Journal of Diabetes Research最新文献

Background: Lifestyle interventions, including Nordic walking, a whole-body exercise session, are beneficial for metabolic diseases, including diabetes. However, evidence from research studies or meta-analyses on the efficacy of Nordic walking in improving clinical outcomes in patients with diabetes/prediabetes remains inconclusive.

Purpose: This systematic review and meta-analysis investigated the efficiency of Nordic walking on anthropometrics, glycemic control, lipid profiles, blood pressure, and peak oxygen uptake (VO₂peak) in adults with prediabetes/diabetes.

Methods: A systematic literature search was performed across PubMed, Web of Science, the Cochrane Library, Scopus, and Embase until June 2025. We included randomized controlled trials (RCTs) involving adults with prediabetes or diabetes that compared the Nordic walking effect with a control trial. Data on clinical outcomes, including anthropometrics, glycemic control, lipid profiles, blood pressure, and VO₂peak, were extracted for meta-analysis and presented as mean difference (MD).

Results: A total of six RCTs, comprising 321 adults with prediabetes or diabetes (63% male), were included in the analysis. Meta-analysis results showed that compared with control, Nordic walking significantly decreased body weight (MD = -0.79 kg, p = 0.02), and marginally reduced waist circumference (MD = -0.82 cm, p = 0.07). Notably, Nordic walking decreased glycated hemoglobin (HbA1c) (MD = -0.37%, p = 0.0001) but showed high heterogeneity (I ² = 69%). Subgroup analysis revealed a greater reduction of HbA1c in adults with diabetes (MD = -0.49%, p < 0.00001) than that of adults with prediabetes (MD = -0.2%, p = 0.001). However, Nordic walking did not affect fasting blood glucose or homeostasis model assessment of insulin resistance (HOMA-IR). Additionally, Nordic walking significantly increased high-density lipoprotein (HDL) cholesterol (MD = 0.07 mmol/L, p = 0.005), while showing no beneficial effects on total cholesterol, triglycerides, and low-density lipoprotein. Nordic walking appears to improve VO₂peak but does not affect systolic or diastolic blood pressure.

Conclusions: Nordic walking exerted beneficial effects on body weight, HbA1c, and HDL in adults with prediabetes or diabetes. Our findings support that Nordic walking can be a practical intervention in managing or treating diabetic complications.

Aims: This retrospective study is aimed at evaluating the effect of SGLT2 inhibitors (SGLT2i) on the risk of sepsis among patients with Type 2 diabetes mellitus (T2DM).

Materials and methods: An active-comparator new user design was utilized based on Taiwan's National Health Insurance Research Database. Adult patients diagnosed with T2DM between 2017 and 2020 who initiated either SGLT2i or DPP-4 inhibitors (DPP-4i) were included. After 1:2 matching by age, sex, and Charlson Comorbidity Index, the study enrolled 34,672 SGLT2i users and 69,344 DPP-4i users. The primary outcome was sepsis, with secondary outcomes including septic shock, organ dysfunction, and mortality. Hazard ratios (HRs) were estimated using Cox proportional hazards regression.

Results: SGLT2i users had a significantly lower risk of sepsis than DPP-4i users (10.1% vs. 15.5%; adjusted HR [aHR]: 0.77; 95% CI: 0.74-0.81). The risk of septic shock and mortality in SGLT2i users was also reduced by 30% (aHR: 0.70; 95% CI: 0.57-0.87) and 40% (aHR: 0.60; 95% CI: 0.54-0.66), respectively, compared with that of DPP-4i users.

Conclusions: The findings suggest that SGLT2i is associated with a significantly lower risk of sepsis, septic shock, and mortality compared with that of DPP-4i in patients with T2DM.

Purpose: The purpose of this study is to identify associative factors of vision threatening complications of diabetic retinopathy (DR), including proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) in a New Mexican patient population with Type 2 diabetes featuring a high proportion of Hispanic and American Indian patients.

Methods: In a retrospective, case-control, cross-sectional study, we performed both univariate and multivariate logistic regression testing of systemic factors for association among patients with nonproliferative diabetic retinopathy (NPDR) without DME, NPDR with DME, and PDR. We also used receiver operating characteristic (ROC) curves to understand how reliable glycemic control is at predicting DR end-complications.

