{"title":"Extending beyond established cardiometabolic benefits of empagliflozin in type 2 diabetes: the evolving paradigm of glycemic variability.","authors":"Dimitrios Patoulias, Emir Muzurović, Viviana Maggio, Manfredi Rizzo","doi":"10.1016/j.jdiacomp.2026.109276","DOIUrl":"https://doi.org/10.1016/j.jdiacomp.2026.109276","url":null,"abstract":"","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":" ","pages":"109276"},"PeriodicalIF":3.1,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jdiacomp.2026.109275
Nicole Glaser, Zachary Chaffin, Daniel Tancredi, Arleta Rewers, Marian Rewers, Spencer Gilles, Bradley Ander, Simona Ghetti
Background: Complications of type 1 diabetes (T1D) are associated with exposure to hyperglycemia. Inflammation is involved in microvascular and macrovascular complications, but associations between hyperglycemia and inflammatory mediators across multiple classes have not been comprehensively described. We aimed to characterize the inflammatory profile associated with hyperglycemia in children with T1D.
Methods: We comprehensively evaluated blood inflammatory mediators (cytokines, chemokines, growth factors, matrix metalloproteinases (MMPs)) using multiplex immunoassays in 117 children with T1D. We used multiple linear regression analyses to assess the relations between inflammatory mediators (transformed to robust z-scores) and hemoglobin A1c (HbA1c), adjusting for age, diabetes duration and body mass index. We computed an inflammatory composite as the within-person mean of significantly associated robust z-scores.
Results: Levels of multiple inflammatory mediators were associated with HbA1c (p < 0.05 and False Discovery Rate-adjusted q < 0.10). These included cytokines [interleukin (IL)-1β, IL-1 receptor antagonist, IL-2, IL-4, IL-6, IL-8, IL-13, IL-17A, IL-17F, IL-18, IL-20, IL-21, IL-23, IL-33, interferon-γ, tumor necrosis factor (TNF)-α, TNF-related apoptosis inducing ligand (TRAIL), thrombopoietin, stem cell factor, leukemia inhibitory factor, chemokines (CCL1, CCL2, CCL4, CCL7, CCL8, CCL13, CCL26, CCL27, CXCL1, CXCL5, CXCL13), growth factors (vascular endothelial growth factor-A, transforming growth factor-α, platelet derived growth factor-AA), and MMPs (MMP-1, MMP-2, tissue inhibitor of MMP-1). Each percentage point increase in HbA1c was associated with a 0.16 increase in inflammatory composite score.
Conclusions: A broad range of inflammatory mediators are correlated with HbA1c in children with T1D. These inflammatory changes precede development of T1D complications, suggesting that possible pathophysiologic involvement should be investigated.
{"title":"Inflammatory profile associated with hyperglycemia in children with type 1 diabetes.","authors":"Nicole Glaser, Zachary Chaffin, Daniel Tancredi, Arleta Rewers, Marian Rewers, Spencer Gilles, Bradley Ander, Simona Ghetti","doi":"10.1016/j.jdiacomp.2026.109275","DOIUrl":"https://doi.org/10.1016/j.jdiacomp.2026.109275","url":null,"abstract":"<p><strong>Background: </strong>Complications of type 1 diabetes (T1D) are associated with exposure to hyperglycemia. Inflammation is involved in microvascular and macrovascular complications, but associations between hyperglycemia and inflammatory mediators across multiple classes have not been comprehensively described. We aimed to characterize the inflammatory profile associated with hyperglycemia in children with T1D.</p><p><strong>Methods: </strong>We comprehensively evaluated blood inflammatory mediators (cytokines, chemokines, growth factors, matrix metalloproteinases (MMPs)) using multiplex immunoassays in 117 children with T1D. We used multiple linear regression analyses to assess the relations between inflammatory mediators (transformed to robust z-scores) and hemoglobin A1c (HbA1c), adjusting for age, diabetes duration and body mass index. We computed an inflammatory composite as the within-person mean of significantly associated robust z-scores.</p><p><strong>Results: </strong>Levels of multiple inflammatory mediators were associated with HbA1c (p < 0.05 and False Discovery Rate-adjusted q < 0.10). These included cytokines [interleukin (IL)-1β, IL-1 receptor antagonist, IL-2, IL-4, IL-6, IL-8, IL-13, IL-17A, IL-17F, IL-18, IL-20, IL-21, IL-23, IL-33, interferon-γ, tumor necrosis factor (TNF)-α, TNF-related apoptosis inducing ligand (TRAIL), thrombopoietin, stem cell factor, leukemia inhibitory factor, chemokines (CCL1, CCL2, CCL4, CCL7, CCL8, CCL13, CCL26, CCL27, CXCL1, CXCL5, CXCL13), growth factors (vascular endothelial growth factor-A, transforming growth factor-α, platelet derived growth factor-AA), and MMPs (MMP-1, MMP-2, tissue inhibitor of MMP-1). Each percentage point increase in HbA1c was associated with a 0.16 increase in inflammatory composite score.</p><p><strong>Conclusions: </strong>A broad range of inflammatory mediators are correlated with HbA1c in children with T1D. These inflammatory changes precede development of T1D complications, suggesting that possible pathophysiologic involvement should be investigated.</p>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 3","pages":"109275"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Circulating extracellular vesicles (EVs) are emerging biomarkers of vascular dysfunction in diabetes. However, the impact of different antihyperglycemic treatments on EV profiles in individuals with type 2 diabetes (T2D) remains poorly investigated. This study aimed to compare circulating EV concentration between individuals with T2D and healthy controls, and to evaluate the effects of liraglutide, empagliflozin, and gliclazide on EV subpopulations.
