Diabetes research and clinical practice最新文献_第8页

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。

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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。

{"title":"Peri-renal and renal sinus fat accumulation and diabetic kidney disease in type 2 diabetes: A Japanese cohort study","authors":"Hayato Tanabe , Teruyuki Kono , Haruka Saito , Gulinu Maimaituxun , Kenichi Tanaka , Junichiro J. Kazama , Michio Shimabukuro","doi":"10.1016/j.diabres.2025.113074","DOIUrl":"10.1016/j.diabres.2025.113074","url":null,"abstract":"<div><h3>Aims</h3><div>This 15-year cohort study assessed whether <em>peri</em>-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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Participants averaged 58 years old; 52.6 % were male with a median diabetes duration of 5 years and a BMI of 25.4 kg/m<sup>2</sup>. 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"232 ","pages":"Article 113074"},"PeriodicalIF":7.4,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846454","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

Major adverse cardiovascular and limb events caused by tirzepatide in patients with type 2 diabetes at high cardiovascular risk: A comparison with sitagliptin 替西帕肽对高危2型糖尿病患者的主要心血管和肢体不良事件：与西格列汀的比较

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-23 DOI: 10.1016/j.diabres.2025.113072

Yoshihiro Iwasaki , Takenobu Shimada , Takefumi Kishimori , Takao Kato , Jumpei Koike , Takehiro Matsumoto , Takafumi Yagi , Masaharu Okada

Aims

To elucidate the overall protective effects of tirzepatide against atherosclerosis-related events, including cardiovascular and lower-extremity events.

Methods

We conducted a retrospective cohort study using the TriNetX global health research network to identify patients with type 2 diabetes (T2D) who initiated tirzepatide or sitagliptin between January 2022 and December 2023. The primary outcome was major adverse cardiovascular and limb events (MACLE), defined as the composite of major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, and stroke) and major adverse limb events (MALE: all-cause death and major lower extremity amputation). Propensity score matching was applied.

Results

After matching, 31,751 patients per group were analyzed. At 1 year, the incidence of MACLE was lower with tirzepatide compared to that with sitagliptin (4.3 % vs. 6.1 %; hazard ratio (HR), 0.70; 95 % confidence interval (CI), 0.66–0.76; p < 0.001). Tirzepatide was also associated with a reduced risk of MACE (HR, 0.71; 95 % CI, 0.66–0.76), MALE (HR, 0.39; 95 % CI, 0.34–0.46), and major lower extremity amputation (HR, 0.61; 95 % CI, 0.44–0.84). Consistent benefits were observed across major subgroups.

Conclusions

Tirzepatide was associated with a significantly lower risk of cardiovascular and limb events compared to sitagliptin in patients with T2D.

目的：阐明替西肽对动脉粥样硬化相关事件的总体保护作用，包括心血管和下肢事件。方法：我们使用TriNetX全球健康研究网络进行了一项回顾性队列研究，以确定在2022年1月至2023年12月期间开始使用替西帕肽或西格列汀的2型糖尿病（T2D）患者。主要终点为主要心血管和肢体不良事件（MACLE），定义为主要心血管不良事件（MACE：全因死亡、心肌梗死和卒中）和主要肢体不良事件（MALE：全因死亡和主要下肢截肢）的组合。采用倾向评分匹配。结果：配对后，每组共分析31751例患者。在1 年时，替西帕肽的MACLE发生率低于西格列汀(4.3 % vs 6.1 %；风险比（HR） 0.70；95 %置信区间（CI）， 0.66-0.76；p 结论：与西格列汀相比，替西帕肽与T2D患者心血管和肢体事件的风险显著降低相关。

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引用次数: 0

Metformin and all-cause mortality in older adults with type 2 diabetes mellitus and hypertension: NHANES 1999–2018 evidence for albumin as a mediator 二甲双胍与老年2型糖尿病和高血压患者的全因死亡率：NHANES 1999-2018白蛋白作为中介的证据

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-22 DOI: 10.1016/j.diabres.2025.113059

Hongmei Li, Xu Li, Fangjiu Liu

Background: Metformin reduces mortality in type 2 diabetes mellitus (T2DM), but its underlying pathways remain incompletely understood. We hypothesize that serum albumin could potentially mediate the effects of metformin on mortality. Methods: Participants were drawn from the National Health and Nutrition Examination Survey (NHANES) across ten cycles for this retrospective longitudinal analysis. We employed mediation analysis to assess the impact of metformin on all-cause mortality risk mediated by albumin (ALB). Results: In our longitudinal study, all-cause mortality was 40.97 %. Multivariate logistic regression analysis identified a significant correlation between metformin and the likelihood of all-cause mortality (HR = 0.8, 95 %CI = 0.71–0.90, P < 0.001). Mediation analysis indicated that the relationship between metformin and all-cause mortality risk was partially mediated by ALB, accounting for 13.32 % of the association (P < 0.0001). Conclusion: ALB mediates the association between metformin use and lower all-cause mortality in older Americans with T2DM and hypertension, underscoring the mortality-reducing importance of nutritional status.

