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Genetics of Type 2 Diabetes: Implications from Large-Scale Studies
Purpose of ReviewType 2 diabetes (T2D) is a multifactorial, heritable syndrome characterized by dysregulated glucose homeostasis that results from impaired insulin secretion and insulin resistance. Genetic association studies have successfully identified hundreds of T2D risk loci implicating many genes in disease pathogenesis. In this review, we provide an overview of the recent T2D genetic studies from the past 3 years with particular focus on the effects of sample size and ancestral diversity on genetic discovery as well as discuss recent work on the use and limitations of genetic risk scores (GRS) for T2D risk prediction.Recent FindingsRecent large-scale, multi-ancestry genetic studies of T2D have identified over 500 novel risk loci. The genetic variants (i.e., single nucleotide polymorphisms (SNPs)) marking these novel loci in general have smaller effect sizes than previously discovered loci. Inclusion of samples from diverse ancestral backgrounds shows a few ancestry specific loci marked by common variants, but overall, the majority of loci discovered are common across ancestries. Inclusion of common variant GRS, even with hundreds of loci, does not substantially increase T2D risk prediction over standard clinical risk factors such as age and family history.SummaryCommon variant association studies of T2D have now identified over 700 T2D risk loci, half of which have been discovered in the past 3 years. These recent studies demonstrate that inclusion of ancestrally diverse samples can enhance locus discovery and improve accuracy of GRS for T2D risk prediction. GRS based on common variants, however, only minimally enhances risk prediction over standard clinical risk factors.
Journal Article
Social Determinants of Health, Race, and Diabetes Population Health Improvement: Black/African Americans as a Population Exemplar
Purpose of ReviewTo summarize evidence of impact of social determinants of health (SDOH) on diabetes risk, morbidity, and mortality and to illustrate this impact in a population context.Recent FindingsKey findings from the American Diabetes Association’s scientific review of five SDOH domains (socioeconomic status, neighborhood and physical environment, food environment, health care, social context) are highlighted. Population-based data on Black/African American adults illustrate persisting diabetes disparities and inequities in the SDOH conditions in which this population is born, grows, lives, and ages, with historical contributors. SDOH recommendations from US national committees largely address a health sector response, including health professional education, SDOH measurement, and patient referral to services for social needs. Fewer recommendations address solutions for systemic racism and socioeconomic discrimination as root causes.SummarySDOH are systemic, population-based, cyclical, and intergenerational, requiring extension beyond health care solutions to multi-sector and multi-policy approaches to achieve future population health improvement.
Journal Article
COVID-19 and Diabetes Outcomes: Rationale for and Updates from the CORONADO Study
Purpose of ReviewIn France, in order to describe the phenotypic characteristics of patients with diabetes hospitalized for coronavirus disease-2019 (COVID-19) and to identify the prognostic factors in this specific population, the CORONADO (CORONAvirus and Diabetes Outcomes) study was launched. This review will summarize the key findings from the CORONADO study and put them in perspectives with others studies published on the subject.Recent FindingsFor almost 2 years, the new SARS-CoV-2 (Severe Acute Respiratory Syndrome-CoronaVirus-2), which causes COVID-19, has spread all around the world leading to a pandemic. From the first epidemiological reports, diabetes mellitus has rapidly emerged as a major risk factor associated with severe forms of COVID-19 but few data were available about diabetes characteristics in hospitalized people with COVID-19.SummaryBetween March 10 and April 10, 2020, 2951 patients were included in 68 centers throughout the national territory, including overseas territories. In the CORONADO study, the primary outcome was a composite endpoint combining invasive mechanical ventilation (IMV) and/or death within day 7 (D7). Secondary outcomes included death, IMV, intensive care unit (ICU) admission, and hospital discharge, all considered within D7 and day 28 (D28). The primary outcome occurred in 29.0% participants within D7 following hospital admission. Within D28, the end of the follow-up period, the mortality rate was 20.6%, while 50.2% of patients were discharged. In multivariable analysis, advanced age, microvascular complications, treatment with insulin or statin prior to admission, dyspnea on admission, as well as biological markers reflecting the severity of the infection (high levels of transaminases, leukocytes and CRP, and low platelet levels) were associated with an increased risk of death. Several exploratory analyses were performed to clarify the influence of some parameters such as weight status, sex, type of diabetes, and some routine drugs, including metformin or statins.
Journal Article
Brute ornament : Kamrooz Aram and Seher Shah
\"Brute Ornament\" is a critical examination of the intersection between Modernism and Ornamentation, centered on the collaborative and individual works of artists Kamrooz Aram and Seher Shah. Developed in conjunction with their exhibition at the Green Art Gallery in Dubai, the volume challenges the traditional Western art historical narrative that views \"ornament\" as a superficial or \"primitive\" additive to the \"pure\" forms of modern architecture and abstraction.
