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Musculoskeletal disorders in type 1 diabetes: Clinical phenotyping and associations with quality of life and glucose control - The French SFDT1 cohort study 1型糖尿病的肌肉骨骼疾病:临床表型及其与生活质量和血糖控制的关系——法国SFDT1队列研究
IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-04-23 DOI: 10.1016/j.diabet.2025.101647
Noémie Topalian , Sylvie Picard , Jean-Pierre Riveline , Dulce Canha , Jean-Baptiste Julla , Sandrine Lablanche , Laurence Salle , Emmanuel Sonnet , Aurélie Berot , Didier Gouet , Kalliopi Bilariki , Chloé Amouyal , Lucien Marchand , Sophie Borot , Nicolas Chevalier , Isabela Banu , Emmanuelle Sokol , Emmanuel Cosson , Guy Fagherazzi , Gloria Aguayo

Background

Musculoskeletal disorders (MSDs) are common, but overlooked, complications of type 1 diabetes mellitus (T1DM). This study aims to describe MSD phenotypes (clinical, lifestyle, socio-economic) in adults with T1DM.

Methods

We analyzed adult participants in the SFDT1 cohort study. We assessed the following MSDs: stress fractures, non-traumatic upper-limb disorders, and entrapment syndromes. We performed a cross-sectional analysis of the association between MSDs and various factors. After applying multiple imputations for missing data, we computed logistic regression models with progressive adjustments on confounding factors.

Results

Of 1832 participants (53 % men, median age 38 (IQR 22) years), 34 % reported at least one personal history of MSD: 8 % for stress fractures, 24 % for upper-limb disorders and 15 % for entrapment syndromes. A higher prevalence of MSDs was found in women, with aging and with diabetes duration. In a fully adjusted model, we observed a positive association between current smoking (OR [95 %CI] = 1.50 [1.14;1.97]), non-excessive alcohol consumption (1.45 [1.14;1.85]), neuropathy (1.70 [1.35;2.15]), retinopathy (1.30 [1.02;1.65]), use of automated insulin delivery systems (1.53 [1.06;2.21]) and MSDs. MSDs were associated with reduced global quality of life (0.97 [0.95;0.98]). MSDs were not associated with HbA1c, social vulnerability or physical activity.

Conclusion

We have shown that MSDs are found in 1 in 3 people with T1DM. They are associated with several lifestyle factors, diabetes complications and the use of automated insulin delivery systems. MSDs should be considered in the T1DM assessment to optimize quality of life.
背景:肌肉骨骼疾病(MSDs)是1型糖尿病(T1DM)常见但被忽视的并发症。本研究旨在描述成年T1DM患者的MSD表型(临床、生活方式、社会经济)。方法我们分析SFDT1队列研究中的成年参与者。我们评估了以下msd:应力性骨折、非创伤性上肢障碍和夹带综合征。我们对MSDs与各种因素之间的关系进行了横断面分析。在对缺失数据进行了多重输入后,我们计算了对混杂因素进行渐进调整的逻辑回归模型。结果在1832名参与者中(53%为男性,中位年龄38岁(IQR 22)), 34%报告至少有一次个人MSD病史:8%为应力性骨折,24%为上肢疾病,15%为夹带综合征。随着年龄的增长和糖尿病病程的延长,女性中MSDs的患病率更高。在一个完全调整的模型中,我们观察到当前吸烟(OR [95% CI] = 1.50[1.14;1.97])、非过量饮酒(1.45[1.14;1.85])、神经病变(1.70[1.35;2.15])、视网膜病变(1.30[1.02;1.65])、使用自动胰岛素输送系统(1.53[1.06;2.21])和msd之间的正相关。MSDs与总体生活质量降低相关(0.97[0.95;0.98])。MSDs与HbA1c、社会脆弱性或身体活动无关。结论:1 / 3的T1DM患者存在msd。它们与几种生活方式因素、糖尿病并发症和使用自动胰岛素输送系统有关。在T1DM评估中应考虑MSDs,以优化生活质量。
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引用次数: 0
Hip fractures and type 2 diabetes in the elderly: Risk factors analysis of the Nedices cohort 老年髋部骨折和2型糖尿病:ne迪斯队列的危险因素分析
IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-04-21 DOI: 10.1016/j.diabet.2025.101656
Federico Hawkins Carranza , Cristina Martín-Arriscado Arroba , Arturo Corbatón-Anchuelo , Guillermo Martínez Díaz-Guerra , Félix Bermejo Pareja

Aim

- To analyze the association between type 2 diabetes (T2D) and the incidence of hip fractures in the elderly, while also considering the influence of socioeconomic status (SES), and other risk factors (RFs).

