Diabetes & metabolism最新文献_第9页

Comparative effectiveness of SGLT2 inhibitors and GLP-1 receptor agonists in preventing Alzheimer's disease, vascular dementia, and other dementia types among patients with type 2 diabetes SGLT2 抑制剂和 GLP-1 受体激动剂在预防 2 型糖尿病患者阿尔茨海默病、血管性痴呆和其他痴呆类型方面的疗效比较。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-02-12 DOI: 10.1016/j.diabet.2025.101623

Mingyang Sun , Xiaoling Wang , Zhongyuan Lu , Yitian Yang , Shuang Lv , Mengrong Miao , Wan-Ming Chen , Szu-Yuan Wu , Jiaqiang Zhang

Background

Type 2 diabetes mellitus (T2DM) is associated with an elevated risk of dementia, including Alzheimer's disease (AD) and vascular dementia (VaD). While sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists have shown neuroprotective potential, comparative data on their efficacy in dementia prevention remain scarce.

Methods

- We conducted a retrospective cohort study using the TriNetX database, including 307,103 SGLT2 inhibitor users and 348,686 GLP-1 receptor agonist users with T2DM. Propensity score matching yielded 221,883 pairs with balanced baseline characteristics. The primary outcome was overall dementia incidence, with secondary outcomes including AD, VaD, and all-cause mortality. Hazard ratios (HRs) were calculated using Cox proportional hazards models.

Results

SGLT2 inhibitors were associated with a significantly lower incidence of overall dementia compared to GLP-1 receptor agonists (2.7 % vs. 3.6 %; HR, 0.92; 95 % CI, 0.89–0.95). The risk of VaD (HR, 0.89; 95 % CI, 0.84–0.95) and AD (HR, 0.90; 95 % CI, 0.86–0.94) was also reduced with SGLT2 inhibitors. All-cause mortality was lower in the SGLT2 group (3.6 % vs. 4.6 %; HR, 0.95; 95 % CI, 0.92–0.98). No significant difference was observed in other dementia subtypes (HR, 0.96; 95 % CI, 0.91–1.01).

Conclusions

In this large, real-world cohort, SGLT2 inhibitors demonstrated superior efficacy over GLP-1 receptor agonists in reducing the risks of overall dementia, VaD, and AD among patients with T2DM. These findings support the preferential use of SGLT2 inhibitors in mitigating dementia risk in this population, though randomized controlled trials are warranted for confirmation.

背景：2型糖尿病（T2DM）与痴呆风险升高相关，包括阿尔茨海默病（AD）和血管性痴呆（VaD）。虽然钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂和胰高血糖素样肽-1 （GLP-1）受体激动剂已经显示出神经保护潜力，但它们在预防痴呆方面的疗效的比较数据仍然很少。方法:。我们使用TriNetX数据库进行了一项回顾性队列研究，包括307,103名SGLT2抑制剂使用者和348,686名GLP-1受体激动剂使用者。倾向评分匹配产生221,883对具有平衡基线特征的配对。主要结局是总体痴呆发病率，次要结局包括AD、VaD和全因死亡率。采用Cox比例风险模型计算风险比（hr）。结果:。-与GLP-1受体激动剂相比，SGLT2抑制剂与总体痴呆发病率显著降低相关(2.7% vs 3.6%；人力资源,0.92;95% ci, 0.89-0.95)。VaD风险(HR, 0.89；95% CI, 0.84-0.95)和AD (HR, 0.90；95% CI, 0.86-0.94)也降低了SGLT2抑制剂。SGLT2组的全因死亡率较低(3.6% vs. 4.6%；人力资源,0.95;95% ci, 0.92-0.98)。其他痴呆亚型无显著差异(HR, 0.96；95% ci, 0.91-1.01)。结论:。在这个庞大的现实世界队列中，SGLT2抑制剂在降低T2DM患者总体痴呆、VaD和AD风险方面表现出优于GLP-1受体激动剂的疗效。这些发现支持优先使用SGLT2抑制剂来减轻该人群的痴呆风险，尽管需要随机对照试验来证实。

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引用次数: 0

Continuous glucose monitoring‑derived time in range and CV are associated with elevated risk of adverse kidney outcomes for patients with type 2 diabetes 2型糖尿病患者持续血糖监测时间范围和CV与肾脏不良结局风险升高相关。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-02-09 DOI: 10.1016/j.diabet.2025.101616

