Archive for month: December, 2023

The cohort study of 17 182 preschool-aged children in Shanghai, China, revealed a negative association between the incident and stable sleep disturbances and resolved emotional and behavioural difficulties (EBDs), and a positive association with incident EBDs after adjustment. Resolved sleep disturbances were positively associated with resolved EBDs.

“These findings underscore the association between sleep disturbances and emotional and behavioural difficulties among preschool-aged children and the importance of sleep health in promoting their mental well-being,” the researchers wrote in the study.

Mental health problems are the foremost cause of the global disease burden in children and adolescents. In preschool years, psychological disorders may have an early onset with documented changes in brain structure and function involved in emotion processing. Emotional and behavioural difficulties deserve particular attention in preschool-aged children due to their high prevalence and harmful effects on optimal mental health and functioning throughout childhood and later life.

Although EBDs may resolve with the growth of the child, 49.9% of young children still exhibit persistence one year after initial presentation. Furthermore, while early intervention in a clinical setting can improve childhood EBDs, multiple barriers such as stigma, high training demands, availability, and cost of services prevent children from receiving treatment.

Therefore, there is a need to identify both protective and risk factors that are modifiable in large community samples to prioritize more scalable and effective intervention and prevention strategies for EBDs in early childhood. Yujiao Deng, Shanghai Jiao Tong University, Shanghai, China, and colleagues investigated the association between the natural history of sleep disturbances and resolved and incident emotional and behavioural difficulties.

The researchers used data from the SCHEDULE-P, a prospective and population-based longitudinal cohort study of children enrolled in preschools in Shanghai, China. 20 324 children (3-4 years) were recruited from the junior class, of these 17 233 participated in the 2-year follow-up. The association between the development of sleep disturbances and the occurrence of incident and resolved EBDs were evaluated.

Sleep disturbances were evaluated using the Children’s Sleep Habit Questionnaire and EBDs were assessed using the Strengths and Difficulties Questionnaire.

Based on the study, the researchers reported the following findings:

• The cohort included 17 182 participants, with a mean age of 3.73 years at enrollment; 52.0% were boys.
• The prevalence of EBDs at school entry and graduation years was 27.8% and 18.7%, respectively, while the prevalence of sleep disturbances was 41.3% and 31.5%, respectively.
• Among those with EBDs at the entry year, 35.0% maintained stability in the graduation year, while sleep disturbances were stable in 50.0% of those with sleep disturbances.
• After controlling for confounding factors, the odds ratio (OR) for resolved EBDs was lower in the incident sleep disturbance (ISD) group (OR, 0.50) and stable sleep disturbance (SSD) group (OR, 0.47) compared with the group with no sleep disturbances.
• The ORs for incident EBDs among the ISD group (OR, 2.58) and SSD group (OR, 2.29) were higher than among the group with no sleep disturbances.

“Our findings support the consistent integration of questions concerning sleep into routine developmental screenings in contexts of primary care and school,” the researchers wrote.

Furthermore, they suggest the need for intervention that targets symptoms of both sleep disturbance and EBDs to determine whether addressing these comorbidities can prevent their progression and effects on a child’s well-being.

Reference:

Deng Y, Zhang Z, Gui Y, et al. Sleep Disturbances and Emotional and Behavioral Difficulties Among Preschool-Aged Children. JAMA Netw Open. 2023;6(12):e2347623. doi:10.1001/jamanetworkopen.2023.47623

Diabetes is a
chronic condition that affects millions of people worldwide. Apart from its
well-known impact on blood sugar levels, diabetes can have a profound effect on
the vascular system. The interplay between diabetes and vascular health is
crucial, as individuals with diabetes are at a significantly higher risk of
developing vascular complications.

Vascular diseases include a range of
conditions such as atherosclerosis, peripheral artery disease (PAD), coronary
artery disease, and stroke, among others. Understanding how to prevent vascular
complications in diabetes is essential for improving the overall well-being of
those affected. This comprehensive guide will explore the steps you can take to
protect your vascular health and reduce the risk of complications associated
with diabetes.

The Diabetes-Vascular Disease Connection:

Before diving into prevention strategies, it’s crucial to comprehend
the link between diabetes and vascular complications. Diabetes, both type 1 and
type 2, can have detrimental effects on the vascular system. The elevated blood
sugar levels characteristic of diabetes can lead to a cascade of events that
damage blood vessels over time. Here’s how it happens:

High Blood Sugar Levels:

Uncontrolled diabetes results in consistently high levels of glucose
in the bloodstream. This excess sugar can injure the delicate inner lining of
blood vessels, leading to inflammation and the formation of fatty deposits.

Atherosclerosis:

Atherosclerosis, often referred to as “hardening of the
arteries,” is a condition where fatty deposits accumulate on the walls of
blood vessels. Over time, these deposits, known as plaques, can narrow and
block blood flow, increasing the risk of heart disease and stroke.

Microvascular Complications:

Diabetes can also affect the small blood vessels throughout the
body. This may lead to microvascular complications such as retinopathy (eye
damage), nephropathy (kidney damage), and neuropathy (nerve damage).

Preventing Vascular Complications:

Preventing vascular complications in diabetes involves a combination
of medical management, lifestyle changes, and proactive self-care. Here are
essential strategies for safeguarding your vascular health:

1. Blood Sugar Control

The cornerstone of diabetes management is controlling blood sugar
levels. Regular monitoring, medication adherence, and following your healthcare
provider’s guidance are crucial in maintaining optimal glucose levels.