背景：二甲双胍降低2型糖尿病（T2DM）的死亡率，但其潜在的途径仍不完全清楚。我们假设血清白蛋白可能介导二甲双胍对死亡率的影响。方法：参与者从国家健康和营养检查调查（NHANES）中抽取，为期10个周期，进行回顾性纵向分析。我们采用中介分析来评估二甲双胍对白蛋白（ALB）介导的全因死亡率风险的影响。结果：在我们的纵向研究中，全因死亡率为40.97% %。多因素logistic回归分析发现二甲双胍与全因死亡率之间存在显著相关性（HR = 0.8,95% %CI = 0.71-0.90,P < 0.001）。中介分析表明，二甲双胍与全因死亡风险的关系部分由ALB介导，占13.32% % （P < 0.0001）。结论：ALB介导了美国老年T2DM合并高血压患者使用二甲双胍与降低全因死亡率之间的关联，强调了营养状况对降低死亡率的重要性。

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引用次数: 0

Solute carrier inhibitors in kidney disease therapy: mechanisms and clinical implications. 溶质载体抑制剂在肾脏疾病治疗中的作用：机制和临床意义。

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-22 DOI: 10.1016/j.diabres.2025.113071

Nan Li, Hongmei Yu, Harvest F Gu

Recent single-cell sequencing analyses confirm that solute carriers (SLCs) are highly expressed in renal tubular epithelial cells, where they are critical for maintaining systemic metabolic homeostasis through solute reabsorption, secretion, and detoxification. SLC dysfunction underpins renal disorders, including chronic kidney disease, diabetic kidney disease, and acute kidney injury. Recent advances in SLC biology have enabled the development of selective inhibitors, offering precise pathway modulation with minimal off-target effects. Clinically, SLC inhibitors have demonstrated efficacy in nephrology, with five SLCs emerging as validated therapeutic targets: SLC5A2 (Na⁺-glucose co-transporter 2), SLC7A11 (xCT cystine/glutamate antiporter), SLC12A3 (Na⁺-Cl^- co-transporter), SLC22A12 (urate transporter 1), and SLC47A1 (multidrug and toxin extrusion protein 1). This article systematically reviews the pharmacological mechanisms of SLC inhibitors targeting these five transporters, analyzing their physiological and pathological roles in kidney diseases, and further discusses clinical applications and future prospects of SLC-targeted therapies in nephrology.

最近的单细胞测序分析证实，溶质载体（SLCs）在肾小管上皮细胞中高度表达，在肾小管上皮细胞中，它们通过溶质重吸收、分泌和解毒维持全身代谢稳态至关重要。SLC功能障碍是肾脏疾病的基础，包括慢性肾病、糖尿病肾病和急性肾损伤。SLC生物学的最新进展使选择性抑制剂的发展成为可能，提供精确的途径调节和最小的脱靶效应。临床研究表明，SLC抑制剂在肾病学方面具有疗效，有5种SLC被证实为有效的治疗靶点：SLC5A2 （Na+-葡萄糖共转运蛋白2）、SLC7A11 （xCT胱氨酸/谷氨酸反转运蛋白）、SLC12A3 （Na+- cl -共转运蛋白）、SLC22A12（尿酸转运蛋白1）和SLC47A1（多药和毒素排挤蛋白1）。本文系统综述了针对这五种转运体的SLC抑制剂的药理学机制，分析了其在肾脏疾病中的生理病理作用，并进一步探讨了SLC靶向治疗在肾脏病学中的临床应用及未来前景。

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引用次数: 0

Comparison of demographics and treatment outcome in children with type 1 diabetes related to the economic background of their country of residence: observations from the SWEET database 1型糖尿病儿童的人口学特征和治疗结果与其居住国经济背景的比较：来自SWEET数据库的观察结果

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-22 DOI: 10.1016/j.diabres.2025.113065

Carolina Martinez-Mateu , Regina Duperval , Olga Kaminska-Jackowiak , Dalia Al-Abdulrazzaq , Suzanne Sap , Sunil Gupta , Marija Požgaj Šepec , Catherine Sanon , Rasha Thabet , Silvia Muñoz , Reinhard W. Holl , Danièle Pacaud , on behalf of the SWEET Study Group

Significant disparities in pediatric type 1 diabetes (T1D) care and outcomes exist globally.

Aim

To examine the relationship between national gross domestic product (GDP), diabetes care, and T1D outcomes.

Methods

Cross-sectional analysis of individuals < 25 years with T1D > 3 months from SWEET registry centers (2022–2023). Centers were grouped into GDP quartiles. Outcomes included technology use, screening rates, HbA1c, BMI SDS, diabetic ketoacidosis (DKA), and severe hypoglycemia. Multivariable regression adjusted for age, sex, and diabetes duration.

