Age + blood sugar + waist circumference can calculate whether diabetic patients will have complications?

*Only for medical professionals to read and refer to Weekly Information No.
207: Knowing the age of onset, fasting blood sugar and waist circumference can simply predict the risk of heart failure, chronic kidney disease, retinal disease, and even the risk of death in diabetic patients! This article summarizes the circadian rhythm of insulin sensitivity leading to the occurrence of dawn phenomenon.
Three indicators can predict the risk of complications in diabetic patients.
Buddhists who are indisputable in the world are more likely to develop diabetic ulcers.
1 Insulin sensitivity circadian rhythm causes the occurrence of dawn phenomenon DOI: 10.
1038/s41586 -021-03358-w.
The dawn phenomenon was first discovered by Schmidt et al.
in 1981.
It refers to the state of hyperglycemia that occurs at dawn from 3 to 9 in the morning when diabetic patients have stable night blood glucose control and no hypoglycemia.

The dawn phenomenon affects the patient's overall blood sugar control level.

If the dawn phenomenon is not fully controlled, the patient's blood glucose levels before and after meals will continue to rise, and even blood glucose will rise throughout the day.

However, in the nearly 40 years since the dawn phenomenon was discovered, the mechanism behind it has been inconclusive.

However, a recent study published in "Nature" suggested that the REV-ERB gene of GABA neurons in the suprachiasmatic nucleus (SCN) of the hypothalamus controls the circadian rhythm of insulin suppression of liver gluconeogenesis, which may be related to the dawn phenomenon.

 Figure 1.
1 Research published in "Nature" This research led by Baylor College of Medicine and Qilu Hospital of Shandong University found that mice lacking the circadian rhythm gene REV-ERB gene in the brain showed similar characteristics to the dawn phenomenon.

Subsequently, the researchers analyzed the expression of the REV-ERB gene in patients with type 2 diabetes and found that the circadian rhythms of gene expression in the patients with the dawn phenomenon were different from those without the dawn phenomenon.

These results suggest that the REV-ERB gene may indeed be closely related to the occurrence of dawn phenomenon.

 Figure 1.
2 Red is the REV-ERB gene expression in the mouse brain.
Insulin sensitivity in blood glucose metabolism has a circadian rhythm, and the REV-ERB gene discovered this time may be the key to regulating this rhythm.

In order to explore the connection between the two, the researchers further knocked out the REV-ERB gene in mice and found that the mice had problems with glucose tolerance at this time.

Analysis shows that REV-ERB gene plays an important role in regulating the rhythm of hepatic insulin sensitivity, but has nothing to do with eating behavior or basal hepatic glucose production.

 Under normal physiological conditions, liver gluconeogenesis reaches a peak before and after the human body wakes up to prevent hypoglycemia in the human body during sleep, and at the same time provide energy for activities after waking up.

The liver’s sensitivity to insulin also peaks when waking up, allowing the body to prepare for eating, which is conducive to absorbing nutrients from food and replenishing energy consumed during sleep.

 The biological clock of the normal human brain has a good correlation with the expression of the REV-ERB gene in the human body.
The REV-ERB gene is only expressed during the day and not at night.

However, the REV-ERB-α and REV-ERB-β genes in diabetic patients with the dawn phenomenon are not so obedient.

When there is no difference in sleep status, there is indeed a difference in expression between patients with dawn phenomenon and patients without dawn phenomenon.

 Figure 1.
3 Dawn blood sugar rise in diabetic patients with dawn phenomenon The difference in circadian rhythm of gene expression can explain the occurrence of dawn phenomenon in people.

This discovery not only provides an explanation for the circadian rhythm of insulin sensitivity, but also explains the pathophysiological mechanism behind the dawn phenomenon.

At present, to a certain extent, insulin can be used to improve the occurrence of dawn phenomenon, and this research provides a new idea for the treatment of this disease, that is, the use of drugs to regulate the expression of REV-ERB genes.

 REF:[1] Ding G, Li X, Hou X, et al.
REV-ERB in GABAergic neurons controls diurnal hepatic insulin sensitivity.
Nature.
2021 Mar 24.
doi: 10.
1038/s41586-021-03358-w.
[2] Circadian clock gene Rev-erb linked to dawn phenomenon in type 2 diabetes.
EurekAlert! 25 Mar 2021.
Accessed via on 2021-03-30 .
2 Three indicators can predict the risk of complications in diabetic patients DOI: 10.
1016/j.
jdiacomp.
2021.
107915.
Type 2 diabetes has significant heterogeneity, and the potential genetic risks, clinical features or risks of subsequent complications in different subgroups of patients Vary.

Although the current stratification method can predict the prognosis of patients with type 2 diabetes to a certain extent, the classification criteria are often more complicated.

At the same time, the indicators selected by various classification methods are relatively random, which makes the classification of diabetes subgroups not widely recognized and applied.

Therefore, the study recently published in "J Diabetes Complications" attempts to determine the risk of patients based on the simple and universal age of onset of diabetes, fasting blood glucose level and waist circumference.

 Figure 2.
1 Study published in "J Diabetes Complications" This study from Wake Forest University School of Medicine in the United States used data from the multi-ethnic study of atherosclerosis and included 1587 participants with diabetes, based on the age at diagnosis of diabetes ( Patients ≤45 years old), fasting blood glucose (FG≥7.
7mmol/l; ≥140mg/dL) and waist circumference (women ≥105cm; men ≥110cm) were classified into patients, and the risk of complications in different subgroups was estimated.

