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

Purpose: We investigated the association of central obesity and glucose metabolism with thyroid nodule (TN) risk and explored whether diabetes/central obesity altered TN risk.

Methods: Data were collected in the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal study, which involved cross-sectional (May-August 2011) and longitudinal cohorts (July-October 2014; 3.2-year follow-up). In all, 8995 subjects were enrolled in the baseline survey; the 5655 subjects evaluated during the 3.2-year follow-up were included in this study. All subjects underwent body measurements, laboratory tests, and thyroid ultrasonography.

Results: Among 5655 participants, 420 had TNs. Participants with central obesity or abnormal glucose metabolism had significantly higher TN risk than participants without central obesity (OR: 1.233; 95% CI: 1.009-1.507) or abnormal glucose metabolism (OR: 1.257; 95% CI: 1.025-1.541). After adjustments for age and sex, this significance was retained for central obesity. Among participants with central obesity, prediabetes (OR: 1.483, 95% CI: 1.016-2.163) and diabetes (OR: 1.622, 95% CI: 1.078-2.407) were associated with TNs, when compared to the euglycemic subgroup (P trend = 0.040). No similar result was observed among participants without central obesity. During follow-up, the incidence rate ratio (IRR) for TNs was 1.026 (95% CI: 1.006-1.050) among those with new-onset central obesity and 1.025 (95% CI: 1.006-1.049) among those with chronic central obesity, as compared with those without central obesity. No significant associations were found among groups based on dynamic changes in glucose metabolism. Only in the chronic central obesity subgroup, new-onset prediabetes (IRR: 1.092, 95% CI: 1.020-1.169) and diabetes (IRR: 1.103, 95% CI: 1.031-1.189) significantly increased TN risk, as compared with euglycemia.

Conclusion: TNs are associated with central obesity and abnormal glucose metabolism. Chronic/new-onset central obesity increased TN risk. New-onset prediabetes/diabetes amplified TN risk among people with chronic central obesity.

Objective: To conduct a systematic, multi-dimensional clinical evaluation of five long-acting glucagon-like peptide-1 receptor agonists (GLP-1RAs) available in China, providing evidence-based guidance for clinical preference and institutional formulary selection.

Methods: This study was structured according to the "A Quick Guideline for Drug Evaluation and Selection in Chinese Medical Institutions. (Second Edition)" and the "Guidelines for the Workflow of Clinical Comprehensive Evaluation of Drugs" We constructed a quantitative evaluation system encompassing six core dimensions: efficacy, safety, economy, innovation, suitability, and accessibility. Indicator weights were determined via a Delphi expert consultation process. Dulaglutide, semaglutide, polyethylene glycol loxenatide, tirzepatide, and mazdutide were evaluated using a 100-point scoring system based on drug labels, systematic literature review, and real-world data.

Results: The comprehensive scores were as follows: semaglutide (76.6), dulaglutide (72.6), polyethylene glycol loxenatide (64.8), tirzepatide (62.9), and mazdutide (55.1). Semaglutide and dulaglutide, classified as Strong Recommendations, demonstrated superior efficacy (particularly in cardio-renal protection) and overall value. Tirzepatide and polyethylene glycol loxenatide were Conditionally Recommended; the former shows outstanding potential for glycaemic control and weight loss but is limited by cost, while the latter offers advantages in accessibility and economy but lacks high-level cardiovascular outcome evidence. Mazdutide is Not Recommended currently due to insufficient evidence, absence from the national reimbursement drug list, and high cost.

Conclusion: This evaluation identifies semaglutide and dulaglutide as the preferred long-acting GLP-1RAs in China's current therapeutic landscape. The standardized, transparent six-dimensional framework provides a replicable methodology for the comprehensive assessment of chronic disease therapies, supporting rational drug selection and resource allocation.

Purpose: This study examines how disease-related knowledge is associated with comorbidities, metabolic and anthropometric indicators, and dietary patterns in individuals with Type 2 diabetes.

Methods: This cross-sectional study included 184 adults with Type 2 diabetes. Data were collected using sociodemographic questionnaires, the Diabetes Knowledge Scale for Adults, and a food frequency questionnaire. Anthropometric and biochemical data were also obtained. Participants were grouped by median knowledge score (low or high). Mann-Whitney U and chi-square tests were used to analyze the data. Structural equation modeling (SEM) was used to model the effect of disease knowledge on health indicators.

