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

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。

{"title":"Disease management, outcomes, and healthcare resource utilization in real-life clinical practice of diabetes and diabetic kidney disease in Finland","authors":"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","doi":"10.1016/j.diabres.2025.113067","DOIUrl":"10.1016/j.diabres.2025.113067","url":null,"abstract":"<div><h3>Aims</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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<sub>1c</sub> values, municipality, and calendar year. In T1D, 29 %, and in T2D, 75 % had HbA<sub>1c</sub> ≤ 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113067"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145818148","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

Digital twin paradigm in diabetes prediction and management 糖尿病预测和管理中的数字孪生范式。

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.2025.113075

David B. Olawade , Rita Chikeru Owhonda , John Oluwatosin Alabi , Eghosasere Egbon , Raphael Igbarumah Ayo Daniel , Oluwakemi Jumoke Bello

Traditional diabetes management employs reactive strategies with therapeutic adjustments after adverse glycaemic events rather than proactive prevention, resulting in suboptimal control and increased complications. Digital twin (DT) technology creates virtual replicas through computational modelling and real time data integration as a transformative approach. However, questions remain regarding clinical validation, implementation feasibility, and generalisability. This review examines current applications, challenges, and future potential of digital twin technology in diabetes prediction and management. PubMed, Scopus, Web of Science, and IEEE Xplore databases were searched for peer reviewed articles (2015–2024) on DT applications in diabetes care, predictive modelling, and therapeutic optimisation. Critical synthesis compared methodological approaches, performance metrics, and implementation challenges. DT demonstrate variable but promising potential through glucose prediction, personalised insulin dosing, dietary optimisation, and complication risk assessment, integrating continuous glucose monitoring, wearable sensors, and machine learning algorithms. Evidence quality varies substantially, with most studies representing proof-of-concept or pilot implementations. Implementation faces data privacy concerns, validation requirements, and integration complexities. Critical gaps exist in long-term effectiveness, algorithmic bias mitigation, and generalisability to underserved populations. DT technology represents an evolving paradigm towards precision diabetes care. However, rigorous clinical validation, addressing equity concerns, and establishing sustainable implementation frameworks remain essential for widespread adoption.

传统的糖尿病管理采用反应性策略，在不良血糖事件发生后进行治疗调整，而不是主动预防，导致控制不佳和并发症增加。数字孪生（DT）技术通过计算建模和实时数据集成创建虚拟副本，作为一种变革性方法。然而，关于临床验证、实施可行性和普遍性的问题仍然存在。本文综述了数字孪生技术在糖尿病预测和管理中的应用现状、挑战和未来潜力。检索PubMed、Scopus、Web of Science和IEEE Xplore数据库，检索同行评审的关于DT在糖尿病护理、预测建模和治疗优化中的应用的文章（2015-2024）。关键综合比较了方法方法、性能指标和实现挑战。DT通过血糖预测、个性化胰岛素剂量、饮食优化、并发症风险评估、集成连续血糖监测、可穿戴传感器和机器学习算法，展示了可变但有前景的潜力。证据质量差异很大，大多数研究代表概念验证或试点实施。实现面临数据隐私问题、验证需求和集成复杂性。在长期有效性、减少算法偏差和向服务不足人群推广方面存在重大差距。DT技术代表了一种不断发展的糖尿病精准护理模式。然而，严格的临床验证、解决公平问题和建立可持续的实施框架对于广泛采用仍然至关重要。

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引用次数: 0

Economic evaluation of NT-proBNP for heart failure risk assessment in patients with type 2 diabetes in China NT-proBNP在中国2型糖尿病患者心力衰竭风险评估中的经济评价

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.2025.113068

Miao Yu , Zhiwei Leng , Xinguo Hou , Junping Wen , Chaogui Tang , Powei Wu , Jianwei Xuan

Aims

Heart failure (HF) affects up to 40 % of patients with type 2 diabetes mellitus (T2DM), imposing significant clinical and economic burdens. N-terminal pro-B-type natriuretic peptide (NT-proBNP) effectively assesses HF risk, but its economic value in China is unclear.

