Diabetes research and clinical practice最新文献_第10页

GLP-1 receptor agonist use during immune checkpoint inhibitor therapy is associated with mortality and Immune-Related adverse events across cancer types in People with type 2 Diabetes: A Target-Trial emulation 免疫检查点抑制剂治疗期间使用GLP-1受体激动剂与2型糖尿病患者不同癌症类型的死亡率和免疫相关不良事件相关：一项目标试验模拟

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 Epub Date: 2025-12-24 DOI: 10.1016/j.diabres.2025.113073

Shan-Ho Chan , Pei-Yun Li , Pin-Hung Li , Yu-Jung Lin , Wei-Hsun Wang , Yu-Nan Huang , Jia-Yuh Chen

Aims

To evaluate whether Glucagon-like peptide-1 receptor agonist (GLP-1 RA) use at immune checkpoint inhibitor (ICI) start is associated with mortality, healthcare use, and immune-related adverse events in adults with type 2 diabetes (T2D).

Methods

A target-trial emulation was conducted in the TriNetX US Collaborative Network among adults with cancer and T2D starting an ICI, with or without overlapping GLP-1 RA at ICI start. A new-user 1:1 propensity-score–matched, intention-to-treat design yielded 2,903 per group and 36-month follow-up. Primary endpoint was all-cause mortality; key secondaries were hospitalization, and composite immune-related adverse events (irAEs). Prespecified per-protocol, 90-day landmark, and semaglutide-only analyses assessed robustness.

Results

GLP-1 RA co-exposure was associated with lower mortality (hazard ratio [HR] 0.55, 95 % CI 0.51–0.61; 36-month absolute risk difference [ARD] − 16.41 %; number needed to treat [NNT] 5). Hospitalization (HR 0.76; ARD − 7.06 %; NNT 11), and composite irAEs (43.93 % vs 51.51 %; ARD − 7.58 %; NNT 11) were also lower. Diabetic-retinopathy progression (HR 1.75; ARD + 2.71 %) and non-arteritic anterior ischemic optic neuropathy (HR 1.51) were higher; hypoglycaemia, acute kidney injury, and dehydration/orthostatic hypotension were lower.

Conclusions

GLP-1 RA use during ICI therapy correlated with lower mortality, reduced acute care, fewer irAEs; ophthalmic signals warrant monitoring.

目的：评估在免疫检查点抑制剂（ICI）开始使用胰高血糖素样肽-1受体激动剂（GLP-1 RA）是否与成人2型糖尿病（T2D）患者的死亡率、医疗保健使用和免疫相关不良事件相关。方法：在TriNetX美国协作网络中对开始ICI的成人癌症和T2D患者，在ICI开始时是否有重叠的GLP-1 RA进行了靶试验模拟。新用户1:1倾向得分匹配，意向治疗设计每组产生2,903例，随访36个月。主要终点为全因死亡率；关键的次要因素是住院和复合免疫相关不良事件（irAEs）。预先指定的每个方案、90天里程碑和仅使用semaglutide的分析评估了鲁棒性。结果：GLP-1 RA共暴露与较低的死亡率相关（危险比[HR] 0.55, 95 % CI 0.51-0.61； 36个月绝对风险差[ARD] - 16.41 %；需要治疗的人数[NNT] 5）。住院率（HR 0.76; ARD - 7.06 %;NNT 11）和综合irae（43.93 % vs 51.51 %;ARD - 7.58 %;NNT 11）也较低。糖尿病视网膜病变进展（HR 1.75; ARD + 2.71 %）和非动脉前缺血性视神经病变（HR 1.51）较高；低血糖、急性肾损伤和脱水/直立性低血压的发生率较低。结论：在ICI治疗期间使用GLP-1 RA与较低的死亡率、减少的急性护理、较少的irae相关；眼科信号需要监测。

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引用次数: 0

Metabolic syndrome mediates the association between body roundness index and incident stroke risk in Chinese adults aged 45 years and older: Evidence from the CHARLS 代谢综合征介导45岁及以上中国成年人体圆度指数与卒中发生风险之间的关联：来自CHARLS的证据

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 Epub Date: 2025-12-10 DOI: 10.1016/j.diabres.2025.113050

Hongwei Liu , Gaiying Ma , Jing Shi , Minheng Zhang , Fei Xu , Miaomiao Hou

Background

The body roundness index (BRI) has been identified as a new way to measure visceral fat, yet its relationship with stroke and how metabolic syndrome (MetS) affects this relationship are still ambiguous.