Results: Participants with higher knowledge had lower total cholesterol, triglycerides, body weight, BMI, and neck circumference, and demonstrated better dietary compliance (p < 0.05). Retinopathy was more common in the high-knowledge group, while hypertension was more prevalent in the low-knowledge group (p=0.037 and p=0.002, respectively). SEM analysis revealed a weak yet directional relationship between knowledge level and health indicators.

Conclusion: The level of knowledge about the disease positively affects specific metabolic and behavioral indicators. Therefore, educational programmes aimed at increasing patients' knowledge and supporting behavioural change should be developed and implemented at the primary care level.

Background: Obesity is a major and escalating public health challenge worldwide. Growing evidence implicates environmental chemicals, especially organophosphate flame retardants (OFRs) and per- and polyfluoroalkyl substances (PFAS), as potential obesogens due to their ability to disrupt endocrine function and lipid metabolism. However, data on the association between these chemical mixtures and overweight in Chinese populations-particularly in industrialized regions-are scarce, representing a critical knowledge gap.

Methods: We conducted a matched case-control study of 214 adults from northern China, including 107 overweight individuals (body mass index [BMI] ≥ 24 kg/m²) and 107 normal-weight controls (BMI < 24 kg/m²), pair-matched by age and sex. Using high-resolution liquid chromatography-tandem mass spectrometry (LC-MS/MS), we quantified serum concentrations of 202 environmental exposures. Multivariable logistic regression, Weighted Quantile Sum (WQS) regression, and Bayesian Kernel Machine Regression (BKMR) models were employed to assess individual and cumulative associations with overweight, adjusting for key metabolic covariates (eg, blood pressure, lipids, and fasting glucose).

Results: Thirteen chemicals showed significant differences between groups (|log₂ fold change| ≥ 1). Ten were elevated in the overweight group, most notably tris(2-butoxyethyl) phosphate (TBOEP; adjusted odds ratio [OR] = 2.40, 95% confidence interval [CI]: 1.79-3.33), 1,3,5-triazine-2,4,6-trione tris(2,3-dibromopropyl) ester (TBC), perfluorooctanoic acid (PFOA), and perfluorobutane sulfonic acid (PFBS). The WQS index reflecting the combined effect of these 13 chemicals was strongly associated with higher odds of overweight (OR = 2.33, 95% CI: 1.77-3.07). BKMR analysis further revealed a non-linear cumulative exposure-response relationship, with maximal risk observed at moderate exposure levels.

Conclusion: This study provides robust epidemiological evidence that circulating levels of specific environmental pollutants-particularly TBOEP, PFOA, PFBS, and TBC-are significantly associated with increased likelihood of overweight in a northern Chinese adult population. Our findings highlight the potential contribution of complex chemical mixtures to obesity etiology in rapidly industrializing settings and underscore the need for targeted environmental health interventions.

Background: Diabetes health literacy is a critical determinant of a patient's ability to effectively self-manage the condition, and its accurate assessment is paramount for developing targeted interventions. This study aims to translate and validate the reliability and validity of the Chinese version of the Diabetes Health Literacy Scale (DHLS) among Chinese patients with type 2 diabetes mellitus based on factor analysis and item response theory (IRT) models.

Methods: The cross-sectional study was conducted among 251 adult patients with type 2 diabetes mellitus admitted to a tertiary hospital in Wuhu City. The 14-item DHLS was administered to all participants. Reliability was evaluated using Cronbach's alpha. The three-factor structure of the scale was assessed through both exploratory and confirmatory factor analysis (EFA/CFA). Furthermore, the Graded Response Model from IRT was employed to analyze item discrimination, difficulty parameters, and the scale information function.

