Diabetes research and clinical practice最新文献_第7页

The burden and mortality impact of cardiovascular disease–metabolic dysfunction–associated steatotic liver disease comorbidity 心血管疾病-代谢功能障碍相关脂肪变性肝病合并症的负担和死亡率影响

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-07 DOI: 10.1016/j.diabres.2026.113092

Siyuan Tan , Ting Huang , Zixi Zhang , Jiabao Zhou , Hao Chen , Tao Tu , Qiuzhen Lin , Yichao Xiao , Qiming Liu

Background

Cardiovascular disease (CVD) and metabolic dysfunction–associated steatotic liver disease (MASLD) are metabolically linked, yet their combined burden and mortality impact remain underexplored.

Methods

Using Global Burden of Disease (GBD) 2023 data, we assessed temporal and regional trends in CVD, MASLD, and metabolic risk factors. National Health and Nutrition Examination Survey (NHANES) data were subsequently analyzed to examine the association between CVD–MASLD comorbidity and mortality using multivariable and survival models.

Results

From 1990 to 2023, the global burden of CVD declined steadily, whereas MASLD rose continuously, showing divergent and regionally heterogeneous trends. In high-income countries, CVD indicators decreased despite increasing MASLD burden, whereas this inverse pattern was weaker in upper–middle-income regions. In NHANES, individuals with CVD–MASLD comorbidity exhibited the highest metabolic abnormalities and mortality risk. Compared with those without comorbidities, adjusted hazard ratios were 1.68 for all-cause and 2.68 for cardiovascular mortality. Mortality rose progressively with fibrosis severity. PAF analyses showed that CVD, MASLD, and their comorbidity accounted for 13.3%, 1.3%, and 7.8% of cardiovascular deaths, respectively, totaling 22.4%. These associations demonstrated marked age-related heterogeneity.

Conclusion

CVD–MASLD comorbidity is an emerging global concern associated with excess mortality, emphasizing the need to incorporate MASLD screening and fibrosis evaluation into cardiovascular prevention strategies.

背景：心血管疾病（CVD）和代谢功能障碍相关的脂肪变性肝病（MASLD）是代谢相关的，但它们的综合负担和死亡率影响仍未得到充分研究。方法：利用全球疾病负担（GBD） 2023数据，我们评估了CVD、MASLD和代谢危险因素的时间和区域趋势。随后分析NHANES数据，使用多变量和生存模型检查CVD-MASLD合并症与死亡率之间的关系。结果：从1990年到2023年，全球心血管疾病负担稳步下降，而MASLD持续上升，呈现出差异和区域异质性趋势。在高收入国家，尽管MASLD负担增加，但心血管疾病指标有所下降，而在中高收入地区，这种相反的模式较弱。在NHANES中，患有CVD-MASLD合并症的个体表现出最高的代谢异常和死亡风险。与无合并症的患者相比，调整后的全因死亡率风险比为1.68，心血管死亡率风险比为2.68。死亡率随着纤维化的严重程度逐渐上升。PAF分析显示，CVD、MASLD及其合并症分别占心血管死亡的13.3%、1.3%和7.8%，总计22.4%。这些关联显示出明显的年龄相关异质性。结论：CVD-MASLD合并症是一个新兴的全球关注的问题，与过高的死亡率有关，强调需要将MASLD筛查和纤维化评估纳入心血管预防策略。

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引用次数: 0

Glucagon-like peptide-1 receptor agonists and risk of osteoarthritis among individuals with type 2 diabetes: A population-based cohort study 胰高血糖素样肽-1受体激动剂与2型糖尿病患者骨关节炎风险：一项基于人群的队列研究

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-07 DOI: 10.1016/j.diabres.2026.113091

Minjeong Jeon , Bin Hong , Hwa Yeon Ko , Hong Ji Song , Soo Heon Kwak , Ju Hwan Kim , Ju-Young Shin

Aims

To compare the risk of osteoarthritis among patients with type 2 diabetes mellitus (T2DM) initiating glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus dipeptidyl peptidase-4 inhibitors (DPP4Is).

Methods

We conducted a nationwide cohort study applying a target trial emulation framework. From the National Health Insurance Service data of South Korea (2010–2022), eligible patients included adult patients with T2DM initiated GLP-1RAs or DPP4Is. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs of incident osteoarthritis, and were weighted using propensity score fine stratification.

