Journal of diabetes and its complications最新文献_第2页

Inflammatory profile associated with hyperglycemia in children with type 1 diabetes 1型糖尿病儿童与高血糖相关的炎症特征

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-03-01 Epub Date: 2026-02-01 DOI: 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.

背景：1型糖尿病（T1D）的并发症与高血糖暴露有关。炎症与微血管和大血管并发症有关，但高血糖和多种炎症介质之间的关系尚未得到全面描述。我们的目的是表征与T1D儿童高血糖相关的炎症特征。方法：采用多重免疫分析法对117例T1D患儿的血液炎症介质（细胞因子、趋化因子、生长因子、基质金属蛋白酶（MMPs））进行综合评价。我们使用多元线性回归分析来评估炎症介质（转化为稳健z分数）与血红蛋白A1c （HbA1c）之间的关系，调整年龄、糖尿病病程和体重指数。我们计算了炎症复合物作为显著相关稳健z分数的人内平均值。结果：多种炎症介质的水平与HbA1c相关(p)。结论：广泛的炎症介质与T1D儿童HbA1c相关。这些炎症变化先于T1D并发症的发展，表明应该调查可能的病理生理参与。

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引用次数: 0

Effects of GLP-1 receptor agonists on vascular dementia: a systematic review and meta-analysis GLP-1受体激动剂对血管性痴呆的影响：系统回顾和荟萃分析

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-03-01 Epub Date: 2026-01-26 DOI: 10.1016/j.jdiacomp.2026.109271

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

Background and aims

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.

背景和目的血管性痴呆（VaD）与2型糖尿病（T2DM）、超重和肥胖密切相关。胰高血糖素样肽-1受体激动剂（GLP-1 RAs）可降低心血管风险并具有神经保护特性，但其在VaD中的作用仍不确定。本研究评估GLP-1 RAs是否具有预防2型糖尿病、超重或肥胖成人VaD的潜力。方法对随机对照临床试验（RCTs）进行系统回顾和荟萃分析，以评估GLP-1 RAs治疗与安慰剂治疗相比，T2DM或超重/肥胖患者发生VaD的风险。使用随机效应模型合并数据，结果以风险比（rr）和95%置信区间（ci）表示。在按人群类型（T2DM vs.超重/肥胖）分层后进行亚组分析，并进行meta回归评估RCT持续时间和效应大小之间的关系。结果共纳入7项随机对照试验（6项T2DM， 1项超重/肥胖），共61610名参与者。GLP-1 RA治疗与VaD发病率无统计学意义差异（RR: 0.50; 95% CI: 0.19-1.32; I2 = 0%）。亚组分析显示组间无显著差异（亚组p = 0.612），尽管数值上T2DM亚组VaD发生率较低（RR: 0.38; 95% CI: 0.13-1.11）。meta回归未显示随访时间与治疗效果之间存在显著关联（β = - 0.291; SE = 0.212; 95% CI: - 0.843至0.262;p = 0.229）。结论：综合证据未证实GLP-1 RA治疗可显著降低VaD风险。数字上较低的VaD发病率在T2DM人群中值得进一步的调查，在充分的动力和系统裁决的试验。

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引用次数: 0

Corrigendum to “What type 1 diabetes endotype is most suitable for anti-CD3 antibodies prevention trials?” [JDC, volume 39, issue 10, October 2025, 109132] “哪种1型糖尿病内型最适合抗cd3抗体预防试验？”的勘误表[JDC，第39卷，第10期，2025年10月，109132]

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-03-01 Epub Date: 2026-02-04 DOI: 10.1016/j.jdiacomp.2025.109229

Maria Aurora Roma-Wilson , Paolo Pozzilli

引用次数: 0

Contents/Barcode 内容/条形码

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-03-01 Epub Date: 2026-02-11 DOI: 10.1016/S1056-8727(26)00026-7

引用次数: 0

Pre-treatment estimated glomerular filtration rate trajectory modifies the renoprotective effect of finerenone in patients with chronic kidney disease associated with type 2 diabetes. 治疗前估计的肾小球滤过率轨迹改变了芬烯酮在2型糖尿病相关慢性肾病患者中的肾保护作用。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-02-27 DOI: 10.1016/j.jdiacomp.2026.109308

Takamasa Iwamoto, Shuji Hidaka, Miyuki Iwamoto, Hirotaka Shibata

Aims: In this study, we aimed to investigate whether pre-treatment estimated glomerular filtration rate (eGFR) trajectory modifies the effects of finerenone on kidney function and albuminuria in patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D) (CKD-T2D).

