Diabetes research and clinical practice最新文献_第2页

Exclusive association of non-HDL/HDL ratio with albuminuria in diabetes and its nonlinear pattern in advanced CKD: Findings from NHANES 2015-2020. 非高密度脂蛋白/高密度脂蛋白比率与糖尿病蛋白尿的独家关联及其在晚期CKD中的非线性模式：NHANES 2015-2020的发现

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-02-11 DOI: 10.1016/j.diabres.2026.113150

Xiaosu Ke

Objective: To investigate the diabetes-specific association between non-HDL/HDL cholesterol ratio (NHHR) and urinary albumin-to-creatinine ratio (UACR), and its nonlinear threshold effect in chronic kidney disease (CKD) stages.

Methods: This cross-sectional study included 10,613 U.S. adults(aged 20-70 years, estimated glomerular filtration rate ≥ 30 mL/min/1.73 m²) from NHANES 2015-2020. NHHR was calculated as the difference between total cholesterol and HDL-C divided by HDL-C. To explore the relationship between NHHR and UACR, a multivariable logistic regression model, smoothed curve fitting and subgroup analyses were employed.

Results: Each 1-unit NHHR increase elevated UACR by 4.46 mg/g overall(95% CI: 1.13-7.78, P = 0.009). Crucially, NHHR-UACR association wasexclusive to diabetics(β = 23.56 mg/g, 95% CI: 8.59-38.54, P < 0.001) with no significance in non-diabetics(P for interaction < 0.001). A nonlinear pattern emerged and intensified with declining renal function: Stage 1 showed a linear relationship(P = 0.426), Stage 2 demonstrated marginal nonlinearity(P = 0.031), and Stage 3 displayed a markedly nonlinear relationship(P < 0.001),characterized by an accelerated increase in UACR beyond an NHHR of approximately 3.5. Effect modification was significant by ethnicity (stronger in Non-Hispanic Blacks, P = 0.016) and sex(greater in females, P = 0.048).

Conclusion: NHHR associates with albuminuriaexclusively in diabetesand exhibits anonlinear pattern in CKD stage 3. These findings indicate diabetes-specific renal injury patterns and CKD stage-dependent pathophysiological mechanisms.

目的：探讨非高密度脂蛋白/高密度脂蛋白胆固醇比值（NHHR）与尿白蛋白/肌酐比值（UACR）在慢性肾脏疾病（CKD）分期中的相关性及其非线性阈值效应。方法：这项横断面研究纳入了来自NHANES 2015-2020的10,613名美国成年人（年龄20-70岁，肾小球滤过率 ≥ 30 mL/min/1.73 m2）。NHHR计算方法为总胆固醇与HDL-C之差除以HDL-C。为了探讨NHHR与UACR之间的关系，我们采用了多变量logistic回归模型、平滑曲线拟合和亚组分析。结果：每增加1单位NHHR，总UACR升高4.46 mg/g （95% CI: 1.13-7.78, P = 0.009）。关键是，NHHR- uacr的相关性仅存在于糖尿病患者（β = 23.56 mg/g, 95% CI: 8.59-38.54, P ）。结论：NHHR与蛋白尿的相关性仅存在于糖尿病患者，且在CKD 3期表现为非线性模式。这些发现表明糖尿病特异性肾损伤模式和CKD阶段依赖的病理生理机制。

{"title":"Exclusive association of non-HDL/HDL ratio with albuminuria in diabetes and its nonlinear pattern in advanced CKD: Findings from NHANES 2015-2020.","authors":"Xiaosu Ke","doi":"10.1016/j.diabres.2026.113150","DOIUrl":"https://doi.org/10.1016/j.diabres.2026.113150","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the diabetes-specific association between non-HDL/HDL cholesterol ratio (NHHR) and urinary albumin-to-creatinine ratio (UACR), and its nonlinear threshold effect in chronic kidney disease (CKD) stages.</p><p><strong>Methods: </strong>This cross-sectional study included 10,613 U.S. adults(aged 20-70 years, estimated glomerular filtration rate ≥ 30 mL/min/1.73 m<sup>2</sup>) from NHANES 2015-2020. NHHR was calculated as the difference between total cholesterol and HDL-C divided by HDL-C. To explore the relationship between NHHR and UACR, a multivariable logistic regression model, smoothed curve fitting and subgroup analyses were employed.</p><p><strong>Results: </strong>Each 1-unit NHHR increase elevated UACR by 4.46 mg/g overall(95% CI: 1.13-7.78, P = 0.009). Crucially, NHHR-UACR association wasexclusive to diabetics(β = 23.56 mg/g, 95% CI: 8.59-38.54, P < 0.001) with no significance in non-diabetics(P for interaction < 0.001). A nonlinear pattern emerged and intensified with declining renal function: Stage 1 showed a linear relationship(P = 0.426), Stage 2 demonstrated marginal nonlinearity(P = 0.031), and Stage 3 displayed a markedly nonlinear relationship(P < 0.001),characterized by an accelerated increase in UACR beyond an NHHR of approximately 3.5. Effect modification was significant by ethnicity (stronger in Non-Hispanic Blacks, P = 0.016) and sex(greater in females, P = 0.048).</p><p><strong>Conclusion: </strong>NHHR associates with albuminuriaexclusively in diabetesand exhibits anonlinear pattern in CKD stage 3. These findings indicate diabetes-specific renal injury patterns and CKD stage-dependent pathophysiological mechanisms.</p>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":" ","pages":"113150"},"PeriodicalIF":7.4,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146194390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Limitation of existing GFR estimating equations and application of artificial intelligence in improving GFR estimation and chronic kidney disease progression in people with diabetes. 现有GFR估算方程的局限性及人工智能在改善GFR估算和糖尿病患者慢性肾脏疾病进展中的应用

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-02-10 DOI: 10.1016/j.diabres.2026.113152

Digsu N Koye, Rodney Kwok, Yih-Chung Tham, Tina Zafari, Kartik Kishore, Elif I Ekinci

The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation is the most commonly used equation for estimating glomerular filtration rate (GFR) in clinical practice. However, recent studies have questioned the accuracy of this equation in estimating GFR in people with diabetes. We conducted a comprehensive review of existing literature on the role of artificial intelligence and machine learning in estimating GFR and the progression of chronic kidney disease (CKD), specifically in people with diabetes. Artificial intelligence, including machine learning and image-based deep learning algorithms have shown promise in improving the accuracy of GFR estimation. Artificial Neural Networks is the commonly used machine learning algorithm in GFR estimation studies. Other artificial intelligence methods include random forests, support vector machines, and ensemble learning models. Many of the studies included in this review reported that artificial intelligence-based GFR estimation equations exhibit lower bias, as well as higher precision and accuracy. However, these findings are not consistent across all the studies. In addition, currently available studies are limited to smaller sample sizes and majority of the studies are from selected countries or populations. Therefore, before implementing these methods in clinical practice, it is essential to validate them on larger sample sizes and diverse patient populations.

