Pub Date : 2026-03-01Epub Date: 2026-01-27DOI: 10.1016/j.diabres.2026.113115
Ching Chung Hsiao , Jia-Jin Chen , Shu-Chun Huang , Chieh-Li Yen , Wen-Yu Ho , Yu-Wei Fang , Mon-Ting Chen , Jeng How Yang , Ming-Hsien Tsai
Aims
To compare the risk of infections between GLP-1 receptor agonists (GLP-1 RAs) and SGLT2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM) and advanced chronic kidney disease (CKD).
Methods
Using the TriNetX U.S. Collaborative Network, we conducted a retrospective cohort study of adults with T2DM and eGFR ≤ 45 mL/min/1.73 m2 from 2016 to 2023. After 1:1 propensity score matching, 22,393 new users of GLP-1 RAs and SGLT2i were compared. Infection outcomes were analyzed over a 4-year follow-up using Cox models and Kaplan–Meier analysis.
Results
GLP-1 RA use was associated with a modest increase in overall infection risk compared to SGLT2i (HR 1.04, 95% CI: 1.00–1.07; P = 0.044). Notably, higher risks were observed for biliary tract infections (HR 1.37), catheter-related infections (HR 1.34), and infective endocarditis (HR 1.31). No differences were seen in pneumonia, sepsis, or urinary tract infections. Subgroup analyses showed consistent trends across age, sex, BMI, and cardiovascular status.
Conclusions
In patients with T2DM and advanced CKD, GLP-1 RAs were associated with higher risks of select infections compared to SGLT2i. These findings highlight the need for careful infection monitoring in this vulnerable population.
{"title":"Comparative risk of infections with GLP-1 receptor agonists versus SGLT2 inhibitors in patients with advanced chronic kidney disease and type 2 diabetes","authors":"Ching Chung Hsiao , Jia-Jin Chen , Shu-Chun Huang , Chieh-Li Yen , Wen-Yu Ho , Yu-Wei Fang , Mon-Ting Chen , Jeng How Yang , Ming-Hsien Tsai","doi":"10.1016/j.diabres.2026.113115","DOIUrl":"10.1016/j.diabres.2026.113115","url":null,"abstract":"<div><h3>Aims</h3><div>To compare the risk of infections between GLP-1 receptor agonists (GLP-1 RAs) and SGLT2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM) and advanced chronic kidney disease (CKD).</div></div><div><h3>Methods</h3><div>Using the TriNetX U.S. Collaborative Network, we conducted a retrospective cohort study of adults with T2DM and eGFR ≤ 45 mL/min/1.73 m<sup>2</sup> from 2016 to 2023. After 1:1 propensity score matching, 22,393 new users of GLP-1 RAs and SGLT2i were compared. Infection outcomes were analyzed over a 4-year follow-up using Cox models and Kaplan–Meier analysis.</div></div><div><h3>Results</h3><div>GLP-1 RA use was associated with a modest increase in overall infection risk compared to SGLT2i (HR 1.04, 95% CI: 1.00–1.07; P = 0.044). Notably, higher risks were observed for biliary tract infections (HR 1.37), catheter-related infections (HR 1.34), and infective endocarditis (HR 1.31). No differences were seen in pneumonia, sepsis, or urinary tract infections. Subgroup analyses showed consistent trends across age, sex, BMI, and cardiovascular status.</div></div><div><h3>Conclusions</h3><div>In patients with T2DM and advanced CKD, GLP-1 RAs were associated with higher risks of select infections compared to SGLT2i. These findings highlight the need for careful infection monitoring in this vulnerable population.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113115"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084789","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}
Pub Date : 2026-03-01Epub Date: 2026-02-02DOI: 10.1016/j.diabres.2026.113136
Kate M. Seaton , Hanna C. Jones , Melissa H. Lee , Gary Kilov , Alicia J. Jenkins , Landy M. Wu , Cecilia Pham , Frank Gao , Elif I. Ekinci , Pamela Taylor , Stephen Stranks , Megan Herson , Jennifer Wong , Barbora Paldus , Dev Kevat , Adamandia Kriketos , Spiros Fourlanos , John Wentworth , Katherine Wu , Harsan Kanagaretnam , David N. O’Neal
Aim
To compare real-world glycaemic and clinical outcomes in adults with Type 1 Diabetes (T1DM) using Automated Insulin Delivery (AID) vs. those using manual insulin delivery.
