Diabetes research and clinical practice最新文献_第5页

Human factors in the use and efficacy of decision support technologies for type 1 diabetes: evidence from a randomized controlled trial 1型糖尿病决策支持技术使用和疗效中的人为因素：来自一项随机对照试验的证据

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-10 DOI: 10.1016/j.diabres.2025.113049

Jacopo Pavan , Ralf Nass , Chiara Fabris , Anas El Fathi , Emma G. Emory , Giulio Santini , Annanda M.F.B. Batista , Mary C. Oliveri , Chaitanya K.L. Koravi , Charlie L. Barnett , Katharine Barnard-Kelly , Linda Gonder-Frederick , Marc D. Breton

Aim

Studies on decision support systems (DSS) for type 1 diabetes show low user engagement and marginal glycemic benefits. This work investigates the interplay between human factors and DSS use and efficacy.

Methods

Adults using insulin injections or pump and continuous glucose monitoring (CGM) underwent three 2-month interventions, in randomized order: i) no DSS; ii) informative DSS (iDSS), providing summary feedback for decision-making; iii) prescriptive DSS (pDSS), recommending precise treatment actions. DSS advisory modules included tools for smart bolusing and therapy optimization. Primary outcomes were CGM-derived glycemic metrics. Exploratory analyses investigated the association between glycemic outcomes, DSS use, and psychosocial variables.

Results

Fifty-three participants (26 injections, 27 pump) completed the study. Glycemic outcomes did not differ between interventions. However, using iDSS vs no DSS reduced average time >180 mg/dl for participants with lower diabetes-related knowledge (−6 %, p < 0.001) and higher hemoglobin A1c (−6 %, p < 0.01). Emotional distress (p < 0.001) and hypoglycemia worry (p < 0.01) were associated with lower DSS engagement. Participants engaged more with their preferred system (p < 0.01); 40 % of them preferred iDSS.

Conclusions

Personalized feedback (iDSS) may offer an important learning tool, especially for individuals with lower diabetes-related knowledge. Addressing diabetes-related distress and hypoglycemia worry could unlock the full potential of DSS technologies.

目的针对1型糖尿病的决策支持系统（DSS）的研究表明，该系统的用户参与度较低，血糖获益甚微。这项工作调查了人为因素与DSS使用和疗效之间的相互作用。方法使用胰岛素注射或泵和持续血糖监测（CGM）的成年人接受三个为期2个月的干预，随机顺序：i)无DSS；ii)信息性决策支持系统（iDSS），为决策提供总结反馈；iii)规定性DSS (pDSS)，建议精确的治疗行动。DSS咨询模块包括智能bolouse和治疗优化工具。主要结局是cgm衍生的血糖指标。探索性分析调查了血糖结局、DSS使用和社会心理变量之间的关系。结果53例受试者（注射26例，泵送27例）完成研究。不同干预措施的血糖结果没有差异。然而，对于糖尿病相关知识较低（- 6%,p < 0.001）和血红蛋白A1c较高（- 6%,p < 0.01）的参与者，使用iDSS与不使用DSS相比，平均时间减少了180 mg/dl。情绪困扰（p < 0.001）和低血糖担忧（p < 0.01）与较低的DSS投入相关。参与者更喜欢他们喜欢的系统（p < 0.01）；40%的人选择了iDSS。结论个性化反馈（iDSS）是一种重要的学习工具，尤其适用于糖尿病相关知识较低的个体。解决与糖尿病相关的痛苦和低血糖的担忧可以释放DSS技术的全部潜力。

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引用次数: 0

Association of GLP-1 receptor agonist use with psychiatric outcomes in adults with type 2 diabetes: a target trial emulation GLP-1受体激动剂与成人2型糖尿病患者精神预后的关系：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 : 2025-12-10 DOI: 10.1016/j.diabres.2025.113038

Huilin Tang , Yiwen Lu , Bingyu Zhang , Dazheng Zhang , Ting Zhou , Jiajie Chen , Ying Lu , Tianchu Lyu , Kai Zheng , Yong Chen

In a real-world target trial emulation, GLP-1 receptor agonist initiation was not associated with increased risk of most psychiatric disorders compared with SGLT2i or DPP4i use, though a modest association with anxiety disorder was observed. Findings suggest the psychiatric safety of GLP-1RAs warrants further investigation.