Results: Among our 584 patients, 172 were diagnosed with NPDR without DME, 293 with PDR, and 119 with NPDR with DME. A total of 25% of patients with NPDR without DME had poor glycemic control (HbA1c levels of ≥ 9.0%). Similarly, 10% of PDR and 7% of NPDR with DME patients had good glycemic control (HbA1c levels ≤ 7.0%), despite their advanced eye disease. For patients with PDR, we identified significant independent associations with microalbuminuria and macroalbuminuria, Hispanic ethnicity, duration of diabetes, and the use of insulin and beta-blocker medications. In NPDR with DME patients, significant associations were noted with microalbuminuria and macroalbuminuria, HbA1c, GFR, and beta-blocker medications. The hemoglobin A1c level was not significantly associated with PDR but was significantly associated with NPDR with DME. The ROC curve analysis indicated poor predictability for the HbA1c model concerning the presence of PDR (AUC = 0.640) and NPDR with DME (AUC = 0.640).

Conclusions: This study suggests that glycemic exposure alone is not a good enough predictor of DR progression. Other diabetic microvascular complications such as nephropathy, in addition to race/ethnicity with differing genetic associative factors, may also play a role in the multifactorial progression through DR phenotypes.

Background: The link between dietary choline/betaine and Type 2 diabetes (T2D) has been shown in several studies. However, the findings are controversial. This meta-analysis evaluated the connection between dietary choline/betaine and the incidence of T2D.

Methods: A thorough and organized search was conducted through PubMed, Scopus, and Web of Science up to September 2024. All reported effect sizes and their 95% CIs for risk of T2D were used to estimate log RRs with their standard errors (SEs). The overall combined effect size was obtained via a random effects model. The variability among the studies was examined using Cochrane's Q test and the I-squared statistic.

Results: A total of five studies, including 76,678 subjects, provided data on the relationship between dietary choline and T2D risk. Compared with the lowest category of dietary choline, the combined RR for the diabetes incidence was 1.15 (95% CI: 1.00, 1.33; p = 0.058; I ² = 63.1%) for the highest category of dietary choline. The pooled analysis of three studies, with 65,725 subjects, indicated no significant link between dietary betaine and T2D incidence. Compared with the lowest category of dietary betaine, the combined RR for the diabetes incidence was 0.99 (95% CI: 0.90, 1.10; p = 0.871; I ² = 58.1%). The certainty of the evidence was rated very low for choline intake and T2D incidence as well as betaine intake and T2D incidence, with a downgrade for risk of bias, inconsistency, imprecision, and indirectness.

Conclusion: The findings of this study do not advocate the role of dietary choline/betaine in T2D incidence. Due to the limited number of primary studies and high heterogeneities among them, more rigorously designed prospective studies are required to confirm our results.

Background: Kidney damage in chronic kidney disease patients is affected by the degradation products of polyamines. However, the effect of polyamine metabolism-related genes (PM-RGs) in diabetic nephropathy (DN) is not clear. The objective of this study is to elucidate the potential correlation between PM-RGs and DN.

Methods: DN-related datasets and 59 PM-RGs were obtained from the public database. Then, Differentially Expressed Gene 1 (DEG 1) related to DN in GSE142153 and DEG 2 related to PM-RGs were crossed to obtain intersection genes. The gene with the same expression trend in DEG 3 obtained in GSE185011 and DEG 1 was overlapped with the intersection gene to obtain the candidate genes. Thereafter, two machine learning algorithms and ROC curves were adopted to select biomarkers. Moreover, enrichment analysis, immune infiltration analysis, and drug prediction were implemented to further study the biomarkers. Finally, the expressions of biomarkers were analyzed in clinical samples assessed by RT-qPCR and IHC.

Results: KAZALD1, GLCE, and RPRD1B were identified as biomarkers for DN, with their area under the curve values being greater than 0.8. They were involved in multiple biological pathways, such as valine, leucine, and isoleucine degradation, cytokine-cytokine receptor interaction, and peroxisome. Furthermore, immune cells were found to correlate with biomarkers. For instance, the expression of KAZALD1 and RPRD1B showed positive correlations with naive CD8 T cells and M1 macrophages among other immune cells while exhibiting negative correlations with CD8 T cells, B cells, T helper cells, and others. Additionally, based on three biomarkers, 11 drugs (benzopyrene, Bisphenol A, ethinyl estradiol, etc.) were predicted. KAZALD1 and RPRD1B were notably highly expressed in clinical DN samples in RT-qPCR and IHC.

