Pub Date : 2025-12-03DOI: 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.
{"title":"Association of atherogenic index of plasma baselines and trajectories with the progression from prediabetes to diabetes","authors":"Yongsheng Zhang , Wenqi Hu , Dawei Wang , Hongyu Zhang , Guang Zhang","doi":"10.1016/j.jdiacomp.2025.109238","DOIUrl":"10.1016/j.jdiacomp.2025.109238","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>N</em> = 4422, 26.95 %), the medium decreasing trajectory (<em>N</em> = 8183, 49.86 %), and the high decreasing trajectory (<em>N</em> = 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).</div></div><div><h3>Conclusion</h3><div>Patients with higher baseline AIP and higher trajectories are associated with higher risks for the progression from prediabetes to diabetes.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 2","pages":"Article 109238"},"PeriodicalIF":3.1,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693124","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 : 2025-12-01DOI: 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.
{"title":"Linking HbA1c and white blood cell counts to the development of diabetic macular edema in type 2 diabetes: A systematic review and meta-analysis","authors":"Linh Khanh Do , Charisse Yu-Jean Kuo , Stuti Lonie Misra , Rinki Murphy , Odunayo Omolola Mugisho","doi":"10.1016/j.jdiacomp.2025.109237","DOIUrl":"10.1016/j.jdiacomp.2025.109237","url":null,"abstract":"<div><h3>Aim</h3><div>To investigate the association between HbA1c and white blood cell (WBC) counts with diabetic macular edema (DME) in type 2 diabetes (T2DM).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 2","pages":"Article 109237"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736012","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 : 2025-11-27DOI: 10.1016/j.jdiacomp.2025.109235
William B. Horton , Mitra Mosslemi , Maria Sanchez Valenzuela , Rachel G. Miller , Trevor J. Orchard , Tina Costacou
This study investigated whether NT-proBNP values were associated with long-term heart failure (HF) incidence in people with type 1 diabetes. Our results showed continuous lnNT-proBNP was significantly associated with 10-year HF risk, while the guideline-recommended threshold NT-proBNP ≥125 ng/L was not, in the Epidemiology of Diabetes Complications Study.
{"title":"Baseline NT-proBNP and incident heart failure in type 1 diabetes: The epidemiology of diabetes complications study","authors":"William B. Horton , Mitra Mosslemi , Maria Sanchez Valenzuela , Rachel G. Miller , Trevor J. Orchard , Tina Costacou","doi":"10.1016/j.jdiacomp.2025.109235","DOIUrl":"10.1016/j.jdiacomp.2025.109235","url":null,"abstract":"<div><div>This study investigated whether NT-proBNP values were associated with long-term heart failure (HF) incidence in people with type 1 diabetes. Our results showed continuous lnNT-proBNP was significantly associated with 10-year HF risk, while the guideline-recommended threshold NT-proBNP ≥125 ng/L was not, in the Epidemiology of Diabetes Complications Study.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 1","pages":"Article 109235"},"PeriodicalIF":3.1,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648662","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 : 2025-11-26DOI: 10.1016/j.jdiacomp.2025.109234
Amparo Ortiz-Seller , José Tomás Real , Esteban Morcillo , José Luis Ortiz
Aims
To update evidence on the relationship between dipeptidyl peptidase-4 (DPP-4) inhibitors and incident diabetic retinopathy (DR) in type 2 diabetes.
Methods
We searched Embase, PubMed, Web of Science, and ClinicalTrials.gov (to July 2025) for randomized controlled trials (RCTs) and pooled odds ratios (ORs) with 95 % credible intervals (CrIs) using a Bayesian network meta-analysis. Network meta-regression assessed estimated effect modification; a model-based network meta-analysis (MBNMAdose) evaluated dose–response. Evidence certainty was appraised with Confidence in Network Meta-Analysis (CINeMA).
Results
Forty-three trials (74,546 participants; 779 DR events) were analyzed. No DPP-4 inhibitor significantly changed the DR risk versus placebo (ORs ranged from 0.31 [omarigliptin] to 2.31 [saxagliptin]; all CrIs crossed 1.0). Rankings suggested omarigliptin as most favorable, alogliptin/linagliptin/sitagliptin intermediate, and saxagliptin/teneligliptin least favorable. Baseline DR incidence moderated treatment effects; other prespecified covariates were not significant. MBNMAdose showed no dose-response relationship for DR.