慢性肾脏疾病流行病学合作组织（CKD-EPI） 2009方程是临床实践中最常用的估算肾小球滤过率（GFR）的方程。然而，最近的研究质疑这个公式在估计糖尿病患者GFR时的准确性。我们对人工智能和机器学习在估计GFR和慢性肾脏疾病（CKD），特别是糖尿病患者的进展中的作用的现有文献进行了全面的回顾。人工智能，包括机器学习和基于图像的深度学习算法，在提高GFR估计的准确性方面显示出了希望。人工神经网络是GFR估计研究中常用的机器学习算法。其他人工智能方法包括随机森林、支持向量机和集成学习模型。本综述中包括的许多研究报告称，基于人工智能的GFR估计方程具有更低的偏差，以及更高的精度和准确性。然而，这些发现在所有研究中并不一致。此外，目前可获得的研究仅限于较小的样本量，大多数研究来自选定的国家或人口。因此，在临床实践中实施这些方法之前，有必要在更大的样本量和不同的患者群体上验证它们。

{"title":"Limitation of existing GFR estimating equations and application of artificial intelligence in improving GFR estimation and chronic kidney disease progression in people with diabetes.","authors":"Digsu N Koye, Rodney Kwok, Yih-Chung Tham, Tina Zafari, Kartik Kishore, Elif I Ekinci","doi":"10.1016/j.diabres.2026.113152","DOIUrl":"https://doi.org/10.1016/j.diabres.2026.113152","url":null,"abstract":"<p><p>The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation is the most commonly used equation for estimating glomerular filtration rate (GFR) in clinical practice. However, recent studies have questioned the accuracy of this equation in estimating GFR in people with diabetes. We conducted a comprehensive review of existing literature on the role of artificial intelligence and machine learning in estimating GFR and the progression of chronic kidney disease (CKD), specifically in people with diabetes. Artificial intelligence, including machine learning and image-based deep learning algorithms have shown promise in improving the accuracy of GFR estimation. Artificial Neural Networks is the commonly used machine learning algorithm in GFR estimation studies. Other artificial intelligence methods include random forests, support vector machines, and ensemble learning models. Many of the studies included in this review reported that artificial intelligence-based GFR estimation equations exhibit lower bias, as well as higher precision and accuracy. However, these findings are not consistent across all the studies. In addition, currently available studies are limited to smaller sample sizes and majority of the studies are from selected countries or populations. Therefore, before implementing these methods in clinical practice, it is essential to validate them on larger sample sizes and diverse patient populations.</p>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":" ","pages":"113152"},"PeriodicalIF":7.4,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146178406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gestational diabetes mellitus phenotypes defined by 75-g oral glucose tolerance test response patterns: associations with perinatal outcomes and persistent postpartum diabetes 75克口服葡萄糖耐量试验反应模式定义的妊娠糖尿病表型：与围产期结局和产后持续性糖尿病的关系

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-02-08 DOI: 10.1016/j.diabres.2026.113148

Hanne Bulat Cim , Canan Satır Özel , Melis Altuğ İnan , Nisan Helin Dönmez , Esmehan Ayşit , Ergül Demirçivi , Bilge Kapudere , Neslişah Ar , Abdulkadir Turgut

Aims

To assess whether 75-g oral glucose tolerance test (OGTT) response patterns define clinically meaningful phenotypes among women with gestational diabetes mellitus (GDM) and whether these phenotypes are associated with perinatal outcomes and persistent postpartum diabetes.

Methods

This single-center ambispective cohort included women diagnosed with GDM by a 75-g OGTT at 24–28 weeks’ gestation (IADPSG) between January 2020 and May 2025. Women were classified as isolated fasting hyperglycemia (Group 1), isolated post-load hyperglycemia (Group 2), or combined hyperglycemia (Group 3). From ≥ 12 weeks postpartum onward, participants were recontacted for assessment of glycemic status, and outcomes were verified using available clinical records, laboratory results when available, and medication data.

Results

Among 251 women (mean age 31.4 years; mean BMI 32.5 kg/m²), insulin therapy was most frequent in Group 3 (27.4%; p < 0.001), which also had higher HbA1c (p = 0.011) and earlier delivery (p = 0.008). Persistent postpartum diabetes occurred in 12%. In multivariable analyses, higher BMI and phenotypes incorporating fasting hyperglycemia (Groups 1/3) were independently associated with persistent postpartum diabetes.

Conclusion

OGTT pattern–based phenotyping differentiates GDM subgroups in routine care, with differences in metabolic severity, treatment need, selected perinatal indicators, and postpartum diabetes risk, supporting targeted antenatal management and postpartum follow-up.

目的：评估75 g口服葡萄糖耐量试验（OGTT）反应模式是否定义妊娠糖尿病（GDM）妇女的临床有意义的表型，以及这些表型是否与围产期结局和产后持续性糖尿病相关。方法：该单中心双视角队列纳入了2020年1月至2025年5月期间24-28 孕周（IADPSG）通过75 g OGTT诊断为GDM的女性。将女性分为空腹高血糖组（1组）、负荷后高血糖组（2组）和合并高血糖组（3组）。从产后 ≥ 12 周开始，再次联系参与者评估血糖状态，并使用可用的临床记录、实验室结果和药物数据验证结果。结果：251名女性（平均年龄31.4 岁，平均BMI 32.5 kg/m2）中，胰岛素治疗在第3组最常见（27.4%）；p 结论：基于OGTT模式的表型分型在常规护理中区分GDM亚组，在代谢严重程度、治疗需求、围产期指标选择和产后糖尿病风险方面存在差异，支持有针对性的产前管理和产后随访。

