We explored the association between epicardial adipose tissue (EAT) volume and diabetic retinopathy.
Methods
We used clinical data from a monocentric mixed retrospective and prospective observational study of 1093 individuals living with diabetes who had a computed tomography (CT) scan in order to calculate their coronary artery calcium (CAC) score. This scan was also used to compute EAT volume. For the present study, only persons whose diabetic retinopathy status was known (i.e., yes/no) were included.
Results
We included 1037 individuals living with diabetes (type 2 79.1 %, type 1 14.8 %, other types 6.2 %) for 14.6 ± 9.9 years. Mean body mass index was 29.4 ± 5.9 kg/m², HbA1c was 8.7 ± 2.2 %, 38.2 % had diabetic retinopathy, and EAT volume was 93 ± 40 cm3. Diabetic retinopathy was positively associated with North African ethnicity, type 1 diabetes, longer diabetes duration, higher HbA1c levels, and more hypertension and diabetes-related complications (nephropathy, neuropathy, macroangiopathy and a high CAC score). EAT volume was lower in patients with diabetic retinopathy than in those without (87 ± 37 vs 97 ± 42 cm3, P < 0.0001), independently of confounders (per 10cm3 increase: odds ratio 0.89 [95 % confidence interval 0.84;0.93], P < 0.0001).
Conclusion
We found an unexpected negative association between the volume of EAT—a proinflammatory tissue—and diabetic retinopathy prevalence. This finding warrants further mechanistic investigation.
前言：我们探讨了心外膜脂肪组织（EAT）体积与糖尿病视网膜病变之间的关系。方法：我们使用了一项来自1093例糖尿病患者的单中心混合回顾性和前瞻性观察研究的临床数据，这些糖尿病患者进行了计算机断层扫描（CT），以计算他们的冠状动脉钙（CAC）评分。该扫描也用于计算EAT体积。在本研究中，仅包括糖尿病视网膜病变状态已知的人（即，是/否）。结果：纳入1037例糖尿病患者（2型79.1%，1型14.8%，其他型6.2%），随访14.6±9.9年。平均体重指数为29.4±5.9 kg/m²，糖化血红蛋白为8.7±2.2%，糖尿病视网膜病变38.2%，EAT体积为93±40 cm3。糖尿病视网膜病变与北非种族、1型糖尿病、糖尿病病程较长、HbA1c水平较高、高血压和糖尿病相关并发症（肾病、神经病变、大血管病变和高CAC评分）呈正相关。糖尿病视网膜病变患者的EAT体积低于无糖尿病视网膜病变患者（87±37 vs 97±42 cm3, P < 0.0001），独立于混杂因素（每增加10cm3：优势比0.89[95%可信区间0.84;0.93],P < 0.0001）。结论：我们发现促炎组织eat的体积与糖尿病视网膜病变患病率之间存在意想不到的负相关。这一发现值得进一步的机理研究。
{"title":"Epicardial adipose tissue volume and diabetic retinopathy","authors":"Emmanuel Cosson , Sopio Tatulashvili , Marouane Boubaya , Amir Abdul Khalife , Imen Rezgani , Lucie Allard , Meriem Sal , Ines Barka , Mohamed Lamine Mariko , Mohamed Zerguine , Omar Nouhou Koutcha , Bénédicte Gaborit , Coralie Bloch-Queyrat , Pierre-Yves Brillet , Héloïse Torres-Villaros , Audrey Giocanti-Aurégan , Hélène Bihan","doi":"10.1016/j.diabet.2025.101706","DOIUrl":"10.1016/j.diabet.2025.101706","url":null,"abstract":"<div><h3>Introduction</h3><div>We explored the association between epicardial adipose tissue (EAT) volume and diabetic retinopathy.</div></div><div><h3>Methods</h3><div>We used clinical data from a monocentric mixed retrospective and prospective observational study of 1093 individuals living with diabetes who had a computed tomography (CT) scan in order to calculate their coronary artery calcium (CAC) score. This scan was also used to compute EAT volume. For the present study, only persons whose diabetic retinopathy status was known (i.e., yes/no) were included.</div></div><div><h3>Results</h3><div>We included 1037 individuals living with diabetes (type 2 79.1 %, type 1 14.8 %, other types 6.2 %) for 14.6 ± 9.9 years. Mean body mass index was 29.4 ± 5.9 kg/m², HbA1c was 8.7 ± 2.2 %, 38.2 % had diabetic retinopathy, and EAT volume was 93 ± 40 cm<sup>3</sup>. Diabetic retinopathy was positively associated with North African ethnicity, type 1 diabetes, longer diabetes duration, higher HbA1c levels, and more hypertension and diabetes-related complications (nephropathy, neuropathy, macroangiopathy and a high CAC score). EAT volume was lower in patients with diabetic retinopathy than in those without (87 ± 37 vs 97 ± 42 cm<sup>3</sup>, <em>P</em> < 0.0001), independently of confounders (per 10cm<sup>3</sup> increase: odds ratio 0.89 [95 % confidence interval 0.84;0.93], <em>P</em> < 0.0001).</div></div><div><h3>Conclusion</h3><div>We found an unexpected negative association between the volume of EAT—a proinflammatory tissue—and diabetic retinopathy prevalence. This finding warrants further mechanistic investigation.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101706"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277026","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 : 2025-09-19DOI: 10.1016/j.diabet.2025.101705