Qin Zhang , Shucai Xiao , Fang Zou , Xiaojuan Jiao , Yunfeng Shen

Current guidelines recommend assessing glycemic control using continuous glucose monitoring (CGM), which provides a comprehensive glycemic profile to supplement HbA1c measurement. However, the association between CGM-derived metrics and risk of adverse kidney outcomes is not entirely clear. This retrospective cohort study included 1274 patients with type 2 diabetes hospitalized from July 2020 to December 2022, with a median follow-up time of 923 days. Monitor using CGM at baseline and evaluate renal function indicators of participants at baseline and end of follow-up. Multiple CGM-derived metrics, particularly time in range (TIR) and glucose coefficient of variation (CV), were calculated from 3-day glucose profiles obtained from CGM. Relevant clinical data was collected from clinical records and/or patient interviews. The primary outcome was chronic-kidney-disease (CKD) progression. Secondary outcomes included worsening of albuminuria and, all-cause mortality and major-adverse-cardiac-events(MACE). Multivariate regression models were employed to analyze the association between CGM-derived indices, particularly TIR and CV, and the risk of adverse kidney outcomes. We demonstrated that the lower TIR categories had a remarkably increased risk of CKD progression, with a HR per 10 % increment of 0.90 (95 %CI:0.83–0.91). Conversely, higher CV was positively related to the subsequent risk of CKD progression, with an HR per 10 % increment of 1.30 (95 %CI:1.07–1.59). These results were consistent across various subgroups and sensitivity analyses. This study found that TIR and CV are significantly associated with CKD progression, proteinuria deterioration, all-cause mortality, and the risk of MACE. These findings have elasticity in adjusting for multiple covariates and have been confirmed in different subgroups and sensitivity analyses.

目前的指南建议使用连续血糖监测（CGM）来评估血糖控制，它提供了一个全面的血糖概况来补充HbA1c测量。然而，cgm衍生指标与不良肾脏结局风险之间的关系尚不完全清楚。本回顾性队列研究纳入了2020年7月至2022年12月住院的1274例2型糖尿病患者，中位随访时间为923天。在基线时使用CGM进行监测，并在基线和随访结束时评估参与者的肾功能指标。多个CGM衍生的指标，特别是范围内时间（TIR）和葡萄糖变异系数（CV），从CGM获得的3天葡萄糖谱计算。从临床记录和/或患者访谈中收集相关临床数据。主要终点是慢性肾脏疾病（CKD）进展。次要结局包括蛋白尿恶化、全因死亡率和主要心脏不良事件（MACE）。采用多变量回归模型分析cgm衍生指数（尤其是TIR和CV）与肾脏不良结局风险之间的关系。我们证明，TIR较低的类别CKD进展的风险显著增加，HR每增加10%为0.90 （95%CI:0.83-0.91）。相反，较高的CV与随后CKD进展的风险呈正相关，每增加10%的HR为1.30 （95%CI:1.07-1.59）。这些结果在不同的亚组和敏感性分析中是一致的。该研究发现，TIR和CV与CKD进展、蛋白尿恶化、全因死亡率和MACE风险显著相关。这些发现在调整多个协变量时具有弹性，并已在不同的亚组和敏感性分析中得到证实。

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引用次数: 0

Efficacy and safety of pharmacological treatments for gestational diabetes: a systematic review comparing metformin with glibenclamide and insulin 妊娠期糖尿病药物治疗的有效性和安全性：二甲双胍与格列本脲和胰岛素比较的系统综述。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-02-07 DOI: 10.1016/j.diabet.2025.101622

Louise Bodier , Maela Le Lous , Hélène Isly , Christèle Derrien , Patricia Vaduva

Aim

Gestational diabetes, characterized by impaired glucose tolerance occurring or diagnosed during pregnancy, is a significant public health concern. When lifestyle and dietary measures fail (30 % of women), insulin is the standard treatment. Oral antidiabetic agents, such as metformin (Glucophage) and glibenclamide, could provide a promising alternative. The aim here was to evaluate the effectiveness and safety of these treatments in gestational diabetes.

Methods

This study is based on a systematic literature review. A keyword search for "metformin (Glucophage)," "glibenclamide," "pregnancy," and "gestational diabetes" was conducted in the PubMed and Google Scholar databases from 2013 to 2023.

