Diabetes & metabolism最新文献_第9页

Practical implementation of automated insulin delivery systems in 2025: A French position statement update 2025年自动化胰岛素输送系统的实际实施：法国立场声明更新

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-05-01 Epub Date: 2025-03-10 DOI: 10.1016/j.diabet.2025.101637

E Bismuth , M Joubert , E Renard , N Tubiana-Rufi , L Chaillous , E Bonnemaison , H Hanaire , R Coutant , P Schaepelynck , J Beltrand , Y Reznik , F Authier , S Borot , S Brunot , C Calvez , G Charpentier , F Dalla-Vale , A Delawoevre , B Delemer , A Desserprix , PY Benhamou

The advent of automated insulin delivery (AID) systems in 2020 marked a disruptive event in managing type 1 diabetes, benefiting children and adults alike. By 2024, advances in real-world data and research motivated an update to the French consensus on AID systems to expand accessibility, refine guidelines, and optimize patient follow-up.

AID systems have consistently improved glycemic control by reducing HbA1c, increasing time-in-range (TIR), and minimizing hypoglycemia, with significant benefits even for specific populations such as individuals with poor glycemic control, brittle diabetes, children, very young children, pregnant women, those with insulin resistance or gastroparesis, or after bariatric surgery. Recent studies support the broadening of AID indications for these special situations, also demonstrating safe transitions directly from multiple daily injections. A careful selection of the most appropriate system for these special situations is essential to achieve optimal personalization for each patient.

Training healthcare professionals and patients remains essential for optimizing AID usage. Updated guidelines emphasize multidisciplinary education, telemonitoring, and individualized follow-up to ensure safety and efficacy.

The potential of fully automated systems and adjunctive therapies, such as GLP-1 receptor agonists, is being explored alongside promising evidence that AID systems improve glycemic control in type 2 diabetes without increasing hypoglycemia. The future of AID systems lies in innovation and expanding their applicability across diverse patient populations.

2020年，自动化胰岛素输送（AID）系统的出现标志着1型糖尿病管理领域的一个颠覆性事件，儿童和成人都将受益。到2024年，现实数据和研究的进步促使法国更新了关于艾滋病系统的共识，以扩大可及性，完善指南并优化患者随访。AID系统通过降低HbA1c，增加时间范围（TIR）和最小化低血糖来持续改善血糖控制，甚至对特定人群（如血糖控制不良的个体，脆性糖尿病，儿童，幼儿，孕妇，胰岛素抵抗或胃轻瘫患者，或减肥手术后）也有显着益处。最近的研究支持扩大针对这些特殊情况的艾滋病适应症，也表明从每天多次注射直接过渡到安全。为这些特殊情况仔细选择最合适的系统对于实现每个患者的最佳个性化至关重要。培训保健专业人员和患者对于优化艾滋病的使用仍然至关重要。更新的指南强调多学科教育、远程监测和个性化随访，以确保安全性和有效性。全自动系统和辅助疗法（如GLP-1受体激动剂）的潜力正在被探索，同时有希望的证据表明AID系统改善2型糖尿病的血糖控制而不增加低血糖。艾滋病系统的未来在于创新和扩大其在不同患者群体中的适用性。

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引用次数: 0

Real-world use and effectiveness of tirzepatide among people without evidence of type 2 diabetes in the United States 在美国，替西帕肽在无2型糖尿病证据人群中的实际使用和有效性

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-05-01 Epub Date: 2025-03-07 DOI: 10.1016/j.diabet.2025.101636

Emily R. Hankosky , Karishma Desai , Chanadda Chinthammit , Michael Grabner , Grace Stockbower , Xuanyao He , Donna Mojdami , Cachet Wenziger , Theresa Hunter Gibble

Aim

To understand treatment patterns and effectiveness of tirzepatide among people without type 2 diabetes (T2D) in the US.