Hamza Khan
{"title":"Comment on “Association between smoking status and suicide mortality in patients with type 2 diabetes: A nationwide population-based cohort study”","authors":"Hamza Khan","doi":"10.1016/j.diabet.2025.101705","DOIUrl":"10.1016/j.diabet.2025.101705","url":null,"abstract":"","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101705"},"PeriodicalIF":4.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116077","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}
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are widely used in type 2 diabetes (T2D) management, but their efficacy and tolerance in Prader-Willi syndrome (PWS) remains unknown. Given the early onset of diabetes and treatment challenges, evaluating SGLT2is in this population is essential.
Research and methods
In this retrospective, multicenter study, 48 adults with PWS and T2D, among whom 24 patients receiving SGLT2is, were followed over 6 months. Glycemic and renal parameters were analyzed at baseline and 6 months.
Results
HbA1c was higher in the SGLT2i group and significantly improved (P < 0.05) while it remained stable in controls. The albumin-to-creatinine ratio also decreased significantly. No significant weight change was noted. Adverse events occurred in 37.5 % of treated patients, including acute kidney injury in 8.3 %.
Conclusions
SGLT2is improve glycemic control and renal markers in PWS with no weight loss. Close safety monitoring is warranted, particularly regarding renal function in PWS and more generally towards all complex obesity with neurodevelopmental disorders.
{"title":"Glycemic and renal effects of SGLT2 Inhibitors in Prader-Willi syndrome: Benefits and risks","authors":"Juliette Jacquot-Thierry , Sarah Chalopin , Héléna Mosbah , Émilie Montastier , Fabien Mourre , Blandine Gatta-Cherifi , Julien Bourry , Eléonore Guichard , Pauline Faucher , Christine Poitou , Chloé Amouyal","doi":"10.1016/j.diabet.2025.101704","DOIUrl":"10.1016/j.diabet.2025.101704","url":null,"abstract":"<div><h3>Objective</h3><div>Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are widely used in type 2 diabetes (T2D) management, but their efficacy and tolerance in Prader-Willi syndrome (PWS) remains unknown. Given the early onset of diabetes and treatment challenges, evaluating SGLT2is in this population is essential.</div></div><div><h3>Research and methods</h3><div>In this retrospective, multicenter study, 48 adults with PWS and T2D, among whom 24 patients receiving SGLT2is, were followed over 6 months. Glycemic and renal parameters were analyzed at baseline and 6 months.</div></div><div><h3>Results</h3><div>HbA1c was higher in the SGLT2i group and significantly improved (<em>P</em> < 0.05) while it remained stable in controls. The albumin-to-creatinine ratio also decreased significantly<strong>.</strong> No significant weight change was noted. Adverse events occurred in 37.5 % of treated patients, including acute kidney injury in 8.3 %.</div></div><div><h3>Conclusions</h3><div>SGLT2is improve glycemic control and renal markers in PWS with no weight loss. Close safety monitoring is warranted, particularly regarding renal function in PWS and more generally towards all complex obesity with neurodevelopmental disorders.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101704"},"PeriodicalIF":4.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102692","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 : 2025-09-12DOI: 10.1016/j.diabet.2025.101703
Beatriz Barquiel , Daniel Álvarez , Óscar Moreno Domínguez , Elena García-Pérez de Sevilla , Natalia Hillman , Ricardo Romero , Ruth Gaspar , Montserrat Arévalo , Noemí González-Perez de Villar
Aims
Diabetic retinopathy (DR) is a complication of chronic hyperglycemia in people living with type 1 diabetes (PLWT1D). The use of automated insulin delivery (AID) systems may modify this course. In this prospective observational study, we evaluated whether the MiniMed 780G AID system was associated with remission or improvement in the severity of DR.
