Toe necrosis is a common complication of diabetic foot ulcer (DFU). Amputation surgery is usually performed by a surgeon in the operating room. In response to the limited availability of operating rooms, clinicians from two specialized diabetic foot units performed bedside surgery to amputate isolated toe-necrosis-complicated DFU.
The aim of our study was to compare the rate of wound healing 6 months after toe amputation following bedside amputation surgery (BAS) and conventional amputation surgery (CAS).
Methods
This retrospective observational multi-center study was conducted in two French diabetic foot units. All patients with diabetes mellitus (DM) who underwent a toe amputation for isolated necrosis in an operating room (CAS) or at bedside (BAS) were included (05/2016 – 07/2023). The primary endpoint was the 6-month healing rate, defined as a complete skin epithelialization without recurrence at 6 months, without secondary amputation.
Results
Out of 2029 patients admitted for DFU, 189 had isolated toe necrosis requiring limited amputation (9%). Among the 171 patients who attended follow-up at 6 months: males 82.5%, type 2 DM 94.7%, average duration of DM 18.3 ± 0.9years, average HbA1c 8.6 ± 2%. BAS was performed on 106/171(62%) patients. The 6-month healing rate was not significantly different between the two groups (BAS 53.8% vs CAS 52.3%, P = 0.852). The rate of secondary surgery was not significantly different (BAS 24.5% vs CAS 16.9%, P = 0.241).
Conclusion
BAS is a safe and efficient approach for the treatment of isolated toe necrosis, resulting in a healing rate similar to that of conventional surgery.
目的：脚趾坏死是糖尿病足溃疡（DFU）的常见并发症。截肢手术通常由外科医生在手术室进行。由于手术室的可用性有限，来自两个专门的糖尿病足科室的临床医生进行了床边手术，切除了孤立的脚趾坏死合并的DFU。我们的研究目的是比较床边截肢手术（BAS）和常规截肢手术（CAS）后6个月脚趾截肢的伤口愈合率。方法：这项回顾性观察性多中心研究在两个法国糖尿病足单位进行。所有因孤立性坏死在手术室（CAS）或床边（BAS）接受脚趾截肢的糖尿病（DM）患者被纳入研究（2016年5月- 2023年7月）。主要终点是6个月的愈合率，定义为6个月完全皮肤上皮化，无复发，无继发截肢。结果：在入院的2029例DFU患者中，189例有孤立性脚趾坏死，需要有限截肢（9%）。随访6个月的171例患者中：男性82.5%，2型糖尿病94.7%，糖尿病平均病程18.3±0.9年，平均HbA1c 8.6±2%。171例患者中有106例（62%）接受了BAS。两组6个月的治愈率差异无统计学意义（BAS 53.8% vs CAS 52.3%, P = 0.852）。两组患者的二次手术率差异无统计学意义（BAS 24.5% vs CAS 16.9%, P = 0.241）。结论：BAS是一种安全有效的治疗孤立性足趾坏死的方法，其治愈率与常规手术相似。
{"title":"Bedside amputation surgery for isolated toe necrosis in diabetes units as an alternative to conventional amputation in surgery units","authors":"Florine Féron , Jean-Philippe Kevorkian , Jean-Baptiste Julla , Nadjet Ghozlane , Serge Aho Glele , Coralie Fourmont , Jean-Michel Petit , Jean-François Gautier , Mathilde Didier , Benjamin Bouillet","doi":"10.1016/j.diabet.2026.101727","DOIUrl":"10.1016/j.diabet.2026.101727","url":null,"abstract":"<div><h3>Aim</h3><div>Toe necrosis is a common complication of diabetic foot ulcer (DFU). Amputation surgery is usually performed by a surgeon in the operating room. In response to the limited availability of operating rooms, clinicians from two specialized diabetic foot units performed bedside surgery to amputate isolated toe-necrosis-complicated DFU.</div><div>The aim of our study was to compare the rate of wound healing 6 months after toe amputation following bedside amputation surgery (BAS) and conventional amputation surgery (CAS).</div></div><div><h3>Methods</h3><div>This retrospective observational multi-center study was conducted in two French diabetic foot units. All patients with diabetes mellitus (DM) who underwent a toe amputation for isolated necrosis in an operating room (CAS) or at bedside (BAS) were included (05/2016 – 07/2023). The primary endpoint was the 6-month healing rate, defined as a complete skin epithelialization without recurrence at 6 months, without secondary amputation.</div></div><div><h3>Results</h3><div>Out of 2029 patients admitted for DFU, 189 had isolated toe necrosis requiring limited amputation (9%). Among the 171 patients who attended follow-up at 6 months: males 82.5%, type 2 DM 94.7%, average duration of DM 18.3 ± 0.9years, average HbA1c 8.6 ± 2%. BAS was performed on 106/171(62%) patients. The 6-month healing rate was not significantly different between the two groups (BAS 53.8% vs CAS 52.3%, <em>P</em> = 0.852). The rate of secondary surgery was not significantly different (BAS 24.5% vs CAS 16.9%, <em>P</em> = 0.241).</div></div><div><h3>Conclusion</h3><div>BAS is a safe and efficient approach for the treatment of isolated toe necrosis, resulting in a healing rate similar to that of conventional surgery.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"52 2","pages":"Article 101727"},"PeriodicalIF":4.7,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carbohydrate counting enables flexible prandial insulin dosing in type 1 diabetes but remains cognitively demanding. Concerns persist that such sustained attention to food may contribute to disordered eating behaviors. The primary aim of this study was to examine whether carbohydrate-counting knowledge is associated with disordered eating behaviors.