Methods

This retrospective, observational, descriptive study used the Healthcare Integrated Research Database (index date: first-observed tirzepatide claim; index period: May 13, 2022–May 24, 2023). Key eligibility criteria were: age ≥ 18 years; ≥ 1 tirzepatide claim; no T2D diagnosis codes or glycated hemoglobin ≥ 6.5 %, no anti-diabetes medications (except metformin); and continuous medical/pharmacy enrollment for ≥ 12 months pre-index (Overall cohort). Tirzepatide persistence and utilization (6-months post-index) were assessed among obesity management medication (OMM)-eligible individuals (body mass index [BMI] ≥ 30 kg/m², or ≥ 27 kg/m² with ≥ 1 obesity-related complication [ORC]; OMM-eligible cohort). Tirzepatide effectiveness was assessed among individuals who were OMM-eligible, naive to glucagon-like peptide-1 receptor agonists, and persistent on tirzepatide for ≥6 months (Persistent+GLP-1 naive cohort).

Results

The overall cohort included 4,177 individuals with mean age 46.0 years, 75.6 % female, and mean BMI 37.1 kg/m². At baseline, 73.8 % of individuals had ≥ 1 ORC while 51.0 % had ≥ 2 ORCs. Persistence in the OMM-eligible cohort was 73.8 %; by the sixth prescription fill, 56.2 % were receiving < 10 mg tirzepatide. Individuals in the Persistent+GLP-1 naive cohort with pre- and post-index weight and BMI measurements (n = 200) achieved mean weight reduction of 12.9 % at 6-months post-index (≥ 5 %: 88.5 %; ≥ 10 %: 69.0 %).

Conclusion

Real-world evidence suggests multimorbidity among tirzepatide initiators, slower tirzepatide dose escalation than in clinical trials, and clinically meaningful weight reduction among people persisting on tirzepatide for ≥ 6 months.

目的：了解替西肽在美国非2型糖尿病（T2D）患者中的治疗模式和有效性。方法：这项回顾性、观察性、描述性研究使用了医疗保健综合研究数据库(索引日期：首次观察到替西肽索赔；指标期：2022年5月13日- 2023年5月24日)。主要入选标准为：年龄≥18岁；≥1个替西肽索赔；无T2D诊断代码或糖化血红蛋白≥6.5%，无抗糖尿病药物（二甲双胍除外）；以及指数前连续≥12个月的医疗/药房登记（总队列）。在肥胖管理药物（OMM）符合条件的个体（体重指数[BMI]≥30 kg/m2，或≥27 kg/m2并伴有≥1个肥胖相关并发症[ORC]）中评估替西肽的持久性和利用率（指数后6个月）；OMM-eligible队列)。替西帕肽的有效性在符合omm条件、未接受胰高血糖素样肽-1受体激动剂治疗、持续使用替西帕肽≥6个月的个体中进行评估（持续性+GLP-1初始队列）。结果：整个队列包括4177人，平均年龄46.0岁，75.6%为女性，平均BMI为37.1 kg/m2。基线时，73.8%的患者ORC≥1次，51.0%的患者ORC≥2次。在符合omm条件的队列中，持久性为73.8%；到第六次处方填充时，56.2%的患者接受了< 10 mg的替西帕肽。在持续性+GLP-1初始队列中，具有指数前和指数后体重和BMI测量的个体（n=200）在指数后6个月平均体重减轻12.9%(≥5%:88.5%；≥10%:69.0%)。结论：现实世界的证据表明，在替西帕肽启动者中存在多发病，与临床试验相比，替西帕肽的剂量递增速度较慢，并且在坚持使用替西帕肽≥6个月的人群中有临床意义的体重减轻。

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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

Diabetes & metabolism

Pub Date : 2025-05-01 Epub 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

Association of daily sleep duration with risk of metabolic dysfunction-associated steatotic liver disease and adverse liver outcomes 每日睡眠时间与代谢功能障碍相关脂肪变性肝病和不良肝脏结局风险的关系

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-05-01 Epub Date: 2025-02-19 DOI: 10.1016/j.diabet.2025.101628

Qian Wang , Huiyi Chen , Huiling Deng , Minyi Zhang , Haoyue Hu , Haotong Ouyang , Lien Ma , Ruiyan Liu , Jian Sun , Guifang Hu , Kaifeng Wang

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease worldwide, leading to substantial disease burden globally. Whether sleep duration is associated with the risk of MASLD, cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality remains underexplored.