在现实世界的目标试验模拟中，与使用SGLT2i或DPP4i相比，GLP-1受体激动剂与大多数精神疾病的风险增加无关，尽管与焦虑症有一定的关联。研究结果表明，GLP-1RAs的精神病学安全性值得进一步研究。

引用次数: 0

Preoperative plasma miR-144-3p to predict persistent type 2 diabetes after gastric bypass – a pilot proof-of-concept study 术前血浆miR-144-3p预测胃旁路术后持续2型糖尿病-一项概念验证的试点研究

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-10 DOI: 10.1016/j.diabres.2025.113052

Ana Cristina Martinez , Dan Linetzky Waitzberg , Natália Cruz e Melo , Aritania Sousa Santos , Fátima Solange Pasini , Danielle Cristina Fonseca , Raquel Susana Torrinhas

Although RYGB induces substantial metabolic benefits, remission of type 2 diabetes mellitus (T2DM) is not universal, creating a clinical challenge in identifying patients unlikely to achieve glycemic success. This prospective observational cohort study investigated whether preoperative circulating microRNAs (miRNAs) predict persistent T2DM after Roux-en-Y gastric bypass (RYGB) in women with obesity. Twenty-eight women were assessed preoperatively and at 3, 12, and 60 months after surgery. According to ADA criteria, patients were classified as responders (R; n = 18) or non-responders (NR; n = 10). Plasma collected preoperatively and at 3 months was analyzed for circulating miRNAs. Preoperative screening was conducted using TaqMan Low Density Array (n = 17), followed by RT-qPCR validation in the full cohort (n = 28). In the screening phase, NR patients showed higher preoperative miR-144-3p expression (p = 0.033), which also correlated inversely with plasma insulin (p = 0.018). During validation, elevated preoperative miR-144-3p predicted persistent T2DM with an AUC of 0.771 (p = 0.023) and 100 % specificity. Additionally, a post hoc exploratory analysis showed that R patients who relapsed at 5 years had higher miR-144-3p levels at 3 months than those maintaining remission (p < 0.0001). Overall, these findings identify preoperative miR-144-3p as a candidate biomarker for predicting persistent T2DM after RYGB.

尽管RYGB诱导了大量的代谢益处，但2型糖尿病（T2DM）的缓解并不普遍，这给识别不太可能取得血糖控制成功的患者带来了临床挑战。这项前瞻性观察队列研究探讨了术前循环microRNAs （miRNAs）是否能预测肥胖女性Roux-en-Y胃旁路手术（RYGB）后持续的T2DM。28名女性在术前、术后3个月、12个月和60个月分别接受评估。根据ADA标准，将患者分为反应者（R; n = 18）和无反应者（NR; n = 10）。术前和3 个月收集血浆，分析循环mirna。术前使用TaqMan低密度阵列进行筛查（n = 17），然后在全队列中进行RT-qPCR验证（n = 28）。筛查阶段，NR患者术前miR-144-3p表达较高（p = 0.033），且与血浆胰岛素水平呈负相关（p = 0.018）。在验证过程中，术前miR-144-3p升高预测持续性T2DM， AUC为0.771 (p = 0.023)，特异性为100% %。此外，一项事后探索性分析显示，在5 年复发的R患者在3 个月时的miR-144-3p水平高于维持缓解的患者(p

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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 : 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

Differential gut microbiome profiles in diabetic retinopathy: A comparative study across continental populations 糖尿病视网膜病变的不同肠道微生物群特征：跨大陆人群的比较研究。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-05 DOI: 10.1016/j.diabres.2025.113043

Pieu Adhikary , Ankita Maddheshiya , Brijesh Takkar , Taraparsad Das , Souvik Mukherjee

