BACKGROUND Continuous glucose monitoring(CGM)metrics,such as time in range(TIR)and glycemic risk index(GRI),have been linked to various diabetes-related complications,including diabetic foot(DF).AIM To investigate the...BACKGROUND Continuous glucose monitoring(CGM)metrics,such as time in range(TIR)and glycemic risk index(GRI),have been linked to various diabetes-related complications,including diabetic foot(DF).AIM To investigate the association between CGM-derived indicators and the risk of DF in individuals with type 2 diabetes mellitus(T2DM).METHODS A total of 591 individuals with T2DM(297 with DF and 294 without DF)were enrolled.Relevant clinical data,complications,comorbidities,hematological parameters,and 72-hour CGM data were collected.Logistic regression analysis was employed to examine the relationship between these measurements and the risk of DF.RESULTS Individuals with DF exhibited higher mean blood glucose(MBG)levels and increased proportions of time above range(TAR),TAR level 1,and TAR level 2,but lower TIR(all P<0.001).Patients with DF had significantly lower rates of achieving target ranges for TIR,TAR,and TAR level 2 than those without DF(all P<0.05).Logistic regression analysis revealed that GRI,MBG,and TAR level 1 were positively associated with DF risk,while TIR was inversely correlated(all P<0.05).Achieving TIR and TAR was inversely correlated with white blood cell count and glycated hemoglobin A1c levels(P<0.05).Additionally,achieving TAR was influenced by fasting plasma glucose,body mass index,diabetes duration,and antidiabetic medication use.CONCLUSION CGM metrics,particularly TIR and GRI,are significantly associated with the risk of DF in T2DM,emphasizing the importance of improved glucose control.展开更多
国际糖尿病足工作组(IWGDF)自1999年以来发布了糖尿病相关的足部疾病管理和预防的循证指南,本指南是《国际糖尿病足工作组:糖尿病足感染诊断与治疗指南(2019)》的更新。推荐、评估、发展和评价分级(The Grading of Recommendations,Asse...国际糖尿病足工作组(IWGDF)自1999年以来发布了糖尿病相关的足部疾病管理和预防的循证指南,本指南是《国际糖尿病足工作组:糖尿病足感染诊断与治疗指南(2019)》的更新。推荐、评估、发展和评价分级(The Grading of Recommendations,Assessment,Development,and Evaluation;GRADE)框架用于制定本指南。这是围绕着以人群-干预(评估)-比较-结局[P(A)ICO]格式识别临床相关问题、确定患者重要结果、系统地审查证据、评估证据的确定性,以及最终从证据转向推荐而构建的。本指南是为参与糖尿病相关足部管理的医务人员制定的,通过患者的重要的临床结局,为临床实践提供参考。本次编写时更新了2019年的两项系统综述,为该指南提供了信息,从更新的检索中确定了符合纳入标准的149项研究(62项为新的研究),并将其纳入本指南。更新的推荐来源于这些系统综述,以及在没有证据的情况下由专家提出的最佳实践声明。本次指南在更新中根据获益和危害对证据进行权衡,得出推荐。本次更新修改了一些推荐证据的质量,以患者重要的临床结局为中心,对GRADE框架进行了更精细的应用。这一点在本次更新的推荐的理由部分得到了强调。还要注意到,新确定的证据没有改变先前推荐的证据质量及其强度。本次提出的推荐继续涵盖软组织和骨组织感染诊断的各个方面,包括诊断感染及其严重程度的分类方案。还概述了如何收集微生物样本以及如何对其进行处理以识别病原体。最后,指南介绍了治疗糖尿病患者足感染的方法,包括在软组织和骨组织感染时选择合适的经验性的和明确的抗菌疗法,何时和如何进行手术治疗,以及哪些辅助治疗可能会或不会影响糖尿病相关的足病的感染结果。我们认为,遵循这些推荐将有助于医务人员为糖尿病合并足感染患者提供更好的管理,防止截肢和减少截肢的次数,并减少糖尿病相关的足部疾病患者数量和医疗负担。展开更多
Objective To investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. Methods In total 1 397 type 2 ...Objective To investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. Methods In total 1 397 type 2 diabetic patients aged 50 years and older were enrolled and determined ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in 15 Class III Grade A hospitals in 7 major cities of China. Results Mean patient age was 63.7±8.2 years and mean duration of diabetes mellitus was 9.39±7.4 years. Two hundreds and seventy-two (19.47%) patients were diagnosed as PAD by ABI <0.9, 122 (18.37%) in male and 150 (20.46%) in female. PAD patients had a significantly longer duration of diabetes mellitus, higher hemoglobin Alc, and a significantly lower mean body mass index than non-PAD ones. Aging, smoking, and systolic blood pressure were found to be positively related with the prevalence of PAD. In terms of lipid profiles, no variable was found to relate with PAD. Notably, baPWV showed as the same significant guiding index for PAD, almost matched with ABI. Conclusions PAD is a common complication in China type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for diabetic patients with high risk factors.展开更多
基金Supported by Yunnan Province Academician(Expert)Workstation Project,No.202305AF150097the Basic Research Program of Yunnan Province(Kunming Medical University Joint Special Project),No.202101AY070001-276+3 种基金the National Natural Science Foundation of China,No.82160159the Key Project Program of Yunnan Province(Kunming Medical University Joint Special Project),No.202301AY070001-013the Major Science and Technology Project of Yunnan Province,No.202202AA100004the Double First-class University Construction Project of Yunnan University,No.CY22624106.