Results: The Chinese version of the DHLS demonstrated excellent overall reliability (Cronbach's alpha = 0.938). Both EFA and CFA strongly supported the original three-factor structure (informational, computational, and communicative literacy). Convergent validity was satisfactory, with all subscales achieving the average variance extracted (AVE) > 0.50, and composite reliability values > 0.70. Discriminant validity was also confirmed, as the square roots of the AVE for each subscale exceeded the inter-construct correlations. IRT analysis confirmed that all 14 items had satisfactory discrimination parameters and exhibited monotonic increasing difficulty patterns. Importantly, the total information curve revealed that the scale provides the most precise measurement for individuals with moderate levels of health literacy.

Conclusion: The Chinese version of the DHLS is a valid and reliable instrument with robust psychometric properties. Its application can facilitate the development of targeted interventions, ultimately improving diabetes management outcomes.

Background: Obesity is a global epidemic, with rising prevalence rates in both developed and developing countries. In Saudi Arabia, the prevalence exceeds the global average, reaching 35%, and is associated with increased morbidity and mortality. This study explores changes in quality of life (QoL) following laparoscopic sleeve gastrectomy (LSG) among adults in the Aseer region, an area previously unexamined in this context.

Methods: A retrospective study was conducted involving patients who underwent LSG in Abha between January 2018 and December 2023. The study included 385 participants, selected from an initial pool of 450 after excluding individuals with incomplete data. QoL was assessed using the RAND 36-Item Health Survey, which evaluates various domains such as physical functioning, emotional well-being, and general health perception.

Results: Postoperative assessments revealed significant improvements in QoL, with patients reporting enhanced physical and emotional health. Mean scores demonstrated notable gains, particularly in energy/fatigue and emotional well-being domains. A substantial majority (79%) expressed satisfaction with their weight loss outcomes. Furthermore, many participants experienced significant improvements in obesity-related comorbidities, including diabetes and gastroesophageal reflux disease. Statistical analyses identified key predictors of patient satisfaction, such as age, education level, and income.

Conclusion: This study confirms the effectiveness of LSG as a viable intervention for obesity management in the Aseer region, leading to improved health-related quality of life. It underscores the importance of a comprehensive approach to obesity treatment that combines surgical intervention with ongoing lifestyle support. Future research should focus on long-term outcomes and the psychological aspects of post-bariatric surgery to optimize patient care. Overall, this study provides valuable insights into obesity management and QoL enhancement following surgery in Saudi Arabia.

Objective: Early and delayed menarche are associated with increased cardiovascular disease (CVD) risk in the general population, but data are limited in type 1 diabetes (T1D). We thus examined the relationship between menarche age and CVD risk in women with childhood-onset T1D, representing the first study to evaluate the association between menarche timing and macrovascular disease risk in this population.

Methods: Female participants from the Pittsburgh Epidemiology of Diabetes Complications (EDC) prospective cohort study were categorized by menarche age: early (≤12 years), normal (13-15 years), or delayed (≥16 years). Coronary artery disease (CAD) and major adverse cardiovascular events (MACE) were ascertained through clinical examination and surveys. Cox regression models were constructed to assess the relationship between menarche age and each outcome.

Results: At baseline, 320 participants were free of CAD and 319 were free of MACE (mean age, 27.8 years; T1D duration, 19.3 years; and median menarche age, 13 years). During 30 years of follow-up, 37.2% developed CAD and 31.3% MACE. A weak, non-significant, U-shaped pattern was observed between menarche age and both outcomes. In multivariable Cox models, compared with normal menarche, early menarche was significantly associated only with higher CAD risk (HR =1.71, 95% CI: 1.11-2.64); no other significant associations were observed.

Conclusion: Among women with childhood-onset T1D, early menarche is associated with increased CAD risk.

Objective: The comorbidity of type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) represents a significant public health challenge. We quantified the mediating role of the coronary fat attenuation index (FAI) in the association between the triglyceride-glucose (TyG) index and OSA risk, characterizing its nonlinear dynamics.

Methods: In this retrospective cross-sectional study, we assessed OSA risk using the STOP-Bang questionnaire in 420 patients with T2DM undergoing coronary computed tomography angiography, classifying scores as low-risk (<3), intermediate-risk (3-4), or high-risk (≥5). We measured pericoronary adipose tissue (PCAT)-FAI in three major epicardial coronary arteries (the right coronary artery, the left anterior descending artery, and the left circumflex artery) and in the culprit vessels. The TyG index was calculated using: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Statistical associations were evaluated using multivariable logistic regression, restricted cubic splines (RCS), and PROCESS macro-mediated analyses.

