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

Associations between diabetic retinopathy and disease severity of diabetic nephropathy in patients with type 2 diabetes 2型糖尿病患者糖尿病视网膜病变与糖尿病肾病严重程度的关系

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-01-08 DOI: 10.1016/j.jdiacomp.2026.109256

Jia-hui Zhang , Jian-chen Hao , Dong-yuan Chang , Ming-hui Zhao , Min Chen

Background

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.

背景：糖尿病肾病（DN）和糖尿病视网膜病变（DR）是糖尿病（DM）的两大微血管并发症；然而，这两种糖尿病并发症的严重程度和进展之间的关系尚不清楚。方法回顾性研究303例活检证实的DN合并2型DM （T2DM）患者，通过眼底成像和光学相干断层扫描（OCT）对DR状态进行分层[增殖性DR （PDR）和糖尿病性黄斑水肿（DME）]。采用Kaplan-Meier分析和Cox回归模型评估肾脏预后，采用相应的统计检验评估组间比较和相关性。结果DR患者，尤其是晚期DR （PDR或DME）患者蛋白尿更重，肾脏病理更严重，表现为更高的分级（III/IV级），更严重的间质纤维化和肾小管萎缩，以及更高的Kimmelstiel-Wilson结节患病率。视网膜中央厚度与蛋白尿和血清总胆固醇呈正相关，与血红蛋白和血清白蛋白呈负相关。DR或DME的存在在一定程度上与不良肾结局相关。总之，这些发现表明，DR的存在和严重程度反映了t2dm相关DN患者更晚期的DN。需要进一步的调查来推断更广泛的T2DM人群的发现。

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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 : 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

A real-world experience with ranibizumab 0.5 mg initial intensive treatment for diabetic macular edema: 24-week outcomes of the RISING-K study 雷尼单抗0.5 mg初始强化治疗糖尿病黄斑水肿的真实世界经验：RISING-K研究的24周结果

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-12-22 DOI: 10.1016/j.jdiacomp.2025.109251

Kunho Bae , Na-Kyung Ryoo , Yong-Sok Ji , Jeong Hun Bae , In Young Chung , Han Joo Cho , Junyeop Lee , Jae Yon Won , Hyewon Chung , Younghoon Lee , Jihyun Park , Seung-Young Yu

Objective

To evaluate the efficacy of initial intensive ranibizumab 0.5 mg treatment in Korean patients with diabetic macular edema (DME).

Methods

This was a multicenter, observational, retrospective study including patients with DME who received an initial intensive treatment, operationally defined as ≥3 ranibizumab 0.5 mg injections within 4 months (including the first dose). Primary outcome was mean change in best-corrected visual acuity (BCVA) at Week 24. Secondary outcomes were mean change in central subfield thickness (CST), intraretinal (IRF) and subretinal fluid (SRF), and diabetic retinopathy severity score (DRSS). Subgroup analyses evaluated these endpoints according to patients with/without prior anti-vascular endothelial growth factor (VEGF) treatment and by fluid compartment.

Results

Of total 83 patients (mean age: 63.4 years), 15 (18.1 %) received prior anti-VEGFs. At Week 24, mean BCVA gain from baseline was 5.1 ± 9.3 letters (p < 0.001), 52.5 % and 13.8 % patients had ≥5 and ≥15 letters gain, respectively. Mean CST reduction from baseline was significant (−99.8 ± 122.1 μm; p < 0.001). DRSS improved in 19.2 % patients. BCVA gain showed higher tendency in eyes with prior anti-VEGF exposure (7.1 vs 4.7 letters; p = 0.0873), whereas CST reduction tended to be greater in treatment-naïve eyes (−106.7 vs −68.3 μm; p = 0.3377. All patients had IRF at baseline which disappeared in 29 % patients after 24 weeks resulting in BCVA improvement. At baseline, 23 % patients had SRF, of which 13 % resolved by Week 24. Patients without SRF at baseline had greater BCVA improvement, while patients with SRF at baseline had greater mean CST reduction.

Conclusion

Initial intensive treatment with ranibizumab 0.5 mg was effective in both treatment-naïve and prior-treated patients with DME. Functional outcomes varied by prior anti-VEGF treatment and fluid compartment.