 Compared with patients without risk factors, the subgroup with higher fasting blood glucose and earlier age of onset had higher deaths (HR 4.
14, 95%CI 2.
10-8.
18), cardiovascular disease (HR 4.
30, 95%CI 2.
25-8.
24), heart failure (HR 6.
51, 95%CI 2.
53-16.
7), chronic kidney disease (HR 2.
85, 95%CI 1.
67-4.
88) and retinopathy (HR 3.
65, 95%CI 2.
54-4.
76).

 Compared with patients without risk factors, the subgroup with a larger waist circumference and an early age of onset had higher cardiovascular disease (HR 2.
73, 95%CI 1.
22-6.
12) and heart failure (HR 3.
03, 95%CI 1.
09 -8.
41), chronic kidney disease (HR 3.
29, 95%CI 1.
69-6.
40) and retinopathy (HR 3.
53, 95%CI 2.
20-4.
86).

 Compared with patients without risk factors, the subgroup with larger waist circumference and higher fasting blood glucose had higher deaths (HR 1.
42, 95% CI 1.
02-1.
96) and retinopathy (HR 1.
83, 95% CI 1.
33- 2.
32) risk.

This group has a slightly lower risk of complications than the previous two groups, but it is still not to be taken lightly.

 If fasting blood glucose is high, waist circumference is large and the age of onset is early, then death (HR 3.
70, 95%CI 1.
98-6.
92), heart failure (3.
54, 95%CI 1.
31-9.
53), chronic kidney disease (HR 2.
15, 95%CI 1.
27-3.
65) and retinopathy (HR 3.
68, 95%CI 2.
56-4.
80) will have a higher risk.

 Figure 2.
2 There are differences in the incidence of complications among patients in each subgroup.
The study used age at onset of diabetes, fasting blood glucose, and central obesity (waist circumference) to simply stratify patients to predict the risk of complications.

The risk grouping indicators proposed in this study are simpler and easier to implement than other studies.
The age of onset of diabetes, fasting blood glucose and waist circumference are all routinely collected data during the diagnosis and treatment of diabetes, and they can be used in clinical practice immediately.

Researchers hope that these findings will help doctors communicate with patients the risk of complications of diabetes in a simpler way, as well as help the choice of preventive treatments.

 REF: Bancks MP, Carnethon M, Chen H, et al.
, Diabetes subgroups and risk for complications: The Multi-Ethnic Study of Atherosclerosis (MESA).
J Diabetes Complications.
2021.
doi:10.
1016/j.
jdiacomp.
2021.
107915.
3 Buddhism people who are inconsistent with the world are more likely to suffer from diabetic foot ulcers DOI: 10.
1016/j.
diabet.
2021.
101245.
A method of personality classification divides people into type A and type B.
Type A is more aggressive , Aggressiveness, self-confidence, sense of accomplishment, and easy to get nervous, while type B personality is looser, uncontested, and calm about everything.

Although Type A personality has a higher risk of cardiovascular disease, a recent study published in Diab Metab found that Type A personality may have a lower risk of diabetic foot ulcers.

 Figure 3.
1 Study published in "Diabetes Metab" This study from the University Hospital of Dijon, France included 104 patients with diabetic foot ulcers and 282 patients without diabetic foot ulcers.
The study used three questionnaires to assess the personality of the patients Characteristics and state of stress and depression.

The Bortner scale questionnaire used in the study is currently recognized.
The questionnaire for assessing type A personality characteristics includes 14 items.
The higher the score, the more obvious the type A personality characteristics of the patient.

 Figure 3.
2.
Patients without diabetic ulcers had higher scores on the Bortner scale.
The results showed that in patients with diabetic foot ulcers, the scores on the Bortner scale were significantly lower (166.
64±38.
76 vs 178.
79±36.
61, P=0.
005), suggesting a diabetic foot The personality of patients with ulcers may be closer to type B.

Among patients with diabetic foot ulcers, there was no significant difference in the Bortner scale scores between those who had diabetic foot ulcers and those who had diabetic foot ulcers for the first time (166.
27±36.
27 vs 167.
22±42.
77, P=0.
90).

Similarly, the Bortner score did not differ between patients who had been amputees and those who had not.

 The Bortner score has nothing to do with the patient's body mass index (BMI), HbA1c, the course of diabetes or the course of diabetic foot ulcers, but is related to the Bortner scale score.

In patients with diabetic foot ulcers, the proportion of type A personality is significantly lower (48% vs 64.
5%, P=0.
005), while type B personality is significantly more (52% vs 35.
5%, P=0.
005) .

The analysis found that type A personality was negatively correlated with diabetic foot ulcers (P=0.
008).

At the same time, older age, men, and greater stress are positively correlated with diabetic foot ulcers.

 Type A personality is more likely to choose problem-centered coping strategies for things.
In the process of diabetes treatment, it appears to be more active in seeking appropriate medical treatment, and more compliant with drug treatment and corresponding preventive measures. Previous studies have found that postmenopausal women with type A personality are more likely to use mammography as required to screen for breast cancer.

We have reason to believe that type 2 diabetes patients with type A personality characteristics may have better compliance during the course of diabetes treatment and corresponding follow-up.

 Figure 3.
3 Patients with type A personality have fewer diabetic ulcers.
Researchers pointed out that the proportion of type A personality in patients with type 2 diabetic foot ulcers is significantly lower, while the proportion of type B personality is higher.

This may be due to less attention to the problem's coping strategies and reduced adherence to care.

Type B personality is a good choice to be incompetent with the world, but it is still necessary to be proactive in the treatment of diabetic foot ulcers.
You can't be too buddhist, and you will have bad feet by accident! REF: Vergès B, Brands R, Fourmont C, et al.
Fewer Type A personality traits in type 2 diabetes patients with diabetic foot ulcer.
Diabetes Metab.
2021 Mar 12:101245.
doi: 10.
1016/j.
diabet.
2021.
101245.