Methods

The investigation employed CHARLS cohort data for prospective analysis. To analyze the connection between BRI and stroke, Cox proportional hazards models and restricted cubic spline analysis were employed. The analysis of mediation assessed the role of MetS and its individual components. The discriminative effectiveness of BRI/other anthropometric measures was assessed using receiver operating characteristic (ROC) curves.

Results

The association continued to be significant among participants without MetS (HR = 2.50, 95 %CI: 1.69–3.67; p < 0.001), unlike those with MetS (HR = 0.97, 95 %CI: 0.43–2.18; p < 0.935). In ROC analysis, BRI outperformed traditional indices in stroke discrimination, particularly in those without MetS (AUC = 0.660 compared to 0.638 with MetS). Metabolic components explained about 22 % of the BRI-stroke association, with blood pressure contributing 11 %. Although statistically significant, this mediation was modest, and other components were not individually significant, suggesting a limited indirect effect that should be interpreted cautiously.

Conclusion

In metabolically healthy individuals, BRI shows a moderate predictive value for stroke, partly mediated by blood pressure.

身体圆度指数（BRI）已被确定为一种测量内脏脂肪的新方法，但其与中风的关系以及代谢综合征（MetS）如何影响这种关系仍不清楚。方法采用CHARLS队列资料进行前瞻性分析。为了分析BRI与脑卒中之间的关系，采用了Cox比例风险模型和受限三次样条分析。中介分析评估了MetS及其各个组成部分的作用。采用受试者工作特征（ROC）曲线评估BRI/其他人体测量指标的判别有效性。结果在没有MetS的参与者中（HR = 2.50, 95% CI: 1.69-3.67; p < 0.001），与有MetS的参与者（HR = 0.97, 95% CI: 0.43-2.18; p < 0.935）不同。在ROC分析中，BRI在卒中识别方面优于传统指标，特别是在没有MetS的患者中（AUC = 0.660，而met患者为0.638）。代谢成分解释了大约22%的脑卒中相关性，血压占11%。虽然具有统计学意义，但这一中介作用并不显著，其他成分个别不显著，表明间接影响有限，应谨慎解释。结论在代谢健康的个体中，BRI对脑卒中具有中等预测价值，部分由血压介导。

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引用次数: 0

Kidney function decline mediates the adverse effects of arterial stiffness on all-cause and cardiovascular disease mortality in Cardiovascular-Kidney-Metabolic syndrome population: A cohort study 在心血管-肾脏-代谢综合征人群中，肾功能下降介导动脉僵硬对全因和心血管疾病死亡率的不良影响：一项队列研究

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 Epub Date: 2025-12-11 DOI: 10.1016/j.diabres.2025.113051

Song Liu , Qizhang Man , Shuan Wang , Yifeng Huang , Jinfeng Wen , Ying Yang , Hao Xie , Lei Fan

Aids

Cardiovascular-Kidney-Metabolic (CKM) syndrome links metabolic, renal, and cardiovascular disorders. The prognostic value and mechanisms of estimated pulse wave velocity (ePWV) in CKM syndrome remain unclear.

Methods

We analyzed 34,004 CKM syndrome patients from NHANES 1999–2018. Cox regression, restricted cubic splines, and mediation analyses examined ePWV-mortality associations and renal function’s mediating role.

Results

Over 104 months median follow-up, 4,141 all-cause and 1,261 cardiovascular deaths occurred. In fully adjusted model, each unit ePWV increase associated with 32 % higher all-cause mortality (HR: 1.32, 95 % CI: 1.29–1.35) and 34 % higher CVD mortality (HR: 1.34, 95 % CI: 1.28–1.40). The association showed L-shaped patterns in non-advanced CKM cases and linear relationships in advanced stages. Kidney function decline mediated 24 % of all-cause and 26 % of CVD mortality risk.

Conclusions.

Elevated ePWV predicts increased mortality in CKM syndrome patients, with kidney function decline as a significant mediating pathway. These findings highlight the importance of arterial stiffness assessment and renal protection in CKM management.