Methods
This cross-sectional study (NCT07021456) was conducted online. Participants completed questionnaires assessing carbohydrate-counting knowledge (Gluciquizz), disordered eating behaviors (DEPS-R), and likely eating disorders (SCOFF-F). Additional questionnaires evaluated quality of life (ADDQoL), diabetes-related distress (PAID-5), and fear of hypoglycemia (HFS-II short form). Elevated DEPS-R was defined as a score ≥ 20, and likely eating disorders as SCOFF-F ≥ 2.
Results
A total of 100 adults with type 1 diabetes were included. No correlation was observed between Gluciquizz and DEPS-R (ρ = −0.03, 95% CI (−0.23 to 0.17), P = 0.73). Similarly, Gluciquizz scores did not differ between participants with SCOFF-F < 2 and ≥ 2 (P = 0.745). Diabetes-related distress was significantly higher among participants with elevated DEPS-R scores (PAID-5 median 15 vs 8; P = 0.006), whereas ADDQoL and HFS-II did not differ significantly.
Conclusion
In this selected adult population with type 1 diabetes, carbohydrate-counting knowledge was not associated with disordered eating behaviors. However, positive DEB screening was linked with higher diabetes-related distress, supporting the importance of psychosocial assessment.
目的：碳水化合物计数使1型糖尿病患者的膳食胰岛素剂量灵活，但仍需要认知。人们一直担心，这种对食物的持续关注可能会导致饮食失调。本研究的主要目的是研究碳水化合物计数知识是否与饮食紊乱行为有关。方法：本横断面研究（NCT07021456）在线进行。参与者完成了评估碳水化合物计数知识（Gluciquizz）、饮食失调行为（DEPS-R）和可能的饮食失调（SCOFF-F）的问卷调查。额外的问卷评估生活质量（ADDQoL）、糖尿病相关的痛苦（pay -5）和对低血糖的恐惧（HFS-II）。dps - r升高定义为评分≥20，SCOFF-F≥2为可能的饮食失调。结果：共纳入100例成人1型糖尿病患者。Gluciquizz与DEPS-R无相关性（ρ = -0.03,95% CI (-0.23 ~ 0.17), P = 0.73）。同样，SCOFF-F < 2和≥2的受试者之间的Gluciquizz评分也没有差异（P = 0.745）。在dps -r评分升高的参与者中，糖尿病相关的痛苦显著增加（pay -5中位数为15 vs 8； P = 0.006），而ADDQoL和HFS-II没有显著差异。结论：在这一选定的1型糖尿病成年人群中，碳水化合物计数知识与饮食失调行为无关。然而，阳性的DEB筛查与较高的糖尿病相关痛苦有关，这支持了心理社会评估的重要性。
{"title":"No association between carbohydrate-counting knowledge and disordered eating behaviors in adults with type 1 diabetes","authors":"Laura Albaladejo , Melissa Ferguene , Béatrice Genoux , Lucien Marchand , Hélène du Boullay , Sandrine Lablanche , Céline Vermorel , Aurélie Gauchet , Jean-Luc Bosson , Cécile Bétry","doi":"10.1016/j.diabet.2026.101735","DOIUrl":"10.1016/j.diabet.2026.101735","url":null,"abstract":"<div><h3>Aims</h3><div>Carbohydrate counting enables flexible prandial insulin dosing in type 1 diabetes but remains cognitively demanding. Concerns persist that such sustained attention to food may contribute to disordered eating behaviors. The primary aim of this study was to examine whether carbohydrate-counting knowledge is associated with disordered eating behaviors.</div></div><div><h3>Methods</h3><div>This cross-sectional study (NCT07021456) was conducted online. Participants completed questionnaires assessing carbohydrate-counting knowledge (Gluciquizz), disordered eating behaviors (DEPS-R), and likely eating disorders (SCOFF-F). Additional questionnaires evaluated quality of life (ADDQoL), diabetes-related distress (PAID-5), and fear of hypoglycemia (HFS-II short form). Elevated DEPS-R was defined as a score ≥ 20, and likely eating disorders as SCOFF-F ≥ 2.</div></div><div><h3>Results</h3><div>A total of 100 adults with type 1 diabetes were included. No correlation was observed between Gluciquizz and DEPS-R (ρ = −0.03, 95% CI (−0.23 to 0.17), P = 0.73). Similarly, Gluciquizz scores did not differ between participants with SCOFF-F < 2 and ≥ 2 (P = 0.745). Diabetes-related distress was significantly higher among participants with elevated DEPS-R scores (PAID-5 median 15 vs 8; P = 0.006), whereas ADDQoL and HFS-II did not differ significantly.</div></div><div><h3>Conclusion</h3><div>In this selected adult population with type 1 diabetes, carbohydrate-counting knowledge was not associated with disordered eating behaviors. However, positive DEB screening was linked with higher diabetes-related distress, supporting the importance of psychosocial assessment.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"52 2","pages":"Article 101735"},"PeriodicalIF":4.7,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.diabet.2026.101734
Arnaud Dosda , Grégoire Fauchier , Nadia Sabbah , Laurent Fauchier , Thierry Lecomte , Pierre Henri Ducluzeau
Objectives
To evaluate the association between glucagon-like peptide-1 receptor agonist (GLP1-RA) use and all-cause mortality in patients with type 2 diabetes treated for colorectal cancer, using a real-world health database.