Methods

This study evaluated the cost-effectiveness of three HF risk assessment strategies in patients with T2DM: NT-proBNP-guided assessment (using a cut-off of ≥125 pg/mL), usual care in China, and Systematic COronary Risk Evaluation (SCORE). A decision tree and Markov model with 1-year cycles simulated lifetime direct medical costs (given in United States dollars [US$]) and health outcomes in patients with T2DM aged ≥40 years from a Chinese healthcare perspective. High-risk patients received SGLT2 inhibitors plus standard of care.

Results

Compared with usual care, the NT-proBNP-guided strategy was cost-saving, reducing costs by US$1002.73 while increasing QALYs by 0.055 per patient. It was also less costly and more effective than the SCORE strategy. Probabilistic sensitivity analysis confirmed the robustness of this finding, demonstrating a 96.9 % probability of the NT-proBNP strategy being cost-saving versus usual care.

Conclusions

NT-proBNP is a dominant and robust cost-saving strategy for HF risk assessment in patients with T2DM in China, reducing both HF cases and associated healthcare costs.

目的：心力衰竭（HF）影响高达40% %的2型糖尿病（T2DM）患者，造成重大的临床和经济负担。n端前b型利钠肽（NT-proBNP）可有效评估HF风险，但其在中国的经济价值尚不清楚。方法：本研究评估了三种T2DM患者HF风险评估策略的成本-效果：nt - probnp引导评估（临界值≥125 pg/mL）、中国常规护理和系统性冠状动脉风险评估（SCORE）。一个具有1年周期的决策树和马尔可夫模型模拟了年龄≥40 岁T2DM患者的终生直接医疗费用（以美元[US$]表示）和健康结果。高危患者接受SGLT2抑制剂加标准治疗。结果：与常规护理相比，nt - probnp指导策略节省了成本，每位患者减少了1002.73美元的成本，同时增加了0.055个QALYs。它也比SCORE战略成本更低，更有效。概率敏感性分析证实了这一发现的稳健性，表明NT-proBNP策略与常规护理相比节省成本的概率为96.9 %。结论：NT-proBNP是中国T2DM患者HF风险评估的主要和可靠的成本节约策略，减少了HF病例和相关的医疗成本。

{"title":"Economic evaluation of NT-proBNP for heart failure risk assessment in patients with type 2 diabetes in China","authors":"Miao Yu , Zhiwei Leng , Xinguo Hou , Junping Wen , Chaogui Tang , Powei Wu , Jianwei Xuan","doi":"10.1016/j.diabres.2025.113068","DOIUrl":"10.1016/j.diabres.2025.113068","url":null,"abstract":"<div><h3>Aims</h3><div>Heart failure (HF) affects up to 40 % of patients with type 2 diabetes mellitus (T2DM), imposing significant clinical and economic burdens. N-terminal pro-B-type natriuretic peptide (NT-proBNP) effectively assesses HF risk, but its economic value in China is unclear.</div></div><div><h3>Methods</h3><div>This study evaluated the cost-effectiveness of three HF risk assessment strategies in patients with T2DM: NT-proBNP-guided assessment (using a cut-off of ≥125 pg/mL), usual care in China, and Systematic COronary Risk Evaluation (SCORE). A decision tree and Markov model with 1-year cycles simulated lifetime direct medical costs (given in United States dollars [US$]) and health outcomes in patients with T2DM aged ≥40 years from a Chinese healthcare perspective. High-risk patients received SGLT2 inhibitors plus standard of care.</div></div><div><h3>Results</h3><div>Compared with usual care, the NT-proBNP-guided strategy was cost-saving, reducing costs by US$1002.73 while increasing QALYs by 0.055 per patient. It was also less costly and more effective than the SCORE strategy. Probabilistic sensitivity analysis confirmed the robustness of this finding, demonstrating a 96.9 % probability of the NT-proBNP strategy being cost-saving versus usual care.</div></div><div><h3>Conclusions</h3><div>NT-proBNP is a dominant and robust cost-saving strategy for HF risk assessment in patients with T2DM in China, reducing both HF cases and associated healthcare costs.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113068"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827140","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

Simultaneous assessment of one-hour plasma glucose levels and age as a potential predictor of glucose intolerance development in individuals with normal glucose tolerance 在糖耐量正常的个体中，同时评估一小时血浆葡萄糖水平和年龄作为糖耐量不良发展的潜在预测因子

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-31 DOI: 10.1016/j.diabres.2025.113079

Misaki Takakado , Yasuharu Tabara , Shota Inoue , Toshimi Hadate , Ryoichi Kawamura , Koutatsu Maruyama , Isao Saito , Jun Ohashi , Haruhiko Osawa , Yasunori Takata

Aims

Early detection of impaired glucose tolerance (IGT) is critical for preventing overt diabetes and cardiovascular disease. Few studies have evaluated the predictors of the transition from normal glucose tolerance (NGT) to glucose intolerance (GI; IGT or type 2 diabetes, and/or impaired fasting glucose). We conducted a 5-year prospective study of individuals with NGT to evaluate the predictors of GI development.

