.5 h or <7.0 h per day, particularly among participants aged <60 years at the baseline examination, significantly increased the risk of developing diabetes.
- The effect of short sleep duration was attenuated among individuals of advancing age.
- Our findings indicated that young or middle-aged Japanese individuals with insufficient sleep time should be offered appropriate management for the modifiable risk factor of short sleep duration.
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Obesity index and the risk of diabetes among Chinese women with prior gestational diabetes
- Pages: 1368-1377
- First Published: 24 June 2014
What's new?
- There is some confusion regarding which anthropometric measurement of adiposity should be used to indicate diabetes, especially for Asians. The present study evaluated different indicators of adiposity (BMI, waist circumference and body fat) with Type 2 diabetes risk among women with prior gestational diabetes mellitus in China and concluded that waist circumference and body fat were better indicators than BMI, and that body fat might be the best indicator for risk of Type 2 diabetes among Chinese women with prior gestational diabetes.
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Comparison of different aspects of BMI history to identify undiagnosed diabetes in Japanese men and women: Toranomon Hospital Health Management Center Study 12 (TOPICS 12)
- Pages: 1378-1386
- First Published: 18 April 2014
What's new?
- In this study of Japanese men and women, we showed that, although current BMI was positively associated with the presence of undiagnosed diabetes, maximum BMI history and change between an individual's BMI in the early 20s and that individual's maximum BMI were also strongly associated with having prevalent undiagnosed diabetes.
- Adding information on lifetime maximum BMI and changes in BMI after early adulthood to information on current obesity/overweight would be of benefit in detecting patients with undiagnosed diabetes as simply and accurately as possible.
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Interpretation of HbA1c : association with mean cell volume and haemoglobin concentration
- Pages: 1387-1392
- First Published: 09 June 2014
What's new?
- Mean cell haemoglobin concentration (MCHC) correlates with HbA1c.
- Mean cell volume correlates with HbA1c in women.
- HbA1c can differ by 5 mmol/mol (5%) across the MCHC range.
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Association between changes in body composition and risk of developing Type 2 diabetes in Koreans
- Pages: 1393-1398
- First Published: 23 June 2014
What's new?
- This study examined the association between longitudinal changes in body composition and the risk of developing Type 2 diabetes in a large cohort of Korean adults.
- An increase or decrease in total body fat mass is associated with the risk of Type 2 diabetes independently of baseline measures of general or central obesity.
- An increase or decrease in lean body mass is not independently associated with risk of Type 2 diabetes.
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Metabolic syndrome and sex-specific socio-economic disparities in childhood and adulthood: the Korea National Health and Nutrition Examination Surveys
- Pages: 1399-1409
- First Published: 12 June 2014
What's new?
- Sex-specific socio-economic disparities in childhood and adulthood have different roles in the aetiology of metabolic syndrome and its individual components.
- The differing influences of socio-economic disparities by gender on the prevalence of metabolic syndrome might be explained by the sociocultural patterning of gender norms and attitudes.
- Reducing socio-economic disparities could be an effective preventative strategy for reducing health disparities.
- Public health policy and tailored interventions that consider sex differences in the effects of socio-economic disparities are necessary to reduce the burden of metabolic syndrome.
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Gender differences in the impact of poverty on health: disparities in risk of diabetes-related amputation
- Pages: 1410-1417
- First Published: 23 May 2014
What's new?
- This study provides novel information on the interplay between socio-economic status, gender and the risk of diabetes-related amputation, showing that men in low-income groups have a substantially greater risk of diabetes-related amputation, than any other socio-economic status/gender group.
- This study had a sufficiently large sample size (N > 600 000) and duration of follow-up to evaluate the combined influence of gender and poverty on these outcomes, after accounting for differences in access and use of healthcare services.
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Impaired metabolic control and socio-demographic status in immigrant children at onset of Type 1 diabetes
- Pages: 1418-1423
- First Published: 26 May 2014
What's new?
- Using the concept of migration of the parents to Sweden from other countries, this observational register study compares immigrant children with Swedish indigenous peers at the onset of diabetes.
- We found that children of immigrant parents had higher HbA1c and a greater proportion of low capillary pH (< 7.30).
- These facts could not be explained by lower social conditions among immigrant families.
- To our knowledge, this is the first time metabolic status at onset in immigrant children has been compared with indigenous children with diabetes derived from population-based registries of an entire country.
Educational and Psychological Issues
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The psychosocial impact associated with diabetes-related amputation
- Pages: 1424-1430
- First Published: 26 April 2014
What's new?
- The manuscript is the first to empirically examine the isolated impact of a diabetes-related amputation by controlling for important medical factors.
- The manuscript is the methodologically strongest study in this area to date.