Methods

- Data were collected from 5278 participants aged ≥ 65 years. The study included a baseline and a follow-up survey 3 years later. Participants completed a questionnaire, anthropometric measurements, blood tests, and physical and cognitive tools. The research was conducted in three Spanish communities with different socioeconomic backgrounds.

Results

- At baseline, there were 874 T2D and 4494 controls. Body mass index (BMI) was slightly higher in individuals with hip fractures. Significant differences were observed in BMI, education level, physical activity, osteoporosis, cataracts, and osteoarthritis. In the follow-up survey, 96 newly, 615 previously T2D, and 2985 controls were compared. Those with hip fractures were associated with lower educational attainment, sedentary life, and higher diagnoses of osteoporosis, cataracts, and osteoarthritis. Charlson index was higher in individuals with hip fractures. A higher proportion of fractures occurred in urban areas. The rate of incidence of T2D between individuals with and without fractures was not different.

Conclusion

- RFs for hip fractures in T2D are similar to those in the general population. Osteoporosis, being female, and advancing age were independent RFs for hip fractures. There was an inverse association between educational level, community allocation, and physical activity which may further contribute to hip fracture risk. These highlights the need for research to better understand the role of T2D and these RFs in hip fracture incidence.
目的:分析2型糖尿病(T2D)与老年人髋部骨折发生率的关系,同时考虑社会经济地位(SES)和其他危险因素(RFs)的影响。方法:数据来自5278名年龄≥65岁的参与者。该研究包括基线和3年后的随访调查。参与者完成了问卷调查、人体测量、血液测试以及身体和认知工具。这项研究是在三个不同社会经济背景的西班牙社区进行的。结果:-基线时,有874例T2D和4,494例对照。髋部骨折患者的身体质量指数(BMI)略高。在BMI、受教育程度、体力活动、骨质疏松、白内障和骨关节炎方面观察到显著差异。在随访调查中,96例新发患者,615例既往T2D患者和2985例对照患者进行比较。髋部骨折患者受教育程度较低,久坐不动,骨质疏松症、白内障和骨关节炎的发病率较高。髋骨骨折患者的Charlson指数更高。骨折发生在城市地区的比例较高。t2dm的发生率在有和没有骨折的个体之间没有差异。结论:t2dm髋部骨折的rf与普通人群相似。骨质疏松、女性和高龄是髋部骨折的独立风险因素。教育水平、社区分配和体育活动之间存在负相关,这可能进一步增加髋部骨折的风险。这些突出表明需要进行研究,以更好地了解T2D和这些RFs在髋部骨折发生率中的作用。
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引用次数: 0
Comparative study of SGLT2 inhibitors and metformin: Evaluating first-line therapies for dementia prevention in type 2 diabetes SGLT2抑制剂和二甲双胍的比较研究:评价预防2型糖尿病痴呆的一线疗法
IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-04-21 DOI: 10.1016/j.diabet.2025.101655
Mingyang Sun , Xiaoling Wang , Zhongyuan Lu , Yitian Yang , Shuang Lv , Mengrong Miao , Wan-Ming Chen , Szu-Yuan Wu , Jiaqiang Zhang

Background

- Type 2 diabetes (T2D) increases the risk of dementia by 1.5 to 2.5 times. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) and metformin, widely used antidiabetic therapies, have demonstrated potential neuroprotective effects. Their comparative effectiveness in dementia prevention remains unknown.

Methods

- This retrospective cohort study used the TriNetX global federated network, analyzing de-identified records from over 98 healthcare organizations. Adults with T2D initiating SGLT2i or metformin as first-line therapy were propensity score-matched (1:1). The primary outcome was overall dementia incidence, including vascular dementia, Alzheimer’s disease, and other subtypes. Secondary outcomes included all-cause mortality. Time-to-event outcomes were assessed using Kaplan-Meier curves and Cox models.

Results

- Among 74,975 matched patients in each cohort, SGLT2i use was associated with a lower incidence of overall dementia: 2.7 % vs. 6.9 %: adjusted hazard ratio (aHR) 0.80 [95 % CI 0.76;0.84]. Reductions were observed in vascular dementia (0.8 % vs. 2.0 %; aHR 0.87), Alzheimer’s dementia (1.1 % vs. 3.2 %; aHR, 0.76), and all-cause mortality (6.8 % vs. 15.4 %; aHR, 0.92). Benefits were pronounced in older adults, particularly those aged ≥80 years.