Methods
In this single-centre clinical study, we enrolled 60 individuals with T2D and 20 healthy controls. Baseline concentrations of total, endothelial- (CD31+/CD41−), platelet- (CD31+/CD41+), and leukocyte-derived (CD45+) EVs were measured by flow cytometry on whole blood. In the interventional phase, sixty individuals with T2D were randomized to receive liraglutide (n = 20), empagliflozin (n = 20), or gliclazide (n = 20), in add on to metformin, for 12 weeks. EV subpopulations were assessed as exploratory mechanistic outcomes, alongside metabolic parameters, which were re-assessed post-treatment.
Results
At baseline, individuals with T2D had significantly higher concentrations of total, endothelial-, and platelet-derived EVs compared to healthy controls (p < 0.0001). After 12 weeks, liraglutide significantly reduced total EVs (−57%), endothelial-EVs (−85%), and platelet-EVs (−55%) (all p < 0.002), independently of changes in HbA1c or body weight. All subjects completed the study treatment. No significant EV changes were observed with empagliflozin or gliclazide. Leukocyte-derived EVs remained unchanged across all groups.
Conclusions
Circulating EVs are elevated in individuals with T2D even in the absence of overt vascular complications, suggesting early endothelial activation. Among antihyperglycemic agents, only liraglutide significantly reduced EV concentrations, pointing to potential direct vascular benefits. This study provides proof-of-concept data supporting EVs as translational markers of vascular health and treatment response in T2D.
{"title":"Modulation of circulating extracellular vesicles by antihyperglycemic therapies: A pilot randomized controlled trial","authors":"Maria Pompea Antonia Baldassarre , Federica Carrieri , Sara Coluzzi , Francesca D'Ascanio , Nadia Di Pietrantonio , Giorgia Centorame , Caterina Pipino , Paola Lanuti , Agostino Consoli , Gloria Formoso","doi":"10.1016/j.jdiacomp.2026.109273","DOIUrl":"10.1016/j.jdiacomp.2026.109273","url":null,"abstract":"<div><h3>Aims</h3><div>Circulating extracellular vesicles (EVs) are emerging biomarkers of vascular dysfunction in diabetes. However, the impact of different antihyperglycemic treatments on EV profiles in individuals with type 2 diabetes (T2D) remains poorly investigated. This study aimed to compare circulating EV concentration between individuals with T2D and healthy controls, and to evaluate the effects of liraglutide, empagliflozin, and gliclazide on EV subpopulations.</div></div><div><h3>Methods</h3><div>In this single-centre clinical study, we enrolled 60 individuals with T2D and 20 healthy controls. Baseline concentrations of total, endothelial- (CD31+/CD41−), platelet- (CD31+/CD41+), and leukocyte-derived (CD45+) EVs were measured by flow cytometry on whole blood. In the interventional phase, sixty individuals with T2D were randomized to receive liraglutide (<em>n</em> = 20), empagliflozin (n = 20), or gliclazide (n = 20), in add on to metformin, for 12 weeks. EV subpopulations were assessed as exploratory mechanistic outcomes, alongside metabolic parameters, which were re-assessed post-treatment.</div></div><div><h3>Results</h3><div>At baseline, individuals with T2D had significantly higher concentrations of total, endothelial-, and platelet-derived EVs compared to healthy controls (<em>p</em> < 0.0001). After 12 weeks, liraglutide significantly reduced total EVs (−57%), endothelial-EVs (−85%), and platelet-EVs (−55%) (all <em>p</em> < 0.002), independently of changes in HbA1c or body weight. All subjects completed the study treatment. No significant EV changes were observed with empagliflozin or gliclazide. Leukocyte-derived EVs remained unchanged across all groups.</div></div><div><h3>Conclusions</h3><div>Circulating EVs are elevated in individuals with T2D even in the absence of overt vascular complications, suggesting early endothelial activation. Among antihyperglycemic agents, only liraglutide significantly reduced EV concentrations, pointing to potential direct vascular benefits. This study provides proof-of-concept data supporting EVs as translational markers of vascular health and treatment response in T2D.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 3","pages":"Article 109273"},"PeriodicalIF":3.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1016/j.jdiacomp.2026.109269