Methods: This single-center retrospective study evaluated 60 patients with CKD-T2D treated with finerenone. The patients were categorized based on pre-treatment annual eGFR slope: Rising, Moderate-lowering, and Rapid-lowering. Linear mixed-effects models were used to assess longitudinal changes in eGFR and urinary albumin-to-creatinine ratio (UACR) over 12 months.

Results: A significant three-way interaction (P = 0.0004) confirmed the heterogeneous responses. Finerenone significantly attenuated eGFR decline in patients with pre-treatment deterioration: Rapid-lowering group improved by 3.9 mL/min/1.73 m²/year (P = 0.005) and Moderate-lowering group by 2.3 mL/min/1.73 m²/year (P = 0.014). Conversely, the Rising group showed slope conversion from +1.99 to -1.30 mL/min/1.73 m²/year (P = 0.009). In the overall cohort, eGFR change was not significant (P = 0.10). Notably, finerenone reduced UACR by approximately 32% in the overall cohort (P < 0.0001), with consistent reductions of 24-45% across all subgroups.

Conclusions: The renoprotective effect of finerenone was modified by pre-treatment eGFR trajectory, with substantial attenuation of eGFR decline in the Rapid- and Moderate-lowering groups. Conversely, in patients with a rising pre-treatment eGFR trajectory, finerenone induced an initial negative shift in the eGFR slope; however, this was accompanied by a significant reduction in albuminuria, suggesting a hemodynamic stabilization of glomerular hyperfiltration. Classification based on pre-treatment trajectory might inform personalized therapy in patients with CKD-T2D.

目的：在这项研究中，我们旨在研究治疗前估计的肾小球滤过率（eGFR）轨迹是否会改变芬烯酮对慢性肾脏疾病（CKD）合并2型糖尿病（T2D）（CKD-T2D）患者肾功能和蛋白尿的影响。方法：本单中心回顾性研究评估了60例接受芬烯酮治疗的CKD-T2D患者。根据治疗前的年eGFR斜率将患者分为上升、中等下降和快速下降。使用线性混合效应模型评估eGFR和尿白蛋白与肌酐比值（UACR）在12个月内的纵向变化。结果：显著的三方交互作用（P = 0.0004）证实了异质性反应。芬尼酮显著减缓治疗前恶化患者eGFR下降：快速降低组改善了3.9 mL/min/1.73 m2/年（P = 0.005），中等降低组改善了2.3 mL/min/1.73 m2/年（P = 0.014）。相反，上升组的斜率从+1.99到-1.30 mL/min/1.73 m2/年（P = 0.009）。在整个队列中，eGFR变化不显著（P = 0.10）。值得注意的是，在整个队列中，芬尼酮使UACR降低了约32% (P结论：芬尼酮的肾保护作用被预处理eGFR轨迹所改变，在快速和中度降低组中，eGFR下降明显减弱。相反，在治疗前eGFR升高的患者中，芬烯酮诱导了eGFR斜率的初始负移；然而，这伴随着蛋白尿的显著减少，提示肾小球高滤过的血流动力学稳定。基于治疗前轨迹的分类可能为CKD-T2D患者的个性化治疗提供信息。

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引用次数: 0

Rethinking diabetic foot ulcer care: Integrating exercise and physical activity 重新思考糖尿病足溃疡的护理：结合运动和体育活动。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-02-01 Epub Date: 2025-12-18 DOI: 10.1016/j.jdiacomp.2025.109252

Jane E. Nakamura , Angela J. Fong , Abbi D. Lane , Michael E. Munson , Brian M. Schmidt , Crystal M. Holmes , Jacob M. Haus

Because repetitive trauma and pressure contributes to diabetic foot ulcer (DFU) development and progression, offloading is one of the main therapies used in treatment. The term offloading has become conflated with a reduction in movement altogether, increasing sedentary time and, with it, the risk of associated adverse health outcomes. The aim of this narrative review is to evaluate the literature on movement-based interventions (reducing sedentary time, increasing physical activity (PA), or increasing exercise) in DFU patients. We found 16 articles that looked at the effect of exercise in individuals with a DFU. While many studies demonstrate the therapeutic potential of exercise, methodological inconsistencies between them prevent firm conclusions from being drawn regarding the efficacy of movement in promoting ulcer healing. The collected evidence underscores the need to address factors such as patient adherence, weight-bearing progression, and specifics surrounding movement programs (frequency, intensity, etc.) in future studies. Addressing these gaps, as well as determining barriers and facilitators to engaging in movement unique to those with a DFU, will advance research rigor and, with it, our understanding of how movement can be effectively leveraged to improve DFU care.