Methods
The study included PLWT1D with DR treated either with the AID system or with multiple daily insulin injections (MDI) combined with intermittent glucose monitoring. The follow-up period was two years. DR was graded annually, and HbA1c levels were recorded. Glucose monitoring parameters were also assessed to evaluate the impact of glucose ranges and variability on retinopathy. Group comparisons were performed using univariate and multivariate statistical analyses.
Results
DR remission occurred in 15/30 (50 %) participants treated with the AID system, compared with 0/30 (0 %) in the MDI group (P < 0.001). Improvement in DR stage was observed in 15/30 (50 %) participants in the AID group, compared with 2/30 (6.7 %) in the MDI group (P < 0.001). These outcomes were associated with lower HbA1c, reduced time above range (TAR), and a lower coefficient of variation (CV) in the remission group.
Conclusion
Remission or improvement of DR was observed in patients with type 1 diabetes treated with an AID system.
{"title":"Diabetic retinopathy remission in patients using an automated insulin delivery system: A prospective controlled study","authors":"Beatriz Barquiel , Daniel Álvarez , Óscar Moreno Domínguez , Elena García-Pérez de Sevilla , Natalia Hillman , Ricardo Romero , Ruth Gaspar , Montserrat Arévalo , Noemí González-Perez de Villar","doi":"10.1016/j.diabet.2025.101703","DOIUrl":"10.1016/j.diabet.2025.101703","url":null,"abstract":"<div><h3>Aims</h3><div>Diabetic retinopathy (DR) is a complication of chronic hyperglycemia in people living with type 1 diabetes (PLWT1D). The use of automated insulin delivery (AID) systems may modify this course. In this prospective observational study, we evaluated whether the MiniMed 780G AID system was associated with remission or improvement in the severity of DR.</div></div><div><h3>Methods</h3><div>The study included PLWT1D with DR treated either with the AID system or with multiple daily insulin injections (MDI) combined with intermittent glucose monitoring. The follow-up period was two years. DR was graded annually, and HbA1c levels were recorded. Glucose monitoring parameters were also assessed to evaluate the impact of glucose ranges and variability on retinopathy. Group comparisons were performed using univariate and multivariate statistical analyses.</div></div><div><h3>Results</h3><div>DR remission occurred in 15/30 (50 %) participants treated with the AID system, compared with 0/30 (0 %) in the MDI group (<em>P</em> < 0.001). Improvement in DR stage was observed in 15/30 (50 %) participants in the AID group, compared with 2/30 (6.7 %) in the MDI group (<em>P</em> < 0.001). These outcomes were associated with lower HbA1c, reduced time above range (TAR), and a lower coefficient of variation (CV) in the remission group.</div></div><div><h3>Conclusion</h3><div>Remission or improvement of DR was observed in patients with type 1 diabetes treated with an AID system.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101703"},"PeriodicalIF":4.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067011","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 evaluate the association between modelled substitution of total, red, and white meat with dairy subtypes (low-fat, full-fat, and fermented) and the 20-year cumulative incidence of type 2 diabetes (T2D), among apparently healthy adults.
Methods
The present analysis included data from 2000 individuals free of atherosclerotic cardiovascular disease and T2D at baseline (age 43 ± 13 years; 51% women), participating in the ATTICA cohort study (2002–2022). Food intake was assessed using a validated semi-quantitative food-frequency questionnaire.
