Diabetes & metabolism最新文献_第4页

Incidence of death and amputation in patients with a first diabetic foot ulcer: results from the CODIA cohort 首次糖尿病足溃疡患者的死亡和截肢发生率：来自CODIA队列的结果

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-09-05 DOI: 10.1016/j.diabet.2025.101700

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

Aim

- 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.

目的：调查首次糖尿病足溃疡住院患者的死亡和下肢截肢（LLA）发生率，并确定相关危险因素。方法：-我们利用大巴黎医院临床数据仓库中2017年8月至2023年10月的医疗记录。主要终点是12个月时估计的累积死亡发生率。我们使用Kaplan-Meier和aallen - johansen估计器来评估死亡和LLA的发生率（通过ICD-10代码确定）。我们使用多变量Cox回归和Fine和Gray模型来估计死亡和LLA的危险因素（临床/生物学数据、药物和基线时的合并症），并将死亡作为一个竞争事件。结果：纳入3102例患者；年龄中位数为70.66岁，男性占67.64%。12个月累计死亡率为21.64% [95%CI 20.11;23.26]。死亡风险与年龄较大、慢性心脏、肝脏或肾脏疾病、癌症病史和全身性炎症有关，而超重与较低的死亡率有关。12个月LLA累计发生率为24.15%[22.54;25.79]。LLA的危险因素包括男性、外周动脉疾病史、急诊入院和全身性炎症标志物，而痴呆的风险较低。结论：在首次糖尿病足溃疡住院后的几个月内，全因死亡率和LLA的累积发生率高得惊人。死亡风险主要与患者合并症相关，而截肢风险与全身炎症和外周动脉疾病史密切相关。

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引用次数: 0

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 在一组因新诊断或未控制的非自身免疫性糖尿病住院的成年患者中，计算机断层扫描检测胰腺病变的患病率和预测因素

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-08-27 DOI: 10.1016/j.diabet.2025.101699

Noëmie Lemétayer , Lucille Quénéhervé , Jean-Romain Risson , Charlotte Nachtergaele , Geneviève Crouzeix , Emmanuel Sonnet , Nathalie Roudaut , Véronique Kerlan , Vianney Deméocq , Philippe Thuillier

Objective

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.

目的:。评估新诊断或未控制的糖尿病住院患者胰腺病变的患病率，并确定胰腺病理的潜在预测因素。方法：我们于2016年2月至2022年2月在布雷斯特大学医院进行了一项回顾性、单中心观察性研究。新诊断的糖尿病或未控制的糖尿病住院的成年患者在入院6个月内接受了计算机断层扫描（CT）扫描。排除1型糖尿病患者、既往胰腺切除术患者或已知胰腺腺癌病史患者。对临床、生物学和影像学资料进行分析。结果：412例患者中，53例（12.9%）出现胰腺异常（PA），其中胰腺恶性病变11例（2.7%）。PA的预测因素(P 2 (2.65 [1.1;4.98])；LDL/HDL比值≤3.0 (4.75 [2.03;11.10])；并且存在至少一种临床警告信号（饮酒、脂肪漏、腹痛）（2.29[1.21;4.33]）。综合使用所有四个标准，412个CT扫描中有68个可以避免，没有遗漏病例。结论：在因糖尿病相关血糖失衡住院的患者中，胰腺病变的患病率显著，尽管恶性肿瘤仍然很低。年龄≥65岁、低体重指数和血脂改变可能有助于确定需要胰腺影像学检查的患者。未来的前瞻性研究应完善这些标准，以制定筛选出的高风险糖尿病人群早期胰腺癌检测的筛查策略。

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引用次数: 0

SGLT2 inhibitors and the risk of hepatocellular carcinoma in patients with MASLD and Type 2 diabetes SGLT2抑制剂与MASLD和2型糖尿病患者肝细胞癌的风险

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-08-22 DOI: 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。

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引用次数: 0

Ketoacidosis associated with type 2 sodium-glucose cotransporter inhibitors (SGLT2i) in patients aged 65 and older: Evidence from the French national pharmacovigilance database 65岁及以上患者与2型钠-葡萄糖共转运蛋白抑制剂（SGLT2i）相关的酮症酸中毒：来自法国国家药物警戒数据库的证据

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-08-18 DOI: 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.