由于重复性创伤和压力有助于糖尿病足溃疡（DFU）的发展和进展，减压是治疗中使用的主要疗法之一。“减重”一词已经与运动的减少、久坐时间的增加以及相关不良健康结果的风险混为一谈。这篇叙述性综述的目的是评估关于DFU患者运动干预（减少久坐时间，增加身体活动（PA）或增加锻炼）的文献。我们找到了16篇研究运动对DFU患者影响的文章。虽然许多研究证明了运动的治疗潜力，但它们之间方法上的不一致阻碍了关于运动促进溃疡愈合功效的确切结论的得出。收集到的证据强调了在未来的研究中需要解决诸如患者依从性、负重进展和具体的运动计划（频率、强度等）等因素。解决这些差距，以及确定DFU患者独特的运动障碍和促进因素，将提高研究的严谨性，并由此提高我们对如何有效利用运动来改善DFU护理的理解。

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引用次数: 0

Linking HbA1c and white blood cell counts to the development of diabetic macular edema in type 2 diabetes: A systematic review and meta-analysis HbA1c和白细胞计数与2型糖尿病黄斑水肿发展的关系：一项系统综述和荟萃分析

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-02-01 Epub Date: 2025-12-01 DOI: 10.1016/j.jdiacomp.2025.109237

Linh Khanh Do , Charisse Yu-Jean Kuo , Stuti Lonie Misra , Rinki Murphy , Odunayo Omolola Mugisho

Aim

To investigate the association between HbA1c and white blood cell (WBC) counts with diabetic macular edema (DME) in type 2 diabetes (T2DM).

Methods

The study was registered on PROSPERO (registration number: CRD42024523016). A comprehensive literature search was conducted on PubMed and EMBASE up to May 2024, including studies investigating HbA1c and WBC counts in patients with T2DM, with and without DME. Standardized mean differences (SMD) and odds ratios (OR) with 95 % confidence intervals (CI) were calculated. A random-effects model was used to pool data. Risk of bias was evaluated using the Newcastle-Ottawa Scale.

Results

Forty-eight studies involving 207,536 participants were included. Egger's test indicated a significant publication bias among studies reporting HbA1c as OR 95 %CI. Pooled results showed that higher HbA1c may increase DME risk (SMD = 0.29, 95 %CI: 0.17 to 0.41; OR = 1.32, 95 %CI: 1.19 to 1.48). Although the same cohort, subgroup analyses found no associations between HbA1c and center-involved DME (SMD = 0.3, 95 %CI: -0.08 to 0.53) or DME development in severe non-proliferative diabetic retinopathy (NPDR)/PDR (SMD = -0.14, 95 %CI: -0.37 to 0.09). In contrast, lower lymphocyte count was significantly associated with DME (SMD = -0.24, 95 %CI: -0.45 to -0.03).

Conclusions

Higher HbA1c and lower lymphocyte count may increase DME risk in T2DM, suggesting potential roles of hyperglycemia and systemic inflammation in its etiology. However, substantial heterogeneity and publication bias warrant cautious interpretation. Future research should clarify the causal role of systemic inflammation through longitudinal studies and investigate DME across different DR stages and diagnostic criteria.

目的探讨2型糖尿病（T2DM）患者糖化血红蛋白（HbA1c）和白细胞（WBC）计数与糖尿病黄斑水肿（DME）的关系。方法本研究在PROSPERO注册（注册号：CRD42024523016）。到2024年5月，我们在PubMed和EMBASE上进行了全面的文献检索，包括研究T2DM患者的HbA1c和WBC计数，伴有和不伴有DME。计算95%置信区间（CI）的标准化平均差（SMD）和比值比（OR）。随机效应模型用于汇集数据。偏倚风险采用纽卡斯尔-渥太华量表进行评估。结果共纳入48项研究，共207,536名受试者。Egger的检验表明，报告HbA1c的研究有显著的发表偏倚，OR 95% CI。综合结果显示，较高的HbA1c可能增加DME的风险（SMD = 0.29, 95% CI: 0.17 ~ 0.41; OR = 1.32, 95% CI: 1.19 ~ 1.48）。在同一队列中，亚组分析发现HbA1c与中心相关性DME （SMD = 0.3, 95% CI: -0.08至0.53）或重度非增生性糖尿病视网膜病变(NPDR)/PDR （SMD = -0.14, 95% CI: -0.37至0.09）之间没有关联。相比之下，较低的淋巴细胞计数与DME显著相关（SMD = -0.24, 95% CI: -0.45至-0.03）。结论较高的HbA1c和较低的淋巴细胞计数可能增加T2DM患者DME的风险，提示高血糖和全身性炎症在其病因中可能起作用。然而，实质性的异质性和发表偏倚值得谨慎解释。未来的研究应通过纵向研究阐明全身性炎症的因果作用，并调查不同DR分期和诊断标准的DME。

