Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy最新文献

Objective: To investigate fasting C-peptide to high-density lipoprotein cholesterol ratio (FHR) as a predictor for non-alcoholic fatty liver disease (NAFLD) in Chinese adults with type 2 diabetes mellitus (T2DM).

Methods: This study enrolled 718 participants with T2DM from Shenzhen People's Hospital, China. Participants were stratified by FCP/HDL-C ratio (FHR) quartiles. Multiple linear regression assessed the association between FHR and NAFLD. A generalized additive model (GAM) tested for nonlinearity. Subgroup analyses evaluated result robustness. The area under the curve (AUC) evaluated the performance of the FHR model for NAFLD occurrence.

Results: After adjusting for relevant variables, FHR was positively correlated with NAFLD (OR = 1.30, 95% CI (1.15, 1.48)). FHR demonstrated a nonlinear association with NAFLD, characterized by a threshold value of 1.23. The effect sizes and confidence intervals on the left and right sides of the inflection point were 3.07 (1.51, 6.24) and 1.20 (1.05, 1.37), respectively. Subgroup analysis showed a stronger correlation could be detected in patients with systolic blood pressure (SBP) <140 mmHg, alanine transaminase (ALT) > 40U/L, fasting blood glucose (FBG) ⩽7 mmol/L, urinary albumin to creatinine ratio (UACR) ⩽30mg/g, triglyceride (TG) ⩽1.7 mmol/L and the patients with drinking history. The FHR ratio model exhibited better discriminative ability in NAFLD (AUC = 0.697) compared to individual FCP (AUC = 0.649) or HDL-C (AUC = 0.635) alone.

Conclusion: The association between FHR and NAFLD was nonlinear, with a positive relationship observed when FHR exceeded the threshold of 1.23.

Background: The association between Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and the development of new carotid plaque in young adults requires further evidence from prospective studies.

Methods:  In this study, young adults underwent abdominal and a carotid ultrasounds measurement were included. The carotid plaque progression was assessed in 2 years after baseline. MASLD is defined according to the liver ultrasound findings and self-reported alcohol consumption. Stepped adjusting multivariable logistic regression were employed to analyze the association between MASLD and the outcome. Subgroup analysis was conducted among sex and different amount of metabolic risk factors.

Results: A total of 36.54% (2411/6598) of all participants had MASLD at baseline. Among them, 626 (9.49%) participants were found new onset of carotid plaque in two years. Subjects who had progression of plaque had higher proportion of MASLD (53.99% vs 34.71%, SMD=0.396). Statistically significant positive associations were observed in unadjusted logistic regression models in overall or each sex, respectively. After fully adjustment, the association was only significant among female (OR:2.19, 95% CI: 1.28-3.72) and those had no metabolic risk factor (OR:1.67,95% CI:1.01-2.76). No significant associations were identified in all male subgroups, whereas the associations were still existing among female subgroups.

Conclusion: MASLD was found to be a risk factor of progression of carotid plaque among females and those who had not suffered from metabolic risk factor. Prevention should be focused on young adults who have MASLD at physical examination to reduce their risk of future atherosclerosis.

Objective: Hyperuricemia (HUA) is a prevalent metabolic disorder closely linked to both obesity and polycystic ovary syndrome (PCOS). Traditional obesity indices, such as body mass index (BMI), may not fully capture the metabolic risks associated with fat distribution. This study aimed to investigate the association between relative fat mass (RFM), the conicity index (C-index), and the risk of HUA in obese women with PCOS to improve clinical metabolic risk stratification.

Methods: This cross-sectional study included 487 obese women aged 18-45 years with PCOS diagnosed by the revised Rotterdam criteria. Anthropometric indices (RFM, C-index) were calculated and categorized into quartiles. Logistic regression, adjusted for age, diabetes, and hypertension, assessed associations with HUA. Restricted cubic spline (RCS) analyses evaluated nonlinear relationships, and subgroup analyses tested robustness across age and metabolic subgroups.

Results: HUA was significantly more prevalent among obese women with PCOS (71.6%) compared to the rate in the non-PCOS counterparts (50.4%; p < 0.001). Elevated RFM was strongly associated with HUA, with adjusted ORs of 4.94 (95% CI: 1.52-16.11) and 3.41 (95% CI: 1.15-10.12) for the third and fourth quartiles, compared to the first (p < 0.05). Conversely, the C-index demonstrated a weaker association with the manifestation of HUA, with limited increases in risk across quartiles. The RCS analyses revealed a linear relationship between RFM and HUA after adjusting for potential confounders, while the C-index showed no significant dose-response trend. Finally, the subgroup analyses confirmed the stability of these associations across the age, hypertension, and hyperlipidemia subgroups.

Conclusion: RFM is significantly associated with HUA in obese women with PCOS and outperforms the C-index as a predictor of metabolic dysfunction. These findings underscore the potential clinical utility of RFM as a practical tool for early identification and metabolic risk stratification in this high-risk population.

