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

Purpose: To explore the potential of MRI-based radiomics in predicting cognitive dysfunction in patients with diagnosed type 2 diabetes mellitus (T2DM).

Patients and methods: In this study, data on 158 patients with T2DM were retrospectively collected between September 2019 and December 2020. The participants were categorized into a normal cognitive function (N) group (n=30), a mild cognitive impairment (MCI) group (n=90), and a dementia (DM) group (n=38) according to the Chinese version of the Montréal Cognitive Assessment Scale-B (MoCA-B). Radiomics features were extracted from the brain tissue except ventricles and sulci in the 3D T1WI images, support vector machine (SVM) model was then established to identify the CI and N groups, and the MCI and DM groups, respectively. The models were evaluated based on their area under the receiver operating characteristic curve (AUC), Precision (P), Recall rate (Recall, R), F1-score, and Support. Finally, ROC curves were plotted for each model.

Results: The study consisted of 68 cases in the N and CI group, with 54 cases in the training set and 14 in the verification set, and 128 cases were included in the MCI and DM groups, with 90 training sets and 38 verification sets. The consistency for inter-group and intra-group of radiomics features in two physicians were 0.86 and 0.90, respectively. After features selection, there were 11 optimal features to distinguish N and CI and 12 optimal features to MCI and DM. In the test set, the AUC for the SVM classifier was 0.857 and the accuracy was 0.830 in distinguishing CI and N, while AUC was 0.821 and the accuracy was 0.830 in distinguishing MCI and DM.

Conclusion: The SVM model based on MRI radiomics exhibits high efficacy in the diagnosis of cognitive dysfunction and evaluation of its severity among patients with T2DM.

Purpose: The impact of hepatic lipid accumulation on hyperuricemia presents an intriguing research avenue, particularly in light of existing studies linking obesity with hyperuricemia. Nevertheless, there remains a scarcity of quantitative investigations into the correlation between liver fat content (LFC) and hyperuricemia among prediabetic cohorts, notably within the Chinese demographic.

Patients and methods: This cross-sectional study was conducted at the Health Management Center of Henan Provincial People's Hospital between January 2019 and December 2023, involving 2,950 pre-diabetic participants. Participants were categorized into groups based on diagnostic criteria for hyperuricemia. LFC was assessed using computed tomography. Statistical analyses included multivariate logistic regression, limited cubic spline regression models, and subgroup analyses to explore the association between LFC and hyperuricemia among individuals with pre-diabetes.

Results: The prevalence of hyperuricemia among the 2,950 prediabetic individuals was observed to be 22.20%. Prediabetic individuals with hyperuricemia exhibited higher levels of LFC compared to those without hyperuricemia. This association persisted even after adjusting for other variables, indicating a heightened risk of hyperuricemia among prediabetic individuals with elevated LFC [Q4 vs Q1: odds ratio (OR 2.70), 95% confidence interval (CI) 1.93-3.79, P < 0.001; P _{for trend} < 0.001]. Importantly, a nonlinear relationship between LFC and hyperuricemia risk was identified in the prediabetic individuals, showing a significant increase in hyperuricemia risk when LFC exceeded 8.4% (OR per standard deviation = 1.05, 95% CI: 1.02-1.08, P < 0.001).

Conclusion: In individuals with prediabetes, a higher LFC is associated with an elevated risk of hyperuricemia, especially when LFC exceeds 8.4%.

Background: Diabetic foot ulcer (DFU) inpatients admitted with non-ulcer complaints constitute a neglected group that might suffer from more non-standard treatments. This study intends to describe their clinical characteristics, and clarify the problems existing in the DFU management process.

Methods: In this retrospective study, admission complaints were determined by combining the final diagnosis and clinical documentation, and were categorized as: ulcer-related or non-ulcer complaints.

Results: A total of 264 DFU inpatients were included in the final analysis, of which, 80 (30.3%) were admitted with non-ulcer complaints. A total of 82.5% of the DFU inpatients with non-ulcer complaints were admitted to departments without DF specialists. IWGDF/IDSA grade, cerebrovascular diseases, chronic kidney disease, infection in other parts, glycosylated hemoglobin A1c and the source of hospitalization expenses were the independent influencing factors for admission with non-ulcer complaints (all P < 0.05). Before admission, only 11.3% of the patients with non-ulcer complaints had ever been treated by a DF specialist and/or in a clinical setting with DF specialists. After admission, 25.0% of the DFU inpatients with non-ulcer complaints did not receive any local wound care, and only 7.6% of the patients admitted to the departments without DF specialists obtained a referral.