{"title":"Gestational diabetes mellitus phenotypes defined by 75-g oral glucose tolerance test response patterns: associations with perinatal outcomes and persistent postpartum diabetes","authors":"Hanne Bulat Cim , Canan Satır Özel , Melis Altuğ İnan , Nisan Helin Dönmez , Esmehan Ayşit , Ergül Demirçivi , Bilge Kapudere , Neslişah Ar , Abdulkadir Turgut","doi":"10.1016/j.diabres.2026.113148","DOIUrl":"10.1016/j.diabres.2026.113148","url":null,"abstract":"<div><h3>Aims</h3><div>To assess whether 75-g oral glucose tolerance test (OGTT) response patterns define clinically meaningful phenotypes among women with gestational diabetes mellitus (GDM) and whether these phenotypes are associated with perinatal outcomes and persistent postpartum diabetes.</div></div><div><h3>Methods</h3><div>This single-center ambispective cohort included women diagnosed with GDM by a 75-g OGTT at 24–28 weeks’ gestation (IADPSG) between January 2020 and May 2025. Women were classified as isolated fasting hyperglycemia (Group 1), isolated post-load hyperglycemia (Group 2), or combined hyperglycemia (Group 3). From ≥ 12 weeks postpartum onward, participants were recontacted for assessment of glycemic status, and outcomes were verified using available clinical records, laboratory results when available, and medication data.</div></div><div><h3>Results</h3><div>Among 251 women (mean age 31.4 years; mean BMI 32.5 kg/m<sup>2</sup>), insulin therapy was most frequent in Group 3 (27.4%; p < 0.001), which also had higher HbA1c (p = 0.011) and earlier delivery (p = 0.008). Persistent postpartum diabetes occurred in 12%. In multivariable analyses, higher BMI and phenotypes incorporating fasting hyperglycemia (Groups 1/3) were independently associated with persistent postpartum diabetes.</div></div><div><h3>Conclusion</h3><div>OGTT pattern–based phenotyping differentiates GDM subgroups in routine care, with differences in metabolic severity, treatment need, selected perinatal indicators, and postpartum diabetes risk, supporting targeted antenatal management and postpartum follow-up.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113148"},"PeriodicalIF":7.4,"publicationDate":"2026-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Insights to HDL dysfunctionality: hypothesis of exhausted HDL 对HDL功能障碍的认识：HDL耗竭假说。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-02-07 DOI: 10.1016/j.diabres.2026.113145

Abdolkarim Mahrooz

In recent years, a growing understanding of high-density lipoprotein (HDL) properties has significantly reshaped our comprehension of this crucial lipoprotein. Emerging evidence indicates that HDL can lose its well-documented protective functions, becoming dysfunctional and, paradoxically, even proatherogenic. Dysfunctional HDL (dys-HDL) is recognized as a critical contributor to cardiovascular disease and diabetes mellitus, conditions where cardiovascular complications are the main cause of mortality. The concept of dys-HDL appears broad, necessitating a distinction between HDL with diminished protective functionality and HDL that actively promotes proatherogenic effects. In certain conditions, the transition from protective to proatherogenic HDL appears to be a gradual and progressive process. This transition may be conceptualized through the idea of ‘exhausted’ HDL (ex-HDL), which represents HDL that has experienced reduced functionality but has not yet fully acquired proatherogenic characteristics. It signifies an abnormality leading to a state of ‘partial functional impairment’ in HDL. Hypothetically, dys-HDL could be categorized into two groups: ex-HDL and proatherogenic HDL. Such a classifying offers a path towards more targeted therapies for cardiovascular risk reduction. This review aims to enhance our understanding of HDL dysfunctionality and propose ex-HDL, thereby offering insights into the transition from protective to proatherogenic HDL.

近年来，对高密度脂蛋白（HDL）特性的认识不断加深，极大地改变了我们对这种重要脂蛋白的认识。越来越多的证据表明，HDL可能失去其众所周知的保护功能，变得功能失调，甚至可能导致动脉粥样硬化。HDL功能失调（dysi -HDL）被认为是心血管疾病和糖尿病的关键因素，心血管并发症是导致死亡的主要原因。HDL异常的概念似乎很宽泛，因此需要区分保护功能减弱的HDL和积极促进动脉粥样硬化作用的HDL。在某些情况下，从保护性到致动脉粥样硬化性HDL的转变似乎是一个渐进的过程。这种转变可以通过“耗尽”HDL（前HDL）的概念来概念化，它代表HDL经历了功能降低，但尚未完全获得促动脉粥样硬化特征。这表明HDL出现了一种导致“部分功能损伤”的异常。假设，dysi -HDL可分为两组：前HDL和促粥样硬化HDL。这样的分类为降低心血管风险提供了更有针对性的治疗方法。这篇综述旨在提高我们对HDL功能障碍的理解，并提出前HDL，从而为从保护性到促粥样硬化性HDL的转变提供见解。

{"title":"Insights to HDL dysfunctionality: hypothesis of exhausted HDL","authors":"Abdolkarim Mahrooz","doi":"10.1016/j.diabres.2026.113145","DOIUrl":"10.1016/j.diabres.2026.113145","url":null,"abstract":"<div><div>In recent years, a growing understanding of high-density lipoprotein (HDL) properties has significantly reshaped our comprehension of this crucial lipoprotein. Emerging evidence indicates that HDL can lose its well-documented protective functions, becoming dysfunctional and, paradoxically, even proatherogenic. Dysfunctional HDL (dys-HDL) is recognized as a critical contributor to cardiovascular disease and diabetes mellitus, conditions where cardiovascular complications are the main cause of mortality. The concept of dys-HDL appears broad, necessitating a distinction between HDL with diminished protective functionality and HDL that actively promotes proatherogenic effects. In certain conditions, the transition from protective to proatherogenic HDL appears to be a gradual and progressive process. This transition may be conceptualized through the idea of ‘exhausted’ HDL (ex-HDL), which represents HDL that has experienced reduced functionality but has not yet fully acquired proatherogenic characteristics. It signifies an abnormality leading to a state of ‘partial functional impairment’ in HDL. Hypothetically, dys-HDL could be categorized into two groups: ex-HDL and proatherogenic HDL. Such a classifying offers a path towards more targeted therapies for cardiovascular risk reduction. This review aims to enhance our understanding of HDL dysfunctionality and propose ex-HDL, thereby offering insights into the transition from protective to proatherogenic HDL.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113145"},"PeriodicalIF":7.4,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of remnant cholesterol inflammation index with future cardiovascular disease risk in patients with cardiovascular-kidney-metabolic syndrome stages 0–3 0-3期心血管-肾-代谢综合征患者残余胆固醇炎症指数与未来心血管疾病风险的关系

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-02-07 DOI: 10.1016/j.diabres.2026.113146

Nanshan Xie , Lihuan Zeng , Xiangming Hu , Zejia Wu , Weiling Lu , Songyuan Luo , Jianfang Luo

Aims

This study aims to investigate the association between remnant cholesterol inflammation index (RCII) and future cardiovascular diseases (CVD) risk across cardiovascular–kidney–metabolic (CKM) syndrome stages 0–3 population.