Methods
This retrospective cohort study was conducted using the TriNetX global health records network. Adult patients with type 2 diabetes diagnosed with colorectal cancer between 2010 and 2025 were included. Patients were divided into two cohorts based on GLP1-RA exposure versus other oral antidiabetic drugs. Propensity score matching was applied to balance covariates. Overall survival (primary outcome) and metastasis-free survival (secondary outcome) were analysed using Kaplan-Meier curves and Cox proportional hazards models.
Results
After propensity score matching, each cohort included 751 patients. Median follow-up period was 731 days in the GLP1-RA cohort and 779 days in the non-GLP1-RA cohort. GLP1-RA users had a significantly reduced all-cause mortality rate (11.5%) compared with non-users a (20.4%), with a hazard ratio of 0.58 (95%CI: 0.45–0.76; P < 0.001). Metastasis-free survival rate were 5.3% in the GLP1-RA cohort versus 8.9% in the matched non-user cohort, with a hazard ratio of 0.60 (95%CI: 0.40–0.87; P = 0.01). The incidence of major adverse cardiovascular events (MACE) did not differ significantly between cohorts, with a hazard ratio of 0.84 (95%CI: 0.66–1.06; P = 0.16).
Conclusions
In this real-world cohort of diabetic patients treated for colorectal cancer, GLP1-RA therapy was associated with a significant improvement in overall survival. These findings support the continued use of GLP1-RA agents in this population and may provide reassurance to clinicians and patients regarding the safety and potential benefit of these agents following a colorectal cancer diagnosis.
目的：利用真实世界的健康数据库，评估胰高血糖素样肽-1受体激动剂（GLP1-RA）的使用与结直肠癌治疗的2型糖尿病患者全因死亡率之间的关系。方法：采用TriNetX全球健康记录网络进行回顾性队列研究。研究对象包括2010年至2025年间诊断为结直肠癌的成年2型糖尿病患者。根据GLP1-RA暴露与其他口服降糖药的对比，将患者分为两组。使用倾向得分匹配来平衡协变量。使用Kaplan-Meier曲线和Cox比例风险模型分析总生存期（主要结局）和无转移生存期（次要结局）。结果：倾向评分匹配后，每个队列纳入751例患者。GLP1-RA组的中位随访期为731天，非GLP1-RA组的中位随访期为779天。GLP1-RA服用者的全因死亡率（11.5%）明显低于不服用者（20.4%），风险比为0.58 （95%CI: 0.45-0.76; P < 0.001）。GLP1-RA组无转移生存率为5.3%，而匹配的非用户组为8.9%，风险比为0.60 （95%CI: 0.40-0.87; P = 0.01）。主要不良心血管事件（MACE）发生率在队列间无显著差异，风险比为0.84 （95%CI: 0.66-1.06; P = 0.16）。结论：在接受结直肠癌治疗的糖尿病患者的现实世界队列中，GLP1-RA治疗与总生存期的显着改善相关。这些发现支持在该人群中继续使用GLP1-RA药物，并可能为临床医生和患者在结直肠癌诊断后使用这些药物的安全性和潜在益处提供保证。
{"title":"Association between glucagon-like peptide-1 receptor agonists and colorectal cancer survival: A population-based cohort study","authors":"Arnaud Dosda , Grégoire Fauchier , Nadia Sabbah , Laurent Fauchier , Thierry Lecomte , Pierre Henri Ducluzeau","doi":"10.1016/j.diabet.2026.101734","DOIUrl":"10.1016/j.diabet.2026.101734","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the association between glucagon-like peptide-1 receptor agonist (GLP1-RA) use and all-cause mortality in patients with type 2 diabetes treated for colorectal cancer, using a real-world health database.</div></div><div><h3>Methods</h3><div>This retrospective cohort study was conducted using the TriNetX global health records network. Adult patients with type 2 diabetes diagnosed with colorectal cancer between 2010 and 2025 were included. Patients were divided into two cohorts based on GLP1-RA exposure versus other oral antidiabetic drugs. Propensity score matching was applied to balance covariates. Overall survival (primary outcome) and metastasis-free survival (secondary outcome) were analysed using Kaplan-Meier curves and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>After propensity score matching, each cohort included 751 patients. Median follow-up period was 731 days in the GLP1-RA cohort and 779 days in the non-GLP1-RA cohort. GLP1-RA users had a significantly reduced all-cause mortality rate (11.5%) compared with non-users a (20.4%), with a hazard ratio of 0.58 (95%CI: 0.45–0.76; <em>P</em> < 0.001). Metastasis-free survival rate were 5.3% in the GLP1-RA cohort versus 8.9% in the matched non-user cohort, with a hazard ratio of 0.60 (95%CI: 0.40–0.87; <em>P</em> = 0.01). The incidence of major adverse cardiovascular events (MACE) did not differ significantly between cohorts, with a hazard ratio of 0.84 (95%CI: 0.66–1.06; <em>P</em> = 0.16).</div></div><div><h3>Conclusions</h3><div>In this real-world cohort of diabetic patients treated for colorectal cancer, GLP1-RA therapy was associated with a significant improvement in overall survival. These findings support the continued use of GLP1-RA agents in this population and may provide reassurance to clinicians and patients regarding the safety and potential benefit of these agents following a colorectal cancer diagnosis.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"52 2","pages":"Article 101734"},"PeriodicalIF":4.7,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess the outcomes of teleophthalmology-based diabetic retinopathy (DR) screening in individuals over 70 years within the OPHDIAT network and to compare them with those of patients aged 18–69 years.