Yufei Xiang, Xiaohan Tang, Yang Xiao, Xia Li, Gan Huang, Qichang Zhou, Zhiguang Zhou
Background: Latent autoimmune diabetes in adults (LADA) exhibits clinical features overlapping type 1 and type 2 diabetes. However, the burden and longitudinal progression of subclinical atherosclerosis (AS) in LADA, particularly under different treatments, remain insufficiently defined.
Methods: This retrospective secondary analysis used data from a previously conducted clinical trial evaluating β-cell-preserving therapies in LADA. A total of 103 adults with diabetes were included (64 LADA, 39 T2DM). Carotid and femoral intima-media thickness (IMT) were assessed using high-resolution B-mode ultrasound at baseline, and 48 LADA patients underwent repeat assessment after two years. Participants received either insulin-based therapy or oral antidiabetic drugs (OADs), including sulfonylureas (SUs) and non-SU agents. Multivariable regression and mixed-effects models were used to compare baseline IMT and evaluate longitudinal IMT change.
Results: Compared with T2DM, LADA participants were younger (p = 0.002) and had higher HbA1c (p = 0.001), with similar lipid profiles. Baseline carotid IMT was lower in LADA in unadjusted analyses but was comparable after multivariable adjustment (p = 0.579). Over two years, insulin-treated LADA participants showed no significant progression of carotid or femoral IMT. In contrast, SU exposure was associated with significant carotid IMT progression (p = 0.048) and a trend toward increased femoral IMT.
Conclusions: After adjustment for confounders, subclinical atherosclerosis in LADA was comparable to that in T2DM. In longitudinal analyses within LADA, insulin-based therapy was associated with stable IMT, whereas SU exposure was associated with greater IMT progression. These findings support further prospective studies to clarify treatment-related vascular effects in LADA and to inform cardiovascular risk-focused management.
{"title":"Treatment-related progression of subclinical atherosclerosis in latent autoimmune diabetes in adults: A two-year longitudinal study.","authors":"Yufei Xiang, Xiaohan Tang, Yang Xiao, Xia Li, Gan Huang, Qichang Zhou, Zhiguang Zhou","doi":"10.1016/j.jdiacomp.2026.109269","DOIUrl":"https://doi.org/10.1016/j.jdiacomp.2026.109269","url":null,"abstract":"<p><strong>Background: </strong>Latent autoimmune diabetes in adults (LADA) exhibits clinical features overlapping type 1 and type 2 diabetes. However, the burden and longitudinal progression of subclinical atherosclerosis (AS) in LADA, particularly under different treatments, remain insufficiently defined.</p><p><strong>Methods: </strong>This retrospective secondary analysis used data from a previously conducted clinical trial evaluating β-cell-preserving therapies in LADA. A total of 103 adults with diabetes were included (64 LADA, 39 T2DM). Carotid and femoral intima-media thickness (IMT) were assessed using high-resolution B-mode ultrasound at baseline, and 48 LADA patients underwent repeat assessment after two years. Participants received either insulin-based therapy or oral antidiabetic drugs (OADs), including sulfonylureas (SUs) and non-SU agents. Multivariable regression and mixed-effects models were used to compare baseline IMT and evaluate longitudinal IMT change.</p><p><strong>Results: </strong>Compared with T2DM, LADA participants were younger (p = 0.002) and had higher HbA1c (p = 0.001), with similar lipid profiles. Baseline carotid IMT was lower in LADA in unadjusted analyses but was comparable after multivariable adjustment (p = 0.579). Over two years, insulin-treated LADA participants showed no significant progression of carotid or femoral IMT. In contrast, SU exposure was associated with significant carotid IMT progression (p = 0.048) and a trend toward increased femoral IMT.</p><p><strong>Conclusions: </strong>After adjustment for confounders, subclinical atherosclerosis in LADA was comparable to that in T2DM. In longitudinal analyses within LADA, insulin-based therapy was associated with stable IMT, whereas SU exposure was associated with greater IMT progression. These findings support further prospective studies to clarify treatment-related vascular effects in LADA and to inform cardiovascular risk-focused management.</p>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 3","pages":"109269"},"PeriodicalIF":3.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1016/j.jdiacomp.2026.109270