Methods

This study included 7,527 participants with CKM syndrome stages 0–3 and without a prior history of CVD from the China Health and Retirement Longitudinal Study. RCII was calculated as remnant cholesterol (RC) (mg/dL) × high-sensitivity C-reactive protein (hsCRP) (mg/L)/10. The primary endpoint was CVD. Multivariable Cox regression and restricted cubic spline analyses were performed to evaluate the association between RCII and CVD.

Results

Over a median follow-up of 7 years, 1,247 participants (16.5%) experienced CVD events. Compared with participants in the lowest quartile of RCII, those in the highest quartile had a 1.25-fold higher risk of future CVD (hazard ratio: 1.25, 95% confidence interval: 1.03–1.52, P for trend = 0.009). Kaplan–Meier analysis demonstrated that the optimal dichotomous cutoff of RCII for CVD was 1.488 (log-rank test: P < 0.05). RC and hs-CRP exhibited a synergistic effect on CVD, with elevated hs-CRP partially mediating the association between RC and CVD, accounting for 18.87% of the effect (P = 0.040).

Conclusions

Among individuals with CKM syndrome stages 0–3, elevated RCII levels were associated with future risk of CVD.

目的：本研究旨在探讨心血管-肾-代谢（CKM）综合征0-3期人群中残余胆固醇炎症指数（RCII）与未来心血管疾病（CVD）风险之间的关系。方法：本研究包括来自中国健康与退休纵向研究的7,527名CKM综合征0-3期且无心血管疾病史的参与者。RCII计算为残余胆固醇（mg/dL） × 高敏c反应蛋白(mg/L)/10。主要终点为CVD。采用多变量Cox回归和限制性三次样条分析来评估RCII与CVD之间的关系。结果：在中位随访7 年期间，1247名参与者（16.5%）经历了CVD事件。与RCII最低四分位数的参与者相比，最高四分位数的参与者未来心血管疾病的风险高出1.25倍（风险比：1.25,95%置信区间：1.03-1.52，P为趋势 = 0.009）。Kaplan-Meier分析显示，CVD患者RCII的最佳二分类截止值为1.488 （log-rank检验：P < 0.05）。RC和hs-CRP对CVD有协同作用，其中hs-CRP升高部分介导了RC与CVD的关联，占18.87% （P = 0.040）。结论：在CKM综合征0-3期患者中，RCII水平升高与未来CVD风险相关。

{"title":"Association of remnant cholesterol inflammation index with future cardiovascular disease risk in patients with cardiovascular-kidney-metabolic syndrome stages 0–3","authors":"Nanshan Xie , Lihuan Zeng , Xiangming Hu , Zejia Wu , Weiling Lu , Songyuan Luo , Jianfang Luo","doi":"10.1016/j.diabres.2026.113146","DOIUrl":"10.1016/j.diabres.2026.113146","url":null,"abstract":"<div><h3>Aims</h3><div>This study aims to investigate the association between remnant cholesterol inflammation index (RCII) and future cardiovascular diseases (CVD) risk across cardiovascular–kidney–metabolic (CKM) syndrome stages 0–3 population.</div></div><div><h3>Methods</h3><div>This study included 7,527 participants with CKM syndrome stages 0–3 and without a prior history of CVD from the China Health and Retirement Longitudinal Study. RCII was calculated as remnant cholesterol (RC) (mg/dL) × high-sensitivity C-reactive protein (hsCRP) (mg/L)/10. The primary endpoint was CVD. Multivariable Cox regression and restricted cubic spline analyses were performed to evaluate the association between RCII and CVD.</div></div><div><h3>Results</h3><div>Over a median follow-up of 7 years, 1,247 participants (16.5%) experienced CVD events. Compared with participants in the lowest quartile of RCII, those in the highest quartile had a 1.25-fold higher risk of future CVD (hazard ratio: 1.25, 95% confidence interval: 1.03–1.52, P for trend = 0.009). Kaplan–Meier analysis demonstrated that the optimal dichotomous cutoff of RCII for CVD was 1.488 (log-rank test: P < 0.05). RC and hs-CRP exhibited a synergistic effect on CVD, with elevated hs-CRP partially mediating the association between RC and CVD, accounting for 18.87% of the effect (P = 0.040).</div></div><div><h3>Conclusions</h3><div>Among individuals with CKM syndrome stages 0–3, elevated RCII levels were associated with future risk of CVD.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113146"},"PeriodicalIF":7.4,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

SGLT2 inhibitors improve subclinical left ventricular systolic function independent of body mass index in patients with type 2 diabetes: A prospective strain imaging study SGLT2抑制剂改善2型糖尿病患者独立于体重指数的亚临床左心室收缩功能：一项前瞻性应变成像研究

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-02-07 DOI: 10.1016/j.diabres.2026.113147

Ömer Kümet , Fuat Polat , Ozan Durmaz , Veysi Can , Ahmet Ferhat Kaya , Görkem Ayhan , Emrah Özbek

Background

Type 2 diabetes mellitus is associated with subclinical left ventricular dysfunction. SGLT2 inhibitors demonstrate cardiovascular benefits in trials, but their effects on subclinical myocardial function and relationship to body weight in clinical practice remain unclear. This study examined global longitudinal strain (GLS) changes during SGLT2 inhibitor therapy across body mass index (BMI) categories.

Methods

This prospective observational cohort enrolled 614 patients newly initiated on SGLT2 inhibitors (September 2022-May 2025), stratified by BMI: normal weight (n = 300) and overweight/obesity (n = 314). Speckle tracking echocardiography assessed GLS at baseline and 6 months.

