Diabetes & metabolism最新文献_第5页

Association between continuous glucose monitoring metrics and metabolic dysfunction-associated steatotic liver disease in adults with type 1 diabetes undergoing vibration-controlled transient elastography: a multicenter cross-sectional study 在接受振动控制的瞬时弹性成像的成人1型糖尿病患者中，连续血糖监测指标与代谢功能障碍相关的脂肪变性肝病之间的关系：一项多中心横断面研究

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-07-05 DOI: 10.1016/j.diabet.2025.101684

Alessandro Mantovani , Stefano Ciardullo , Elena Sani , Alessandro Csermely , Emigela Shtembari , Ilaria Milani , Paolo Sbraccia , Gianluca Perseghin , Frida Leonetti , Giovanni Targher , Valeria Guglielmi , Danila Capoccia

Background

There is uncertainty regarding the association between continuous glucose monitoring (CGM), derived glycemic metrics, and metabolic dysfunction-associated steatotic liver disease (MASLD) in individuals with type 1 diabetes (T1D).

Methods

We consecutively enrolled 262 adult individuals with established T1D undergoing vibration-controlled transient elastography (VCTE) with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). All participants underwent CGM. MASLD was defined as CAP ≥248 dB/m and the presence of at least one cardiometabolic risk factor. Significant liver fibrosis was defined as LSM ≥8 kPa.

Results

Participants had a mean age of 54±13 years, a mean body mass index (BMI) of 25.8 ± 5.6 kg/m² and a mean HbA1c of 7.7 ± 1.4 %. The prevalence of MASLD and significant liver fibrosis was 35.1 % (n = 92) and 4.6 % (n = 12), respectively. Using quantile regression analysis, time above range 180–250 mg/dl (TAR1) was significantly associated with increased CAP values (coefficient: 1.037; 95 % confidence interval [0.216;1.858]; P = 0.013). This association remained significant even after adjusting for age, sex, BMI, HbA1c, and total daily insulin dose. Other variables independently associated with CAP were older age, male sex, BMI, and total daily insulin dose. Using a random forest regression model, BMI was found to be the most important factor, followed by age, total daily insulin dose, and TAR1.

Conclusions

TAR1 was independently associated with increased CAP values, even after adjustment for age, BMI, sex, HbA1c, and total daily insulin dose, suggesting a potential role for glycemic variability in hepatic fat accumulation in adults with T1D.

背景：在1型糖尿病（T1D）患者中，持续血糖监测（CGM）、衍生血糖指标与代谢功能障碍相关的脂肪变性肝病（MASLD）之间的关系尚不确定。方法采用振动控制瞬态弹性成像（VCTE），结合肝刚度测量（LSM）和可控衰减参数（CAP），对262例已确定T1D的成年患者进行连续实验。所有参与者均行CGM。MASLD定义为CAP≥248 dB/m，且存在至少一种心脏代谢危险因素。LSM≥8 kPa为肝纤维化。结果参与者平均年龄54±13岁，平均体重指数（BMI） 25.8±5.6 kg/m2，平均糖化血红蛋白（HbA1c） 7.7±1.4%。MASLD和显著肝纤维化的患病率分别为35.1% （n = 92）和4.6% （n = 12）。分位数回归分析显示，180 ~ 250 mg/dl （TAR1）以上时间与CAP值升高显著相关(系数：1.037；95%置信区间[0.216;1.858]；P = 0.013)。即使在调整了年龄、性别、BMI、HbA1c和每日总胰岛素剂量后，这种相关性仍然显著。与CAP独立相关的其他变量包括年龄、男性、BMI和每日总胰岛素剂量。使用随机森林回归模型，BMI是最重要的因素，其次是年龄、每日总胰岛素剂量和TAR1。结论：即使在调整了年龄、BMI、性别、HbA1c和每日总胰岛素剂量后，star1仍与CAP值升高独立相关，提示血糖变异性在成年T1D患者肝脏脂肪积累中的潜在作用。

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引用次数: 0

Post-translational modifications of apolipoproteins as promising biomarkers for diabetes-related cardiovascular diseases: A comprehensive review 载脂蛋白翻译后修饰作为糖尿病相关心血管疾病有前景的生物标志物：综述