Results

A total of 45 studies were selected and analyzed. metformin (Glucophage) appears to offer a combination of effectiveness in glycemic control and maternal and neonatal safety. Compared to insulin, it reduces maternal weight gain, lowers maternal hypoglycemia rates, and shows a tendency to reduce gestational hypertension and preeclampsia. Additionally, infants born to mothers on metformin (Glucophage) are less likely to be macrosomic, experience fewer neonatal hypoglycemic episodes, and require fewer admissions to intensive care units. On the other hand, glibenclamide seems effective in glycemic control but is associated with higher rates of macrosomia and neonatal hypoglycemia.

Conclusion

Metformin (Glucophage) appears to be a promising alternative to insulin for treating gestational diabetes, while uncertainties remain regarding the safety of glibenclamide.

目的：妊娠期糖尿病是一个重大的公共卫生问题，其特征是在妊娠期间发生或诊断出糖耐量受损。当生活方式和饮食措施失败时（30%的女性），胰岛素是标准治疗。口服降糖药，如二甲双胍和格列本脲，可能是一个有希望的选择。目的是评估这些治疗方法在妊娠期糖尿病中的有效性和安全性。方法：本研究基于系统的文献回顾。从2013年到2023年，在PubMed和谷歌Scholar数据库中对“二甲双胍”、“格列本脲”、“妊娠”和“妊娠糖尿病”进行了关键词搜索。结果：共选取45项研究进行分析。二甲双胍似乎在血糖控制和母婴安全方面提供了有效的组合。与胰岛素相比，它可以减少产妇体重增加，降低产妇低血糖率，并有减少妊娠高血压和先兆子痫的倾向。此外，服用二甲双胍的母亲所生的婴儿不太可能是巨大的，经历较少的新生儿低血糖发作，并且需要较少的重症监护病房。另一方面，格列本脲在血糖控制方面似乎有效，但与巨大儿和新生儿低血糖的发生率较高有关。结论：二甲双胍似乎是治疗妊娠期糖尿病的有希望的胰岛素替代品，而关于格列本脲的安全性仍然存在不确定性。

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引用次数: 0

Glycemia Risk Index (GRI) and international glucose targets before and 6 months after initiation of hybrid closed loop system in the CIRDIA, a French multisite out-of-hospital center 在CIRDIA（法国一家多站点院外中心）混合闭环系统启动前和启动后6个月血糖风险指数（GRI）和国际血糖指标

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-02-06 DOI: 10.1016/j.diabet.2025.101617

Sylvie Picard , Blandine Courbebaisse , Joëlle Dupont , Fabienne Amiot-Chapoutot , Emmanuelle Lecornet-Sokol , Estelle Personeni , François Mougel , Clara Bouché , Françoise Giroud , Sandrine Lablanche , Sophie Borot

Aims

To analyze in a population of persons with type 1 diabetes (PwT1D) ambulatory glucose profile (AGP) parameters – including glycemia risk index (GRI) – for six months after hybrid closed loop (HCL) initiation in a multisite out-of-hospital French center (CIRDIA). We calculated the percentage of people reaching glucose targets and determined a GRI threshold that could identify patients reaching targets.

Methods

This was a retrospective study conducted in the CIRDIA, a multisite (n=7) out-of-hospital HCL initiation center. AGP metrics for the 14 previous days were manually extracted from HCL platforms at initiation (M0), 3 ± 1 months (M3) and 6 ± 1 months (M6). PwT1D were considered as reaching efficacy and safety targets (EST) if time-in-range was > 70 %, GMI was < 7 %, time-below-range (TBR)^<70 was < 4 % and TBR^<54 was < 1 %. GRI was calculated and ROC analyses were performed to set a GRI threshold that could identify patients reaching EST.

Results

Six-month data were available for 136 persons. The percentage of PwT1D reaching glucose targets at respectively M0, M3 and M6 were for EST: 6.6 %, 40.4 % and 39.7 %. GRI decreased from 56.0 ± 20.9 to 30.1 ± 14.1 and 30.6 ± 13.8. ROC analyses showed that the best GRI value to detect patients who reached EST was GRI <26. A threshold set at this level had very good specificity (92 %) and negative predictive value (93 %) to identify those who do need further intensive support with HCL.

Conclusion

Setting a GRI threshold at 26 could be helpful to detect with a single number, potentially automatically calculated by CGM platforms, PwT1D who require further support.