Serena Low, Angela Moh, Huili Zheng, Kiat Sern Goh, Theedaraj Bun Chuan, Keven Ang, Wern Ee Tang, Ziliang Lim, Tavintharan Subramaniam, Chee Fang Sum, Su Chi Lim
Aims: We investigated if triglyceride glucose-body roundness index (TyG-BRI) was longitudinally related to cognitive function in individuals who had type 2 diabetes (T2D), and possible mediation by arterial stiffness.
Methods: In a prospective T2D cohort (N = 1412), we multiplied TyG (formula Ln [fasting triglyceride level - fasting plasma glucose / 2]) and BRI (formula 364.2-365.5 × √(1 - (waist circumference / 2ϖ)2 / (0.5 × height)2)) to derive TyG-BRI. We measured pulse wave velocity (PWV) using tonometry method. We determined cognitive performance with Repeatable Battery for Assessment for Neuropsychological Status(RBANS).
Results: We observed an inverse relationship between Ln TyG-BRI and RBANS score (total) at baseline (coefficient -1.33, 95%CI -2.62, -0.40) in adjusted analysis. Among 823 patients with follow-up cognitive assessment up to 8.4 years, this inverse relationship persisted (coefficient -2.01, 95%CI -3.60, -0.41) in adjusted linear mixed model analysis. The patients with higher Ln TyG-BRI score experienced RBANS score reduction in delayed memory, visuo-spatial/construction and attention on follow-up. The relationship between Ln TyG-BRI and RBANS score(total) was mediated by PWV (proportion mediated = 16.8%).
Conclusions: TyG-BRI is a promising biomarker for reduction in cognitive function in overall and domains of memory, visuo-spatial/construction and attention in T2D. Our results provide mechanistic insights into mediating role of arterial stiffness in the relationship.
{"title":"Understanding the role of triglyceride glucose-body roundness index (TyG-BRI) in the paradigm of cognitive decline over time in patients with type 2 diabetes.","authors":"Serena Low, Angela Moh, Huili Zheng, Kiat Sern Goh, Theedaraj Bun Chuan, Keven Ang, Wern Ee Tang, Ziliang Lim, Tavintharan Subramaniam, Chee Fang Sum, Su Chi Lim","doi":"10.1016/j.jdiacomp.2026.109270","DOIUrl":"https://doi.org/10.1016/j.jdiacomp.2026.109270","url":null,"abstract":"<p><strong>Aims: </strong>We investigated if triglyceride glucose-body roundness index (TyG-BRI) was longitudinally related to cognitive function in individuals who had type 2 diabetes (T2D), and possible mediation by arterial stiffness.</p><p><strong>Methods: </strong>In a prospective T2D cohort (N = 1412), we multiplied TyG (formula Ln [fasting triglyceride level - fasting plasma glucose / 2]) and BRI (formula 364.2-365.5 × √(1 - (waist circumference / 2ϖ)<sup>2</sup> / (0.5 × height)<sup>2</sup>)) to derive TyG-BRI. We measured pulse wave velocity (PWV) using tonometry method. We determined cognitive performance with Repeatable Battery for Assessment for Neuropsychological Status(RBANS).</p><p><strong>Results: </strong>We observed an inverse relationship between Ln TyG-BRI and RBANS score (total) at baseline (coefficient -1.33, 95%CI -2.62, -0.40) in adjusted analysis. Among 823 patients with follow-up cognitive assessment up to 8.4 years, this inverse relationship persisted (coefficient -2.01, 95%CI -3.60, -0.41) in adjusted linear mixed model analysis. The patients with higher Ln TyG-BRI score experienced RBANS score reduction in delayed memory, visuo-spatial/construction and attention on follow-up. The relationship between Ln TyG-BRI and RBANS score(total) was mediated by PWV (proportion mediated = 16.8%).</p><p><strong>Conclusions: </strong>TyG-BRI is a promising biomarker for reduction in cognitive function in overall and domains of memory, visuo-spatial/construction and attention in T2D. Our results provide mechanistic insights into mediating role of arterial stiffness in the relationship.</p>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 3","pages":"109270"},"PeriodicalIF":3.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vascular dementia (VaD) is strongly associated with type 2 diabetes (T2DM), overweight, and obesity. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduce cardiovascular risk and exhibit neuroprotective properties, yet their effects in incident VaD remain uncertain. This study evaluated whether GLP-1 RAs have preventive potential for VaD in adults with T2DM, overweight, or obesity.