背景：钠-葡萄糖共转运蛋白-2抑制剂（SGLT2i）已被广泛应用于2型糖尿病的治疗，并被证实对心血管和肾脏有益处。然而，它们的使用与糖尿病酮症酸中毒（DKA）的风险有关。目的：本研究旨在根据法国药物警戒数据库的数据，描述65岁及以上患者使用SGLT2i相关的DKA病例的特征。方法：回顾性分析65岁及以上DKA合并SGLT2i的病例。从2020年起检索病例；分析55例。检查患者特征、药物暴露、药物不良反应（ADR）报告、住院细节和促成因素。结果：患者中位年龄为74.0岁（IQR: 69.0; 77.5），男性居多（63.4%）。Charlson合并症指数中位数为8.0 (IQR: 6.0; 10.0)，多种用药较为常见，平均每位患者使用9种药物。感染（36.4%）、脱水（20.0%）和空腹（18.2%）是主要的诱发因素。所有病例都需要住院治疗，其中36.4%住进了重症监护病房。在ICU患者中，35.0%需要经气管插管和/或血管加压治疗。1例（1.8%）死亡。与ICU住院显著相关的因素包括年龄较小（71.3岁vs. 75.4岁，P = 0.009），入院时pH值较低（P = 0.003），感染是诱发因素（P = 0.007）。结论：本研究突出了老年人sglt2i相关DKA的临床特点和危险因素。感染和严重酸中毒是ICU住院的关键预测因素。研究结果强调了在接受SGLT2i治疗的老年患者中，谨慎的患者选择和监测对于降低DKA风险的重要性。

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引用次数: 0

Are GLP-1 receptor agonists and diabetic retinopathy foes or friends? GLP-1受体激动剂和糖尿病视网膜病变是敌是友？

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-08-18 DOI: 10.1016/j.diabet.2025.101696

Kai Liu , Shu Liu , Dong Wang , Hong Qiao

With the increasing number of patients with diabetes worldwide, the number of patients with diabetic retinopathy (DR) is also increasing, which affects the lives of patients. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are anti-diabetic drugs that mimic the action of endogenous glucagon-like peptide-1, which significantly improve glycemic control in patients with type 2 diabetes. GLP-1RAs can repair the blood-retinal barrier function by activating the GLP-1 receptor in retinal endothelial cells and nerve cells, inhibiting the RhoA/ROCK signaling pathway, up-regulating the tight junction protein occludin and ZO-1, and inhibiting the activation of microglia, reducing the release of pro-inflammatory factors, and reducing neuroinflammation and vascular leakage. However, some GLP-1RAs may increase the risk of DR, such as diabetic macular edema and proliferative DR, and may increase the risk of DR deterioration, especially during rapid glucose lowering. Although the new GLP-1/GIP dual-receptor agonists and GLP-1/GIP/glucagon tri-receptor agonists show comprehensive benefit potential by effectively improving body metabolism, the short-term negative effect of sudden blood glucose drop still needs to be paid attention to. For patients with moderate to severe DR, it is necessary to strengthen ophthalmic monitoring to avoid rapid blood glucose decline in the initial treatment. In the long-term treatment, metabolic benefits and retinal risks need to be weighed, and the patient's condition needs to be evaluated before treatment. Therefore, GLP-1RAs has a duality of "mechanism protection and clinical risk" on DR, and individualized treatment strategy should take into consideration drug characteristics, DR severity and glucose control.

随着全球糖尿病患者数量的不断增加，糖尿病视网膜病变（DR）患者数量也在不断增加，影响着患者的生活。胰高血糖素样肽-1受体激动剂（Glucagon-like peptide-1 receptor agonists, GLP-1RAs）是一种模拟内源性胰高血糖素样肽-1作用的降糖药物，可显著改善2型糖尿病患者的血糖控制。GLP-1RAs通过激活视网膜内皮细胞和神经细胞中的GLP-1受体，抑制RhoA/ROCK信号通路，上调紧密连接蛋白occludin和ZO-1，抑制小胶质细胞的活化，减少促炎因子的释放，减少神经炎症和血管渗漏，从而修复血视网膜屏障功能。然而，一些GLP-1RAs可能会增加DR的风险，如糖尿病性黄斑水肿和增殖性DR，并可能增加DR恶化的风险，特别是在血糖快速降低期间。虽然新型GLP-1/GIP双受体激动剂和GLP-1/GIP/胰高血糖素三受体激动剂通过有效改善机体代谢显示出综合获益潜力，但短期内血糖突然下降的负面影响仍需引起重视。对于中重度DR患者，需加强眼科监测，避免初始治疗时血糖迅速下降。在长期治疗中，需要权衡代谢益处和视网膜风险，治疗前需要评估患者的病情。因此，GLP-1RAs对DR具有“机制保护和临床风险”的双重作用，个体化治疗策略应综合考虑药物特性、DR严重程度和血糖控制情况。