Methods

A total of 489,261 middle-aged and older adults from the UK Biobank without prior liver diseases were included. The primary outcome was MASLD, with secondary outcomes, including cirrhosis, HCC, and liver-related mortality ascertained through linked hospital records and death registries. Sleep duration was self-reported at baseline survey and categorized into ≤ 5, 6, 7, 8 and ≥ 9 hours.

Results

During a median (IQR) follow-up of 13.8 (1.5) years, 7,133 MASLD, 5,527 cirrhosis, 1,126 HCC, and 1,125 liver-related mortality cases were identified. After adjusting for potential confounders, the HRs [95% CIs] of MASLD were 1.44 [1.32;1.57], 1.17 [1.09;1.24], 1.00 (reference), 1.05 [0.99;1.11] and 1.35 [1.24;1.46] for ≤ 5, 6, 7, 8 and ≥ 9 hours of sleep duration, respectively. Similar trends were also observed for cirrhosis, HCC, and liver-related mortality. In addition, the U-shaped association between sleep duration and MASLD was more pronounced among participants without abnormal body mass index (overweight and obese), hypertension or insomnia (P for interaction <0.05).

Conclusions

Both short and long sleep duration are associated with an increased risk of MASLD, cirrhosis, HCC, and liver-related mortality. Maintaining a moderate sleep duration of 7 to 8 hours per day could be crucial to prevent against this escalating public health concern.

背景：代谢功能障碍相关脂肪变性肝病（MASLD）是世界范围内最常见的肝脏疾病，在全球范围内造成了巨大的疾病负担。睡眠时间是否与MASLD、肝硬化、肝细胞癌（HCC）和肝脏相关死亡率的风险相关仍未得到充分研究。方法：从英国生物样本库中共纳入489261名既往无肝脏疾病的中老年人。主要结局是MASLD，次要结局包括肝硬化、HCC和通过相关医院记录和死亡登记确定的肝脏相关死亡率。在基线调查中自我报告睡眠时间，分为≤5、6、7、8和≥9小时。结果：在13.8（1.5）年的中位（IQR）随访期间，确定了7133例MASLD， 5527例肝硬化，1126例HCC和1125例肝脏相关死亡病例。在调整潜在混杂因素后，睡眠时间≤5、6、7、8和≥9小时的MASLD的hr [95% ci]分别为1.44[1.32;1.57]、1.17[1.09;1.24]、1.00（参考文献）、1.05[0.99；1.11]和1.35[1.24;1.46]。在肝硬化、HCC和肝脏相关死亡率方面也观察到类似的趋势。此外，在没有异常体重指数（超重和肥胖）、高血压或失眠的参与者中，睡眠时间与MASLD之间的u型关联更为明显（P为相互作用）。结论：短睡眠时间和长睡眠时间都与MASLD、肝硬化、HCC和肝脏相关死亡率的风险增加有关。每天保持7至8小时的适度睡眠时间对于预防这种不断升级的公共卫生问题至关重要。

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引用次数: 0

Screening for autoimmune atrophic gastritis by serum gastrin measurement in subjects with type 1 diabetes 1型糖尿病患者血清胃泌素测定对自身免疫性萎缩性胃炎的筛查

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-05-01 Epub Date: 2025-03-18 DOI: 10.1016/j.diabet.2025.101640

Aude Pacheco , Marc Diedisheim , Claire Goulvestre , Laure Alexandre-Heymann , Roberto Mallone , Danièle Dubois-Laforgue , Etienne Larger

Introduction

Despite associated risk of anemia and gastric cancer, screening for autoimmune atrophic gastritis (AAG) is underperformed in subjects with type 1 diabetes mellitus (T1DM). We measured the predictive value of serum gastrin as a biomarker of gastric atrophy in subjects with T1DM and parietal cell autoantibodies (PCA).