Results

Among 2,056,824 eligible patients, 9,866 started GLP-1RAs (mean age 45 years; 55% male; 67% dulaglutide) and 2,047,158 started DPP4Is (mean age 56 years; 70% male). After weighting, all covariates were well balanced, with patients having a mean age of 45 years and 55% being male. The incidence rates per 100 person-years for osteoarthritis were 3.99 (95% CI, 3.54–4.48) and 4.36 (4.34–4.38) among GLP-1RAs and DPP4Is users, respectively. Compared to DPP4Is, GLP-1RAs were not associated with a lower risk of osteoarthritis (HR 0.93, 95% CI, 0.83–1.05).

Conclusions

The use of GLP-1RAs, primarily dulaglutide, was not associated with lower risk of osteoarthritis compared with DPP4Is use among patients with T2DM.

目的：比较2型糖尿病（T2DM）患者启动胰高血糖素样肽-1受体激动剂（GLP-1RAs）与二肽基肽酶-4抑制剂（DPP4Is）的骨关节炎风险。方法：我们进行了一项全国性队列研究，应用目标试验模拟框架。从韩国国民健康保险服务（2010-2022）的数据中，符合条件的患者包括T2DM初始化GLP-1RAs或DPP4Is的成年患者。Cox比例风险模型用于估计发生骨关节炎的风险比（hr）和95% ci，并使用倾向评分精细分层进行加权。结果：在2,056,824例符合条件的患者中，9,866例开始使用GLP-1RAs（平均年龄45 岁；55%为男性；67%为dulaglutide）， 2,047,158例开始使用DPP4Is（平均年龄56 岁；70%为男性）。加权后，所有协变量平衡良好，患者平均年龄为45 岁，55%为男性。GLP-1RAs和DPP4Is使用者的骨关节炎发病率分别为每100人年3.99 （95% CI, 3.54-4.48）和4.36（4.34-4.38）。与DPP4Is相比，GLP-1RAs与骨关节炎风险降低无关（HR 0.93, 95% CI, 0.83-1.05）。结论：与使用DPP4Is相比，在T2DM患者中使用GLP-1RAs（主要是dulaglutide）与降低骨关节炎风险无关。

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引用次数: 0

The results of ProHCL: Patient-reported outcomes in people living with type 1 diabetes on hybrid closed-loop insulin pump therapy − experiences from the NHS England pilot ProHCL的结果：患者报告的混合闭环胰岛素泵治疗1型糖尿病患者的结果-来自英国国民保健服务试点的经验。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-06 DOI: 10.1016/j.diabres.2026.113084

Tomás P Griffin , Jennifer Hagan , Radhika Chauhan , Thomas SJ Crabtree , Dawn Ackroyd , Jackie Elliott , Parth Narendran , Zosanglura Bawlchhim , Emma G Wilmot , Michelle Hadjiconstantinou , Pratik Choudhary

Aims

This study evaluated the impact of ≥3 months of HCL use on patient-reported outcomes (PROs) in PwT1D and their partners.

Methods

Participants enrolled on the NHS England HCL pilot were invited to take part in a mixed-methods study. Here, we present the results of the quantitative study. PwT1D completed online questionnaires, including INSPIRE (0–100), DTSQc (−18 to +18), System Usability Scale (0–100), and bespoke measures. Self-reported clinical data were collected. Optionally, partners completed the INSPIRE for partners questionnaire.

Results

A total of 125 PwT1D and 33 partners participated. PROs included: INSPIRE 88/100 (IQR 73–95) and DTSQc 17/18(14–18). In INSPIRE, >70 % strongly agree that HCL improved HbA1c, time in range and overall quality of life. In DTSQc, >70 % noted that their blood glucose levels had been unacceptably low/high much less of the time since starting HCL. However, 54.4 % reported increased alarm burden and 21.6 % information overload. People who found HCL harder to use based on the SUS score had lower INSPIRE, DTSQs and DTSQc scores and higher HbA1c than those who found HCL easier to use.

Conclusions

HCL therapy is associated with improved PROs in PwT1D. However, system usability significantly influences outcomes, and alarm and data burden remain concerns.