Conclusions

- SGLT2is significantly reduced dementia risk and mortality compared to metformin in T2D patients. These findings suggest SGLT2is may offer superior neuroprotective benefits, underscoring their potential as a first-line therapy for T2D. Further randomized trials are needed to confirm these results.
背景- 2型糖尿病(T2D)使痴呆的风险增加1.5至2.5倍。钠-葡萄糖共转运蛋白2抑制剂(SGLT2is)和二甲双胍,广泛应用于降糖治疗,已显示出潜在的神经保护作用。它们在预防痴呆症方面的相对有效性尚不清楚。方法:这项回顾性队列研究使用TriNetX全球联合网络,分析了来自98个医疗保健组织的去识别记录。成人t2dm患者采用SGLT2i或二甲双胍作为一线治疗,倾向评分匹配(1:1)。主要结局是总体痴呆发病率,包括血管性痴呆、阿尔茨海默病和其他亚型。次要结局包括全因死亡率。使用Kaplan-Meier曲线和Cox模型评估事件发生时间。结果:在每个队列的74,975名匹配的患者中,SGLT2i的使用与较低的总体痴呆发病率相关:2.7% vs. 6.9%:校正风险比(aHR) 0.80 [95% CI 0.76;0.84]。血管性痴呆减少(0.8% vs. 2.0%;aHR 0.87),阿尔茨海默氏痴呆(1.1%对3.2%;aHR, 0.76)和全因死亡率(6.8% vs. 15.4%;aHR, 0.92)。在老年人中获益明显,尤其是年龄≥80岁的老年人。结论:与二甲双胍相比,sglt2dm可显著降低T2D患者的痴呆风险和死亡率。这些发现表明SGLT2is可能具有更好的神经保护作用,强调了它们作为T2D一线治疗的潜力。需要进一步的随机试验来证实这些结果。
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引用次数: 0
Automated insulin delivery after beta-cell replacement failure in people living with type 1 diabetes 1型糖尿病患者β细胞替代失败后的自动胰岛素输送
IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-04-21 DOI: 10.1016/j.diabet.2025.101654
Quentin Perrier , Sandrine Lablanche , Luc Rakotoarisoa , Orianne Villard , Jean-Pierre Riveline , Jean-Baptiste Julla , Fanny Buron , Sophie Reffet , Eric Renard , Laurence Kessler , Pierre-Yves Benhamou

Aims

Patients living with highly unstable type 1 diabetes (T1D) are eligible for beta-cell replacement (βCR) therapy (islet or pancreas transplantation). This study aimed to evaluate glycemic control in patients treated with automated insulin delivery (AID) following failed βCR therapy, defined as secondary graft failure or marginal function.

Material and Methods

A national, multicenter, retrospective study was conducted with 23 patients who had βCR failure treated with AID for at least three months. The primary outcome was the proportion of patients achieving recommended glucose targets (time in 70–180mg/dl range [TIR] > 70 %, time below range [TBR] < 4 % and HbA1c < 7 %). Secondary outcomes included TIR, glycemia risk index (GRI), HbA1c, coefficient of variation (CV), body weight, insulin doses, severe hypoglycemia and AID discontinuation.

Results

The proportion of patients achieving recommended glucose targets under AID increased from 5.0 % to 57.1 % after 12 months. TIR increased from 54.2 ± 18.0 % to 75.5 ± 9.6 % after 12-month AID, while GRI decreased from 45.8 ± 22.2 % to 25.6 ± 10.3 %. HbA1c levels decreased from 7.5 ± 0.9 % to 7.0 ± 1.1 % after 12-month AID. CV, body weight and insulin doses did not change. All patients were free from severe hypoglycemia under AID, including those who had experienced severe hypoglycemia after βCR failure. No patient discontinued the AID.