Methods
A cohort of 16,459 diabetic patients, without known DR or with mild non-proliferative DR (NPDR), screened in 2024 in 32 OPHDIAT centers, was included and divided into two groups: < 70 years (n = 13,639) and ≥ 70 years (n = 2,820). Two non-mydriatic retinal photographs per eye were analyzed by certified ophthalmologists.
Results
Among patients aged ≥70 years, 21.3% (95% CI: 19.8–22.8) had any DR, and 6.1% (95% CI: 5.2–6.9) were referred to an ophthalmologist for moderate NPDR or a more severe form of the disease, including suspected macular edema. These proportions did not significantly differ from those found in patients < 70 years: 21.9% (95% CI: 21.2–22.6) and 6.1% (95% CI:5.6–6.5), respectively. Severe NPDR or proliferative DR were rare in both groups (1.0%, 95% CI: 0.6–1.4% vs. 1.7%, 95% CI: 1.5–1.9%, P < 0.001). The proportion of ungradable images was higher in the group ≥70 year (14.4%, 95% CI:13.1–15.7% vs. 6.1%, 95% CI: 5.7–6.5%, P < 0.001), particularly in phakic eyes, although 80% of patients had interpretable images for both eyes. Pupil dilation significantly improved image quality in this group. Screening also allowed detecting other ocular disorders, including age-related macular degeneration and glaucoma, which were more common in the group ≥ 70 years (2.1%, 95% CI: 1.5–2.6% vs. 0.6%, 95% CI: 0.4–0.7% P < 0.001).
Conclusion
Teleophthalmology-based DR screening appeared feasible and clinically relevant in patients aged ≥70 years, allowing identifying patients requiring ophthalmologic evaluation, while also detecting other age-related ocular diseases. Pupil dilation is recommended to optimize image quality in this population.
目的:。-评估在OPHDIAT网络中70岁以上个体的远程眼科糖尿病视网膜病变（DR）筛查的结果，并将其与18-70岁患者的结果进行比较。方法:。研究纳入了2024年在32个OPHDIAT中心筛选的16,459例糖尿病患者，这些患者没有已知的DR或轻度非增殖性DR (NPDR)，并分为两组：< 70岁（n=13,639）和≥70岁（n=2,820）。每只眼睛的两张非散光视网膜照片由注册眼科医生分析。结果：在年龄≥70岁的患者中，21.3% （95% CI: 19.8-22.8）有任何DR， 6.1% （95% CI: 5.2-6.9）因中度NPDR或更严重的疾病（包括疑似黄斑水肿）而转诊给眼科医生。这些比例与< 70岁患者的比例没有显著差异：分别为21.9% （95% CI: 21.2-22.6）和6.1% （95% CI:5.6-6.5）。严重的NPDR或增殖性DR在两组中都很少见（1.0%,95% CI: 0.6-1.4% vs. 1.7%, 95% CI: 1.5-1.9%, P < 0.001）。≥70岁组的不可分级图像比例更高（14.4%,95% CI:13.1-15.7% vs. 6.1%, 95% CI: 5.7-6.5%, P < 0.001），特别是在有晶态眼中，尽管80%的患者双眼图像可解释。瞳孔扩张明显改善了图像质量。筛查还允许检测其他眼部疾病，包括年龄相关性黄斑变性和青光眼，这些疾病在≥70岁的人群中更为常见（2.1%,95% CI: 1.5-2.6% vs. 0.6%, 95% CI: 0.4-0.7% P < 0.001）。结论:。-在年龄≥70岁的患者中，基于远距眼科的DR筛查似乎可行且具有临床相关性，可以识别需要眼科评估的患者，同时还可以检测其他与年龄相关的眼部疾病。在这个人群中，推荐瞳孔扩张来优化图像质量。
{"title":"Telemedicine-based diabetic retinopathy screening in patients over 70 Years: a French cohort study within the OPHDIAT network","authors":"Héloïse Torres-Villaros , Joseph Albou , Franck Fajnkuchen , Aude Couturier , Audrey Giocanti-Aurégan , Pascale Massin","doi":"10.1016/j.diabet.2026.101728","DOIUrl":"10.1016/j.diabet.2026.101728","url":null,"abstract":"<div><h3>Aim</h3><div>To assess the outcomes of teleophthalmology-based diabetic retinopathy (DR) screening in individuals over 70 years within the OPHDIAT network and to compare them with those of patients aged 18–69 years.</div></div><div><h3>Methods</h3><div>A cohort of 16,459 diabetic patients, without known DR or with mild non-proliferative DR (NPDR), screened in 2024 in 32 OPHDIAT centers, was included and divided into two groups: < 70 years (<em>n</em> = 13,639) and ≥ 70 years (<em>n</em> = 2,820). Two non-mydriatic retinal photographs per eye were analyzed by certified ophthalmologists.</div></div><div><h3>Results</h3><div>Among patients aged ≥70 years, 21.3% (95% CI: 19.8–22.8) had any DR, and 6.1% (95% CI: 5.2–6.9) were referred to an ophthalmologist for moderate NPDR or a more severe form of the disease, including suspected macular edema. These proportions did not significantly differ from those found in patients < 70 years: 21.9% (95% CI: 21.2–22.6) and 6.1% (95% CI:5.6–6.5), respectively. Severe NPDR or proliferative DR were rare in both groups (1.0%, 95% CI: 0.6–1.4% <em>vs</em>. 1.7%, 95% CI: 1.5–1.9%, <em>P</em> < 0.001). The proportion of ungradable images was higher in the group ≥70 year (14.4%, 95% CI:13.1–15.7% <em>vs</em>. 6.1%, 95% CI: 5.7–6.5%, <em>P</em> < 0.001), particularly in phakic eyes, although 80% of patients had interpretable images for both eyes. Pupil dilation significantly improved image quality in this group. Screening also allowed detecting other ocular disorders, including age-related macular degeneration and glaucoma, which were more common in the group ≥ 70 years (2.1%, 95% CI: 1.5–2.6% <em>vs</em>. 0.6%, 95% CI: 0.4–0.7% <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Teleophthalmology-based DR screening appeared feasible and clinically relevant in patients aged ≥70 years, allowing identifying patients requiring ophthalmologic evaluation, while also detecting other age-related ocular diseases. Pupil dilation is recommended to optimize image quality in this population.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"52 2","pages":"Article 101728"},"PeriodicalIF":4.7,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.diabet.2026.101726
Jessica L Harding , Tegveer S Uppal , Dunya Tomic , Mohammed K Ali , Agus Salim , Dianna J Magliano
Objective
The true burden of diabetes is likely underestimated by not considering the full range of complications associated with diabetes. Our aim was to compare cause-specific hospitalizations in adults with vs. without diabetes.