Conclusions
Current randomized evidence indicates class-level neutrality of DPP-4 inhibitors on DR incidence, with no dose–response signal. Choice among gliptins may therefore be guided primarily by glycemic efficacy, safety, and participant characteristics rather than retinal risk.
目的研究二肽基肽酶-4 （DPP-4）抑制剂与2型糖尿病视网膜病变（DR）之间关系的最新证据。方法：我们检索Embase、PubMed、Web of Science和ClinicalTrials.gov（截至2025年7月）的随机对照试验（rct），并使用贝叶斯网络元分析合并95%可信区间（CrIs）的优势比（ORs）。网络元回归评估估计效果修正；基于模型的网络荟萃分析（MBNMAdose）评估了剂量-反应。证据确定性用网络元分析（CINeMA）的置信度评价。结果共纳入43项试验（74,546例受试者，779例DR事件）。与安慰剂相比，DPP-4抑制剂没有显著改变DR风险（ORs范围为0.31[奥马格利汀]至2.31[沙格列汀]；所有CrIs均超过1.0）。排名显示奥马格列汀最有利，阿格列汀/利格列汀/西格列汀中间，沙格列汀/替尼格列汀最不利。基线DR发生率调节治疗效果；其他预先指定的协变量不显著。结论目前的随机证据表明，DPP-4抑制剂对DR发病率的影响是类水平中性的，不存在剂量-反应信号。因此，格列汀类药物的选择可能主要以血糖功效、安全性和受试者特征为指导，而不是视网膜风险。
{"title":"Dipeptidyl peptidase-4 inhibitors and diabetic retinopathy in type 2 diabetes: A network meta-analysis of randomized clinical trials","authors":"Amparo Ortiz-Seller , José Tomás Real , Esteban Morcillo , José Luis Ortiz","doi":"10.1016/j.jdiacomp.2025.109234","DOIUrl":"10.1016/j.jdiacomp.2025.109234","url":null,"abstract":"<div><h3>Aims</h3><div>To update evidence on the relationship between dipeptidyl peptidase-4 (DPP-4) inhibitors and incident diabetic retinopathy (DR) in type 2 diabetes.</div></div><div><h3>Methods</h3><div>We searched Embase, PubMed, Web of Science, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (to July 2025) for randomized controlled trials (RCTs) and pooled odds ratios (ORs) with 95 % credible intervals (CrIs) using a Bayesian network meta-analysis. Network meta-regression assessed estimated effect modification; a model-based network meta-analysis (MBNMAdose) evaluated dose–response. Evidence certainty was appraised with Confidence in Network Meta-Analysis (CINeMA).</div></div><div><h3>Results</h3><div>Forty-three trials (74,546 participants; 779 DR events) were analyzed. No DPP-4 inhibitor significantly changed the DR risk versus placebo (ORs ranged from 0.31 [omarigliptin] to 2.31 [saxagliptin]; all CrIs crossed 1.0). Rankings suggested omarigliptin as most favorable, alogliptin/linagliptin/sitagliptin intermediate, and saxagliptin/teneligliptin least favorable. Baseline DR incidence moderated treatment effects; other prespecified covariates were not significant. MBNMAdose showed no dose-response relationship for DR.</div></div><div><h3>Conclusions</h3><div>Current randomized evidence indicates class-level neutrality of DPP-4 inhibitors on DR incidence, with no dose–response signal. Choice among gliptins may therefore be guided primarily by glycemic efficacy, safety, and participant characteristics rather than retinal risk.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 1","pages":"Article 109234"},"PeriodicalIF":3.1,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615023","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 : 2025-11-25DOI: 10.1016/j.jdiacomp.2025.109233
Aleksandra Zeljkovic, Jelena Vekic, Mohamed A Elrayess, Manfredi Rizzo
{"title":"The role of small, dense lipoproteins in type-2 diabetes and maturity-onset diabetes of the young (MODY): What's new.","authors":"Aleksandra Zeljkovic, Jelena Vekic, Mohamed A Elrayess, Manfredi Rizzo","doi":"10.1016/j.jdiacomp.2025.109233","DOIUrl":"https://doi.org/10.1016/j.jdiacomp.2025.109233","url":null,"abstract":"","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":" ","pages":"109233"},"PeriodicalIF":3.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634304","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 : 2025-11-25DOI: 10.1016/j.jdiacomp.2025.109236
Qi Fan , Guoqiang Qin , Bingyu Du , Mengfan Kan , Mengyuan Li , Qiu Li , Zhongwen Zhang
Aim
To evaluate the clinical efficacy and explore the potential mechanisms of novel mineralocorticoid receptor antagonists (MRAs) in reducing the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM).
