5.Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis.
Fengshi LI ; Rui ZHANG ; Xiao DI ; Shuai NIU ; Zhihua RONG ; Changwei LIU ; Leng NI
Chinese Medical Journal 2023;136(12):1401-1409
BACKGROUND:
There is still uncertainty regarding whether diabetes mellitus (DM) can adversely affect patients undergoing carotid endarterectomy (CEA) for carotid stenosis. The aim of the study was to assess the adverse impact of DM on patients with carotid stenosis treated by CEA.
METHODS:
Eligible studies published between 1 January 2000 and 30 March 2023 were selected from the PubMed, EMBASE, Web of Science, CENTRAL, and ClinicalTrials databases. The short-term and long-term outcomes of major adverse events (MAEs), death, stroke, the composite outcomes of death/stroke, and myocardial infarction (MI) were collected to calculate the pooled effect sizes (ESs), 95% confidence intervals (CIs), and prevalence of adverse outcomes. Subgroup analysis by asymptomatic/symptomatic carotid stenosis and insulin/noninsulin-dependent DM was performed.
RESULTS:
A total of 19 studies (n = 122,003) were included. Regarding the short-term outcomes, DM was associated with increased risks of MAEs (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 5.1%), death/stroke (ES = 1.61, 95% CI: [1.13-2.28], prevalence = 2.3%), stroke (ES = 1.55, 95% CI: [1.16-1.55], prevalence = 3.5%), death (ES = 1.70, 95% CI: [1.25-2.31], prevalence =1.2%), and MI (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 1.4%). DM was associated with increased risks of long-term MAEs (ES = 1.24, 95% CI: [1.04-1.49], prevalence = 12.2%). In the subgroup analysis, DM was associated with an increased risk of short-term MAEs, death/stroke, stroke, and MI in asymptomatic patients undergoing CEA and with only short-term MAEs in the symptomatic patients. Both insulin- and noninsulin-dependent DM patients had an increased risk of short-term and long-term MAEs, and insulin-dependent DM was also associated with the short-term risk of death/stroke, death, and MI.
CONCLUSIONS
In patients with carotid stenosis treated by CEA, DM is associated with short-term and long-term MAEs. DM may have a greater impact on adverse outcomes in asymptomatic patients after CEA. Insulin-dependent DM may have a more significant impact on post-CEA adverse outcomes than noninsulin-dependent DM. Whether DM management could reduce the risk of adverse outcomes after CEA requires further investigation.
Humans
;
Endarterectomy, Carotid/adverse effects*
;
Carotid Stenosis/surgery*
;
Risk Factors
;
Treatment Outcome
;
Time Factors
;
Stents/adverse effects*
;
Diabetes Mellitus, Type 2/complications*
;
Diabetes Mellitus, Type 1
;
Stroke/complications*
;
Insulin/therapeutic use*
;
Myocardial Infarction/complications*
;
Risk Assessment
7.Continuous Blood Glucose Monitoring:Technological Progress and Application Extension.
Chinese Journal of Medical Instrumentation 2023;47(4):424-427
Continuous glucose monitoring (CGM) technology developed rapidly in recent years, and new products came out all the time. Nowadays, CGM plays an important role in diabetes management and has been recommended by various guideline all over the world. CGM equipment classification, progress on glucose sensor technology, and the new application and expansion of CGM technology in the field of diabetes and non-diabetes were briefly introduced in the study.
Humans
;
Diabetes Mellitus, Type 1
;
Blood Glucose
;
Blood Glucose Self-Monitoring
;
Technology
9.Characteristics of children with newly diagnosed type 1 diabetes mellitus in Brunei Darussalam
Chun Yen Wee ; Alice Moi Ling Yong ; Chee Fui Chong ; Ing Shian Soon
Journal of the ASEAN Federation of Endocrine Societies 2023;38(2):8-12
Objective:
This study aims to characterize the presentation, biochemical status of children with T1DM at diagnosis, the type of subcutaneous insulin regimens initiated, and to determine the incidence of T1DM in Bruneian children aged 18 years and younger.
Methodology:
A retrospective electronic and paper medical chart review was performed on patients aged 18 years and younger diagnosed with T1DM from 2013 to 2018 in Brunei Darussalam.
Results:
A total of 31 children with a mean age of 10.2 ± 3.6 years old were diagnosed with T1DM, of which 66.7% presented with diabetic ketoacidosis (DKA), a majority in severe DKA with an intercurrent illness (p=0.021). The mean HbA1c was 13.6 ± 2.7% with a mean serum glucose of 37.0±14.9 mmol/L at diagnosis. In the majority of the children (67.7%), multiple daily injections of subcutaneous insulin were initiated. The incidence of T1DM in children aged 18 years and younger was 4.9 per 100,000 for the year 2018.
Conclusions
The majority of the patients in this study presented with severe DKA with an intercurrent illness. This highlights the importance of childhood T1DM awareness among the public and healthcare providers. The incidence of childhood T1DM in Brunei Darussalam is similar to other countries in the Asian region, being relatively low, compared to the rest of the world.
Diabetes Mellitus, Type 1
;
Diabetic Ketoacidosis
10.Behavioural and emotional problems in Malaysian children and adolescents with type 1 diabetes mellitus: A cross-sectional study in a single centre
Wong Lee Ching ; Arini Nuran Idris ; Norazlin Kamal Nor ; Lim Poi Giok
Journal of the ASEAN Federation of Endocrine Societies 2023;38(2):13-19
Introduction:
Type 1 diabetes mellitus (T1DM) is an autoimmune disorder that requires a lifelong treatment regimen which may affect psychosocial development.
Objective:
To identify behavioural and emotional problems in children and adolescents with T1DM.
Methodology:
A cross-sectional study using the Child Behaviour Check List (CBCL) was conducted among all T1DM patients receiving treatment at the Paediatric Endocrine Unit, Hospital Tunku Azizah Kuala Lumpur, Malaysia.
Results:
Forty T1DM patients were included. The mean age of the participants was 12.4 years (SD=2.69), with 52.5% males, and 75% Malay. The average duration of illness was 4.8 years, 9 were pre-pubertal, while mean HbA1c was 9.4%. Thirty-five percent of the respondents had parent-reported internalizing problems and 17.5% had parent-reported externalizing problems. Those >12 years old had more internalizing problems (p=0.004) compared to those ≤12 years old. The differences were in the anxious/depressed syndrome subscale (p=0.001) and withdrawn/depressed syndrome subscale (p=0.015). There were no statistically significant differences in the 3 main global scores by gender, glycaemic control, duration of illness and pubertal status by univariate analysis.
Conclusion
T1DM patients >12 years old were at higher risk of developing psychosocial difficulties. This highlighted the benefit of screening of behavioural and emotional issues in children and adolescents with T1DM.
Diabetes Mellitus, Type 1
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