ENDO Online 2020: The Top Diabetes News From March 30
ENDO 2020 has been rescheduled for June 2020, but a virtual news conference produced these diabetes headlines.
In light of the2019冠状病毒病大流行，Endo 2020年内分泌学会年度会议，被推迟到2020年6月。代替该会议，该会议原定于2020年3月28日至31日在旧金山举行，组织者于3月30日和31日举行了虚拟新闻会议，分享最新的内分泌科学科学。所有ENDO 2020年研究都将在补充问题中发表Journal of the Endocrine Society。
Drones Could Be Used in a Disaster or Pandemic to Deliver Insulin and Other Medications
The world’s first use of a drone to deliver insulin to a patient living in a remote community was performed late last year in Ireland, an accomplishment that has implications for wider use of drones to deliver medications in trying circumstances. Such circumstances might include infectious-disease pandemics like theCOVID-19爆发。
An international team of researchers spent a year planning the drone test flight from Galway, Ireland, to the Aran Islands, about 12 miles off the west coast of Ireland. The drone was used to drop off insulin and return with the patient’s blood sample so that a doctor could check the patient’s glucose levels, saysSpyridoula Maraka，医学博士，阿肯色大学医学科学大学的内分泌学家和小石城中部的阿肯色州退伍军人医疗保健系统。
马拉卡博士说，在爱尔兰的医疗保健专业人员指出，人们在2017年飓风期间和2018年爱尔兰的暴风雪中遇到的困难。她说，患有糖尿病的人需要胰岛素，如果他们用完药物，可能会严重患病。无人机已经在非洲偏远地区使用，以提供血液供应。
Maraka说：“医学在紧急情况发生之前就具有练习的记录。”“有多个医疗交付无人机机会。”
Ireland’s Diabetes Drone Mission was launched with a team of experts across different fields, including medical, pharmaceutical, technical, flight operations, telecommunications, and regulatory agencies. The team selected a Wingcopter 178 drone for the first flight and received Irish Aviation Authority approval to conduct the mission.
该团队计划将未来的药物扩展到偏远地区。Maraka说，重要的是要获得公众对该计划的信心，并与空域当局进行谈判，以便允许交付访问。在人口稠密的地区，这可能具有挑战性。
在孕妇中发现的化学会增加孙女的肥胖风险
孕妇血液中发现的一种称为PFA的普通化学物质与孙女的肥胖风险更高有关。PFAS（人均和多氟烷基物质）是人为的化学物质，用作石油和水的驱虫剂，以及用于包括炊具，地毯和纺织品在内的普通产品的涂料环保局。They are known as endocrine-disrupting “forever” chemicals because they persist when released into the environment and accumulate over time.
这项研究是由加利福尼亚州伯克利公共卫生研究所的研究人员进行的研究，对一个名为The的项目的数据进行了分析儿童健康与发展研究。在1960年代收集并存储了来自孕妇和产后妇女的血液样本。在2000年代初期，研究人员测量了研究参与者的女儿和孙女的一部分的体重，身高和腰围。他们确定了女儿和孙女的肥胖和腹部肥胖的风险。该研究包括213套祖母，母亲和孙女。然后，加利福尼亚州有毒物质控制部测量了祖母储存的血液中的PFASS和其他化学物质。
该研究表明，孙女的腹部和全身肥胖风险增加了53％，祖母的PFAS血液水平增加一倍，当时她的祖母也有下胆固醇（在最低的25％中）。对于祖母在PFAS暴露的前25％而言，与PFAS暴露的最低25％相比，这转化为估计腹部肥胖和全身肥胖风险的2.3倍增加2.3倍。研究人员指出，胆固醇在某种程度上参与了化学物质的运输和代谢。
“Pregnancy appears to be — based on our study and animal research and other work in progress — a critical window of exposure for three generations in humans,” says the lead author of the study,芭芭拉·科恩（Barbara A. Cohn），博士, the director of Child Health and Development Studies, who is based in Oakland, California.
These findings may help to explain the current U.S. and worldwide increases in obesity in young adults, she says. “We don’t understand the mechanisms for this association. We do know it has implications for the current epidemic of obesity if this can be confirmed.”
Consumers can reduce their exposure to the chemicals by avoiding eating out of take-out and to-go food containers and using glass or stainless steel food storage containers. Another source of exposure is stain- and water-resistant carpet.
但是，她说：“个人措施可能还不够，因为像其他旧式化合物一样，它们是如此无处不在。到处都有很多。”
有关的：新报告发现31个州的饮用水中有毒的“永远的化学物质”
最佳糖尿病管理很重要。
People with diabetes who have a stroke have a better chance of preserving cognitive function if they have good blood glucose control after the stroke, according to a study from the Sheba Medical Center and the Sackler School of Medicine of Tel Aviv University in Israel.
该研究涉及患有lacunar的患者strokes，这是一个普遍的type of stroke这发生在大脑内部深处的动脉中。中风会导致神经系统损害。研究人员研究了942名患有糖尿病的成年人，他们的中风有lucunar中风，以评估其中风后的A1C管理。A1C是医生用来评估糖尿病患者如何管理其葡萄糖的方法。它也用于诊断糖尿病疾病预防与控制中心。The study showed better glucose management was linked to greater cognitive function and less cognitive decline. The research was observational, meaning that it only links better glucose management with cognitive benefits following stroke. A clinical trial could help prove a causal effect between the two, the authors said.
Still, “Understanding potentially modifiable risk factors has large public health implications. One such factor may be A1C control,” says the study's lead author, Tali Cukierman-Yaffe, MD, a physician and researcher at the Sheba Medical Center and the Sackler School of Medicine of Tel Aviv University. For example, she says, “It may be that individuals with cognitive impairment who have difficulty managing their disease would have worse glucose control.”