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引用次数: 0

Reduced risks of colorectal cancer with GLP-1RAs in type 2 diabetes: A nationwide cohort study using a target trial emulation framework GLP-1RAs降低2型糖尿病患者患结直肠癌的风险：一项使用目标试验模拟框架的全国性队列研究

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-08-10 DOI: 10.1016/j.diabet.2025.101695

Chih-Chien Wu , Chien-Chou Su , Yu-Ching Chang , Pei-Ting Lee , Yi-Chia Su

Aim

- Type 2 diabetes (T2D) is associated with increased risk of colorectal cancer (CRC). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) may reduce CRC risk compared to insulin therapy; however, current evidence is controversial. We aimed to evaluate the association between CRC and the use of GLP-1RAs and long-acting insulins (LAIs).

Methods

- This target trial emulation employed nationwide data from a Taiwanese T2D cohort. We identified new GLP-1RA and LAI users from 2013 to 2021, and applied propensity score (PS) matching to ensure comparable baseline characteristics. The primary outcome was CRC. Follow-up lasted until outcome occurrence, death, or study end in 2022, whichever came first. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated to assess the association between treatment and outcomes. Sensitivity analyses—including stabilized inverse probability weighting, time-dependent survival analysis, E-values, and negative control outcome analyses—were conducted to test the robustness of findings.

Results

- We included 11,726 PS-matched pairs of GLP-1RA and LAI users and found no significant baseline disparities between cohorts. Compared to LAIs, GLP-1RAs were associated with significantly reduced CRC risk (HR [95 % CI]: 0.66 [0.48–0.92]), with the association limited to the rectum (HR: 0.53 [0.28–0.92]) but not observed in the right- or left-sided colon (right, HR: 0.69 [0.41–1.19]; left, HR: 0.77 [0.44–1.33]). These findings were consistent across sensitivity analyses and among patients with varying baseline characteristics.

Conclusion

- Among patients with T2D requiring injectable glucose-lowering agents, GLP-1RA use, compared to LAIs, was associated with reduced CRC risk, particularly in the rectum.

目的- 2型糖尿病（T2D）与结直肠癌（CRC）风险增加相关。与胰岛素治疗相比，胰高血糖素样肽-1受体激动剂（GLP-1RAs）可能降低结直肠癌的风险；然而，目前的证据是有争议的。我们的目的是评估结直肠癌与GLP-1RAs和长效胰岛素（LAIs）使用之间的关系。方法：这项目标试验模拟采用了台湾t2dm队列的全国数据。我们从2013年到2021年确定了新的GLP-1RA和LAI用户，并应用倾向评分（PS）匹配来确保可比较的基线特征。主要结局为结直肠癌。随访持续到2022年结果发生、死亡或研究结束，以先到者为准。计算95%置信区间（ci）的风险比（hr），以评估治疗与结果之间的关联。进行敏感性分析，包括稳定的逆概率加权、时间相关的生存分析、e值和阴性对照结果分析，以检验结果的稳健性。结果：我们纳入了11,726对ps匹配的GLP-1RA和LAI使用者，发现队列之间没有显著的基线差异。与LAIs相比，GLP-1RAs与显著降低结直肠癌风险相关（HR [95% CI]: 0.66[0.48-0.92]），这种关联仅限于直肠（HR: 0.53[0.28-0.92]），但在左右结肠(HR: 0.69 [0.41-1.19]；左，HR: 0.77[0.44-1.33])。这些发现在敏感性分析和不同基线特征的患者中是一致的。结论：在需要注射降糖药的T2D患者中，与LAIs相比，GLP-1RA的使用与降低结直肠癌风险相关，特别是在直肠。

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引用次数: 0

Body weight trends in individuals with type 1 diabetes using automated insulin delivery vs. traditional insulin pumps 1型糖尿病患者使用自动胰岛素输送与传统胰岛素泵的体重变化趋势

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-07-29 DOI: 10.1016/j.diabet.2025.101693

Charles Thivolet , Zoé Henry , Nathalie Bendelac , Sylvie Villar Fimbel

Objective

This study analyzed the determinants of weight gain among participants initiating an automated insulin delivery (AID) system.