目的分析1型糖尿病（PwT1D）患者群体在混合闭环（HCL）开始后6个月的动态血糖谱（AGP）参数-包括血糖风险指数（GRI）。我们计算了达到血糖目标的人的百分比，并确定了可以识别达到目标的患者的GRI阈值。方法这是一项在CIRDIA进行的回顾性研究，CIRDIA是一个多站点（n=7）的院外HCL起始中心。在开始（M0）、3±1个月（M3）和6±1个月（M6）时，人工提取HCL平台前14天的AGP指标。如果时间范围为>，则认为PwT1D达到了疗效和安全性目标（EST）；70%， GMI为<；7%，时间低于范围（TBR）<70 %；4%, TBR<；54为<；1%。计算GRI并进行ROC分析，设定GRI阈值，以识别达到est的患者。结果136例患者获得6个月的数据。EST在M0、M3和M6时，PwT1D达到葡萄糖目标的比例分别为6.6%、40.4%和39.7%。GRI由56.0±20.9降至30.1±14.1和30.6±13.8。ROC分析显示，GRI值为GRI <；26是检测EST患者的最佳GRI值。该水平的阈值具有非常好的特异性（92%）和阴性预测值（93%），以确定那些确实需要进一步强化HCL支持的患者。结论将GRI阈值设为26，可以通过单个数字进行检测，CGM平台可能会自动计算出需要进一步支持的PwT1D。

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引用次数: 0

Lp(a) concentration and polymorphic size are not associated with new onset diabetes in individuals with prediabetes 在糖尿病前期个体中，Lp(a)浓度和多态性大小与新发糖尿病无关。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-02-03 DOI: 10.1016/j.diabet.2025.101621

Maxime Carpentier , Matthieu Wargny , Mikaël Croyal , Cédric Le May , Sarra Smati , Edith Bigot-Corbel , Samy Hadjadj , Bertrand Cariou

Aim

Observational studies in the general population suggest that low concentrations of lipoprotein (a) [Lp(a)] are associated with an increased risk of type 2 diabetes. Here, we aim to determine whether Lp(a) plasma concentration and Kringle-IV (K-IV) repeat polymorphism were associated with new-onset diabetes (NOD) in individuals with prediabetes.

Methods

IT-DIAB is an observational, prospective study including 303 participants with impaired fasting glucose (fasting plasma glucose [FPG]: 110–125 mg/dl) followed annually for 5 years. The primary endpoint was the development of NOD, defined as a first FPG value ≥ 126 mg/dl during follow-up. Lp(a) concentrations were measured by immunoturbidimetry, apo(a) concentrations and the number of K-IV domains by mass spectrometry. Survival analyses for NOD were modeled using Kaplan-Meier curves and a multivariable Cox model, after binarization on threshold values of Lp(a) or K-IV.

Results

Among the participants, 113 (37%) developed NOD during follow-up. The concentrations of Lp(a) and the number of K-IV domains were not significantly different according to NOD status. Similarly, the percentage of patients with a non-detectable (≤ 7 nmol/l) or elevated (>125 nmol/l) Lp(a) concentration was similar between those with or without NOD: 68.1 vs 63.7% (P = 0.46) and 8.8 vs 8.9% (P > 0.99), respectively. Kaplan-Meier curves and Cox models did not show any association between Lp(a) concentration (threshold 7 nmol/l and 125 nmol/l) or number of K-IV domain (threshold 23) and the risk of NOD.

Conclusion

In a high-risk population, Lp(a) concentration or polymorphic size do not appear to be substantially associated with type 2 diabetes risk.

目的：在普通人群中的观察性研究表明，低浓度脂蛋白(a) [Lp(a)]与2型糖尿病的风险增加有关。在这里，我们的目的是确定Lp(a)血浆浓度和Kringle-IV （K-IV）重复多态性是否与糖尿病前期个体的新发糖尿病（NOD）相关。方法：IT-DIAB是一项观察性前瞻性研究，包括303名空腹血糖受损（空腹血糖[FPG]: 110-125 mg/dl）的参与者，每年随访5年。主要终点是NOD的发展，定义为随访期间首次FPG值≥126 mg/dl。免疫比浊法测定Lp(a)浓度，质谱法测定载脂蛋白(a)浓度和K-IV结构域数量。在Lp(a)或K-IV阈值二值化后，使用Kaplan-Meier曲线和多变量Cox模型对NOD的生存分析进行建模。结果：在参与者中，113例（37%）在随访期间发生NOD。不同NOD状态下Lp(a)的浓度和K-IV结构域的数量无显著差异。同样，在有或没有NOD的患者中，Lp(a)浓度不可检测（≤7 nmol/l）或升高（>125 nmol/l）的患者比例相似：分别为68.1 vs 63.7% （P = 0.46）和8.8 vs 8.9% （P > 0.99）。Kaplan-Meier曲线和Cox模型未显示Lp(a)浓度（阈值为7 nmol/l和125 nmol/l）或K-IV结构域数量（阈值为23）与NOD风险之间存在任何关联。结论：在高危人群中，Lp(a)浓度或多态性大小似乎与2型糖尿病风险无关。