Gut dysbiosis damages gut barrier, stimulates inflammation, endotoxemia, and breakdown of blood-retina barrier, promoting diabetic retinopathy (DR). Most microbiome studies on DR relied on 16S rRNA gene sequencing, documenting altered microbial richness, diversity, and shifts in dominant phyla and genera, though these findings remain inconsistent across populations. The only shotgun metagenomic study to date identified species Eubacterium hallii, Firmicutes bacterium and Alistipes finegoldii enriched in DR, with altered metabolic pathways. The β-diversity showed distinct inter-individual variations in diseased individuals compared to healthy controls (HC). The objective of this narrative review is to highlight the key microbial biomarkers, metabolic pathways, and putative microbiota–gut–retina axis integrating both 16S rRNA and shotgun data to compare microbial alterations across HC, T2DM, and DR. The review concludes with a comprehensive understanding of dysbiotic gut taxa associated with DM and DR in different populations showing wide variability in results mostly due to small sample size, geography, antidiabetic medications, lack of demographic and clinical data and limited taxonomic classification by 16S sequencing. This emphasizes the need of a large scale, multi-ethnic shotgun metagenomic sequencing study with systematically collected medical data and dietary information to understand the contributions of gut microbiome in the progression of DR.

肠道生态失调损害肠道屏障，刺激炎症、内毒素血症和血视网膜屏障的破坏，促进糖尿病视网膜病变（DR）。大多数关于DR的微生物组研究依赖于16S rRNA基因测序，记录了微生物丰富度、多样性的改变，以及优势门和属的变化，尽管这些发现在人群中仍然不一致。迄今为止唯一的霰弹枪宏基因组研究鉴定了富含DR的哈里真杆菌（Eubacterium hallii）、厚壁菌门细菌（Firmicutes bacteria）和阿里斯提普（Alistipes finegoldii），它们的代谢途径发生了改变。与健康对照相比，患病个体的β-多样性表现出明显的个体间差异（HC）。这篇叙述性综述的目的是强调关键的微生物生物标志物、代谢途径和假定的微生物-肠道-视网膜轴，整合16S rRNA和shotgun数据，以比较HC、T2DM和DR之间的微生物变化。综述的结论是对不同人群中与DM和DR相关的益生菌肠道分类群的全面了解，结果存在很大差异，主要是由于样本量小、地理位置、抗糖尿病药物、缺乏人口学和临床资料，16S测序的分类也有限。这强调了需要进行大规模、多种族的散弹枪宏基因组测序研究，系统地收集医学数据和饮食信息，以了解肠道微生物群在DR进展中的作用。

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引用次数: 0

Comparison of efficacy of different glucose control strategies in critically ill adults: a network meta-analysis of randomized controlled trials 危重成人不同血糖控制策略的疗效比较：随机对照试验的网络荟萃分析。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-05 DOI: 10.1016/j.diabres.2025.113034

Zhuoyang Xia , Jiahao Meng , Lidan Mei , Hui Peng , Xingui Dai , Baimei He , Pan Liu , Yumei Wu , Shuguang Gao

Aims

This network meta-analysis aimed to compare the efficacy and safety of four glucose control strategies—strict (≤110 mg/dL), intermediate strict (≤150 mg/dL), liberal (≤180 mg/dL), and very liberal (≤252 mg/dL) among critically ill adults in the intensive care unit (ICU).

Methods

PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to August 28, 2025, for randomized controlled trials (RCTs) comparing glucose control strategies in adult ICU patients. Frequentist random-effects models were used for direct and indirect comparisons, assessed risk of bias with RoB 2.0, and ranked strategies using surface under the cumulative ranking (SUCRA).

Results

Across 63 trials (N = 31,556), no statistically significant differences in all-cause mortality were observed among strategies. However, liberal control ranked highest in reducing mortality (SUCRA 0.8720) and balanced safety. Significant heterogeneity existed in adverse events (I² = 75.8 %, p < 0.01), especially hypoglycemia risk. Surgical ICU subgroup analysis suggested potential benefit from strict control, though requiring intensified monitoring.

Conclusion

Liberal glucose control is the optimal strategy for most ICU patients, balancing mortality reduction and safety. In surgical ICUs, strict control may be considered but requires vigilant hypoglycemia monitoring.

