Diabetes/Metabolism Research and Reviews最新文献_第9页

Seasonal Variations in HbA1c and Body Composition: A Sex-Specific Analysis in Adolescents With Type 1 Diabetes HbA1c和身体成分的季节性变化：1型糖尿病青少年患者的性别特异性分析

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews

Pub Date : 2025-04-28 DOI: 10.1002/dmrr.70047

Hussein Zaitoon, Hadel Khalil, Eyal Cohen-Sela, Ori Eyal, Hagar Interator, Asaf Oren, Irina Laurian, Anna Dorfman, Efrat Chorna, Yael Lebenthal, Avivit Brener

Background

Circannual fluctuations in glycated haemoglobin (HbA1c) levels are recognized among adults, but comparable changes and contributing factors in adolescents with type 1 diabetes (T1D) have not been investigated in depth.

Objectives

To examine the seasonal changes in HbA1c and their association with body composition in youth with T1D.

Methods

This retrospective observational study included adolescents with T1D followed at our paediatric diabetes centre (2021–2023). Seasonal means were calculated for two periods (winter-spring: December to May and summer-autumn: June to November), and ΔHbA1c was calculated as the difference between the values. The patients' body composition (via bioelectrical impedance analysis (BIA)) data were reviewed, and correlation analyses were performed between sex- and age-adjusted z-scores of body composition components [appendicular muscle mass (ASMM) and fat mass (FATM)] and ΔHbA1c.

Results

The seasonal means of HbA1c calculated for 259 adolescents with T1D (56% male, mean age: 16.01 ± 2.23 years) were significantly higher during winter-spring compared to summer-autumn (7.75% vs. 7.24%, p < 0.001, CI: 0.42–0.57), (61.16 mmol/mol vs. 55.72 mmol/mol, respectively p < 0.001, CI: 4.64–6.23). ΔHbA1c displayed a sex-specific association with body composition components in 102 patients (50% males) who underwent BIA. The correlation was significant for only ASMM z-scores in boys (r = 0.277, p = 0.049), while both the ASMM and FATM z-scores significantly correlated with ΔHbA1c (r = 0.301, p = 0.032 and r = 0.284, p = 0.043, respectively) in girls.

Conclusions

There is a seasonal variation in HbA1c levels in adolescents with T1D, with higher values during winter-spring. The link between seasonal variability and body composition components varied by sex, indicating a need for sex-specific strategies in adolescent diabetes management.

成人糖化血红蛋白（HbA1c）水平的年度波动是公认的，但青少年1型糖尿病（T1D）患者的类似变化及其影响因素尚未深入研究。目的探讨青年T1D患者HbA1c的季节性变化及其与体成分的关系。方法本回顾性观察研究纳入了2021-2023年在儿科糖尿病中心随访的青少年T1D患者。计算两个时期（冬春季：12月至5月和夏秋季：6月至11月）的季节平均值，并计算ΔHbA1c作为值的差值。对患者的身体组成（通过生物阻抗分析（BIA））数据进行回顾，并对身体组成成分（阑尾肌肉量（ASMM）和脂肪量（FATM））的性别和年龄调整z分数与ΔHbA1c进行相关性分析。结果259例青少年T1D患者HbA1c的季节平均值（男性56%，平均年龄：16.01±2.23岁）在冬春季明显高于夏秋季(7.75% vs. 7.24%, p <；0.001, CI: 0.42-0.57), (61.16 mmol/mol vs. 55.72 mmol/mol, p <；0.001, ci: 4.64-6.23)。ΔHbA1c在102例接受BIA的患者（50%为男性）中显示出与身体成分的性别特异性关联。只有男生的ASMM z-score与ΔHbA1c的相关性显著（r = 0.277, p = 0.049），女生的ASMM和FATM z-score与ΔHbA1c的相关性显著（r = 0.301, p = 0.032, r = 0.284, p = 0.043）。结论青少年T1D患者HbA1c水平存在季节性变化，冬春季较高。季节变化和身体成分之间的联系因性别而异，这表明在青少年糖尿病管理中需要针对性别的策略。

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引用次数: 0

The Impact of Cardiometabolic Index on Cardiovascular Disease Risk Among Diabetic Patients: Evidence From Two National Cohorts 心血管代谢指数对糖尿病患者心血管疾病风险的影响：来自两个国家队列的证据

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews

Pub Date : 2025-04-28 DOI: 10.1002/dmrr.70044

Changxing Liu, Zhirui Zhang, Tianwei Meng, Boyu Wang, Chengjia Li, Ximing Yu, Xulong Zhang

Background

This study investigates the relationship between the Cardiometabolic Index (CMI) and cardiovascular disease (CVD) risk in diabetic populations using data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS). Understanding the predictive role of CMI in assessing CVD risk is essential for enhancing preventive strategies in diabetic patients.

