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Diabetology, Volume 6, Issue 2 (February 2025) – 5 articles

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12 pages, 852 KiB  
Article
Prescribed Total Daily Insulin Dose and Predictors of Insulin Dose for Adults with Type 2 Diabetes on Multiple Daily Injections of Insulin: A Retrospective Cohort Study
by Eugene E. Wright, Jr., Viral N. Shah, Eden Miller, Andrew Thach, Pasha Javadi, Shawn Davies and Ray Sieradzan
Diabetology 2025, 6(2), 13; https://doi.org/10.3390/diabetology6020013 - 12 Feb 2025
Abstract
Background/Objectives: Limited evidence is available regarding insulin total daily dose (TDD), or the factors associated with TDD, among adults with type 2 diabetes (T2D) using multiple daily injections of insulin (MDI). Our aim was to determine the percentage of adults in the [...] Read more.
Background/Objectives: Limited evidence is available regarding insulin total daily dose (TDD), or the factors associated with TDD, among adults with type 2 diabetes (T2D) using multiple daily injections of insulin (MDI). Our aim was to determine the percentage of adults in the United States (US) with T2D who are prescribed MDI, their prescribed insulin TDD, and potential factors associated with TDD. Methods: This retrospective cohort study used deidentified data from the US IQVIA ambulatory electronic medical record database to study adults (≥18 years) with T2D initiating MDI (≥3 daily basal-plus-prandial insulin injections) from 1 January 2017 to 1 July 2022. The TDD was calculated from first evidence of MDI (index date). We used a generalized linear model regression analysis to model the relationship between TDD and clinically relevant factors associated with TDD. Results: During the study period, of 3,339,663 adults with T2D, 451,769 (13.5%) had ≥1 basal insulin prescriptions, 206,000 (6.2%) had both basal and prandial insulin prescriptions, and 41,215 (1.2%) were prescribed MDI (mean age, 58 years; 52% women; 62% White/Caucasian, 14% African American; mean body mass index [BMI], 34 kg/m2). Mean TDD was 96 units (1.0 units/kg/day); median TDD was 80 units (interquartile range, 54–124). In the regression analysis (model R2, 0.14), factors predicting lower TDD included female sex, African American race, and prior 6-month (pre-index) prescriptions of sulfonylurea, metformin, or 2–3 noninsulin glucose-lowering medications. Predictors of greater TDD included increasing BMI, age 30–64 years, and pre-index SGLT2 inhibitor or GLP-1 RA prescription. Conclusions: Among US adults with T2D, 1.2% were prescribed MDI, with a wide range of TDD and median TDD of 80 units. Further research in other populations and using other data sources is warranted to explore prescribed insulin TDD for T2D and to examine other potentially relevant predictors of TDD. Full article
(This article belongs to the Special Issue Insulin Injection Techniques and Skin Lipodystrophy)
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14 pages, 402 KiB  
Article
Coffee and Tea Consumption and Risk of Type 2 Diabetes in Older Australians
by Tommy Hon Ting Wong, George Burlutsky, Bamini Gopinath, Victoria M. Flood, Paul Mitchell and Jimmy Chun Yu Louie
Diabetology 2025, 6(2), 12; https://doi.org/10.3390/diabetology6020012 - 11 Feb 2025
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Abstract
Background: The prospective relationship between coffee and tea consumption and the risk of developing type 2 diabetes mellitus (T2DM) is seldom assessed in older adults. This study investigated the association between coffee and tea consumption and the 10-year incidence of T2DM in older [...] Read more.
Background: The prospective relationship between coffee and tea consumption and the risk of developing type 2 diabetes mellitus (T2DM) is seldom assessed in older adults. This study investigated the association between coffee and tea consumption and the 10-year incidence of T2DM in older Australian adults. Method: Data were collected from participants aged 49 years or above at baseline of the Blue Mountains Eye Study (n = 1668). Coffee and tea intakes were assessed using a validated food frequency questionnaire. T2DM was ascertained by the self-reported history, fasting blood glucose ≥ 7.0 mmol/L, or self-reported use of diabetes medication. Associations were assessed using discrete-time logistic regression, adjusting for lifestyle and demographic factors. Results: Compared to no consumption, coffee intake of 1 cup/day was associated with a lower risk of developing T2DM (multivariate-adjusted HR: 0.46, 95% CI: 0.23, 0.91) in the 10-year follow-up period. However, consumption of 2–3 cups/day (HR: 0.66, 95% CI: 0.37, 1.18) or ≥4 cups/day (HR: 1.04, 95% CI: 0.52, 2.08) showed no significant association. Tea consumption at any level was not significantly associated with T2DM incidence. Results were similar after excluding participants with implausible energy intake. Conclusions: In older adults, moderate coffee intake (1 cup/day) was associated with lower T2DM incidence, while higher coffee consumption and tea intake at any level were not. The lack of a dose-dependent effect in coffee consumption warrants further investigation. These findings should be verified in larger studies, considering different coffee and tea types and potential age-related and genetic factors. Full article
(This article belongs to the Special Issue Dietary Patterns and Risk of Type 2 Diabetes)
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17 pages, 3545 KiB  
Review
Genetic Susceptibility of Type 2 Diabetes and Metabolic Syndrome
by Vladimir Ercegović, Monika Džimbeg and Andrea Gelemanović
Diabetology 2025, 6(2), 11; https://doi.org/10.3390/diabetology6020011 - 6 Feb 2025
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Abstract
Type 2 diabetes (T2D) and metabolic syndrome (MetS) represent complex, multifactorial conditions that pose significant challenges to public health and healthcare costs worldwide. These two conditions share common risk factors such as obesity, dyslipidemia, and hypertension and, as a consequence, are frequently jointly [...] Read more.