BOOK
The Relationship Between Type 2 Diabetes, NAFLD, and Cardiovascular Risk
Purpose of ReviewNonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are strongly associated. Both also associate with an increased risk of cardiovascular disease (CVD).Recent FindingsSeveral studies have provided evidence that NAFLD could be an independent CVD risk factor. Given the strong association between NAFLD and T2DM, assessing the independent CV effect of these two conditions remains challenging. However, patients with T2DM and NAFLD exhibit higher risk of CVD compared with T2DM without NAFLD suggesting a potential synergistic increase of CV risk in patients with both T2DM and NAFLD supported by several shared pathophysiological pathways. Several anti-diabetic therapies have shown beneficial effect on both NAFLD and CVD.SummaryPatients with T2DM and NAFLD should be considered at high risk of CVD and could benefit from more intensive CV prevention. Additional long-term follow-up is needed to demonstrate that the treatment of NAFLD effectively reduces the risk of CVD.
Journal Article
مذكرات /
عندما أتذكر ذلك الصباح من يناير 1979 يعاودني نفس إحساس الحزن الموجع بكل حدته. كانت طهران تعاني هجوما ضاريا منذ شهور، لكن صمتا متوترا يخيم الآن على المدينة كما لو أن عاصمة بلدنا تحبس أنفاسها فجأة اليوم السادس عشر من الشهر ونحن على وشك مغادرة بلدنا، تبدأ قصتها كبدايات القصص الخيالية، ففي الحادية والعشرين من عمرها تزوجت (فرح ديبا) شاه إيران (محمد رضا شاه بهلوي) وخلال أيام انقلبت حياتها الهادئة رأسا على عقب : غطت صحافة العالم حفل تتويجها إمبراطورة لإيران وبين ليلة وضحاها صارت شخصية مشهورة عالميا وشهدت سنوات زواجها الأولى زواجا قائما على الحب وتربية أربعة أطفال وتفانيا في القضايا الاجتماعية والثقافية، على الرغم من دلائل كانت ماثلة في الأفق على وجود انقسامات وطنية خطيرة وبعد عشرين عاما تحول الحلم إلى كابوس ؛ هزت البلاد مظاهرات وأعمال شغب وقررت (فرح) والشاه الرحيل لتجنب إراقة الدماء ولم ير الشاه المنفي وهو يعاني مرضا خطيرا وطنه بعد ذلك أبدا وسعيا معا إلى اللجوء للمغرب وجزر البهاما والمكسيك وبنما واختفيا عن الأعين في مستشفى بنيويورك حيث تلقى الشاه علاجا، حتى منحهما الرئيس المصري (أنور السادات) ملاذا في آخر المطاف، ثم اغتيل هو نفسه على أيدي الأصوليين بعد ثمانية عشر شهرا فحسب، قصة السنوات الأخيرة للشاه واحدة من أكثر الحلقات المؤثرة والمقلقة في أواخر القرن العشرين، حيث بدأت علاقة أمريكا المتوترة مع الشرق الأوسط تكشف عن أسسها الواهية وللمرة الأولى تحطم (فرح ديبا) ـالشاهبانوـ زوجة آخر أباطرة إيران حاجز صمتها وتحكي قصة حبها الموجعة لرجل وبلده وتطرح (حب باق) رؤيتها الحميمة لعصر من الاضطرابات، لكن الأهم من كل ذلك أنها تظل وثيقة إنسانية قوية لشخصية انحصرت حياتها بين ملحمة ومأساة المعركة الوطنية.
BOOK
Adipose Tissue Inflammation and Cardiovascular Disease: An Update
Purpose of ReviewThe obesity epidemic is on the rise, and while it is well known that obesity is associated with an increase in cardiovascular risk factors such as type 2 diabetes mellitus, hypertension, and obstructive sleep apnea, recent data has highlighted that the degree and type of fat distribution may play a bigger role in the pathogenesis of cardiovascular disease (CVD) than body mass index (BMI) alone. We aim to review updated data on adipose tissue inflammation and distribution and CVD.Recent FindingsWe review the pathophysiology of inflammation secondary to adipose tissue, the association of obesity-related adipokines and CVD, and the differences and significance of brown versus white adipose tissue. We delve into the clinical manifestations of obesity-related inflammation in CVD. We discuss the available data on heterogeneity of adipose tissue-related inflammation with a focus on subcutaneous versus visceral adipose tissue, the differential pathophysiology, and clinical CVD manifestations of adipose tissue across sex, race, and ethnicity. Finally, we present the available data on lifestyle modification, medical, and surgical therapeutics on reduction of obesity-related inflammation.SummaryObesity leads to a state of chronic inflammation which significantly increases the risk for CVD. More research is needed to develop non-invasive VAT quantification indices such as risk calculators which include variables such as sex, age, race, ethnicity, and VAT concentration, along with other well-known CVD risk factors in order to comprehensively determine risk of CVD in obese patients. Finally, pre-clinical biomarkers such as pro-inflammatory adipokines should be validated to estimate risk of CVD in obese patients.
Journal Article