Methods
Randomized controlled trials (RCTs), including relevant subgroup analyses, of steroidal MRAs (eplerenone, canrenone) and non-steroidal MRAs (finerenone, esaxerenone) in T2DM patients were identified through systematic searches of English and Chinese databases. Meta-analysis was performed to assess clinical outcomes, and network pharmacology was used to explore underlying molecular mechanisms.
Result
18 RCTs (including relevant subgroup analyses) involving 30,103 participants were included. MRAs significantly reduced MACE risk (OR = 0.81, 95 % CI: 0.75–0.86; P < 0.00001). MRAs also significantly decreased cardiovascular mortality (OR = 0.86, 95 % CI: 0.77–0.97; P = 0.01) and hospitalization for heart failure (OR = 0.77, 95 % CI: 0.68–0.87; P < 0.0001). Network pharmacology identified that steroidal MRAs mainly act via IL-17 and relaxin signaling pathways, targeting MAPK10, GSK3B, PTGS2, NOS2, and MMP1. Non-steroidal MRAs primarily modulate Ras and relaxin pathways, involving targets such as EGFR and PIK3C.
Conclusions
This study provides high-certainty evidence supporting MRAs in reducing MACE and heart failure hospitalization, and moderate-certainty evidence for benefits on cardiovascular mortality. Cardioprotective effects may involve Ras, IL-17, and relaxin signaling.
目的评价新型矿皮质激素受体拮抗剂（MRAs）降低2型糖尿病（T2DM）患者主要不良心血管事件（MACE）风险的临床疗效并探讨其潜在机制。方法通过系统检索中英文数据库，对2型糖尿病患者的甾体MRAs （eplerenone、canrenone）和非甾体MRAs （finerenone、esaxerenone）进行随机对照试验（rct），并进行亚组分析。meta分析用于评估临床结果，网络药理学用于探索潜在的分子机制。结果共纳入18项随机对照试验（含相关亚组分析），共纳入30103名受试者。MRAs显著降低MACE风险（OR = 0.81, 95% CI: 0.75-0.86; P < 0.00001）。MRAs还显著降低心血管死亡率（OR = 0.86, 95% CI: 0.77 - 0.97; P = 0.01）和心力衰竭住院率（OR = 0.77, 95% CI: 0.68-0.87; P < 0.0001）。网络药理学发现甾体MRAs主要通过IL-17和松弛素信号通路起作用，靶向MAPK10、GSK3B、PTGS2、NOS2和MMP1。非甾体MRAs主要调节Ras和松弛素通路，涉及EGFR和PIK3C等靶点。结论：本研究提供了高确定性证据支持MRAs降低MACE和心力衰竭住院率，中等确定性证据支持MRAs对心血管死亡率的益处。心脏保护作用可能涉及Ras、IL-17和松弛素信号。
{"title":"Evidence-based validation of cardiovascular benefits from novel MRAs in type 2 diabetes: A meta-analysis of over 30,000 patients","authors":"Qi Fan , Guoqiang Qin , Bingyu Du , Mengfan Kan , Mengyuan Li , Qiu Li , Zhongwen Zhang","doi":"10.1016/j.jdiacomp.2025.109236","DOIUrl":"10.1016/j.jdiacomp.2025.109236","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate the clinical efficacy and explore the potential mechanisms of novel mineralocorticoid receptor antagonists (MRAs) in reducing the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>Randomized controlled trials (RCTs), including relevant subgroup analyses, of steroidal MRAs (eplerenone, canrenone) and non-steroidal MRAs (finerenone, esaxerenone) in T2DM patients were identified through systematic searches of English and Chinese databases. Meta-analysis was performed to assess clinical outcomes, and network pharmacology was used to explore underlying molecular mechanisms.</div></div><div><h3>Result</h3><div>18 RCTs (including relevant subgroup analyses) involving 30,103 participants were included. MRAs significantly reduced MACE risk (OR = 0.81, 95 % CI: 0.75–0.86; <em>P</em> < 0.00001). MRAs also significantly decreased cardiovascular mortality (OR = 0.86, 95 % CI: 0.77–0.97; <em>P</em> = 0.01) and hospitalization for heart failure (OR = 0.77, 95 % CI: 0.68–0.87; <em>P</em> < 0.0001). Network pharmacology identified that steroidal MRAs mainly act via IL-17 and relaxin signaling pathways, targeting MAPK10, GSK3B, PTGS2, NOS2, and MMP1. Non-steroidal MRAs primarily modulate Ras and relaxin pathways, involving targets such as EGFR and PIK3C.</div></div><div><h3>Conclusions</h3><div>This study provides high-certainty evidence supporting MRAs in reducing MACE and heart failure hospitalization, and moderate-certainty evidence for benefits on cardiovascular mortality. Cardioprotective effects may involve Ras, IL-17, and relaxin signaling.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 1","pages":"Article 109236"},"PeriodicalIF":3.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615454","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 : 2025-11-24DOI: 10.1016/j.jdiacomp.2025.109231
Mahmoud Ibrahim , Ebtesam M. Ba-Essa , Asma Ahmed , David G. Armstrong , Mario Barmaki , Avivit Cahn , Kevin Cassar , Omer Hamtzany , José Luis Lázaro Martínez , Helard Manrique , Omar Mobarak , Ashu Rastogi , Manfredi Rizzo , Shehla Shaikh , Guillermo E. Umpierrez