目的：本网络meta分析旨在比较重症监护病房（ICU）危重成人中严格（≤110 mg/dL）、中等严格（≤150 mg/dL）、自由（≤180 mg/dL）和非常自由（≤252 mg/dL）四种血糖控制策略的疗效和安全性。方法：检索PubMed、Embase、Cochrane Library和Web of Science，检索自成立以来至2025年8月28日的比较成人ICU患者血糖控制策略的随机对照试验（RCTs）。使用频率随机效应模型进行直接和间接比较，使用RoB 2.0评估偏倚风险，并使用累积排名（SUCRA）下的表面对策略进行排名。结果：在63项试验中（N = 31,556），不同策略的全因死亡率没有统计学上的显著差异。然而，自由对照在降低死亡率（SUCRA 0.8720）和平衡安全性方面排名最高。不良事件发生率存在显著的异质性（I2 = 75.8 %,p ）结论：自由血糖控制是大多数ICU患者的最佳策略，可以平衡降低死亡率和安全性。在外科icu中，可以考虑严格控制，但需要警惕低血糖监测。

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引用次数: 0

Limb Salvage: A review of stem cell and growth factor therapies for diabetic foot ulcers 残肢修复：干细胞和生长因子治疗糖尿病足溃疡的综述。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-04 DOI: 10.1016/j.diabres.2025.113036

Arwa Metwaly , Shimaa Ismail , Yousef M. Nagy , Amany Abdallah , Shahd M Hassanin , Karim Ramadan , Ahmed Nady , Lydia Melad , Maryam Mahmoud , Menna ullah Abdullah , Abdulla Tantawi Alkarni , Yasser M. Nagy

Diabetic foot ulcers (DFUs) remain a major cause of morbidity, hospitalization, and lower-limb amputation among individuals with diabetes, despite advancements in conventional wound care. Increasing evidence highlights the therapeutic potential of stem cell–based and growth factor–based interventions in correcting impaired angiogenesis, chronic inflammation, and defective extracellular matrix remodeling characteristic of diabetic wounds. This review synthesizes current mechanistic and clinical insights into mesenchymal stem cells, mononuclear cells, pluripotent stem cells, and key growth factors—including EGF, PDGF, VEGF, and PRP—and evaluates their comparative efficacy based on recent randomized trials and network meta-analyses. Findings demonstrate significant improvements in ulcer healing, perfusion indices, and amputation reduction in selected modalities; however, clinical translation remains limited by small sample sizes, methodological heterogeneity, variable delivery techniques, and short-term follow-up. Emerging approaches such as exosome therapy, bioengineered matrices, and combined biologic platforms represent promising future directions. This review underscores the need for standardized protocols and robust multicenter trials to integrate regenerative therapies effectively into DFU management.

尽管传统伤口护理有所进步，但糖尿病足溃疡（DFUs）仍然是糖尿病患者发病、住院和下肢截肢的主要原因。越来越多的证据表明，基于干细胞和生长因子的干预在纠正糖尿病伤口的血管生成障碍、慢性炎症和细胞外基质重塑缺陷方面具有治疗潜力。本综述综合了目前间充质干细胞、单核细胞、多能干细胞和关键生长因子（包括EGF、PDGF、VEGF和prp）的机制和临床见解，并基于最近的随机试验和网络荟萃分析评估了它们的比较疗效。研究结果表明，在选择的模式显著改善溃疡愈合，灌注指数和截肢减少；然而，临床翻译仍然受到样本量小、方法异质性、不同的递送技术和短期随访的限制。新兴的方法，如外泌体治疗、生物工程基质和联合生物平台代表了未来有希望的方向。本综述强调需要标准化的方案和强大的多中心试验，将再生疗法有效地整合到DFU管理中。

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引用次数: 0

Perspectives on antibiotic management of diabetic foot osteomyelitis: A scoping review on routes of administration 糖尿病足骨髓炎抗生素治疗的前景：对给药途径的综述。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-04 DOI: 10.1016/j.diabres.2025.113035

Narimane Meddas , Benoit Gachet , Arthur Piraux , Eric Senneville , Laura M. Drudi , Magali Brousseau-Foley , Virginie Blanchette

Diabetic foot ulcers can progress to diabetic foot osteomyelitis (DFO). Intravenous (IV) antibiotics are traditionally the standard treatment for DFO, but it might reduce quality of life, increase adverse events and costs. Our objective was to examine the potential advantages and disadvantages of antibiotic administration routes for DFO to support a future patient decision aid tool. We conducted a scoping review using the Joanna Briggs Institute methodological framework to map evidence on antibiotic administration routes for DFO using the quintuple aim for quality of care. Records from databases, reference lists, and grey literature were deduplication in EndNote, screened in Rayyan, and assessed independently by two interdisciplinary reviewers. Of 6814, 25 studies were included, all quantitative and mainly retrospective observational (76 %). The majority (68 %) included adult patients with diabetic foot infection or DFO. Oral and IV antibiotics demonstrated comparable clinical outcomes across studies. Data on patient-reported outcomes and experience, team management, equity factors, and standardized definitions of clinical endpoints were largely scarce across studies. Current data suggest that oral antibiotic therapy may be a safe and effective alternative to IV therapy in selected patients with DFO, though substantial evidence gaps remain beyond infection management.