目的：本研究评估HCL使用≥3个月对PwT1D及其伴发患者报告结局（pro）的影响。方法：参加NHS英格兰HCL试点的参与者被邀请参加一项混合方法研究。在这里，我们提出了定量研究的结果。PwT1D完成了在线问卷调查，包括INSPIRE（0-100）、DTSQc（-18至+18）、系统可用性量表（0-100）和定制测量。收集自我报告的临床资料。合作伙伴还可选择完成INSPIRE for partners问卷调查。结果：共有125名PwT1D和33名合作伙伴参与。优点包括：INSPIRE 88/100 （IQR 73-95）和DTSQc 17/18（14-18）。在INSPIRE中，bbb70 %强烈同意HCL改善了HbA1c、生存范围时间和整体生活质量。在DTSQc中，bbb70 %注意到他们的血糖水平在开始使用HCL后一直处于不可接受的低/高水平。然而，54.4% %报告报警负担增加，21.6% %报告信息过载。根据SUS评分发现HCL更难使用的人比发现HCL更容易使用的人有更低的INSPIRE、DTSQs和DTSQc评分和更高的HbA1c。结论：HCL治疗可改善PwT1D患者的PROs。然而，系统可用性显著影响结果，报警和数据负担仍然值得关注。

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引用次数: 0

The effects of e-Health and artificial intelligence literacy levels on disease self-management in patients with diabetes 电子健康和人工智能素养水平对糖尿病患者疾病自我管理的影响

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-03 DOI: 10.1016/j.diabres.2026.113082

Nilhan Töyer Şahin , Seda Pehlivan

Background

This study was conducted to examine the effects of eHealth and artificial intelligence literacy on disease self-management in patients with diabetes.

Methods

The cross-sectional study was conducted with 212 patients with diabetes who were followed up in Endocrinology clinics and outpatient clinics of a hospital between October 2024 and June 2025. Data were collected through face-to-face interviews using a Personal Information Form, the eHealth Literacy Scale, the Artificial Intelligence (AI) Literacy Scale, and the Diabetes Self-Management Questionnaire. Data were analysed using the SPSS-27 software, and p = 0.05 was considered statistically significant.

Results

The mean age of the 212 patients was 52.09 ± 17.02, and their mean disease duration was 9.66 ± 8.47 years. The patients had mean Diabetes Self-Management Questionnaire, eHealth Literacy Scale, and AI Literacy Scale scores of 6.47 ± 1.50, 27.87 ± 8.83, and 48.12 ± 11.26, respectively. Diabetes self-management was significantly and positively correlated with eHealth literacy (r = 0.505; p = 0.000) and AI literacy (r = 0.499; p = 0.000). Additionally, a positive significant relationship was found between general eHealth literacy and AI literacy (r = 0.865; p = 0.000).

Conclusions

The results of this study suggest that general eHealth and AI literacy play a significant role in supporting diabetes self-management.

背景：本研究旨在探讨电子健康和人工智能素养对糖尿病患者疾病自我管理的影响。方法：对2024年10月~ 2025年6月在某医院内分泌科门诊和门诊随访的212例糖尿病患者进行横断面研究。通过面对面访谈收集数据，使用个人信息表、电子健康素养量表、人工智能（AI）素养量表和糖尿病自我管理问卷。采用SPSS-27软件对数据进行分析，p = 0.05认为有统计学意义。结果：212例患者平均年龄为52.09 ± 17.02岁，平均病程为9.66 ± 8.47 年。患者糖尿病自我管理问卷、电子健康素养量表和人工智能素养量表的平均得分分别为6.47 ± 1.50、27.87 ± 8.83和48.12 ± 11.26。糖尿病自我管理与eHealth素养（r = 0.505;p = 0.000）和AI素养（r = 0.499;p = 0.000）呈显著正相关。此外，一般电子健康素养与人工智能素养之间存在显著的正相关关系（r = 0.865;p = 0.000）。结论：本研究的结果表明，一般的电子健康和人工智能素养在支持糖尿病自我管理方面发挥着重要作用。

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引用次数: 0

Cerebral microbleeds are associated with deficits in cognitive processing speed and executive functions in middle-aged adults with type 1 diabetes 1型糖尿病中年患者脑微出血与认知处理速度和执行功能缺陷有关。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-02 DOI: 10.1016/j.diabres.2025.113080

Iiris Kyläheiko , Aleksi Tarkkonen , Linda Kuusela , Juha Martola , Teemu I. Paajanen , Jussi Virkkala , Per-Henrik Groop , Lena M. Thorn , Turgut Tatlisumak , Jukka Putaala , Daniel Gordin , Hanna Jokinen , on behalf of the FinnDiane Study Group

Aims

Adults with type 1 diabetes (T1D) have an increased risk of cerebral small vessel disease (cSVD)-related brain changes already in midlife, yet their significance for cognitive functions remains poorly understood. We investigated associations between cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and cognition in individuals with T1D and without any neurological symptoms.

Methods

Participants (n=167; age 46.4±7.7 years) underwent cross-sectional clinical and biochemical evaluations, brain magnetic resonance imaging, and neuropsychological assessment. CMB number and topography (lobar, deep/infratentorial, or mixed location) and WMHs, quantified volumetrically, were evaluated.