Methods
Demographic and diabetes-related glycaemic and clinical data were prospectively collected via a survey from consecutive participants with T1DM attending TIDM clinics in Australia during 2024–25.
Results
Of 406 participants surveyed (233 females [57.4%], age 45.6 ± 16.5 years). AID was used by 141 participants (34.8%), with 50.2% of non-users expressing interest in AID use. AID use vs. non-use was associated with lower HbA1c (7.2 ± 1.0% [63 ± 19 mmol/mol] vs 7.9 ± 1.6% [63 ± 18 mmol/mol], p < 0.001), Glucose Management Indicator (GMI) (7.2 ± 0.8% [55 ± 8 mmol/mol vs 8.0 ± 1.4% [63 ± 15 mmol/mol], p < 0.001), and higher Time In Range (TIR) (69.21 ± 14.79% vs 50.53 ± 21.8%, p < 0.001), with fewer severe hypoglycaemia episodes (n = 3 [2.1%] vs n = 31 [11.7%], p < 0.001). These associations were observed irrespective of Socio-Economic Indexes for Areas (SEIFA) group.
Conclusion
AID use was associated with better glycaemic and clinical outcomes irrespective of socio-economic status. AID use tended to be more prevalent among the socio-economically advantaged. We strongly advocate for equitable AID access based on clinical need rather than financial means.
{"title":"Survey of glucose levels in adults with T1DM attending clinic using automated insulin delivery (AID) devices compared with manual insulin delivery","authors":"Kate M. Seaton , Hanna C. Jones , Melissa H. Lee , Gary Kilov , Alicia J. Jenkins , Landy M. Wu , Cecilia Pham , Frank Gao , Elif I. Ekinci , Pamela Taylor , Stephen Stranks , Megan Herson , Jennifer Wong , Barbora Paldus , Dev Kevat , Adamandia Kriketos , Spiros Fourlanos , John Wentworth , Katherine Wu , Harsan Kanagaretnam , David N. O’Neal","doi":"10.1016/j.diabres.2026.113136","DOIUrl":"10.1016/j.diabres.2026.113136","url":null,"abstract":"<div><h3>Aim</h3><div>To compare real-world glycaemic and clinical outcomes in adults with Type 1 Diabetes (T1DM) using Automated Insulin Delivery (AID) vs. those using manual insulin delivery.</div></div><div><h3>Methods</h3><div>Demographic and diabetes-related glycaemic and clinical data were prospectively collected via a survey from consecutive participants with T1DM attending TIDM clinics in Australia during 2024–25.</div></div><div><h3>Results</h3><div>Of 406 participants surveyed (233 females [57.4%], age 45.6 ± 16.5 years). AID was used by 141 participants (34.8%), with 50.2% of non-users expressing interest in AID use. AID use vs. non-use was associated with lower HbA1c (7.2 ± 1.0% [63 ± 19 mmol/mol] vs 7.9 ± 1.6% [63 ± 18 mmol/mol], <em>p</em> < 0.001), Glucose Management Indicator (GMI) (7.2 ± 0.8% [55 ± 8 mmol/mol vs 8.0 ± 1.4% [63 ± 15 mmol/mol], <em>p</em> < 0.001), and higher Time In Range (TIR) (69.21 ± 14.79% vs 50.53 ± 21.8%, <em>p</em> < 0.001), with fewer severe hypoglycaemia episodes (n = 3 [2.1%] vs n = 31 [11.7%], <em>p</em> < 0.001). These associations were observed irrespective of Socio-Economic Indexes for Areas (SEIFA) group.</div></div><div><h3>Conclusion</h3><div>AID use was associated with better glycaemic and clinical outcomes irrespective of socio-economic status. AID use tended to be more prevalent among the socio-economically advantaged. We strongly advocate for equitable AID access based on clinical need rather than financial means.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113136"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117456","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}
Pub Date : 2026-03-01Epub Date: 2026-02-07DOI: 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.