Diabetes-related foot disease is a significant source of morbidity and mortality among people with diabetes, affecting approximately 1.8 % of the global population and leading to many hospital admissions and non-traumatic amputations. Structured multidisciplinary care for the management of diabetes-related foot disease has been shown to reduce complication rates. The role of primary care providers is crucial in the education, recognition, management, and referral of people with diabetes-related foot disease. This evidence-based review article combines expert opinion with research-based consensus to offer comprehensive yet actionable guidance for primary care providers. It discusses the different domains of care for diabetes-related foot disease, including prevention, cardiometabolic biomarkers, education, risk stratification, complication detection, disease staging, treatment options, and management considerations for different geographic populations.
{"title":"Current primary care approaches to diabetic foot prevention and treatment","authors":"Mahmoud Ibrahim , Ebtesam M. Ba-Essa , Asma Ahmed , David G. Armstrong , Mario Barmaki , Avivit Cahn , Kevin Cassar , Omer Hamtzany , José Luis Lázaro Martínez , Helard Manrique , Omar Mobarak , Ashu Rastogi , Manfredi Rizzo , Shehla Shaikh , Guillermo E. Umpierrez","doi":"10.1016/j.jdiacomp.2025.109231","DOIUrl":"10.1016/j.jdiacomp.2025.109231","url":null,"abstract":"<div><div>Diabetes-related foot disease is a significant source of morbidity and mortality among people with diabetes, affecting approximately 1.8 % of the global population and leading to many hospital admissions and non-traumatic amputations. Structured multidisciplinary care for the management of diabetes-related foot disease has been shown to reduce complication rates. The role of primary care providers is crucial in the education, recognition, management, and referral of people with diabetes-related foot disease. This evidence-based review article combines expert opinion with research-based consensus to offer comprehensive yet actionable guidance for primary care providers. It discusses the different domains of care for diabetes-related foot disease, including prevention, cardiometabolic biomarkers, education, risk stratification, complication detection, disease staging, treatment options, and management considerations for different geographic populations.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 1","pages":"Article 109231"},"PeriodicalIF":3.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614948","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 : 2025-11-23DOI: 10.1016/j.jdiacomp.2025.109232
Sanja Medenica , Dzihan Abazovic , Jovana Vukovic , Tanja Vojinovic , Filip Tomovic , Giuseppe Defeudis , Rossella Mazzilli , Zlata Kovacevic , Dusan Djurdjic , Vladimir Prelevic , Tanja Abazovic , Manfredi Rizzo , Essam M. Abdelalim
Diabetes mellitus, a chronic metabolic disorder characterized by hyperglycemia, has become a global health issue. The disease primarily presents as type 1 diabetes (T1D), caused by autoimmune β-cell destruction; type 2 diabetes (T2D), driven by insulin resistance and β-cell dysfunction; and monogenic diabetes, resulting from single-gene mutations affecting insulin production or β-cell function. Chronic hyperglycemia increases the risk of severe complications, including cardiovascular disease, neuropathy, and kidney failure. Despite advancements in insulin therapy and glucose monitoring, no cure currently exists for diabetes, with treatments mainly focused on managing symptoms rather than addressing the underlying β-cell loss. Regenerative medicine offers new hope, particularly through β-cell replacement strategies such as islet and stem cell-derived β-cell transplantation. Advances in generating hypoimmunogenic stem cell-derived pancreatic β-cells may help overcome immune rejection and donor shortages. These therapies have shown promise in clinical trials for both T1D and T2D. Furthermore, pharmacological strategies targeting β-cell regeneration show promise in enhancing β-cell proliferation and function. This review highlights the significant advancements in regenerative approaches for diabetes, underscoring the potential for long-term management and, ultimately, a cure for diabetes in the future.