Methods
A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) was conducted to estimate the risk of incident VaD among patients with T2DM or overweight/obesity treated with GLP-1 RAs versus placebo. Data were pooled using a random-effects model, with outcomes expressed as risk ratios (RRs) and 95% confidence intervals (CIs). Subgroup analysis was performed after stratification by population type (T2DM vs. overweight/obesity), and meta-regression assessed the association between RCT duration and effect size.
Results
Seven RCTs (six in T2DM, one in overweight/obesity) comprising 61,610 participants were included. GLP-1 RA treatment was not associated with a statistically significant difference in VaD incidence (RR: 0.50; 95% CI: 0.19–1.32; I2 = 0%). Subgroup analysis revealed no significant between-group differences (p for subgroups = 0.612), although numerically lower VaD rates were observed in the T2DM subgroup (RR: 0.38; 95% CI: 0.13–1.11). Meta-regression did not demonstrate a significant association between follow-up duration and treatment effect (β = −0.291; SE = 0.212; 95% CI: −0.843 to 0.262; p = 0.229).
Conclusions
The pooled evidence did not confirm a statistically significant reduction in VaD risk with GLP-1 RA therapy. Numerically lower VaD incidence in T2DM populations warrants further investigation in adequately powered and systematically adjudicated trials.
{"title":"Effects of GLP-1 receptor agonists on vascular dementia: a systematic review and meta-analysis","authors":"Maria-Ioanna Stefanou , Anastasios Tentolouris , Evangelos Panagiotopoulos , Aikaterini Theodorou , Annerose Mengel , Athanasia Athanasaki , Vaia Lambadiari , Melpomeni Peppa , Marianna Papadopoulou , Georgios P. Paraskevas , Sotirios Giannopoulos , Gerasimos Siasos , Vijay K. Sharma , Ulf Ziemann , Georgios Tsivgoulis","doi":"10.1016/j.jdiacomp.2026.109271","DOIUrl":"10.1016/j.jdiacomp.2026.109271","url":null,"abstract":"<div><h3>Background and aims</h3><div>Vascular dementia (VaD) is strongly associated with type 2 diabetes (T2DM), overweight, and obesity. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduce cardiovascular risk and exhibit neuroprotective properties, yet their effects in incident VaD remain uncertain. This study evaluated whether GLP-1 RAs have preventive potential for VaD in adults with T2DM, overweight, or obesity.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) was conducted to estimate the risk of incident VaD among patients with T2DM or overweight/obesity treated with GLP-1 RAs versus placebo. Data were pooled using a random-effects model, with outcomes expressed as risk ratios (RRs) and 95% confidence intervals (CIs). Subgroup analysis was performed after stratification by population type (T2DM vs. overweight/obesity), and meta-regression assessed the association between RCT duration and effect size.</div></div><div><h3>Results</h3><div>Seven RCTs (six in T2DM, one in overweight/obesity) comprising 61,610 participants were included. GLP-1 RA treatment was not associated with a statistically significant difference in VaD incidence (RR: 0.50; 95% CI: 0.19–1.32; I<sup>2</sup> = 0%). Subgroup analysis revealed no significant between-group differences (p for subgroups = 0.612), although numerically lower VaD rates were observed in the T2DM subgroup (RR: 0.38; 95% CI: 0.13–1.11). Meta-regression did not demonstrate a significant association between follow-up duration and treatment effect (β = −0.291; SE = 0.212; 95% CI: −0.843 to 0.262; p = 0.229).</div></div><div><h3>Conclusions</h3><div>The pooled evidence did not confirm a statistically significant reduction in VaD risk with GLP-1 RA therapy. Numerically lower VaD incidence in T2DM populations warrants further investigation in adequately powered and systematically adjudicated trials.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 3","pages":"Article 109271"},"PeriodicalIF":3.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1016/j.jdiacomp.2026.109268
Nick S.R. Lan , P. Gerry Fegan , Alicia J. Jenkins
{"title":"High risk, low evidence: Need for more research on lipid-lowering therapies for people with type 1 diabetes","authors":"Nick S.R. Lan , P. Gerry Fegan , Alicia J. Jenkins","doi":"10.1016/j.jdiacomp.2026.109268","DOIUrl":"10.1016/j.jdiacomp.2026.109268","url":null,"abstract":"","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 3","pages":"Article 109268"},"PeriodicalIF":3.1,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.jdiacomp.2026.109267