Results

Both groups showed significant GLS improvement (normal weight: −17.83 ± 1.30% to −19.22 ± 1.20%; overweight/obesity: −17.70 ± 1.48% to −19.05 ± 1.24%; both p < 0.001), with similar magnitude (p = 0.696). Overweight/obesity patients experienced modest BMI reduction (−0.66 kg/m², p < 0.001); normal weight remained stable. Baseline GLS strongly predicted improvement (OR = 1.553, p < 0.001), while baseline BMI showed no association (OR = 1.000, p = 0.993).

Conclusion

SGLT2 inhibitor therapy was associated with similar subclinical left ventricular systolic function improvement across BMI categories. While causality cannot be established without controls and BMI imperfectly measures adiposity, findings align with randomized trial cardiovascular benefits, suggesting benefits may extend across the body weight spectrum.

背景：2型糖尿病与亚临床左心室功能障碍相关。SGLT2抑制剂在试验中显示出心血管益处，但在临床实践中其对亚临床心肌功能的影响以及与体重的关系尚不清楚。本研究考察了SGLT2抑制剂治疗期间不同体重指数（BMI）类别的整体纵向应变（GLS）变化。方法：该前瞻性观察队列纳入614例新开始使用SGLT2抑制剂的患者（2022年9月- 2025年5月），按BMI分层：正常体重（n = 300）和超重/肥胖（n = 314）。斑点跟踪超声心动图在基线和6 个月时评估GLS。结果:两组显示显著的gl改进(正常体重:-17.83 ± 1.30%至-19.22 ± 1.20%;超重/肥胖:-17.70 ± 1.48%至-19.05 ± 1.24%;p 2,p 结论:SGLT2抑制剂治疗与类似的亚临床改善左心室收缩功能在BMI类别。虽然没有对照不能确定因果关系，BMI也不能完美地衡量肥胖，但研究结果与随机试验的心血管益处一致，表明益处可能延伸到整个体重范围。

{"title":"SGLT2 inhibitors improve subclinical left ventricular systolic function independent of body mass index in patients with type 2 diabetes: A prospective strain imaging study","authors":"Ömer Kümet , Fuat Polat , Ozan Durmaz , Veysi Can , Ahmet Ferhat Kaya , Görkem Ayhan , Emrah Özbek","doi":"10.1016/j.diabres.2026.113147","DOIUrl":"10.1016/j.diabres.2026.113147","url":null,"abstract":"<div><h3>Background</h3><div>Type 2 diabetes mellitus is associated with subclinical left ventricular dysfunction. SGLT2 inhibitors demonstrate cardiovascular benefits in trials, but their effects on subclinical myocardial function and relationship to body weight in clinical practice remain unclear. This study examined global longitudinal strain (GLS) changes during SGLT2 inhibitor therapy across body mass index (BMI) categories.</div></div><div><h3>Methods</h3><div>This prospective observational cohort enrolled 614 patients newly initiated on SGLT2 inhibitors (September 2022-May 2025), stratified by BMI: normal weight (n = 300) and overweight/obesity (n = 314). Speckle tracking echocardiography assessed GLS at baseline and 6 months.</div></div><div><h3>Results</h3><div>Both groups showed significant GLS improvement (normal weight: −17.83 ± 1.30% to −19.22 ± 1.20%; overweight/obesity: −17.70 ± 1.48% to −19.05 ± 1.24%; both p < 0.001), with similar magnitude (p = 0.696). Overweight/obesity patients experienced modest BMI reduction (−0.66 kg/m<sup>2</sup>, p < 0.001); normal weight remained stable. Baseline GLS strongly predicted improvement (OR = 1.553, p < 0.001), while baseline BMI showed no association (OR = 1.000, p = 0.993).</div></div><div><h3>Conclusion</h3><div>SGLT2 inhibitor therapy was associated with similar subclinical left ventricular systolic function improvement across BMI categories. While causality cannot be established without controls and BMI imperfectly measures adiposity, findings align with randomized trial cardiovascular benefits, suggesting benefits may extend across the body weight spectrum.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113147"},"PeriodicalIF":7.4,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reproductive factors, insulin resistance surrogate indices, and circadian syndrome among middle-aged and elderly women a mediation analysis using two-national cohorts 生殖因素、胰岛素抵抗替代指标和中老年妇女的昼夜节律综合征：两国队列的中介分析

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-02-06 DOI: 10.1016/j.diabres.2026.113141

Linli Liu , Jun Lin , LinHong Li , Sanshan Wu , Zhang Shen , JinHua Chen , Y. Peng , Minlan Lin , Xiafei Ye , Danru Chen , Quping Tan

Aims

We investigated the mediation effects of seven insulin resistance(IR) indices: triglyceride glucose (TyG), triglyceride glucose-waist to height ratio (TyG-WHtR), triglyceride glucose-waist circumference (TyG-WC), estimated glucose disposal rate (eGDR), metabolic score for IR, lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) on the associations between reproductive factors and circadian syndrome (CircS) in middle-aged and elderly women.

Methods

This study was conducted using the China Health and Retirement Longitudinal Study (CHARLS) as training set and the English Longitudinal Study on Aging (ELSA) as validation set, with baseline non-CircS individuals. Regression models established causal relationships between reproductive factors and incident CircS. Mediation analysis quantified IR mediation effects. Receiver operating characteristic curves evaluated IR indices’ predictive capacity.

Results

The incidence of new-onset CircS was 465 (15.94%) in CHARLS and 291 (11.89%) in ELSA, respectively. The CircS incidence was higher in earlier age at menarche or menopause. Mediation analyses revealed that TyG, TyG-WHtR, TyG-WC, LAP, CVAI, and eGDR mediated the menarche-CircS association, with TyG-WHtR accounting for 14.3% of the mediating effect. The TyG-WHtR cutoff value for predicting CircS was identified 4.507 for early menarche.

Conclusion

Significant inverse relationships were observed between early age at menarche/menopause and increased CircS risk, with IR largely mediating these associations.

