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

Objective: To investigate the associations of anthropometric indicators and left ventricular hypertrophy (LVH) in middle-aged and elderly individuals with type 2 diabetes mellitus (T2DM).

Methods: This was a cross-sectional study. A total of 3330 individuals were recruited from three tertiary hospitals across China between July 2018 and June 2023. Demographic characteristics, biochemical parameters, and echocardiographic measurements were systematically collected. Anthropometric indices, including body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI), body roundness index (BRI), and weight-adjusted-waist index (WWI) were calculated using standardized protocols. Multivariable binary logistic regression models were employed to evaluate the associations between anthropometric indices and LVH. The diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis.

Results: Multivariable logistic regression analysis revealed that WHR (OR:1.128, 95% CI:1.043, 1.220) and BRI (OR:1.455, 95% CI:1.011, 2.094) were independently associated with increased LVH risk in middle-aged males. Among middle-aged females, BAI (OR:1.112, 95% CI:1.046, 1.182), WHtR (OR:1.048, 95% CI:1.007, 1.090), and BRI (OR:1.234, 95% CI:1.040, 1.465) demonstrated significant associations with LVH. However, in the elderly population, none of the variables showed a statistically significant association with LVH (P>0.05). ROC curve analysis identified WHR as the strongest predictor in middle-aged males (AUC:0.674, 95% CI:0.584, 0.764), whereas BAI exhibited the highest discriminatory accuracy among middle-aged females (AUC:0.578, 95% CI:0.523, 0.633).

Conclusion: Sex-specific associations between obesity indices and LVH were observed in middle-aged individuals with T2DM, necessitating distinct risk-stratification strategies: prioritizing abdominal obesity in males and comprehensive adiposity distribution in females. Notably, the broad relevance of BRI in both sexes highlights its clinical utility.

Aim: To assess the association between sodium-glucose cotransporter 2 (SGLT2) inhibitor use and the risk of tumor development and survival outcomes in patients with type 2 diabetes.

Methods: This retrospective cohort study included 350 patients with type 2 diabetes treated at our institution between January 2021 and January 2025. Patients were categorized into an observation group (n = 189) receiving SGLT2 inhibitors and a control group (n = 161) treated with other antidiabetic medications. Clinical characteristics, glycemic control, cumulative drug exposure, and tumor incidence (lung, colorectal, prostate, breast, bladder, and hepatic cancers) were analyzed. Kaplan-Meier methods were used to evaluate cancer incidence and mortality outcomes.

Results: Overall tumor incidence was significantly lower in the SGLT2 inhibitor group than in the control group (P < 0.001), mainly due to reduced lung (P = 0.018) and ovarian cancers (P = 0.017). Smoking, alcohol consumption, and poor glycemic control were associated with higher overall and site-specific tumor risks. The SGLT2 inhibitor group showed better metabolic profiles, with lower FBG, HbA1c, LDL, TC, TG, and higher HDL levels (all P < 0.05), as well as improved renal function indicated by lower BUN and creatinine and higher eGFR (all P < 0.001). Kaplan-Meier analysis demonstrated significantly longer progression-free and overall survival in the SGLT2 inhibitor group (both P < 0.01).

Conclusion: SGLT2 inhibitors reduced overall tumor risk, especially lung and ovarian cancers, and improved metabolic and survival outcomes in type 2 diabetes.

Purpose: This randomized controlled mixed methods pilot study evaluated the preliminary signal of effectiveness of a culturally tailored intervention embedded within a standard Diabetes Self-Management Education (DSME) program.

Patients and methods: Fourteen Black adults with uncontrolled diabetes (A1C ≥ 7.5) enrolled in the study. The study was conducted at a community center and over the phone within a US Midwestern State. All participants participated in a 6-week evidence-based DSME program, with a subset of participants (n=7) randomized to the intervention receiving additional education sessions and race-congruent phone-based peer support throughout the 6-month intervention. Changes in Hemoglobin A1c (A1C) (primary outcome) and self-reported medication adherence (secondary outcome), and other psychosocial outcomes (beliefs about diabetes, self-efficacy, diabetes empowerment, etc.) were assessed at 3 and 6 months using paired t-tests. Between-group differences were analyzed using the Mann-Whitney U-test and within-group differences were analyzed using Wilcoxon signed-rank test. Qualitative data on participant's perceived impact of the intervention on primary and secondary outcomes were collected through semi-structured interviews and analyzed to identify themes. Subsequently, a mixed methods analysis was conducted to compare quantitative and qualitative findings.

Results: At 6-months, A1C was statistically significantly lower in the intervention group (7.9% (SD =0.4; 95% CI [7.6-8.2]); n=7) compared to the control group (10.6% (SD =0.7; 95% CI [9.9-11.2]); p =0.01; d=0.73; n = 6). There were no significant between-group differences (p =0.22) in medication adherence between the 2 groups. Qualitative themes related to beliefs about medicines, diabetes distress, etc. were identified, and integrated with quantitative psychosocial outcomes further explaining the findings.

Conclusion: The findings suggest a signal of evidence for a future adequately powered, randomized controlled trial, testing whether the addition of the theory and evidence-informed culturally specific components of the intervention improve outcomes compared to the DSME program alone.

Objective: Managing diabetes daily can be an emotional burden for older adults. Research shows that self-compassion, which refers to the ability to be kind and understanding toward oneself, can help improve emotional well-being. This study aimed to develop a machine learning prediction model to identify the influencing factors of self-compassion among community-dwelling older adults with type 2 diabetes.

Methods: We conducted this study in Jiaxing, China, during July and August 2024. We invited community-dwelling older adults with type 2 diabetes to complete a questionnaire that measured their levels of self-compassion, depression, and anxiety. Our goal was to find which of 26 different personal and health-related factors most influenced self-compassion. To achieve this, we used several machine learning algorithms to build and compare predictive models, selecting the best-performing one. Finally, we applied a technique called SHapley Additive exPlanations (SHAP) to clearly understand and interpret how each factor impacts self-compassion.

Results: The random forest model performed the best. SHAP analysis indicated that depression, hemoglobin A1c (HbA1C), waist circumference, and anxiety were risk factors of self-compassion, while fasting blood-glucose (FBG) was a protective factor.

Conclusion: This study provides a reliable tool for identifying older adults with type 2 diabetes who may benefit from support. The findings suggest that healthcare providers should prioritize managing depression and anxiety, along with controlling HbA1c and waist circumference, to enhance self-compassion. These results can be translated into a practical risk scorecard to guide personalized care strategies in community health settings.

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.