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-07-05 DOI: 10.1016/j.diabet.2025.101683

Chloé Chevalier , Arsênio Rodrigues Oliveira , Valentin Blanchard , Cédric Le May , Bertrand Cariou , Samy Hadjadj , Mikaël Croyal

Lipoproteins are biochemical complexes of apolipoproteins and lipids that primarily mediate the transport of lipids through the circulation, from sites of absorption or synthesis to those of use, storage, or excretion. In type 2 diabetes (T2D), disruptions in lipoprotein metabolism are key drivers of complications and strongly contribute to atherosclerotic cardiovascular disease (ASCVD). As a result, ASCVD remains the leading cause of death in T2D, with significantly higher prevalence than in non-diabetic individuals. Protein post-translational modifications (PTMs) have emerged as key contributors to organ failure mechanisms, with specific PTMs closely linked to the pathogenesis of T2D. Several reports also emphasized the value of plasma apolipoproteins for the early prediction of ASCVD in cardiometabolic diseases. Thus, apolipoproteins, and especially their structurally post-translational modified forms, offer new insights into the molecular mechanisms of lipoprotein dysfunction and may enhance the specificity of ASCVD risk stratification in T2D. This review outlines major apolipoprotein PTMs identified in T2D, many of which can now be quantified in biological samples, particularly via mass spectrometry. We also discuss their role in lipoprotein metabolism dysfunction and their potential value in assessing ASCVD risk in T2D, highlighting their growing potential as clinical biomarkers in population-based cohort studies.

脂蛋白是载脂蛋白和脂质的生化复合物，主要介导脂质的循环运输，从吸收或合成点到使用、储存或排泄点。在2型糖尿病（T2D）中，脂蛋白代谢紊乱是并发症的关键驱动因素，也是动脉粥样硬化性心血管疾病（ASCVD）的重要诱因。因此，ASCVD仍然是T2D患者死亡的主要原因，其患病率明显高于非糖尿病患者。蛋白质翻译后修饰（PTMs）已成为器官衰竭机制的关键因素，特定的PTMs与T2D的发病机制密切相关。一些报告也强调了血浆载脂蛋白在心血管代谢疾病ASCVD早期预测中的价值。因此，载脂蛋白，特别是其结构翻译后修饰形式，为脂蛋白功能障碍的分子机制提供了新的见解，并可能增强T2D中ASCVD风险分层的特异性。本文概述了在T2D中发现的主要载脂蛋白PTMs，其中许多现在可以在生物样品中定量，特别是通过质谱法。我们还讨论了它们在脂蛋白代谢功能障碍中的作用，以及它们在评估T2D患者ASCVD风险方面的潜在价值，强调了它们在基于人群的队列研究中作为临床生物标志物的潜力。

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引用次数: 0

GLP-1 receptor agonists, body composition, skeletal muscle and risk of sarcopaenia: from promising findings in animal models to debated concern in human studies GLP-1受体激动剂，身体成分，骨骼肌和肌少症的风险：从动物模型的有希望的发现到人类研究中有争议的问题

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-06-24 DOI: 10.1016/j.diabet.2025.101681

André J. Scheen

Background. - Glucagon-like peptide-1 (GLP-1)-based therapies induce a clinically relevant weight loss, which is associated with overall better prognosis in people with type 2 diabetes and/or clinical obesity. However, a risk of excessive reduction in fat-free mass (FFM) and skeletal muscle mass (SSM), potentially leading to sarcopaenia in at-risk patients, is currently a matter of debate as this negative effect could minimize their benefit/risk balance. Methods. - An extensive literature search to detect animal and human studies that investigated the effects of GLP-1-based therapies on changes in body composition (FFM and SMM), muscle strength, structure, and function. Results. - Favourable effects on SMM, intramuscular lipid deposition, inflammation and mitochondrial health were consistently reported in different rodent models with GLP-based therapies. However, mixed results were reported in human studies, some reported an excessive FFM/SMM loss while others arguing for a protective effect against sarcopaenia (including less myosteatosis). This controversy may result from misinterpretation of SMM derived from FFM changes and a lack of studies that properly investigate SMM, muscle function and structure in humans. Conclusion. - Maximizing fat loss while preserving lean (muscle) tissue mass and function is a central goal of modern obesity pharmacological treatments. Currently, available data preclude to have a definite conclusion about positive/negative effects of GLP-1-based therapies on muscle. Further investigations using accurate methodologies to assess not only SMM but also muscle structure, function (strength) and performance are needed to better analyse the effects of GLP-1-based therapies, especially among individuals at higher risk of sarcopaenia, older patients and frail people.