Methods

A cross-sectional analysis was conducted on diabetic participants from NHANES (2005–2018) and CHARLS (2011). CMI was calculated based on the waist-to-height ratio and the triglyceride-to-HDL-C ratio. Multivariable logistic regression models and restricted cubic spline analyses were utilised to evaluate the associations between CMI and CVD risk, adjusting for demographic and clinical covariates.

Results

In the NHANES cohort (n = 2044), a higher CMI was significantly associated with an increased risk of CVD after adjusting for confounding factors (OR = 2.01, p = 0.0074). Similarly, in the CHARLS cohort (n = 3964), a higher CMI was linked to an elevated CVD risk (OR = 1.45, p = 0.009). Subgroup analyses demonstrated consistent results across various age, gender and health status subgroups. The restricted cubic spline analysis revealed significant non-linear trends between CMI and CVD risk in both cohorts (p < 0.05).

Conclusion

CMI is a robust and independent predictor of CVD risk among diabetic individuals across different populations. These findings highlight the potential clinical value of incorporating CMI into routine assessments to identify high-risk diabetic patients. Future longitudinal studies are needed to further validate these findings and explore the underlying mechanisms.

本研究利用全国健康与营养调查（NHANES）和中国健康与退休纵向研究（CHARLS）的数据，探讨糖尿病人群心脏代谢指数（CMI）与心血管疾病（CVD）风险之间的关系。了解CMI在评估CVD风险中的预测作用对于加强糖尿病患者的预防策略至关重要。方法对NHANES（2005-2018）和CHARLS（2011）的糖尿病参与者进行横断面分析。CMI是根据腰高比和甘油三酯与hdl - c的比值计算的。多变量logistic回归模型和限制三次样条分析用于评估CMI和CVD风险之间的关系，调整了人口统计学和临床协变量。结果在NHANES队列中（n = 2044），校正混杂因素后，较高的CMI与CVD风险增加显著相关（OR = 2.01, p = 0.0074）。同样，在CHARLS队列中（n = 3964），较高的CMI与CVD风险升高相关（OR = 1.45, p = 0.009）。亚组分析表明，不同年龄、性别和健康状况亚组的结果一致。限制性三次样条分析显示，两组患者CMI和CVD风险之间存在显著的非线性趋势(p <；0.05)。结论CMI是不同人群糖尿病患者CVD风险的可靠且独立的预测因子。这些发现强调了将CMI纳入常规评估以识别高危糖尿病患者的潜在临床价值。未来的纵向研究需要进一步验证这些发现并探索潜在的机制。

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引用次数: 0

Attenuated Niacin Skin Flushing Response in Diabetic Peripheral Neuropathy Patients: A Novel Clinical Diagnostic Tool 糖尿病周围神经病变患者烟酸皮肤潮红反应减弱：一种新的临床诊断工具

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews

Pub Date : 2025-04-25 DOI: 10.1002/dmrr.70042

Tianyuan Jiang, Dandan Wang, Ruoting Chai, Yanyun Hu, Liying Zhu, Fang Fang, Na Li, Chunling Wan, Fang Liu

Aims

The diagnosis of diabetic peripheral neuropathy (DPN) remains challenging because of the lack of objective biomarkers. In this study, we explored the niacin-induced skin flushing response (NSFR) as a novel diagnostic biomarker for DPN on the basis of its association with microangiopathy.

Materials and Methods

We recruited 114 patients with type 2 diabetes (51 with DPN, 59 without DPN, and 4 with unclear neuropathy status) and 91 healthy controls. Peripheral neuropathy was assessed through clinical symptoms and signs, vibration threshold testing and electromyography. NSFR was measured using a six-chamber sandwich patch and six concentrations of aqueous methyl nicotinate. Demographic and clinical data were collected via questionnaires and medical records.

Results

The NSFR was significantly lower in patients with type 2 diabetes than in healthy controls (1613 ± 1130.1 vs. 2494.6 ± 1071.9, p < 0.001) and was further reduced in DPN patients than in those without DPN (1105.4 ± 950.93 vs. 2063.7 ± 1119.3, p < 0.001). The association between the NSFR and the risk of developing DPN remained significant after adjusting for potential confounding factors (OR 0.848, 95% CI 0.757–0.949; p = 0.004). A nomogram illustrated the role of the NSFR in predicting DPN occurrence. The ROC curve for the NSFR had an AUC of 0.740, with 72.55% sensitivity and 66.10% specificity. For the combined model, the AUC improved to 0.898, with 89.58% sensitivity and 78.85% specificity. Decision curve analysis confirmed the practical clinical value of the NSFR for predicting DPN risk.

Conclusions

NSFR is significantly associated with the risk of developing peripheral neuropathy in diabetic patients and shows promise as a diagnostic tool for DPN.

