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}
Pub Date : 2026-03-01Epub Date: 2026-01-28DOI: 10.1016/j.diabres.2026.113122
Xuecan Cui , Liran Zheng , Min Ding , Bai Chang , Chunmei Zhang , Hairong Ma , Wenyan Xu , Shuai Wang , Meijun Wang
Aims
The C-reactive protein-triglyceride-glucose index (CTI) is a novel biomarker of insulin resistance and inflammation. This study aimed to investigate the association between baseline CTI and all-cause and cardiovascular (CVD) mortality in patients with diabetic foot (DF), providing a scientific basis for clarifying this relationship in clinical practice.
Methods
A total of 827 inpatients meeting inclusion criteria were enrolled from a tertiary hospital DF department in Tianjin (2020–2021), with median follow-up of 47 months. Outcomes included all-cause and CVD mortality. Multivariable Cox regression, restricted cubic splines (RCS), Kaplan–Meier analysis, and ROC curves were used to evaluate associations and predictive performance.
Results
During follow-up, 325 all-cause deaths occurred, including 158 CVD deaths. Fully adjusted models showed that high CTI was associated with 57% higher all-cause mortality (HR = 1.57, 95% CI:1.24–2.00) and 50% higher CVD mortality (HR = 1.50, 95% CI:1.06–2.11). RCS indicated nonlinear associations (P < 0.05), and ROC supported CTI’s predictive accuracy for mortality.
Conclusions
A higher CTI level was independently associated with an increased risk of all-cause and cardiovascular mortality in patients with diabetic foot. The CTI may serve as a promising and easily accessible risk stratification tool, though its clinical utility requires validation in prospective studies.
{"title":"The association between the C-reactive protein-triglyceride-glucose index and all-cause and cardiovascular mortality in patients with diabetic foot: A retrospective cohort study","authors":"Xuecan Cui , Liran Zheng , Min Ding , Bai Chang , Chunmei Zhang , Hairong Ma , Wenyan Xu , Shuai Wang , Meijun Wang","doi":"10.1016/j.diabres.2026.113122","DOIUrl":"10.1016/j.diabres.2026.113122","url":null,"abstract":"<div><h3>Aims</h3><div>The C-reactive protein-triglyceride-glucose index (CTI) is a novel biomarker of insulin resistance and inflammation. This study aimed to investigate the association between baseline CTI and all-cause and cardiovascular (CVD) mortality in patients with diabetic foot (DF), providing a scientific basis for clarifying this relationship in clinical practice.</div></div><div><h3>Methods</h3><div>A total of 827 inpatients meeting inclusion criteria were enrolled from a tertiary hospital DF department in Tianjin (2020–2021), with median follow-up of 47 months. Outcomes included all-cause and CVD mortality. Multivariable Cox regression, restricted cubic splines (RCS), Kaplan–Meier analysis, and ROC curves were used to evaluate associations and predictive performance.</div></div><div><h3>Results</h3><div>During follow-up, 325 all-cause deaths occurred, including 158 CVD deaths. Fully adjusted models showed that high CTI was associated with 57% higher all-cause mortality (HR = 1.57, 95% CI:1.24–2.00) and 50% higher CVD mortality (HR = 1.50, 95% CI:1.06–2.11). RCS indicated nonlinear associations (P < 0.05), and ROC supported CTI’s predictive accuracy for mortality.</div></div><div><h3>Conclusions</h3><div>A higher CTI level was independently associated with an increased risk of all-cause and cardiovascular mortality in patients with diabetic foot. The CTI may serve as a promising and easily accessible risk stratification tool, though its clinical utility requires validation in prospective studies.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113122"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092427","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: 2026-01-29DOI: 10.1016/j.diabres.2026.113131
Soree Ryang , Jinmi Kim , Minsoo Kim , Myungsoo Im , Doohwa Kim , Yeong Jin Kim , Hyuk Kang , Young Jin Kim , In Joo Kim , Stephane T. Chung , Michael Bergman , Arthur Sherman , Sang Soo Kim , Joon Ha
Aims: Early identification of individuals at risk for type 2 diabetes (T2D) is essential for prevention. We evaluated a novel model-derived disposition index without insulin (mDI-woI), which requires only glucose values from a three time-point oral glucose tolerance test (OGTT: 0, 60, 120 min).
Methods: Among 5,742 healthy Koreans (age 51.2 ± 8.6 years, BMI 24.5 ± 3.1 kg/m2) followed biennially for up to 14 years with repeated OGTTs, we compared baseline mDI-woI with current diabetes biomarkers and the oral disposition index (oDI) using AUC-ROC analyses.