背景。-以胰高血糖素样肽-1 （GLP-1）为基础的治疗可诱导临床相关的体重减轻，这与2型糖尿病和/或临床肥胖患者的总体预后较好相关。然而，过度减少无脂肪量（FFM）和骨骼肌量（SSM）的风险，可能导致高危患者的肌少症，目前是一个有争议的问题，因为这种负面影响可能会使他们的利益/风险平衡最小化。方法。-广泛的文献检索，以检测基于glp -1的治疗对身体成分（FFM和SMM）、肌肉力量、结构和功能变化的影响的动物和人类研究。结果。-在不同的啮齿动物模型中，glp疗法对SMM、肌内脂质沉积、炎症和线粒体健康均有良好的影响。然而，在人体研究中报告了不同的结果，一些报告了过度的FFM/SMM损失，而另一些则认为对肌少症有保护作用（包括减少肌骨化病）。这一争议可能源于对源自FFM变化的SMM的误解，以及缺乏适当研究人类SMM、肌肉功能和结构的研究。结论。-最大限度地减少脂肪，同时保持瘦（肌肉）组织的质量和功能是现代肥胖药物治疗的中心目标。目前，现有的数据排除了对基于glp -1的治疗对肌肉的正面或负面影响的明确结论。为了更好地分析基于glp -1的治疗的效果，特别是在肌少症高风险人群、老年患者和体弱人群中，需要使用准确的方法进行进一步的研究，不仅要评估SMM，还要评估肌肉结构、功能（力量）和表现。

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引用次数: 0

Prediction of cardiovascular events by skin auto-fluorescence: the DIABAGE follow-up study 皮肤自身荧光预测心血管事件：DIABAGE随访研究

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-06-23 DOI: 10.1016/j.diabet.2025.101682

Jorys Bueno , Alpha M. Diallo , Stéphane Jaisson , Jenny Fontaine , Céline Lukas , Romain Barriquand , Géraldine Vitellius , Philippe Gillery , Brigitte Delemer , Sara Barraud

Aim

Advanced glycation end-products (AGEs) are known to play a role in the pathophysiology of type 1 diabetes (T1D) complications. The aim of this study was to assess the predictive value of AGEs indirectly evaluated by skin auto-fluorescence (SAF) on the occurrence of cardiovascular events (CVEs) in T1D.

Methods

We measured baseline SAF in T1D patients with at least 10 years history of diabetes and assessed incident CVEs. An optimum threshold of SAF was determined using ROC curve, and its predictive value was assessed by Cox proportional regression.

Results

The study included 179 patients, 53 % of whom were women. At baseline, the mean age was 47.7 ± 15.9 years, the mean duration of diabetes was 26.4 ± 12.2 years. Median HbA_1c was 7.7 % (7.3–8.7) and median LDL cholesterol was 2.58 mmol/l (2.14–3.07). Median follow-up was 7.4 years (6.85 - 7.7) with 34 CVEs in 24 patients.

The median SAF level was 2.7 (2.3–3.1) in patients with incident CVEs and 2.1 (1.8–2.6) in patients without CVEs. The optimum threshold of SAF to differentiate patients with or without incident CVEs was 2.2. The occurrence of CVE was predicted by the optimum SAF threshold in the unadjusted model (HR 6.46), but also after adjustment with different models (HR 3.15–5.05).