{"title":"Regenerative medicine approaches for treating diabetes: Current advances and future directions","authors":"Sanja Medenica , Dzihan Abazovic , Jovana Vukovic , Tanja Vojinovic , Filip Tomovic , Giuseppe Defeudis , Rossella Mazzilli , Zlata Kovacevic , Dusan Djurdjic , Vladimir Prelevic , Tanja Abazovic , Manfredi Rizzo , Essam M. Abdelalim","doi":"10.1016/j.jdiacomp.2025.109232","DOIUrl":"10.1016/j.jdiacomp.2025.109232","url":null,"abstract":"<div><div>Diabetes mellitus, a chronic metabolic disorder characterized by hyperglycemia, has become a global health issue. The disease primarily presents as type 1 diabetes (T1D), caused by autoimmune β-cell destruction; type 2 diabetes (T2D), driven by insulin resistance and β-cell dysfunction; and monogenic diabetes, resulting from single-gene mutations affecting insulin production or β-cell function. Chronic hyperglycemia increases the risk of severe complications, including cardiovascular disease, neuropathy, and kidney failure. Despite advancements in insulin therapy and glucose monitoring, no cure currently exists for diabetes, with treatments mainly focused on managing symptoms rather than addressing the underlying β-cell loss. Regenerative medicine offers new hope, particularly through β-cell replacement strategies such as islet and stem cell-derived β-cell transplantation. Advances in generating hypoimmunogenic stem cell-derived pancreatic β-cells may help overcome immune rejection and donor shortages. These therapies have shown promise in clinical trials for both T1D and T2D. Furthermore, pharmacological strategies targeting β-cell regeneration show promise in enhancing β-cell proliferation and function. This review highlights the significant advancements in regenerative approaches for diabetes, underscoring the potential for long-term management and, ultimately, a cure for diabetes in the future.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 1","pages":"Article 109232"},"PeriodicalIF":3.1,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615455","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 : 2025-11-21DOI: 10.1016/j.jdiacomp.2025.109228
Jared Rosenberg , Allison Williams , Anny Gano , Molly M. Deak , Gabriel Q. Shaibi , Joon Young Kim
Gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), the two incretin hormones, play an important pathophysiological role in glucose homeostasis with insulinotropic effects on the pancreatic β-cells. While two previous studies in youth have examined the effects of a lifestyle intervention on incretin concentrations, neither study focused on improvements in glycemic status or oral glucose tolerance test (OGTT)-derived biomarkers. Therefore, we aimed to examine changes in the incretin responses during an OGTT before and after a 12-week lifestyle intervention in Latino youth with obesity and impaired glucose tolerance (IGT). A total of 9 Latino youth with obesity and IGT underwent a two-hour OGTT with 30-min blood samples collected for the measurement of glucose, insulin, and incretin hormones before and after the lifestyle intervention (nutrition education and 180 min of moderate-vigorous exercise weekly for a total of 12 weeks). From pre- to post-intervention, a trend towards reduction was observed in the total GIP area under the curve (AUC) during the OGTT (5499.1 ± 715.3 vs. 4085.2 ± 389.5 pg/mL, p = 0.059), with no change in GLP-1. Moreover, BMI%, glucose AUC, and two-hour glucose concentrations were significantly reduced after the intervention. Our data suggest that a lifestyle intervention in Latino youth with obesity and IGT could influence incretin and glucose metabolism. Future studies should examine if the GIP response to a lifestyle intervention is mediated by baseline glycemic status.