Conclusion: The research pinpointed KAZALD1, GLCE, and RPRD1B as biomarkers for DN, offering a novel target reference for diagnosing and treating DN.

Background: Maturity-onset diabetes of the young (MODY), a common type of monogenic diabetes caused by a pathogenic variant in a single gene, is characterized by starting at an early age, autosomal dominant inheritance, and decreased secretion of insulin. Despite its clinical importance, its accurate diagnosis is challenging, and it is often misdiagnosed as other types of diabetes. Therefore, understanding the genetic basis of MODY can improve diagnostic accuracy.

Methods: We initially performed genetic counseling for 2964 probands who visited the Yazd Diabetes Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, between 2018 and 2022. Clinical assessments and pedigree analyses were conducted for the accurate clinical diagnosis and management of diabetes. Among these, 11 probands with unknown types of diabetes who met specific criteria, including an inheritance pattern across at least three generations, at least seven affected individuals, and probands being under age 55, were selected for whole-exome sequencing (WES). Finally, variants were verified by Sanger sequencing, pedigree analysis, and segregation analysis.

Results: WES analysis detected pathogenic variants in two families, which confirmed MODY. Family 202 had a novel missense variant (GCK: c.484G > C; p.Gly162Arg; NM_000162.5). In Family 105, an extremely rare pathogenic frameshift variant (HNF1A: c.1136_1137del; p.Pro379ArgfsTer39; NM_000545.8) was identified. The segregation analyses of these variants also revealed that the variants largely co-segregated with the diabetes phenotype in their respective families.

Conclusion: This study clearly demonstrates the effectiveness of WES for the accurate identification of MODY subtypes in Iranian families. Moreover, these findings emphasize the need for further genetic screening programs in Iran to enhance MODY diagnosis, personalized treatment, and family genetic counseling.

Background: Digital health interventions, such as mobile diabetes apps, are aimed at supporting glycemic control. Real-world data (RWD) provide valuable insights into their long-term effectiveness beyond the controlled conditions of randomized trials.

Objective: This study evaluates the effectiveness of the mobile diabetes app ESYSTA in improving glycemic control using real-world evidence.

Methods: A retrospective analysis of 475 users was conducted to assess HbA1c changes after 6 months of usage and also long-term usage (12 and 15 months). A linear mixed model was used to adjust for confounding factors.

Results: After 6 months, ESYSTA users achieved a significant HbA1c reduction of -0.59 (-0.70; -0.48) percentage points compared to baseline, which was maintained for up to 15 months. Users with higher baseline HbA1c showed greater reductions. Seventy-five percent of users tracked their blood glucose values consistently during the whole observation period.

Conclusion: These real-world evidence findings demonstrate the effectiveness of a mobile diabetes app in improving glycemic control over an extended period. While statistical adjustments addressed potential biases, missing data remain a challenge. Further research, including controlled studies, is needed to confirm these real-world results and further explore the underlying mechanisms of sustained HbA1c improvement.

The morbidity and mortality associated with Type 1 diabetes are primarily linked to vascular complications. While overt clinical manifestations of microvascular complications and cardiovascular disease predominantly occur during adulthood, a noteworthy proportion of adolescents with Type 1 diabetes have one or more risk factors for the development of vascular complications. In addition, early subclinical stages of vascular complications can be detected already in youth with diabetes. Intensive diabetes management and targeted screening strategies can effectively delay or halt the progression of these complications. Preventative strategies should focus on three main principles: achieving optimal glycemic targets, preventing and targeting cardiometabolic risk factors, and implementing early screening programs. For managing complications, a comprehensive approach is essential, combining insulin therapy to optimize glycemic targets, motivational lifestyle interventions, and timely pharmacological treatments. This review summarizes the epidemiology and risk factors for vascular complications in youth with Type 1 diabetes and emphasizes the importance of early detection and prevention, and effective treatment strategies.

