Diabetology & Metabolic Syndrome最新文献

Background: Diabetic Foot Ulcers (DFUs) represent a global healthcare challenge, imposing substantial socioeconomic burdens due to their increasing incidence and associated mortality. This study evaluates the efficacy and safety of external phytotherapy (utilizing various plant-derived compounds, including Chinese herbal medicines and plant-derived liposomes, administered topically) for the treatment of DFUs.

Methods: Relevant studies were identified from major electronic databases (PUBMED, EMBASE, WOS, and the Cochrane Library) that were searched up to April 30, 2024. Randomized controlled trials (RCTs) that evaluated the effects of external phytotherapy for DFUs. The treatment group was treated with external phytotherapy plus conventional treatment, while the control group received conventional treatment alone. Two evaluators independently screened and selected literature, extracted data, and assessed the risk of bias. The outcome measures included complete ulcer healing, ulcer improvement, ulcer area reduction, and healing time. Weighted mean difference (WMD), standardized mean difference (SMD), and relative risk (RR) with 95% confidence intervals (CI) were used for data analysis. Heterogeneity was quantified using I² statistics, with appropriate application of fixed-effects or random-effects models. Methodological quality was ensured through Review Manager and Stata software, complemented by GRADE evidence assessment.

Results: Twenty studies with a total of 1,854 participants were identified. Our analysis suggested that compared with conventional treatment, external phytotherapy significantly enhances complete ulcer healing (RR: 1.84; 95% CI: 1.55 to 2.19), promotes ulcer improvement (RR: 1.32; 95% CI: 1.11 to 1.57), reduces ulcer area (WMD: -1.14; 95% CI: -1.45 to -0.83), and accelerates healing time (WMD: -3.93; 95% CI: -7.48 to -0.39). Safety profiles and ulcer depth measurements showed no significant intergroup differences. GRADE assessments indicated high-certainty evidence for most primary outcomes, whereas the evidence for percentage ulcer reduction was of low certainty due to serious inconsistency and imprecision.

Conclusion: External phytotherapy demonstrates potential as an adjunctive treatment for diabetic foot ulcers, improving primary outcomes like complete healing with moderate to high certainty of evidence. Nevertheless, regional bias-with most evidence derived from East Asia-warrants caution in generalizing these results. Further rigorous, multi-regional trials are needed to solidify the evidence base and refine clinical application.

Background: Patients with type 2 diabetes mellitus (T2DM) undergoing percutaneous coronary intervention (PCI) are at high risk of adverse cardiovascular and renal outcomes. While both sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) are widely used in this population, direct evidence comparing their long-term efficacy and safety after PCI remains scarce. This meta-analysis aimed to compare cardiovascular and renal outcomes between SGLT-2i and DPP-4i in patients with T2DM post-PCI.

Methods: PubMed, Web of Science, Scopus, and Cochrane CENTRAL were searched through June 2025. Primary outcomes were all-cause mortality, worsening renal function, and heart failure. We included primary studies and assessed the quality of studies using Newcastle Ottawa Scale. RevMan software was used to calculate hazard ratios (HR) estimates and 95% confidence intervals (CI) using the random-effects model.

Results: We analyzed the outcomes between SGLT-2i (n = 7,025 patients) and DPP-4i (n = 7,459 patients). The mean age was 62.7 years, and 77.4% were males. SGLT-2i significantly reduced all-cause mortality (HR = 0.65; 95% CI: 0.54-0.79; P < 0.001) and the risk of worsening renal function (HR = 0.15; 95% CI: 0.09-0.26; P < 0.001). They also demonstrated a significant reduction in heart failure events (HR = 0.59; 95% CI: 0.48-0.74; P < 0.001). For myocardial infarction, a non-significant trend toward risk reduction with SGLT-2i was observed (HR = 0.85; 95% CI: 0.72-1.02; P = 0.08). For cerebrovascular accidents and the need for repeat revascularization (PCI/CABG), no significant difference was observed.

Conclusion: SGLT-2i demonstrates more clinical benefits, and current evidence supports its initiation over DPP-4i in T2DM patients after PCI.

Background: Alcohol use disorder (AUD) affects nearly half a billion people globally and is associated with significant physical and psychiatric comorbidities. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), approved for diabetes and obesity, have shown promise in modulating reward-related brain pathways, suggesting potential benefits in the management of AUD.

Methods: This systematic review and meta-analysis, registered in PROSPERO and conducted per PRISMA guidelines, assessed the effects of GLP-1RA use on AUD and alcohol-related outcomes in adults with obesity or type 2 diabetes mellitus. Five databases (PubMed, Embase, Web of Science, Scopus, and Cochrane Library) were searched up to September 30, 2025. Random-effects models were applied, and sensitivity analyses examined result stability. No subgroup or meta-regression analyses were performed owing to the small number of eligible studies.

Results: Five observational cohort studies (three on AUD diagnosis, two on alcohol-related hospitalization) were included, with sample sizes ranging from 4,321 to > 53,000 participants. GLP-1RA use was associated with a 28% lower risk of AUD diagnosis (HR = 0.72, 95% CI 0.59-0.89; I² = 65%). For alcohol-related hospitalization, a non-significant reduction was observed (HR = 0.76, 95% CI 0.57-1.01; I² = 77%). Leave-one-out sensitivity analyses confirmed the direction and magnitude of the AUD finding but highlighted the limited evidence base for hospitalization.

Conclusion: GLP-1RA use was associated with a reduced risk of AUD diagnosis, with a possible but non-significant reduction in alcohol-related hospitalization. Effects may be mediated through modulation of mesolimbic reward pathways and the gut-brain axis. Further large-scale trials are warranted to confirm these findings.