艾滋病：心血管-肾脏-代谢（CKM）综合征与代谢、肾脏和心血管疾病有关。估计脉波速度（ePWV）在CKM综合征中的预后价值和机制尚不清楚。方法：我们分析了NHANES 1999-2018年的34,004例CKM综合征患者。Cox回归、受限三次样条和中介分析检验了epwv死亡率关联和肾功能的中介作用。结果：在104 个月的中位随访中，发生了4141例全因死亡和1261例心血管死亡。在完全调整模型中，每单位ePWV增加，全因死亡率增加32% % (HR: 1.32, 95 % CI: 1.29-1.35)，心血管疾病死亡率增加34% % （HR: 1.34, 95 % CI: 1.28-1.40）。该关联在非晚期CKM病例中呈l形模式，在晚期呈线性关系。肾功能下降介导了24% %的全因死亡风险和26% %的CVD死亡风险。结论：ePWV升高预示CKM综合征患者死亡率增加，肾功能下降是一个重要的介导途径。这些发现强调了动脉硬度评估和肾脏保护在CKM管理中的重要性。

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引用次数: 0

Optimal age, duration of diabetes and frequency of screening for diabetic nephropathy in children and youths with type 1 Diabetes: A systematic review 儿童和青少年1型糖尿病患者的最佳年龄、糖尿病病程和糖尿病肾病筛查频率：一项系统综述

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 Epub Date: 2025-12-08 DOI: 10.1016/j.diabres.2025.113042

Stefano Passanisi , Claudia Piona , Valentina Mancioppi , Louise Puli , Kim C. Donaghue

Diabetic nephropathy (DN) is a major complication of type 1 diabetes (T1D) with lifelong health implications. This systematic review evaluated the optimal age, duration of diabetes, and frequency for DN screening in children and adolescents with T1D. A comprehensive literature search (1995–2024) across major databases identified 36 eligible studies, predominantly cross-sectional, encompassing 21,778 participants. Moderate albuminuria prevalence was 9.5 % overall, with most cases occurring after seven years of diabetes duration and in individuals older than 14 years, though rare cases were reported as early as 8.5 years and within two years of diagnosis. Severe albuminuria was less frequent (0.3–14.6 %), while end-stage kidney disease was rare, and no deaths were reported. Higher HbA1c levels (≥9%) were strongly associated with increased nephropathy risk, whereas limited data were available on blood pressure and other risk factors. No randomized trials or direct comparisons of screening strategies were identified, and heterogeneity in definitions and diagnostic methods limited evidence quality. Overall, findings support current international guidelines recommending screening from age 11 or puberty after 2–5 years of T1D duration, with intensified strategies potentially warranted for those with elevated HbA1 levels. High-quality, prospective studies are needed, especially in low- and middle-income countries.

糖尿病肾病（DN）是1型糖尿病（T1D）的主要并发症，具有终身健康影响。本系统综述评估了儿童和青少年T1D患者的最佳年龄、糖尿病病程和DN筛查频率。在主要数据库中进行了全面的文献检索（1995-2024），确定了36项符合条件的研究，主要是横断面研究，包括21,778名参与者。中度蛋白尿患病率总体为9.5% %，大多数病例发生在糖尿病持续7年后和年龄大于14 岁的个体中，尽管罕见病例早在8.5 岁和诊断后两年内报告。严重蛋白尿发生率较低（0.3-14.6 %），而终末期肾病罕见，无死亡报告。较高的HbA1c水平（≥9%）与肾病风险增加密切相关，而关于血压和其他危险因素的数据有限。没有发现随机试验或直接比较筛查策略，定义和诊断方法的异质性限制了证据质量。总的来说，研究结果支持目前的国际指南，建议从11岁或2-5 年T1D持续时间后的青春期筛查，对HbA1水平升高的患者可能需要强化策略。需要高质量的前瞻性研究，特别是在低收入和中等收入国家。

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引用次数: 0

Acute hypoglycemia attenuates serum matrix metalloproteinases and tissue inhibitors of metalloproteinases in type 2 diabetes 急性低血糖降低2型糖尿病患者血清基质金属蛋白酶和金属蛋白酶组织抑制剂。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 Epub Date: 2025-12-29 DOI: 10.1016/j.diabres.2025.113076

Abu Saleh Md Moin , Radwan Darwish , Thozhukat Sathyapalan , Stephen L. Atkin , Alexandra E. Butler

Background

Extracellular matrix (ECM) remodeling by matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) contributes to vascular complications in type 2 diabetes (T2D), but the impact of acute insulin-induced hypoglycemia on this axis is unclear.