Results

Compared to absence of CMBs, higher burden of CMBs (≥3) was associated independently of age with poorer processing speed (standardized β from 0.18 to 0.23, p<0.05) and executive functions (standardized β from 0.18 to –0.25, p<0.05), but not with episodic memory. Mild WMHs had no independent relationships with cognition. Compared to other topographies, mixed CMB location was more often negatively related to cognition (standardized β from 0.20 to 0.32, p<0.05).

Conclusions

CMBs were related to a subtle, yet systematic impairment in cognition, whereas mild WMHs were not. The results provide insight into the development of early cSVD-related cognitive changes already in midlife and suggest an increased risk of cognitive decline in T1D.

目的：1型糖尿病（T1D）成人在中年时发生脑血管疾病（cSVD）相关脑变化的风险增加，但其对认知功能的意义仍知之甚少。我们研究了没有任何神经系统症状的T1D患者脑微出血（CMBs）、白质高信号（WMHs）和认知之间的关系。方法：167名参与者（年龄46.4±7.7岁）接受了横断面临床和生化评估、脑磁共振成像和神经心理学评估。定量评估CMB数量和地形（大叶、深/幕下或混合位置）和wmh。结果：与没有CMBs相比，CMBs负担高（≥3）与较差的处理速度（标准化β从0.18到0.23）独立相关。结论：CMBs与细微的系统性认知障碍有关，而轻度wmh与此无关。该结果为中年早期csvd相关认知变化的发展提供了见解，并表明T1D患者认知能力下降的风险增加。

{"title":"Cerebral microbleeds are associated with deficits in cognitive processing speed and executive functions in middle-aged adults with type 1 diabetes","authors":"Iiris Kyläheiko , Aleksi Tarkkonen , Linda Kuusela , Juha Martola , Teemu I. Paajanen , Jussi Virkkala , Per-Henrik Groop , Lena M. Thorn , Turgut Tatlisumak , Jukka Putaala , Daniel Gordin , Hanna Jokinen , on behalf of the FinnDiane Study Group","doi":"10.1016/j.diabres.2025.113080","DOIUrl":"10.1016/j.diabres.2025.113080","url":null,"abstract":"<div><h3>Aims</h3><div>Adults with type 1 diabetes (T1D) have an increased risk of cerebral small vessel disease (cSVD)-related brain changes already in midlife, yet their significance for cognitive functions remains poorly understood. We investigated associations between cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and cognition in individuals with T1D and without any neurological symptoms.</div></div><div><h3>Methods</h3><div>Participants (n=167; age 46.4±7.7 years) underwent cross-sectional clinical and biochemical evaluations, brain magnetic resonance imaging, and neuropsychological assessment. CMB number and topography (lobar, deep/infratentorial, or mixed location) and WMHs, quantified volumetrically, were evaluated.</div></div><div><h3>Results</h3><div>Compared to absence of CMBs, higher burden of CMBs (≥3) was associated independently of age with poorer processing speed (standardized <em>β</em> from 0.18 to 0.23, p<0.05) and executive functions (standardized <em>β</em> from 0.18 to –0.25, p<0.05), but not with episodic memory. Mild WMHs had no independent relationships with cognition. Compared to other topographies, mixed CMB location was more often negatively related to cognition (standardized <em>β</em> from 0.20 to 0.32, p<0.05).</div></div><div><h3>Conclusions</h3><div>CMBs were related to a subtle, yet systematic impairment in cognition, whereas mild WMHs were not. The results provide insight into the development of early cSVD-related cognitive changes already in midlife and suggest an increased risk of cognitive decline in T1D.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"232 ","pages":"Article 113080"},"PeriodicalIF":7.4,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Two phenotypes of metabolic cardiomyopathy: Data-driven cluster analysis of non-invasively determined cardiovascular phenotypical traits 代谢性心肌病的两种表型：非侵入性确定的心血管表型特征的数据驱动聚类分析

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-02 DOI: 10.1016/j.diabres.2025.113081

Per Lav Madsen , Ikram Mizrak , Martin Heyn Sørensen , Peter Haulund Gæde , Annemie Stege Bojer

Objective

To evaluate if metabolic cardiomyopathy comprises different phenotypes.

Methods

Data-driven cluster analysis with hierarchical clustering followed by gap and silhouette width analysis and clustering by k-means was conducted on cardiovascular variables in a cohort of 192 patients with type 2 diabetes (T2D).