Results: mDI-woI and mean OGTT glucose (mean G) showed the strongest prediction for incident T2D (AUC = 0.79 each), outperforming fasting plasma glucose (0.67), 1 h-PG (0.77), 2 h-PG (0.72), HbA1c (0.71), and oDI (0.68; all P < 0.001). In individuals who progressed to T2D, baseline mDI-woI, mean G, and 1-PG exceeded their thresholds while fasting and 2 h glucose were still below prediabetes cutoffs, indicating earlier risk detection. Moreover, the novel marker mDI-woI is the earliest one, 4 years earlier than mean G and 4.5 years earlier than 1 h-PG, the next two earliest.
Conclusions: Using only three glucose measurements without measuring insulin, mDI-woI provides a simple, sensitive, and clinically practical early marker that outperforms current diabetes criteria for predicting T2D progression, with strong potential for large-scale studies.
{"title":"A novel disposition index without insulin is an earlier and sensitive predictor of type 2 diabetes than current diagnostic criteria","authors":"Soree Ryang , Jinmi Kim , Minsoo Kim , Myungsoo Im , Doohwa Kim , Yeong Jin Kim , Hyuk Kang , Young Jin Kim , In Joo Kim , Stephane T. Chung , Michael Bergman , Arthur Sherman , Sang Soo Kim , Joon Ha","doi":"10.1016/j.diabres.2026.113131","DOIUrl":"10.1016/j.diabres.2026.113131","url":null,"abstract":"<div><div>Aims: Early identification of individuals at risk for type 2 diabetes (T2D) is essential for prevention. We evaluated a novel model-derived disposition index without insulin (mDI-woI), which requires only glucose values from a three time-point oral glucose tolerance test (OGTT: 0, 60, 120 min).</div><div>Methods: Among 5,742 healthy Koreans (age 51.2 ± 8.6 years, BMI 24.5 ± 3.1 kg/m<sup>2</sup>) followed biennially for up to 14 years with repeated OGTTs, we compared baseline mDI-woI with current diabetes biomarkers and the oral disposition index (oDI) using AUC-ROC analyses.</div><div>Results: mDI-woI and mean OGTT glucose (mean G) showed the strongest prediction for incident T2D (AUC = 0.79 each), outperforming fasting plasma glucose (0.67), 1 h-PG (0.77), 2 h-PG (0.72), HbA1c (0.71), and oDI (0.68; all P < 0.001). In individuals who progressed to T2D, baseline mDI-woI, mean G, and 1-PG exceeded their thresholds while fasting and 2 h glucose were still below prediabetes cutoffs, indicating earlier risk detection. Moreover, the novel marker mDI-woI is the earliest one, 4 years earlier than mean G and 4.5 years earlier than 1 h-PG, the next two earliest.</div><div>Conclusions: Using only three glucose measurements without measuring insulin, mDI-woI provides a simple, sensitive, and clinically practical early marker that outperforms current diabetes criteria for predicting T2D progression, with strong potential for large-scale studies.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113131"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096989","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 longitudinally investigate early indicators of cardiovascular disease (CVD) in youths with Type 1 Diabetes Mellitus (T1DM) and their associations with novel metrics derived from continuous glucose monitoring (CGM) systems.
Patients and methods
Eighty-seven patients (mean age: 10.72 ± 3.35 years), completed 3 visits at six-to-twelve-month intervals. In each visit, Pulse Wave Velocity (PWV) and Augmentation Index @75 (AIx@75) were quantified using a validated, non-invasive method, while glycemic parameters such as HbA1c, time in range (TIR), time above range (TAR) and time below range (TBR) were assessed in the trimester prior to the assessment. Patients were categorized according to TIR into TIR improvers: patients with constantly TIR ≥ 70% or constantly TIR ≥ 60% and improved by +≥10% from baseline versus TIR non-improvers and additionally according to HbA1c into HbA1c improvers: patients with constantly HbA1c ≤ 7% or constantly HbA1c ≤ 8% and improved by −≥0.8% from baseline versus HbA1c non-improvers.
Results
TIR improvers showed significant improvement in Δ PWV Z-score according to age and in Δ Systolic Blood Pressure index. No significant difference was observed between HbA1c improvers and non-improvers.
Conclusion
New glycemic metrics seem to serve as more sensitive and early predictors of CVD in young patients with T1DM. Further studies are needed to replicate and confirm these preliminary results.
