Diabetes research and clinical practice最新文献

Aims: To evaluate the prevalence of cardiovascular-kidney-metabolic syndrome (CKM) and its association with cardiovascular disease (CVD) risk across CKM stages in a Middle Eastern population.

Methods: We analyzed data from 7,770 CVD-free adults aged 30-79 years. Multivariable Cox models assessed associations of CKM with incident CVD, coronary heart disease (CHD), myocardial infarction (MI), stroke, and CVD mortality. We also evaluated the impact of CKM stage transitions over approximately 3 years on cardiovascular endpoints.

Results: Baseline prevalence of CKM stages 0-3 was 11.2%, 12.0%, 72.8%, and 4.0%, respectively. Over a median 19.9 years of follow-up, 1,450 CVD events occurred, including 338 CVD deaths. Compared with stage 0, the HRs (95% CIs) for CVD were 2.03 (1.59-2.58) for stage 2 and 2.76 (2.05-3.73) for stage 3; similar associations were observed for CHD, stroke, and MI. For CVD mortality, stage 3 conferred a risk of 2.61 (1.53-4.45). Each 1-stage progression in CKM over ∼ 3 years was associated with 1.40-2.01 times significantly greater risk of endpoints, except for MI.

Conclusions: Nearly 77% of participants were classified in poor CKM stages (2-3), strongly associated with excess cardiovascular risk. These findings highlight the importance of early CKM detection and targeted interventions.

Aims: Type 1 diabetes is one of the most common chronic diseases in childhood and has a significant impact on children's quality of life. The aim of this study was to evaluate the factors affecting the quality of life and glycemic control of adolescents with type 1 diabetes.

Methods: This descriptive and cross-sectional study was conducted in pediatric endocrinology outpatient clinics of three hospitals in Turkey between January 2023 and January 2024. The descriptive information form, clinical data including blood glucose and glycated hemoglobin levels were obtained from medical records, and Pediatric Quality of Life Scale (PedsQL) were used as data collection tools.

Results: A total of 217 adolescents (average age = 14) participated in the study. The mean PedsQL total score was 43.8 ± 14.6. Scale scores were significantly affected by factors such as HbA1c level (p = 0.000), regular physical activity (p = 0.016), carbohydrate counting (p = 0.018), sharing diabetes with friends (p = 0.019), and education level (p = 0.008). Scale score was found to be lower in individuals with HbA1c ≥ 7.5.

Conclusion: The quality of life of adolescents with type 1 diabetes is affected by multidimensional factors, including not only glycemic control but also individual education, social support, and physical activity. Therefore, a holistic care model should be developed.

Aims: Lifestyle interventions induce remission in people with type 2 diabetes (T2D) and those with impaired glucose tolerance (IGT). We examined the long-term remission of IGT in the participants of the Finnish Diabetes Prevention Study and evaluated factors predicting remission during extended follow-up.

Methods: 505 participants were included in analyses. The median duration of lifestyle intervention was four years, and follow-up lasted up to 18 years. Remission was defined as normoglycaemia (fasting plasma glucose < 5.6 mmol/L, 2-h post-load glucose < 7.8 mmol/L, HbA1c < 39 mmol/mol). We examined predictors of remission (weight, fat distribution, physical activity, diet, and insulin sensitivity and insulin secretion based on repeated oral glucose tolerance tests).

Results: Remission rates were 32% at least once, 13%, 12%, and 11% at year 1, year 3, and the first post-intervention follow-up visit (median 5 years, range 4 - 8 years). Short-term predictors of remission included weight loss, reduction in waist circumference, higher intake of fibre and lower intake of saturated fats, physical activity, enhanced insulin sensitivity, and recovery of insulin secretion. In the longer term, only insulin secretory and sensitivity indices were associated with remission.

Conclusion: IGT may be normalised in the long term through weight loss and healthier lifestyles choices.

Aims: To investigate sex-related differences in the association of body fat distribution with hepatic insulin clearance (HIC) in type 2 diabetes mellitus (T2DM), determining whether HIC associates more strongly with static hepatic steatosis or visceral adiposity.

Methods: We retrospectively analyzed 234 inpatients with T2DM (146 men, 88 women). Regional and ectopic fat were quantified via deep-learning computed tomography (CT). HIC was derived from oral glucose tolerance tests. Multivariable regression and propensity score matching (PSM) identified independent HIC determinants.

Results: Men had larger visceral adipose tissue (VAT) areas; women had higher hepatic fat. VAT was independently associated with systemic insulin resistance. After adjusting for insulin resistance, VAT was positively associated with HIC in women (β = 0.395, P = 0.008), but not men (β = -0.047, P = 0.636). These patterns persisted in the PSM cohort (P for interaction = 0.025), even after additional adjustment for insulin resistance (P for interaction = 0.07). CT-assessed hepatic fat showed no independent association with HIC.

Conclusions: The association between visceral adiposity and HIC is sex-related, with preserved adaptation in women but not in men. Visceral adiposity is more strongly associated with clearance dynamics than static hepatic steatosis, improving the pathophysiological characterization of T2DM.

Objective: To identify independent risk factors for diabetic peripheral neuropathic pain (DPNP), construct a nomogram prediction model, and quantify the contribution of predictive factors using SHapley Additive exPlanations (SHAP) values.