Conclusion

SAF level is higher in people living with T1D who will present CVEs. Furthermore, SAF threshold of 2.2 predicted the occurrence of CVE. If these results are confirmed, SAF could be a useful marker in cardiovascular risk stratification in T1D.

目的:。已知晚期糖基化终产物（AGEs）在1型糖尿病（T1D）并发症的病理生理中发挥作用。本研究的目的是评估皮肤自身荧光（SAF）间接评估的AGEs对T1D患者心血管事件（CVEs）发生的预测价值。方法:。我们测量了至少有10年糖尿病病史的T1D患者的基线SAF，并评估了cve的发生率。采用ROC曲线确定SAF的最佳阈值，并采用Cox比例回归评价其预测价值。结果:。该研究包括179名患者，其中53%是女性。基线时，平均年龄为47.7±15.9岁，平均糖尿病病程为26.4±12.2年。中位HbA1c为7.7%(7.3-8.7)，中位LDL胆固醇为2.58 mmol/l（2.14-3.07）。24例患者34例cve，中位随访7.4年（6.85 - 7.7）。发生cve患者的中位SAF水平为2.7(2.3-3.1)，无cve患者的中位SAF水平为2.1（1.8-2.6）。SAF区分有无cve的最佳阈值为2.2。未调整模型的最佳SAF阈值可以预测CVE的发生（HR 6.46），不同模型调整后的最佳SAF阈值也可以预测CVE的发生（HR 3.15-5.05）。结论:。出现cve的T1D患者的SAF水平较高。SAF阈值为2.2预测CVE的发生。如果这些结果得到证实，SAF可能是T1D患者心血管危险分层的有用标志物。

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引用次数: 0

The impact of chiglitazar, a pan-PPAR agonist, on metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes: a real-world study chiglitazar（一种泛ppar激动剂）对2型糖尿病患者代谢功能障碍相关脂肪变性肝病的影响：一项现实世界研究

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-06-21 DOI: 10.1016/j.diabet.2025.101680

Yijiong Tan , Wenjun Qu , Jiehua Zhao , Yunqin Ma , Qidi Zhang , Hong Gao , Qin Zhen , Yufan Wang , Yongde Peng , Fang Liu , Nengguang Fan

Aim

To evaluate the efficacy of chiglitazar, a novel pan-PPAR agonist, on metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes (T2D) in a real-world clinical setting.

Materials and methods

This prospective cohort study included T2D patients with MASLD who received either chiglitazar or other glucose-lowering medications over a 24-week period. To minimize selection bias, 1:1 propensity score matching (PSM) was implemented. The primary outcomes were changes in controlled attenuation parameter (CAP, measuring hepatic steatosis) and liver stiffness measurement (LSM, assessing fibrosis). Secondary outcomes included glycemic parameters and liver enzymes.

Results

A total of 235 T2D patients were enrolled (40 chiglitazar users, 195 non-chiglitazar users), and 31 matched pairs were derived after 1:1 PSM. The adjusted mean reduction in CAP from baseline to 24 weeks was significantly greater in the chiglitazar group (-28.38 dB/m [95 % CI:36.11;-20.65]) compared to the non-chiglitazar group (-16.74 dB/m [-24.47;-9.01]), with a between-group difference of -11.64 dB/m (-22.38;-0.90, P = 0.038). LSM changes were similar between groups (difference in LS mean:0.11 [-1.04;0.82], P = 0.813). Subgroup analyses indicated that the beneficial effect of chiglitazar was consistent across variables such as sex, age, body mass index, and concomitant use of SGLT-2 inhibitors or GLP-1 receptor agonists (all P for interaction > 0.05).

Conclusions

Chiglitazar administration is associated with a significant reduction in CAP values in T2D patients with MASLD, suggesting its potential as a dual therapeutic approach for both conditions.