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引用次数: 0

Early use of hybrid closed-loop following total pancreaticoduodenectomy 混合闭环在全胰十二指肠切除术后的早期应用。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-02-02 DOI: 10.1016/j.diabet.2025.101619

Alice Larroumet , Arthur Marichez , Marion Camoin , Laurence Baillet-Blanco , Jean-Philippe Adam , Christophe Laurent , Vincent Rigalleau , Kamel Mohammedi , Laurence Chiche

Diabetes secondary to total pancreaticoduodenectomy (TP) is challenging to manage due to high glycemic variability and risk of hypoglycemia, in a frail population. We report the case of four patients with no prior diabetes who underwent TP. Three of four patients needed artificial nutritional support. Hybrid closed-loop (HCL) insulin therapy was initiated within 12 weeks of surgery. After 90 days of HCL treatment, continuous glucose measurement showed a 70.4 ± 11.8 % time in range (versus 43 ± 6.5 % before HCL); 0.2 ± 0.2 % time below range (versus 0.6 ± 0.5 % before HCL); 23.8 ± 9.1 % time above range 180–250 mg/dl (versus 22.9 ± 6.1 % before HCL); 4.2 ± 2.5 % time above range > 250 mg/dl (versus 33.8 ± 3.9 % before HCL). The glucose management indicator improved from 8.5 ± 0.6 % to 6.9 ± 0.6 %. There was no severe hypoglycemia or need for unplanned medical attention. Early post-operative use of HCL allowed our patients to achieve safely optimal glycemic control after TP.

糖尿病继发于全胰十二指肠切除术（TP）是具有挑战性的管理，由于高血糖变异性和低血糖的风险，在虚弱的人群。我们报告4例既往无糖尿病的患者接受TP治疗。4名患者中有3名需要人工营养支持。混合闭环（HCL）胰岛素治疗在手术12周内开始。HCL治疗90天后，连续血糖测量显示70.4±11.8%的时间在范围内（HCL治疗前为43±6.5%）；低于范围0.2±0.2%的时间（HCL前为0.6±0.5%）；180-250 mg/dl以上时间为23.8±9.1%（盐酸前为22.9±6.1%）；在> ~ 250mg /dl以上时间为4.2±2.5% （HCL前为33.8±3.9%）。血糖管理指标由8.5±0.6%提高到6.9±0.6%。没有严重的低血糖，也不需要计划外的医疗照顾。术后早期使用HCL使我们的患者在TP后获得安全的最佳血糖控制。

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引用次数: 0

Physical frailty, genetic predisposition, and type 2 diabetes mellitus 身体虚弱，遗传易感性和2型糖尿病

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-02-01 DOI: 10.1016/j.diabet.2025.101618

Zhenyi Xu , Ruilang Lin , Xueying Ji , Chen Huang , Ce Wang , Yongfu Yu , Zhijun Bao

Aim

To examine the association between frailty and incident type 2 diabetes mellitus (T2DM), considering the joint effect of multimorbidity and genetic risk.

Methods

The study included 429,022 individuals in the UK Biobank. We used Cox regression with hazard ratio (HR) and 95 % confidence interval (CI) to 1) evaluate the associations of frailty with incident T2DM, 2) explore whether frailty and multimorbidity would have a joint effect, and 3) assess whether the associations were modified by genetic risk.