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引用次数: 0

Association of atherogenic index of plasma baselines and trajectories with the progression from prediabetes to diabetes 血浆动脉粥样硬化指数基线和轨迹与糖尿病前期发展到糖尿病的关系

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-02-01 Epub Date: 2025-12-03 DOI: 10.1016/j.jdiacomp.2025.109238

Yongsheng Zhang , Wenqi Hu , Dawei Wang , Hongyu Zhang , Guang Zhang

Background

The atherogenic index of plasma (AIP) is recognized as a robust predictor of cardiovascular outcomes and diabetes incidence. However, no studies have comprehensively investigated the impact of baseline AIP levels and longitudinal AIP trajectories on diabetes progression in patients with prediabetes.

Methods

After data inclusion and exclusion, this retrospective cohort study included 16,411 patients with prediabetes undergoing ≥3 health examinations (2019–2024). Latent Class Trajectory Modeling characterized longitudinal AIP trajectory patterns, and Cox proportional-hazards models evaluated associations of baseline AIP quartiles and trajectory groups with diabetes progression.

Results

During a mean 4-year follow-up (65,644 person-years), 14.14 % patients with prediabetes (2320) progressed to diabetes. Baseline AIP quartiles showed a graded relationship with diabetes progression risk. Three AIP trajectories were identified: the low plateau trajectory (N = 4422, 26.95 %), the medium decreasing trajectory (N = 8183, 49.86 %), and the high decreasing trajectory (N = 3806, 23.19 %). Compared to the low plateau trajectory, the medium decreasing trajectory, and the high decreasing trajectory exhibited progressively elevated diabetes risk in the fully adjusted model (HR = 1.42, 95 % CI: 1.22–1.65 and HR = 2.26, 95 % CI: 1.81–2.83, respectively).

Conclusion

Patients with higher baseline AIP and higher trajectories are associated with higher risks for the progression from prediabetes to diabetes.

血浆动脉粥样硬化指数（AIP）被认为是心血管结局和糖尿病发病率的可靠预测指标。然而，目前还没有研究全面调查基线AIP水平和纵向AIP轨迹对糖尿病前期患者糖尿病进展的影响。方法经资料纳入和排除后，本回顾性队列研究纳入了16,411例接受≥3次健康检查的糖尿病前期患者（2019-2024年）。潜在类别轨迹模型表征了纵向AIP轨迹模式，Cox比例风险模型评估了基线AIP四分位数和轨迹组与糖尿病进展的关系。结果在平均4年的随访期间（65,644人年），14.14%的糖尿病前期患者（2320人）进展为糖尿病。基线AIP四分位数与糖尿病进展风险呈分级关系。AIP有3种轨迹：低平台轨迹（N = 4422, 26.95%）、中等下降轨迹（N = 8183, 49.86%）和高下降轨迹（N = 3806, 23.19%）。与低平台轨迹相比，中度下降轨迹和高下降轨迹在完全调整模型中表现出逐渐升高的糖尿病风险（HR = 1.42, 95% CI: 1.22-1.65, HR = 2.26, 95% CI: 1.81-2.83）。结论基线AIP越高，病程越长，糖尿病前期发展为糖尿病的风险越高。

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引用次数: 0

Effects of high estimated glomerular filtration rate on kidney prognosis in individuals with type 2 diabetes 高肾小球滤过率对2型糖尿病患者肾脏预后的影响。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-02-01 Epub Date: 2025-12-26 DOI: 10.1016/j.jdiacomp.2025.109255

Ko Hanai , Yurika Yamashige , Tomomi Mori , Yui Yamamoto , Hidekazu Murata , Tomohiro Shinozaki , Tomoko Nakagami

Aims

To clarify the effects of high glomerular filtration rate (GFR) at baseline on subsequent kidney failure in diabetes.