目的：研究甘油三酯葡萄糖（TyG）、甘油三酯葡萄糖-腰高比（TyG- whtr）、甘油三酯葡萄糖-腰围（TyG- wc）、估计葡萄糖处理率（eGDR）、IR代谢评分、脂质积累产物（LAP）和中国内脏脂肪指数（CVAI）等7项胰岛素抵抗（IR）指标在中老年妇女生殖因素与昼夜节律综合征（CircS）之间的中介作用。方法：本研究采用中国健康与退休纵向研究（CHARLS）作为训练集，英国老龄化纵向研究（ELSA）作为验证集，以基线非circs个体为研究对象。回归模型建立了生殖因素与事件CircS之间的因果关系。中介分析量化了IR中介效应。受试者工作特征曲线评价红外指标的预测能力。结果：CHARLS组新发CircS发生率为465例（15.94%），ELSA组为291例（11.89%）。初潮或绝经年龄越早，CircS发病率越高。中介分析显示，TyG、TyG- whtr、TyG- wc、LAP、CVAI和eGDR介导了月经初潮与circs的关联，其中TyG- whtr的中介作用占14.3%。预测早期月经初潮的TyG-WHtR截止值为4.507。结论：初潮/绝经年龄与CircS风险增加之间存在显著的负相关，IR在很大程度上介导了这些关联。

{"title":"Reproductive factors, insulin resistance surrogate indices, and circadian syndrome among middle-aged and elderly women a mediation analysis using two-national cohorts","authors":"Linli Liu , Jun Lin , LinHong Li , Sanshan Wu , Zhang Shen , JinHua Chen , Y. Peng , Minlan Lin , Xiafei Ye , Danru Chen , Quping Tan","doi":"10.1016/j.diabres.2026.113141","DOIUrl":"10.1016/j.diabres.2026.113141","url":null,"abstract":"<div><h3>Aims</h3><div>We investigated the mediation effects of seven insulin resistance(IR) indices: triglyceride glucose (TyG), triglyceride glucose-waist to height ratio (TyG-WHtR), triglyceride glucose-waist circumference (TyG-WC), estimated glucose disposal rate (eGDR), metabolic score for IR, lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) on the associations between reproductive factors and circadian syndrome (CircS) in middle-aged and elderly women.</div></div><div><h3>Methods</h3><div>This study was conducted using the China Health and Retirement Longitudinal Study (CHARLS) as training set and the English Longitudinal Study on Aging (ELSA) as validation set, with baseline non-CircS individuals. Regression models established causal relationships between reproductive factors and incident CircS. Mediation analysis quantified IR mediation effects. Receiver operating characteristic curves evaluated IR indices’ predictive capacity.</div></div><div><h3>Results</h3><div>The incidence of new-onset CircS was 465 (15.94%) in CHARLS and 291 (11.89%) in ELSA, respectively. The CircS incidence was higher in earlier age at menarche or menopause. Mediation analyses revealed that TyG, TyG-WHtR, TyG-WC, LAP, CVAI, and eGDR mediated the menarche-CircS association, with TyG-WHtR accounting for 14.3% of the mediating effect. The TyG-WHtR cutoff value for predicting CircS was identified 4.507 for early menarche.</div></div><div><h3>Conclusion</h3><div>Significant inverse relationships were observed between early age at menarche/menopause and increased CircS risk, with IR largely mediating these associations.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113141"},"PeriodicalIF":7.4,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of prior COVID-19 infection with gestational diabetes mellitus 既往COVID-19感染与妊娠期糖尿病的关系

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-02-06 DOI: 10.1016/j.diabres.2026.113144

J. Sajnani , M. Siavoshi , L. Kwan , C.S. Han

Background

There is an increase incidence of diabetes and anti-hyperglycemic use after COVID-19 infection in non-pregnant adult populations. COVID-19 has also been shown to be associated with adverse pregnancy outcomes such as pre-eclampsia and preterm birth.

Objective

To evaluate if COVID-19 infection during preconception or in early pregnancy is associated with increased risk of gestational diabetes mellitus (GDM) diagnosis.

Study design

We performed a retrospective matched cohort study of patients delivering at two university affiliated hospitals from 6/1/2021 to 12/31/2021, prior to widespread vaccinations or home antigen testing for SARS-CoV-2. We included pregnant individuals aged 18 to 45 who were ≥ 24 weeks gestational age at time of delivery. We excluded those with a history of pre-gestational diabetes, multiple gestation, or prior diagnosis of cystic fibrosis or pancreatic insufficiency. Subjects with confirmed COVID-19 infection during preconception or the first 20 weeks of pregnancy were identified as cases and were matched 1:1 by age and BMI with eligible controls. GDM diagnosis was based on a two-step approach using Carpenter-Coustan criteria. Kruskal-Wallis and Chi-Square tests were performed as appropriate.

Results

During the study period, 183 cases with prior positive COVID-19 antigen test and 1066 potential controls were identified. One case could not be matched due to an outlier BMI; therefore 182 matched patients were included in each group. The cases were less likely to have public insurance and more likely to have reported thyroid disorder, sleep apnea, or asthma. No differences were seen in GDM incidence between the cases and controls (OR 0.75, 95% CI 0.38–1.46) or based on timing of COVID-19 infection (p = 0.097). No differences were noted in delivery method, obstetrical lacerations, or Apgar scores.

Conclusions

COVID-19 infection in the preconception or early pregnancy period was not associated with increased incidence of GDM.

背景：在未怀孕的成年人群中，COVID-19感染后糖尿病和抗高血糖药物的发病率增加。COVID-19还被证明与子痫前期和早产等不良妊娠结局有关。目的：探讨孕前或妊娠早期感染COVID-19是否与妊娠期糖尿病（GDM）诊断风险增加相关。研究设计：在广泛接种SARS-CoV-2疫苗或进行家庭抗原检测之前，我们对2021年6月1日至2021年12月31日在两所大学附属医院分娩的患者进行了回顾性匹配队列研究。我们纳入了年龄在18 - 45岁、分娩时胎龄 ≥ 24 周的孕妇。我们排除了那些有妊娠前糖尿病史、多胎妊娠史、或先前诊断为囊性纤维化或胰腺功能不全的患者。在孕前或妊娠前20 周确诊COVID-19感染的受试者被确定为病例，并按年龄和BMI与符合条件的对照组进行1:1匹配。GDM诊断基于卡朋特-库斯坦标准的两步法。采用Kruskal-Wallis检验和卡方检验。结果：在研究期间，发现既往COVID-19抗原检测阳性病例183例，潜在对照1066例。1例因BMI异常而无法匹配；因此，每组纳入182例匹配患者。这些病例不太可能有公共保险，更有可能有甲状腺疾病、睡眠呼吸暂停或哮喘。病例和对照组的GDM发病率无差异（OR 0.75, 95% CI 0.38-1.46），也没有基于COVID-19感染时间的差异（p = 0.097）。分娩方式、产科撕裂或Apgar评分均无差异。结论：孕前或妊娠早期感染COVID-19与GDM发病率增加无关。