Si Hui Evangeline Tan, Priscilla Juay Qi Gan, Ester Yeoh, Allen Yan Lun Liu
Background: Hypoglycaemia remains a prevalent and dangerous complication of diabetes management in hospitalised dialysis patients, contributing to increased morbidity, mortality, and healthcare burden. This study evaluates the diagnostic performance, clinical applicability, and user acceptability of continuous glucose monitoring (CGM) in this vulnerable inpatient population.
Methods: A prospective pilot study was conducted involving 30 adult patients with diabetes mellitus undergoing either haemodialysis or peritoneal dialysis in an inpatient renal ward. Participants were monitored with the Dexcom G6 CGM system in parallel with routine capillary blood glucose (CBG) testing. Hypoglycaemic detection was assessed via sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and ROC analysis. Clinical concordance was evaluated using Bland-Altman plots, linear regression, mean absolute relative difference (MARD) and Parkes (Consensus) Error Grid analysis. Nurse and patient feedback were captured via validated questionnaires.
Results: CGM demonstrated a sensitivity of 68.8% and specificity of 97.3% for hypoglycaemia detection, with a PPV of 42.3% and a NPV of 99.1%. Subgroup analysis revealed similar trends across dialysis modalities, with slightly higher sensitivity in peritoneal dialysis patients. ROC curve analysis showed high diagnostic accuracy (area under the curve >0.95), while Bland-Altman and regression analyses confirmed strong agreement with CBG. The estimated MARD was 11.1%. Parkes (Consensus) Error Grid analysis also revealed that 98.6% (570 of 578) of CGM readings in clinically acceptable Zones A and B. Both patient satisfaction and nursing acceptance were high, supporting real-world feasibility.
Conclusions: CGM is a safe, reliable, and well-accepted adjunct for detecting hypoglycaemia in hospitalised dialysis patients. Its high specificity and NPV make it particularly valuable for ruling out hypoglycaemia. Broader implementation may enhance safety and reduce nursing burden. Further research with larger cohorts is warranted.
{"title":"Effectiveness and acceptability of continuous glucose monitoring in the detection of hypoglycaemia among renal dialysis patients with diabetes mellitus: A pilot study.","authors":"Si Hui Evangeline Tan, Priscilla Juay Qi Gan, Ester Yeoh, Allen Yan Lun Liu","doi":"10.1016/j.jdiacomp.2026.109267","DOIUrl":"https://doi.org/10.1016/j.jdiacomp.2026.109267","url":null,"abstract":"<p><strong>Background: </strong>Hypoglycaemia remains a prevalent and dangerous complication of diabetes management in hospitalised dialysis patients, contributing to increased morbidity, mortality, and healthcare burden. This study evaluates the diagnostic performance, clinical applicability, and user acceptability of continuous glucose monitoring (CGM) in this vulnerable inpatient population.</p><p><strong>Methods: </strong>A prospective pilot study was conducted involving 30 adult patients with diabetes mellitus undergoing either haemodialysis or peritoneal dialysis in an inpatient renal ward. Participants were monitored with the Dexcom G6 CGM system in parallel with routine capillary blood glucose (CBG) testing. Hypoglycaemic detection was assessed via sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and ROC analysis. Clinical concordance was evaluated using Bland-Altman plots, linear regression, mean absolute relative difference (MARD) and Parkes (Consensus) Error Grid analysis. Nurse and patient feedback were captured via validated questionnaires.</p><p><strong>Results: </strong>CGM demonstrated a sensitivity of 68.8% and specificity of 97.3% for hypoglycaemia detection, with a PPV of 42.3% and a NPV of 99.1%. Subgroup analysis revealed similar trends across dialysis modalities, with slightly higher sensitivity in peritoneal dialysis patients. ROC curve analysis showed high diagnostic accuracy (area under the curve >0.95), while Bland-Altman and regression analyses confirmed strong agreement with CBG. The estimated MARD was 11.1%. Parkes (Consensus) Error Grid analysis also revealed that 98.6% (570 of 578) of CGM readings in clinically acceptable Zones A and B. Both patient satisfaction and nursing acceptance were high, supporting real-world feasibility.</p><p><strong>Conclusions: </strong>CGM is a safe, reliable, and well-accepted adjunct for detecting hypoglycaemia in hospitalised dialysis patients. Its high specificity and NPV make it particularly valuable for ruling out hypoglycaemia. Broader implementation may enhance safety and reduce nursing burden. Further research with larger cohorts is warranted.</p>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 3","pages":"109267"},"PeriodicalIF":3.1,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-10DOI: 10.1016/S1056-8727(26)00006-1