{"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":"2026-03-01","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}
Pub Date : 2026-03-01Epub Date: 2026-02-14DOI: 10.1016/j.diabres.2026.113159
Bettina Schuppelius , Elena Lalama , Jiudan Zhang , Kilian Ruether , Marta Csanalosi , Stefan Kabisch , Anette Christ , Eicke Latz , Nicolle Kraenkel , Olga Pivovarova-Ramich , Knut Mai , Andreas F.H. Pfeiffer
Aims
To investigate the impact of diabetes duration and different nutrient profiles on type 2 diabetes remission (T2DR) in response to very low-calorie diets (VLCDs).
Methods
Participants with a BMI > 27 kg/m2 and diabetes duration of ≤ 4 years or ≥ 8 years were studied before and after a VLCD (600–800 kcal/day) for three months, including discontinuation of antidiabetic medication. Individuals were randomly assigned to one of two VLCDs with slightly different macronutrient composition.
Results
T2DR, defined as plasma fasting glucose < 126 mg/dl, was achieved in 34 of 47 participants (72%). Despite similar weight loss of subjects with short and long diabetes duration (−15.2 ± 5.8 kg vs. −13.9 ± 4.8 kg; p = 0.473), subjects with long diabetes duration had a 32% lower remission rate (82% vs. 50%; p = 0.027). T2DR was found to be higher with the high-fiber, high-protein, and low-carb, low-fat formula diet (91% vs. 56%; p = 0.008). Individuals that achieved T2DR had significantly lower fasting plasma glucose and higher C-peptide levels at baseline.
Conclusions
Fasting plasma glucose, C-peptide levels, diabetes duration, and used macronutrient profile emerged as important factors for the achievement of T2DR, although a considerable remission is still possible after long duration of type 2 diabetes.
{"title":"Remission of type 2 diabetes depends on time since diagnosis and low-calorie diet composition: Results of a randomized controlled trial in individuals with overweight and obesity","authors":"Bettina Schuppelius , Elena Lalama , Jiudan Zhang , Kilian Ruether , Marta Csanalosi , Stefan Kabisch , Anette Christ , Eicke Latz , Nicolle Kraenkel , Olga Pivovarova-Ramich , Knut Mai , Andreas F.H. Pfeiffer","doi":"10.1016/j.diabres.2026.113159","DOIUrl":"10.1016/j.diabres.2026.113159","url":null,"abstract":"<div><h3>Aims</h3><div>To investigate the impact of diabetes duration and different nutrient profiles on type 2 diabetes remission (T2DR) in response to very low-calorie diets (VLCDs).</div></div><div><h3>Methods</h3><div>Participants with a BMI > 27 kg/m<sup>2</sup> and diabetes duration of ≤ 4 years or ≥ 8 years were studied before and after a VLCD (600–800 kcal/day) for three months, including discontinuation of antidiabetic medication. Individuals were randomly assigned to one of two VLCDs with slightly different macronutrient composition.</div></div><div><h3>Results</h3><div>T2DR, defined as plasma fasting glucose < 126 <!--> <!-->mg/dl, was achieved in 34 of 47 participants (72%). Despite similar weight loss of subjects with short and long diabetes duration (−15.2 ± 5.8 kg vs. −13.9 ± 4.8 kg; p = 0.473), subjects with long diabetes duration had a 32% lower remission rate (82% vs. 50%; p = 0.027).<!--> <!-->T2DR was found to be higher with the high-fiber, high-protein, and low-carb, low-fat formula diet (91% vs. 56%; p = 0.008). Individuals that achieved T2DR had significantly lower fasting plasma glucose and higher C-peptide levels at baseline.</div></div><div><h3>Conclusions</h3><div>Fasting plasma glucose, C-peptide levels, diabetes duration, and used macronutrient profile emerged as important factors for the achievement of T2DR, although a considerable remission is still possible after long duration of type 2 diabetes.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113159"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206356","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}
Pub Date : 2026-03-01Epub Date: 2026-01-26DOI: 10.1016/j.diabres.2026.113119
Jesús Gibran Hernández-Pérez , Omer Abdelgadir , Maryam R. Hussain , Jaime P. Almandoz , Carlos H. Barcenas , Amil Shah , Lindsay G. Cowell , Sarah E. Messiah , David S. Lopez
Aims
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have demonstrated cardioprotective effects; however, their association with cardiomyopathy remains unclear among patients with cancer and type 2 diabetes mellitus (T2D) treated with chemotherapy, radiation, or immunotherapy. We evaluated whether GLP-1 RA initiation reduces cardiomyopathy risk compared with metformin.
