Journal of Diabetes and Metabolic Disorders最新文献

Background: Obesity has become a significant global health issue, linked to a range of metabolic disorders The Triglyceride-Glucose (TyG) index has shown a robust association with well-established markers of metabolic dysfunction.

Methods: This was a cross-sectional study involving people with a BMI exceeding 40 kg/m² or a BMI between 35 and 40 kg/m² accompanied by 2 comorbidities. These individuals were referred for metabolic surgery, specifically sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). The data were collected at baseline and during various post-surgical follow-up intervals.

Results: This cross-sectional study included 1,005 participants with severe obesity who were candidates for bariatric surgery. The cohort comprised 813 females (80.9%) and 192 males (19.2%), with a mean age of 37.95 ± 10.52 years. Approximately 80% of participants were diagnosed with grade 2 or 3 fatty liver disease. Among those who underwent elastography, 38.7% presented with hepatic fibrosis. The majority of participants with steatosis and fibrosis were female, accounting for 77.2% and 72.1% of cases, respectively. Additionally, both the TyG index and HOMA-IR levels were significantly elevated in individuals with moderate to severe steatosis and hepatic fibrosis. The area under the curve (AUC) for steatosis and fibrosis prediction was 0.65. The TyG index emerged as an independent predictor for hepatic fibrosis [OR (95% CI): 8.262 (3.468-19.684), p < 0.001] and moderate to severe hepatic steatosis [OR (95% CI): 9.4 (4.228-20.904), p < 0.001].

Conclusion: The TyG index stands out as a valuable biomarker for evaluating metabolic health in people with severe obesity. It offers clinicians a pragmatic tool for managing obesity-related metabolic disorders, enabling early detection and timely intervention to enhance patient care.

Background: Type 2 diabetes mellitus (T2DM) is a major global health challenge, characterized by insulin resistance, progressive β-cell dysfunction, and persistent hyperglycemia. Yoga is a mind-body practice that has been studied as a potential complementary therapy for T2DM. However, no systematic review has specifically synthesized evidence on the effects of a three-month yoga intervention on glycemic control.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted in accordance with PRISMA guidelines (PROSPERO: CRD42024599832). Three electronic databases (PubMed, Science Direct, Cochrane Library) were searched from inception to October 2024. Eligible studies included participants with T2DM who had undergone yoga for three months. The primary outcome was glycated hemoglobin (HbA1c), secondary outcomes were fasting blood glucose (FBG) and postprandial blood glucose (PPBG).

Results: Fourteen RCTs comprising 1876 participants with T2DM met the eligibility criteria. Pooled analysis showed a significant reduction in HbA1c (Mean difference [MD] = - 0.55; 95% Confidence interval [CI]: - 1.02 to - 0.08; I² = 97%), FBG (MD = - 24.72 mg/dL; 95% CI: - 34.10 to - 15.34; I² = 80%), and PPBG (MD = - 26.01 mg/dL; 95% CI: - 40.91 to - 11.12; I² = 51%) after three months of yoga. Most trials had a high overall risk of bias.

Conclusion: A three-month yoga practice significantly reduces HbA1c, FBG, and PPBG in participants with T2DM without adverse effects, supporting its role as a safe, low-cost adjunct to standard care. However, high heterogeneity restricts certainty. High-quality, multicenter RCTs with standardized yoga protocols are warranted to confirm these findings.

Purpose: SCORE2 is a 10-year CVD risk prediction model developed for use in European populations. This study aimed to externally validate the SCORE2 model and assess its clinical usefulness in an Iranian adult population using data from the TLGS cohort.

Methods: A total of 4,942 individuals aged 40-69 years participated in the TLGS cohort, which was randomly sampled from the population. A Fine and Gray competing risk model was fitted to estimate sex-specific regression coefficients in the TLGS cohort for comparison with the original SCORE2 model. The outcome was first fatal or non-fatal CVD event (myocardial infarction, stroke, or CVD death), considering non-CVD mortality as a competing event. The predictors included age, sex, smoking status, history of diabetes, SBP, total cholesterol, and HDL cholesterol. Model performance was evaluated as statistical performance (discrimination using Harrell's C-index , calibration via plots and O/E ratio) and clinical performance (sensitivity, specificity, decision curve analysis, and net benefit fraction) across different SCORE2 risk thresholds.

Results: A total of 4,579 adults without a history of CVD were included in this study. During the follow-up period, CVD events occurred in 211 (11.05%) men and 151 (5.70%) women. The 10-year cumulative incidence of CVD was 8.00% (95% CI: 6.90-9.40) in men and 3.70% (3.00-4.50) in women. The validated SCORE2 model showed higher discrimination in women (C-index: 0.80; 0.76-0.83) than in men (0.70; 0.67-0.74), but it underestimated the CVD risk in both sexes (men: O/E: 2.05; 2.02-2.08, women: O/E: 1.50; 1.40-1.50). At the risk threshold of ≤ 2.5% for individuals under 50 years and ≤ 5% for those aged 50 years and older, sensitivity in men was 0.65 (0.57-0.73) and specificity was 0.63 (0.60-0.65). In women, sensitivity was 0.54 (0.44-0.64) and specificity was 0.88 (0.87-0.89). Decision curve analysis supported its clinical usefulness, particularly at intermediate risk levels (7.5-15%) in both sexes. The net benefit fraction ranged from 0.13 to 0.49 in men and 0.07-0.42 in women.