Current medical recommendations urge healthcare providers to screen older people with diabetes for cognitive impairment, she notes.
“Cognitive assessment should be part of the routine checkup of older people with diabetes,” she said. “The reasons for that are, one, the relationship between cognitive dysfunction and diabetes self-care; and the other is that cognitive function is another糖尿病并发症我们应该寻找的。”
有关的：Why Some Researchers Are Calling Alzheimer’s a ‘Type 3 Diabetes’
内窥镜技术可以改善2型糖尿病患者的葡萄糖管理
在欧洲批准的一种微创内窥镜技术可以帮助管理不良的2型糖尿病患者改善其A1C。该程序称为Revita Duodenal Mucosal Refafacing（DMR），在美国尚未批准使用。
在手术过程中，医生将气球导管通过嘴插入十二指肠，这是上小肠的一部分。他们提供热能以去除十二指肠衬里或消融。去除损坏的十二指肠内衬后，最终形成了新的组织。
与接受假手术的患者相比，手术后三个月后三个月，收到DMR的70人的新研究（称为Revita-2）的新研究表明，接受DMR的人的血糖水平和肝胰岛素敏感性有所改善。
该新技术基于研究表明，十二指肠内衬对于激素变化和激素信号至关重要insulin resistance。研究作者说，破坏衬里可能会中断糖尿病的过程。
关于DMR的一个主要问题是效果持续多长时间。研究人员报告说，有些患者最多改善了糖尿病控制长达两年。但是，不知道该程序是否必须定期重复。
“This procedure would be for patients who have not been helped by previous treatments,” says the study investigatorDavid Hopkins, MBChB, a physician and the director of the Institute of Diabetes, Endocrinology, and Obesity at King’s Health Partners in London. But, he adds, treatment earlier in the course of diabetes could likely produce the most benefit by changing the course of disease.
有关的：How to Stabilize Your Blood Sugar
Bariatric Surgery Before a Diabetes Diagnosis Leads to Greater Weight Loss
在另一项研究中bariatric surgery密歇根大学安阿伯分校的研究人员于2020年发行。
Researchers studied 714 participants who had either gastric bypass or sleeve gastrectomy surgery. All of them had a体重指数（BMI）手术前40多个。手术时患有糖尿病的患者，无论手术类型如何，都会失去至少50％体重的50％。
密歇根大学的一位研究合着者Yingying Luo博士说：“手术前的糖尿病是未来减肥结果的预测指标。”
一位主要研究人员说，研究表明，在患糖尿病之前进行减肥手术可能是重要的预防策略。Elif A. Oral, MD, of the University of Michigan. More research is needed to confirm the study results, the authors said. Yet doctors and patients should consider the timing of bariatric surgery.
Luo博士说：“我们知道，减肥手术可以保护或延迟糖尿病的发作。”“我们需要更大的样本量。如果我们能找到对糖尿病的存在的真正影响，也许这表明我们应该向前迈出一步来进行手术。”
Lack of Tears May Signal Elevated Blood Sugar Levels
People with diabetes who lose a gland that helps lubricate the eye by producing tears may have elevated blood glucose levels, say the authors of a study from the University of California in San Francisco.
患有糖尿病的人可以体验dry eye和眼睛不适。他们可能会损失眼睛中的梅博米亚腺。该研究研究了被诊断为干眼的2型糖尿病患者。有更高的人A1C水平与具有更高的A1C水平的素质相比，一种血糖水平的度量更可能损失Meibomian腺体。即使在没有糖尿病的人中，A1C水平较高的人也会损失更大的巨腺腺体。
合着者说，医生应检查抱怨眼睛的糖尿病患者的眼睑。医学博士Gloria Wu, an adjunct faculty member at the University of California in San Francisco.
她说：“有些人有严重的不适和痛苦。”“这是看糖尿病的一种简单诊断方式。”
有关的：降低A1C级别的5种方法
First Hybrid Closed-Loop Systems Live Up to Expectations
患有1型糖尿病的人using the Medtronic MiniMedTM 670G insulin pump system are able to maintain blood glucose levels in the targeted range over 71 percent of the time, according to a study that analyzed some 6 million days of real-world data.
数据比较与导致该设备批准的临床试验中发现的结果相比。最小化的TM 670G系统是美国食品药品监督管理局（FDA）批准的第一个混合闭环系统，用于1型糖尿病患者。
有时被称为人造pancreas, the device consists of an insulin pump with a tiny infusion catheter worn under the skin and a small continuous glucose monitor that is also placed under the skin. The device measures glucose levels every five minutes and sends the results to the pump to dispense insulin as needed. Individuals upload data from the device to a website so that physicians can monitor their patients.
The real-world study involved more than 51,000 people. Researchers found that individuals were able to maintain blood glucose levels in the targeted range more than 71 percent of the time. When managing diabetes, the goal is to be in the target glucose range of 70–180 milligrams per deciliter (mg/dL) more than 70 percent of the time.
“Real-world experience does not necessarily live up to the results seen in a clinical trial that recruits highly motivated participants who are under close supervision,” says the study's principal investigator, Robert Vigersky, MD, the chief medical officer of Medtronic Diabetes, in Northridge, California. “Our results demonstrate that the glycemic control using the MiniMedTM 670G in the real world is excellent and mirrors the results of the small pivotal trials that led to the system’s approval.”
二月里，FDAannounced Medtronic had recalled MiniMed 670Ginsulin pumpswith broken or missing retainer rings following reports that a broken or missing part could lead to incorrect dosing. Insulin pumps with the retainer ring intact do not need to be returned to Medtronic.