文摘BACKGROUND Continuous glucose monitoring(CGM)metrics,such as time in range(TIR)and glycemic risk index(GRI),have been linked to various diabetes-related complications,including diabetic foot(DF).AIM To investigate the association between CGM-derived indicators and the risk of DF in individuals with type 2 diabetes mellitus(T2DM).METHODS A total of 591 individuals with T2DM(297 with DF and 294 without DF)were enrolled.Relevant clinical data,complications,comorbidities,hematological parameters,and 72-hour CGM data were collected.Logistic regression analysis was employed to examine the relationship between these measurements and the risk of DF.RESULTS Individuals with DF exhibited higher mean blood glucose(MBG)levels and increased proportions of time above range(TAR),TAR level 1,and TAR level 2,but lower TIR(all P<0.001).Patients with DF had significantly lower rates of achieving target ranges for TIR,TAR,and TAR level 2 than those without DF(all P<0.05).Logistic regression analysis revealed that GRI,MBG,and TAR level 1 were positively associated with DF risk,while TIR was inversely correlated(all P<0.05).Achieving TIR and TAR was inversely correlated with white blood cell count and glycated hemoglobin A1c levels(P<0.05).Additionally,achieving TAR was influenced by fasting plasma glucose,body mass index,diabetes duration,and antidiabetic medication use.CONCLUSION CGM metrics,particularly TIR and GRI,are significantly associated with the risk of DF in T2DM,emphasizing the importance of improved glucose control.
文摘国际糖尿病足工作组(IWGDF)自1999年以来发布了糖尿病相关的足部疾病管理和预防的循证指南,本指南是《国际糖尿病足工作组:糖尿病足感染诊断与治疗指南(2019)》的更新。推荐、评估、发展和评价分级(The Grading of Recommendations,Assessment,Development,and Evaluation;GRADE)框架用于制定本指南。这是围绕着以人群-干预(评估)-比较-结局[P(A)ICO]格式识别临床相关问题、确定患者重要结果、系统地审查证据、评估证据的确定性,以及最终从证据转向推荐而构建的。本指南是为参与糖尿病相关足部管理的医务人员制定的,通过患者的重要的临床结局,为临床实践提供参考。本次编写时更新了2019年的两项系统综述,为该指南提供了信息,从更新的检索中确定了符合纳入标准的149项研究(62项为新的研究),并将其纳入本指南。更新的推荐来源于这些系统综述,以及在没有证据的情况下由专家提出的最佳实践声明。本次指南在更新中根据获益和危害对证据进行权衡,得出推荐。本次更新修改了一些推荐证据的质量,以患者重要的临床结局为中心,对GRADE框架进行了更精细的应用。这一点在本次更新的推荐的理由部分得到了强调。还要注意到,新确定的证据没有改变先前推荐的证据质量及其强度。本次提出的推荐继续涵盖软组织和骨组织感染诊断的各个方面,包括诊断感染及其严重程度的分类方案。还概述了如何收集微生物样本以及如何对其进行处理以识别病原体。最后,指南介绍了治疗糖尿病患者足感染的方法,包括在软组织和骨组织感染时选择合适的经验性的和明确的抗菌疗法,何时和如何进行手术治疗,以及哪些辅助治疗可能会或不会影响糖尿病相关的足病的感染结果。我们认为,遵循这些推荐将有助于医务人员为糖尿病合并足感染患者提供更好的管理,防止截肢和减少截肢的次数,并减少糖尿病相关的足部疾病患者数量和医疗负担。
文摘Objective To investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. Methods In total 1 397 type 2 diabetic patients aged 50 years and older were enrolled and determined ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in 15 Class III Grade A hospitals in 7 major cities of China. Results Mean patient age was 63.7±8.2 years and mean duration of diabetes mellitus was 9.39±7.4 years. Two hundreds and seventy-two (19.47%) patients were diagnosed as PAD by ABI <0.9, 122 (18.37%) in male and 150 (20.46%) in female. PAD patients had a significantly longer duration of diabetes mellitus, higher hemoglobin Alc, and a significantly lower mean body mass index than non-PAD ones. Aging, smoking, and systolic blood pressure were found to be positively related with the prevalence of PAD. In terms of lipid profiles, no variable was found to relate with PAD. Notably, baPWV showed as the same significant guiding index for PAD, almost matched with ABI. Conclusions PAD is a common complication in China type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for diabetic patients with high risk factors.
