Influence of prior walking on postprandial lipaemia in South Asian and White European women

Influence of prior walking on postprandial lipaemia in South Asian and White European wome

Prediction of diabetic foot ulceration: The value of using microclimate sensor arrays

Background: Accurately predicting the risk of diabetic foot ulceration (DFU) could dramatically reduce the enormous burden of chronic wound management and amputation. Yet, current prognostic models are unable to precisely predict DFU events. Typically, efforts have focused on individual factors like temperature, pressure or shear rather than the overall foot microclimate. Method: A systematic review was conducted by searching PubMed reports with no restrictions on start date covering literature published until 20 February 2019 using relevant keywords, including temperature, pressure, shear and relative humidity. We review the use of these variables as predictors of DFU, highlighting gaps in our current understanding and suggesting which specific features should be combined to develop a real-time microclimate prognostic model. Results: Current prognostic models rely either solely on contralateral temperature, pressure or shear measurement; these parameters, however, rarely reach 50% specificity in relation to DFU. There is also considerable variation in methodological investigation, anatomical sensor configuration and resting time prior to temperature measurements (5-20 minutes). Few studies have considered relative humidity and mean skin resistance. Conclusions: Very limited evidence supports the use of single clinical parameters in predicting the risk of DFU. We suggest the microclimate as a whole should be considered to predict DFU more effectively and suggest nine specific features which appear to be implicated for further investigation. Technology supports real-time inshoe data collection and wireless transmission, providing a potentially rich source of data to better predict risk of DFU

The effect of prior walking on coronary heart disease risk markers in South Asian and European men

Purpose: Heart disease risk is elevated in South Asians possibly due to impaired postprandial metabolism. Running has been shown to induce greater reductions in postprandial lipaemia in South Asian than European men but the effect of walking in South Asians is unknown. Methods: Fifteen South Asian and 14 White European men aged 19-30 years completed two, 2-d trials in a randomised crossover design. On day 1, participants rested (control) or walked for 60 min at approximately 50% maximum oxygen uptake (exercise). On day 2, participants rested and consumed two high fat meals over a 9h period during which 14 venous blood samples were collected. Results: South Asians exhibited higher postprandial triacylglycerol (geometric mean (95% confidence interval) 2.29(1.82 to 2.89) vs. 1.54(1.21 to 1.96) mmol·L-1·hr-1), glucose (5.49(5.21 to 5.79) vs. 5.05(4.78 to 5.33) mmol·L-1·hr-1), insulin (32.9(25.7 to 42.1) vs. 18.3(14.2 to 23.7) μU·mL-1·hr-1) and interleukin-6 (2.44(1.61 to 3.67) vs. 1.04(0.68 to 1.59) pg·mL-1·hr-1) than Europeans (all ES ≥ 0.72, P≤0.03). Between-group differences in triacylglycerol, glucose and insulin were not significant after controlling for age and percentage body fat. Walking reduced postprandial triacylglycerol (1.79(1.52 to 2.12) vs. 1.97(1.67 to 2.33) mmol·L-1·hr-1) and insulin (21.0(17.0 to 26.0) vs. 28.7(23.2 to 35.4) μU·mL-1·hr-1) (all ES ≥ 0.23. P≤0.01), but group differences were not significant. Conclusions: Healthy South Asians exhibited impaired postprandial metabolism compared with White Europeans, but these differences were diminished after controlling for potential confounders. The small-moderate reduction in postprandial triacylglycerol and insulin after brisk walking was not different between the ethnicities

The influence of adiposity and acute exercise on circulating hepatokines in normal weight and overweight/obese men

Hepatokines are liver-secreted proteins with potential to influence glucose regulation and other metabolic parameters. This study investigated differences in adiposity status on five novel hepatokines and characterised their response to acute moderate-intensity exercise in groups of normal weight and overweight/obese men. Twenty-two men were recruited into normal weight and overweight/obese groups (BMI: 18.5 to 24.9 and 25.0 to 34.9 kg∙m-2). Each completed two experimental trials, exercise and control. During exercise trials, participants performed 60 min of moderate-intensity treadmill exercise (~60% V̇O2 peak) and then rested for 6 h. Participants rested throughout control trials. Circulating fibroblast growth factor-21 (FGF21), follistatin, leukocyte cell-derived chemotaxin 2 (LECT2), fetuin-A and selenoprotein-P (SeP) were measured throughout. Fasted (resting) FGF21 and LECT2 were higher in overweight/obese individuals (129% and 55%; P ≤ 0.01) and correlated with indices of adiposity and insulin resistance; whereas circulating follistatin was lower in overweight/obese individuals throughout trial days (17%, P < 0.05). In both groups, circulating concentrations of FGF21 and follistatin were transiently elevated after exercise for up to 6 h (P ≤ 0.02). Circulating fetuin-A and SeP were no different between groups (P ≥ 0.19) and, along with LECT2, were unaffected by exercise (P ≥ 0.06). These findings show that increased adiposity is associated with a modified hepatokine profile, which may represent a novel mechanism linking excess adiposity to metabolic health. Furthermore, acute perturbations in circulating FGF21 and follistatin after exercise may contribute to the health benefits of an active lifestyle