Conclusion: Approximately one-third of inpatients with DFU are admitted with non-ulcer complaints and most of them are admitted to departments without DF specialists. Inpatients with non-ulcer complaints have milder wounds but more severe and greater comorbidities and worse organ function. These patients do not receive standardized management for DFU either before or after admission. Targeted measures are needed to improve this situation.

Objective: Elevated serum ferritin (SF) levels are associated with oxidative stress (OS) and systemic inflammation in various disorders. However, the changes in SF levels during pregnancy and their relationship with gestational diabetes mellitus (GDM) and blood glucose levels are not well understood.

Methods: This prospective longitudinal study included 390 participants (130 GDM cases and 260 controls) during early pregnancy. We measured SF levels in the1^st, 2^nd, and 3^rd trimesters, as well as plasma malondialdehyde (MDA) and C-reactive protein (CRP) in the 1^st trimester, blood glucose levels in the oral glucose tolerance test (OGTT), and glycosylated hemoglobin (HbA1c) in the 2^nd trimester. We used Spearman's rank correlation to estimate the association between SF, OS, inflammation and glucose levels. Logistic regression analysis was performed to estimate the OR of GDM associated with SF. Multiple stepwise regression models were used to assess the relationship between glucose levels and the risk factors.

Results: SF levels decreased with increasing gestation in the study population. Compared to controls, GDM patients had significantly higher levels of SF (1^st and 2^nd trimesters), MDA, CRP, and HbA1c. SF was positively correlated with MDA and fasting plasma glucose (FPG). Elevated SF levels during early pregnancy were significantly associated with increased GDM risks (OR = 2.024, 95% CI: 1.076 - 3.807). The explanatory variables that contributed to increased glucose levels were SF, MDA, body mass index (BMI), maternal age, and family history of diabetes.

Conclusion: SF is significantly associated with GDM and may be a potential biomarker for GDM in early pregnancy.

Aim: The aim of this study was to develop a predictive model for the progression of diabetic kidney disease (DKD) to end-stage renal disease (ESRD) and to evaluate the effectiveness of renal pathology and the kidney failure risk equation (KFRE) in this context.

Methods: The study comprised two parts. The first part involved 555 patients with clinically diagnosed DKD, while the second part focused on 85 patients with biopsy-proven DKD. Cox regression analysis and competing risk regression were employed to identify independent predictors. Time-dependent receiver operating characteristic (ROC) was used to evaluate prediction performance, and the area under the curve (AUC) was calculated to assess the model's accuracy.

Results: The Cox regression model developed for the 555 patients clinically diagnosed with DKD identified 5 predictors (body mass index (BMI), estimated glomerular filtration rate (eGFR), 24-hour urinary total protein (UTP), systemic immune-inflammatory index (SII), and controlling nutritional status (CONUT), whereas the Competing risks model included 4 predictors (BMI, eGFR, UTP, CONUT). Among 85 patients with biopsy-proven diabetic DKD, the combined prognostic model integrating KFRE, interstitial fibrosis and tubular atrophy (IFTA), SII and BMI demonstrated enhanced predictive ability at 5 years. The developed models offer improved accuracy over existing methods by incorporating renal pathology and novel inflammatory indices, making them more applicable in clinical settings.

Conclusion: The predictive model proved to be effective in assessing the progression of DKD to ESRD. Additionally, the combined model of KFRE, IFTA, SII, and BMI demonstrates high predictive performance. Future studies should validate these models in larger cohorts and explore their integration into routine clinical practice to enhance personalized risk assessment and management.

Aim: To assess and compare subclinical alterations in superficial capillary plexus vessel density (SCPVD) and retinal layers thickness in the macular region between individuals with type 2 diabetes mellitus (DM) and healthy controls.