Conclusions

This study highlights the effectiveness of AID in achieving glucose control targets and preventing severe hypoglycemia in patients with T1D following βCR failure. AID may serve as a valuable therapeutic option to improve glucose control when graft function declines.
高度不稳定型1型糖尿病(T1D)患者适合β细胞替代(βCR)治疗(胰岛或胰腺移植)。本研究旨在评估βCR治疗失败(继发性移植物衰竭或边缘功能)后接受自动胰岛素输送(AID)治疗的患者的血糖控制情况。材料与方法对23例经AID治疗至少3个月的βCR失败患者进行了一项全国性、多中心、回顾性研究。主要终点是达到推荐血糖目标的患者比例(在70-180mg /dl范围内的时间[TIR] >;70%,时间低于范围[TBR] <;4%和HbA1c <;7%)。次要结局包括TIR、血糖危险指数(GRI)、糖化血红蛋白(HbA1c)、变异系数(CV)、体重、胰岛素剂量、严重低血糖和停药。结果12个月后,AID下达到推荐血糖指标的患者比例从5.0%上升到57.1%。12个月后,TIR由54.2±18.0%上升至75.5±9.6%,GRI由45.8±22.2%下降至25.6±10.3%。艾滋病12个月后,HbA1c水平从7.5±0.9%降至7.0±1.1%。CV、体重和胰岛素剂量没有变化。所有患者在AID下均无严重低血糖,包括βCR失败后出现严重低血糖的患者。没有患者停药。结论本研究强调了AID在T1D患者βCR失效后实现血糖控制目标和预防严重低血糖的有效性。当移植物功能下降时,AID可作为改善血糖控制的有价值的治疗选择。
{"title":"Automated insulin delivery after beta-cell replacement failure in people living with type 1 diabetes","authors":"Quentin Perrier ,&nbsp;Sandrine Lablanche ,&nbsp;Luc Rakotoarisoa ,&nbsp;Orianne Villard ,&nbsp;Jean-Pierre Riveline ,&nbsp;Jean-Baptiste Julla ,&nbsp;Fanny Buron ,&nbsp;Sophie Reffet ,&nbsp;Eric Renard ,&nbsp;Laurence Kessler ,&nbsp;Pierre-Yves Benhamou","doi":"10.1016/j.diabet.2025.101654","DOIUrl":"10.1016/j.diabet.2025.101654","url":null,"abstract":"<div><h3>Aims</h3><div>Patients living with highly unstable type 1 diabetes (T1D) are eligible for beta-cell replacement (βCR) therapy (islet or pancreas transplantation). This study aimed to evaluate glycemic control in patients treated with automated insulin delivery (AID) following failed βCR therapy, defined as secondary graft failure or marginal function.</div></div><div><h3>Material and Methods</h3><div>A national, multicenter, retrospective study was conducted with 23 patients who had βCR failure treated with AID for at least three months. The primary outcome was the proportion of patients achieving recommended glucose targets (time in 70–180mg/dl range [TIR] &gt; 70 %, time below range [TBR] &lt; 4 % and HbA1c &lt; 7 %). Secondary outcomes included TIR, glycemia risk index (GRI), HbA1c, coefficient of variation (CV), body weight, insulin doses, severe hypoglycemia and AID discontinuation.</div></div><div><h3>Results</h3><div>The proportion of patients achieving recommended glucose targets under AID increased from 5.0 % to 57.1 % after 12 months. TIR increased from 54.2 ± 18.0 % to 75.5 ± 9.6 % after 12-month AID, while GRI decreased from 45.8 ± 22.2 % to 25.6 ± 10.3 %. HbA1c levels decreased from 7.5 ± 0.9 % to 7.0 ± 1.1 % after 12-month AID. CV, body weight and insulin doses did not change. All patients were free from severe hypoglycemia under AID, including those who had experienced severe hypoglycemia after βCR failure. No patient discontinued the AID.</div></div><div><h3>Conclusions</h3><div>This study highlights the effectiveness of AID in achieving glucose control targets and preventing severe hypoglycemia in patients with T1D following βCR failure. AID may serve as a valuable therapeutic option to improve glucose control when graft function declines.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 4","pages":"Article 101654"},"PeriodicalIF":4.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877476","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
Increased fatty acid-binding protein 4 levels are associated with the risk of developing retinopathy in type 2 diabetes mellitus patients 脂肪酸结合蛋白4水平升高与2型糖尿病患者发生视网膜病变的风险相关
IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-04-18 DOI: 10.1016/j.diabet.2025.101653
Yan Liu , Kaihui Ma , Aiying Zhang , Yun Cui , Hui Zhao , Xinhua Li , Ke Zhao

Aim

Fatty acid-binding protein 4 (FABP4) is associated with the risk of developing diabetes and its microvascular complications. We aimed to explore the association between serum FABP4 levels and the risk of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).