由于缺乏客观的生物标志物，糖尿病周围神经病变（DPN）的诊断仍然具有挑战性。在这项研究中，我们基于烟酸诱导的皮肤潮红反应（NSFR）与微血管病变的相关性，探索了其作为DPN新的诊断生物标志物。材料和方法我们招募了114例2型糖尿病患者（51例伴有DPN， 59例无DPN， 4例神经病变状态不明确）和91名健康对照。通过临床症状和体征、振动阈值测试和肌电图评估周围神经病变。NSFR采用六室夹心贴片和六种浓度的烟酸甲酯水溶液进行测量。通过问卷调查和医疗记录收集人口统计和临床数据。结果2型糖尿病患者NSFR明显低于健康对照组(1613±1130.1∶2494.6±1071.9,p <；0.001)， DPN患者比无DPN患者进一步降低(1105.4±950.93比2063.7±1119.3,p <；0.001)。在调整潜在混杂因素后，NSFR与DPN发生风险之间的相关性仍然显著(OR 0.848, 95% CI 0.757-0.949；p = 0.004)。图显示NSFR在预测DPN发生中的作用。NSFR的ROC曲线AUC为0.740，敏感性为72.55%，特异性为66.10%。联合模型的AUC提高至0.898，敏感性89.58%，特异性78.85%。决策曲线分析证实了NSFR预测DPN风险的实用临床价值。结论：NSFR与糖尿病患者发生周围神经病变的风险显著相关，有望作为DPN的诊断工具。

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引用次数: 0

Long-Term Effectiveness of Once-Weekly Semaglutide in Patients With Type 2 Diabetes Previously Treated With Insulin. A Multicentre Real-World Study 每周一次的西马鲁肽对既往胰岛素治疗的2型糖尿病患者的长期疗效。多中心真实世界研究

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews

Pub Date : 2025-04-25 DOI: 10.1002/dmrr.70045

Benedetta Maria Bonora, Andrea Giaccari, Agostino Consoli, Fabio Broglio, Angelo Avogaro, Gian Paolo Fadini, for the GLIMPLES Study Investigators

Background

The introduction of glucagon-like peptide 1 receptor agonists (GLP-1RAs) has provided new avenues for managing type 2 diabetes (T2D), aiming to achieve optimal glycaemic control while minimising treatment burden. We conducted a multicentre retrospective real-world study to assess the effectiveness of semaglutide once-weekly (OW) in patients previously treated with insulin.

Methods

We included individuals with T2D who were on insulin (basal and/or bolus) and initiated OW semaglutide at 18 specialist care centres. We collected retrospective data on baseline clinical characteristics and updated values of HbA1c and body weight. The primary outcome was the change in HbA1c analysed using the mixed model for repeated measures. Secondary outcomes included the changes in body weight, insulin discontinuation and the change in insulin doses.

Results

The study included 674 individuals. At baseline, participants were 61.7 years old, with a mean diabetes duration of 11.5 years and an HbA1c of 8.2%. During a median follow-up of 18 months, OW semaglutide initiation led to a significant reduction in HbA1c (−0.9%) and body weight (−4.3 kg), with 60% of patients achieving HbA1c < 7%. 32.8% of patients discontinued insulin therapy, 72.5% of whom achieved an HbA1c < 7%. Among patients on basal-bolus insulin, 75% completely discontinued bolus, 62% of whom achieved an HbA1c < 7%. Predictors of insulin discontinuation included shorter diabetes duration, lower baseline HbA1c, and lower insulin doses. Among patients who remained on insulin, initiation of OW semaglutide was associated with a decrease in total daily insulin requirement.

Conclusion

Our study highlights OW semaglutide as a valuable addition to a T2D regimen based on insulin, offering effective glycaemic and weight control with the potential for insulin deintensification or discontinuation.

胰高血糖素样肽1受体激动剂（GLP-1RAs）的引入为治疗2型糖尿病（T2D）提供了新的途径，旨在实现最佳的血糖控制，同时最大限度地减少治疗负担。我们进行了一项多中心回顾性现实世界研究，以评估每周一次的semaglutide （OW）对先前接受胰岛素治疗的患者的有效性。方法：我们纳入了在18个专科护理中心接受胰岛素（基础和/或大剂量）和OW西马鲁肽治疗的T2D患者。我们收集了基线临床特征、最新HbA1c值和体重的回顾性数据。主要结果是使用重复测量的混合模型分析HbA1c的变化。次要结局包括体重变化、胰岛素停药和胰岛素剂量变化。结果共纳入674名受试者。在基线时，参与者年龄为61.7岁，平均糖尿病病程为11.5年，HbA1c为8.2%。在中位18个月的随访期间，OW西马鲁肽启动导致HbA1c（- 0.9%）和体重（- 4.3 kg）显著降低，60%的患者达到HbA1c和lt；7%。32.8%的患者停止胰岛素治疗，72.5%的患者达到HbA1c和lt；7%。在接受基础胰岛素治疗的患者中，75%完全停药，62%达到HbA1c和lt；7%。胰岛素停药的预测因素包括糖尿病持续时间较短、基线HbA1c较低和胰岛素剂量较低。在继续使用胰岛素的患者中，开始使用OW西马鲁肽与每日总胰岛素需求量的降低有关。结论：我们的研究强调了OW semaglutide作为基于胰岛素的T2D方案的有价值的补充，提供有效的血糖和体重控制，具有胰岛素去强化或停药的潜力。

