Diabetology & Metabolic Syndrome最新文献

Background: Prediabetes is a well-established risk factor for cardiovascular diseases (CVD), stroke, and cancer, but whether this risk is uniform across all individuals remains uncertain. Additionally, heterogeneity within the prediabetic population, driven by mechanisms like lipid metabolism dysfunction and inflammation, has not been fully explored.

Methods: This study analyzed data from 3,065 prediabetic participants (mean age: 58.8 ± 9.7, 53.8% women) from the China Health and Retirement Longitudinal Study. We used generalized linear models, Cox regression, and subgroup analyses to evaluate the risk of progression to CVD, stroke, and cancer. To delineate distinct subgroups among individuals with prediabetes, we devised a stratification framework predicated on the coexistence of dyslipidemia, the triglyceride-glucose (TyG) index, and the C-reactive protein-triglyceride glucose (CTI) index.

Results: Prediabetic participants were classified into four subgroups: metabolically sensitive, inflammation-driven, metabolic lipotoxicity, and systemic metabolic-inflammatory (a subtype defined by concurrent dyslipidemia and elevated CTI values indicating combined metabolic and inflammatory dysregulation). Compared with the metabolically sensitive subtype, the inflammation-driven, metabolic lipotoxicity, and systemic metabolic-inflammatory subtypes exhibited significantly heightened risks of cancer, CVD, and stroke, even after adjustment for confounding variables (all p < 0.05). Furthermore, dose-response analyses revealed a robust linear association between increasing levels of CTI, low-density lipoprotein cholesterol, and TyG index and the incidence of cancer, CVD, and stroke.

Conclusions: Prediabetic individuals with inflammation and/or lipid metabolism dysregulation are at a markedly higher risk of developing CVD, stroke, and cancer. Tailored prevention and intervention strategies are necessary to address the distinct risk profiles within the prediabetic population.

Background/aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common but understudied disease in adolescents. We aimed to estimate the updated prevalence of MASLD and related fibrosis among US adolescents using transient elastography.

Methods: This study analyzed data from the National Health and Nutrition Examination Survey 2017 to March 2020 and August 2021 to August 2023 among adolescents ages 12-19 years. Steatotic liver disease was assessed using the median controlled attenuation parameter (CAP) and fibrosis by median liver stiffness measurement.

Results: A total of 2588 participants were included in the analysis (mean [SD] age, 15.4 [2.3] years; 1366 male participants [52.8%]). The overall age-adjusted prevalence of MASLD was 21.0% (95% CI: 19.1-23.0) using a CAP threshold of ≥ 248 dB/m and 16.1% (95% CI: 14.4-17.8) using ≥ 263 dB/m. The prevalence of MASLD-related fibrosis was 9.0% and 9.7% using CAP thresholds of 248 dB/m and 263 dB/m, respectively. Higher prevalence of MASLD and fibrosis was observed among adolescents with overweight, obesity, and prediabetes. Between the two survey cycles, the age-standardized prevalence of MASLD remained stable, with a non-significant decline observed in the prevalence of fibrosis. Multivariable analysis identified male sex, non-Hispanic Asian ethnicity, increased waist circumference, overweight, and obesity as independent risk factors for MASLD, while waist circumference was the only independent factor associated with MASLD-related fibrosis.

Conclusions: In this cross-sectional study, MASLD and MASLD-related fibrosis were highly prevalent among US adolescents, with significant disparities observed by sex, race, and ethnicity. These findings highlight the substantial burden of MASLD in the adolescent population and underscore the need for continued public health focus.

Objective: This study aimed to investigate whether electroacupuncture (EA) can regulate skeletal muscle glucose metabolism through the AMPK/PGC-1α/TFAM signaling pathway in a rat model of type 2 diabetes mellitus (T2DM).

Methods: T2DM was induced by feeding rats a high-fat, high-sugar diet followed by intraperitoneal streptozotocin (35 mg/kg). Rats were randomly assigned to five groups: model, EA, EA plus AMPK inhibitor (Compound C, 20 mg/kg, three times weekly), sham acupuncture (tail non-acupoint stimulation), and control. EA was applied at Zusanli, Sanyinjiao, and Weiwanxiashu for 20 min daily, six days per week, for four weeks. Random blood glucose (RBG) and body weight were monitored weekly. After intervention, fasting blood glucose (FBG), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), fasting insulin (FINS), and C-peptide (C-P) were measured, and HOMA-IR and ISI were calculated based on FBG and FINS. Skeletal muscle morphology was assessed by H&E staining; ATP levels were measured; and AMPK/PGC-1α/TFAM pathway related protein and gene expression were analyzed by Western blotting and RT-PCR.