Objective

Assess whether hypoglycemia alters circulating MMP/TIMP levels in T2D versus controls.

Methods

In a prospective study, 46 adults (23 T2D; 23 matched controls) underwent stepwise insulin to glucose ≤2.2 mmol/L. Eleven MMPs and three TIMPs were measured at baseline, during hypoglycemia, and up to 24 h post-recovery.

Results

At baseline, T2D had higher MMP1, MMP7, MMP9, and TIMP1/3. During hypoglycemia, controls showed a transient MMP1 rise with post-recovery decline. In T2D, MMP8 increased from 1–24 h and exceeded controls at 1–4 h. MMP2 fell early then rebounded at 4 h. MMP3 rose at 4 h in both groups and persisted to 24 h in T2D. MMP9 remained elevated in T2D, decreasing only at 24 h. TIMP3 declined during recovery in controls but stayed elevated in T2D; TIMP1/2 were unchanged.

Conclusion

Acute hypoglycemia induces subtype-specific, time-dependent MMP–TIMP shifts. T2D shows amplified, prolonged responses—especially MMP8, MMP3, and MMP9—with insufficient TIMP buffering, suggesting a proteolytic milieu that may impair ECM integrity and vascular stability.

背景：基质金属蛋白酶（MMPs）及其抑制剂（TIMPs）的ECM重塑有助于2型糖尿病（T2D）的血管并发症，但急性胰岛素诱导的低血糖对该轴的影响尚不清楚。目的：评估低血糖是否会改变t2dm患者与对照组的循环MMP/TIMP水平。方法：在一项前瞻性研究中，46名成年人（23名T2D患者，23名对照组）接受胰岛素降糖≤2.2 mmol/L逐步治疗。在基线、低血糖期间和恢复后24 h测量11个MMPs和3个TIMPs。结果：在基线时，T2D的MMP1、MMP7、MMP9和TIMP1/3较高。在低血糖期间，对照组显示短暂的MMP1升高，恢复后下降。在T2D中，MMP8从1-24 h增加，并在1-4 h超过对照组。MMP2早盘下跌后反弹至4 h。两组的MMP3均在4 h升高，T2D时持续到24 h。MMP9在T2D中保持升高，仅在24 h时下降。TIMP3在对照组恢复期间下降，但在T2D时保持升高；TIMP1/2不变。结论：急性低血糖可诱导亚型特异性、时间依赖性的MMP-TIMP移位。T2D表现出放大、延长的反应，尤其是MMP8、MMP3和mmp9， TIMP缓冲不足，提示蛋白水解环境可能损害ECM完整性和血管稳定性。

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引用次数: 0

Weight loss from glucagon-like peptide-1 receptor agonists by genetic factors in adults with type 2 diabetes 2型糖尿病成人患者胰高血糖素样肽-1受体激动剂所致体重减轻的遗传因素

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 Epub Date: 2025-12-03 DOI: 10.1016/j.diabres.2025.113041

Yulu Zheng , Zheng Guo , Eugene Jeong , Shuai Xu , Jason M. Samuels , Ghadeer K Dawwas , Ran Tao , Gitanjali Srivastava , You Chen , Danxia Yu

Aims

To identify whether genetic predisposition to obesity influences the weight loss effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) among adults with type 2 diabetes (T2D).

Methods

This study evaluated 52-week weight loss trajectories. Genetic exposures comprised: 1) a BMI polygenic risk score (PRS) incorporating 935,416 single-nucleotide polymorphisms (SNPs) and stratified into low (bottom 20 %), intermediate (middle 60 %), and high (top 20 %) categories; and 2) five major genetic variants for BMI PRS. Linear mixed models were applied to assess the associations between genetic factors and weight loss percentage, and the interaction effect between genetic factors and follow-up time was further considered.

Results

Among the 1,055 included adults (mean age 59 ± 11 years, 55 % female), intermediate and high BMI PRS groups were modestly associated with less weight loss over 52 weeks (0.7 % and 1.5 %, P = 0.0017 and 0.0023, respectively) than the low BMI PRS group. Individual SNPs showed no significant association with weight loss. BMI PRS modified response over time—intermediate PRS showed less early weight loss, whereas high PRS showed less late weight loss; several genotypes also showed significant time-varying effects.

Conclusions

BMI PRS could potentially be used to personalize obesity management with GLP-1RAs. Large-scale, multi-ancestry studies are needed to validate the application.

