Diabetes & metabolism最新文献_第6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 : 2025-09-01 Epub 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 : 2025-09-01 Epub 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

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 : 2025-09-01 Epub Date: 2025-06-04 DOI: 10.1016/j.diabet.2025.101673

Shu Yuan , Zi-Lin Li , Jing Hu

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 : 2025-09-01 Epub 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

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 : 2025-09-01 Epub 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 : 2025-09-01 Epub 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。

{"title":"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","authors":"Yijiong Tan , Wenjun Qu , Jiehua Zhao , Yunqin Ma , Qidi Zhang , Hong Gao , Qin Zhen , Yufan Wang , Yongde Peng , Fang Liu , Nengguang Fan","doi":"10.1016/j.diabet.2025.101680","DOIUrl":"10.1016/j.diabet.2025.101680","url":null,"abstract":"<div><h3>Aim</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>P</em> = 0.038). LSM changes were similar between groups (difference in LS mean:0.11 [-1.04;0.82], <em>P</em> = 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 <em>P</em> for interaction > 0.05).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 5","pages":"Article 101680"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370031","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

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 : 2025-09-01 Epub 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

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 : 2025-09-01 Epub 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

Cardiorenal outcomes and safety of SGLT2 inhibitors in patients with diabetes secondary to disorders of the exocrine pancreas: a nationwide population-based study SGLT2抑制剂治疗继发于外分泌胰腺疾病的糖尿病患者的心肾结局和安全性：一项基于全国人群的研究

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-09-01 Epub Date: 2025-05-30 DOI: 10.1016/j.diabet.2025.101668

Kyoung Hwa Ha , Minae Park , Yujin Lee , Dae Jung Kim , Seung Jin Han

Aims

Limited data are available on the effectiveness of pharmacological treatments for diabetes secondary to disorders of the exocrine pancreas (DEP). This study evaluated the real-world effectiveness and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors in individuals with DEP.

Methods

A retrospective cohort study was conducted using data from the Korean National Health Insurance Service database. Data on 66,120 individuals with DEP who initiated glucose-lowering drugs (GLDs) between September 2014 and December 2022 were analyzed. Patients initiating SGLT2 inhibitors were matched 1:1 with patients initiating other GLDs using propensity-score matching. The effectiveness outcomes included major adverse cardiovascular events (MACEs), heart failure, end-stage kidney disease (ESKD), and all-cause mortality. The safety outcomes included hypoglycemia, diabetic ketoacidosis, genital infections, urinary tract infections, fractures, pancreatitis, and pancreatic cancer.

Results

After matching, 4,128 SGLT2 inhibitor-other GLD user pairs were included in the analysis, with a mean follow-up of 2.3 years. Compared with use of other GLDs, use of SGLT2 inhibitors was associated with a significantly lower risk of MACE (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.51–0.93), hospitalization for heart failure (HR: 0.70; 95% CI: 0.51–0.95), ESKD (HR: 0.19; 95% CI: 0.06–0.61), and all-cause mortality (HR: 0.38; 95% CI: 0.27–0.53). SGLT2 inhibitor use was associated with a reduced risk of urinary tract infections (HR: 0.87; 95% CI: 0.78–0.96) and pancreatitis (HR 0.71; 95% CI 0.58–0.87).

Conclusions

SGLT2 inhibitors were associated with a reduced risk of adverse cardiorenal outcomes and all-cause mortality and were safely used in patients with DEP.