Results: EA reduced RBG, body weight, FBG, TG, LDL-C, FINS, C-P levels, and HOMA-IR, while improving ISI. Moreover, EA enhances the expression of AMPK, PGC-1α, TFAM, and GLUT 4 at both the protein and mRNA levels, alleviates skeletal muscle cell injury, and increases ATP content in skeletal muscle. These beneficial effects are abolished by co-administration of an AMPK inhibitor.

Conclusion: EA improves glycolipid metabolism and alleviates insulin resistance in T2DM rats, potentially via activation of the AMPK/PGC-1α/TFAM pathway. These effects may be linked to improved skeletal muscle function and glucose utilization. EA shows promise as a therapeutic strategy for T2DM, warranting further investigation into its mechanisms and clinical relevance.

Background: This study aimed to explore the association between sarcopenic obesity (SO) and advanced stages of cardiovascular-kidney-metabolic (CKM) syndrome, as well as to prospectively examine its relationship with cardiovascular events in CKM stages 0-3.

Methods: Data were drawn from the China Health and Retirement Longitudinal Study (2011-2020) encompassing a median follow-up of 9.0 years for incident cardiovascular events. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Non-sarcopenic participants with optimal body mass index or waist circumference served as the reference group. Outcome was major adverse cardiovascular events (MACEs) defined as a composite of all-cause death, cardiovascular problem, and stroke. Multivariable logistic regression and Cox proportional hazards models were employed to assess associations.

Results: A total of 6,766 participants (age 60.0 ± 9.9 years, 46.9% male) were included. At baseline, SO was associated with a significantly higher likelihood of advanced CKM stages [OR (95% CI): 3.317 (2.533, 4.345)] compared to reference. Similarly, sarcopenic overweight [OR (95% CI): 3.171 (2.601, 3.865)] and sarcopenic abdominal obesity [OR (95% CI): 3.268 (2.662, 4.013)] were also linked to higher odds of advanced CKM stages. Over a median follow-up of 9.0 years, 1,322 participants (21.1%) from CKM stages 0-3 experienced MACEs. After adjusting for multiple covariates, SO was associated with an increased risk of MACEs [HR (95% CI): 2.248 (1.789, 2.824)] compared to reference. Similarly, sarcopenic overweight [HR (95% CI): 1.768 (1.465, 2.135)] and sarcopenic abdominal obesity [HR (95% CI): 1.730 (1.414, 2.115)] were also associated with an elevated risk of MACEs.

Conclusions: SO was significantly associated with more advanced stages of the CKM spectrum. Furthermore, among individuals categorized with CKM stages 0-3 and without pre-existing cardiovascular disease, SO was independently associated with a substantially elevated risk of future MACEs.

Diabetes mellitus includes a wide range of chronic metabolic disorders that result in severe hyperglycemia and other damages in diabetic patients due to impaired insulin secretion or insulin inefficiency. This study purpose was to consider of the potential therapeutic properties of MSCs-derived EVs/Exo against DM. A complete systematic search was achieved in various electronic databases (Scopus, Web of Science, PubMed and Embase) up to June 2025, following the PRISMA guidelines. A whole of 89 studies were screened based on predetermined standards for inclusion and exclusion. Eventually, the current systematic study contained 13 publications that had the criteria of inclusion. According to the findings of this study, MSCs-derived EVs/Exo reduce DM and hyperglycemia with the high ability to regulate inflammatory-immune responses and activate autophagy pathways. However, compared to the diabetic groups, treatment with MSCs-derived EVs/Exo revealed tendency towards immunomodulatory, anti-inflammatory, anti-diabetic, regeneration and neogenesis of β-islets. In other studies, have been identified that DM causes significant biochemical changes in beta cells/pancreas tissue. In addition, obvious histological changes were observed in pancreatic tissue following DM. Generally, MSCs-derived EVs/Exo administration modulated most of the histological and biochemical changes caused by diabetes. Notably, the DM is improved through recovering damaged tissues, increasing insulin levels and glycemic stability. It seems that, MSCs-derived EVs/Exo exert these protective and therapeutic properties through the modulating of multiple mechanisms that are implicated in DM.

Objectives: The primary aim of this meta-analysis is to assess the association of dietary protein with the risk of metabolic syndrome (MetS) in observational studies. In addition, the secondary aim is to evaluate the effectiveness of protein intake on MetS components.

Methods: An Initial search was conducted from PubMed, Web of Science (WOS), and Scopus until May 2024. Cohort, cross-sectional, and case-control studies were included, and their quality and certainty were evaluated by the Newcastle - Ottawa Quality Assessment Scale (NOS) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tools, respectively.