{"title":"Contents/Barcode","authors":"","doi":"10.1016/S1056-8727(26)00006-1","DOIUrl":"10.1016/S1056-8727(26)00006-1","url":null,"abstract":"","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 2","pages":"Article 109261"},"PeriodicalIF":3.1,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetic nephropathy (DN) and diabetic retinopathy (DR) are two major microvascular complications of diabetes mellitus (DM); however, the association of the severity and progression between these two diabetic complications remains unclear.
Methods
This retrospective study included 303 biopsy-confirmed DN patients with type 2 DM (T2DM), stratified by DR status [proliferative DR (PDR) and diabetic macular edema (DME)] via fundus imaging and optical coherence tomography (OCT). Renal outcomes were evaluated using Kaplan-Meier analysis and Cox regression models, with between-group comparisons and correlations assessed using corresponding statistical tests.
Results
Patients with DR, particularly those with advanced DR (PDR or DME) had heavier proteinuria, more severe renal pathology, characterized by higher class (III/IV), more severe interstitial fibrosis and tubular atrophy, and a higher prevalence of Kimmelstiel-Wilson nodules. Central retinal thickness correlated positively with proteinuria and serum total cholesterol, negatively with hemoglobin and serum albumin. The presence of DR or DME was to some extent associated with adverse renal outcomes.
Conclusion
Collectively, these findings indicate that the presence and severity of DR reflect more advanced DN in patients with T2DM-associated DN. Further investigation is needed to extrapolate the findings to a broader T2DM population.
{"title":"Associations between diabetic retinopathy and disease severity of diabetic nephropathy in patients with type 2 diabetes","authors":"Jia-hui Zhang , Jian-chen Hao , Dong-yuan Chang , Ming-hui Zhao , Min Chen","doi":"10.1016/j.jdiacomp.2026.109256","DOIUrl":"10.1016/j.jdiacomp.2026.109256","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic nephropathy (DN) and diabetic retinopathy (DR) are two major microvascular complications of diabetes mellitus (DM); however, the association of the severity and progression between these two diabetic complications remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective study included 303 biopsy-confirmed DN patients with type 2 DM (T2DM), stratified by DR status [proliferative DR (PDR) and diabetic macular edema (DME)] <em>via</em> fundus imaging and optical coherence tomography (OCT). Renal outcomes were evaluated using Kaplan-Meier analysis and Cox regression models, with between-group comparisons and correlations assessed using corresponding statistical tests.</div></div><div><h3>Results</h3><div>Patients with DR, particularly those with advanced DR (PDR or DME) had heavier proteinuria, more severe renal pathology, characterized by higher class (III/IV), more severe interstitial fibrosis and tubular atrophy, and a higher prevalence of Kimmelstiel-Wilson nodules. Central retinal thickness correlated positively with proteinuria and serum total cholesterol, negatively with hemoglobin and serum albumin. The presence of DR or DME was to some extent associated with adverse renal outcomes.</div></div><div><h3>Conclusion</h3><div>Collectively, these findings indicate that the presence and severity of DR reflect more advanced DN in patients with T2DM-associated DN. Further investigation is needed to extrapolate the findings to a broader T2DM population.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 3","pages":"Article 109256"},"PeriodicalIF":3.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145957636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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