目的：关于外分泌胰腺（DEP）继发糖尿病的药物治疗有效性的数据有限。本研究评估了钠-葡萄糖共转运蛋白2 （SGLT2）抑制剂在dep患者中的实际有效性和安全性。方法：使用韩国国民健康保险服务数据库的数据进行回顾性队列研究。分析了2014年9月至2022年12月期间66120名开始使用降糖药物（GLDs）的DEP患者的数据。使用倾向评分匹配，启动SGLT2抑制剂的患者与启动其他gld的患者进行1:1匹配。疗效结局包括主要不良心血管事件（mace）、心力衰竭、终末期肾病（ESKD）和全因死亡率。安全性结果包括低血糖、糖尿病酮症酸中毒、生殖器感染、尿路感染、骨折和胰腺炎。结果：匹配后，4128名SGLT2抑制剂-其他GLD用户对被纳入分析，平均随访时间为2.3年。与使用其他GLDs相比，使用SGLT2抑制剂与MACE风险显著降低相关(风险比[HR]: 0.69；95%可信区间[CI]: 0.51-0.93)，心力衰竭住院(HR: 0.70；95% ci: 0.51-0.95), eskd (hr: 0.19；95% CI: 0.06-0.61)和全因死亡率(HR: 0.38；95% ci: 0.27-0.53)。使用SGLT2抑制剂与尿路感染风险降低相关(HR: 0.87；95% CI: 0.78-0.96)和胰腺炎(HR 0.71；95% ci 0.58-0.87)。结论：SGLT2抑制剂与不良心肾结局和全因死亡率的降低相关，并且可以安全地用于DEP患者。

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引用次数: 0

What the diabetologist needs to know about the risk of non-arteritic anterior ischaemic optic neuropathy and GLP-1 receptor agonist use in patients with type 2 diabetes 糖尿病学家需要了解的关于非动脉性前缺血性视神经病变的风险和GLP-1受体激动剂在2型糖尿病患者中的应用

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-07-01 Epub Date: 2025-05-16 DOI: 10.1016/j.diabet.2025.101664

Sylvie Feldman-Billard

Aim

Recent findings have raised concern about a potential association between semaglutide use and non-arteritic anterior ischaemic optic neuropathy (NAION), a rare form of permanent vision loss. This report provides a critical analysis of the current knowledge of GLP-1 receptor agonist (RA) use and risk of NAION in patients with type 2 diabetes (T2D).

Methods

A literature search strategy was conducted for all English-language literature with a systematic review of key references up to April 2025.

Results

Across studies including patients with T2D, the relative increase in NAION risk associated with the use of a GLP-1 RA, mainly semaglutide, ranged from nonsignificant to fourfold, while the absolute number of affected patients remained low. Given the retrospective design of the main studies, no causal link could be established between the use of GLP-1RAs and NAION. Some mechanistic hypotheses have been put forward without any being formally demonstrated to date. The profound metabolic and haemodynamic changes induced by GLP-1RAs might be the trigger of NAION in predisposed patients with an optic “disc-at-risk”, a potent anatomical risk factor easily detected by ocular examination.

Conclusion

Pending studies clarifying this risk, these findings call for cautious use of GLP-1 RAs, particularly in patients with ocular risk factors. Given the widespread use of GLP-1RAs, clinicians should be aware of this potential risk, without overshadowing the remarkable benefit of GLP-1RAs in patients with type 2 diabetes.

目的：最近的研究结果引起了人们对使用西马鲁肽与非动脉性前缺血性视神经病变（NAION）之间的潜在关联的关注，NAION是一种罕见的永久性视力丧失。本报告对GLP-1受体激动剂（RA）在2型糖尿病（T2D）患者中的使用和NAION风险的当前知识进行了批判性分析。方法：采用文献检索策略，对截至2025年4月的所有英文文献进行系统综述。结果：在包括T2D患者的研究中，与使用GLP-1 RA（主要是西马鲁肽）相关的NAION风险的相对增加从不显著到四倍不等，而受影响患者的绝对数量仍然很低。考虑到主要研究的回顾性设计，GLP-1RAs的使用与NAION之间没有因果关系。有人提出了一些机械性的假设，但迄今为止还没有得到正式证明。GLP-1RAs诱导的深刻的代谢和血流动力学变化可能是易患视神经“危险盘”的患者发生NAION的触发因素，这是一个很容易通过眼部检查发现的强大的解剖学危险因素。结论：有待研究澄清这一风险，这些发现呼吁谨慎使用GLP-1 RAs，特别是在有眼部危险因素的患者中。鉴于GLP-1RAs的广泛使用，临床医生应该意识到这种潜在的风险，而不是掩盖GLP-1RAs在2型糖尿病患者中的显着益处。

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