目的：在现实世界的临床环境中，评估新型泛ppar激动剂chiglitazar对2型糖尿病（T2D）患者代谢功能障碍相关脂肪变性肝病（MASLD）的疗效。材料和方法：这项前瞻性队列研究纳入了接受齐列他或其他降糖药物治疗24周的t2dm MASLD患者。为了尽量减少选择偏差，采用1:1倾向评分匹配（PSM）。主要结果是控制衰减参数（CAP，测量肝脏脂肪变性）和肝脏硬度测量（LSM，评估纤维化）的变化。次要结局包括血糖参数和肝酶。结果：共纳入235例T2D患者（使用吉列他者40例，非使用吉列他者195例），1:1 PSM后得到31对配对。从基线到24周的CAP调整后平均降低，奇格列扎组（-28.38 dB/m [95% CI: -36.11;-20.65]）显著高于非奇格列扎组（-16.74 dB/m[-24.47;-9.01]），组间差异为-11.64 dB/m （-22.38;-0.90, P = 0.038）。两组间LSM变化相似（LS均值差异：-0.11 [-1.04;0.82],P = 0.813）。亚组分析表明，chiglitazar的有益效果在性别、年龄、体重指数和同时使用SGLT-2抑制剂或GLP-1受体激动剂等变量中是一致的（相互作用的P均为0.05）。结论：Chiglitazar给药与T2D合并MASLD患者CAP值的显著降低相关，提示其作为两种情况的双重治疗方法的潜力。

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引用次数: 0

Effect of dietary reinforcement combined or not with GLP-1 receptor agonist therapy on histological outcomes in MASLD among patients with type 2 diabetes 膳食强化联合或不联合GLP-1受体激动剂治疗对2型糖尿病MASLD患者组织学结局的影响

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-06-19 DOI: 10.1016/j.diabet.2025.101679

Bruno Guerci , Michael Joubert , Ghassan Riachi , Marie-Lauren Antoine , Delphine Clabaut , Renaud Fay , Gaetan Prevost

引用次数: 0

Mitochondrial heteroplasmy-phenotype correlation and response to glucose lowering therapy in subjects with m.3243A>G mutations m.3243A > G突变受试者的线粒体异质性-表型相关性和对降糖治疗的反应

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-06-18 DOI: 10.1016/j.diabet.2025.101678

N Ng , B Sanchez-Lechuga , CJ McCarrick , C Mangan , M Burke , J.A. Ioana , C Gavin , R O’Byrne , JJ O’Byrne , MM Byrne

Introduction

There is a paucity of evidence to guide pharmacological treatment for mitochondrial diabetes. Metformin is generally contraindicated due to the high risk of lactic acidosis, Sulphonylurea (SU) therapy has been used as 1st line therapy but most progress to insulin. The aim of this study is to investigate the glucose-insulin secretory response to oral glucose, the response to glucose lowering therapy, and the heteroplasmy phenotype correlation in subjects with a confirmed m.3243A>G mutation.

Methods

49 subjects were phenotyped in detail. A 2 hr OGTT was performed to establish insulin-secretory response. Heteroplasmy was measured and they had bi-annual clinical follow-up.

Results

34 of 49 m.3243A>G subjects had diabetes mellitus (DM) with an onset at 38 (31–44) years, 7 had impaired glucose tolerance or impaired fasting glucose, and 8 had normal glucose tolerance (NGT). DM subjects had reduced insulin secretion (AUC C-peptide 2009.0[1710.0–3156.0] vs. 4693.75[3768.25–5609.38] pmol/l/120 min, P = 0.002) and insulin sensitivity (OGIS 283.0[209.0–324.0] vs. 437.0 [416.0–524.0]ml min⁻¹m⁻², P < 0.001]) compared to NGT subjects. Heteroplasmy was higher in DM subjects compared to NGT (20[11–26] vs. 6[5–10] %, P = 0.014). 5 of 8 subjects on metformin had raised lactate and 65 % of subjects required insulin to improve glycaemic control. Only 1/6 subjects transitioned from insulin to SU. Two subjects on SGLT2i and GLP-1 agonists progressed to insulin.

Conclusion

β-cell dysfunction and insulin resistance contribute to mitochondrial diabetes development. 65 % of subjects required insulin to improve glycaemic control. Early insulin initiation may be necessary to improve glycaemic control in the long term.