Research Design and Methods
Our denominator included all adults with and without self-reported diabetes from the 2019 Behavioral Risk Factor Surveillance System Survey, weighted to reflect the U.S. population. Our numerator, age-standardized risks of ICD-10-CM-defined inpatient hospitalizations and emergency department (ED) visits, were identified from the 2019 National Inpatient Sample and National ED Sample, respectively, weighted to be representative of U.S. hospitalizations. Each cause-specific hospitalization was classified as traditional, emerging, or other.
Results
For inpatient hospitalizations, the highest absolute risk difference per classification was for sepsis (traditional; 1,680 [95%CI: 1,649–1,712] hospitalizations per 100,000), pneumonia (emerging; 225 [218–232]), and respiratory failure (other; 280 [272–289]). For ED visits, the highest absolute risk difference was for abscess, furuncle, and carbuncle (traditional; 388 [352–423] visits per 100,000), complications of cardiac devices (emerging; 111 [104–118]), and disorders of the urinary system (other; 299 [252–346]).
Conclusions
The causes of excess hospitalizations associated with diabetes extend well beyond traditional complications with implications for population-level planning, resource allocation, and individual diabetes management.
{"title":"Excess burden of hospitalizations in adults with diabetes – a national US cross-sectional study","authors":"Jessica L Harding , Tegveer S Uppal , Dunya Tomic , Mohammed K Ali , Agus Salim , Dianna J Magliano","doi":"10.1016/j.diabet.2026.101726","DOIUrl":"10.1016/j.diabet.2026.101726","url":null,"abstract":"<div><h3>Objective</h3><div>The true burden of diabetes is likely underestimated by not considering the full range of complications associated with diabetes. Our aim was to compare cause-specific hospitalizations in adults with vs. without diabetes.</div></div><div><h3>Research Design and Methods</h3><div>Our denominator included all adults with and without self-reported diabetes from the 2019 Behavioral Risk Factor Surveillance System Survey, weighted to reflect the U.S. population. Our numerator, age-standardized risks of ICD-10-CM-defined inpatient hospitalizations and emergency department (ED) visits, were identified from the 2019 National Inpatient Sample and National ED Sample, respectively, weighted to be representative of U.S. hospitalizations. Each cause-specific hospitalization was classified as traditional, emerging, or other.</div></div><div><h3>Results</h3><div>For inpatient hospitalizations, the highest absolute risk difference per classification was for sepsis (traditional; 1,680 [95%CI: 1,649–1,712] hospitalizations per 100,000), pneumonia (emerging; 225 [218–232]), and respiratory failure (other; 280 [272–289]). For ED visits, the highest absolute risk difference was for abscess, furuncle, and carbuncle (traditional; 388 [352–423] visits per 100,000), complications of cardiac devices (emerging; 111 [104–118]), and disorders of the urinary system (other; 299 [252–346]).</div></div><div><h3>Conclusions</h3><div>The causes of excess hospitalizations associated with diabetes extend well beyond traditional complications with implications for population-level planning, resource allocation, and individual diabetes management.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"52 2","pages":"Article 101726"},"PeriodicalIF":4.7,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.diabet.2026.101723
David M Williams , Jagadish Nagaraj , Laura Wilkinson , Jeffrey W Stephens , Thinzar Min
{"title":"Views and understanding of metabolic dysfunction-associated steatotic liver disease in patients with diabetes","authors":"David M Williams , Jagadish Nagaraj , Laura Wilkinson , Jeffrey W Stephens , Thinzar Min","doi":"10.1016/j.diabet.2026.101723","DOIUrl":"10.1016/j.diabet.2026.101723","url":null,"abstract":"","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"52 2","pages":"Article 101723"},"PeriodicalIF":4.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assessed hyperglycaemia in pregnancy (HIP) prevalence trends over the past decade, accounting for risk factors and screening practices (France introduced early risk-based HIP screening in 2010).
Methods
We analysed national delivery data from the French National Health Data System (SNDS) (2012-2022), excluding women with pre-existing diabetes (n=8,172,911). Poisson regressions with generalized estimating equations estimated prevalence ratios (PR) for HIP risk factors. Counterfactual scenarios quantified contributions of maternal age, early screening, and pre-pregnancy overweight to HIP increase.