Methods
We conducted a retrospective cohort study using a target trial emulation framework within a large global electronic health record database. Adults aged 18–75 years with cancer and T2D, and prior exposure to chemotherapy, radiation, or immunotherapy were included. Treatment strategies were initiation of GLP-1 RA or metformin between January 2006 and July 2024. The primary outcome was incident cardiomyopathy. A 1:1 propensity score–matched cohort was created, and risk differences (RD) and hazard ratios (HR) were estimated.
Results
Among 10,382 matched patients, cardiomyopathy risk at 18.5 years was lower among GLP-1 RA initiators than metformin initiators (0.31% vs 0.94%; RD − 0.64%, 95% CI − 0.90 to − 0.30; HR 0.43, 95% CI 0.24–0.76). Results were consistent across high-risk subgroups.
Conclusions
GLP-1 RA initiation was associated with a lower risk of cardiomyopathy compared with metformin among patients with cancer and T2D, supporting a potential role for GLP-1 RA in cardio-oncology prevention strategies.
目的：胰高血糖素样肽-1受体激动剂（GLP-1 RA）已被证明具有心脏保护作用；然而，在接受化疗、放疗或免疫治疗的癌症和2型糖尿病（T2D）患者中，它们与心肌病的关系尚不清楚。我们评估GLP-1 RA起始与二甲双胍相比是否能降低心肌病风险。方法：我们在一个大型全球电子健康记录数据库中使用目标试验模拟框架进行了一项回顾性队列研究。年龄在18-75岁的癌症和T2D患者，既往接受过化疗、放疗或免疫治疗。治疗策略为2006年1月至2024年7月间开始GLP-1 RA或二甲双胍。主要结局为偶发心肌病。建立一个1:1倾向评分匹配的队列，并估计风险差异（RD）和风险比（HR）。结果：在10382名匹配的患者中，GLP-1 RA启动者的18.5岁心肌病风险低于二甲双胍启动者（0.31% vs 0.94%; RD - 0.64%, 95% CI - 0.90至- 0.30;HR 0.43, 95% CI 0.24-0.76）。结果在高危亚组中是一致的。结论：在癌症和T2D患者中，与二甲双胍相比，GLP-1 RA的起始与较低的心肌病风险相关，支持GLP-1 RA在心脏肿瘤预防策略中的潜在作用。
{"title":"GLP-1 RA initiation versus metformin and risk of cardiomyopathy in patients with cancer and diabetes treated with chemotherapy, radiation, or immunotherapy: a target trial emulation","authors":"Jesús Gibran Hernández-Pérez , Omer Abdelgadir , Maryam R. Hussain , Jaime P. Almandoz , Carlos H. Barcenas , Amil Shah , Lindsay G. Cowell , Sarah E. Messiah , David S. Lopez","doi":"10.1016/j.diabres.2026.113119","DOIUrl":"10.1016/j.diabres.2026.113119","url":null,"abstract":"<div><h3>Aims</h3><div>Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have demonstrated cardioprotective effects; however, their association with cardiomyopathy remains unclear among patients with cancer and type 2 diabetes mellitus (T2D) treated with chemotherapy, radiation, or immunotherapy. We evaluated whether GLP-1 RA initiation reduces cardiomyopathy risk compared with metformin.