Methods

Serum FABP4 levels were measured via enzyme-linked immunosorbent assay in 275 individuals (78 healthy controls, 197 T2DM patients). DR severity was determined via fundus fluorescence angiography. Multivariate analyses were performed via logistic regression models. The diagnostic value of these measures was assessed via receiver operating characteristic curve analysis.

Results

Serum FABP4 levels were significantly greater in the proliferative DR (PDR) group than in the ZeroDR (ZDR) and non-proliferative DR (NPDR) groups, and the FABP4 levels positively with DR severity (r = 0.328, P < 0.001). Logistic regression analysis revealed that after adjusting for potential confounders, increased FABP4, fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels were risk factors for DR development, and FABP4 was an independent risk factor for PDR development. A multivariate logistic regression model that included FABP4 as a categorical binary variable with a cutoff value of 20.57 ng/ml revealed that a level of FABP4 above the cutoff value increased the DR risk (OR=6.394; 95 % CI=3.18;13.58; P < 0.001). Similarly, a FABP4 concentration above the cutoff value of 24.40 ng/ml increased the PDR risk (OR=4.686; 95 % CI=1.907;12.34; P = 0.001).

Conclusion

The FABP4 level is associated with DR severity and has the potential as a serum biomarker for DR prediction.
脂肪酸结合蛋白4 (FABP4)与糖尿病及其微血管并发症的发生风险相关。我们旨在探讨血清FABP4水平与2型糖尿病(T2DM)患者糖尿病视网膜病变(DR)风险之间的关系。方法采用酶联免疫吸附法测定275例(健康对照78例,T2DM患者197例)血清FABP4水平。通过眼底荧光血管造影确定DR严重程度。通过logistic回归模型进行多变量分析。通过受试者工作特征曲线分析评估这些指标的诊断价值。结果增殖性DR (PDR)组血清FABP4水平显著高于无增殖性DR (ZDR)和非增殖性DR (NPDR)组,且与DR严重程度呈正相关(r = 0.328, P <;0.001)。Logistic回归分析显示,在调整潜在混杂因素后,FABP4、空腹血糖(FPG)和血红蛋白A1c (HbA1c)水平升高是DR发生的危险因素,FABP4是PDR发生的独立危险因素。将FABP4作为分类二元变量(截断值为20.57 ng/ml)的多因素logistic回归模型显示,高于截断值的FABP4水平增加了DR风险(OR=6.394;95% ci =3.18;13.58;P & lt;0.001)。同样,高于临界值24.40 ng/ml的FABP4浓度会增加PDR风险(OR=4.686;95% ci =1.907;12.34;P = 0.001)。结论FABP4水平与DR严重程度相关,可作为预测DR的血清生物标志物。
{"title":"Increased fatty acid-binding protein 4 levels are associated with the risk of developing retinopathy in type 2 diabetes mellitus patients","authors":"Yan Liu ,&nbsp;Kaihui Ma ,&nbsp;Aiying Zhang ,&nbsp;Yun Cui ,&nbsp;Hui Zhao ,&nbsp;Xinhua Li ,&nbsp;Ke Zhao","doi":"10.1016/j.diabet.2025.101653","DOIUrl":"10.1016/j.diabet.2025.101653","url":null,"abstract":"<div><h3>Aim</h3><div>Fatty acid-binding protein 4 (FABP4) is associated with the risk of developing diabetes and its microvascular complications. We aimed to explore the association between serum FABP4 levels and the risk of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>Serum FABP4 levels were measured via enzyme-linked immunosorbent assay in 275 individuals (78 healthy controls, 197 T2DM patients). DR severity was determined via fundus fluorescence angiography. Multivariate analyses were performed via logistic regression models. The diagnostic value of these measures was assessed via receiver operating characteristic curve analysis.</div></div><div><h3>Results</h3><div>Serum FABP4 levels were significantly greater in the proliferative DR (PDR) group than in the ZeroDR (ZDR) and non-proliferative DR (NPDR) groups, and the FABP4 levels positively with DR severity (<em>r</em> = 0.328, <em>P</em> &lt; 0.001). Logistic regression analysis revealed that after adjusting for potential confounders, increased FABP4, fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels were risk factors for DR development, and FABP4 was an independent risk factor for PDR development. A multivariate logistic regression model that included FABP4 as a categorical binary variable with a cutoff value of 20.57 ng/ml revealed that a level of FABP4 above the cutoff value increased the DR risk (OR=6.394; 95 % CI=3.18;13.58; <em>P</em> &lt; 0.001). Similarly, a FABP4 concentration above the cutoff value of 24.40 ng/ml increased the PDR risk (OR=4.686; 95 % CI=1.907;12.34; <em>P</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>The FABP4 level is associated with DR severity and has the potential as a serum biomarker for DR prediction.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 4","pages":"Article 101653"},"PeriodicalIF":4.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870631","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