{"title":"Longitudinal study of arterial stiffness in pediatric patients with Type 1 Diabetes Mellitus (T1DM). Correlations with glycemic metrics derived from Continuous Glucose Monitoring (CGM) devices","authors":"Eirini Georeli , Georgia Sotiriou , Athanasia Chainoglou , Assimina Galli-Tsinopoulou , Stella Stabouli , Athanasios Christoforidis","doi":"10.1016/j.diabres.2026.113132","DOIUrl":"10.1016/j.diabres.2026.113132","url":null,"abstract":"<div><h3>Aim</h3><div>To longitudinally investigate early indicators of cardiovascular disease (CVD) in youths with Type 1 Diabetes Mellitus (T1DM) and their associations with novel metrics derived from continuous glucose monitoring (CGM) systems.</div></div><div><h3>Patients and methods</h3><div>Eighty-seven patients (mean age: 10.72 ± 3.35 years), completed 3 visits at six-to-twelve-month intervals. In each visit, Pulse Wave Velocity (PWV) and Augmentation Index @75 (AIx@75) were quantified using a validated, non-invasive method, while glycemic parameters such as HbA1c, time in range (TIR), time above range (TAR) and time below range (TBR) were assessed in the trimester prior to the assessment. Patients were categorized according to TIR into TIR improvers: patients with constantly TIR ≥ 70% or constantly TIR ≥ 60% and improved by +≥10% from baseline versus TIR non-improvers and additionally according to HbA1c into HbA1c improvers: patients with constantly HbA1c ≤ 7% or constantly HbA1c ≤ 8% and improved by −≥0.8% from baseline versus HbA1c non-improvers.</div></div><div><h3>Results</h3><div>TIR improvers showed significant improvement in Δ PWV Z-score according to age and in Δ Systolic Blood Pressure index. No significant difference was observed between HbA1c improvers and non-improvers.</div></div><div><h3>Conclusion</h3><div>New glycemic metrics seem to serve as more sensitive and early predictors of CVD in young patients with T1DM. Further studies are needed to replicate and confirm these preliminary results.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113132"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097033","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.2026.113147
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.
{"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":"2026-03-01","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}
Pub Date : 2026-02-28DOI: 10.1016/j.diabres.2026.113193
Xiang Xianrong, Liu Xichang
Diabetes-related cognitive dysfunction (DCI) is a common central nervous system complication of diabetes mellitus; however, its pathogenesis remains poorly understood despite its significant clinical impact. The glymphatic system (GS), a waste clearance pathway in the brain, has been implicated in various central nervous system disorders. This review aims to systematically elaborate on the central role of the glymphatic system in DCI. We first summarize neuroimaging evidence of glymphatic system dysfunction in diabetes, including a reduced DTI-ALPS index and enlarged perivascular spaces. Furthermore, we examine its mechanisms, including dysregulated AQP4, impaired perivascular space function, and compromised drivers like arterial pulsation and sleep. Finally, we discuss the potential of glymphatic-targeted therapies, from lifestyle adjustments to pharmacological agents, for ameliorating DCI. This review emphasizes that glymphatic system dysfunction is a key link connecting diabetic metabolic disturbances to cognitive decline, offering a novel perspective and direction for research in this field.
{"title":"Advances in the study of the glymphatic system and diabetes-related cognitive dysfunction.","authors":"Xiang Xianrong, Liu Xichang","doi":"10.1016/j.diabres.2026.113193","DOIUrl":"10.1016/j.diabres.2026.113193","url":null,"abstract":"<p><p>Diabetes-related cognitive dysfunction (DCI) is a common central nervous system complication of diabetes mellitus; however, its pathogenesis remains poorly understood despite its significant clinical impact. The glymphatic system (GS), a waste clearance pathway in the brain, has been implicated in various central nervous system disorders. This review aims to systematically elaborate on the central role of the glymphatic system in DCI. We first summarize neuroimaging evidence of glymphatic system dysfunction in diabetes, including a reduced DTI-ALPS index and enlarged perivascular spaces. Furthermore, we examine its mechanisms, including dysregulated AQP4, impaired perivascular space function, and compromised drivers like arterial pulsation and sleep. Finally, we discuss the potential of glymphatic-targeted therapies, from lifestyle adjustments to pharmacological agents, for ameliorating DCI. This review emphasizes that glymphatic system dysfunction is a key link connecting diabetic metabolic disturbances to cognitive decline, offering a novel perspective and direction for research in this field.</p>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":" ","pages":"113193"},"PeriodicalIF":7.4,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343915","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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