导言：缺乏证据来指导线粒体糖尿病的药物治疗。二甲双胍因乳酸性酸中毒的危险性高而被普遍禁用，磺脲类（SU）治疗已被用作一线治疗，但多数进展为胰岛素治疗。本研究的目的是探讨口服葡萄糖对葡萄糖-胰岛素分泌的反应，对降糖治疗的反应，以及确认m.3243A >g突变的受试者的异质性表型相关性。方法：对49例患者进行详细表型分析。进行2小时OGTT以确定胰岛素分泌反应。测量异质性，并进行两年一次的临床随访。结果：49例m.3243A > G受试者中有34例糖尿病（DM），发病时间为38.0（31.0-44.0）岁，7例糖耐量受损或空腹血糖受损，8例糖耐量正常（NGT）。糖尿病患者胰岛素分泌（AUC c肽2009.0[1710.0-3156.0]比4693.75[3768.25-5609.38]pmol/l/120min, P = 0.002）和胰岛素敏感性（OGIS 283.0[209.0-324.0]比437.0 [416.0-524.0]ml min-1m-2, P < 0.001）较NGT组降低。糖尿病患者的异质性高于非糖尿病患者（20[11-26]比6[5-10]%，P = 0.014）。服用二甲双胍的8名受试者中有5名乳酸水平升高，65%的受试者需要胰岛素来改善血糖控制。只有1/8的受试者从胰岛素过渡到SU， 2名使用SGLT2-I和GLP-1激动剂的受试者进展到胰岛素。结论：β细胞功能障碍和胰岛素抵抗与线粒体糖尿病的发生有关。65%的受试者需要胰岛素来改善血糖控制。从长期来看，早期胰岛素治疗对于改善血糖控制是必要的。

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引用次数: 0

The significance of ophthalmological evaluation in the correct diagnosis of pediatric insulin-dependent diabetes mellitus: lessons from novel WFS1 variants 眼科评估在小儿胰岛素依赖型糖尿病正确诊断中的意义：来自新型WFS1变异的经验教训。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-06-15 DOI: 10.1016/j.diabet.2025.101676

Eleni Papageorgiou , Panagiotis N. Toumasis , Aspasia Tsezou , Emmanouil Manolakos , Georgia Gazeti , Efthimios Dardiotis , Eleni Arnaoutoglou , Aggeliki Alagianni , Argyro Petsiti , Polyxeni Stamati , Zisis Tsouris , Aspasia Michoula , Sofia Androudi , Ioanna Grivea , Dimitrios T. Papadimitriou

Wolfram syndrome 1 is an autosomal recessive disorder often commencing as insulin dependent diabetes, but with inherent progressive ultimately fatal neurodegeneration. We report two pediatric cases, referred as unregulated insulin dependent diabetes mellitus, initially misdiagnosed as type 1 diabetes, in whom whole exome sequencing confirmed the clinical diagnosis of Wolfram syndrome with novel Wolfram syndrome gene 1 variants. An 11-year-old Asian male refugee with presumed type 1 diabetes since the age of 6 years, acknowledged progressive visual decline the last 6 months, but only after ophthalmological evaluation revealing bilateral optic atrophy, confirmed by optical coherence tomography and retinal nerve fiber layer thinning, leading to genetic testing and revealing a novel homozygous missense variant (c.1598C>T, p.Pro533Leu). A 15-year-old male with severely progressive autism spectrum disorder since the age of 3 years, and poorly regulated presumed type 1 diabetes since the age of 9 years, had signs of a progressive neurodegenerative disorder at presentation. Bilateral optic nerve pallor and sensorineural hearing loss were documented. Genetic testing revealed the pathogenic Wolfram syndrome gene 1 variant c.1523_1524delTA; p.Tyr508CysfsTer34 (frameshift deletion) in trans with the previously undescribed missense variant c.497T>C; p.Leu166Pro, reclassified now as likely pathogenic. Both cases highlight the importance of ophthalmological evaluation in the early diagnostic workup of pediatric insulin dependent diabetes when autoimmunity is not confirmed. Although not mandated by current guidelines, early ophthalmologic assessment, at least in insulin dependent diabetes with non-previously established autoimmunity, can enable timely diagnosis of Wolfram syndrome, enabling prompt multidisciplinary intervention and potential enrollment in emerging disease-modifying therapies.