目的探讨肥胖遗传易感性是否会影响2型糖尿病（T2D）患者使用胰高血糖素样肽-1受体激动剂（GLP-1RAs）的减肥效果。方法本研究评估了52周的减肥轨迹。遗传暴露包括：1)BMI多基因风险评分（PRS），包含935,416个单核苷酸多态性（snp），并分为低（最低20%）、中（中间60%）和高（最高20%）三类；2) BMI PRS的5个主要基因变异。采用线性混合模型评估遗传因素与减重率之间的关系，并进一步考虑遗传因素与随访时间之间的交互作用。结果在1055名纳入的成年人（平均年龄59±11岁，55%为女性）中，与低BMI PRS组相比，中等和高BMI PRS组在52周内的体重减轻较少（分别为0.7%和1.5%，P分别= 0.0017和0.0023）。单个snp与体重减轻没有显著关联。随着时间的推移，BMI - PRS改善了反应-中间PRS显示较低的早期体重减轻，而高PRS显示较低的晚期体重减轻；几个基因型也表现出显著的时变效应。结论bmi PRS可用于GLP-1RAs的个体化肥胖管理。需要大规模、多祖先的研究来验证这一应用。

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引用次数: 0

Major adverse cardiovascular and limb events caused by tirzepatide in patients with type 2 diabetes at high cardiovascular risk: A comparison with sitagliptin 替西帕肽对高危2型糖尿病患者的主要心血管和肢体不良事件：与西格列汀的比较

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 Epub Date: 2025-12-23 DOI: 10.1016/j.diabres.2025.113072

Yoshihiro Iwasaki , Takenobu Shimada , Takefumi Kishimori , Takao Kato , Jumpei Koike , Takehiro Matsumoto , Takafumi Yagi , Masaharu Okada

Aims

To elucidate the overall protective effects of tirzepatide against atherosclerosis-related events, including cardiovascular and lower-extremity events.

Methods

We conducted a retrospective cohort study using the TriNetX global health research network to identify patients with type 2 diabetes (T2D) who initiated tirzepatide or sitagliptin between January 2022 and December 2023. The primary outcome was major adverse cardiovascular and limb events (MACLE), defined as the composite of major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, and stroke) and major adverse limb events (MALE: all-cause death and major lower extremity amputation). Propensity score matching was applied.

Results

After matching, 31,751 patients per group were analyzed. At 1 year, the incidence of MACLE was lower with tirzepatide compared to that with sitagliptin (4.3 % vs. 6.1 %; hazard ratio (HR), 0.70; 95 % confidence interval (CI), 0.66–0.76; p < 0.001). Tirzepatide was also associated with a reduced risk of MACE (HR, 0.71; 95 % CI, 0.66–0.76), MALE (HR, 0.39; 95 % CI, 0.34–0.46), and major lower extremity amputation (HR, 0.61; 95 % CI, 0.44–0.84). Consistent benefits were observed across major subgroups.

Conclusions

Tirzepatide was associated with a significantly lower risk of cardiovascular and limb events compared to sitagliptin in patients with T2D.

目的：阐明替西肽对动脉粥样硬化相关事件的总体保护作用，包括心血管和下肢事件。方法：我们使用TriNetX全球健康研究网络进行了一项回顾性队列研究，以确定在2022年1月至2023年12月期间开始使用替西帕肽或西格列汀的2型糖尿病（T2D）患者。主要终点为主要心血管和肢体不良事件（MACLE），定义为主要心血管不良事件（MACE：全因死亡、心肌梗死和卒中）和主要肢体不良事件（MALE：全因死亡和主要下肢截肢）的组合。采用倾向评分匹配。结果：配对后，每组共分析31751例患者。在1 年时，替西帕肽的MACLE发生率低于西格列汀(4.3 % vs 6.1 %；风险比（HR） 0.70；95 %置信区间（CI）， 0.66-0.76；p 结论：与西格列汀相比，替西帕肽与T2D患者心血管和肢体事件的风险显著降低相关。

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引用次数: 0

Disease management, outcomes, and healthcare resource utilization in real-life clinical practice of diabetes and diabetic kidney disease in Finland 芬兰糖尿病和糖尿病肾病临床实践中的疾病管理、结果和医疗资源利用

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 Epub Date: 2025-12-21 DOI: 10.1016/j.diabres.2025.113067

Merja K. Laine , Mervi Haapala , Kristiina Uusi-Rauva , Juhani Aakko , Markku Pentikäinen , Kirsi Mikkola , Nami Halonen , Kari Pulkki , Niina Säävuori , Per-Henrik Groop , Kaj Metsärinne

Aims

A significant number of individuals with diabetes have chronic kidney disease (CKD). Delays in diagnosis and management of CKD hinder treatment initiation and worsen outcomes. The adherence to monitoring and pharmacological treatments is poorly characterized worldwide.