Management of diabetes in patients hospitalized for acute cardiac events: Joint position paper from the French Society of Cardiology and the French-speaking Diabetes Society 急性心脏事件住院患者的糖尿病管理:法国心脏病学会和法语糖尿病学会的联合立场文件
IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-04-15 DOI: 10.1016/j.diabet.2025.101645
Patrick Henry , Sophie Jacqueminet , Gilles Lemesle , Gaetan Prevost , Franck Boccara , Emmanuel Cosson , Etienne Puymirat , Denis Angoulvant , François Roubille , Serge Kownator , Paul Valensi , Victor Aboyans , Bruno Vergès
Patients with type 2 diabetes, but also older patients with type 1 diabetes, are at major risk of cardiovascular morbidity and death. After an acute cardiac event, the prognosis of patients with diabetes is impaired, with clear increases in in-hospital and long-term morbidity and deaths. Both hyper- and hypoglycaemia are deleterious after an acute cardiac event, and the decision to start intravenous insulin is often challenging. Moreover, some antidiabetic treatments have cardioprotective effects, and the onset of an acute cardiac event provides an opportunity to shift to these treatments. The objective of this position statement is to offer practical tools to cardiologists seeking to improve the care of patients with diabetes hospitalized for an acute cardiac event, and to optimize collaboration between cardiologists and diabetologists. After a summary of the evidence for antidiabetic treatments in patients with acute cardiac events, we propose an algorithm to start and adapt intravenous insulin in the most severe patients, and conclude with standard insulin protocols or oral treatments at discharge. We also discuss appropriate antidiabetic treatment of these patients at discharge, based on the main cardiological diagnosis, kidney function and antidiabetic strategies. Finally, situations in which the diabetologist must be consulted are discussed.
2型糖尿病患者,以及老年1型糖尿病患者,心血管发病率和死亡的风险很大。急性心脏事件发生后,糖尿病患者的预后受损,住院和长期发病率和死亡率明显增加。急性心脏事件后的高血糖和低血糖都是有害的,决定开始静脉注射胰岛素通常是具有挑战性的。此外,一些抗糖尿病治疗具有心脏保护作用,急性心脏事件的发作提供了转向这些治疗的机会。本立场声明的目的是为心脏病专家提供实用的工具,以改善因急性心脏事件住院的糖尿病患者的护理,并优化心脏病专家和糖尿病专家之间的合作。在总结了急性心脏事件患者抗糖尿病治疗的证据后,我们提出了一种算法,在最严重的患者中开始和适应静脉注射胰岛素,并在出院时采用标准胰岛素方案或口服治疗。我们还讨论了这些患者出院时的适当降糖治疗,基于主要的心脏科诊断,肾功能和降糖策略。最后,讨论了必须咨询糖尿病专家的情况。
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引用次数: 0
Impact of SGLT-2i on COPD exacerbations in patients with type 2 diabetes mellitus: A systematic review and meta-analysis SGLT-2i对2型糖尿病患者COPD加重的影响:一项系统综述和荟萃分析
IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-04-11 DOI: 10.1016/j.diabet.2025.101646
Prakasini Satapathy , Abhay M Gaidhane , Nasir Vadia , Soumya V Menon , Kattela Chennakesavulu , Rajashree Panigrahi , Jayaraj Patil , Ganesh Bushi , Mahendra Singh , Awakash Turkar , Sanjit Sah , S. Govinda Rao , Khang Wen Goh , Muhammed Shabil

Background

Chronic Obstructive Pulmonary Disease (COPD) and Type 2 Diabetes Mellitus (T2DM) often coexist, leading to compounded morbidity, mortality, and healthcare burden. COPD exacerbations significantly impact patients with T2DM, with increased frequency and severity. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated promising benefits in managing both glycemic control and respiratory health. This systematic review and meta-analysis aim to assess the impact of SGLT-2 inhibitors on COPD exacerbations in T2DM patients.