糖尿病足溃疡可发展为糖尿病足骨髓炎（DFO）。静脉注射（IV）抗生素是DFO的传统标准治疗方法，但它可能降低生活质量，增加不良事件和成本。我们的目的是研究DFO抗生素给药途径的潜在优点和缺点，以支持未来患者决策辅助工具。我们使用乔安娜布里格斯研究所的方法学框架进行了范围审查，以利用护理质量的五项目标绘制DFO抗生素给药途径的证据。EndNote中删除数据库、参考文献列表和灰色文献中的记录，在Rayyan中进行筛选，并由两名跨学科审稿人独立评估。6814项研究共纳入25项，均为定量研究，主要为回顾性观察性研究（76%）。大多数（68%）包括糖尿病足感染或DFO的成年患者。口服和静脉注射抗生素在所有研究中显示出相似的临床结果。关于患者报告的结果和经验、团队管理、公平因素和临床终点的标准化定义的数据在研究中基本上是稀缺的。目前的数据表明，对于某些DFO患者，口服抗生素治疗可能是一种安全有效的静脉治疗替代方案，尽管在感染管理方面仍存在大量证据空白。

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引用次数: 0

Prediction of gestational diabetes mellitus using continuous glucose monitoring metrics 使用连续血糖监测指标预测妊娠期糖尿病。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-04 DOI: 10.1016/j.diabres.2025.113044

Ling-Wei Chen , Chee Wai Ku , Ruther Teo Zheng , Jerry Kok Yen Chan , Fabian Yap , See Ling Loy

Aims

We evaluated continuous glucose monitoring (CGM)-derived metrics for predicting gestational diabetes mellitus (GDM).

Methods

We analyzed data from 167 pregnant participants who had ≥ 3 days of CGM data at 18–24 weeks’ gestation and who underwent 75-gram oral-glucose-tolerance-tests at 24–28 weeks in a multi-ethnic prospective cohort. Predictive performance of CGM metrics was assessed using the area-under-the-receiver-operating-characteristic-curve (AUROC) with 20 repetitions of 5-fold cross-validation; optimal cut-points were determined using Youden’s index.

Results

There were 30 (18 %) GDM cases. The strongest predictors were %time-above-7.8-mmol/L (%TA7.8) [AUROC (95 % CI): 0.862 (0.780, 0.945); cut-point: 1.23 %; sensitivity: 0.800; specificity: 0.847] and the hyperglycemia-component-of-the-Glycemic-Risk-Index (Hyper-GRI) [0.862 (0.779, 0.945); cut-point: 0.79; sensitivity: 0.767; specificity: 0.883]. J-index, standard deviation (SD), and mean-amplitude-of-glucose-excursions(MAGE) also achieved AUROCs > 0.80. The predictive performance of these metrics was stronger in women with BMI < 23 kg/m² (n = 89; AUROC range: 0.813–0.882) than in those with BMI ≥ 23 kg/m² (n = 78; AUROC range: 0.657–0.756). Among Chinese participants (n = 142), %TA7.8 and J-index had AUROC > 0.80; in non-Chinese participants (n = 25), SD performed best (AUROC: 0.845). Adding individual CGM metrics to a model including maternal age, pre-pregnancy BMI, job status, ethnicity, history of GDM, and family history of diabetes improved the AUROC from 0.642 to 0.895 (%TA7.8), 0.867 (Hyper-GRI), 0.877 (J-index), 0.868 (SD), and 0.848 (MAGE).

Conclusions

CGM-derived metrics show good performance in predicting GDM and potential for earlier detection of adverse pregnancy glycemic profiles.