Results
The 20-year cumulative incidence of T2D was 26.3% (95%CI [24.4, 28.3%]). Participants who developed T2D during follow-up reported significantly higher red meat consumption compared to those who did not (5.0 vs. 4.5 times/week; P = 0.016). Modelled substitution of one daily serving of total meat per 1000 kcal with full-fat dairy, in fully adjusted models, suggested a trend (at P < 0.10) of lowering 20-year T2D risk (OR 0.38, 95%CI [0.14, 1.05]); similarly, substitution of one daily serving/1000 kcal of total meat with fermented dairy showed a trend of lowering T2D risk (OR 0.39, 95%CI [0.15, 1.07]). Substituting red meat with full-fat dairy was not associated with T2D risk (OR per one daily serving/1000 kcal = 0.37, 95%CI [0.11, 1.19]); similarly, substitutions with low-fat, fermented dairy or white meat showed not significant associations with T2D risk.
Conclusion
Substituting total and red/processed meat with full-fat or fermented dairy products in modeled analyses indicated potentially favorable, though largely non-significant, associations with long-term risk of T2D.
{"title":"Modelled substitution of meat with dairy products and the 20-year cumulative incidence of type 2 diabetes: Insights from the ATTICA cohort study (2002–2022)","authors":"Ioanna Kechagia , Mary Yannakoulia , Fotios Barkas , Evangelos Liberopoulos , Petros P. Sfikakis , Christos Pitsavos , Demosthenes Panagiotakos","doi":"10.1016/j.diabet.2025.101701","DOIUrl":"10.1016/j.diabet.2025.101701","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate the association between modelled substitution of total, red, and white meat with dairy subtypes (low-fat, full-fat, and fermented) and the 20-year cumulative incidence of type 2 diabetes (T2D), among apparently healthy adults.</div></div><div><h3>Methods</h3><div>The present analysis included data from 2000 individuals free of atherosclerotic cardiovascular disease and T2D at baseline (age 43 ± 13 years; 51% women), participating in the ATTICA cohort study (2002–2022). Food intake was assessed using a validated semi-quantitative food-frequency questionnaire.</div></div><div><h3>Results</h3><div>The 20-year cumulative incidence of T2D was 26.3% (95%CI [24.4, 28.3%]). Participants who developed T2D during follow-up reported significantly higher red meat consumption compared to those who did not (5.0 vs. 4.5 times/week; <em>P</em> = 0.016). Modelled substitution of one daily serving of total meat per 1000 kcal with full-fat dairy, in fully adjusted models, suggested a trend (at <em>P</em> < 0.10) of lowering 20-year T2D risk (OR 0.38, 95%CI [0.14, 1.05]); similarly, substitution of one daily serving/1000 kcal of total meat with fermented dairy showed a trend of lowering T2D risk (OR 0.39, 95%CI [0.15, 1.07]). Substituting red meat with full-fat dairy was not associated with T2D risk (OR per one daily serving/1000 kcal = 0.37, 95%CI [0.11, 1.19]); similarly, substitutions with low-fat, fermented dairy or white meat showed not significant associations with T2D risk.</div></div><div><h3>Conclusion</h3><div>Substituting total and red/processed meat with full-fat or fermented dairy products in modeled analyses indicated potentially favorable, though largely non-significant, associations with long-term risk of T2D.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101701"},"PeriodicalIF":4.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056556","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 investigate the incidences of death and lower limb amputation (LLA) among patients hospitalized with a first diabetic foot ulcer and to identify the associated risk factors.
Methods
- We leveraged medical records from 08/2017 to 10/2023 in the clinical data warehouse of the Greater Paris Hospitals. The primary outcome was the cumulative incidence of death estimated at 12 months. We used Kaplan-Meier and Aalen-Johansen estimators to assess the incidence of death and LLA (identified through ICD-10 codes). We used multivariate Cox regression and Fine and Gray models to estimate risk factors (clinical/biological data, medications, and comorbidities at baseline) for death and LLA, accounting for death as a competing event.
Results
- 3102 patients were included; the median age was 70.66 years and there were 67.64% males. The cumulative incidence of death at 12 months was 21.64% [95%CI 20.11;23.26]. Mortality risk was associated with older age, chronic cardiac, hepatic, or renal diseases, cancer history, and systemic inflammation, whereas being overweight was linked to lower mortality. The cumulative incidence of LLA at 12 months was 24.15% [22.54;25.79]. Risk factors for LLA included male sex, history of peripheral artery disease, emergency admission, and systemic inflammation markers, while dementia was associated with a lower risk.