Methods

We conducted a systematic review and meta-analysis following PRISMA guidelines, evaluating studies published until March 2025. A broad search strategy across PubMed, Embase, and Web of Science identified relevant studies comparing SGLT-2 inhibitors with other antidiabetic agents. Studies meeting predefined eligibility criteria, including those providing quantitative data on COPD exacerbation frequency and hospitalization rates, were included in the analysis.

Results

Eight studies involving 4,64,542 participants were included. The pooled hazard ratio (HR) for the impact of SGLT-2 inhibitors on COPD exacerbations was 0.646 (95 % CI: 0.470–0.889), demonstrating a 35 % decrease in exacerbations compared to other antidiabetic agents. SGLT-2 inhibitors demonstrated superior efficacy over DPP-4 inhibitors (HR: 0.618, 95 % CI: 0.462–0.827) and sulfonylureas (HR: 0.620, 95 % CI: 0.526–0.731). However, the reduction in severe exacerbations was not statistically significant (HR: 0.715, 95 % CI: 0.403–1.269). Subgroup analysis indicated that SGLT-2 inhibitors had a modest but significant advantage over GLP-1 receptor agonists (HR: 0.940, 95 % CI: 0.890–0.993).

Conclusions

SGLT-2 inhibitors significantly reduce COPD exacerbations in T2DM patients, offering dual benefits in managing both glycemic control and respiratory health. These findings support the integration of SGLT-2 inhibitors into treatment regimens for T2DM-COPD overlap. Further randomized controlled trials and long-term studies are needed to confirm the lasting efficacy and explore the underlying mechanisms.
背景:慢性阻塞性肺疾病(COPD)和2型糖尿病(T2DM)经常共存,导致复合发病率、死亡率和医疗负担。慢性阻塞性肺病加重显著影响T2DM患者,频率和严重程度增加。钠-葡萄糖共转运蛋白-2抑制剂(SGLT-2i)在血糖控制和呼吸系统健康方面都有良好的疗效。本系统综述和荟萃分析旨在评估SGLT-2抑制剂对T2DM患者COPD加重的影响。方法:我们根据PRISMA指南进行了系统回顾和荟萃分析,评估了截至2025年3月发表的研究。通过PubMed、Embase和Web of Science的广泛搜索策略,确定了比较SGLT-2抑制剂与其他降糖药的相关研究。符合预定义资格标准的研究,包括那些提供COPD加重频率和住院率定量数据的研究,被纳入分析。结果共纳入8项研究,共纳入4,64,542名受试者。SGLT-2抑制剂对COPD加重影响的合并风险比(HR)为0.646 (95% CI: 0.470-0.889),表明与其他抗糖尿病药物相比,加重减少35%。SGLT-2抑制剂的疗效优于DPP-4抑制剂(HR: 0.618, 95% CI: 0.462-0.827)和磺脲类药物(HR: 0.620, 95% CI: 0.526-0.731)。然而,严重恶化的减少没有统计学意义(HR: 0.715, 95% CI: 0.403-1.269)。亚组分析显示,SGLT-2抑制剂与GLP-1受体激动剂相比具有适度但显著的优势(HR: 0.940, 95% CI: 0.890-0.993)。结论:ssglt -2抑制剂可显著降低T2DM患者COPD加重,在血糖控制和呼吸健康管理方面具有双重益处。这些发现支持将SGLT-2抑制剂整合到T2DM-COPD重叠治疗方案中。需要进一步的随机对照试验和长期研究来证实其持久疗效并探索其潜在机制。
{"title":"Impact of SGLT-2i on COPD exacerbations in patients with type 2 diabetes mellitus: A systematic review and meta-analysis","authors":"Prakasini Satapathy ,&nbsp;Abhay M Gaidhane ,&nbsp;Nasir Vadia ,&nbsp;Soumya V Menon ,&nbsp;Kattela Chennakesavulu ,&nbsp;Rajashree Panigrahi ,&nbsp;Jayaraj Patil ,&nbsp;Ganesh Bushi ,&nbsp;Mahendra Singh ,&nbsp;Awakash Turkar ,&nbsp;Sanjit Sah ,&nbsp;S. Govinda Rao ,&nbsp;Khang Wen Goh ,&nbsp;Muhammed Shabil","doi":"10.1016/j.diabet.2025.101646","DOIUrl":"10.1016/j.diabet.2025.101646","url":null,"abstract":"<div><h3>Background</h3><div>Chronic Obstructive Pulmonary Disease (COPD) and Type 2 Diabetes Mellitus (T2DM) often coexist, leading to compounded morbidity, mortality, and healthcare burden. COPD exacerbations significantly impact patients with T2DM, with increased frequency and severity. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated promising benefits in managing both glycemic control and respiratory health. This systematic review and meta-analysis aim to assess the impact of SGLT-2 inhibitors on COPD exacerbations in T2DM patients.