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引用次数: 0

Long-Term Anti-SARS-CoV-2 IgG Antibody Levels in Vaccinated Diabetes Patients After Recovery From COVID-19 接种疫苗的糖尿病患者COVID-19康复后的长期抗sars - cov -2 IgG抗体水平

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews

Pub Date : 2025-04-23 DOI: 10.1002/dmrr.70043

Xiaoying Zhou, Wenjuan Wang, Yang Yuan, Shanhu Qiu, Yandong Cheng, Zilin Sun

Background

Long-term persistence of anti-SARS-CoV-2 IgG antibodies is critical to protect against SARS-CoV-2 infection or to alleviate the severity of COVID-19. However, the persistence of anti-SARS-CoV-2 IgG after infection in vaccinated diabetes patients is unclear. This study aimed to investigate levels of anti-SARS-CoV-2 IgG 1 year after SARS-CoV-2 infection in diabetes patients.

Methods

This study was conducted between December 2023 and January 2024. Participants with SARS-CoV-2 infection during December 2022 to January 2023 were included, and were classified into the diabetes group and non-diabetes group. Anti-N/S IgG antibodies were measured with chemiluminescence immunoassay.

Results

A total of 500 participants, 265 diabetes and 235 non-diabetes patients, were included. Anti-N/S IgG levels in the diabetes group were significantly lower than those in the non-diabetes group (1.92 ± 0.58 vs. 2.08 ± 0.42 log₁₀ AU/mL, p = 0.001). In vaccinated subjects, antibody levels in diabetes patients were also lower than those in non-diabetic patients. After adjustment for sex, age, body mass index, estimated glomerular filtration rate, hypertension, and heart disease, diabetes was negatively correlated with antibody titres (β = −0.16, 95% confidence interval (CI) −0.26 to −0.06, p = 0.002). In the diabetes group, after adjustment for confounders, use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) was positively associated with high antibody levels (odds ratio 3.84, 95% CI 1.70–8.65, p = 0.001).

Conclusion

Vaccinated diabetes patients have lower anti-N/S IgG antibodies than non-diabetic patients 12 months after infection. SGLT-2i is associated with higher anti-N/S IgG antibody levels in diabetes patients.

长期维持抗SARS-CoV-2 IgG抗体对于预防SARS-CoV-2感染或减轻COVID-19的严重程度至关重要。然而，接种疫苗的糖尿病患者感染后抗sars - cov -2 IgG的持久性尚不清楚。本研究旨在探讨糖尿病患者感染SARS-CoV-2后1年的抗SARS-CoV-2 IgG水平。方法本研究于2023年12月至2024年1月进行。纳入了2022年12月至2023年1月期间感染SARS-CoV-2的参与者，并将其分为糖尿病组和非糖尿病组。化学发光免疫法检测抗n /S IgG抗体。结果共纳入受试者500人，其中糖尿病患者265人，非糖尿病患者235人。糖尿病组抗n /S IgG水平明显低于非糖尿病组（1.92±0.58∶2.08±0.42 log10 AU/mL, p = 0.001）。在接种疫苗的受试者中，糖尿病患者的抗体水平也低于非糖尿病患者。在校正性别、年龄、体重指数、肾小球滤过率、高血压和心脏病后，糖尿病与抗体滴度呈负相关（β = - 0.16, 95%可信区间(CI) - 0.26至- 0.06,p = 0.002）。在糖尿病组，调整混杂因素后，钠-葡萄糖共转运蛋白-2抑制剂（SGLT-2i）的使用与高抗体水平呈正相关（优势比3.84,95% CI 1.70-8.65, p = 0.001）。结论接种疫苗的糖尿病患者感染后12个月的抗n /S IgG抗体水平低于非糖尿病患者。SGLT-2i与糖尿病患者较高的抗n /S IgG抗体水平相关。

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引用次数: 0

Is Now the Time to Review the Diabetes Diagnostic Criteria? 现在是审查糖尿病诊断标准的时候了吗？

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews

Pub Date : 2025-04-22 DOI: 10.1002/dmrr.70046

Maja Cigrovski Berkovic, Felice Strollo, Antonio Ceriello

The prevention of prediabetes and type 2 diabetes mellitus (T2DM) remains a significant challenge for health systems worldwide. New technology and its expanding spread within the general population can be a helpful tool for healthcare professionals to identify those at risk for diabetes and develop effective and personalized interventions. Recent advancements in continuous glucose monitoring (CGM) technology have provided new insights into interstitial glucose levels, even among healthy individuals. An increasing number of athletes, especially in endurance sports, utilize CGM data during training and competitions to optimize their energy levels. This data-driven approach has led to significant improvements, such as reducing race times by critical seconds—often enough to secure medals. Furthermore, non-athletes are utilizing CGM to make healthier food choices and mitigate postprandial glucose excursions, which can help them achieve the desired body weight. Therefore, use of CGM has the potential to enhance the early detection of dysglycemia (prediabetes and diabetes) and refine the current diagnostic criteria to help individualised interventions and prevent long-term complications.