Conclusion
- Cumulative incidences of all-cause mortality and LLA during the months following hospitalization with a first diabetic foot ulcer were alarmingly high. Mortality risk was primarily associated with patient comorbidities, while amputation risk was closely associated with systemic inflammation and history of peripheral artery disease.
{"title":"Incidence of death and amputation in patients with a first diabetic foot ulcer: results from the CODIA cohort","authors":"Julla Jean-Baptiste , Jolivet Théo , Estellat Candice , Varoquaux Gaël , Carlier Aurélie , Gautier Jean-François , Alberge Julie , Abouleka Yawa , Bergès Audrey , Liu Elise , Abecassis Judith , Tubach Florence , Potier Louis","doi":"10.1016/j.diabet.2025.101700","DOIUrl":"10.1016/j.diabet.2025.101700","url":null,"abstract":"<div><h3>Aim</h3><div><em>-</em> To investigate the incidences of death and lower limb amputation (LLA) among patients hospitalized with a first diabetic foot ulcer and to identify the associated risk factors.</div></div><div><h3>Methods</h3><div><em>-</em> We leveraged medical records from 08/2017 to 10/2023 in the clinical data warehouse of the Greater Paris Hospitals. The primary outcome was the cumulative incidence of death estimated at 12 months. We used Kaplan-Meier and Aalen-Johansen estimators to assess the incidence of death and LLA (identified through ICD-10 codes). We used multivariate Cox regression and Fine and Gray models to estimate risk factors (clinical/biological data, medications, and comorbidities at baseline) for death and LLA, accounting for death as a competing event.</div></div><div><h3>Results</h3><div><em>-</em> 3102 patients were included; the median age was 70.66 years and there were 67.64% males. The cumulative incidence of death at 12 months was 21.64% [95%CI 20.11;23.26]. Mortality risk was associated with older age, chronic cardiac, hepatic, or renal diseases, cancer history, and systemic inflammation, whereas being overweight was linked to lower mortality. The cumulative incidence of LLA at 12 months was 24.15% [22.54;25.79]. Risk factors for LLA included male sex, history of peripheral artery disease, emergency admission, and systemic inflammation markers, while dementia was associated with a lower risk.</div></div><div><h3>Conclusion</h3><div><em>-</em> Cumulative incidences of all-cause mortality and LLA during the months following hospitalization with a first diabetic foot ulcer were alarmingly high. Mortality risk was primarily associated with patient comorbidities, while amputation risk was closely associated with systemic inflammation and history of peripheral artery disease.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101700"},"PeriodicalIF":4.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017021","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 prevalence of pancreatic lesions in patients hospitalized for newly diagnosed or uncontrolled diabetes mellitus and identify potential predictive factors for pancreatic pathology.
Methods
We conducted a retrospective, single-center observational study at Brest University Hospital between February 2016 and February 2022. Adult patients hospitalized for newly diagnosed diabetes or uncontrolled diabetes mellitus who underwent a computed tomography (CT) scan within six months of admission were included. Patients with type 1 diabetes, prior pancreatectomy, or a known history of pancreatic adenocarcinoma were excluded. Clinical, biological, and imaging data were analyzed.
Results
Among 412 patients analyzed, 53 (12.9 %) presented pancreatic abnormalities (PA), including 11 cases (2.7 %) of malignant pancreatic lesion. Predictive factors for PA (P < 0.05) included (odds ratio [95 % confidence interval]): age ≥ 65 years (2.00 [1.52;5.27]); body mass index ≤ 26.4 kg/m2 (2.65 [1.1;4.98]); LDL/HDL ratio ≤ 3.0 (4.75 [2.03;11.10]); and presence of at least one clinical warning sign (alcoholic use, steatorrhea, abdominal pain) (2.29 [1.21;4.33]). Using all four criteria together, 68 of 412 CT scans would have been avoided, with no missed cases.
Conclusions
The prevalence of pancreatic lesions in patients hospitalized for diabetes-related glycemic imbalance was significant although malignancy remained low. Age ≥ 65 years, low body mass index, and altered lipid profile may help identify patients requiring pancreatic imaging. Future prospective studies should refine these criteria to develop screening strategies for early pancreatic cancer detection in high-risk selected diabetic populations.