Subjects and Methods

PCA measurements were retrospectively retrieved in 1,425 consecutive subjects with T1DM between 2014 and 2018. Screening for AAG was conducted in PCA+ subjects by measuring blood counts, serum ferritin, vitamin B12 and gastrin; and by performing gastroduodenal fibroscopy, with fundic biopsies for histology and Helicobacter pylori. The performance of blood biomarkers of gastric atrophy was analyzed in comparison with the histopathological gold standard.

Results

PCA were found in 185/1,425 subjects (13 %). PCA positivity was associated with female sex, older age, longer T1DM duration, and co-occurrence of anti-GAD and anti-thyroperoxydase autoantibodies. Of the 185 PCA+ subjects, 122 (66 %) participated in screening. AAG was found in 69/122 (57 %) subjects and Helicobacter pylori infection in 20/122 (16 %). Compared to PCA+ subjects without gastric atrophy, those with gastric atrophy had more frequently iron deficiency (65 % vs. 18 %, P < 0.0001), and/or vitamin B12 deficiency (57 % vs. 7 %, P < 0.0001); 44/69 (64 %) presented a pre-tumoral lesion and 6 % a tumor. Using a cut-off of 1.2-fold above the upper normal limit, serum gastrin concentration displayed 91 % sensitivity and 82 % specificity at predicting gastric atrophy.

Conclusion

In subjects with T1DM and PCA, serum gastrin is a reliable biomarker of gastric atrophy that can be used to select subjects requiring gastroduodenal fibroscopy.

导论：尽管存在贫血和胃癌的相关风险，但自身免疫性萎缩性胃炎（AAG）在1型糖尿病（T1DM）患者中的筛查效果不佳。我们测量了血清胃泌素作为T1DM和壁细胞自身抗体（PCA）受试者胃萎缩的生物标志物的预测价值。对象和方法：回顾性检索2014年至2018年期间连续1425例T1DM患者的PCA测量值。通过测定血球计数、血清铁蛋白、维生素B12和胃泌素，对PCA+患者进行AAG筛查；并进行胃十二指肠纤维镜检查，并进行组织学和幽门螺杆菌的基础活检。与组织病理学金标准比较，分析胃萎缩血液生物标志物的表现。结果：1425例患者中有185例发现PCA（13%）。PCA阳性与女性、年龄较大、T1DM病程较长、抗广泛性焦虑症和抗甲状腺过氧酶自身抗体同时出现有关。185例PCA+患者中，122例（66%）参加了筛查。其中69/122例（57%）存在AAG， 20/122例（16%）存在幽门螺杆菌感染。与没有胃萎缩的PCA+受试者相比，胃萎缩患者更经常缺铁（65%对18%，P < 0.0001）和/或维生素B12缺乏症（57%对7%，P < 0.0001）；44/69（64%）为瘤前病变，6%为肿瘤。使用高于正常上限1.2倍的截止值，血清胃泌素浓度在预测胃萎缩方面显示出91%的敏感性和82%的特异性。结论：在T1DM和PCA患者中，血清胃泌素是一种可靠的胃萎缩生物标志物，可用于选择需要胃十二指肠镜检查的受试者。

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引用次数: 0

Persistent gaps in the implementation of lipid-lowering therapy in patients with established atherosclerotic cardiovascular disease: A French nationwide study 一项法国全国范围的研究表明，在已确诊的动脉粥样硬化性心血管疾病患者中，降脂治疗的实施存在持续差距。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-05-01 Epub Date: 2025-03-16 DOI: 10.1016/j.diabet.2025.101638