Incidence, prevalence, and potential risk factors for diabetic foot ulceration: A retrospective review at a multidisciplinary centre in Barbados

Objective Diabetes and lower extremity amputation rates in Barbados are among some of the highest globally, with peripheral neuropathy and peripheral vascular disease found to be independent risk factors for this population. Despite this, there is currently a lack of research evidence on rates of diabetic foot ulceration, which has amputation as its sequela. We aimed to evaluate the incidence and prevalence rates of active ulceration in a population of people with diabetes in Barbados. Secondly, we explored the risk factors for new/recurrent ulceration. Research Design and Methods Data were extracted from the electronic medical records for the period January 1, 2019 to December 31, 2020 for a retrospective cross-sectional study for patients of a publicly-funded diabetes management programme. Eligible records included people aged 18 years and above with a diagnosis of type 1 or 2 diabetes. Potential risk factors were explored using univariable logistic regression models. Results A total of 225 patients were included in the study (96% type 2 diabetes, 70.7% female, 98.7% Black Caribbean). The 1-year period prevalence of diabetic foot ulceration was 14.7% (confidence interval [CI]: 10.5, 20.1). Incidence of ulceration in the same period was 4.4% (CI: 4.4, 4.5). Risk factors associated with diabetic foot ulceration included: retinopathy (OR 3.85, CI: 1.24, 11.93), chronic kidney disease (OR 9.86, CI: 1.31, 74.22), aspirin use (OR 3.326, CI: 1.02, 10.85), and clopidogrel use (OR 3.13, CI: 1.47, 6.68). Conclusion This study provided some insight into potential risk factors for foot ulceration in this population, which previous studies have shown to have higher rates of lower extremity amputations. Further research in this understudied group through a larger prospective cohort would allow more meaningful associations with risk factors and would be useful for the creation of risk prediction models.</p

In-shoe pressure thresholds for people with diabetes and neuropathy at risk of ulceration: A systematic review

IntroductionIn-shoe pressure thresholds play an increasingly important role in the prevention of diabetes-related foot ulceration (DFU). The evidence of their effectiveness, methodological consistency and scope for refinement are the subject of this review. Methods1,107 records were identified (after duplicate removal) based on a search of five databases for studies which applied a specific in-shoe pressure threshold to reduce the risk of ulceration. 37 full text studies were assessed for eligibility of which 21 were included. Results Five in-shoe pressure thresholds were identified, which are employed to reduce the risk of diabetes-related foot ulceration: a mean peak pressure threshold of 200 kPa used in conjunction with a 25% baseline reduction target; a sustained pressure threshold of 35 mmHG, a threshold matrix based on risk, shoe size and foot region, and a 40-80% baseline pressure reduction target. The effectiveness of the latter two thresholds have not been assessed yet and the evidence for the effectiveness of the other in-shoe pressure thresholds is limited, based only on two RCTs and two cohort studies. ConclusionsThe heterogeneity of current measures precludes meta-analysis and further research and methodological standardisation is required to facilitate ready comparison and the further development of these pressure thresholds

逆凸計画問題に対する内部近似法 (最適化のための連続と離散数理)