Result: Based on our meta-analysis, we found that plant protein (PP), and animal protein (AP) had an inverse association with MetS (OR: 0.77, 95% CI: 0.69, 0.87, P < 0.001; I² = 93.0%; P_{heterogeneity} < 0.001), (OR: 0.92, 95% CI: 0.86, 0.98, P = 0.012; I² = 83.5%; P_{heterogeneity} < 0.001), respectively. Besides, there was no association between total protein (TP) and MetS (OR: 0.90, 95% CI: 0.82, 1.00, P < 0.051; I² = 91.3%; P_{heterogeneity} < 0.001) as the primary outcomes. Furthermore, TP, AP, and PP had a negative association with MetS components, except TP-WC (OR: 0.78; 95% CI: 0.55, 1.12; P = 0.178; I² = 80.0%; P_{heterogeneity} < 0.001), TP-FBS (OR: 0.93; 95% CI: 0.82, 1.05; P = 0.231; I² = 91.0%; P_{heterogeneity} < 0.001), TP-BP (OR: 0.86; 95% CI: 0.76, 0.96; P = 0.008; I² = 87.9%; P_{heterogeneity} < 0.001), AP-FBS (OR: 1.04, 95% CI: 1.00, 1.07, P = 0.061; I² = 29.6%; P_{heterogeneity} >0.001), PP-FBS (OR: 0.94, 95% CI: 0.86, 1.03, P = 0.207; I² = 72.2%; P_{heterogeneity} =0.001).

Conclusion: Current evidence suggests that PP and AP intake may be associated with reduced risk of MetS as the primary outcome. However, in specific contexts, such as some of the secondary outcomes, results showed no reaction, e.g., TP-WC, TP-FBS, TP-BP, AP-FBS, PP-FBS. Besides, due to the high heterogeneity, methodological quality, and significant bias in PP-MetS and PP-TG, recommendations must be made cautiously. Finally, no definitive conclusions can be drawn regarding a causal or uniform protective relationship.

Trial registration: Prospero ID 1020957.

Abatract: BACKGROUND : Sensorineural hearing loss (SNHL) is a common but underrecognized complication of type 2 diabetes mellitus (T2DM). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) use was associated with favorable renal and cardiovascular outcomes beyond glycemic control, but their impact on auditory outcomes remains unclear.

Methods: We conducted a nationwide cohort study using Taiwan's National Health Insurance Research Database (2000-2021). Patients with T2DM who received SGLT2i for ≥ 90 days were compared with matched non-users. Propensity score matching was applied 1:1 based on demographic, clinical, and treatment characteristics. The primary outcome was the incidence of SNHL, confirmed by audiometric testing.

Results: A total of 381,592 patients with type 2 diabetes mellitus (T2DM) were included. Compared with non-users, SGLT2i users exhibited a significantly lower risk of SNHL (adjusted hazard ratios (aHRs) = 0.84; 95% CI: 0.75-0.94). Subgroup analyses confirmed a consistent lower risk across sex, age, urbanization, and comorbidity strata. Notably, long-term SGLT2i use (≥ 366 days) showed a strong dose-response association with reduced SNHL risk (aHR = 0.32; 95% CI: 0.27-0.39).

Conclusion: SGLT2i use in T2DM patients is associated with a reduced risk of SNHL, particularly with sustained therapy. These findings highlight a potential association between SGLT2i use and a lower risk of auditory complications in diabetes, underscoring the importance of considering hearing health within comprehensive diabetes management.

Background: Although frailty has been associated with individual components of cardiovascular-kidney-metabolic (CKM) syndrome, the overall relationship between frailty and CKM syndrome, as well as the potential mediating role of insulin resistance (IR), remains inadequately understood.

Methods: We analyzed data from 4,615 adults aged ≥ 45 years who participated in the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2025. Frailty status was evaluated using the Frailty Index (FI) and classified into three categories: robust, prefrail, and frail. Changes in frailty over time were measured based on frailty status at baseline and during a follow-up survey conducted four years later. Logistic regression, linear regression, and bootstrap analyses were employed to examine the association between frailty and progression to advanced CKM stages, as well as the mediating role of the estimated glucose disposal rate (eGDR) as a proxy for IR.

Results: Individuals who remained in or progressed to pre-frail or frail states during the study period exhibited significantly increased risks of developing advanced CKM syndrome. In the fully adjusted model, the highest risk of CKM syndrome was observed among individuals who remained consistently pre-frail or frail (OR = 3.80; 95% CI: 2.67-5.46;P < 0.001), followed by those who transitioned from a robust state to a worse frailty category (OR = 3.08; 95% CI: 2.13-4.48;P < 0.001). Furthermore, greater increases in the Frailty Index (ΔFI) and higher overall FI scores were significantly associated with an elevated risk of CKM syndrome (ΔFI: OR = 2.12; 95% CI: 1.51-2.98; FI score: OR = 2.19; 95% CI: 1.54-3.11; P < 0.001), after full adjustment.Mediation analysis indicated that IR accounted for approximately 31.6% of the total effect of frailty on the development of CKM syndrome.

Conclusion: Both baseline frailty and its progression over time were independently associated with an elevated risk of advanced CKM syndrome. IR was identified as a partial mediator in this relationship. This finding suggests that IR may serve as a modifiable biological target for intervention.