Results

Data from 54,285 individuals across 130 centers were analyzed. Technology use and BMI SDS increased with GDP. Insulin pump use ranged 17.4–70.2 %; CGM 36.2–91.5 %; AID 11.2–38.2 %; and rapid-acting analogs 56.9–78.2 %. BMI SDS ranged from + 0.04 (lowest GDP) to + 0.89 (highest). HbA1c showed a non-linear pattern: 8.74 % (lowest), 7.50 % (lower-middle), 7.66 % (higher-middle), 8.18 % (highest). Severe hypoglycemia ranged from 9.6 to 1.3 events/100 PY, while DKA ranged from 0.90 (lower-middle) to 3.10 events/100 PY (highest). Screening rates for comorbidities peaked in middle GDP quartiles.

Conclusions

GDP is significantly, but not linearly, associated with technology use and metabolic outcomes in pediatric T1D. Middle GDP countries achieved the best metabolic control, underscoring the need for equitable resource allocation.

全球儿童1型糖尿病（T1D）的治疗和结局存在显著差异。目的：研究国民生产总值（GDP）、糖尿病护理和T1D预后之间的关系。方法：对SWEET登记中心（2022-2023）  3个月的个体进行横断面分析。中心按GDP四分位数分组。结果包括技术使用、筛查率、HbA1c、BMI SDS、糖尿病酮症酸中毒（DKA）和严重低血糖。多变量回归校正了年龄、性别和糖尿病病程。结果：来自130个中心的54285个人的数据进行了分析。技术使用和BMI SDS随GDP增加而增加。胰岛素泵使用率为17.4-70.2 %；CGM 36.2 - -91.5 %;援助11.2 - -38.2 %;速效类似物56.9- 78.2% %。BMI SDS范围从 + 0.04（最低GDP）到 + 0.89（最高GDP）。HbA1c呈非线性模式：8.74 %（最低），7.50 %（中下），7.66 %（中上），8.18 %（最高）。严重低血糖的范围从9.6到1.3事件/100 PY，而DKA范围从0.90（中下）到3.10事件/100 PY（最高）。合并症的筛查率在GDP的中间四分位数达到峰值。结论：GDP与儿童T1D的技术使用和代谢结果显著相关，但不是线性相关。中等GDP国家实现了最好的代谢控制，强调了公平分配资源的必要性。

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引用次数: 0

Association between Life’s Simple 7 and life’s essential 8 with all-cause and cardiovascular mortality in cardiovascular-kidney-metabolic syndrome population 心血管-肾脏-代谢综合征人群中简单生活和必要生活与全因死亡率和心血管死亡率之间的关系

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-12-21 DOI: 10.1016/j.diabres.2025.113064

Shan Yin , Shuang Yan , Zhenzhen Yang , Pingyu Zhu , Tielong Tang , Yan Borné

Aims

This study compares the associations of Life’s Simple 7 (LS7) and Life’s Essential 8 (LE8) with all-cause and cardiovascular mortality in cardiovascular-kidney-metabolic (CKM) syndrome populations.

Methods

This cohort study analyzed 11,487 participants aged ≥20 years with CKM syndrome from NHANES 2005–2018. Participants were categorized into non-advanced (stages 0–2) and advanced (stages 3–4) CKM stages. LS7 and LE8 scores were calculated, and Cox proportional hazards models were used to assess mortality associations. Time-dependent ROC analysis compared LS7 and LE8’s predictive performance.

Results

During a median follow-up of 91 months, 1167 all-cause deaths and 360 cardiovascular deaths occurred. Both LS7 and LE8 showed strong negative associations with mortality. In fully adjusted models for the entire CKM population, high versus low CVH groups demonstrated significant risk reductions: LE8 (HR 0.63 for all-cause; HR 0.53 for cardiovascular mortality) and LS7 (HR 0.69; HR 0.59). Similar protective associations were observed in non-advanced CKM stages but not in advanced stages. Both metrics had comparable predictive ability with similar AUC values.

Conclusion

LS7 and LE8 demonstrate comparable predictive ability for mortality outcomes in CKM syndrome, particularly in non-advanced stages. LS7’s simplicity makes it favorable for clinical and public health practice.

目的：本研究比较了生命简单7 （LS7）和生命必需8 （LE8）与心血管-肾代谢（CKM）综合征人群全因死亡率和心血管死亡率的关系。方法：本队列研究分析了NHANES 2005-2018年11487名年龄≥20 岁的CKM综合征患者。参与者被分为非晚期（0-2期）和晚期（3-4期）CKM阶段。计算LS7和LE8评分，并使用Cox比例风险模型评估死亡率相关性。时间相关ROC分析比较LS7和LE8的预测性能。结果：在中位随访91 个月期间，发生了1167例全因死亡和360例心血管死亡。LS7和LE8与死亡率呈显著负相关。在整个CKM人群的完全调整模型中，高CVH组与低CVH组显示出显著的风险降低：LE8（全因HR 0.63；心血管死亡率HR 0.53）和LS7 （HR 0.69; HR 0.59）。在非晚期CKM阶段观察到类似的保护关联，但在晚期没有观察到。这两个指标具有类似AUC值的可比较的预测能力。结论：LS7和LE8对CKM综合征的死亡率结果具有相当的预测能力，特别是在非晚期阶段。LS7的简单性使其有利于临床和公共卫生实践。

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