Purpose: To analyze differences in quality of life (QoL) among patients with Type 2 Diabetes Mellitus (T2DM) across three levels of healthcare facilities in Bandung, Indonesia, and to identify factors associated with poor QoL.

Methods: This cross-sectional analytical study involved 369 adult T2DM patients from primary, secondary, and tertiary healthcare facilities in Bandung, Indonesia. The participants were enrolled in the National Health Insurance program and had available data on blood glucose levels, diabetes-related complications, and treatments. Quality of life was assessed using the Indonesian version of the Asian Diabetes Quality of Life (ADQOL) questionnaire.

Results: Significant differences in patient characteristics were observed across the three healthcare levels. The highest proportion of patients experiencing multiple complications was found in secondary and tertiary care settings (62.5% and 63.3%, respectively). Patients attending secondary healthcare facilities had the worst quality of life (40.2%), followed by those in tertiary and primary care (33.0% and 26.8%, respectively). Although QoL revealed variability across healthcare levels, it was not statistically significant. Multivariate analysis revealed that complications were significantly associated with poor QoL (one complication: AOR = 4.118, 95% CI: 1.567-10.827).

Conclusion: While patient characteristics varied among healthcare facility levels, they did not independently associate with quality of life. Instead, diabetes complications are significantly associated with quality of life for T2DM patients in Bandung, Indonesia. Although this study limited by its cross-sectional design, this finding highlights the need for screening and early management of complications across all levels of healthcare to improve patient QoL.

Purpose: This study aimed to investigate the association between CD38⁺ cells and the risk of pulmonary tuberculosis (PTB) complicated with diabetes mellitus (DM), providing insights into the immune mechanisms underlying PTB-DM.

Patients and methods: Clinical data and lymphocyte subset profiles of 596 TB patients admitted to Affiliated Hospital of Shaoxing University from November 2022 to November 2024 were analyzed, including 115 DM-complicated and 481 non-DM cases. Logistic regression was used to evaluate the correlations between clinical indicators, lymphocyte subsets and PTB-DM. Generalized linear models were employed to assess the association of CD38⁺ cells with PTB-DM risk, while restricted cubic spline curves were used to explore potential linear relationships.

Results: The PTB-DM group exhibited a significantly higher prevalence of advanced age, male gender, and hypertension compared to the non-DM group (p < 0.05). Lymphocyte subset analysis revealed marginally elevated NKT cells but reduced B lymphocytes, B1 cells, and CD38⁺ cells in the DM group, with the most pronounced difference in CD38⁺ cells (p < 0.001). Multivariate logistic regression identified multidrug-resistant TB and hypertension as independent risk factors, whereas higher CD38⁺ cell counts served as an independent protective factor for TB-DM comorbidity (OR 0.50, 95% CI 0.32-0.77). Generalized linear models demonstrated a persistent negative correlation between CD38⁺ cell levels (analyzed as continuous or quartile-categorized variables) and PTB-DM risk after adjusting for confounders. Restricted cubic spline analysis confirmed a significant linear inverse association (p = 0.003) without evidence of nonlinearity (p = 0.450).

Conclusion: CD38⁺ cells play a critical role in the immune regulation of PTB patients, with elevated expression conferring protective effects against PTB-DM comorbidity.

Introduction: Perianal abscess (PA), a common anorectal emergency, affects approximately 2-3% of the global population. Increasing evidence indicates a relationship between PA and metabolic disorders. Considering the anticipated rise in diabetes mellitus (DM) cases to 1 billion worldwide by 2045, clarifying the epidemiological association and clinical characteristics linking glucose dysregulation with PA holds considerable clinical importance.

Purpose: This study aimed to elucidate the bidirectional epidemiological relationship between DM and PA and to define their respective clinical profiles, thereby contributing to risk stratification and optimization of management strategies.

Methods: Observational studies examining the association between DM and PA were systematically retrieved from PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP databases (from inception to November 2024). Two independent reviewers conducted study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Random-effects models were applied to calculate pooled prevalence, odds ratios (OR), relative risks (RR), and 95% confidence intervals (CI). Heterogeneity, sensitivity, and publication bias were evaluated using Cochran's Q test, I² statistics, subgroup analyses, and Egger's test.

Results: The meta-analysis demonstrated a strong bidirectional association between DM and PA, with 30.7% of PA cases occurring in patients with DM and 22.0% of individuals with DM developing PA. Male sex conferred a significantly higher risk (OR=15.00, 95% CI: 7.87-28.59). DM was linked to altered microbial profiles-lower prevalence of Escherichia coli (OR=0.57, 95% CI: 0.39-0.84) and higher detection of Klebsiella pneumoniae (OR=4.73, 95% CI: 1.30-17.19)-as well as increased occurrence of high abscesses (OR=1.72, 95% CI: 1.00-2.94), older age at onset (+5.53 years), and higher recurrence rates compared with non-DM patients.