- The results reveal that body image disturbance appears to be influenced by the amputation itself, while other psychosocial outcomes previously attributed to amputation may be better accounted for by the overall poorer physical health.
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Increasing capacity to deliver diabetes self-management education: results of the DESMOND lay educator non-randomized controlled equivalence trial
- Pages: 1431-1438
- First Published: 05 May 2014
What's new?
- We evaluated a novel format of delivering education to patients with Type 2 diabetes, involving a lay educator and a healthcare professional educator, with the paired educators taking an equal role.
- We demonstrated that education sessions delivered in this new format can provide psychosocial and health outcome benefits that are equivalent to those obtained from sessions delivered by two healthcare professional educators.
- Equivalent benefits included positive change in terms of participants' understanding of their condition, derived from the Diabetes Illness Perception Questionnaire-Revised, and also reduction in HbA1c levels.
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Self-awareness of foot health status in patients with Type 2 diabetes: the Fremantle Diabetes Study Phase II
- Pages: 1439-1445
- First Published: 12 June 2014
What's new?
- There have been no previous studies that have examined in detail self-awareness of foot health in Type 2 diabetes.
- In this community-based cross-sectional study, a large majority of patients who considered their feet to be normal had features on inspection such as deformity, dry skin, callus and fissures that could promote more serious complications, even though most had undergone foot examination by a healthcare professional in the previous year.
- Most patients with self-reported normal feet also had objective evidence of peripheral sensory neuropathy, and a smaller number of patients had peripheral arterial disease and the combination of neuropathy and arteriopathy.
- Self-assessment of diabetes-related foot problems was unreliable, and intensive education and monitoring may be necessary in those who consider their feet normal but who have neurovascular, structural and/or other precursors of serious foot pathology.
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Assessment of diabetes acceptance can help identify patients with ineffective diabetes self-care and poor diabetes control
- Pages: 1446-1451
- First Published: 21 July 2014
What's new?
- Acceptance-based treatments are gaining increasing relevance, particularly in the treatment of chronic conditions, suggesting that focusing on insufficient acceptance may help improve health outcomes.
- Low acceptance of diabetes is a measure of low involvement with diabetes treatment and is associated with reduced diabetes self-management and glycaemic control.
- There is a lack of instruments to assess diabetes acceptance, limiting opportunities to recognize insufficient acceptance and induce appropriate interventions.
- As low diabetes acceptance can be masked by good well-being, minimal depression or little distress, an independent measure for diabetes acceptance is required.
- The study revealed satisfactory psychometric properties of a six-item diabetes acceptance scale and factorial validity of the acceptance construct, suggesting that reliable and valid assessment of diabetes acceptance is possible.
- We observed strong negative associations between insufficient diabetes acceptance and important diabetes outcomes, including reduced diabetes self-care and impaired glycaemic control.
- Low diabetes acceptance was significantly more strongly associated with poor self-care and glycaemic control than were the frequently highlighted psychosocial aspects depression and diabetes distress.
Complications
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Oesophageal function assessed by high-resolution manometry in patients with diabetes and inadequate glycaemic control
- Pages: 1452-1459
- First Published: 28 April 2014
What's new?
- People with diabetes and gastroparesis might have impaired inhibition of contractile activity during multiple swallows of water.
- Intrabolus pressure might be higher in people with diabetes and gastroparesis than in those with normal gastric emptying.
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At least one in three people with Type 2 diabetes mellitus referred to a diabetes centre has symptomatic obstructive sleep apnoea
- Pages: 1460-1467
- First Published: 28 April 2014
What's new?
- At least one in three people with Type 2 diabetes has symptomatic, yet undiagnosed obstructive sleep apnoea—an observation that calls for focus on systematic screening and treatment in diabetes clinics.
- Results are from a clinic-based cohort of newly referred people with Type 2 diabetes and are therefore of high generalizability to other populations with Type 2 diabetes attending diabetes clinics.
- Screening with ApneaLink™—a portable device for home use—is feasible in people with Type 2 diabetes.
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Motivation, effort and life circumstances as predictors of foot ulcers and amputations in people with Type 2 diabetes mellitus
- Pages: 1468-1476
- First Published: 21 July 2014
What's new?
- Despite improved treatment, amputation incidence among people with Type 2 diabetes remains high.
- Little is known about how patient self-management in diabetes influences development of foot ulcers and amputations.
- General practitioners' assessments of poor patient motivation and effort in diabetes management, together with patient life circumstances, are related to higher foot ulcer prevalence and increased amputation risk.
- General practitioners' existing knowledge of their patients' motivation, effort and life circumstances may be used to identify patients at high risk of amputation.
Correction
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