胃抑制多肽（GIP）和胰高血糖素样肽-1 （GLP-1）是两种肠促胰岛素激素，在葡萄糖稳态中起重要的病理生理作用，对胰腺β细胞具有促胰岛素作用。虽然之前有两项针对年轻人的研究考察了生活方式干预对肠促胰岛素浓度的影响，但这两项研究都没有关注血糖状态的改善或口服葡萄糖耐量试验（OGTT）衍生的生物标志物。因此，我们的目的是研究肥胖和糖耐量受损（IGT）的拉丁裔青年在12周生活方式干预前后OGTT中肠促胰岛素反应的变化。共有9名患有肥胖和IGT的拉丁裔青年接受了两个小时的OGTT，并在生活方式干预（营养教育和每周180分钟的中等剧烈运动，共12周）前后采集了30分钟的血液样本，用于测量葡萄糖、胰岛素和肠促胰岛素激素。从干预前到干预后，OGTT期间总GIP曲线下面积（AUC）有降低的趋势（5499.1±715.3 vs 4085.2±389.5 pg/mL, p = 0.059）， GLP-1无变化。此外，干预后BMI%、葡萄糖AUC和两小时葡萄糖浓度显著降低。我们的数据表明，对肥胖和IGT的拉丁裔青年进行生活方式干预可能会影响肠促胰岛素和葡萄糖代谢。未来的研究应该检查GIP对生活方式干预的反应是否由基线血糖状态介导。
{"title":"The effects of a 12-week lifestyle intervention on incretin response during an oral glucose tolerance test in Latino youth with obesity and impaired glucose tolerance","authors":"Jared Rosenberg , Allison Williams , Anny Gano , Molly M. Deak , Gabriel Q. Shaibi , Joon Young Kim","doi":"10.1016/j.jdiacomp.2025.109228","DOIUrl":"10.1016/j.jdiacomp.2025.109228","url":null,"abstract":"<div><div>Gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), the two incretin hormones, play an important pathophysiological role in glucose homeostasis with insulinotropic effects on the pancreatic β-cells. While two previous studies in youth have examined the effects of a lifestyle intervention on incretin concentrations, neither study focused on improvements in glycemic status or oral glucose tolerance test (OGTT)-derived biomarkers. Therefore, we aimed to examine changes in the incretin responses during an OGTT before and after a 12-week lifestyle intervention in Latino youth with obesity and impaired glucose tolerance (IGT). A total of 9 Latino youth with obesity and IGT underwent a two-hour OGTT with 30-min blood samples collected for the measurement of glucose, insulin, and incretin hormones before and after the lifestyle intervention (nutrition education and 180 min of moderate-vigorous exercise weekly for a total of 12 weeks). From pre- to post-intervention, a trend towards reduction was observed in the total GIP area under the curve (AUC) during the OGTT (5499.1 ± 715.3 vs. 4085.2 ± 389.5 pg/mL, <em>p</em> = 0.059), with no change in GLP-1. Moreover, BMI%, glucose AUC, and two-hour glucose concentrations were significantly reduced after the intervention. Our data suggest that a lifestyle intervention in Latino youth with obesity and IGT could influence incretin and glucose metabolism. Future studies should examine if the GIP response to a lifestyle intervention is mediated by baseline glycemic status.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 1","pages":"Article 109228"},"PeriodicalIF":3.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604447","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 : 2025-11-15DOI: 10.1016/j.jdiacomp.2025.109209
Daniel de Luis, Olatz Izaola, David Primo, Daniel Rico, Juan Jose López
Background and aims
No studies to date have specifically evaluated the effect of the rs1801282 polymorphism on body weight loss. This study evaluates the role of the PPARG rs1801282 polymorphism in modulating body weight loss and cardiovascular risk factor improvements in response to a partial meal replacement (pMR) hypocaloric diet among Caucasian patients with obesity.