{"title":"Prevalence and predictive factors of computed tomography-detected pancreatopathy in a cohort of adult patients hospitalized for newly diagnosed or uncontrolled non-auto-immune diabetes","authors":"Noëmie Lemétayer , Lucille Quénéhervé , Jean-Romain Risson , Charlotte Nachtergaele , Geneviève Crouzeix , Emmanuel Sonnet , Nathalie Roudaut , Véronique Kerlan , Vianney Deméocq , Philippe Thuillier","doi":"10.1016/j.diabet.2025.101699","DOIUrl":"10.1016/j.diabet.2025.101699","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the prevalence of pancreatic lesions in patients hospitalized for newly diagnosed or uncontrolled diabetes mellitus and identify potential predictive factors for pancreatic pathology.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-center observational study at Brest University Hospital between February 2016 and February 2022. Adult patients hospitalized for newly diagnosed diabetes or uncontrolled diabetes mellitus who underwent a computed tomography (CT) scan within six months of admission were included. Patients with type 1 diabetes, prior pancreatectomy, or a known history of pancreatic adenocarcinoma were excluded. Clinical, biological, and imaging data were analyzed.</div></div><div><h3>Results</h3><div>Among 412 patients analyzed, 53 (12.9 %) presented pancreatic abnormalities (PA), including 11 cases (2.7 %) of malignant pancreatic lesion. Predictive factors for PA (<em>P</em> < 0.05) included (odds ratio [95 % confidence interval]): age ≥ 65 years (2.00 [1.52;5.27]); body mass index ≤ 26.4 kg/m<sup>2</sup> (2.65 [1.1;4.98]); LDL/HDL ratio ≤ 3.0 (4.75 [2.03;11.10]); and presence of at least one clinical warning sign (alcoholic use, steatorrhea, abdominal pain) (2.29 [1.21;4.33]). Using all four criteria together, 68 of 412 CT scans would have been avoided, with no missed cases.</div></div><div><h3>Conclusions</h3><div>The prevalence of pancreatic lesions in patients hospitalized for diabetes-related glycemic imbalance was significant although malignancy remained low. Age ≥ 65 years, low body mass index, and altered lipid profile may help identify patients requiring pancreatic imaging. Future prospective studies should refine these criteria to develop screening strategies for early pancreatic cancer detection in high-risk selected diabetic populations.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101699"},"PeriodicalIF":4.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985185","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 : 2025-08-22DOI: 10.1016/j.diabet.2025.101698
Ruey-Shyang Soong , Wan-Ming Chen , An-Tzu Jao , Ming-Che Lee , Szu-Yuan Wu , Chih-Lang Lin
Background
- Hepatocellular carcinoma (HCC) is increasingly driven by non-viral causes, especially metabolic dysfunction–associated steatotic liver disease (MASLD), which is common in type 2 diabetes mellitus (T2D). No pharmacologic agent is currently approved for HCC chemoprevention.
Objective
- To evaluate the association between sodium–glucose cotransporter-2 inhibitor (SGLT2i) use and risks of HCC and all-cause mortality in patients with MASLD and T2D.
Design
- Multinational, retrospective cohort study using the TriNetX federated electronic health record network (2005–2025). Adults aged 18–90 years with non-viral MASLD and pre-existing T2D were identified. We applied a 1-year washout, used an active-comparator design, and performed 1:1 propensity score matching. Adjusted hazard ratios (aHRs) were estimated with Cox models.
Results
- After matching, 93,930 SGLT2i users were compared with 93,930 active comparators with excellent covariate balance. Median follow-up was 3.24 years (IQR 1.72–5.09) in the SGLT2i group and 3.25 years (IQR 1.72–5.08) in comparators. HCC occurred in 43 (0.05 %) SGLT2i users vs 74 (0.08 %) comparators (aHR 0.43; 95 % CI 0.29–0.63). All-cause mortality was 5.32 % vs 10.50 % (aHR 0.34; 95 % CI 0.33–0.35). Results were consistent across subgroups and sensitivity analyses, including time-anchored landmark analyses. Risk reductions were also observed for liver fibrosis/cirrhosis and hepatic nodules.
Conclusions
- Among patients with MASLD and T2D, SGLT2 inhibitor use was associated with lower risks of HCC and all-cause mortality compared with active comparators. While residual confounding cannot be excluded, these findings support prospective evaluation of SGLT2 inhibitors for liver-related risk reduction in this population.