Research design and methods

In this observational study, we evaluated 928 persons with type 1 diabetes initiating an insulin pump therapy, including 467 with AID, 98 with pumps with predictive low-glucose suspend (PLGS) algorithm and 363 initiating a sensor-augmented pump (SAP).

Results

After 3 months, median (95CI) TIR increased from 50.69 % [49.2–52.3] to 67.9 % [66.7–69.1] in the AID group and HbA1c levels showed a mean reduction of 0.82 %. AID resulted in equivalent body weight gain to SAP and PLGS despite significant improvements in glucose control. Multivariable analysis revealed that weight gain was linked to baseline HbA1C (P < 0.001) and age but not to the type of pump system. During follow-up, percentage increase in body weight at 12 months were similar between groups

Conclusions

In persons with T1D, AID did not increase weight gain in comparison to other pump systems.

目的：本研究分析了启动自动胰岛素输送（AID）系统的参与者体重增加的决定因素。研究设计和方法：在这项观察性研究中，我们评估了928例开始胰岛素泵治疗的1型糖尿病患者，其中467例使用AID， 98例使用预测低糖悬浮（PLGS）算法的泵，363例使用传感器增强泵（SAP）。结果：3个月后，AID组的中位（95CI） TIR从50.69%[49.2-52.3]上升至67.9% [66.7-69.1]，HbA1c水平平均下降0.82%。AID导致的体重增加与SAP和PLGS相当，尽管血糖控制有显著改善。多变量分析显示，体重增加与基线HbA1C有关

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引用次数: 0

Association between smoking status and suicide mortality in patients with type 2 diabetes: A nationwide population-based cohort study 吸烟状况与2型糖尿病患者自杀死亡率之间的关系：一项基于全国人群的队列研究

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-07-26 DOI: 10.1016/j.diabet.2025.101692

Chaiho Jeong , Bongseong Kim , Dae Jong Oh , Tae-Seo Sohn , Kyungdo Han , Hyuk-Sang Kwon

Background

Patients with type 2 diabetes (T2D) are at greater risk of suicide due to stresses associated with disease management. Smoking adds to this burden. However, its association with suicide mortality in this population remains unclear. This study aimed to evaluate the relationship between smoking and suicide mortality in this high-risk group.

Methods

This cohort study utilized the Korean National Health Insurance Service (NHIS) database. A total of 2,524,769 participants aged ≥ 20 years with T2D who underwent national health examinations in 2015–2016 were included. Participants were followed until suicide death or the end of the study period.

Results

Over 5.8 years mean follow-up, 5,578 individuals died by suicide. Risk of suicide mortality was significantly higher—adjusted hazard ratio [95 % confidence interval]—in current smokers compared to never-smokers: 1.55 [1.44;1.67]. A dose–response pattern was observed among current smokers: 1.41 [1.22;1.63] for light smokers (<10 cigarettes/day) and 1.66 [1.52;1.81] for heavy smokers (≥20/day). In ex-smokers, only those with a smoking history of ≥ 30 years exhibited an elevated risk: 1.12 [1.02;1.24]. The association was particularly strong in women: 2.97 [2.39;3.69]; and individuals aged <65 years: 1.76 [1.61;1.92].

Conclusions

Current smoking was significantly associated with increased suicide mortality in patients with T2D, particularly among heavy smokers, women and those younger than 65 years. Long-term smoking history was also associated with elevated risk among ex-smokers.

背景：2型糖尿病（T2D）患者由于与疾病管理相关的压力而有更高的自杀风险。吸烟加重了这种负担。然而，其与该人群自杀死亡率的关系尚不清楚。本研究旨在评估吸烟与这一高危人群自杀死亡率之间的关系。方法：本队列研究利用韩国国民健康保险服务（NHIS）数据库。共纳入2015-2016年接受全国健康检查的年龄≥20岁T2D患者2,524,769例。参与者被跟踪到自杀死亡或研究期结束。结果：在5.8年的平均随访中，5578人死于自杀。与不吸烟者相比，当前吸烟者自杀死亡率的调整后危险比[95%置信区间]显著更高：1.55[1.44;1.67]。在当前吸烟者中观察到剂量-反应模式：轻度吸烟者为1.41[1.22;1.63](结论：当前吸烟与T2D患者自杀死亡率增加显著相关，特别是在重度吸烟者、女性和65岁以下的人群中。长期吸烟史也与戒烟者的风险增加有关。