Results
HIP prevalence increased from 7.5% in 2012 to 15.7% in 2022, with early HIP tripling. Prevalence rose in 2020–2021 during the Covid-19 pandemic. After adjustment for maternal age, parity, socioeconomic status, season of pregnancy onset, place of delivery, regional prevalence of pre-pregnancy overweight, and early screening, the aPR were 1.30 [1.11–1.51] in 2021 and 1.15 [0.97–1.36] in 2022 vs. 2012 (unadjusted: 2.24 [2.22–2.26] and 2.08 [2.06–2.10]), suggesting that these factors account for a large proportion of the observed increase. While the observed increase in HIP prevalence was 8.2 percentage points from 2012 to 2022, counterfactual scenarios estimated increases of 6.5 [5.9–7.3] for constant maternal age, 6.2 [5.1–7.7] for constant early screening (13.7%), and 4.3 [2.4–5.9] for constant regional pre-pregnancy overweight (11.8%) at 2012 levels.
Conclusion
Rising maternal age, increased early HIP screening, and higher regional pre-pregnancy overweight prevalence mostly contributed to HIP prevalence increase. Public health strategies should prioritize modifiable risk factors—particularly pre-pregnancy overweight—and evaluate the effectiveness of early screening practices.
{"title":"Factors impacting the recent doubling of French hyperglycaemia prevalence in pregnancy","authors":"Élodie Lebreton , Luveon Tang , Sandrine Fosse-Edorh , Anne Vambergue , Emmanuel Cosson , Nolwenn Regnault","doi":"10.1016/j.diabet.2026.101724","DOIUrl":"10.1016/j.diabet.2026.101724","url":null,"abstract":"<div><h3>Aim</h3><div>To assessed hyperglycaemia in pregnancy (HIP) prevalence trends over the past decade, accounting for risk factors and screening practices (France introduced early risk-based HIP screening in 2010).</div></div><div><h3>Methods</h3><div>We analysed national delivery data from the French National Health Data System (SNDS) (2012-2022), excluding women with pre-existing diabetes (n=8,172,911). Poisson regressions with generalized estimating equations estimated prevalence ratios (PR) for HIP risk factors. Counterfactual scenarios quantified contributions of maternal age, early screening, and pre-pregnancy overweight to HIP increase.</div></div><div><h3>Results</h3><div>HIP prevalence increased from 7.5% in 2012 to 15.7% in 2022, with early HIP tripling. Prevalence rose in 2020–2021 during the Covid-19 pandemic. After adjustment for maternal age, parity, socioeconomic status, season of pregnancy onset, place of delivery, regional prevalence of pre-pregnancy overweight, and early screening, the aPR were 1.30 [1.11–1.51] in 2021 and 1.15 [0.97–1.36] in 2022 vs. 2012 (unadjusted: 2.24 [2.22–2.26] and 2.08 [2.06–2.10]), suggesting that these factors account for a large proportion of the observed increase. While the observed increase in HIP prevalence was 8.2 percentage points from 2012 to 2022, counterfactual scenarios estimated increases of 6.5 [5.9–7.3] for constant maternal age, 6.2 [5.1–7.7] for constant early screening (13.7%), and 4.3 [2.4–5.9] for constant regional pre-pregnancy overweight (11.8%) at 2012 levels.</div></div><div><h3>Conclusion</h3><div>Rising maternal age, increased early HIP screening, and higher regional pre-pregnancy overweight prevalence mostly contributed to HIP prevalence increase. Public health strategies should prioritize modifiable risk factors—particularly pre-pregnancy overweight—and evaluate the effectiveness of early screening practices.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"52 2","pages":"Article 101724"},"PeriodicalIF":4.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.diabet.2026.101722
Jakob Starup-Linde , Katrine Hygum , Henrik Støvring , Jens-Erik Beck Jensen , Pia Eiken , Pernille Hermann , Bente Langdahl , Torben Harsløf
Aims
Traditional risk factors underestimate fracture risk in individuals with diabetes. In this population-based case-control study we aimed to determine T-score thresholds for type 1 and 2 diabetes (T1D and T2D) with equivalent risk of fractures as that of individuals without diabetes and a T-score of -2.5.
Research Design and Methods
We collected dual energy x-ray absorptiometry (DXA) data (2000–2019), information on diagnoses (1977–2019) and redeemed medications (1997–2019) from the National Danish Registries which are linked by a unique identifier. Cases were individuals with the first incident major osteoporotic fracture (MOF) within two years before or one year after a DXA and controls were fracture free and matched on age, gender, and time period of the DXA. Logistic regression modelling was used in the case-control analysis.
Results
We identified 17,703 cases and 17,703 controls. T1D and T2D were associated with an increased risk of MOF (odds ratio: 1.8, 95 % CI:1.4;2.3 and 1.2, 95 % CI:1.1;1.3, respectively) adjusted for hip BMD. T1D and T2D patients had a similar risk of MOF at T-scores (total hip) = -1.4 and -2.1, respectively, as patients without diabetes with a T-score of -2.5. For hip fracture, the equivalent risk was correspondingly reached with T-scores of -1.9 and -1.6. Similar findings apply for femoral neck and lumbar spine BMD.
Conclusions
Compared to individuals without diabetes, fracture risk was increased in patients with T1D and T2D independent of BMD. Our study suggests that the T-score thresholds for treatment initiation in T1D and T2D should be increased.