Methods

We determined the prevalence, outcomes, treatment adherence, and healthcare resource utilization in individuals with type 1 (T1D) or type 2 (T2D) diabetes managed since 2008 in Finland. The management of CKD, glucose monitoring, and outcomes by SGLT-2 inhibitor (SGLT-2i) discontinuation were determined in large subpopulations.

Results

The prevalence of diabetes was 9.9 % in 2021. Despite having averaged 40–50 healthcare contacts per year, only one-third completed the recommended annual urine albumin-creatinine ratio (UACR) test. Factors positively associated with UACR test adherence included older age, male sex, T2D, higher HbA_1c values, municipality, and calendar year. In T1D, 29 %, and in T2D, 75 % had HbA_1c ≤ 53 mmol/mol. SGLT-2i was prescribed to 19 % of individuals with diabetes but one-third discontinued within a year, accompanied by a trend towards increased occurrence of kidney complications and heart failure.

Conclusions

Individuals with diabetes remain neglected for albuminuria screening, pharmacological management of complications, and also glycemic control in T1D, underlining an urgent need for improved awareness and risk management.

目的：相当数量的糖尿病患者患有慢性肾脏疾病（CKD）。CKD诊断和管理的延误阻碍了治疗的开始，并使结果恶化。在世界范围内，对监测和药物治疗的依从性很差。方法：我们确定了芬兰自2008年以来管理的1型（T1D）或2型（T2D）糖尿病患者的患病率、结局、治疗依从性和医疗资源利用率。CKD的管理、血糖监测和SGLT-2抑制剂（SGLT-2i）停药的结果在大亚群中确定。结果：2021年糖尿病患病率为9.9% %。尽管每年平均有40-50个医疗保健联系，但只有三分之一的人完成了推荐的年度尿白蛋白-肌酐比率（UACR）测试。与UACR测试依从性呈正相关的因素包括年龄较大、男性、T2D、较高的HbA1c值、城市和日历年。在T1D中，29 %，在T2D中，75 %的HbA1c ≤ 53 mmol/mol。SGLT-2i被用于19. %的糖尿病患者，但三分之一的患者在一年内停用，并伴有肾脏并发症和心力衰竭发生率增加的趋势。结论：糖尿病患者在T1D患者的蛋白尿筛查、并发症的药理管理和血糖控制方面仍然被忽视，这表明迫切需要提高认识和风险管理。

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引用次数: 0

Effect of early healthcare visits on cardiovascular disease risk in people with newly screened diabetes: emulating a target trial using a large insurance database 早期医疗保健访问对新筛查糖尿病患者心血管疾病风险的影响：使用大型保险数据库模拟目标试验

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 Epub Date: 2025-11-23 DOI: 10.1016/j.diabres.2025.113020

Kiyomitsu Fukaguchi , Tomohiro Shinozaki , Zui C. Narita , Atsushi Goto

Aims

To determine whether healthcare visits within one year after diabetes identification lower 10-year cardiovascular disease (CVD) risk compared with no visits.

Methods

We emulated a target trial in the nationwide JMDC Claims Database (>12 million Japanese beneficiaries). Adults aged 40–74 years with newly identified diabetes (HbA1c ≥ 6.5 % [48 mmol/mol] or fasting glucose ≥126 mg/dL) during annual health checkups between 1 January 2005 and 31 March 2021 and no prior history of CVD were assigned to an early-visit group (≥1 outpatient visit within one year) or a no-visit group. Weighted pooled logistic regression estimated 10-year risk differences and risk ratios for a composite CVD outcome.

Results

Among 148,288 participants (mean age 53 years; 77 % men; 421,466 person-years), 1,741 CVD events occurred. Early visits were associated with a lower 10-year composite CVD risk compared to no visits (risk difference –3.4 percentage points [95 % CI –6.2 to –1.4]; risk ratio 0.73 [95 % CI 0.59 to 0.87]). Subgroup analyses confirmed consistent results across various characteristics.