预防糖尿病前期和2型糖尿病（T2DM）仍然是全球卫生系统面临的一项重大挑战。新技术及其在普通人群中的广泛传播可以成为医疗保健专业人员识别糖尿病风险并制定有效和个性化干预措施的有用工具。最近在连续血糖监测（CGM）技术的进展提供了新的见解间质葡萄糖水平，甚至在健康个体。越来越多的运动员，特别是在耐力运动中，在训练和比赛中利用CGM数据来优化他们的能量水平。这种数据驱动的方法带来了显著的改进，比如将比赛时间缩短了关键的几秒——通常足以获得奖牌。此外，非运动员正在利用CGM来选择更健康的食物，减轻餐后葡萄糖的增加，这可以帮助他们达到理想的体重。因此，使用CGM有可能增强对血糖异常（糖尿病前期和糖尿病）的早期检测，并改进当前的诊断标准，以帮助个体化干预和预防长期并发症。

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引用次数: 0

Body Composition and Regional Adiposity in Adolescents With Type 1 Diabetes: Relation to Insulin Resistance, Glycaemic Control and Vascular Complications 1型糖尿病青少年的体成分和局部肥胖：与胰岛素抵抗、血糖控制和血管并发症的关系

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews

Pub Date : 2025-04-04 DOI: 10.1002/dmrr.70041

Safinaz Adel Elhabashy, Bassma Abdelnasser Abdelhaleem, Sherihane Saieed Madkour, Christein Monir Kamal, Nouran Yousef Salah

Aim

Obesity is increasingly recognized among people with type 1 diabetes mellitus (T1DM). Little is known about the body composition of adolescents with T1DM and its metabolic outcomes. Hence, this study assessed the body composition of adolescents with T1DM and its relationship with glycaemic control, insulin resistance and vascular complications.

Materials and Methods

One hundred twenty adolescents with T1DM were assessed for anthropometric measures, insulin therapy, bioelectrical impedance analysis (BIA), fasting lipids, glycated haemoglobin, with estimated glucose disposal rate (eGDR) calculation. Regional body fat quantification was performed via Magnetic resonance imaging (MRI) 3-T.

Results

Thirty-three adolescents with T1DM were overweight (27.5%), and 8 were obese (6.6%). Adolescents with T1DM having insulin resistance were found to have significantly higher BMI z score, total body fat %, and visceral/subcutaneous fat % than those without insulin resistance (p < 0.05). Moreover, adolescents with T1DM having microvascular complications showed significantly higher total fat % and visceral/subcutaneous fat % than those without microvascular complications (p < 0.05). Visceral fat % and visceral/subcutaneous fat ratio were positively correlated with waist/hip ratio, eGDR and LDL level (p < 0.05). Waist/hip ratio and eGDR were the most significant independent variables associated with visceral fat % and visceral/subcutaneous fat ratio among adolescents with T1DM using multivariate regression analysis.

Conclusions

Overweight and visceral adiposity are frequently encountered among the studied adolescents with T1DM. Visceral adiposity is associated with insulin resistance, hyperlipidaemia and microvascular complications among adolescents with T1DM independent of glycaemic control and insulin dosage.

目的肥胖在1型糖尿病（T1DM）患者中得到越来越多的认识。对青少年T1DM患者的身体组成及其代谢结果知之甚少。因此，本研究评估了青少年T1DM患者的身体组成及其与血糖控制、胰岛素抵抗和血管并发症的关系。材料与方法对120例T1DM青少年患者进行人体测量、胰岛素治疗、生物电阻抗分析（BIA）、空腹血脂、糖化血红蛋白（gly糖化血红蛋白）评估，并计算葡萄糖处置率（eGDR）。通过磁共振成像（MRI） 3-T进行区域体脂量化。结果青少年T1DM超重33例（27.5%），肥胖8例（6.6%）。有胰岛素抵抗的T1DM青少年BMI z评分、全身脂肪百分比和内脏/皮下脂肪百分比明显高于无胰岛素抵抗的青少年(p <；0.05)。此外，有微血管并发症的青少年T1DM患者的总脂肪百分比和内脏/皮下脂肪百分比明显高于无微血管并发症的青少年(p <；0.05)。内脏脂肪%和内脏/皮下脂肪比与腰臀比、eGDR和LDL水平呈正相关(p <；0.05)。多因素回归分析显示，腰臀比和eGDR是青少年T1DM患者内脏脂肪%和内脏/皮下脂肪比最显著的独立变量。结论超重和内脏肥胖是青少年T1DM患者的常见症状。在青少年T1DM患者中，内脏脂肪与胰岛素抵抗、高脂血症和微血管并发症相关，与血糖控制和胰岛素剂量无关。