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using a target trial emulation framework within a large global electronic health record database. Adults aged 18–75 years with cancer and T2D, and prior exposure to chemotherapy, radiation, or immunotherapy were included. Treatment strategies were initiation of GLP-1 RA or metformin between January 2006 and July 2024. The primary outcome was incident cardiomyopathy. A 1:1 propensity score–matched cohort was created, and risk differences (RD) and hazard ratios (HR) were estimated.</div></div><div><h3>Results</h3><div>Among 10,382 matched patients, cardiomyopathy risk at 18.5 years was lower among GLP-1 RA initiators than metformin initiators (0.31% vs 0.94%; RD − 0.64%, 95% CI − 0.90 to − 0.30; HR 0.43, 95% CI 0.24–0.76). Results were consistent across high-risk subgroups.</div></div><div><h3>Conclusions</h3><div>GLP-1 RA initiation was associated with a lower risk of cardiomyopathy compared with metformin among patients with cancer and T2D, supporting a potential role for GLP-1 RA in cardio-oncology prevention strategies.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113119"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104372","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}
Pub Date : 2026-03-01Epub Date: 2026-02-02DOI: 10.1016/j.diabres.2026.113137
Rodney Kwok , Kartik Kishore , Tina Zafari , Digsu N. Koye , Mariam Hachem , Ian H. de Boer , Tae-Dong Jeong , Won-Ki Min , Esteban Porrini , Petter Bjornstad , Yih Chung Tham , Richard J. MacIsaac , Leonid Churilov , Elif I. Ekinci
Background
Existing methods for estimating GFR in people with diabetes have shown inaccuracies when compared to mGFR measurements. We developed and validated an artificial neural network – RenoTrue to improve estimating GFR in people with diabetes.
Methods
5,619 individuals from five international cohorts with type 1 and type 2 diabetes was split into training (70%), validation (10%) and test (20%) datasets. RenoTrue was developed to estimate GFR using age, sex, and serum creatinine. The performance was evaluated in the test dataset by estimating agreement, bias (mean difference), and accuracy (p30), and compared to CKD-EPI estimates through a multi-level mixed effect regression model.
Findings
Median mGFR was 75 ml/ min per 1.73 m2 [IQR: 49, 100] and median age was 59 years [IQR: 38, 69]. RenoTrue demonstrated high agreement (ICC: 0.87 (95% CI: 0.78, 0.93)), low bias (−0.57 (95% CI: -1.59, 0.46) ml/min per 1.73 m2) and p30 of 81% (95% CI: 79%, 83%) compared to mGFR measurements. The 2009 CKD-EPI equation had an ICC of 0.86 (95% CI: 0.77, 0.92), bias of 4.17 (95% CI: 3.14, 5.20) ml/min per 1.73 m2 and p30 of 74% (95% CI: 72%, 77%).
Conclusion
For people with diabetes, RenoTrue demonstrated better performance compared to the 2009 CKD-EPI equation in terms of estimating GFR across the full range of GFR.