背景-肝细胞癌（HCC）越来越多地由非病毒原因引起，特别是代谢功能障碍相关的脂肪变性肝病（MASLD），这在2型糖尿病（T2D）中很常见。目前还没有药物被批准用于肝细胞癌的化学预防。目的：评估钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）的使用与MASLD和T2D患者HCC风险和全因死亡率之间的关系。设计-使用TriNetX联合电子健康记录网络（2005-2025）的多国回顾性队列研究。年龄在18-90岁的非病毒性MASLD和先前存在的T2D的成年人被确定。我们采用了1年的洗脱，采用了主动比较器设计，并进行了1:1的倾向评分匹配。校正风险比（aHRs）采用Cox模型估计。结果-匹配后，93,930名SGLT2i用户与93,930名活跃比较者进行了比较，协变量平衡良好。SGLT2i组中位随访时间为3.24年（IQR为1.72-5.09），对照组中位随访时间为3.25年（IQR为1.72-5.08）。43例（0.05%）SGLT2i使用者发生HCC，而74例（0.08%）对照者（aHR 0.43; 95% CI 0.29-0.63）。全因死亡率为5.32% vs 10.50% （aHR 0.34; 95% CI 0.33-0.35）。结果在亚组和敏感性分析中是一致的，包括时间锚定的里程碑分析。肝纤维化/肝硬化和肝结节的风险也有所降低。结论：在MASLD和T2D患者中，使用SGLT2抑制剂与活性比较物相比，HCC风险和全因死亡率较低相关。虽然不能排除残留的混杂因素，但这些发现支持SGLT2抑制剂在该人群中降低肝脏相关风险的前瞻性评估。
{"title":"SGLT2 inhibitors and the risk of hepatocellular carcinoma in patients with MASLD and Type 2 diabetes","authors":"Ruey-Shyang Soong , Wan-Ming Chen , An-Tzu Jao , Ming-Che Lee , Szu-Yuan Wu , Chih-Lang Lin","doi":"10.1016/j.diabet.2025.101698","DOIUrl":"10.1016/j.diabet.2025.101698","url":null,"abstract":"<div><h3>Background</h3><div>- Hepatocellular carcinoma (HCC) is increasingly driven by non-viral causes, especially metabolic dysfunction–associated steatotic liver disease (MASLD), which is common in type 2 diabetes mellitus (T2D). No pharmacologic agent is currently approved for HCC chemoprevention.</div></div><div><h3>Objective</h3><div>- To evaluate the association between sodium–glucose cotransporter-2 inhibitor (SGLT2i) use and risks of HCC and all-cause mortality in patients with MASLD and T2D.</div></div><div><h3>Design</h3><div><em>-</em> Multinational, retrospective cohort study using the TriNetX federated electronic health record network (2005–2025). Adults aged 18–90 years with non-viral MASLD and pre-existing T2D were identified. We applied a 1-year washout, used an active-comparator design, and performed 1:1 propensity score matching. Adjusted hazard ratios (aHRs) were estimated with Cox models.</div></div><div><h3>Results</h3><div>- After matching, 93,930 SGLT2i users were compared with 93,930 active comparators with excellent covariate balance. Median follow-up was 3.24 years (IQR 1.72–5.09) in the SGLT2i group and 3.25 years (IQR 1.72–5.08) in comparators. HCC occurred in 43 (0.05 %) SGLT2i users vs 74 (0.08 %) comparators (aHR 0.43; 95 % CI 0.29–0.63). All-cause mortality was 5.32 % vs 10.50 % (aHR 0.34; 95 % CI 0.33–0.35). Results were consistent across subgroups and sensitivity analyses, including time-anchored landmark analyses. Risk reductions were also observed for liver fibrosis/cirrhosis and hepatic nodules.</div></div><div><h3>Conclusions</h3><div>- Among patients with MASLD and T2D, SGLT2 inhibitor use was associated with lower risks of HCC and all-cause mortality compared with active comparators. While residual confounding cannot be excluded, these findings support prospective evaluation of SGLT2 inhibitors for liver-related risk reduction in this population.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101698"},"PeriodicalIF":4.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916305","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 : 2025-08-18DOI: 10.1016/j.diabet.2025.101697
Nathanaël Bassas Letissier , Nassir Mirfendereski , Marie-Laure Laroche , Jean- Luc Faillie , Marc Paccalin , Pierre-Jean Saulnier , Marion Allouchery , Helena Mosbah
Background
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been widely used in the management of type 2 diabetes, with proven cardiovascular and renal benefits. However, their use has been associated with a risk of diabetic ketoacidosis (DKA).