{"title":"Association of prior COVID-19 infection with gestational diabetes mellitus","authors":"J. Sajnani , M. Siavoshi , L. Kwan , C.S. Han","doi":"10.1016/j.diabres.2026.113144","DOIUrl":"10.1016/j.diabres.2026.113144","url":null,"abstract":"<div><h3>Background</h3><div>There is an increase incidence of diabetes and anti-hyperglycemic use after COVID-19 infection in non-pregnant adult populations. COVID-19 has also been shown to be associated with adverse pregnancy outcomes such as pre-eclampsia and preterm birth.</div></div><div><h3>Objective</h3><div>To evaluate if COVID-19 infection during preconception or in early pregnancy is associated with increased risk of gestational diabetes mellitus (GDM) diagnosis.</div></div><div><h3>Study design</h3><div>We performed a retrospective matched cohort study of patients delivering at two university affiliated hospitals from 6/1/2021 to 12/31/2021, prior to widespread vaccinations or home antigen testing for SARS-CoV-2. We included pregnant individuals aged 18 to 45 who were ≥ 24 weeks gestational age at time of delivery. We excluded those with a history of pre-gestational diabetes, multiple gestation, or prior diagnosis of cystic fibrosis or pancreatic insufficiency. Subjects with confirmed COVID-19 infection during preconception or the first 20 weeks of pregnancy were identified as cases and were matched 1:1 by age and BMI with eligible controls. GDM diagnosis was based on a two-step approach using Carpenter-Coustan criteria. Kruskal-Wallis and Chi-Square tests were performed as appropriate.</div></div><div><h3>Results</h3><div>During the study period, 183 cases with prior positive COVID-19 antigen test and 1066 potential controls were identified. One case could not be matched due to an outlier BMI; therefore 182 matched patients were included in each group. The cases were less likely to have public insurance and more likely to have reported thyroid disorder, sleep apnea, or asthma. No differences were seen in GDM incidence between the cases and controls (OR 0.75, 95% CI 0.38–1.46) or based on timing of COVID-19 infection (p = 0.097). No differences were noted in delivery method, obstetrical lacerations, or Apgar scores.</div></div><div><h3>Conclusions</h3><div>COVID-19 infection in the preconception or early pregnancy period was not associated with increased incidence of GDM.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113144"},"PeriodicalIF":7.4,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Salivary extracellular vesicles and Raman spectroscopy in precision diagnostics of type 2 diabetes 唾液细胞外囊泡和拉曼光谱在2型糖尿病精确诊断中的应用。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-02-05 DOI: 10.1016/j.diabres.2026.113139

Ajitesh Dhal , Shao-Jung Lin , Arunima Pandey , Chih-Hsuan Liu , Hung-Yi Liu , Tarakanta Jena , Chitralekha Jena , Dharitri Rath , Pei-Wen Peng , Cheng-Jen Chang , Chang-I Chen , Li-Chern Pan , Tzu-Sen Yang

Type 2 Diabetes (T2D) remains a major global health issue, driven by sedentary lifestyles and aging populations, emphasizing the urgent need for precise diagnostics that allow early detection and personalized monitoring. Traditional blood tests, including glucose and HbA1c measurements, offer limited temporal and molecular information. In contrast, saliva provides a non-invasive, easily accessible biofluid that reflects systemic metabolic changes. Its molecular components, especially extracellular vesicles (EVs), such as exosomes and microvesicles, contain proteins, lipids, and microRNAs directly associated with insulin resistance, β-cell dysfunction, and inflammation in T2D. Advances in Raman spectroscopy and surface-enhanced Raman scattering (SERS) now enable high-sensitivity, label-free molecular fingerprinting of salivary EVs, supporting multiplex detection of disease-related biomarkers. Combining Raman-based sensing with EV profiling introduces an innovative approach for non-invasive, precision diabetes diagnostics. This review explores the diagnostic importance of salivary EVs, recent developments in Raman/SERS-based biomolecular detection, and the clinical potential of integrating these technologies for early screening and therapy monitoring. Moreover, incorporating artificial intelligence (AI) for spectral analysis and developing portable Raman devices could facilitate real-time, saliva-based metabolic monitoring, advancing personalized, preventive, and patient-focused diabetes care.

由于久坐不动的生活方式和人口老龄化，2型糖尿病（T2D）仍然是一个主要的全球健康问题，因此迫切需要精确诊断，以便及早发现和个性化监测。传统的血液测试，包括葡萄糖和糖化血红蛋白的测量，提供有限的时间和分子信息。相比之下，唾液提供了一种非侵入性的、易于获取的生物流体，反映了全身代谢变化。其分子成分，特别是细胞外囊泡（EVs），如外泌体和微囊泡，含有与胰岛素抵抗、β细胞功能障碍和T2D炎症直接相关的蛋白质、脂质和microrna。拉曼光谱和表面增强拉曼散射（SERS）技术的进步使得唾液腺EVs的高灵敏度、无标记分子指纹识别成为可能，支持疾病相关生物标志物的多重检测。将拉曼传感与EV分析相结合，为非侵入性、精确的糖尿病诊断提供了一种创新方法。本文综述了唾液EVs的诊断重要性，基于拉曼/ sers的生物分子检测的最新进展，以及将这些技术整合到早期筛查和治疗监测中的临床潜力。此外，将人工智能（AI）用于光谱分析和开发便携式拉曼设备可以促进实时、基于唾液的代谢监测，推进个性化、预防性和以患者为中心的糖尿病护理。