Methods: This retrospective study of 500 type 2 diabetes patients diagnosed DPNP via the Michigan Neuropathy Screening Instrument and clinical evaluation. Predictors were selected using univariate analysis and LASSO regression, with independent risk factors identified by multivariate logistic regression. Nonlinear relationships were assessed using restricted cubic spline (RCS). The nomogram was evaluated using receiver operating characteristic (ROC) curves, precision-recall (PR) curves, calibration plots, and decision curve analysis (DCA). SHAP quantified factor importance.

Results: Seven independent risk factors were identified: age, diabetes duration, BMI, smoking history, fasting blood glucose, hyperlipidemia, and AST-highlighting metabolic parameters, especially AST, as key novel contributors. RCS revealed a nonlinear relationship for diabetes duration. The nomogram exhibited strong discrimination (AUCs: 0.863 training, 0.813 validation), good calibration, and strong clinical utility. SHAP confirmed diabetes duration as the most influential predictor.

Conclusions: This nomogram provides an interpretable tool for early DPNP risk prediction. By quantifying individual risk, it enables clinicians to identify high-risk patients and implement personalized preventive strategies, potentially improving outcomes.

We aimed to estimate the incidence for overall and individual components of diabetes-related foot disease (DFD), and explore potential heterogeneity across studies. We included patients with diabetes who were free of DFD from UK Biobank and Chongqing Diabetes Registry (CDR). We defined DFD according to the International Working Group on the Diabetic Foot 2023 criteria. We further performed meta-analyses by integrating results from the two cohorts and 64 cohorts identified from a systematic review of literature, and quantifying the extent of variation in reported incidence rates. The incidence of DFD was 12.81 (95 % confidence interval[CI]: 12.46-13.15) and 24.97 (21.38-28.99) per 1,000 person-year in UK Biobank and CDR, respectively. The pooled estimates were 19.84 (95 %CI: 16.58-23.10) for peripheral neuropathy, 7.32 (6.17-8.47) for foot ulcer, 2.56 (2.20-2.93) for lower-extremity amputation, 2.56 (1.08-4.04) for lower-extremity arterial disease, and 0.81 (0.00-1.74) for gangrene, respectively. Heterogeneity was high across studies (I² > 99 %). In conclusion, incidence for DFD exceeds 10 per 1,000 person-year among patients with diabetes, and peripheral neuropathy and foot ulcer are major contributors to incident DFD. These estimates should be interpreted as descriptive summaries of available evidence rather than a single universal incidence, and large heterogeneity underscores the context-specific nature of DFD occurrence.

Gestational Diabetes Mellitus (GDM) is a major public health problem. This study aimed to conduct a systematic review and meta-analysis to identify the factors associated with GDM in Low- and Middle-Income Countries (LMICs). Seven electronic databases (PubMed, CINAHL, PsycINFO, Scopus, EMBASE, CABI and Google Scholar) were systematically searched for eligible observational studies published in LMICs between 2015 and August 2025. Statistical heterogeneity was evaluated using the I² statistic, and a random-effects model was applied to calculate pooled estimates. The protocol was pre-registered on PROSPERO (CRD420251247717). Forty-seven studies met the inclusion criteria and contributed 116 factor-specific effect estimates. The pooled analysis demonstrated that several factors were significantly associated with increased risk of GDM. These included maternal age ≥ 30, multiparity, urban residence, pre-pregnancy obesity BMI ≥ 25 kg/m², family history of diabetes, history of gestational diabetes mellitus (GDM), pre-hypertension, preeclampsia, polycystic ovarian syndrome (PCOS) and physical inactivity. This study found that advanced maternal age, pre-pregnancy obesity, family history of diabetes, prior GDM, pre-hypertension, preeclampsia, and PCOS are key factors associated with GDM in LMICs. These findings highlight the need for prevention and screening strategies integrated within maternal pregnant health programs for many LMICs.

This retrospective study assessed barriers to CGM use among 100 adults with type 2 diabetes receiving endocrinology care. Patient preference was the most common reason for non-use (n = 47). Nearly half of patients had no CGM discussion documented (n = 42), and financial (n = 9) and phone compatibility (n = 2) barriers were less common.

Glycated hemoglobin (HbA1c) is a cornerstone of diabetes diagnosis and management. For most individuals, HbA1c remains reliable; however clinically significant discordance between HbA1c levels and actual blood glucose values occurs in defined subpopulations with specific confounding conditions (e.g., anemia, hemoglobinopathies, chronic kidney disease). This narrative review synthesizes current evidence on the multifactorial etiology and clinical consequences of HbA1c-glycemia mismatch. We highlight biological variability, hematological conditions, systemic diseases, and analytical factors that contribute to this discrepancy. The review emphasizes that recognizing these limitations is crucial to avoid clinical misjudgment, such as inappropriate treatment escalation or dangerous therapeutic inertia. We advocate for a systematic diagnostic approach when discordance is suspected, including evaluation for confounders and alternative biomarkers such as fructosamine, and critically, the integration of continuous glucose monitoring (CGM). When CGM is utilized, a comprehensive assessment of glycemic control should incorporate the full panel of consensus metrics- Time-in-Range (TIR), Time-Below-Range (TBR), Glycemic Variability (GV), and the Glucose Management Indicator (GMI). However, CGM systems have their own limitations, including inter-sensor variability and differences between device models, which must be considered when interpreting discordance. This review aims to equip clinicians with the knowledge to navigate HbA1c discordance, promoting personalized, safe, and equitable diabetes care.