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引用次数: 0

Integrating Artificial Intelligence in the Diagnosis and Management of Metabolic Syndrome: A Comprehensive Review 人工智能在代谢综合征诊断和治疗中的应用综述

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews

Pub Date : 2025-03-27 DOI: 10.1002/dmrr.70039

Jingjing Liu, Zhangdaihong Liu, Chang Liu, Hong Sun, Xiaoguang Li, Yang Yang

Background

Metabolic syndrome (MetS) is a progressive chronic pathophysiological state characterised by abdominal obesity, hypertension, hyperglycaemia, and dyslipidaemia. It is recognised as one of the major clinical syndromes affecting human health, with approximately one-quarter of the global population impacted. MetS increases the risk of developing cardiovascular diseases (CVDs), stroke, type 2 diabetes mellitus (T2DM), and diverse metabolic diseases. Early diagnosis of MetS could potentially reduce the prevalence of these diseases. However, care for the MetS population faces significant challenges due to (i) a lack of comprehensive understanding of the full spectrum of associated diseases, stemming from unclear pathophysiological mechanisms and (ii) frequent underdiagnosis or misdiagnosis of MetS in clinical settings due to inconsistent screening guidelines, limited medical resources, time constraints in clinical practice, and insufficient awareness and training. The increasing availability of healthcare and medical data presents opportunities to apply and innovate with artificial intelligence (AI) in addressing these challenges. This review aims to (i) summarise the spectrum of diseases associated with MetS and (ii) review the diverse AI models applied to MetS and metabolic syndrome-related diseases (MetSRD), where MetSRD collectively refers to diseases and conditions directly associated with MetS.

Methods

Our review consists of two phases. Initially, we conducted a literature review on MetS to narrow down the spectrum of MetSRD based on the strength of clinical evidence. We then used the terms ‘Metabolic Syndrome’ and ‘Machine Learning’ in combination with the identified MetSRD for further refinement. In total, we identified 52 related diseases in the first phase and 36 articles in the second phase.

Results

We identified a total of 52 MetSRD after the first phase, with T2DM, CVDs, and cancer being the top three. Among the 36 articles obtained in the second phase, we observed the following: (i) The criteria for MetS were inconsistent across the studies. (ii) The primary purpose of AI applications was to identify risk factors for diseases, thereby improving predictions for MetS or MetSRD. Traditional machine learning models, such as Random Forest and Logistic Regression, were found to be the most effective. (iii) In addition to the MetS criteria, AI models explored other factors, including demographic and physiological variables, dietary influences, lipidomic and proteomic indicators, and more.

代谢综合征（MetS）是一种进行性慢性病理生理状态，以腹部肥胖、高血压、高血糖和血脂异常为特征。它被认为是影响人类健康的主要临床综合症之一，全球约有四分之一的人口受到影响。MetS增加了患心血管疾病（cvd）、中风、2型糖尿病（T2DM）和多种代谢疾病的风险。早期诊断MetS可能潜在地降低这些疾病的患病率。然而，由于(i)不清楚的病理生理机制，对相关疾病的全谱缺乏全面的了解，以及（ii）由于不一致的筛查指南、有限的医疗资源、临床实践的时间限制以及认识和培训不足，在临床环境中经常误诊或误诊MetS，因此对MetS人群的护理面临着重大挑战。越来越多的医疗保健和医疗数据的可用性为应用和创新人工智能（AI）来应对这些挑战提供了机会。本综述旨在(i)总结与MetS相关的疾病谱，（ii）回顾应用于MetS和代谢综合征相关疾病（MetSRD）的各种人工智能模型，其中MetSRD统称为与MetS直接相关的疾病和病症。方法本研究分为两个阶段。最初，我们根据临床证据的强度对MetS进行了文献综述，以缩小MetSRD的范围。然后，我们将术语“代谢综合征”和“机器学习”与确定的MetSRD结合使用，以进一步细化。第一阶段共鉴定出52种相关疾病，第二阶段共鉴定出36篇相关文章。第一阶段后，我们共发现52例MetSRD，其中T2DM、cvd和癌症是前三名。在第二阶段获得的36篇文章中，我们观察到以下情况：(i)研究中MetS的标准不一致。㈡人工智能应用的主要目的是确定疾病的风险因素，从而改进对MetS或MetSRD的预测。传统的机器学习模型，如随机森林和逻辑回归，被发现是最有效的。（iii）除了MetS标准外，人工智能模型还探讨了其他因素，包括人口统计学和生理变量、饮食影响、脂质组学和蛋白质组学指标等。结论：本综述强调了MetS与一系列疾病之间的重要联系，特别关注未被报道的疾病，如非酒精性脂肪性肝病和中风。通过对来自不同来源的数据、人工智能模型和MetS诊断标准的分析，已经确定了传统措施之外的其他指标，强调了结合传统和非传统标志物以增强MetS和MetSRD诊断和预测能力的重要性。人工智能在MetS研究中显示出巨大的潜力，特别是通过整合多源数据，包括临床指标、遗传信息和组学数据。传统机器学习和现代机器学习模型的融合特别有前途，为模型性能和数据复杂性提供了一种平衡的方法。虽然国际定义具有全球适用性，但它们可能并不适用于所有人群和情景，因此需要灵活的诊断标准和自适应的、可解释的算法。最终，这些将使个性化诊断和有针对性的干预成为可能。