Methods: Swept-source OCT images were obtained from 29 control subjects and 24 diabetic subjects. Macular thickness (MT), retinal nerve fiber layer (RNFL) thickness, and ganglion cell layer (GCL) thickness were measured in the central macula and four quadrants of macular region using a 6.0 × 6.0 mm radial macular scan centered on the fovea. OCTA acquisition included a 3.0 × 3.0 mm macular scan for the foveal avascular zone (FAZ) and a 4.5 × 4.5 mm macular scan for SCPVD. The FAZ was manually mapped at the SCP on OCTA images.

Results: In diabetic subjects, the superficial capillary plexus vessel density (SCPVD) was significantly lower in both the central (P = 0.04) and inferior (P = 0.01) regions compared to the control group. Additionally, diabetic patients showed a significant reduction in temporal macular thickness (MT) and thinning of the ganglion cell layer (GCL) in all three quadrants except in the central and inferior macula (P < 0.05). There was also significant thinning of the superior macular retinal nerve fiber layer (RNFL) in diabetics compared to controls (P = 0.02). While the foveal avascular zone (FAZ) was larger in diabetic subjects, this difference was not statistically significant (P = 0.78). Duration of diabetes has shown a significantly high positive correlation (r = 0.77, P < 0.01) with superior macular VD.

Conclusion: The findings of this study suggest that the diabetic macula experiences significant ganglion cell layer (GCL) thinning and reduced superficial capillary plexus (SCP) vascular density even before the onset of clinical retinopathy. Swept-source OCT proves to be an essential tool for detecting these early changes in diabetic patients.

Background & aims: The aim of this study was to assess the association between the level of lactate dehydrogenase (LDH) and the severity of metabolic syndrome (MetS) and Metabolic Associated Fatty Liver Disease (MAFLD) and the potential diagnostic value of LDH for identifying at-risk metabolic associated steatohepatitis (MASH).

Methods: This cross-sectional, real-world retrospective study enrolled a total of 1118 obese patients in the department of bariatric surgery at the Second Affiliated Hospital of Anhui Medical University from January 1, 2018, to December 31, 2021. Of these, 855 were enrolled in the study cohort. MAFLD was defined as the presence or absence of fatty liver disease as suggested by histologic biopsy of liver or postoperative pathology slides, or even hematology, and meets one of the following three conditions: overweight or obesity, T2DM, and metabolic dysfunction (MetS). Serum LDH activity levels were measured in 885 patients, and logistic regression was used to analyze the relationship between LDH and metabolic syndrome and the severity of MAFLD.

Results: In the study cohort of 855 obese patients, 604 (70.6%) had MetS. Patients with MetS (214.1[209.0-219.2]) had significantly higher serum LDH levels than those without MetS (188.7[181.6-195.9]). Particularly, serum LDH level was significantly higher in subjects with hypertension, central obesity, diabetes mellitus or hyperglycemia, elevated levels of triglycerides, or reduced levels of high-density lipoprotein than in those without. Moreover, LDH concentrations were grouped according to the total number of MetS components present in each patient, with Serum LDH levels gradually increase with the total number of MetS components. The MASH subjects had significantly higher LDH levels than the other three less severe non-MASH cohorts, including normal liver, simple fatty steatosis, and B.MASH. Logistic regression showed that LDH was significantly and positively correlated with MAFLD, B.MASH, MASH, at-risk MASH, fibrosis grade ≥1, fibrosis grade ≥2 and fibrosis grade ≥3.

Conclusion: Increased LDH levels were significantly and independently associated with the presence and severity of metabolic syndrome and MAFLD, indicating that LDH could be used as a novel biomarker and clinical predictor of severity of metabolic syndrome and MAFLD.

Purpose: Elevated blood glucose levels may disrupt tear film and meibomian gland function, contributing to dry eye disease (DED) and meibomian gland dysfunction (MGD). This study aimed to explore the relationship between hyperglycemia and DED parameters.

Methods: A cross-sectional study at Chifeng Chaoju Eye Hospital (June-August 2024) included 56 participants with DED symptoms. Tear meniscus height (TMH), non-invasive tear film breakup time (FNIBUT, ANIBUT), bulbar redness, and meibomian gland atrophy (U-LAMG, L-LAMG) were assessed using a non-invasive ocular surface analyzer. Fasting blood glucose levels stratified patients into high (≥7 mmol/l) and normal (<7 mmol/l) groups, and their association with DED parameters was analyzed.