Conclusion: The interrelationship between DM and PA is characterized by mutual risk amplification and distinct clinical manifestations, including sex-related vulnerability, microbial alterations, and poorer prognostic outcomes. These findings indicate the necessity for individualized antimicrobial regimens and enhanced postoperative monitoring in patients with DM.

Purpose: The fixed-dose combination (FDC) of empagliflozin and linagliptin is a promising treatment for type 2 diabetes mellitus (T2DM), but real-world data from Bangladesh is limited. This study aimed to assess the effectiveness and safety of empagliflozin 10 mg/linagliptin 5 mg [Empa/Lina (10/5)] FDC among T2DM patients at real-world settings in Bangladesh.

Patients and methods: This prospective, multicenter, observational study enrolled 822 adults with T2DM across Bangladesh. Patients receiving Empa/Lina (10/5) FDC either alone or with other antidiabetic medications at practice were enrolled. Glycemic control, body mass index (BMI), blood pressure, and adverse events were assessed over three months.

Results: Mean HbA1c decreased significantly from baseline to three months in both the Empa/Lina (10/5) FDC alone group (9.13% to 8.18%, p<0.001) and the FDC plus other antidiabetics group (10.20% to 8.12%, p<0.001). Fasting and post-prandial blood glucose levels also improved significantly (p<0.001). BMI decreased from 26.81 kg/m² to 25.90 kg/m² (p=0.008). Systolic and diastolic blood pressure reduced by 11.09 mmHg and 4.41 mmHg, respectively (p<0.001). The estimated glomerular filtration rate remained stable. Improvements were consistent across patient subgroups with various comorbidities. Adverse events were infrequent, with hypoglycemia (10.95%), genital mycotic infection (3.04%), and urinary tract infections (2.80%) being the most common.

Conclusion: Empa/Lina (10/5) FDC demonstrated significant improvements in glycemic control, BMI, and blood pressure with a favorable safety profile in Bangladeshi patients with T2DM. These real-world findings support its use as an effective treatment option in this population.

Introduction: Diabetic retinopathy (DR), particularly proliferative diabetic retinopathy (PDR), is a leading cause of blindness. This study aimed to evaluate the predictive value of hemoglobin (Hb) and direct bilirubin (DBil) for PDR progression.

Methods: We retrospectively collected data from 1,496 T2DM patients with DR treated at the South District of the First People's Hospital of Hefei. Logistic regression, correlation analysis, restricted cubic spline models, and Mendelian randomization were used.

Results: For each unit increase in Hb and DBil, the risk of PDR decreased by 4.4% and 29.1%, respectively. Restricted cubic spline analyses showed a non-linear association between Hb and PDR: the risk decreased with increasing Hb up to a turning point at approximately 133 g/L and then plateaued thereafter; a turning point of 2.67 µmol/L was identified for DBil. The combined diagnostic model of Hb and DBil yielded an AUC of 0.742 with sensitivity 54.5% and specificity 86.5%, indicating moderate discriminative ability. Subgroup analysis showed higher PDR prevalence with worsening anemia. Mendelian randomization suggested a possible association between genetically predicted anemia and higher PDR risk (OR 1.06, 95% CI 1.003-1.12).

Conclusion: Lower Hb and DBil levels were associated with higher PDR prevalence in this hospitalized population. These findings reflect statistical associations and require confirmation in prospective, population-based studies.

Aim: To explore latent categories of complication risk perception in young and middle-aged patients with T2DM, and to examine their relationship with self-management behavior.

Methods: A cross-sectional study was conducted between September 2024 and March 2025, involving 316 young and middle-aged patients with type 2 diabetes mellitus from the endocrinology department of a tertiary hospital in Jiangsu Province, China. Data were collected via a general information questionnaire, the Diabetes Risk Perception Scale, and the Diabetes Self-Management Behavior Scale. Latent profile analysis identified distinct complication risk perception groups, while logistic regression was performed to identify factors influencing different categories. Self-management Behavior scores were compared across subgroups.

Results: Complication risk perception in young and middle-aged patients with T2DM was divided into three latent categories: the Low Risk Perception-Optimism Bias Group (43.7%, n=138), the Overall Medium Risk Perception Group (42.1%, n=133), and the High Risk Perception-Worry Group (14.2%, n=45). Logistic regression indicated that education level, employment status, disease duration, complications, and the occurrence of hypoglycemia within a week were all significantly associated with the risk perception categories (p < 0.05). Significant differences in self-management behavior scores were observed among the different risk perception categories (p < 0.05). Specifically, patients in the High Risk Perception-Worry Group attained the highest total score (M = 2.54, SD = 0.56), while those in the Low Risk Perception-Optimism Bias Group scored the lowest (M = 2.02, SD = 1.12).

Conclusion: Three latent categories of complication risk perception were identified in young and middle-aged patients with T2DM, and their self-management behaviors differed significantly across these categories. Clinicians should provide targeted interventions based on the risk characteristics of each category to improve self-management behaviors.