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引用次数: 0

Comparison of Benefits and Risks of Metabolic Surgery for Long-Term (5 Years) Weight Loss and Diabetes Remission in Overweight/Obese Patients With Type 2 Diabetes: A Systematic Review and Network Meta-Analysis of Randomized Trials 2型糖尿病超重/肥胖患者长期（5年）体重减轻和糖尿病缓解的代谢手术的获益和风险比较：随机试验的系统评价和网络荟萃分析

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews

Pub Date : 2025-03-23 DOI: 10.1002/dmrr.70033

Xiaoyu Zang, Tong Lin, Jing Ma, Ying Zhang, Boxun Zhang, Yishan Huang, Danni Zhou, Lu Ding, Lili Zhang, Linhua Zhao

Background

While there have been studies comparing the efficiency of several metabolic operations in overweight or obese individuals with type 2 diabetes mellitus (T2DM), there is currently no comprehensive evidence about the complete remission of diabetes and its long-term safety.

Methods

This comprehensive review and network meta-analysis encompassed searches of many databases including PubMed, Web of Science, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ClinicalTrials.gov, and Google Scholar. The search was conducted from the beginning of these databases’ existence until 1 May 2024. The study selected randomized controlled trials (RCTs) with a 5-year follow-up period to compare the clinical benefits and evaluate the occurrence of side events. The network meta-analysis employed a random-effects model. The registration number for PROSPERO is CRD42023412536.

Results

There was a total of 16 RCTs that included 1059 patients. A total of 897 patients, representing 84.7% of the entire sample, successfully completed the 5-year follow-up. Seven metabolic procedures were conducted. All ensuing estimates are to the comparison with a non-surgical treatment (NST). The evidence strongly supports that One-anastomosis gastric bypass (OAGB) is the most effective surgical procedure for achieving long-term complete remission of diabetes (relative risk [RR] 10.28, 95% CI 1.87 to 56.40). Additionally, Biliopancreatic diversion (BPD) is the most effective procedure for achieving long-term partial remission of diabetes (RR 16.74, 95% CI 4.66 to 60.12). The study found that BPD was the most successful method for long-term weight loss, with a mean difference of −11.68 in BMI decrease (95% CI −15.06 to −8.31) and a mean difference of −32.01 in weight change (95% CI −43.27 to −20.74). The evidence supporting this conclusion is of moderate quality. Regarding the occurrence of adverse events and complications related to surgery, gastrointestinal, macrovascular, and microvascular issues are not as frequent in BPD compared with NST (relative risk 0.29, 95% confidence interval 0.06 to 1.37). On the other hand, OAGB may have a higher occurrence of these difficulties, second only to BPD (relative risk 0.08, 95% confidence interval 0.2 to 3.29). Based on the findings on effectiveness and safety, it has been determined that OAGB (One Anastomosis Gastric Bypass) is more effective in obtaining long-term complete remission of diabetes and in assuring overall safety in diabetes management. However, BPD is superior to OAGB in terms of partial remission, weight loss and safety in diabetes management, ranking secon