{"title":"Salivary extracellular vesicles and Raman spectroscopy in precision diagnostics of type 2 diabetes","authors":"Ajitesh Dhal , Shao-Jung Lin , Arunima Pandey , Chih-Hsuan Liu , Hung-Yi Liu , Tarakanta Jena , Chitralekha Jena , Dharitri Rath , Pei-Wen Peng , Cheng-Jen Chang , Chang-I Chen , Li-Chern Pan , Tzu-Sen Yang","doi":"10.1016/j.diabres.2026.113139","DOIUrl":"10.1016/j.diabres.2026.113139","url":null,"abstract":"<div><div>Type 2 Diabetes (T2D) remains a major global health issue, driven by sedentary lifestyles and aging populations, emphasizing the urgent need for precise diagnostics that allow early detection and personalized monitoring. Traditional blood tests, including glucose and HbA1c measurements, offer limited temporal and molecular information. In contrast, saliva provides a non-invasive, easily accessible biofluid that reflects systemic metabolic changes. Its molecular components, especially extracellular vesicles (EVs), such as exosomes and microvesicles, contain proteins, lipids, and microRNAs directly associated with insulin resistance, β-cell dysfunction, and inflammation in T2D. Advances in Raman spectroscopy and surface-enhanced Raman scattering (SERS) now enable high-sensitivity, label-free molecular fingerprinting of salivary EVs, supporting multiplex detection of disease-related biomarkers. Combining Raman-based sensing with EV profiling introduces an innovative approach for non-invasive, precision diabetes diagnostics. This review explores the diagnostic importance of salivary EVs, recent developments in Raman/SERS-based biomolecular detection, and the clinical potential of integrating these technologies for early screening and therapy monitoring. Moreover, incorporating artificial intelligence (AI) for spectral analysis and developing portable Raman devices could facilitate real-time, saliva-based metabolic monitoring, advancing personalized, preventive, and patient-focused diabetes care.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113139"},"PeriodicalIF":7.4,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Distinct microRNA signatures in Platelet-Rich Plasma-Derived extracellular vesicles predict healing outcomes in chronic diabetic foot ulcers 富血小板血浆来源的细胞外囊泡中不同的microRNA特征预测慢性糖尿病足溃疡的愈合结果。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-02-04 DOI: 10.1016/j.diabres.2026.113142

Yu-Chi Tsai , Shu-Yu Wu , Chien-Ju Wu , Hao-Yu Chiao , Hsu-Ping Tseng , Yu-Min He , Tim-Mo Chen , Min-Yu Tu , Yuan-sheng Tzeng

Background

Diabetic foot ulcers (DFUs) present a major challenge due to impaired angiogenesis and chronic inflammation. Autologous platelet-rich plasma (PRP) is a widely used therapy, but clinical outcomes remain inconsistent. We hypothesized that the microRNA (miRNA) cargo of platelet-derived extracellular vesicles (PRP-EVs) drives this therapeutic variability.

Methods

Ten patients with refractory DFUs were enrolled. Autologous PRP-EVs were isolated, and wound healing-associated miRNAs were quantified via qRT-PCR. Clinical wound closure was monitored weekly, with the primary efficacy endpoint assessed at 6 weeks. The biological effects of patient-specific PRP-EVs on keratinocyte migration were evaluated in vitro.

Results

PRP treatment resulted in significant wound area reduction, achieving an average closure rate of approximately 90% by week 6. However, miRNA expression exhibited substantial heterogeneity. High levels of miR-20a-5p and miR-21-5p in PRP-EVs were significantly associated with delayed clinical healing and impaired keratinocyte migration. Conversely, elevated miR-223-3p correlated with accelerated wound closure.

Conclusion

The intrinsic miRNA composition of PRP-EVs is a critical determinant of PRP therapeutic efficacy. miR-20a-5p and miR-21-5p serve as negative predictive biomarkers, whereas miR-223-3p indicates a favorable prognosis. Profiling these miRNAs offers a novel approach for PRP quality control and personalized regenerative strategies.

背景：糖尿病足溃疡（DFUs）由于血管生成受损和慢性炎症而面临重大挑战。自体富血小板血浆（PRP）是一种广泛使用的治疗方法，但临床结果仍不一致。我们假设血小板来源的细胞外囊泡（prp - ev）的microRNA （miRNA）货物驱动了这种治疗变动性。方法：纳入10例难治性dfu患者。分离自体prp - ev，通过qRT-PCR定量检测创面愈合相关mirna。每周监测临床伤口愈合情况，在6 周时评估主要疗效终点。体外评估患者特异性prp - ev对角质形成细胞迁移的生物学效应。结果：PRP治疗显著减少创面面积，到第6周平均愈合率约为90%。然而，miRNA表达表现出实质性的异质性。prp - ev中高水平的miR-20a-5p和miR-21-5p与临床愈合延迟和角质细胞迁移受损显著相关。相反，miR-223-3p升高与伤口愈合加速相关。结论：PRP- ev的内在miRNA组成是PRP治疗效果的关键决定因素。miR-20a-5p和miR-21-5p作为阴性预测生物标志物，而miR-223-3p预示着良好的预后。分析这些mirna为PRP质量控制和个性化再生策略提供了新的方法。

{"title":"Distinct microRNA signatures in Platelet-Rich Plasma-Derived extracellular vesicles predict healing outcomes in chronic diabetic foot ulcers","authors":"Yu-Chi Tsai , Shu-Yu Wu , Chien-Ju Wu , Hao-Yu Chiao , Hsu-Ping Tseng , Yu-Min He , Tim-Mo Chen , Min-Yu Tu , Yuan-sheng Tzeng","doi":"10.1016/j.diabres.2026.113142","DOIUrl":"10.1016/j.diabres.2026.113142","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic foot ulcers (DFUs) present a major challenge due to impaired angiogenesis and chronic inflammation. Autologous platelet-rich plasma (PRP) is a widely used therapy, but clinical outcomes remain inconsistent. We hypothesized that the microRNA (miRNA) cargo of platelet-derived extracellular vesicles (PRP-EVs) drives this therapeutic variability.</div></div><div><h3>Methods</h3><div>Ten patients with refractory DFUs were enrolled. Autologous PRP-EVs were isolated, and wound healing-associated miRNAs were quantified via qRT-PCR. Clinical wound closure was monitored weekly, with the primary efficacy endpoint assessed at 6 weeks. The biological effects of patient-specific PRP-EVs on keratinocyte migration were evaluated in vitro.</div></div><div><h3>Results</h3><div>PRP treatment resulted in significant wound area reduction, achieving an average closure rate of approximately 90% by week 6. However, miRNA expression exhibited substantial heterogeneity. High levels of miR-20a-5p and miR-21-5p in PRP-EVs were significantly associated with delayed clinical healing and impaired keratinocyte migration. Conversely, elevated miR-223-3p correlated with accelerated wound closure.</div></div><div><h3>Conclusion</h3><div>The intrinsic miRNA composition of PRP-EVs is a critical determinant of PRP therapeutic efficacy. miR-20a-5p and miR-21-5p serve as negative predictive biomarkers, whereas miR-223-3p indicates a favorable prognosis. Profiling these miRNAs offers a novel approach for PRP quality control and personalized regenerative strategies.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113142"},"PeriodicalIF":7.4,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0