{"title":"Association between smoking status and suicide mortality in patients with type 2 diabetes: A nationwide population-based cohort study","authors":"Chaiho Jeong , Bongseong Kim , Dae Jong Oh , Tae-Seo Sohn , Kyungdo Han , Hyuk-Sang Kwon","doi":"10.1016/j.diabet.2025.101692","DOIUrl":"10.1016/j.diabet.2025.101692","url":null,"abstract":"<div><h3>Background</h3><div>Patients with type 2 diabetes (T2D) are at greater risk of suicide due to stresses associated with disease management. Smoking adds to this burden. However, its association with suicide mortality in this population remains unclear. This study aimed to evaluate the relationship between smoking and suicide mortality in this high-risk group.</div></div><div><h3>Methods</h3><div>This cohort study utilized the Korean National Health Insurance Service (NHIS) database. A total of 2,524,769 participants aged ≥ 20 years with T2D who underwent national health examinations in 2015–2016 were included. Participants were followed until suicide death or the end of the study period.</div></div><div><h3>Results</h3><div>Over 5.8 years mean follow-up, 5,578 individuals died by suicide. Risk of suicide mortality was significantly higher—adjusted hazard ratio [95 % confidence interval]—in current smokers compared to never-smokers: 1.55 [1.44;1.67]. A dose–response pattern was observed among current smokers: 1.41 [1.22;1.63] for light smokers (<10 cigarettes/day) and 1.66 [1.52;1.81] for heavy smokers (≥20/day). In ex-smokers, only those with a smoking history of ≥ 30 years exhibited an elevated risk: 1.12 [1.02;1.24]. The association was particularly strong in women: 2.97 [2.39;3.69]; and individuals aged <65 years: 1.76 [1.61;1.92].</div></div><div><h3>Conclusions</h3><div>Current smoking was significantly associated with increased suicide mortality in patients with T2D, particularly among heavy smokers, women and those younger than 65 years. Long-term smoking history was also associated with elevated risk among ex-smokers.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101692"},"PeriodicalIF":4.7,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736487","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}

引用次数: 0

Conduction disturbances in Type 1 and Type 2 Diabetes in two large independent nationwide and international databases 1型和2型糖尿病的传导干扰在两个大型独立的全国和国际数据库。

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-07-24 DOI: 10.1016/j.diabet.2025.101690

Lucile Accoceberry , Uazman Alam , Grégoire Fauchier , Lisa Lochon , Arnaud Bisson , Pierre Henri Ducluzeau , Gregory Y.H. Lip , Laurent Fauchier

Aim

Type 1 (T1D) and type 2 diabetes (T2D) are associated with increased cardiovascular risk, but limited data exist on their independent association with conduction disturbances. We evaluated the association between diabetes and conduction disorders, comparing T1D and T2D populations with non-diabetic controls in two independent databases.

Methods

Observational study using two large databases with matched cohorts: the French PMSI and the international TriNetX network. PMSI captures nationwide hospital admissions in France, while TriNetX includes patients from over 120 healthcare organizations worldwide. We identified > 440,000 patients with T2D from PMSI and > 900,000 patients with T2D and > 20,000 patients with T1D from TriNetX. Using 1:1 propensity score matching, these patients were matched to non-diabetic controls based on demographics and comorbidities

Results

Compared to no DM, T2D was associated with a higher risk of conduction disturbances, including atrioventricular block (HR 1.22 [1.19–1.25], PMSI; HR 1.50 [1.45–1.55], TriNetX), left bundle branch block (BBB), (HR 1.12 [1.08–1.17], PMSI; HR 1.50 [1.47–1.54], TriNetX), and right BBB (HR 1.14 [1.09–1.18], PMSI; HR 1.38 [1.34–1.43], TriNetX). Patients with T2D also had a higher risk of myocardial infarction (HR 1.29 [1.25–1.32], PMSI; HR 2.14 [2.08–2.19], TriNetX). Conversely, T1D was not associated with an increased risk of conduction disorders in the TriNetX cohort.

Conclusion

T2D is independently associated with conduction disturbances and a higher incidence of coronary events compared to no DM, whereas T1D does not appear to confer the same risk. This suggests distinct pathophysiological mechanisms and the possible need for enhanced monitoring in T2D patients.