Matthieu Wargny , Thomas Goronflot , Pierre-Guillaume Piriou , Mathilde Pouriel , Alexandre Bastien , Julie Prax , Christophe Leux , Valéry-Pierre Riche , Jean-Noël Trochu , Sophie Béliard , Nadège Costa , Jean Ferrières , Stéphanie Duret , Bertrand Cariou

Background

According to international guidelines, lowering LDL-cholesterol is the cornerstone of atherosclerotic cardiovascular disease (ASCVD) prevention. However, observational studies have identified current gaps in the implementation of lipid-lowering therapy (LLT). This whole-population study aimed to evaluate the prevalence and determinants of LLT use in ASCVD patients.

Methods

Using the national health data system, all French adults with established ASCVD between 2012 and 2021 were identified using specific ICD-10 and/or procedure codes. LLT use was defined as ≥1 dispensing in the last quarter of 2021. Logistic regression was used to identify factors associated with the absence of LLT use.

Findings

In 2021, 2,206,305 individuals (4.89 % among 45,082,270 adults) had established ASCVD (mean age: 72.2 years; 36.9 % women), including 56.1 % with coronary artery disease, 40.4 % with cerebrovascular disease, and 14.5 % with revascularized peripheral artery disease (PAD). Among the 2,056,354 patients alive on 31st December 2021, 32.5 % did not receive any LLT, while 64.8 % received a statin (27.0 % a high-intensity statin), 13.0 % a combination of statin and ezetimibe, and 0.25 % a PCSK9 inhibitor. The absence of LLT use was significantly associated with female sex (adjusted odds ratio [aOR]:1.42, 95 %CI, 1.41–1.43); lowest/highest ages: < 50 years (aOR (/65–74 years): 2.23, 95 %CI 2.20–2.27) and ≥ 85 years (aOR: 2.10, 95 %CI 2.08–2.13); and stroke and PAD, compared to myocardial infarction (aOR: 2.21, 95 %CI 2.19–2.23 and 1.88, 95 %CI 1.86–1.91, respectively).

Interpretation

In real life, one-third of French ASCVD patients was not regularly treated with LLT, highlighting the urgent need to develop implementation strategies for lipid management.

背景：根据国际指南，降低低密度脂蛋白胆固醇是预防动脉粥样硬化性心血管疾病（ASCVD）的基石。然而，观察性研究已经确定了目前在实施降脂疗法（LLT）方面的差距。这项全人群研究旨在评估ASCVD患者使用LLT的患病率和决定因素。方法：-使用国家健康数据系统，使用特定的ICD-10和/或程序代码确定2012年至2021年间所有已确定ASCVD的法国成年人。在2021年最后一个季度，LLT使用被定义为≥1个分配。使用逻辑回归来确定与缺乏LLT使用相关的因素。研究结果：2021年，2,206,305人（45,082,270名成年人中的4.89%）确诊ASCVD(平均年龄：72.2岁；36.9%女性)，其中56.1%患有冠状动脉疾病，40.4%患有脑血管疾病，14.5%患有外周动脉血管重建疾病（PAD）。在2021年12月31日存活的2,056,354名患者中，32.5%未接受任何LLT治疗，而64.8%接受了他汀类药物（27.0%为高强度他汀类药物），13.0%为他汀类药物和依zetimibe联合治疗，0.25%为PCSK9抑制剂。未使用LLT与女性显著相关（校正优势比[aOR]:1.42, 95%CI: 1.41-1.43）；最低/最高年龄：< 50岁（aOR（/65 ~ 74岁）：2.23,95%CI 2.20 ~ 2.27）和≥85岁（aOR: 2.10, 95%CI 2.08 ~ 2.13）；与心肌梗死相比，卒中和PAD （aOR分别为2.21,95%CI 2.19-2.23和1.88,95%CI 1.86-1.91）。解释：-在现实生活中，三分之一的法国ASCVD患者没有定期接受LLT治疗，这突出了制定脂质管理实施策略的迫切需要。