Additional file 1: Database Search - EMBASE/CINAH

ASSESSMENT AND MANAGEMENT OF RISK FACTORS IN PEOPLE WITH CHRONIC KIDNEY DISEASE AND DIABETES MELLITUS MULTIMORBIDITY

Introduction and Aims: Chronic kidney disease (CKD) and diabetes mellitus (DM) are important risk factors for cardiovascular (CV) disease and are associated with increased CV events. Multimorbidity with both DM and CKD is increasing in prevalence. Appropriate monitoring and use of renin-angiotensin system antagonists, as well as optimising blood pressure and lipid levels, are important strategies in the management of people with CKD. Whether the presence or absence of DM influences the clinical assessment of CKD is unknown. We aimed to establish rates of other comorbidities and commonly used medication prescription rates. We also aimed to establish if DM affected the likelihood of confirmatory eGFR or urinary protein assessment being performed. Methods: We analysed the baseline cohort of the PSP-CKD study, a large United Kingdom primary care CKD clinical trial, to study a subgroup with DM. DM was defined using HbA1c, the use of DM medications or a Read code diagnosis of DM. Co-morbidities were based on Read codes and medications on prescription records. Comparison was made to members of the cohort with CKD but not known to have diabetes. Results: The DM subgroup consisted of 5,842 individuals, 55.6% of whom were female. Mean age was 74.1 years (standard deviation (SD) 10.5 years). Mean MDRD eGFR was 49.2 ml/min/1.73m2, 73.5% were CKD stage 3A. Individuals with DM, compared with those without DM, had a lower mean MDRD eGFR (49.4 ml/min/1.73m2 versus 54.4 ml/min/1.73m2, t-test p<0.001) and were more likely to have had a second confirmatory eGFR (76.1% versus 62.7%, Pearson Chi-squared p<0.001) and their urinary protein assessed (86.0% versus 66.5%, Pearson Chi-squared p<0.001). Of those with a urine assessment, 69.9% had stage A1 proteinuria. Mean HbA1c was 7.3% (SD 1.4%). Mean systolic blood pressure was 134.2 mmHg (SD 16.5 mmHg) and diastolic 73.1 mmHg (SD 10.2 mmHg). 76.4% were hypertensive and 38.9% had had a previous cardiovascular event. 74.3% were prescribed either an ACE inhibitor or ARB. 2.6% were prescribed both an ACE inhibitor and ARB, 74.2% were receiving a statin and 48.8% aspirin. Conclusions: Patients with CKD and DM have a significantly lower eGFR compared with patients with CKD alone. In addition, patients with CKD and DM were monitored more closely with confirmatory eGFR or urinary protein assessment compared to patients with CKD alone. RAS blockade medication and statins were prescribed to three quarters and aspirin to just under a half. Overall, the assessment and management of multimorbid patients with both CKD and DM is more thorough than those with CKD alone

Hotspots: Adherence in home foot temperature monitoring interventions for at-risk feet with diabetes - A narrative review.

Background Home foot temperature monitoring (HFTM) is recommended for those at moderate to high ulcer risk. Where a > 2.2°C difference in temperature between feet (hotspot) is detected, it is suggested that individuals (1) notify a healthcare professional (HCP); (2) reduce daily steps by 50%. We assess adherence to this and HFTM upon detecting a recurrent hotspot. Methods PubMed and Google Scholar were searched until 9 June 2023 for English-language peer-reviewed HFTM studies which reported adherence to HFTM, daily step reduction or HCP hotspot notification. The search returned 1030 results excluding duplicates of which 28 were shortlisted and 11 included. Results Typical adherence among HFTM study participants for >3 days per week was 61%–93% or >80% of study duration was 55.6%–83.1%. Monitoring foot temperatures >50% of the study duration was associated with decreased ulcer risk (Odds Ratio: 0.50, p 80% adherence. Voluntary dropout was 5.2% (Smart mats); 8.1% (sock sensor) and 4.8%–35.8% (infrared thermometers). Only 16.9%–52.5% of participants notified an HCP upon hotspot detection. Objective evidence of adherence to 50% reduction in daily steps upon hotspot detection was limited to one study where the average step reduction was a pedometer-measured 51.2%. Conclusions Ulcer risk reduction through HFTM is poorly understood given only half of the participants notify HCPs of recurrent hotspots and the number of reducing daily steps is largely unknown. HFTM adherence and dropout are variable and more research is needed to determine factors affecting adherence and those likely to adhere.</p

Health impacts of seated arm ergometry training in patients with a diabetic foot ulcer: protocol for a randomised controlled trial.

INTRODUCTION:Once diagnosed with a diabetic foot ulcer (DFU), patients are advised to offload, keeping pressure off the foot in order to facilitate ulcer healing. An increase in offloading is often accompanied by reductions in physical activity which can worsen the overall health of patients.While unable to perform traditional forms of upright activity, one mode of exercise that would allow patients to be physically active while adhering to offloading instruction is seated arm ergometry. The merits of tailored aerobic exercise in DFU remain unexplored. METHODS AND ANALYSIS:This is a prospective open-label randomised controlled trial. Participants will be randomised to one of two groups, an exercise intervention group or control. The intervention group are required to undertake arm ergometry training at a moderate intensity (65%-75% HRpeak), three times per week for 12 weeks as individually prescribed by an exercise physiologist, while the control group will continue to receive standard care alone. Assessment of outcome measures will occur at baseline and after the intervention period, these will include: a seated VO2 peak test, a blood sample, a short physical performance battery, a dual-energy X-ray absorptiometry scan and completing a range of health-based questionnaires. The above will be used to determine: cardiorespiratory fitness, metabolic health, physical function, body composition and quality of life, respectively. Ulcer area will also be measured as an approximate marker of ulcer healing. ETHICS AND DISSEMINATION:This trial has been approved by 'Yorkshire & The Humber-Leeds West Research Ethics Committee' (19/YH/0269). Trial results will be published in peer-reviewed journals and through conference presentations. TRIAL REGISTRATION NUMBER:ISRCTN16000053. Registered in accordance with WHO Trial Registration Data Set (version 1.3.1)