Conclusion: The validated SCORE2 model demonstrated good discriminatory performance, particularly in women, but calibration tended to underestimate risk. Although net benefit indicated that the model provides meaningful clinical usefulness in identifying individuals who may benefit from preventive interventions, recalibration and updating the model according to national data is recommended.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-025-01730-5.

Purpose: This systematic review and meta-analysis aimed to synthesize the current evidence on the associations of metabolic syndrome (MetS) and its components, central obesity, hypertension, dyslipidemia, and elevated fasting plasma glucose (FPG) with brain volumes and structural connectivities.

Methods: We conducted a comprehensive literature search in major databases (PubMed, Web of Science, Scopus, and ScienceDirect) up to December 2024. Studies were included if they reported quantitative data on the association between MetS or its components and brain volumetric or white matter (WM) integrity outcomes in adults. Two independent reviewers screened titles, abstracts, and full texts, extracted data, and assessed study quality using established tools. Random-effects meta-analyses were performed to pool effect sizes (ESs) for key outcomes. Heterogeneity was assessed using I² statistics, and sensitivity analyses were conducted to evaluate the robustness of findings.

Results: A total of 38 studies (n = 27 to 37395 participants) met the inclusion criteria. Central obesity and hypertension were robustly associated with reduced total brain volume and increased WM hyperintensity volume, respectively (n = 4677, ES = -0.15, 95% CI: -0.24, -0.05 and n = 36135, ES = 0.22, 95% CI: 0.13, 0.31, respectively). Hypertension also demonstrated a significant negative association with WM fractional anisotropy (FA) (n = 31167, ES = -0.20, 95% CI: -0.35, -0.05). Elevated FPG and low HDL cholesterol were linked to adverse brain changes, though the evidence was less consistent. High triglyceride levels did not consistently predict brain structural alterations. Heterogeneity was high for the analyses (I² >80%), and results remained significant in sensitivity analyses.

Conclusions: MetS and its key components are associated with detrimental effects on brain structure and connectivity. These findings underscore the importance of early detection and management of metabolic risk factors for preserving brain health and reducing the risk of cognitive decline and dementia.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-025-01800-8.

Background: Diabetes mellitus type 2 (DMT2) is a chronic metabolic disorder caused by a disruption or resistance in insulin secretion. AKT /PI3K, GSK-3β and CREB signaling pathways influence insulin sensitivity and glucose metabolism.

Purpose: This study aimed to compare the therapeutic impact of pectin extracted from different sources (lemon, orange and grapefruit peels) against diabetic rats.

Methods: Fourier transform infrared spectroscopy (FT-RI) and Proton Nuclear Magnetic Resonance (¹H-NMR) analysis of pectin were done. Treatments were administered daily for one month (500 mg/kg) post diabetes induction via a single dose of streptozotocin (STZ) (40 mg/kg) considering Metformin as a reference drug (250 mg/kg). Biochemical, mutagenicity and genotoxicity analyses were assessed.

Results: The FT-IR and¹H-NMR revealed that lemon pectin had a strong peak at ≈3.7 ppm. Orange pectin showed a moderate peak at ≈3.7 ppm, and grapefruit pectin showed a weak peak at ≈3.7 ppm. Diabetic rats showed alterations in glucose, insulin, liver function enzymes, urea, oxidative stress indices, IL-6, TNF-α, AKT, PI3K levels and GSK-3β and cAMP responsive element binding protein 1(CREB) genes expression. Changes in micronuclei of polychromatic erythrocytes, chromosomal aberrations, sperm abnormalities and the histopathology of liver and pancreas were also observed. Pectin treatments declared a notable amelioration in glucose and insulin levels as well as the other selected parameters.

Conclusion: Pectin extracted from lemon, orange and grapefruit peels showed a promising therapeutic impact against DMT2. High degree of esterification in lemon pectin may explore its potent effect via regulating glucose, α-amylase and the metabolic genes expression pathways. Orange pectin exhibits the strongest anti-mutagenic properties. Together, citrus pectin may be considered as a nutraceutical agent against diabetes.

Graphical abstract:

[This corrects the article DOI: 10.1007/s40200-025-01756-9.].

Objective: To determine the global prevalence and factors associated with overweight and obesity in children and adolescents with type 1 diabetes (T1D).

Methods: A systematic database search was conducted in PubMed, CINAHL, EMBASE, MEDLINE, and Web of Science from 2000 to October 2024. Studies were included if they: (1) used observational designs (2) reported the prevalence of overweight and/or obesity among children with TID (< 20 years) (3) were published in English Language. Studies with both T1D and T2D participants that lacked separate T1D findings were excluded. The DerSimonian-Laird random-effects model was used to estimate the pooled prevalence, with heterogeneity assessed using I² statistics. Publication bias was assessed using funnel plots, Egger's and Begg's tests.

