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

High risk, low evidence: Need for more research on lipid-lowering therapies for people with type 1 diabetes 高风险，低证据：需要对1型糖尿病患者的降脂疗法进行更多研究

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-01-22 DOI: 10.1016/j.jdiacomp.2026.109268

Nick S.R. Lan , P. Gerry Fegan , Alicia J. Jenkins

引用次数: 0

Effectiveness and acceptability of continuous glucose monitoring in the detection of hypoglycaemia among renal dialysis patients with diabetes mellitus: A pilot study 持续血糖监测在糖尿病肾透析患者中检测低血糖的有效性和可接受性：一项初步研究。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2026-01-16 DOI: 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.

背景：低血糖仍然是住院透析患者糖尿病管理的一个普遍和危险的并发症，有助于增加发病率、死亡率和医疗负担。本研究评估了连续血糖监测（CGM）在这一弱势住院人群中的诊断性能、临床适用性和用户可接受性。方法：对30例接受血液透析或腹膜透析的成年糖尿病患者进行前瞻性初步研究。受试者在常规毛细血管血糖（CBG）检测的同时，采用Dexcom G6 CGM系统进行监测。低血糖检测通过敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和ROC分析进行评估。临床一致性评估采用Bland-Altman图、线性回归、平均绝对相对差（MARD）和Parkes（共识）误差网格分析。通过有效的问卷收集护士和患者的反馈。结果：CGM检测低血糖的灵敏度为68.8%，特异性为97.3%，PPV为42.3%，NPV为99.1%。亚组分析揭示了不同透析方式的相似趋势，腹膜透析患者的敏感性略高。ROC曲线分析显示较高的诊断准确率（曲线下面积>0.95），Bland-Altman和回归分析证实了与CBG的强一致性。估计MARD为11.1%。Parkes（共识）误差网格分析还显示，98.6%（578个中的570个）的CGM读数在临床可接受的A区和b区。患者满意度和护理接受度都很高，支持现实世界的可行性。结论：CGM是一种安全、可靠、被广泛接受的检测住院透析患者低血糖的辅助手段。它的高特异性和净现值使其在排除低血糖方面特别有价值。更广泛的实施可以提高安全性并减轻护理负担。进一步的研究更大的队列是有必要的。

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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 : 2026-01-10 DOI: 10.1016/S1056-8727(26)00006-1

引用次数: 0

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。

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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