Results

Compared with non-frail individuals, prefrail and frail individuals were at higher risk of T2DM: HR[95 %CI] = 1.42 [1.38;1.47] for prefrailty and 1.81[1.70;1.92] for frailty. Five frailty components were associated with increased risk of T2DM: HR[95 %CI] = 1.21[1.17;1.26] for weight loss, 1.35[1.30;1.40] for exhaustion, 1.31[1.26;1.37] for low physical activity, 1.27[1.20;1.33] for low grip strength, and 1.47[1.41;1.52] for slow gait speed. The increased risks were more pronounced among frail individuals with more than three morbidities: HR[95 %CI] = 4.10[3.76;4.46]. Frail individuals at high genetic risk had a four and a half-fold greater risk of T2DM compared with non-frail individuals at low genetic risk: HR[95 %CI] = 4.54[4.14;4.97].

Conclusion

Frailty was associated with increased risk of T2DM, especially in individuals with higher number of morbidities and high genetic risk. Frailty may be an independent risk factor for T2DM and targeted strategies to prevent and manage frailty would contribute to reducing the risk of T2DM.

目的探讨虚弱与2型糖尿病（T2DM）发病之间的关系，同时考虑多种疾病和遗传风险的共同作用。该研究包括英国生物银行的429,022名个体。我们使用带有风险比（HR）和95%置信区间（CI）的Cox回归来1)评估虚弱与T2DM事件的关联，2)探索虚弱和多病是否会有联合效应，以及3)评估这种关联是否被遗传风险所改变。结果与非体弱者相比，体弱者和体弱者发生T2DM的风险更高：体弱者的HR[95% CI] = 1.42[1.38;1.47]，体弱者的HR[95% CI] = 1.81[1.70;1.92]。五种虚弱因素与T2DM风险增加相关：体重减轻的HR[95% CI] = 1.21[1.17;1.26]，疲劳的HR[95% CI] = 1.35[1.30;1.40]，体力活动不足的HR[1.31][1.26;1.37]，握力不足的HR[1.27][1.20;1.33]，步态速度慢的HR[1.41;1.52]。在有三种以上疾病的体弱个体中，风险增加更为明显：HR[95% CI] = 4.10[3.76;4.46]。高遗传风险的体弱个体患T2DM的风险是低遗传风险的非体弱个体的4.5倍：HR[95% CI] = 4.54[4.14;4.97]。结论虚弱与T2DM风险增加有关，特别是在发病率高、遗传风险高的人群中。虚弱可能是2型糖尿病的独立危险因素，有针对性的预防和管理虚弱有助于降低2型糖尿病的风险。

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引用次数: 0

Dynamics of diabetes prevalence, incidence and mortality in France: A nationwide study, 2013–2021 2013-2021年法国糖尿病患病率、发病率和死亡率动态研究

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-01-31 DOI: 10.1016/j.diabet.2025.101615

Sandrine Fosse-Edorh , Marie Guion , Sarah Goria , Laurence Mandereau-Bruno , Emmanuel Cosson

Aim

To estimate the time trends of treated diabetes incidence, prevalence and mortality in France from 2013 to 2019 and to compare with the Covid-19 pandemic period (2020–2021).

Methods

Using the French National Health Data System, people with treated diabetes ≥ 45 years-old were identified based on their medications. Annual time trends over 2013–2019 were estimated using Poisson log-linear model controlled for age, year and region for prevalence (aPTT), incidence (aITT) and mortality (aMTT). Numbers of incident cases and deaths in 2020–2021 were estimated from these trends, and compared with those observed.

Results

Over 2013–2019, incidence and mortality declined significantly in men, aITT=-0.61 % (-0.95;-0.26); aMTT=-0.52 % (-0.81;-0.22), leading to a stable prevalence, aPTT=0.18 % (-0.03;0.40). In women, the fall in incidence was more marked, aITT=-1.45 % (-1.95;-0.95), mortality was stable, aMTT=-0.19 % (-0.54;0.15), leading to a significant decrease in prevalence, aPTT=-0.31 % (-0.60;-0.02). Compared with people not treated for diabetes, the relative risk of mortality increased significantly in men over the 2013–2019 period, from 1.38 (1.37;1.39) to 1.42 (1.41;1.43), while the risk remained stable in women, from 1.45 (1.44;1.46) to 1.46 (1.45;1.47).

In 2020, there were 7,458 and 4,404 additional deaths and 3,550 and 4,919 new cases in respectively men and women. In 2021, there were 11,576 and 6,371 additional deaths and 30,057 and 26,169 new cases in respectively men and women.

Conclusion

This study reports a favorable dynamic of diabetes over 2013–2019 followed by a sharp increase in incidence and mortality in 2020 and 2021. Continued monitoring is necessary to identify long-term trend and potential indirect effect of the pandemic.