Methods

A 75-g oral glucose tolerance test was performed to diagnose GI. We enrolled 1,008 Japanese individuals with NGT who completed a 5-year follow-up. Using logistic regression analyses, we explored the predictive factors for GI development and assessed the single-nucleotide polymorphisms of type 2 diabetes susceptibility.

Results

We identified the 1-h plasma glucose (1-h PG) level and age interaction as predictors of GI development. In the stratified analysis, the sex-and body mass index-adjusted odds ratios for GI development in individuals with 1-h PG ≥ 8.3 mmol/L and age ≥ 57 years was 12.9 (95 % CI: 5.7–29.2) compared to the reference. Genetic risk was associated with the aggravation of 1-h PG levels.

Conclusions

The combination of 1-h PG and age serves as a potential predictor of GI development in individuals with NGT.

目的：早期发现糖耐量受损（IGT）对于预防显性糖尿病和心血管疾病至关重要。很少有研究评估从正常葡萄糖耐量（NGT）到葡萄糖不耐受（GI、IGT或2型糖尿病，和/或空腹血糖受损）转变的预测因素。我们对NGT患者进行了一项为期5年的前瞻性研究，以评估GI发展的预测因素。方法：采用75 g口服葡萄糖耐量试验诊断GI。我们招募了1008名日本NGT患者，他们完成了5年的随访。使用逻辑回归分析，我们探讨了GI发展的预测因素，并评估了2型糖尿病易感性的单核苷酸多态性。结果：我们确定了1小时血浆葡萄糖（1小时PG）水平和年龄相互作用是GI发展的预测因素。在分层分析中，1-h PG≥8.3 mmol/L和年龄 ≥ 57 岁的个体，经性别和体重指数调整的GI发展优势比为12.9（95 % CI: 5.7-29.2）。遗传风险与1-h PG水平加重有关。结论：1-h PG与年龄的结合可作为NGT患者GI发展的潜在预测因子。

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引用次数: 0

Lived experience of fully closed-loop insulin delivery in adolescents with type 1 diabetes and HbA1c above target HbA1c高于目标的青少年1型糖尿病患者全闭环胰岛素输送的生活经验

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-30 DOI: 10.1016/j.diabres.2025.113078

Nithya Kadiyala , Janet Allen , Rama Lakshman , Charlotte K. Boughton , Malgorzata E. Wilinska , Ajay Thankamony , Sara Hartnell , Hood Thabit , Ruben H. Willemsen , Pratik Shah , Julia Ware , Roman Hovorka

Aims

The aim of this qualitative study was to explore the impact of using the CamAPS HX fully closed-loop system, which does not require carbohydrate counting, meal announcements or pre-meal bolusing, on the daily lives of adolescents with type 1 diabetes and HbA1c above the recommended target (≥ 7.5 % [58 mmol/mol]).

Methods

Twelve adolescents took part in virtual semi-structured interviews. Data was analyzed thematically using an inductive-deductive approach. Study participants also completed quality of life questionnaires.

Results

All interviewees reported reduced effort in managing diabetes, as they no longer needed to count carbohydrates or bolus, and worried less about their glucose levels. This led to improved quality of life, with a greater sense of freedom and normalcy, particularly around meals. A few also noted benefits in physical activity, sleep, work and social life. Interviewees expressed dissatisfaction with the algorithm’s slow response to postprandial glucose spikes, and the need for a tethered pump. Questionnaires showed no significant differences in hypoglycaemia fear or diabetes distress between study periods but reflected a positive experience with the closed-loop system.

Conclusions

In adolescents with type 1 diabetes, fully closed-loop insulin delivery reduced the daily burden of self-management, leading to improved quality of life.

Clinical trial registration: NCT05653050.