Type 2 diabetes (T2D) and metabolic syndrome (MetS) represent complex, multifactorial conditions that pose significant challenges to public health and healthcare costs worldwide. These two conditions share common risk factors such as obesity, dyslipidemia, and hypertension and, as a consequence, are frequently jointly diagnosed in an individual. More specifically, it is estimated that around 85% of T2D patients also have MetS, while patients diagnosed with MetS are five times as likely to develop T2D. While lifestyle and environmental factors, such as poor diet and physical inactivity, play a crucial role, genetic susceptibility also has a substantial influence on the overall risk. Recent advancements in genome-wide association studies (GWAS) have had a major impact on identifying numerous genetic loci associated with these conditions. This narrative review summarizes key findings from T2D and MetS genome-wide association studies, highlighting key genetic loci and pathways and their clinical implications. The objective of this review is to provide a comprehensive understanding of the known genetic underpinnings of T2D and MetS to inform future research and open potential therapeutic and preventive strategies. Full article
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10 pages, 360 KiB  
Article
The Role of Vitamin C in Wound Healing in Surgically Managed Diabetic Foot Disease
by Kiran Kancherla, Jason Chow, Rajat Mittal, Nakul Kaushik, Tamer Kamal, Gary Low and Brian Martin
Diabetology 2025, 6(2), 9; https://doi.org/10.3390/diabetology6020009 - 5 Feb 2025
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Abstract
Background: Diabetic foot ulcers (DFUs) represent a significant cause of morbidity in diabetic patients, with surgical management frequently required in advanced cases. This study examines the association between preoperative vitamin C levels and wound-healing outcomes in patients with diabetic foot disease (DFD) requiring [...] Read more.
Background: Diabetic foot ulcers (DFUs) represent a significant cause of morbidity in diabetic patients, with surgical management frequently required in advanced cases. This study examines the association between preoperative vitamin C levels and wound-healing outcomes in patients with diabetic foot disease (DFD) requiring surgical debridement. Methods: A retrospective cohort study was conducted at a tertiary referral centre, with the study including diabetic patients who had undergone surgical debridement for forefoot and midfoot diabetic foot infections between January 2020 and July 2024. Patients with ISDA grades 3 and 4 ulcers and preoperative measurements of vitamin C, albumin, HbA1c, and BMI were included. The primary outcome was time to wound healing, defined as the duration from surgery to discharge from the orthopaedic diabetic foot clinic. Data were analysed using generalized linear models to assess the impact of preoperative vitamin C levels on healing time, controlling for confounding variables. Results: In the 61 patients included in the multivariable regression analysis, higher preoperative vitamin C levels were significantly associated with faster wound healing (p = 0.01). Other significant factors included albumin levels and ulcer location, with midfoot ulcers healing more slowly than forefoot ulcers. The mean time to healing was 3 months, with vitamin C levels showing a statistically significant effect on wound-healing outcomes. Conclusions: Our study demonstrates that higher preoperative vitamin C levels were associated with faster wound healing in surgically treated diabetic foot ulcers. Future prospective randomized controlled trials are needed to confirm these findings and assess the role of vitamin C supplementation in the management of surgically treated DFUs. Full article
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15 pages, 858 KiB  
Review
Diabetes, Chronic Kidney Disease, and Vascular Ulcers: Prevention Strategies and Clinical Implications
by Stefano Mancin, Alfonso Zarrella, Fabio Petrelli, Simone Cosmai, Daniela Cattani, Diego Lopane, Sarah Scollo, Sara Morales Palomares, Marco Sguanci, Antonella Amendola, Giovanni Cangelosi and Beatrice Mazzoleni
Diabetology 2025, 6(2), 10; https://doi.org/10.3390/diabetology6020010 - 5 Feb 2025
Viewed by 409
Abstract
Background/Aim: Chronic kidney disease (CKD), primarily caused by diabetes, predisposes patients to a high risk of systemic complications, including vascular ulcers. This study aimed to evaluate the impact of arterial vascular ulcers in patients with CKD, with particular attention to predisposing factors including [...] Read more.
Background/Aim: Chronic kidney disease (CKD), primarily caused by diabetes, predisposes patients to a high risk of systemic complications, including vascular ulcers. This study aimed to evaluate the impact of arterial vascular ulcers in patients with CKD, with particular attention to predisposing factors including diabetes and prevention strategies. Methods: A narrative literature review was conducted, adopting the Scale for the Assessment of Narrative Review Articles (SANRA), using databases such as PubMed, CINAHL, Embase, and Cochrane Library, along with grey literature sources. Results: The literature review revealed a significant association between peripheral arterial disease (PAD) and CKD, highlighting the prevalence (41.5%) and associated risk factors, such as type 1 diabetes (OR, 2.993; 95% CI: 1.477–6.065, p = 0.002), type 2 diabetes (OR, 2.498; 95% CI: 1.466–4.256, p = 0.001), and hypertension (OR, 1.781; 95% CI: 1.293–2.450, p < 0.001) in hemodialysis patients. Preventive strategies were discussed, emphasizing the automation of ankle–brachial index (ABI) measurement. Conclusions: This review identifies risk factors and preventive strategies for PAD in CKD patients, emphasizing diabetes as a key contributor. Evidence supports current diagnostic approaches and guidelines but highlights the need for larger studies. Standardized protocols and targeted training are crucial for improved management. Full article
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