Results: Out of 10,491 references, 21 articles met the inclusion criteria. The overall pooled prevalence of obesity and overweight among children and adolescents was 30.0%, with substantial geographical and gender differences. The pooled prevalence of obesity alone was 8.8% and overweight prevalence was higher at 20.0%. Key factors such as female gender, increasing age, lower household income, and lower parental education, increased insulin doses, reduced physical activity, lower self-monitoring of blood glucose, perceived stress, poor diabetes care activities, and poor quality of life were associated with higher overweight and obesity risk.

Conclusion: Obesity and overweight in children with T1D stem from a complex interplay of sociodemographic, clinical, and behavioral factors. Data from underrepresented areas, especially Africa, highlight the need for further research to guide global policies for managing and preventing obesity.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-025-01774-7.

[This corrects the article DOI: 10.1007/s40200-025-01687-5.].

Purpose: In patients with SARS-CoV-2 infection overweight and diabetes are associated with poor prognosis. Therefore, effectiveness and tolerance of booster vaccination against SARS-CoV-2 has to be ensured. We examined the impact of overweight and diabetes on anti-SARS-CoV-2-titers and the incidence of side effects after booster vaccination.

Methods: We performed a cross-sectional study with consecutive recruitment and convenience sampling of 100 participants vaccinated three times against SARS-CoV-2. Anti-SARS-CoV-2-titers, immunological parameters and biochemical markers of glucose metabolism were measured. Prevalence of vaccination side effects was assessed by personal interview. Moreover, metabolic status was assessed by performance of body composition measurement and body impedance analysis. The glycemic and metabolic parameters were correlated with the anti-SARS-CoV-2-titers and the incidence of side effects. The results were compared between patient with and without overweight and diabetes.

Results: Levels of anti-SARS-CoV-2-titers did not differ between participants with and without overweight (5756.6 ± 6848.9 vs. 4997.0 ± 5050.3, p.83) or participants with and without diabetes (6681.0 ± 6795.2 vs. 5124.0 ± 5070.4 BAU/ml, p = .28). Moreover, the investigated glycemic parameters and parameters of the body composition measurement and body impedance analysis did not present any correlation with the antibody levels. Furthermore, we could reveal that vaccination side effects are more likely to occur in participants without diabetes (OR 2.9 (95%-CI: 0.5-4.3, p.04)).

Conclusions: Overweight and diabetes are not associated with lower anti-SARS-CoV-2-titers after booster vaccination. Parameters of the body composition and body impedance analysis did not reveal any further association regarding development of anti-SARS-CoV-2-titers. Vaccination side effects are more likely to occur in participants without diabetes.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-025-01699-1.

Background: Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus and a leading cause of visual impairment. While dyslipidemia has been implicated in DR pathogenesis, the relationship between high-density lipoprotein cholesterol (HDL-C) and DR remains controversial. This study aimed to investigate the association between HDL-C levels and DR prevalence in diabetic patients type 2 diabetes mellitus (T2DM).

Methods: This study is the second analysis based on a cross-sectional studv. A total of 2001 (858 men and 1143 women) diabetic patients who visited the diabetic clinic in the Internal Medicine out-patient departments of two hospitals in southern Taiwan between April 2002 and November 2004. Demographic and clinical data were collected, and serum HDL-C levels were measured. The association between HDL-C and DR was analyzed using multivariate logistic regression, accounting for potential confounders. Additionally, we explored the potential correlation between HDL-C and DR through a smooth curve fitting approach, utilizing a generalized additive model (GAM). and a generalized additive model (GAM).

Results: Among the 2001 participants, 701 (35.0%) were diagnosed with DR. Our findings demonstrated a significant inverse linear relationship between HDL-C levels and the presence of DR. Higher HDL-C was inversely associated with diabetic retinopathy (DR). In continuous analyses, each 10 mg/dL increase in HDL-C corresponded to lower odds of DR across all models, including Model 3 (OR 0.92; 95% CI 0.84-0.99; P = 0.027).Additionally, analysis of HDL-C levels by tertiles revealed that participants in the highest tertile (53.0-99.0 mg/dL) had a lower prevalence of DR, with an OR of 0.78 (95% CI: 0.62-0.97; P = 0.029) in Model 1; this association was borderline in Model 2 (OR: 0.80; 95% CI: 0.63-1.01; P = 0.055) and non-significant in Model 3 (OR: 0.86; 95% CI: 0.66-1.09; P = 0.209). In categorical analyses (reference: ≤40 mg/dL), participants with HDL-C ≥ 60 mg/dL exhibited a significantly lower prevalence of DR in Model 1 (OR: 0.73; 95% CI: 0.56-0.97; P = 0.028), a borderline association in Model 2 (OR: 0.76; 95% CI: 0.57-1.01; P = 0.059), and a non-significant association in Model 3 (OR: 0.83; 95% CI: 0.61-1.14; P = 0.259).

Conclusions: This study provides evidence of a linear association that elevated HDL-C levels are associated with decreased odds of DR in diabetic patients. Future research should further focus on elucidating the mechanisms underlying this association and its implications for therapeutic strategies.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-025-01728-z.