目的：估计2013 - 2019年法国治疗糖尿病发病率、患病率和死亡率的时间趋势，并与2019冠状病毒病大流行期（2020-2021年）进行比较。方法：使用法国国家健康数据系统，根据用药情况确定≥45岁的糖尿病患者。使用泊松对数线性模型对2013-2019年的年度时间趋势进行了估计，该模型控制了年龄、年份和地区的患病率（aPTT）、发病率（aITT）和死亡率（aMTT）。根据这些趋势估计了2020-2021年的事件病例数和死亡人数，并与观察到的情况进行了比较。结果：2013-2019年，男性的发病率和死亡率显著下降，aITT=-0.61% (-0.95;-0.26)；aMTT=-0.52%(-0.81;-0.22)，患病率稳定，aPTT=0.18%（-0.03;0.40）。在女性中，发病率下降更为明显，aITT=-1.45%(-1.95;-0.95)，死亡率稳定，aMTT=-0.19%(-0.54;0.15)，导致患病率显著下降，aPTT=-0.31%（-0.60;-0.02）。与未接受糖尿病治疗的人相比，2013-2019年期间，男性的相对死亡风险显著增加，从1.38（1.37;1.39）增加到1.42(1.41;1.43)，而女性的风险保持稳定，从1.45（1.44;1.46）增加到1.46（1.45;1.47）。2020年，男性和女性分别新增死亡7 458人和4 404人，新增病例3 550人和4 919人。2021年，男性和女性的死亡人数分别增加了11 576人和6 371人，新增病例分别为300 057人和26 169人。结论：本研究报告了2013-2019年糖尿病的有利动态，随后在2020年和2021年发病率和死亡率急剧上升。有必要继续进行监测，以确定大流行的长期趋势和潜在的间接影响。

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引用次数: 0

Association between Type 2 Diabetes onset age and risk of cardiovascular disease and mortality: Two cohort studies from United Kingdom and Hong Kong 2型糖尿病发病年龄与心血管疾病风险和死亡率之间的关系：来自英国和香港的两项队列研究

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-01-18 DOI: 10.1016/j.diabet.2025.101607

Boyuan Wang , Ivy Lynn Mak , Kiki Sze Nga Liu , Edmond Pui Hang Choi , Cindy Lo Kuen Lam , Eric Yuk Fai Wan

Objective

This study aimed to evaluate the association between type 2 diabetes mellitus (T2DM) onset age and risk of cardiovascular disease (CVD) and mortality.

Method

Two retrospective cohort studies were conducted using the electronic health records from the United Kingdom (UK) and Hong Kong (HK) on adults without CVD. During 2008-2013, 128,918 and 185,646 patients with new-onset T2DM were assigned to the T2DM group, and 5,052,770 and 3,159,396 patients without T2DM were included as controls in the UK and HK cohort, respectively. Patients were stratified into six age groups. Multivariable Cox regression, adjusted for baseline characteristics and fine stratification weights, was used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) for each outcome.

Results

New-onset T2DM was associated with increased CVD and mortality risk, but the risks decreased with age. Compared to those without T2DM in the same age groups, the HR (95 % CI) for CVD in the UK cohort was 3.22 (2.80, 3.71), 1.21 (1.15, 1.26), and 0.99 (0.93, 1.05) for T2DM individuals at ages 18–39, 60–69, and ≥ 80, respectively. Similarly, the HR (95 % CI) for mortality among new-onset T2DM patients was 2.41 (2.06, 2.83) for age 18–39, 1.40 (1.34, 1.46) for age 60–69, and 1.12 (1.08, 1.16) for age ≥ 80. Results from the HK cohort showed a similar pattern.

Conclusion

Young onset of T2DM is associated with a significant impact on cardiovascular health later in life. This highlights the importance of the prevention of DM in young adults.