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis following PRISMA guidelines, evaluating studies published until March 2025. A broad search strategy across PubMed, Embase, and Web of Science identified relevant studies comparing SGLT-2 inhibitors with other antidiabetic agents. Studies meeting predefined eligibility criteria, including those providing quantitative data on COPD exacerbation frequency and hospitalization rates, were included in the analysis.</div></div><div><h3>Results</h3><div>Eight studies involving 4,64,542 participants were included. The pooled hazard ratio (HR) for the impact of SGLT-2 inhibitors on COPD exacerbations was 0.646 (95 % CI: 0.470–0.889), demonstrating a 35 % decrease in exacerbations compared to other antidiabetic agents. SGLT-2 inhibitors demonstrated superior efficacy over DPP-4 inhibitors (HR: 0.618, 95 % CI: 0.462–0.827) and sulfonylureas (HR: 0.620, 95 % CI: 0.526–0.731). However, the reduction in severe exacerbations was not statistically significant (HR: 0.715, 95 % CI: 0.403–1.269). Subgroup analysis indicated that SGLT-2 inhibitors had a modest but significant advantage over GLP-1 receptor agonists (HR: 0.940, 95 % CI: 0.890–0.993).</div></div><div><h3>Conclusions</h3><div>SGLT-2 inhibitors significantly reduce COPD exacerbations in T2DM patients, offering dual benefits in managing both glycemic control and respiratory health. These findings support the integration of SGLT-2 inhibitors into treatment regimens for T2DM-COPD overlap. Further randomized controlled trials and long-term studies are needed to confirm the lasting efficacy and explore the underlying mechanisms.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 4","pages":"Article 101646"},"PeriodicalIF":4.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143843437","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
Open source automated insulin delivery: State of play in France 开源自动胰岛素输送:法国的发展现状。
IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-04-04 DOI: 10.1016/j.diabet.2025.101644
Audrey Poisson, Patricia Vaduva, Agathe Guenego
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引用次数: 0
Secukinumab (Anti-IL-17) induces clinical regression in early diagnosed type 1 diabetes: A case report Secukinumab(抗il -17)诱导早期诊断的1型糖尿病临床退化:1例报告
IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-04-04 DOI: 10.1016/j.diabet.2025.101643
Blanca Gómez-Zaragoza , María Ruiz-Rodríguez , Pablo Rodríguez de Vera Gómez , Daniela Decan-Bardasz , María Asunción Martínez-Brocca
We report the case of a 30-year-old male with psoriatic arthritis treated with secukinumab (anti-IL-17A) who developed new-onset type 1 diabetes mellitus (T1DM). During follow-up, a consistent reduction in insulin requirements and glycemic variability was observed in the two weeks following each dose of secukinumab. This suggests a possible immunomodulatory effect of IL-17 inhibition on beta-cell function and glycemic control. To our knowledge, this is the first report describing clinical benefits of secukinumab in the early stages of T1DM, highlighting its potential as a therapeutic tool in modulating autoimmune processes involved in disease progression.
我们报告一例30岁男性银屑病关节炎患者,接受secukinumab(抗il - 17a)治疗,并发新发1型糖尿病(T1DM)。在随访期间,在每次给药后的两周内观察到胰岛素需求和血糖变异性的持续降低。这表明IL-17抑制可能对β细胞功能和血糖控制有免疫调节作用。据我们所知,这是第一份描述secukinumab在T1DM早期临床获益的报告,强调了其作为调节自身免疫过程参与疾病进展的治疗工具的潜力。
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引用次数: 0
Automated insulin delivery for people living with Type 1 Diabetes in France: A long road ahead 法国1型糖尿病患者的自动胰岛素输送:前面的路还很长
IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-03-28 DOI: 10.1016/j.diabet.2025.101642
Coralie Amadou , Alfred Penfornis
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引用次数: 0
期刊
Diabetes & metabolism
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