{"title":"Fracture risk and treatment thresholds in patients with diabetes","authors":"Jakob Starup-Linde , Katrine Hygum , Henrik Støvring , Jens-Erik Beck Jensen , Pia Eiken , Pernille Hermann , Bente Langdahl , Torben Harsløf","doi":"10.1016/j.diabet.2026.101722","DOIUrl":"10.1016/j.diabet.2026.101722","url":null,"abstract":"<div><h3>Aims</h3><div>Traditional risk factors underestimate fracture risk in individuals with diabetes. In this population-based case-control study we aimed to determine T-score thresholds for type 1 and 2 diabetes (T1D and T2D) with equivalent risk of fractures as that of individuals without diabetes and a T-score of -2.5.</div></div><div><h3>Research Design and Methods</h3><div>We collected dual energy x-ray absorptiometry (DXA) data (2000–2019), information on diagnoses (1977–2019) and redeemed medications (1997–2019) from the National Danish Registries which are linked by a unique identifier. Cases were individuals with the first incident major osteoporotic fracture (MOF) within two years before or one year after a DXA and controls were fracture free and matched on age, gender, and time period of the DXA. Logistic regression modelling was used in the case-control analysis.</div></div><div><h3>Results</h3><div>We identified 17,703 cases and 17,703 controls. T1D and T2D were associated with an increased risk of MOF (odds ratio: 1.8, 95 % CI:1.4;2.3 and 1.2, 95 % CI:1.1;1.3, respectively) adjusted for hip BMD. T1D and T2D patients had a similar risk of MOF at T-scores (total hip) = -1.4 and -2.1, respectively, as patients without diabetes with a T-score of -2.5. For hip fracture, the equivalent risk was correspondingly reached with T-scores of -1.9 and -1.6. Similar findings apply for femoral neck and lumbar spine BMD.</div></div><div><h3>Conclusions</h3><div>Compared to individuals without diabetes, fracture risk was increased in patients with T1D and T2D independent of BMD. Our study suggests that the T-score thresholds for treatment initiation in T1D and T2D should be increased.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"52 2","pages":"Article 101722"},"PeriodicalIF":4.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.diabet.2025.101721
Jean-Pierre Riveline , Colin Hopley , Anamaria-Vera Olivieri , Gabriel Guigand , Melanie Littlewood , Alfred Penfornis
Aim
-To compare long-term cost-effectiveness between the Omnipod® 5 Automated Insulin Delivery System and continuous subcutaneous insulin infusion + continuous glucose monitoring for type 1 diabetes among adults in France.
Methods
- The analysis used the IQVIA Core Diabetes Model (v9.5) and considered both the French healthcare system and societal perspective. The study population and treatment effects were from the OP5–003 randomized controlled trial. Life-years, quality-adjusted life-years, incremental cost-effectiveness ratios and incremental cost-utility ratios, modeled over a 50-year horizon (base case), were analyzed. Sensitivity analyses were conducted to test treatment effects with different time horizons and discounting. Utility values were based on Omnipod 5 EuroQoL 3-Dimensions data and literature sources.
Results
- In the base case, Omnipod 5 showed better clinical outcomes and lower diabetes-related complication rates than continuous subcutaneous insulin infusion + continuous glucose monitoring, gaining 0.373 life-years and 1.568 quality-adjusted life-years (incremental cost-utility ratio considering direct costs from a healthcare perspective = €791 per quality-adjusted life-year). With Omnipod 5, although direct healthcare costs were €1240 higher, there were savings from reduced complications, and total costs including societal productivity were €3071 lower. Sensitivity analyses confirmed lower total costs with Omnipod 5 across time horizons and discounting, and the direct cost-utility ratio was €2438 per quality-adjusted life-year when the treatment effect on glycosylated hemoglobin was halved.
Conclusion
- Considering the reported benefits on glycemic control and health-related quality of life, Omnipod 5 is a cost-effective alternative to continuous subcutaneous insulin infusion + continuous glucose monitoring for adults with type 1 diabetes in France.
{"title":"Is Omnipod 5 cost effective for the management of type 1 diabetes among adults in France?","authors":"Jean-Pierre Riveline , Colin Hopley , Anamaria-Vera Olivieri , Gabriel Guigand , Melanie Littlewood , Alfred Penfornis","doi":"10.1016/j.diabet.2025.101721","DOIUrl":"10.1016/j.diabet.2025.101721","url":null,"abstract":"<div><h3>Aim</h3><div><em>-</em>To compare long-term cost-effectiveness between the Omnipod® 5 Automated Insulin Delivery System and continuous subcutaneous insulin infusion + continuous glucose monitoring for type 1 diabetes among adults in France.</div></div><div><h3>Methods</h3><div><em>-</em> The analysis used the IQVIA Core Diabetes Model (v9.5) and considered both the French healthcare system and societal perspective. The study population and treatment effects were from the OP5–003 randomized controlled trial. Life-years, quality-adjusted life-years, incremental cost-effectiveness ratios and incremental cost-utility ratios, modeled over a 50-year horizon (base case), were analyzed. Sensitivity analyses were conducted to test treatment effects with different time horizons and discounting. Utility values were based on Omnipod 5 EuroQoL 3-Dimensions data and literature sources.</div></div><div><h3>Results</h3><div><em>-</em> In the base case, Omnipod 5 showed better clinical outcomes and lower diabetes-related complication rates than continuous subcutaneous insulin infusion + continuous glucose monitoring, gaining 0.373 life-years and 1.568 quality-adjusted life-years (incremental cost-utility ratio considering direct costs from a healthcare perspective = €791 per quality-adjusted life-year). With Omnipod 5, although direct healthcare costs were €1240 higher, there were savings from reduced complications, and total costs including societal productivity were €3071 lower. Sensitivity analyses confirmed lower total costs with Omnipod 5 across time horizons and discounting, and the direct cost-utility ratio was €2438 per quality-adjusted life-year when the treatment effect on glycosylated hemoglobin was halved.</div></div><div><h3>Conclusion</h3><div><em>-</em> Considering the reported benefits on glycemic control and health-related quality of life, Omnipod 5 is a cost-effective alternative to continuous subcutaneous insulin infusion + continuous glucose monitoring for adults with type 1 diabetes in France.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"52 1","pages":"Article 101721"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1016/j.diabet.2025.101720
Elise Berchoux , Ilan Szwarc , Jean-Baptiste Bonnet , Joanna Pissarra , Antoine Avignon , Sébastien Jugant , Moglie Le Quintrec , Ariane Sultan
Backgroung
In patients with type 2 diabetes (T2D) undergoing hemodialysis (HD), glycemic control is challenging, and glycated hemoglobin (HbA1c) is often unreliable due to altered red blood cell turnover, anemia, and treatments such as erythropoiesis-stimulating agents. Continuous glucose monitoring (CGM) provides additional metrics—such as time in range (TIR), time below range (TBR), and glycemic variability—that may better reflect glucose control in this population. This study aimed to assess the usefulness of 14-day CGM data compared to HbA1c in evaluating glycemic control in T2D patients on HD.