目的：评价雷尼单抗0.5 mg初始强化治疗韩国糖尿病性黄斑水肿（DME）的疗效。方法：这是一项多中心、观察性、回顾性研究，纳入了最初接受强化治疗的DME患者，手术定义为在4个月内注射≥3次0.5 mg雷尼单抗（包括首次剂量）。主要终点是第24周最佳矫正视力（BCVA）的平均变化。次要结果是中心亚场厚度（CST）、视网膜内（IRF）和视网膜下液（SRF）的平均变化，以及糖尿病视网膜病变严重程度评分（DRSS）。亚组分析根据接受/未接受抗血管内皮生长因子（VEGF）治疗和液体室治疗的患者评估这些终点。结果：83例患者（平均年龄：63.4岁）中，15例（18.1%）接受过抗vegf治疗。在第24周，平均BCVA较基线增加为5.1±9.3个字母(p)。结论：初始强化治疗0.5 mg雷尼单抗对treatment-naïve和既往治疗的DME患者均有效。功能结果因先前的抗vegf治疗和液体腔室而异。

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引用次数: 0

Corrigendum to "Impact of technologies on quality of life in relation to glucose control in patients with type 1 diabetes" [JDC, volume 40, issue 1, (2026) 109215]. “技术对与1型糖尿病患者血糖控制相关的生活质量的影响”的更正[JDC，卷40，第1期，（2026）109215]。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-12-20 DOI: 10.1016/j.jdiacomp.2025.109254

Silvia Irina Briganti, Oreste Lanza, Valerio Renzelli, Giuseppe Campagna, Daria Maggi, Massimiliano Caprio, Silvia Manfrini, Rocky Strollo

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 : 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

Diabetic ketoacidosis and hyperosmolar hyperglycemic state in type 2 diabetes patients with severe kidney disease: a 7-year retrospective analysis 2型糖尿病合并严重肾脏疾病患者的糖尿病酮症酸中毒和高渗性高血糖状态：7年回顾性分析

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-12-18 DOI: 10.1016/j.jdiacomp.2025.109253

Weiwei Liang , Haocheng Yu , Honghua Deng , Junxin Chen , Yanglei Cheng , Zijun Xu , Yanbing Li , Hongyu Guan

Background

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) represent two critical, acute hyperglycemic emergencies that can occur in individuals with diabetes. This study specifically aims to evaluate the in-hospital outcomes of DKA and HHS among patients with type 2 diabetes (T2D) who have severe kidney disease.

Methods

We analyzed data from the National Inpatient Sample (2016–2022) to classify adults with T2D and severe kidney disease into three groups: DKA, HHS, and neither. We looked at in-hospital mortality as the primary outcome and assessed complications, length of stay (LOS), and hospitalization costs as secondary outcomes.

Results

A total of 4773 admissions had DKA, 2179 had HHS, and 683,079 had neither. DKA was associated with significantly worse outcomes, including higher in-hospital mortality, increased rates of complications, as well as longer hospital stays and higher costs compared to those without DKA or HHS. HHS showed smaller and less consistent differences compared to non-DKA/HHS. It was associated with increased risks of neurologic events, septic shock, and the need for mechanical ventilation. Direct comparison confirmed that DKA imposed a substantially greater clinical and economic burden than HHS.

Conclusions

DKA poses a significantly greater risk of in-hospital mortality and complications in T2D with severe kidney disease. This highlights the critical need for targeted prevention and management strategies for DKA in this vulnerable population.

糖尿病酮症酸中毒（DKA）和高渗性高血糖状态（HHS）是糖尿病患者可能发生的两种严重的急性高血糖紧急情况。本研究旨在评估伴有严重肾脏疾病的2型糖尿病（T2D）患者DKA和HHS的住院预后。方法分析2016-2022年全国住院患者样本数据，将t2dm合并严重肾脏疾病的成人患者分为DKA、HHS和两者均不存在的三组。我们将住院死亡率作为主要结局，评估并发症、住院时间（LOS）和住院费用作为次要结局。结果共4773例患者有DKA， 2179例有HHS， 683079例均无。与没有DKA或HHS的患者相比，DKA与更差的结果相关，包括更高的住院死亡率、并发症发生率增加、住院时间更长和费用更高。与非dka /HHS相比，HHS表现出较小且不一致的差异。它与神经系统事件、感染性休克和需要机械通气的风险增加有关。直接比较证实，DKA比HHS造成了更大的临床和经济负担。结论sdka对合并严重肾脏疾病的t2dm患者的院内死亡和并发症风险显著增加。这突出了在这一脆弱人群中制定有针对性的预防和管理DKA战略的迫切需要。