{"title":"RenoTrue: A diabetes-specific machine learning model to estimate glomerular filtration rate for people with diabetes","authors":"Rodney Kwok , Kartik Kishore , Tina Zafari , Digsu N. Koye , Mariam Hachem , Ian H. de Boer , Tae-Dong Jeong , Won-Ki Min , Esteban Porrini , Petter Bjornstad , Yih Chung Tham , Richard J. MacIsaac , Leonid Churilov , Elif I. Ekinci","doi":"10.1016/j.diabres.2026.113137","DOIUrl":"10.1016/j.diabres.2026.113137","url":null,"abstract":"<div><h3>Background</h3><div>Existing methods for estimating GFR in people with diabetes have shown inaccuracies when compared to mGFR measurements. We developed and validated an artificial neural network – RenoTrue to improve estimating GFR in people with diabetes.</div></div><div><h3>Methods</h3><div>5,619 individuals from five international cohorts with type 1 and type 2 diabetes was split into training (70%), validation (10%) and test (20%) datasets. RenoTrue was developed to estimate GFR using age, sex, and serum creatinine. The performance was evaluated in the test dataset by estimating agreement, bias (mean difference), and accuracy (p30), and compared to CKD-EPI estimates through a multi-level mixed effect regression model.</div></div><div><h3>Findings</h3><div>Median mGFR was 75 ml/ min per 1.73 m<sup>2</sup> [IQR: 49, 100] and median age was 59 years [IQR: 38, 69]. RenoTrue demonstrated high agreement (ICC: 0.87 (95% CI: 0.78, 0.93)), low bias (−0.57 (95% CI: -1.59, 0.46) ml/min per 1.73 m<sup>2</sup>) and p30 of 81% (95% CI: 79%, 83%) compared to mGFR measurements. The 2009 CKD-EPI equation had an ICC of 0.86 (95% CI: 0.77, 0.92), bias of 4.17 (95% CI: 3.14, 5.20) ml/min per 1.73 m<sup>2</sup> and p30 of 74% (95% CI: 72%, 77%).</div></div><div><h3>Conclusion</h3><div>For people with diabetes, RenoTrue demonstrated better performance compared to the 2009 CKD-EPI equation in terms of estimating GFR across the full range of GFR.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113137"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118241","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}
Pub Date : 2026-03-01Epub Date: 2026-02-05DOI: 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.
{"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":"2026-03-01","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}
Pub Date : 2026-03-01Epub Date: 2026-02-12DOI: 10.1016/j.diabres.2026.113143
Romy Slebe , Eva Wenker , Linda J. Schoonmade , Emma J. Bouman , Denis P. Blondin , David J.T. Campbell , André C. Carpentier , Joris Hoeks , Parminder Raina , Patrick Schrauwen , Mireille J. Serlie , Dirk Jan Stenvers , Renée de Mutsert , Joline W.J. Beulens , Femke Rutters
{"title":"Corrigendum to “The effect of preprandial versus postprandial physical activity on glycaemia: Meta-analysis of human intervention studies”. [Diabetes Res. Clin. Pract. 210 (2024) 111638]","authors":"Romy Slebe , Eva Wenker , Linda J. Schoonmade , Emma J. Bouman , Denis P. Blondin , David J.T. Campbell , André C. Carpentier , Joris Hoeks , Parminder Raina , Patrick Schrauwen , Mireille J. Serlie , Dirk Jan Stenvers , Renée de Mutsert , Joline W.J. Beulens , Femke Rutters","doi":"10.1016/j.diabres.2026.113143","DOIUrl":"10.1016/j.diabres.2026.113143","url":null,"abstract":"","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113143"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146194411","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}
Pub Date : 2026-03-01Epub Date: 2026-02-13DOI: 10.1016/j.diabres.2026.113155
Pitchai Balakumar , Noohu Abdulla Khan , Vigneshwaran Easwaran , Khalid M. Orayj
Hypoglycemia unawareness is characterized by a reduction in autonomic and neuroglycopenic signals of hypoglycemia; therefore, it is hardly perceivable. Glucagon-like peptide-1 (GLP-1) plays a critical role in glucose metabolism. Experimental model of recurrent hypoglycemia in type 1 diabetes mellitus suggests that increased intestinal GLP-1 expression is associated with impaired counterregulatory responses. However, whether incretin-based drugs or elevated intestinal GLP-1 produce similar impairments, in patients with type 1 and 2 diabetes mellitus and preexisting hypoglycemia-associated autonomic failure, remain incompletely understood. Clinical applications of incretin-based therapies might require caution, especially in sensitive patients, because of GLP-1-mediated disruption of hypoglycemic counterregulation. The impaired counterregulatory response to hypoglycemia could be because of GLP-1’s actions, such as glucagon suppression, reduced sympathoadrenal signaling, modulatory effects on brain signaling during hypoglycemia, delayed gastric emptying, and among others. These factors might collectively contribute to abrogation of counterregulatory mechanisms to hypoglycemia, particularly when GLP-1 is overactive. This impairment should be carefully considered when managing patients with diabetes, especially hypoglycemic-sensitive individuals utilizing incretin-based medications chronically or when these medications are combined with insulin or sulfonylureas. This review brings together the complex role of GLP-1 in disrupting hypoglycemia counterregulation, the related mechanistic insights, and new therapeutic accountabilities pertaining to incretin-based medications.