Results: PCAT-FAI was significantly elevated in LAD, LCX, RCA, and culprit vessels in patients at intermediate or high OSA risk versus the low-risk group (all p < 0.05). After adjusting for age, sex, BMI, and medication, each 1-unit TyG increase conferred a 2.3-fold higher OSA risk (adjusted OR = 3.30, 95% CI [1.92, 5.67], p < 0.01). RCS revealed threshold effects: OSA risk increased nonlinearly when RCA-FAI exceeded -80 Hounsfield units (HU). RCA-FAI mediated 11.78% of the TyG index-OSA association (p = 0.03).

Conclusion: RCA-FAI partially mediates the impact of TyG on OSA severity through nonlinear pathways. These findings elucidate PCAT inflammation as a mechanistic link in T2DM-OSA comorbidity, supporting the use of RCA-FAI ≥ -80 HU screening for precision risk stratification.

Continuous Glucose Monitoring (CGM) has transformed diabetes management by providing real-time glucose data, improving glycemic control, and potentially influencing patient well-being. However, the extent to which CGM affects health-related quality of life (HR-QoL) in individuals with type 2 diabetes mellitus (T2DM) remains unclear. This systematic review aimed to evaluate the effects of CGM on QoL and glycemic outcomes in adults with T2DM by comparing CGM use with conventional self-monitoring of blood glucose (SMBG). A systematic literature search was conducted in March 2025 across Scopus, MEDLINE, and EBSCO databases. Eligible studies included adult T2DM patients using CGM (flash or real-time), reported QoL and HbA1c outcomes, and provided a control group. Out of 1525 identified records, five studies met the inclusion criteria. CGM was consistently associated with greater HbA1c reduction than SMBG, with two studies reporting statistically significant improvements. However, most studies showed no significant difference in QoL between CGM and control groups, except for one study reporting psychological benefit. Methodological quality was moderate, with JADAD scores ranging from 2 to 3. In conclusion, CGM use in T2DM patients is associated with improved glycemic control and may provide psychological benefits, although its overall impact on QoL remains inconclusive. Further long-term studies using diabetes-specific QoL tools are needed to better understand the broader implications of CGM on patient-centered outcomes.

Purpose: Bone morphogenetic protein 9 (BMP9), a hepatokine belonging to the transforming growth factor-β (TGF-β) superfamily, plays a critical role in glucose and lipid metabolism. This study aimed to investigate the dynamic changes of BMP9 under metabolic stress in patients with different severities of non-alcoholic fatty liver disease (NAFLD), and to evaluate its associations with metabolic abnormalities and clinical diagnostic value.

Patients and methods: A total of 84 participants were enrolled and categorized into normal control (Con), mild, moderate, and severe NAFLD groups. Standardized oral fat tolerance tests (OFTT) were conducted to assess dynamic alterations in circulating BMP9 and related metabolic indices. Trend analysis, Spearman correlation, multivariate regression, and receiver operating characteristic (ROC) curve analyses were performed to explore the relationships between BMP9 and metabolic parameters as well as its diagnostic performance.

Results: Both fasting and postprandial BMP9 levels declined with increasing NAFLD severity, with a more pronounced reduction observed in the severe group (P < 0.05). In the severe NAFLD group, baseline BMP9 levels were reduced by 47.2%, and the time-integrated area under the concentration-time curve (AUC) was reduced by 52.7% compared with controls. The BMP9 AUC was negatively correlated with BMI, HOMA-IR, TG, and LDL-C, and positively correlated with HDL-C (all P < 0.05). Multivariate regression identified HOMA-IR and TG as independent predictors of lower BMP9 levels. Furthermore, ROC analysis demonstrated excellent diagnostic performance of BMP9 AUC in identifying moderate-to-severe NAFLD (ROC-AUC = 0.965).

Conclusion: BMP9 exhibits both basal deficiency and functional impairment in NAFLD and is closely associated with multiple metabolic abnormalities. Its dynamic profile may represent a promising early diagnostic biomarker for NAFLD and could potentially serve as a tool for metabolic disease screening and intervention.