虽然已经有研究比较了超重或肥胖2型糖尿病（T2DM）患者几种代谢手术的效率，但目前还没有关于糖尿病完全缓解及其长期安全性的全面证据。方法本综合综述和网络荟萃分析包括PubMed、Web of Science、Embase、Cochrane Central Register of Controlled Trials （Central）、Scopus、ClinicalTrials.gov和谷歌Scholar等多个数据库的检索。搜索从这些数据库存在之初一直进行到2024年5月1日。该研究选择随机对照试验（RCTs），随访5年，比较临床获益并评估副反应的发生。网络荟萃分析采用随机效应模型。普洛斯彼罗的注册号是CRD42023412536。结果共纳入16项rct，共纳入1059例患者。共897例患者成功完成5年随访，占整个样本的84.7%。进行了7个代谢过程。所有随后的估计是与非手术治疗（NST）的比较。证据有力地支持单吻合术胃旁路术（OAGB）是实现糖尿病长期完全缓解的最有效的手术方法（相对危险度[RR] 10.28, 95% CI 1.87 ~ 56.40）。此外，胆胰分流术（BPD）是实现糖尿病长期部分缓解最有效的手术（RR 16.74, 95% CI 4.66 - 60.12）。研究发现，BPD是最成功的长期减肥方法，BMI下降平均差值为- 11.68 (95% CI为- 15.06 ~ - 8.31)，体重变化平均差值为- 32.01 （95% CI为- 43.27 ~ - 20.74）。支持这一结论的证据质量一般。关于与手术相关的不良事件和并发症的发生，与NST相比，BPD中胃肠道、大血管和微血管问题的发生率较低（相对危险度0.29,95%可信区间0.06 ~ 1.37）。另一方面，OAGB可能有更高的这些困难的发生率，仅次于BPD（相对风险0.08,95%置信区间0.2至3.29）。基于有效性和安全性的研究结果，已经确定OAGB（一次吻合胃旁路术）在获得糖尿病的长期完全缓解和确保糖尿病治疗的总体安全性方面更有效。然而，BPD在部分缓解、体重减轻和糖尿病管理的安全性方面优于OAGB，在这些方面排名第二。结论：BPD和OAGB在超重/肥胖T2DM患者实现长期体重减轻和糖尿病缓解方面均具有卓越的疗效。OAGB对于实现糖尿病的长期完全缓解尤其有利，总体上具有更高的安全性。研究发现，BPD对于长期糖尿病患者实现部分缓解和体重减轻是最有效的治疗方法，同时报告的副作用也最少。

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引用次数: 0

Development of a Prediction Model for Predicting 10-year Incidence of Type 2 Diabetes in Japanese People; Panasonic Cohort Study 7 日本人10年2型糖尿病发病率预测模型的建立松下队列研究7

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews

Pub Date : 2025-03-18 DOI: 10.1002/dmrr.70040

Chihiro Munekawa, Go Horiguchi, Akari Naito, Masahide Hamaguchi, Kazushiro Kurogi, Hiroaki Murata, Masato Ito, Akihiro Obora, Takao Kojima, Hiroshi Okada, Satoshi Teramukai, Michiaki Fukui

Aims

In Japan, several prediction models and scoring systems for type 2 diabetes have been reported; however, none have high utility. We developed a new clinical prediction model for the onset of type 2 diabetes.

Materials and Methods

The development dataset was obtained from 72,124 Japanese employees who participated in a health check-up programme conducted by Panasonic Corporation (Osaka, Japan), were aged 40 years or older, were diabetes-free at baseline, and followed-up for up to 10 years. The external validation dataset was obtained from 12,885 participants of the NAGALA (Gifu City, Gifu Prefecture Longitudinal Analysis) cohort. A prediction model was developed to predict the 10-year risk of developing diabetes using information from the health checkup programme. The developed model was internally validated, and externally validated using the NAGALA cohort.

Results

Using information on age, sex, body mass index, systolic blood pressure, log-triglycerides, high-density lipoprotein, log-alanine aminotransferase, fasting plasma glucose, weight gain, and smoking status obtained from a health checkup programme, we developed a novel, highly sensitive, and specific model for predicting the 10-year risk of developing diabetes. The prediction model showed excellent performance, with an optimism-corrected c-index of 0.877 and a c-index of 0.882 in the external validation cohort.

Conclusion

We developed a noninvasive diabetes risk-prediction model for the Japanese population and confirmed its utility for identifying individuals at high risk of type 2 diabetes over time.

在日本，已经报道了几种2型糖尿病的预测模型和评分系统；然而，它们都没有很高的效用。我们开发了一种新的2型糖尿病发病的临床预测模型。资料和方法研究数据来自72,124名日本员工，这些员工参加了松下公司（日本大阪）开展的健康检查项目，年龄在40岁或以上，基线时无糖尿病，随访时间长达10年。外部验证数据集来自NAGALA（岐阜市，岐阜县纵向分析）队列的12,885名参与者。利用健康检查项目的信息，建立了一个预测模型来预测10年内患糖尿病的风险。开发的模型进行了内部验证，并使用NAGALA队列进行了外部验证。结果：利用健康检查项目中获得的年龄、性别、体重指数、收缩压、甘油三酯、高密度脂蛋白、丙氨酸转氨酶、空腹血糖、体重增加和吸烟状况等信息，我们建立了一种新的、高度敏感的、特异性的模型，用于预测10年患糖尿病的风险。该预测模型表现优异，乐观校正后的c-index为0.877，外部验证队列的c-index为0.882。我们为日本人群建立了一种非侵入性糖尿病风险预测模型，并证实了其在识别2型糖尿病高风险个体方面的实用性。

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