目的：我们评估连续血糖监测（CGM）衍生指标预测妊娠糖尿病（GDM）。方法：我们分析了167名妊娠参与者的数据，这些孕妇在妊娠18-24 周时CGM数据≥3 天，并在妊娠24-28 周时进行了75克口服葡萄糖耐量试验。采用受试者工作特征曲线下面积（AUROC）评估CGM指标的预测性能，并进行20次5重交叉验证；利用约登指数确定最佳切点。结果：GDM患者30例（18 %）。最强的预测因子为时间≥7.8 mmol/L (%TA7.8) [AUROC(95 % CI): 0.862(0.780, 0.945)；切割点:1.23 %;灵敏度:0.800;特异性：0.847]，高血糖成分-血糖风险指数（Hyper-GRI） [0.862(0.779, 0.945)；切割点:0.79;灵敏度:0.767;特异性:0.883)。j指数、标准差（SD）和葡萄糖漂移平均振幅（MAGE）也达到了auroc > 0.80。这些指标对BMI为 2 （n = 89；AUROC范围：0.813-0.882）的女性的预测效果强于BMI为 ≥ 23 kg/m2 （n = 78；AUROC范围：0.657-0.756）的女性。在中国参与者中（n = 142），%TA7.8和J-index为AUROC > 0.80；在非华裔参与者中（n = 25），SD表现最佳（AUROC:0.845）。将个体CGM指标加入到包括母亲年龄、孕前BMI、工作状态、种族、GDM史和糖尿病家族史的模型中，AUROC从0.642提高到0.895（%TA7.8）、0.867（super - gri）、0.877（J-index）、0.868（SD）和0.848（MAGE）。结论：cgm衍生的指标在预测GDM和早期发现不良妊娠血糖谱方面表现良好。

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引用次数: 0

The Emerging role of lipoprotein(a) in diabetic kidney disease: possible pathophysiological links and unresolved mechanisms 脂蛋白(a)在糖尿病肾病中的新作用：可能的病理生理联系和尚未解决的机制

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-03 DOI: 10.1016/j.diabres.2025.113040

Habib Yaribeygi , Mina Maleki , Sercan Karav , Prashant Kesharwani , Amirhossein Sahebkar

Diabetic kidney disease (DKD) is one of the most serious microvascular complications of diabetes mellitus and a leading cause of end-stage renal disease worldwide. Although hyperglycemia and hypertension are well-established drivers of DKD, accumulating evidence suggests that additional factors, such as lipoprotein(a) [Lp(a)], may contribute to its pathogenesis. Lp(a) is a genetically determined lipoprotein with pro-atherogenic, pro-inflammatory, and pro-thrombotic properties, and elevated circulating levels have been associated with increased cardiovascular and renal risk in diabetic individuals. In this review, we summarize the current understanding of the relationship between Lp(a) and DKD, with a focus on the proposed molecular mechanisms. These include activation of TGF-β/Smad signaling leading to fibrosis, induction of oxidative stress, chronic inflammation, endothelial dysfunction, impaired fibrinolysis, and direct injury to podocytes resulting in proteinuria. While several clinical and experimental studies support the involvement of Lp(a) in these pathways, the precise molecular mediators remain largely undefined. Understanding these mechanisms may offer novel insights into the pathophysiology of DKD and identify new therapeutic targets. This article aims to provide a comprehensive overview of the potential role of Lp(a) in DKD and to highlight areas requiring further investigation.

糖尿病肾病（DKD）是糖尿病最严重的微血管并发症之一，也是世界范围内终末期肾脏疾病的主要原因。虽然高血糖和高血压是公认的DKD的驱动因素，但越来越多的证据表明，脂蛋白(a) [Lp(a)]等其他因素可能有助于其发病机制。Lp(a)是一种基因决定的脂蛋白，具有促动脉粥样硬化、促炎症和促血栓形成的特性，在糖尿病患者中，循环水平升高与心血管和肾脏风险增加有关。在这篇综述中，我们总结了目前对Lp(a)和DKD之间关系的理解，并重点讨论了可能的分子机制。这些包括导致纤维化的TGF-β/Smad信号的激活、氧化应激的诱导、慢性炎症、内皮功能障碍、纤维蛋白溶解受损以及导致蛋白尿的足细胞直接损伤。虽然一些临床和实验研究支持Lp(a)参与这些途径，但精确的分子介质在很大程度上仍未确定。了解这些机制可以为DKD的病理生理学提供新的见解，并确定新的治疗靶点。本文旨在全面概述Lp(a)在DKD中的潜在作用，并强调需要进一步研究的领域。

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引用次数: 0