Conclusions

Early healthcare visits within one year of diabetes identification were associated with a lower 10-year CVD risk. Health systems should facilitate early follow-up after screening to translate early detection into cardiovascular benefit.

目的：确定糖尿病确诊后一年内就诊与未就诊相比是否能降低10年心血管疾病（CVD）风险。方法：我们在全国JMDC索赔数据库（1,200万日本受益人）中模拟了一项目标试验。在2005年1月1日至2021年3月31日期间进行的年度健康检查中，年龄40-74岁 岁的新发现糖尿病（HbA1c ≥ 6.5 %[48 mmol/mol]或空腹血糖≥126 mg/dL）的成年人被分配到早期就诊组（一年内≥1次门诊就诊）或未就诊组。加权合并逻辑回归估计复合心血管疾病结局的10年风险差异和风险比。结果：在148,288名参与者中（平均年龄53 岁；77%为男性；421,466人年），发生了1,741例CVD事件。与没有就诊相比，早期就诊与较低的10年综合心血管疾病风险相关（风险差异为-3.4个百分点[95 % CI -6.2至-1.4]；风险比为0.73[95 % CI 0.59至0.87]）。亚组分析证实了不同特征的一致结果。结论：糖尿病患者1年内的早期就诊与10年心血管疾病风险降低相关。卫生系统应促进筛查后的早期随访，将早期发现转化为心血管益处。

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引用次数: 0

National and regional burden of early-onset type 2 diabetes mellitus in the Americas from 1990 to 2023, attributable to modifiable risk factors, and projections to 2050: a systematic analysis for the global burden of disease study 2023 1990年至2023年美洲早发性2型糖尿病的国家和区域负担，归因于可改变的风险因素，以及到2050年的预测：2023年全球疾病负担研究的系统分析

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 Epub Date: 2025-11-24 DOI: 10.1016/j.diabres.2025.113007

Zihao Liu , Xuanyi Li , Li Liang , Wei Cheng , Liying Zhao

Aims

This study aims to estimate the burden of early-onset type 2 diabetes mellitus (T2DM) attributable to modifiable risk factors (MRFs) in the Americas from 1990 to 2050.

Methods

We used data from the Global Burden of Disease Study 2023 to analyze mortality and disability-adjusted life years (DALYs) from early-onset T2DM due to MRFs in people aged 25–39 years. We calculated age-standardized rates, analyzed trends using Joinpoint regression, assessed health inequalities using the slope and concentration indices, and projected outcomes using a Bayesian age-period-cohort model.

Results

In 2023, Central Latin America recorded the highest age-standardized rates, while high-income regions reported the lowest rates. From 1990 to 2023, the age-standardized DALY rate exhibited an upward trend in Andean Latin America and High-income North America. Health inequality analysis revealed a slight concentration of the burden towards lower socioeconomic groups. Projections forecast a continued rise in absolute deaths and DALYs through 2050. Males consistently bore a higher burden than females across all regions.

Conclusion

Between 1990 and 2023, the burden of early-onset T2DM attributable to MRFs varied widely across the Americas, and, although health inequality improved in some regions, the overall burden is projected to increase through 2050.

目的：本研究旨在评估1990年至2050年美洲由可改变危险因素（mrf）引起的早发型2型糖尿病（T2DM）负担。方法：我们使用来自2023年全球疾病负担研究的数据，分析25-39岁人群中MRFs引起的早发性T2DM的死亡率和残疾调整生命年（DALYs）。我们计算了年龄标准化率，使用Joinpoint回归分析了趋势，使用斜率和浓度指数评估了健康不平等，并使用贝叶斯年龄-时期-队列模型预测了结果。结果2023年，拉美中部的年龄标准化率最高，而高收入地区的年龄标准化率最低。从1990年到2023年，安第斯拉丁美洲和高收入北美的年龄标准化DALY率呈上升趋势。健康不平等分析显示，负担略微向社会经济地位较低的群体集中。预测显示，到2050年，绝对死亡人数和伤残调整生命年将继续上升。在所有区域，男性的负担始终高于女性。结论：1990年至2023年间，美洲地区由mrf引起的早发型2型糖尿病负担差异很大，尽管某些地区的健康不平等有所改善，但预计到2050年，总体负担将增加。

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引用次数: 0