{"title":"Diabetic ketoacidosis and hyperosmolar hyperglycemic state in type 2 diabetes patients with severe kidney disease: a 7-year retrospective analysis","authors":"Weiwei Liang , Haocheng Yu , Honghua Deng , Junxin Chen , Yanglei Cheng , Zijun Xu , Yanbing Li , Hongyu Guan","doi":"10.1016/j.jdiacomp.2025.109253","DOIUrl":"10.1016/j.jdiacomp.2025.109253","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) represent two critical, acute hyperglycemic emergencies that can occur in individuals with diabetes. This study specifically aims to evaluate the in-hospital outcomes of DKA and HHS among patients with type 2 diabetes (T2D) who have severe kidney disease.</div></div><div><h3>Methods</h3><div>We analyzed data from the National Inpatient Sample (2016–2022) to classify adults with T2D and severe kidney disease into three groups: DKA, HHS, and neither. We looked at in-hospital mortality as the primary outcome and assessed complications, length of stay (LOS), and hospitalization costs as secondary outcomes.</div></div><div><h3>Results</h3><div>A total of 4773 admissions had DKA, 2179 had HHS, and 683,079 had neither. DKA was associated with significantly worse outcomes, including higher in-hospital mortality, increased rates of complications, as well as longer hospital stays and higher costs compared to those without DKA or HHS. HHS showed smaller and less consistent differences compared to non-DKA/HHS. It was associated with increased risks of neurologic events, septic shock, and the need for mechanical ventilation. Direct comparison confirmed that DKA imposed a substantially greater clinical and economic burden than HHS.</div></div><div><h3>Conclusions</h3><div>DKA poses a significantly greater risk of in-hospital mortality and complications in T2D with severe kidney disease. This highlights the critical need for targeted prevention and management strategies for DKA in this vulnerable population.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 2","pages":"Article 109253"},"PeriodicalIF":3.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788351","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}

引用次数: 0

Ezetimibe attenuates diabetic retinopathy via NRF2-mediated suppression of inflammation and oxidative stress 依折替米贝通过nrf2介导的炎症和氧化应激抑制糖尿病视网膜病变。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-12-13 DOI: 10.1016/j.jdiacomp.2025.109250

Lei Cheng , Shan Cheng , Ran Zhu , Guoxu Xu

Background

Diabetic retinopathy (DR) is a leading cause of blindness in working-age adults, driven by chronic inflammation and oxidative stress. Ezetimibe (EZE), a lipid-lowering agent, has been shown to activate the NRF2 pathway, but its role in DR remains unexplored. Our study utilized in vitro and in vivo models to investigate the protective effects of EZE on diabetic retinopathy (DR).

Methods

ARPE-19 cells were exposed to high glucose (HG, 25 mM) with or without EZE (5–20 μM) and/or ML385 (NRF2 inhibitor). NRF2 nuclear translocation, mitochondrial ROS (mtROS), and inflammatory mediators were assessed by Western blot, Immunofluorescence analysis, qPCR, and flow cytometry. In vivo, streptozotocin-induced diabetic wild-type (WT) and NRF2 knockout (Nrf2 KO) mice were treated with EZE (2 or 10 mg/kg/day) for 4 weeks. Retinal inflammation and structural integrity were evaluated by Western blot, H&E staining, and immunohistochemistry.

Results

EZE dose-dependently promoted NRF2 nuclear translocation and reduced HG-induced mtROS, NF-κB activation, and expression of TNF-α, IL-6, MCP-1, COX-2, iNOS, and VEGFA in ARPE-19 cells. These effects were abolished by ML385. In WT diabetic mice, EZE improved fasting glucose, preserved retinal layer thickness, and reduced retinal inflammation. In contrast, EZE failed to exert protective effects in Nrf2 KO mice.

Conclusions

EZE exerts retinal protection in DR via NRF2-mediated suppression of oxidative stress and inflammation. These findings support the potential repurposing of EZE as a safe intervention for DR.