Methods
A total of 512 subjects with severe obesity, defined by a body mass index (BMI) exceeding 35 kg/m2, were recruited for the study. Each participant was instructed to follow a pMR hypocaloric diet a 12-week intervention period. Throughout the trial, comprehensive assessments were performed, including anthropometric parameters (body weight, BMI, fat mass, and waist circumference), blood pressure, biochemical profiling (lipid concentrations, fasting insulin levels, and calculation of the homeostatic model assessment of insulin resistance (HOMA-IR)) and Metabolic syndrome (MS).
Results
The cohort included 107 individuals (20.9 %) homozygous for the CC allele, 203 individuals (39.6 %) heterozygous (CG), and 202 individuals (39.5 %) homozygous for the GG allele. BMI (−2.3 ± 0.3 kg/m2 vs − 1.0 ± 0.1 kg/m2 (p = 0.01)), body weight (−9.0 ± 1.1 kg vs − 3.8 ± 2.1 kg (p = 0.01)), fat mass (−8.1 ± 0.2 kg vs − 2.8 ± 0.2 kg (p = 0.01)), waist circumference (−6.8 ± 0.1 cm vs − 5.1 ± 0.1 cm (p = 0.01)), glucose levels (−15.1 ± 1.9 mg/dl vs − 4.1 ± 2.8 mg/dl, p = 0.01), insulin (−9.8 ± 1.3 UI/L vs − 3.7 ± 2.1 UI/L, p = 0.01), HOMA-IR (−2.2 ± 1.0 units vs − 0.60 ± 0.2 units, p = 0.01), CRP (−1.3 ± 0.1 mg/dl vs − 0.2 ± 0.2 mg/dl, p = 0.01), triglycerides (−24.1 ± 3.3 mg/dl vs − 4.1 ± 3.2 mg/dl, p = 0.01), total-cholesterol (−23.2 ± 1.1 mg/dl vs − 8.9 ± 1.2 mg/dl, p = 0.01), LDL-cholesterol (−17.2 ± 1.2 mg/dl vs − 5.7 ± 1.1 mg/dl, p = 0.01), and HDL-cholesterol (8.2 ± 0.3 mg/dl vs 2.3 ± 1.2 mg/dl, p = 0.01) modifications were better in non-G allele carriers. After intervention, the odds ratio (OR) of MS in non-carrier of G allele improved OR 0.39 (95 %CI: 0.24–0.63; p = 0.02).
Conclusions
This study shows that the PPARG rs1801282 polymorphism modulates the response to pMR in Caucasian patients with obesity, with G allele carriers displaying a less favourable improvement in body weight and metabolic parameters.
背景与目的：迄今为止，尚无研究专门评估rs1801282多态性对体重减轻的影响。本研究评估了PPARG rs1801282多态性在调节高加索肥胖患者部分代餐（pMR）低热量饮食后体重减轻和心血管危险因素改善中的作用。方法：共招募512名体重指数（BMI）超过35 kg/m2的重度肥胖受试者。每位参与者被要求在12周的干预期内遵循pMR低热量饮食。在整个试验过程中，进行了全面的评估，包括人体测量参数（体重、BMI、脂肪量和腰围）、血压、生化分析（脂质浓度、空腹胰岛素水平，以及胰岛素抵抗（HOMA-IR）的稳态模型评估计算）和代谢综合征（MS）。结果：CC等位基因纯合子107例（20.9%），CG杂合子203例（39.6%），GG等位基因纯合子202例（39.5%）。BMI(-2.3±0.3 kg / m2 vs - 1.0±0.1 kg / m2) (p = 0.01),体重(-9.0±1.1公斤vs - 3.8±2.1公斤(p = 0.01)),脂肪量(-8.1±0.2公斤vs - 2.8±0.2公斤(p = 0.01)),腰围(-6.8±0.1厘米和5.1±0.1厘米(p = 0.01),血糖水平(-15.1±1.9 mg / dl vs - 4.1±2.8 mg / dl, p = 0.01),胰岛素(-9.8±1.3 UI / UI / L L vs - 3.7±2.1,p = 0.01), HOMA-IR(-2.2±1.0单位vs - 0.60±0.2单位,p = 0.01), c反应蛋白(-1.3±0.1 mg / dl vs - 0.2±0.2 mg / dl, p = 0.01),甘油三酯(-24.1±3.3 mg / dl vs - 4.1±3.2 mg / dl, p = 0.01),总胆固醇(-23.2±1.1 mg / dl vs - 8.9±1.2 mg / dl, p = 0.01),低密度脂蛋白胆固醇(-17.2±1.2 mg / dl vs - 5.7±1.1 mg / dl, p = 0.01),和脂蛋白胆固醇(8.2±0.3 mg / dl vs 2.3±1.2 mg / dl, p = 0.01)修改好non-G等位基因携带者。干预后，非G等位基因携带者MS的优势比（OR）改善OR 0.39 （95% CI: 0.24 ~ 0.63; p = 0.02）。结论：本研究表明，PPARG rs1801282多态性调节了高加索肥胖患者对pMR的反应，G等位基因携带者在体重和代谢参数方面表现出不太有利的改善。