2. Healthy Eating

A balanced diet that’s low in saturated and trans fats, cholesterol,
and sodium can significantly reduce the risk of atherosclerosis. Focus on
incorporating whole grains, fruits, vegetables, lean proteins, and healthy fats
into your meals.

3. Regular Physical Activity

Exercise plays a pivotal role in vascular health. It helps manage
blood sugar, lowers blood pressure, and keeps your weight in check. Aim for at
least 150 minutes of moderate-intensity exercise per week.

4. Medications

Your healthcare provider may prescribe medications to manage risk
factors such as high blood pressure, cholesterol, or blood-thinning agents.
Complying with your medication regimen is crucial.

5. Smoking Cessation

Smoking damages blood vessels and accelerates atherosclerosis. If
you smoke, seeking support to quit is one of the most significant steps you can
take to protect your vascular health.

6. Regular Check-Ups

Frequent check-ups with your healthcare provider are essential for
monitoring your vascular health. They can conduct tests to assess your risk
factors and identify issues in their early stages.

7. Foot Care

For individuals with diabetes, foot care is paramount. Nerve damage
can lead to reduced sensation in the feet, making them susceptible to injuries
and infections. Regularly inspect your feet, keep them clean and moisturized,
and choose appropriate footwear.

8. Medication Management

If you’ve been prescribed medications, follow your healthcare
provider’s instructions carefully. This includes taking prescribed dosages,
adhering to schedules, and reporting any side effects or concerns.

Conclusion:

Preventing vascular complications in diabetes is a proactive and
ongoing process. By adopting a comprehensive approach that combines medical
management, a heart-healthy lifestyle, and vigilant self-care, individuals with
diabetes can significantly reduce their risk of vascular issues.

Keep in mind
that personalized guidance from your healthcare provider is indispensable in
crafting a plan that suits your unique needs and circumstances. Protecting your
vascular health is an investment in your overall well-being and longevity.

The ADA’s Standards of Care for 2024 include new recommendations to screen for heart failure, type 1 diabetes risk, and peripheral arterial disease (PAD), along with new obesity management guidance. It also includes new recommendations related to bone health and liver disease. The Standards of Care are essentially the global guidelines for the care of individuals with diabetes and those at risk.

The ADA’s Professional Practice Committee developed the document via a scientific literature review. The panel comprised 21 professionals, including physicians from many specialities, certified diabetes care and education specialists, nurse practitioners, pharmacists, and dieticians.

This article will mainly focus on the ADA’s updates on updated recommendations for screening peripheral arterial disease (PAD) and heart failure.

Atherosclerotic cardiovascular disease (ASCVD) defined as coronary heart disease (CHD), peripheral artery disease (PAD), or cerebrovascular disease is the leading cause of mortality and morbidity for people with diabetes. Addressing multiple cardiovascular risk factors (lipid control, glycemic, and blood pressure) can lead to large benefits.

Heart failure is another major cause of morbidity and mortality from cardiovascular disease.

The increased risk for heart failure in diabetic patients is classified as the presence of stage A heart failure, i.e., an increased risk for heart failure but without symptoms, structural heart disease, or biomarker evidence of myocardial strain. People with stage B heart failure are asymptomatic but have evidence of structural heart disease or functional cardiac abnormalities, including elevated biomarkers of myocardial strain or increased filling pressure. During these asymptomatic stages of heart failure, people with diabetes are at particularly high risk for progression to symptomatic stage C and D heart failure.

Recommendations For Heart Failure Screening 

• The committee recommends considering screening asymptomatic adults with diabetes for the development of cardiac structural or functional abnormalities (stage B heart failure) by measurement of natriuretic peptides, including BNP or NT-proBNP levels.
• Risk stratification for incident heart failure (stage A) and identification of people with asymptomatic cardiac abnormalities (stage B) may prevent progression to the symptomatic stages of heart failure (stages C and D).
• People with diabetes and an elevated natriuretic peptide level without any symptoms of heart failure should be considered to have stage B heart failure, as there is evidence for increased filling pressure and wall strain.
• In people with diabetes and an abnormal natriuretic peptide level, echocardiography is recommended as the next step to screen for structural heart disease and echocardiographic Doppler indices for evidence of diastolic dysfunction and increased filling pressures.

Screening for Asymptomatic Peripheral Artery Disease in People With Diabetes

• The committee recommends screening for asymptomatic PAD using ankle-brachial index in people with diabetes at high risk for PAD, including any of the following: age ≥50 years, diabetes with duration ≥10 years, comorbid microvascular disease, clinical evidence of foot complications, or any end-organ damage from diabetes.
• The committee recommends screening people with diabetes and high risk for PAD, including those aged≥50 years, diabetes with duration ≥10 years, microvascular disease, clinical evidence of foot complications, or any end-organ damage from diabetes.

Screening for asymptomatic PAD may lead to early detection and treatment strategies to reduce the risk for progression of PAD and limb preservation. In addition, secondary prevention of PAD has been shown to reduce adverse cardiovascular and limb outcomes.

Reference:

American Diabetes Association Professional Practice Committee; 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S179–S218. https://doi.org/10.2337/dc24-S010