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引用次数: 0

Acute kidney injury is associated with liver-related events in patients with metabolic dysfunction-associated fatty liver disease 代谢功能障碍相关脂肪肝患者的急性肾损伤与肝脏相关事件相关

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-05-01 Epub Date: 2025-03-16 DOI: 10.1016/j.diabet.2025.101639

Caoxiang She , Zhixin Guo , Yaduan Lin , Shiyu Zhou , Mingzhen Pang , Jiao Liu , Lisha Cao , Licong Su , Yinfang Sun , Chuyao Fang , Xian Shao , Sheng Nie

Background

Evidence regarding the role of acute kidney injury (AKI) in long-term development of metabolic dysfunction-associated fatty liver disease (MAFLD) is limited. We aimed to investigate the associations between AKI and liver-related events in patients with MAFLD.

Methods

This study involved 50,499 Chinese adults with MAFLD from the China Renal Data System (CRDS) database. We identified AKI using patient-level serum creatinine data according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The primary outcome was a composite of liver-related mortality and major adverse liver outcomes. The secondary outcome was an escalation of fibrosis-4 (FIB-4) risk scores. Cox proportional hazard models were performed to assess the association between AKI and the study outcomes.

Results

The median age of the patients was 59.17 years, with 54.7% being male. There were 3,711 (7.3%) patients who experienced AKI during hospitalization. A total of 1,660 (3.3%) patients experienced composite liver outcome. Patients with AKI during hospitalization had higher risk of composite liver outcomes (adjusted hazard ratio (aHR) 1.83 [95% confidence interval 1.38;2.41] P < 0.001), especially among those with severe AKI (stage 2/3) (aHR 2.36 [1.57;3.54] P < 0.001). Regarding the secondary outcome, AKI was also associated with an increased risk of escalation of FIB-4 risk scores (aHR 1.28 [1.14;1.44] P < 0.001). These associations remained consistent across various subgroups and sensitivity analyses.

Conclusions

AKI was significantly associated with an increased risk of liver-related events among patients with MAFLD. These findings suggest that enhanced vigilance toward AKI may be justifiable in MAFLD patients.

背景：关于急性肾损伤（AKI）在代谢功能障碍相关脂肪肝（MAFLD）长期发展中的作用的证据有限。我们的目的是调查AKI与MAFLD患者肝脏相关事件之间的关系。方法：本研究纳入来自中国肾脏数据系统（CRDS）数据库的50499名中国成年MAFLD患者。我们根据肾病改善全球结局（KDIGO）标准，使用患者水平的血清肌酐数据确定AKI。主要结局是肝脏相关死亡率和主要不良肝脏结局的综合。次要结局是纤维化-4 （FIB-4）风险评分升高。采用Cox比例风险模型评估AKI与研究结果之间的关系。结果：患者中位年龄为59.17岁，男性占54.7%。3711例（7.3%）患者在住院期间发生AKI。共有1660例（3.3%）患者出现了复合肝脏结局。住院期间发生AKI的患者发生复合肝脏结局的风险较高（校正危险比（aHR） 1.83[95%可信区间1.38;2.41]P < 0.001），尤其是重度AKI（2/3期）患者（aHR 2.36 [1.57;3.54] P < 0.001）。至于次要结局，AKI也与FIB-4风险评分升高的风险增加相关（aHR 1.28 [1.14;1.44] P < 0.001）。这些关联在不同的亚组和敏感性分析中保持一致。结论：AKI与MAFLD患者肝脏相关事件风险增加显著相关。这些发现表明，在MAFLD患者中提高对AKI的警惕性可能是合理的。

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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 : 2025-03-01 Epub 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。