Methods

We performed a retrospective cohort study including 8369 individuals with type 2 diabetes. The exposure was baseline estimated GFR (eGFR), treated both as a categorical variable (with seven categories: ≥105, 90–105, 75–90, 60–75, 45–60, 30–45, and <30 mL/min/1.73 m²) and as a continuous variable. The outcome was a composite of a ≥40 % eGFR decrease or the kidney-replacement therapy initiation. We estimated the hazard ratios using a multivariable Cox proportional hazards model.

Results

Individuals with eGFR of ≥90 mL/min/1.73 m² as well as those with eGFR of <60 mL/min/1.73 m² significantly had higher outcome hazards than those with eGFR of 60–75 mL/min/1.73 m². The spline model exhibited a similar trend. When classifying individuals into three groups based on baseline urinary albumin-to-creatinine ratio (UACR) of <10, 10–30 or ≥30 mg/g, the outcome hazard of those with eGFR of ≥90 mL/min/1.73 m² increased as baseline UACR decreased, with a significant interaction (p < 0.001).

Conclusions

A high eGFR was a risk factor for kidney failure in individuals with type 2 diabetes. The lower the baseline UACR level, the stronger this association.

目的：阐明基线时高肾小球滤过率（GFR）对糖尿病患者继发肾衰竭的影响。方法：我们进行了一项包括8369例2型糖尿病患者的回顾性队列研究。暴露量为基线估计GFR (eGFR)，作为分类变量（7个类别：≥105、90-105、75-90、60-75、45-60、30-45和2）和连续变量处理。结果是eGFR下降≥40%或开始肾脏替代治疗的综合结果。我们使用多变量Cox比例风险模型估计风险比。结果：eGFR≥90 mL/min/1.73 m2及eGFR为2者预后风险明显高于eGFR为60 ~ 75 mL/min/1.73 m2者。样条模型也表现出类似的趋势。根据基线尿白蛋白与肌酐比值（UACR）为2而基线UACR降低，将个体分为三组，两者之间存在显著的相互作用(p)。结论：高eGFR是2型糖尿病患者肾衰竭的危险因素。基线UACR水平越低，这种关联就越强。

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引用次数: 0

Variability in the urinary albumin-to-creatinine ratio predicts mortality in patients with type 2 diabetes 尿白蛋白与肌酐比值的变化预测2型糖尿病患者的死亡率。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-02-01 Epub Date: 2025-12-05 DOI: 10.1016/j.jdiacomp.2025.109249

Jui-Tang Wu , Yu-Hsuan Li , Yu-Cheng Cheng , Kuo-Hsiung Shu , Junyi Wu , I-Te Lee

Aim

To investigate the effects of variability in urinary albumin-to-creatinine ratio (UACR) on mortality in patients with type 2 diabetes mellitus (T2DM).

Methods

This retrospective cohort study included 3536 patients with T2DM. The annual UACR data were collected not only in the index year but also within two years before the index year to calculate standard deviation (SD). The primary endpoint was all-cause mortality, which was identified by the National Death Registry files from the Ministry of Health and Welfare in Taiwan.

Results

During a median follow-up of 49.3 months, 242 (6.8 %) patients died. Among patients with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m², those in the increased UACR with high SD group had the highest hazard ratio (HR) for mortality (3.686; 95 % confidence interval [CI]: 2.116–6.421) compared with those in the normal UACR with low SD group. Similarly, among patients with an eGFR <60 mL/min/1.73m², those in the increased UACR with high SD group had the highest HR for mortality (3.404; 95 % CI: 1.361–8.511) compared with those in the normal UACR with low SD group.

Conclusion

UACR variability and increased UACR have a synergistic effect on mortality prediction in patients with T2DM.

目的：探讨尿白蛋白与肌酐比值（UACR）变异性对2型糖尿病（T2DM）患者死亡率的影响。方法：本回顾性队列研究纳入3536例T2DM患者。每年的UACR数据不仅收集指标年的数据，还收集指标年前两年的数据，计算标准差（SD）。主要终点为全因死亡率，由台湾卫生福利部的国家死亡登记档案确定。结果：在49.3个月的中位随访期间，242例（6.8%）患者死亡。在估计肾小球滤过率(glomerular filtration rate, eGFR)≥60 mL/min/1.73m2的患者中，UACR升高且SD值高的患者与UACR正常且SD值低的患者相比，死亡风险比（HR）最高（3.686；95%可信区间[CI]: 2.116-6.421）。同样，在eGFR 2患者中，与UACR正常且SD低的患者相比，UACR增高且SD高的患者死亡率最高（3.404;95% CI: 1.361-8.511）。结论：UACR变异性和升高的UACR对T2DM患者的死亡率预测具有协同作用。

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引用次数: 0