目的：本质性研究的目的是探讨使用CamAPS HX全闭环系统对HbA1c高于推荐目标（≥7.5 %[58 mmol/mol]）的青少年1型糖尿病患者日常生活的影响，该系统不需要碳水化合物计数、进餐通知或餐前bolings。方法：对12名青少年进行虚拟半结构化访谈。使用归纳演绎方法对数据进行主题分析。研究参与者还完成了生活质量调查问卷。结果：所有受访者都表示，他们管理糖尿病的努力减少了，因为他们不再需要计算碳水化合物或丸剂，也不太担心自己的血糖水平。这导致了生活质量的提高，有了更大的自由和正常的感觉，特别是在吃饭的时候。一些人还指出，锻炼身体、睡眠、工作和社交生活都有好处。受访者对该算法对餐后血糖峰值的缓慢反应以及需要拴绳泵表示不满。问卷调查显示，在研究期间，低血糖恐惧或糖尿病困扰没有显著差异，但反映了闭环系统的积极体验。结论：在青少年1型糖尿病患者中，全闭环胰岛素输送减轻了日常自我管理的负担，从而提高了生活质量。临床试验注册：NCT05653050。

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引用次数: 0

Peri-renal and renal sinus fat accumulation and diabetic kidney disease in type 2 diabetes: A Japanese cohort study 2型糖尿病患者肾周和窦性脂肪堆积与糖尿病肾病：一项日本队列研究

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-25 DOI: 10.1016/j.diabres.2025.113074

Hayato Tanabe , Teruyuki Kono , Haruka Saito , Gulinu Maimaituxun , Kenichi Tanaka , Junichiro J. Kazama , Michio Shimabukuro

Aims

This 15-year cohort study assessed whether peri-renal fat volume index (PRFVI) and renal sinus fat volume index (RSFVI) predict diabetic kidney disease (DKD) better than general or abdominal obesity measures in Japanese adults with type 2 diabetes (T2D).

Methods

Researchers studied 190 DKD-free individuals, measured their abdominal and renal fat via computed tomography, and categorized them into tertiles based on five adiposity indices: body mass index (BMI), visceral fat area (VFA), subcutaneous fat area (SFA), PRFVI, and RSFVI.

Results

Participants averaged 58 years old; 52.6 % were male with a median diabetes duration of 5 years and a BMI of 25.4 kg/m². PRFVI correlated with BMI, whereas RSFVI correlated with aging. Over a median 8.5-year follow-up, 53.7 % of patients developed DKD. Notably, higher RSFVI tertiles were significantly associated with DKD risk (hazard ratio 1.96, 95 % confidence interval 1.14–3.39, P = 0.016), and RSFVI had the best predictive value for DKD among all indices (AUC = 0.769). Both renal fat indices showed stronger associations with DKD development than traditional obesity measures.

Conclusions

The findings demonstrate that renal fat measure, particularly RSFVI, provides incremental predictive value independent of conventional DKD risk variables, suggesting that local renal fat may be a target for early DKD detection and intervention in people with T2D.

目的：这项为期15年的队列研究评估了日本成人2型糖尿病（T2D）患者肾周脂肪体积指数（PRFVI）和肾窦脂肪体积指数（RSFVI）是否比一般或腹部肥胖指标更能预测糖尿病肾病（DKD）。方法：研究人员对190例无dkd患者进行了研究，通过计算机断层扫描测量了他们的腹部和肾脏脂肪，并根据BMI、内脏脂肪面积（VFA）、皮下脂肪面积（SFA）、PRFVI和RSFVI这5个肥胖指数将他们分类。结果：参与者平均58岁 ；52.6% 为男性，中位糖尿病病程为5 年，BMI为25.4 kg/m2。PRFVI与BMI相关，而RSFVI与年龄相关。在中位8.5年的随访中，53.7 %的患者发生了DKD。值得注意的是，较高的RSFVI分位数与DKD风险显著相关（风险比1.96,95 % CI 1.14-3.39, P = 0.016），在所有指标中，RSFVI对DKD的预测价值最好（AUC = 0.769）。两项肾脏脂肪指标均显示与DKD发展的相关性强于传统的肥胖指标。结论：研究结果表明，PRFVI，特别是RSFVI，提供了独立于传统DKD风险变量的增量预测价值，提示局部肾脂肪可能是T2D患者早期DKD检测和干预的目标。

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