{"title":"The impact of GLP-1 and incretin-based therapies on counterregulatory responses to hypoglycemia in diabetes mellitus: mechanisms and clinical implications","authors":"Pitchai Balakumar , Noohu Abdulla Khan , Vigneshwaran Easwaran , Khalid M. Orayj","doi":"10.1016/j.diabres.2026.113155","DOIUrl":"10.1016/j.diabres.2026.113155","url":null,"abstract":"<div><div>Hypoglycemia unawareness is characterized by a reduction in autonomic and neuroglycopenic signals of hypoglycemia; therefore, it is hardly perceivable. Glucagon-like peptide-1 (GLP-1) plays a critical role in glucose metabolism. Experimental model of recurrent hypoglycemia in type 1 diabetes mellitus suggests that increased intestinal GLP-1 expression is associated with impaired counterregulatory responses. However, whether incretin-based drugs or elevated intestinal GLP-1 produce similar impairments, in patients with type 1 and 2 diabetes mellitus and preexisting hypoglycemia-associated autonomic failure, remain incompletely understood. Clinical applications of incretin-based therapies might require caution, especially in sensitive patients, because of GLP-1-mediated disruption of hypoglycemic counterregulation. The impaired counterregulatory response to hypoglycemia could be because of GLP-1’s actions, such as glucagon suppression, reduced sympathoadrenal signaling, modulatory effects on brain signaling during hypoglycemia, delayed gastric emptying, and among others. These factors might collectively contribute to abrogation of counterregulatory mechanisms to hypoglycemia, particularly when GLP-1 is overactive. This impairment should be carefully considered when managing patients with diabetes, especially hypoglycemic-sensitive individuals utilizing incretin-based medications chronically or when these medications are combined with insulin or sulfonylureas. This review brings together the complex role of GLP-1 in disrupting hypoglycemia counterregulation, the related mechanistic insights, and new therapeutic accountabilities pertaining to incretin-based medications.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113155"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200388","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}
To investigate the prevalence and clinical characteristics of distal symmetrical polyneuropathy (DSPN) in prediabetes and associations with cardiometabolic risk factors, insulin resistance and arterial stiffness.
Methods
Consecutive adults with prediabetes attending the Outpatient Lipid and Obesity Clinic at the University Hospital of Ioannina, Greece were recruited. This is a cross sectional- analysis of the baseline characteristics of a prospective observational study. DSPN was diagnosed using the neuropathy symptom score (NSS), the neuropathy disability score (NDS) and the vibration perception threshold (VTP). Arterial stiffness was assessed with carotid-femoral pulse wave velocity (PWV).
Results
We studied 160 consecutive adults with prediabetes, of whom 27 (16.9%) were diagnosed with DSPN. In multivariate analysis, waist circumference (OR: 1.092, 95% CI: 1.037–1.148, p < 0.001) and HOMA-IR (OR: 1.247, 95% CI: 1.095–1.425, p = 0.004) were independently associated with prevalent DSPN. Additionally, sensitivity analysis showed that current/previous smoking vs never-smoking (OR: 1.347, 95% CI: 1.116–1.891, p = 0.042) and height (OR: 1.083, 95% CI: 1.004–1.168, p = 0.039) were independently linked with prevalent DSPN. Subjects with DSPN had significantly higher median PWV (8.8 vs 8.0 m/s, p = 0.031) and prevalence of abnormal PWV (≥10 m/s) (29.6% vs 11.3%, p = 0.029) compared with no DSPN. PWV was independently associated with VPT (beta: 1.010, 95% CI:0.123–1.897, p = 0.026).