Adherence to lifestyle modification recommendations plays a significant role in the management of diabetes mellitus, which commonly affects elderly groups. Low or nonadherence to dietary and physical activity recommendations is a major problem that retrogresses efforts invested in diabetes care and management. This subject is underexplored in Kenya, with no existing study conducted in Kericho County. The study is aimed at bridging the existing compliance gap through assessment of dietary and physical activity adherence among Type 2 diabetes patients aged 40+ years in Kericho County, Kenya. A hospital-based cross-sectional study involving 207 type 2 diabetes patients at Kericho County Referral Hospital using a pretested and structured interviewer-administered questionnaire was conducted. Validated and customized perceived dietary adherence questionnaire (PDAQ) and global physical activity questionnaire (GPAQ) were utilized. Data on sociodemographic and behavioral characteristics, and diet and exercise were collected from selected respondents through systematic random sampling technique. Collected data were analyzed using SPSS Version 26. Bivariate and multivariate logistic regression was performed to identify factors influencing adherence, with significance set at < 0.05. Results showed that 51.7% and 35.3% of the respondents were adherent to recommended dietary and physical activity, respectively. Being aged ≥ 70 years (AOR = 2.13, 95% CI: 1.01-4.87, p = 0.02), postprimary education (AOR = 1.71, 95% CI: 1.39-5.28, p = 0.02), absence of comorbidities (AOR = 1.68, 95% CI: 1.33-1.08, p = 0.01), and absence of complications (AOR = 1.57, 95% CI: 1.32-1.96, p = 0.03) had higher likelihood of adherence to dietary recommendations. Unmarried patients (AOR = 0.22, 95% CI: 0.07-0.68, p = 0.008) and lack of family support (AOR = 0.51, 95% CI: 0.31-0.91, p = 0.01) were significantly associated with lower adherence to dietary recommendations. Higher odds of physical activity adherence were associated with postprimary education (AOR = 1.75, 95% CI: 1.27-3.18, p = 0.03) and diabetes duration of > 10 years (AOR = 1.52, 95% CI: 1.03-2.13, p = 0.04), while lower among patients aged ≥ 70 years (AOR = 0.64, 95% CI: 0.29-0.87, p = 0.02) and lacked family support (AOR = 0.54, 95% CI: 0.37-0.85, p = 0.04). These findings underscore urgent need for targeted and context-specific tailored health education, promotion of family support and involvement, and designing of individualized lifestyle modification plan that integrated functional disparities for sustainable adherence and improved diabetes outcomes.

Background: The serum creatinine-cystatin C ratio (SCR/CysC) and relative fat mass (RFM) are both important indicators reflecting muscle and fat content, respectively, and are closely related to metabolic diseases and cardiovascular diseases. However, the roles of SCR/CysC and RFM in cardiometabolic multimorbidity (CMM) remain unclear. This study is aimed at exploring the relationships between SCR/CysC, RFM, and CMM, providing a new perspective for the early identification and intervention of CMM.

Methods: This study included 9292 Chinese participants from the CHARLS database and 3822 American individuals from the NHANES database. Multivariate logistic regression analysis, restricted cubic spline (RCS) plots, and subgroup analyses were employed to explore the associations of SCR/CysC and RFM with CMM.

Results: Analyses based on two databases revealed that the level of SCR/CysC levels was significantly negatively correlated with the risk of CMM. Conversely, higher RFM levels were positively correlated with an increased risk of CMM. Specifically, compared to the lower quartile (Q1) of SCR/CysC, the highest quartile (Q4) was associated with a decreased risk of CMM (CHARLS: odds ratio (OR) = 0.89, 95% confidence interval (CI): 0.87-0.91, p < 0.001; NHANES: OR = 0.90, 95% CI: 0.86-0.94, p < 0.001). Compared to the lower quartile (Q1) of RFM, the highest quartile (Q4) was associated with an increased risk of CMM (CHARLS: OR = 1.18, 95% CI: 1.16-1.21, p < 0.001; NHANES: OR = 1.20, 95% CI: 1.15-1.25, p < 0.001). The RCS plot results further supported this relationship, demonstrating that after adjusting for multiple confounding factors, a decrease in SCR/CysC and an increase in RFM were both associated with a higher risk of CMM.

Conclusions: This study found that SCR/CysC levels were negatively correlated with CMM risk, whereas RFM levels showed a positive correlation. Thus, SCR/CysC and RFM may both serve as potential biomarkers for CMM screening.