Aim
This study aims to describe the characteristics of DKA cases associated with SGLT2i use in patients aged 65 and over, based on data from the French pharmacovigilance database.
Methods
A retrospective analysis was conducted on all cases of DKA reported with SGLT2i in patients aged 65 years and older. Cases were retrieved from 2020 onward; 55 were analyzed. Patient characteristics, drug exposure, adverse drug reaction (ADR) reports, hospitalization details, and precipitating factors were examined.
Results
Median patient age was 74.0 years (IQR: 69.0; 77.5), with a predominance of males (63.4 %). The median Charlson comorbidity index was 8.0 (IQR: 6.0; 10.0), and polypharmacy was common, with a median of nine drugs per patient. Infections (36.4 %), dehydration (20.0 %), and fasting (18.2 %) were the main precipitating factors. All cases required hospitalization, with 36.4 % admitted to an intensive care unit (ICU). Among ICU patients, 35.0 % required orotracheal intubation and/or vasopressor therapy. One case (1.8 %) resulted in death. Factors significantly associated with ICU admission included younger age (71.3 vs. 75.4 years, P = 0.009), lower pH at admission (P = 0.003), and infection as a precipitating factor (P = 0.007).
Conclusion
This study highlights the clinical characteristics and risk factors of SGLT2i-associated DKA in older adults. Infections and severe acidosis were key predictors of ICU admission. The findings underscore the importance of careful patient selection and monitoring to mitigate DKA risk in older patients receiving SGLT2i therapy.
{"title":"Ketoacidosis associated with type 2 sodium-glucose cotransporter inhibitors (SGLT2i) in patients aged 65 and older: Evidence from the French national pharmacovigilance database","authors":"Nathanaël Bassas Letissier , Nassir Mirfendereski , Marie-Laure Laroche , Jean- Luc Faillie , Marc Paccalin , Pierre-Jean Saulnier , Marion Allouchery , Helena Mosbah","doi":"10.1016/j.diabet.2025.101697","DOIUrl":"10.1016/j.diabet.2025.101697","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been widely used in the management of type 2 diabetes, with proven cardiovascular and renal benefits. However, their use has been associated with a risk of diabetic ketoacidosis (DKA).</div></div><div><h3>Aim</h3><div>This study aims to describe the characteristics of DKA cases associated with SGLT2i use in patients aged 65 and over, based on data from the French pharmacovigilance database.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on all cases of DKA reported with SGLT2i in patients aged 65 years and older. Cases were retrieved from 2020 onward; 55 were analyzed. Patient characteristics, drug exposure, adverse drug reaction (ADR) reports, hospitalization details, and precipitating factors were examined.</div></div><div><h3>Results</h3><div>Median patient age was 74.0 years (IQR: 69.0; 77.5), with a predominance of males (63.4 %). The median Charlson comorbidity index was 8.0 (IQR: 6.0; 10.0), and polypharmacy was common, with a median of nine drugs per patient. Infections (36.4 %), dehydration (20.0 %), and fasting (18.2 %) were the main precipitating factors. All cases required hospitalization, with 36.4 % admitted to an intensive care unit (ICU). Among ICU patients, 35.0 % required orotracheal intubation and/or vasopressor therapy. One case (1.8 %) resulted in death. Factors significantly associated with ICU admission included younger age (71.3 vs. 75.4 years, <em>P</em> = 0.009), lower pH at admission (<em>P</em> = 0.003), and infection as a precipitating factor (<em>P</em> = 0.007).</div></div><div><h3>Conclusion</h3><div>This study highlights the clinical characteristics and risk factors of SGLT2i-associated DKA in older adults. Infections and severe acidosis were key predictors of ICU admission. The findings underscore the importance of careful patient selection and monitoring to mitigate DKA risk in older patients receiving SGLT2i therapy.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101697"},"PeriodicalIF":4.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884785","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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