Methods
This is a prospective and multicenter study. Patients included were of > 18 years, DM2, and hemodialysis patients. We assessed glycemic control of diabetic hemodialysis patient over 14 days with the CGM freestyle 1 comparing to HbA1c.
Results
Forty-one patients were included. While 68 % had HbA1c < 8 %, only 21 % met the CGM targets (P < 0.005). Mean glucose levels were significantly lower on dialysis days (−13 mg/dl, P < 0.0001), without an increase in hypoglycemic episodes. Discrepancies between HbA1c and CGM metrics were associated with diabetes-related nephropathy and longer duration of HD.
Conclusion
HbA1c alone may substantially underestimate glycemic burden in patients on hemodialysis. CGM provides a more accurate assessment of glucose control and reveals undetected hypo- and hyperglucose levels. Incorporating CGM into routine care may improve diabetes management and therapeutic decision-making in this high-risk population.
背景：在接受血液透析（HD）的2型糖尿病（T2D）患者中，血糖控制具有挑战性，糖化血红蛋白（HbA1c）通常不可靠，原因是红细胞周转改变、贫血和使用促红细胞生成药物等治疗。连续血糖监测（CGM）提供了额外的指标，如范围内时间（TIR）、范围下时间（TBR）和血糖变异性，可以更好地反映这一人群的血糖控制情况。本研究旨在评估14天CGM数据与HbA1c在评估糖尿病合并糖尿病患者血糖控制方面的有用性。方法：这是一项前瞻性多中心研究。纳入的患者包括18岁以下、DM2和血液透析患者。我们用CGM自由式1与HbA1c比较，评估糖尿病血液透析患者14天的血糖控制情况。结果：纳入41例患者。68%的患者HbA1c < 8%，只有21%的患者达到CGM目标（P < 0.005）。透析日的平均血糖水平显著降低（-13 mg/dl, P < 0.0001），低血糖发作没有增加。HbA1c和CGM指标之间的差异与糖尿病相关性肾病和更长的HD持续时间有关。结论：单独的HbA1c可能大大低估了血液透析患者的血糖负担。CGM提供更准确的血糖控制评估，揭示未检测到的低血糖和高血糖水平。将CGM纳入常规护理可改善这一高危人群的糖尿病管理和治疗决策。
{"title":"\"Usefulness of continuous interstitial glucose in diabetic patient undergoing hemodialysis","authors":"Elise Berchoux , Ilan Szwarc , Jean-Baptiste Bonnet , Joanna Pissarra , Antoine Avignon , Sébastien Jugant , Moglie Le Quintrec , Ariane Sultan","doi":"10.1016/j.diabet.2025.101720","DOIUrl":"10.1016/j.diabet.2025.101720","url":null,"abstract":"<div><h3>Backgroung</h3><div>In patients with type 2 diabetes (T2D) undergoing hemodialysis (HD), glycemic control is challenging, and glycated hemoglobin (HbA1c) is often unreliable due to altered red blood cell turnover, anemia, and treatments such as erythropoiesis-stimulating agents. Continuous glucose monitoring (CGM) provides additional metrics—such as time in range (TIR), time below range (TBR), and glycemic variability—that may better reflect glucose control in this population. This study aimed to assess the usefulness of 14-day CGM data compared to HbA1c in evaluating glycemic control in T2D patients on HD.</div></div><div><h3>Methods</h3><div>This is a prospective and multicenter study. Patients included were of > 18 years, DM2, and hemodialysis patients. We assessed glycemic control of diabetic hemodialysis patient over 14 days with the CGM freestyle 1 comparing to HbA1c.</div></div><div><h3>Results</h3><div>Forty-one patients were included. While 68 % had HbA1c < 8 %, only 21 % met the CGM targets (<em>P</em> < 0.005). Mean glucose levels were significantly lower on dialysis days (−13 mg/dl, <em>P</em> < 0.0001), without an increase in hypoglycemic episodes. Discrepancies between HbA1c and CGM metrics were associated with diabetes-related nephropathy and longer duration of HD.</div></div><div><h3>Conclusion</h3><div>HbA1c alone may substantially underestimate glycemic burden in patients on hemodialysis. CGM provides a more accurate assessment of glucose control and reveals undetected hypo- and hyperglucose levels. Incorporating CGM into routine care may improve diabetes management and therapeutic decision-making in this high-risk population.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"52 1","pages":"Article 101720"},"PeriodicalIF":4.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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