{"title":"Effect of the PPARG rs1801282 polymorphism on weight reduction and metabolic syndrome outcomes in obese individuals undergoing a partial meal replacement hypocaloric diet","authors":"Daniel de Luis, Olatz Izaola, David Primo, Daniel Rico, Juan Jose López","doi":"10.1016/j.jdiacomp.2025.109209","DOIUrl":"10.1016/j.jdiacomp.2025.109209","url":null,"abstract":"<div><h3>Background and aims</h3><div>No studies to date have specifically evaluated the effect of the <em>rs1801282</em> polymorphism on body weight loss. This study evaluates the role of the PPARG <em>rs1801282</em> polymorphism in modulating body weight loss and cardiovascular risk factor improvements in response to a partial meal replacement (pMR) hypocaloric diet among Caucasian patients with obesity.</div></div><div><h3>Methods</h3><div>A total of 512 subjects with severe obesity, defined by a body mass index (BMI) exceeding 35 kg/m<sup>2</sup>, were recruited for the study. Each participant was instructed to follow a pMR hypocaloric diet a 12-week intervention period. Throughout the trial, comprehensive assessments were performed, including anthropometric parameters (body weight, BMI, fat mass, and waist circumference), blood pressure, biochemical profiling (lipid concentrations, fasting insulin levels, and calculation of the homeostatic model assessment of insulin resistance (HOMA-IR)) and Metabolic syndrome (MS).</div></div><div><h3>Results</h3><div>The cohort included 107 individuals (20.9 %) homozygous for the CC allele, 203 individuals (39.6 %) heterozygous (CG), and 202 individuals (39.5 %) homozygous for the GG allele. BMI (−2.3 ± 0.3 kg/m<sup>2</sup> vs − 1.0 ± 0.1 kg/m<sup>2</sup> (p = 0.01)), body weight (−9.0 ± 1.1 kg vs − 3.8 ± 2.1 kg (p = 0.01)), fat mass (−8.1 ± 0.2 kg vs − 2.8 ± 0.2 kg (p = 0.01)), waist circumference (−6.8 ± 0.1 cm vs − 5.1 ± 0.1 cm (p = 0.01)), glucose levels (−15.1 ± 1.9 mg/dl vs − 4.1 ± 2.8 mg/dl, p = 0.01), insulin (−9.8 ± 1.3 UI/L vs − 3.7 ± 2.1 UI/L, p = 0.01), HOMA-IR (−2.2 ± 1.0 units vs − 0.60 ± 0.2 units, p = 0.01), CRP (−1.3 ± 0.1 mg/dl vs − 0.2 ± 0.2 mg/dl, p = 0.01), triglycerides (−24.1 ± 3.3 mg/dl vs − 4.1 ± 3.2 mg/dl, p = 0.01), total-cholesterol (−23.2 ± 1.1 mg/dl vs − 8.9 ± 1.2 mg/dl, p = 0.01), LDL-cholesterol (−17.2 ± 1.2 mg/dl vs − 5.7 ± 1.1 mg/dl, p = 0.01), and HDL-cholesterol (8.2 ± 0.3 mg/dl vs 2.3 ± 1.2 mg/dl, p = 0.01) modifications were better in non-G allele carriers. After intervention, the odds ratio (OR) of MS in non-carrier of G allele improved OR 0.39 (95 %CI: 0.24–0.63; p = 0.02).</div></div><div><h3>Conclusions</h3><div>This study shows that the PPARG rs1801282 polymorphism modulates the response to pMR in Caucasian patients with obesity, with G allele carriers displaying a less favourable improvement in body weight and metabolic parameters.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 1","pages":"Article 109209"},"PeriodicalIF":3.1,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563924","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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