Results

Two distinct clusters were identified. 59 % of patients with DM2 had small left ventricles and atria with normal mass, high heart rate with small stroke volumes, and only moderately impaired myocardial perfusion reserve (3.32 ± 1.20 vs. 5.07 ± 1.51 ml/min/g in normal controls, p < 0.01). With equal e/e and extracellular volumes, other 41 % of patients with T2D had eccentric hypertrophic large left ventricles with dilated left atria, high stroke volumes, and a mean 6 mmHg higher mean arterial blood pressure and mean 15 mmHg higher pulse pressure, lower heart rates and lower myocardial perfusion reserve (2.60 ± 0.87 mL/min/g, P < 0.01 vs. other groups).

Conclusions

Two distinct types of cardiomyopathies were identified. The majority exhibited small left hearts with only moderate impairment in myocardial perfusion ratio. However, when stiff conductance arteries were present, cardiomyopathy with larger and eccentrically hypertrophic left ventricles and markedly reduced myocardial perfusion ratio was observed. Future research should seek to determine if these two phenotypes carry independent prognostic implications and should be treated differently.

目的：评价代谢性心肌病是否包括不同的表型。方法：对192例2型糖尿病（T2D）患者的心血管变量进行数据驱动的分层聚类分析、间隙和轮廓宽度分析以及k-means聚类。结果：鉴定出两个不同的簇。59 %的DM2患者左心室和心房体积小，体积正常，心率高，每搏容量小，心肌灌注储备仅中度受损(正常对照为3.32 ± 1.20 vs. 5.07 ± 1.51 ml/min/g， p 结论：确定了两种不同类型的心肌病。大多数患者左心较小，心肌灌注比仅出现中度损伤。然而，当存在僵硬的传导动脉时，心肌病表现为左心室增大和偏心肥厚，心肌灌注比明显降低。未来的研究应该寻求确定这两种表型是否具有独立的预后意义，是否应该区别对待。

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引用次数: 0

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

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 DOI: 10.1016/j.diabres.2025.113073

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

Aims

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 DOI: 10.1016/j.diabres.2025.113076

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

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

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引用次数: 0

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 DOI: 10.1016/j.diabres.2025.113077

Julie Wagner , Angela Bermúdez-Millán , Richard S. Feinn

Aims

To examine the association between health-related social needs (HRSNs) and indicators of self-rated health in adults with type 1 diabetes (T1D). Methods: Using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), we examined the association between HRSNs and 1) self-reported health (excellent to poor), 2) days of mental health not good, and, 3) days of physical health not good in the past 30 days. Data were from 476 adults with T1D in the U.S. Results: Participants were mostly white (75 %), male (54 %), and over 50 years old (52 %). Factor analysis of the 10 federal HRSN items produced three factors we named Psychosocial, Financial, and Employment. After controlling for age, sex, race/ethnicity, insurance, healthcare access, smoking, binge drinking, and comorbidities, higher Psychosocial HRSN score and Financial HRSN score were associated with lower self-reported health, more days of mental health not good, and more days of physical health not good. Employment HRSN was not associated with any measure of self-reported health. Conclusion: This is the first examination of HRSN and self-rated health in T1D. Screening for HRSNs should be integrated into diabetes care to identify and serve high-risk patients.

目的探讨成人1型糖尿病（T1D）患者健康相关社会需求（HRSNs）与自评健康指标之间的关系。方法：利用2022年行为风险因素监测系统（BRFSS）的数据，研究HRSNs与1)自我报告健康状况（从优到差）、2)心理健康状况不佳天数和3)过去30天身体健康状况不佳天数的相关性。数据来自美国476名患有T1D的成年人。结果：参与者主要是白人（75%），男性（54%）和50岁以上（52%）。对10个联邦HRSN项目的因素分析产生了三个因素，我们将其命名为社会心理、经济和就业。在控制了年龄、性别、种族/民族、保险、医疗保健获取、吸烟、酗酒和合共病等因素后，较高的社会心理HRSN评分和财务HRSN评分与较低的自我报告健康状况、较长的心理健康状况不佳天数和较长的身体健康状况不佳天数相关。就业HRSN与自我报告的健康状况没有任何关系。结论：这是T1D患者HRSN和自评健康状况的首次检测。应将HRSNs筛查纳入糖尿病护理，以识别和服务高危患者。

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引用次数: 0

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

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2026-01-01 DOI: 10.1016/j.diabres.2025.113067

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

Aims

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

Methods

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

Results

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

Conclusions

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

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

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