Wolfram综合征1是一种常染色体隐性遗传病，通常以胰岛素依赖型糖尿病开始，但具有固有的进行性最终致命的神经变性。我们报告了两例儿童病例，被称为不调节胰岛素依赖性糖尿病，最初被误诊为1型糖尿病，其中全外显子组测序证实了Wolfram综合征的临床诊断与新的Wolfram综合征基因1变异。一名11岁的亚洲男性难民，自6岁起被推测为1型糖尿病，承认过去6个月视力进行性下降，但仅在眼科检查显示双侧视神经萎缩后，通过光学相干断层扫描和视网膜神经纤维层变薄证实，导致基因检测并发现一种新的纯合错义变异（c.1598C>T, p.Pro533Leu）。一名15岁男性，自3岁起患有严重进行性自闭症谱系障碍，自9岁起患有调节不良的1型糖尿病，在就诊时有进行性神经退行性疾病的迹象。双侧视神经苍白和感音神经性听力丧失。基因检测显示致病性Wolfram综合征基因1变异c.1523_1524delTA；p.Tyr508CysfsTer34（移码缺失）与先前未描述的错义变体C . 497t >；C；p.Leu166Pro，现在被重新归类为可能致病的。这两个病例强调了眼科评估在小儿胰岛素依赖型糖尿病的早期诊断工作中的重要性，当自身免疫未得到证实时。尽管目前的指南没有强制要求，但至少对胰岛素依赖型糖尿病患者进行早期眼科评估，可以及时诊断Wolfram综合征，促进多学科干预，并有可能纳入新兴的疾病改善疗法。

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引用次数: 0

Can diabetic peripheral neuropathy predict lacunar stroke in patients with diabetes? 糖尿病周围神经病变能否预测糖尿病患者的腔隙性卒中？

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-06-09 DOI: 10.1016/j.diabet.2025.101675

Nathalie Deschamps , Nadia Sabbah , Amina Nasri , Michel Haba , Mathieu Nacher , Bertrand De Toffol

Stroke is the leading-cause of death in women and motor-disability in adults. In patients with diabetes, diabetic peripheral neuropathy (DPN) increases the risk of ischemic stroke. The aim of this work was to test the hypothesis that an etiological pattern of ischemic stroke in patients with DPN can be recognized. This was a single-center retrospective observational study of patients hospitalized in Cayenne general-hospital with ischemic stroke. The primary endpoint was to determine if there is an association between the mechanism of stroke and the presence of DPN. We included 226 patients: mean age 64.14 ± 15.2 years; male predominance (62.4 %); and 5.8 % with DPN, i.e., 14.9 % of patients with diabetes. DPN was significantly associated with small-vessel disease (SVD): adjusted odds ratio=5.08 [1.17;22.14]. These findings highlight a common pathophysiology between DPN and SVD. DPN can provide a window of opportunity to detect SVD and prevent its complications like stroke or dementia.

中风是妇女死亡和成人运动障碍的主要原因。在糖尿病患者中，糖尿病周围神经病变（DPN）增加缺血性卒中的风险。这项工作的目的是测试的假设，缺血性卒中的病因模式的患者DPN可以被识别。这是一项针对卡宴综合医院缺血性脑卒中住院患者的单中心回顾性观察研究。主要目的是确定卒中机制与DPN存在之间是否存在关联。我们纳入226例患者：平均年龄64.14±15.2岁；男性占优势（62.4%）；DPN占5.8%，即糖尿病患者占14.9%。DPN与小血管病变（SVD）显著相关：校正优势比=5.08[1.17;22.14]。这些发现强调了DPN和SVD之间的共同病理生理。DPN可以为检测SVD和预防其并发症（如中风或痴呆）提供机会。

引用次数: 0

The association between hip fractures and type 2 diabetes in the elderly 老年人髋部骨折与2型糖尿病的关系。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-06-04 DOI: 10.1016/j.diabet.2025.101673

Shu Yuan , Zi-Lin Li , Jing Hu

引用次数: 0