目的：本研究评估2型糖尿病（T2DM）发病年龄与心血管疾病（CVD）风险和死亡率之间的关系。方法：采用英国（UK）和香港（HK）（2008-2013）的电子健康记录对无心血管疾病的成年人进行了两项回顾性队列研究。T2DM组新诊断T2DM患者128,918例，185,646例，对照组无T2DM患者分别为英国和香港队列的5,052,770例和3,159,396例。根据基线年龄、精细分层权重和多变量Cox回归校正基线特征和权重，将各组分为6组。结果：在英国和香港队列中，中位随访时间分别为11.6年和9.5年，T2DM与CVD和死亡风险增加相关，但风险随着年龄的增长而降低。在英国队列中，18-39岁CVD合并T2DM发病的风险(风险比（HR）（95%可信区间（CI）： 3.22(2.80, 3.71)）高于60-69岁组（1.21(1.15,1.26)）和≥80岁组（0.99(0.93,1.05)）。同样，年龄在18-39岁的年轻T2DM患者的死亡风险（2.41(2.06,2.83)）高于年龄在60-69岁（1.40(1.34,1.46)）和年龄≥80岁（1.12(1.08,1.16)）的T2DM患者。香港队列的结果显示了类似的模式。结论：年轻发病的T2DM对以后的心血管健康有很大的影响。这突出了预防年轻成人糖尿病的重要性。(247字)。

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引用次数: 0

Use of glucagon-like peptide-1 receptor agonists in people with history of acute pancreatitis: TriNetX analysis 胰高血糖素样肽-1受体激动剂在急性胰腺炎病史患者中的应用：TriNetX分析

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-01-17 DOI: 10.1016/j.diabet.2025.101613

Mahmoud Nassar , Hazem Abosheaishaa , Anoop Misra , Paresh Dandona , Husam Ghanim , Ajay Chaudhuri (Prof.)

Introduction

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used in subjects with type 2 diabetes (T2D) and obesity. However, concerns over their association with acute pancreatitis (AP) have emerged. Our aim was to evaluate the risk of recurrence of AP in subjects on GLP-1RAs with a history of AP.

Methods

This retrospective study deployed the TriNetX platform. We identified adult cohorts of subjects with a history of AP and analyzed the impact of individual medications (GLP-1RAs, SGLT2i, or DPP4i) on the risk of recurrence of AP. To adjust for baseline differences, propensity score matching was done in cohorts with and without risk factors for AP.

Results

Our analysis of 672,069 patients with a history of AP and T2D revealed significant risk reductions associated with GLP-1RAs compared to other treatments. Over one to five years, GLP-1RAs consistently showed a lower risk of AP recurrence compared to SGLT2i and DPP-4i. Specifically, over a one-year period, GLP-1RAs users had a risk reduction of -0.071 (95 % CI:0.085 to -0.057) (p < 0.001) compared to SGLT2i, and -0.064 (95 % CI:0.080 to -0.048) (p< 0.001) compared to DPP-4i. These trends persisted, with the risk differences further widening by the fifth year to -0.086 and -0.094, respectively.

Conclusion

Based on our findings, we conclude that GLP-1RAs may be safely used in subjects with a history of acute pancreatitis. While our analysis showed that there was a significantly lower risk of AP recurrence in subjects on GLP-1compared to DPP-IV inhibitors and SGLT2 inhibitors, as this is a retrospective analysis we suggest that these findings need to be confirmed in prospective studies.

作品简介:。胰高血糖素样肽-1受体激动剂（GLP-1RAs）用于2型糖尿病（T2D）和肥胖患者。然而，对它们与急性胰腺炎（AP）的关联的担忧已经出现。我们的目的是评估有AP病史的GLP-1RAs患者AP复发的风险。本回顾性研究采用TriNetX平台。我们确定了有AP病史的成人队列，并分析了个体药物（GLP-1RAs、SGLT2i或DPP4i）对AP复发风险的影响。为了调整基线差异，在有和没有AP危险因素的队列中进行了倾向评分匹配。我们对672,069例AP和T2D病史患者的分析显示，与其他治疗方法相比，GLP-1RAs显著降低了风险。与SGLT2i和DPP-4i相比，在1至5年内，GLP-1RAs始终显示出较低的AP复发风险。具体来说，在一年的时间里，GLP-1RAs使用者与sgltti相比风险降低-0.071 (95% CI: -0.085至-0.057)，与DPP-4i相比风险降低-0.064 （95% CI: -0.080至-0.048）。这种趋势持续下去，风险差异在第五年进一步扩大，分别达到-0.086和-0.094。结论:。基于我们的研究结果，我们得出结论，GLP-1RAs可以安全地用于有急性胰腺炎病史的受试者。虽然我们的分析显示，与DPP-IV抑制剂和SGLT2抑制剂相比，glp -1患者的AP复发风险显著降低，但由于这是一项回顾性分析，我们建议这些发现需要在前瞻性研究中得到证实。

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引用次数: 0