Results: Among 56 patients (mean age 52.5 ± 18.0 years), those with elevated glucose levels (n=28) had more severe DED symptoms (OSDI, p = 0.046), lower TMH, FNIBUT, ANIBUT, and higher bulbar redness scores (all p < 0.05). In contrast, lower glucose levels were associated with greater U-LAMG and L-LAMG atrophy (p < 0.05). Glucose positively correlated with intraocular pressure (IOP), redness, U-LAMG, and L-LAMG but negatively correlated with TMH, FNIBUT, and ANIBUT (all p < 0.05).

Conclusion: Hyperglycemia is linked to impaired tear film stability, meibomian gland function, and DED symptoms. Ocular surface disorders in individuals with diabetes may be prevented by effective glycemic control.

Aim: To investigate the correlation of advanced glycation end products (AGEs) with diabetic cardiovascular autonomic neuropathy (DCAN). Factors affecting DCAN and those related to skin AGE accumulation in patients with DCAN were analyzed.

Materials and methods: A total of 192 patients with type 2 diabetes mellitus (T2DM) who were hospitalized in the Department of Endocrinology of Hefei Second People's Hospital from November 2020 to December 2022 were included and divided into DCAN (n=121) and No_DCAN (n=71) groups based on the results of Ewing test. All patients completed the detection of skin AGEs accumulation. The clinical features of the two groups were analyzed; the factors affecting DCAN were analyzed by multiple logistic regression analysis, and those related to skin AGE accumulation in patients with DCAN were analyzed by Spearman correlation analysis and Pearson correlation analysis.

Results: Compared with the No_DCAN group, the combined DR ratio, fasting plasma glucose (FPG), and skin AGEs were increased in the DCAN group (all P<0.05). Multivariate logistic regression analysis showed that FPG, combined DR, and skin AGEs all affected DCAN (P<0.05). Spearman correlation analysis showed that skin AGE accumulation in patients with DCAN was correlated with sex (male or female) and the presence of vascular plaques (All P<0.05). Pearson correlation analysis showed that skin AGE accumulation in patients with DCAN was correlated with age, diabetes course, diastolic blood pressure, uric acid, creatinine and UACR levels (All P<0.05).

Conclusion: Skin AGEs, combined DR and FPG affected DCAN, and skin AGEs, combined DR and FPG were closely related to the incidence of DCAN. Sex (male or female), presence of vascular plaques, age, diabetes course, diastolic blood pressure, uric acid levels, creatinine levels and UCAR levels were correlated with skin AGE accumulation in patients with DCAN.

Purpose: To investigate the potential association between the serum concentrations of high mobility group protein B1 (HMGB1) and the receptor for advanced glycation end-products (RAGE) in relation to the occurrence of restenosis following interventional therapy for lower extremity vascular disease in patients diagnosed with type 2 diabetes mellitus (T2DM).

Patients and methods: From March 2023 to January 2024, 96 T2DM patients with lower extremity vascular disease who underwent interventional therapy and 6-month follow-up in our hospital were studied. Patients were divided into in-stent restenosis (ISR) (n=38) and none-in-stent restenosis (NISR) (n=58) groups based on the occurrence of ISR. Pre-surgery demographics and serum levels of HMGB1, RAGE, glycated hemoglobin (HbA1c), and high-sensitivity C-reactive protein (hs-CRP) were analyzed. A Pearson correlation and multivariate Logistic regression were used to identify factors influencing restenosis. A predictive nomogram was built based on the identified factors. The receiver operating characteristic (ROC) curve analysis evaluated the predictive value of serum RAGE and HMGB1 for restenosis post-intervention.

Results: The ISR group exhibited statistically significant elevations in HbA1c, hs-CRP, HMGB1, and RAGE levels compared to the NISR group (P<0.05). Multivariate logistic regression analysis revealed that HMGB1 and RAGE were independent risk factors for restenosis in T2DM patients with lower extremity vascular disease undergoing interventional therapy. The predictive nomogram model developed specifically for this patient population demonstrated high accuracy. ROC curve analysis further emphasized the superior combined predictive value of HMGB1 and RAGE over individual biomarkers for restenosis after interventional therapy in this cohort.

Conclusion: Elevated preoperative serum levels of HMGB1 and RAGE in T2DM patients with lower extremity vascular disease are linked to restenosis following interventional therapy.