Conclusions
The prevalence of DSPN in prediabetes is not negligible in our study. DSPN is independently associated with central obesity and insulin resistance.
目的：探讨糖尿病前期远端对称性多神经病变（DSPN）的患病率、临床特征及其与心脏代谢危险因素、胰岛素抵抗和动脉僵硬的关系。方法：在希腊约阿尼纳大学医院脂质和肥胖门诊连续招募患有前驱糖尿病的成年人。这是一项前瞻性观察性研究的基线特征的横断面分析。采用神经病变症状评分（NSS）、神经病变失能评分（NDS）和振动感知阈值（VTP）诊断DSPN。用颈-股脉波速度（PWV）评估动脉僵硬度。结果：我们研究了160名连续患有前驱糖尿病的成年人，其中27人（16.9%）被诊断为DSPN。在多变量分析中，腰围（OR: 1.092, 95% CI: 1.037-1.148, p ）结论：在我们的研究中，DSPN在前驱糖尿病中的患病率不容忽视。DSPN与中心性肥胖和胰岛素抵抗独立相关。
{"title":"Distal symmetrical polyneuropathy in prediabetes is associated with abdominal obesity and insulin resistance","authors":"Georgia Anastasiou , Nikolaos Papanas , Fotios Barkas , Nicholas Tentolouris , Georgios Liamis , Lampros K. Michalis , Aris Bechlioulis , Rigas Kalaitzidis , Evangelos Liberopoulos","doi":"10.1016/j.diabres.2026.113140","DOIUrl":"10.1016/j.diabres.2026.113140","url":null,"abstract":"<div><h3>Aims</h3><div>To investigate the prevalence and clinical characteristics of distal symmetrical polyneuropathy (DSPN) in prediabetes and associations with cardiometabolic risk factors, insulin resistance and arterial stiffness.</div></div><div><h3>Methods</h3><div>Consecutive adults with prediabetes attending the Outpatient Lipid and Obesity Clinic at the University Hospital of Ioannina, Greece were recruited. This is a cross sectional- analysis of the baseline characteristics of a prospective observational study. DSPN was diagnosed using the neuropathy symptom score (NSS), the neuropathy disability score (NDS) and the vibration perception threshold (VTP). Arterial stiffness was assessed with carotid-femoral pulse wave velocity (PWV).</div></div><div><h3>Results</h3><div>We studied 160 consecutive adults with prediabetes, of whom 27 (16.9%) were diagnosed with DSPN. In multivariate analysis, waist circumference (OR: 1.092, 95% CI: 1.037–1.148, p < 0.001) and HOMA-IR (OR: 1.247, 95% CI: 1.095–1.425, p = 0.004) were independently associated with prevalent DSPN. Additionally, sensitivity analysis showed that current/previous smoking vs never-smoking (OR: 1.347, 95% CI: 1.116–1.891, p = 0.042) and height (OR: 1.083, 95% CI: 1.004–1.168, p = 0.039) were independently linked with prevalent DSPN. Subjects with DSPN had significantly higher median PWV (8.8 vs 8.0 m/s, p = 0.031) and prevalence of abnormal PWV (≥10 m/s) (29.6% vs 11.3%, p = 0.029) compared with no DSPN. PWV was independently associated with VPT (beta: 1.010, 95% CI:0.123–1.897, p = 0.026).</div></div><div><h3>Conclusions</h3><div>The prevalence of DSPN in prediabetes is not negligible in our study. DSPN is independently associated with central obesity and insulin resistance.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113140"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131029","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}
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