目的：1型（T1D）和2型糖尿病（T2D）与心血管风险增加相关，但关于它们与传导障碍的独立关联的数据有限。我们评估了糖尿病和传导障碍之间的关系，在两个独立的数据库中比较了T1D和T2D人群与非糖尿病对照组。方法：观察性研究，使用两个具有匹配队列的大型数据库：法国PMSI和国际TriNetX网络。PMSI捕获法国全国范围内的医院入院情况，而TriNetX包括来自全球120多个医疗机构的患者。我们从PMSI中发现了440,000例T2D患者，从TriNetX中发现了900,000例T2D患者和20,000例T1D患者。采用1:1倾向评分匹配，根据人口统计学和合并症将这些患者与非糖尿病对照进行匹配。结果：与非DM相比，T2D与传导障碍的风险较高相关，包括房室传导阻滞(HR 1.22 [1.19-1.25]， PMSI；HR 1.50 [1.45-1.55], TriNetX)，左束支阻滞（BBB）， (HR 1.12 [1.08-1.17]， PMSI；HR 1.50 [1.47-1.54], TriNetX)，右BBB (HR 1.14 [1.09-1.18]， PMSI；HR 1.38 [1.34-1.43], TriNetX)。t2dm患者发生心肌梗死的风险也较高(HR 1.29 [1.25-1.32]， PMSI；hr2.14 [2.08-2.19]；相反，在TriNetX队列中，T1D与传导障碍风险增加无关。结论：与非DM相比，T2D与传导障碍和更高的冠状动脉事件发生率独立相关，而T1D似乎不具有相同的风险。这表明不同的病理生理机制和可能需要加强监测的T2D患者。

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引用次数: 0

Exploring perceived barriers to physical activity among individuals with type 1 diabetes in the era of new technologies: An analysis from the BETTER registry 探索新技术时代1型糖尿病患者身体活动的感知障碍：来自BETTER注册表的分析

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-07-06 DOI: 10.1016/j.diabet.2025.101677

C. Guédet , L. Alexandre-Heymann , J.E. Yardley , V. Messier , V. Boudreau , T. Chahal , M. Dostie , M-E. Mathieu , A-S. Brazeau , S. Tagougui , R. Rabasa-Lhoret

Objective

We aimed to identify barriers to physical activity for people living with type 1 diabetes (PwT1D) and their relationship with sociodemographic and disease-specific factors.

Methods

- Cross-sectional study with BETTER registry participants (>14 years) who completed the BAPAD1 (Barriers to Physical Activity in T1D) questionnaire. An item with a score of 5 or more was defined as a barrier. Participants were categorized into 4 subgroups based on their insulin therapy and blood glucose monitoring modality: 1) multiple daily injections (MDI) without continuous glucose monitoring (CGM), 2) MDI with CGM, 3) continuous subcutaneous insulin infusion (CSII) with CGM, and 4) automated insulin delivery system (AID).

Results

Among 1117 participants, the main perceived barrier was fear of hypoglycemia. BAPAD1 scores were similar across all subgroups, but more individuals in the AID group perceived "fear of hypoglycemia" and "loss of control over diabetes" as barriers. Being female, having a low income or education level, being overweight or obese, taking medication for depression, younger diabetes, higher HbA1c, presence of microvascular complications, and lack of confidence in managing hypoglycemia were associated with higher BAPAD1 score.

Conclusion

Fear of hypoglycemia remains the main barrier to physical activity for PwT1D. Technological advances alone are not sufficient to reduce perceived barriers to physical activity, highlighting the need for complementary educational and behavioral interventions.

目的：-我们旨在确定1型糖尿病患者（PwT1D）的身体活动障碍及其与社会人口统计学和疾病特定因素的关系。方法：-对BETTER注册中心的参与者（> - 14岁）进行横断面研究，他们完成了BAPAD1 （T1D身体活动障碍）问卷。得分在5分或以上的项目被定义为障碍。根据胰岛素治疗和血糖监测方式将参与者分为4个亚组：1)每日多次注射（MDI）不进行连续血糖监测（CGM）， 2) MDI合并连续血糖监测（CGM）， 3)连续皮下胰岛素输注（CSII）与CGM， 4)胰岛素自动输送系统（AID）。结果：在1117名参与者中，主要的感知障碍是对低血糖的恐惧。所有亚组的BAPAD1得分相似，但AID组中更多的个体认为“害怕低血糖”和“失去对糖尿病的控制”是障碍。女性、收入或受教育程度低、超重或肥胖、服用抑郁症药物、糖尿病年轻化、HbA1c较高、存在微血管并发症以及对低血糖管理缺乏信心与较高的BAPAD1评分相关。结论：对低血糖的恐惧仍然是PwT1D患者进行体育活动的主要障碍。仅靠技术进步并不足以减少人们所认为的身体活动障碍，这突出表明需要补充教育和行为干预措施。(图1)。

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引用次数: 0