背景：糖尿病性视网膜病变（DR）是导致工作年龄成年人失明的主要原因，由慢性炎症和氧化应激驱动。Ezetimibe （EZE）是一种降脂剂，已被证明可以激活NRF2通路，但其在DR中的作用仍未被探索。本研究利用体外和体内模型研究EZE对糖尿病视网膜病变（DR）的保护作用。方法：将ARPE-19细胞暴露于高糖（HG, 25 mM）中，加或不加EZE （5-20 μM）和/或ML385 （NRF2抑制剂）。通过Western blot、免疫荧光分析、qPCR和流式细胞术评估NRF2核易位、线粒体ROS （mtROS）和炎症介质。在体内，用EZE（2或10 mg/kg/天）治疗链脲佐菌素诱导的糖尿病野生型（WT）和NRF2敲除（NRF2 KO）小鼠4周。采用Western blot、H&E染色和免疫组织化学评价视网膜炎症和结构完整性。结果：EZE剂量依赖性地促进NRF2核易位，降低hg诱导的ARPE-19细胞mtROS、NF-κB活化以及TNF-α、IL-6、MCP-1、COX-2、iNOS和VEGFA的表达。这些效果被ML385取消了。在WT糖尿病小鼠中，EZE改善空腹血糖，保持视网膜层厚度，减少视网膜炎症。相比之下，EZE在Nrf2 KO小鼠中没有发挥保护作用。结论：EZE通过nrf2介导的氧化应激和炎症抑制对DR视网膜有保护作用。这些发现支持了EZE作为DR安全干预的潜在用途。

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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 : 2025-12-07 DOI: 10.1016/S1056-8727(25)00296-X

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 : 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

Corrigendum to 'What type 1 diabetes endotype is most suitable for anti-CD3 antibodies prevention trials?' [JDC, Vol. 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？[JDC, Vol. 39, Issue 10, 2025年10月，109132]。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-12-03 DOI: 10.1016/j.jdiacomp.2025.109230

Maria Aurora Roma-Wilson, Paolo Pozzilli

Type 1 Diabetes (T1D) is a heterogeneous autoimmune disease with multiple endotypes, each demonstrating distinct clinical and immunological characteristics. Teplizumab, an anti-CD3 monoclonal antibody, has emerged as a promising immunomodulatory therapy capable of delaying the progression of T1D in individuals with stage 2 disease. However, variability in therapeutic response suggests that certain endotypes may derive greater benefit from treatment. This review evaluates the suitability of different T1D endotypes (T1DE) for teplizumab prevention trials, with a particular focus on early-onset T1DE1 and T1DE2. Clinical trials demonstrate that individuals under 15 years of age, who demonstrate the highest immune activity, marked by aggressive T-cell infiltration and rapid pancreatic β-cell destruction, experience the most significant delay in disease progression following teplizumab treatment, highlighting the importance of early intervention. Furthermore, shifting individuals from the rapidly progressing T1DE1 trajectory to the more gradual T1DE2 course may extend functional insulin production and improve long-term metabolic outcomes. This paper underscores the need for expanded endotype-specific prevention trials and optimised screening protocols to identify high-risk individuals at the earliest stage. Future research should explore teplizumab's efficacy in younger populations and refine predictive biomarkers to enhance personalised intervention strategies in T1D management.

1型糖尿病（T1D）是一种具有多种内型的异质自身免疫性疾病，每种内型都表现出不同的临床和免疫学特征。Teplizumab是一种抗cd3单克隆抗体，已成为一种有前景的免疫调节疗法，能够延缓2期T1D患者的进展。然而，治疗反应的可变性表明某些内型可能从治疗中获得更大的益处。本综述评估了不同T1D内型（T1DE）在teplizumab预防试验中的适用性，特别关注早发性T1DE1和T1DE2。临床试验表明，15岁以下的个体表现出最高的免疫活性，以侵略性t细胞浸润和快速胰腺β细胞破坏为特征，在接受teplizumab治疗后，疾病进展的延迟最为显著，突出了早期干预的重要性。此外，将个体从快速发展的T1DE1轨迹转变为更缓慢的T1DE2过程可能会延长功能性胰岛素的产生并改善长期代谢结果。这篇论文强调了扩大内源性特异性预防试验和优化筛选方案的必要性，以便在早期阶段识别高风险个体。未来的研究应该探索teplizumab在年轻人群中的疗效，并完善预测性生物标志物，以增强T1D管理的个性化干预策略。

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引用次数: 0