{"title":"Use of glucagon-like peptide-1 receptor agonists in people with history of acute pancreatitis: TriNetX analysis","authors":"Mahmoud Nassar , Hazem Abosheaishaa , Anoop Misra , Paresh Dandona , Husam Ghanim , Ajay Chaudhuri (Prof.)","doi":"10.1016/j.diabet.2025.101613","DOIUrl":"10.1016/j.diabet.2025.101613","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101613"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019242","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

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 : 2025-03-01 Epub 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

Epidemiology of major amputation following diabetic foot ulcer: Insights from recent nationwide data in the french national health registry (SNDS) 糖尿病足溃疡后大截肢的流行病学：来自法国国家健康登记处（SNDS）最新全国数据的见解

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2025-03-01 Epub Date: 2025-01-13 DOI: 10.1016/j.diabet.2025.101606

Jean-Baptiste Bonnet , Claire Duflos , Helena Huguet , Antoine Avignon , Ariane Sultan

Objective

The out-of-hospital care pathways of people with DFU have been little studied. We used the French National Health Data System (SNDS) to collect refund and care pathway data for all French residents. The aim of this study was to determine the incidence of major lower limb amputation (MA) and associated risk factors in a population with an incident DFU.

Research Design and Methods

We included any person living with diabetes and incident DFU. The primary endpoint was the occurrence of MA within one year. We considered the course and consumption of care one year before and one year after the initial event.

Results

In 2018, 133,791 people were included, and during the follow-up, MA was performed in 4,733 (3.5 %). Among these people with MAs, 16.4 % were included via the out-of-hospital part of the protocol, and their first contact with the hospital led to MA. Factors associated (hazard ratio, HR [95 % confidence interval, CI]) with MA were: being male (1.92 [1.78;2.08]), arteriopathy of the lower limb (10.16 [9.36;11.03]), psychiatric disease (1.10 [1.01;1.20]) and end-stage renal disease (2.12 [1.93;2.33]).

Regarding the care pathway, associations (HR [95 %CI]) were observed between lower MA rates and people with more general practitioner (0.83 [0.75–0.91]), private nurse (0.88 [0.81–0.95]) and diabetologist (0.88 [0.81–0.95]) visits.

Living in the most disadvantaged municipalities was associated (HR [95 %CI]) with a higher MA rate (1.17[1.06–1.29]).

Conclusion

This is the first national study of the care pathways followed by people with DFU. Failures in the care pathway, precariousness and several comorbidities were identified, with an impact on the MA risk.

目的：对DFU患者院外护理途径的研究较少。我们使用法国国家健康数据系统（SNDS）收集所有法国居民的退款和护理路径数据。本研究的目的是确定在发生DFU的人群中主要下肢截肢（MA）的发生率和相关危险因素。研究设计和方法：我们纳入了所有患有糖尿病和DFU的人。主要终点是一年内MA的发生情况。我们考虑了发病前一年和发病后一年的治疗过程和消耗。结果：2018年纳入133791人，在随访期间，4733人（3.5%）进行了MA。在这些MA患者中，16.4%通过方案的院外部分纳入，他们与医院的首次接触导致了MA。与MA相关的因素（风险比，HR[95%可信区间，CI]）为：男性（1.92[1.78;2.08]）、下肢动脉病变（10.16[9.36;11.03]）、精神疾病（1.10[1.01;1.20]）和终末期肾脏疾病（2.12[1.93;2.33]）。在护理途径方面，低MA率与全科医生（0.83[0.75-0.91]）、私人护士（0.88[0.81-0.95]）和糖尿病专家（0.88[0.81-0.95]）就诊次数较多的人存在相关性（HR [95%CI]）。生活在最贫困的城市（HR [95%CI]）与较高的MA率相关（1.17[1.06-1.29]）。结论：这是第一个针对DFU患者护理路径的全国性研究。护理途径的失败、不稳定性和一些合并症被确定，对MA风险有影响。

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引用次数: 0