Journal of diabetes and its complications最新文献

英文中文

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。

{"title":"Variability in the urinary albumin-to-creatinine ratio predicts mortality in patients with type 2 diabetes","authors":"Jui-Tang Wu , Yu-Hsuan Li , Yu-Cheng Cheng , Kuo-Hsiung Shu , Junyi Wu , I-Te Lee","doi":"10.1016/j.jdiacomp.2025.109249","DOIUrl":"10.1016/j.jdiacomp.2025.109249","url":null,"abstract":"<div><h3>Aim</h3><div>To investigate the effects of variability in urinary albumin-to-creatinine ratio (UACR) on mortality in patients with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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/1.73m<sup>2</sup>, 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/1.73m<sup>2</sup>, 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.</div></div><div><h3>Conclusion</h3><div>UACR variability and increased UACR have a synergistic effect on mortality prediction in patients with T2DM.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 2","pages":"Article 109249"},"PeriodicalIF":3.1,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714732","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

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。

{"title":"Corrigendum to ‘What type 1 diabetes endotype is most suitable for anti-CD3 antibodies prevention trials?’ [JDC, Vol. 39, Issue 10, October 2025, 109132]","authors":"Maria Aurora Roma-Wilson , Paolo Pozzilli","doi":"10.1016/j.jdiacomp.2025.109230","DOIUrl":"10.1016/j.jdiacomp.2025.109230","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>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.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 3","pages":"Article 109230"},"PeriodicalIF":3.1,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145677830","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

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 : 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。

{"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}

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 : 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。

{"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}

引用次数: 0

Baseline NT-proBNP and incident heart failure in type 1 diabetes: The epidemiology of diabetes complications study 基线NT-proBNP与1型糖尿病心力衰竭：糖尿病并发症的流行病学研究

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-27 DOI: 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.

这项研究调查了NT-proBNP值是否与1型糖尿病患者长期心力衰竭（HF）发生率相关。我们的研究结果显示，在糖尿病并发症流行病学研究中，持续的lnNT-proBNP与10年HF风险显著相关，而指南推荐的NT-proBNP阈值≥125 ng/L则没有。

引用次数: 0

Dipeptidyl peptidase-4 inhibitors and diabetic retinopathy in type 2 diabetes: A network meta-analysis of randomized clinical trials 二肽基肽酶-4抑制剂与2型糖尿病视网膜病变：随机临床试验的网络荟萃分析

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-26 DOI: 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}

引用次数: 0

The role of small, dense lipoproteins in type-2 diabetes and maturity-onset diabetes of the young (MODY): What's new. 小而致密的脂蛋白在2型糖尿病和年轻人成熟型糖尿病（MODY）中的作用：什么是新的？

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-25 DOI: 10.1016/j.jdiacomp.2025.109233

Aleksandra Zeljkovic, Jelena Vekic, Mohamed A Elrayess, Manfredi Rizzo

引用次数: 0

Evidence-based validation of cardiovascular benefits from novel MRAs in type 2 diabetes: A meta-analysis of over 30,000 patients 新型MRAs治疗2型糖尿病心血管益处的循证验证：一项超过30,000例患者的荟萃分析

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-25 DOI: 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}

引用次数: 0

Current primary care approaches to diabetic foot prevention and treatment 目前预防和治疗糖尿病足的初级保健方法

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-24 DOI: 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.

糖尿病相关足病是糖尿病患者发病率和死亡率的重要来源，影响全球约1.8%的人口，导致许多人住院和非创伤性截肢。结构化的多学科护理管理糖尿病相关足病已被证明可以减少并发症发生率。初级保健提供者在糖尿病相关足病患者的教育、识别、管理和转诊方面发挥着至关重要的作用。这篇基于证据的评论文章结合了专家意见和基于研究的共识，为初级保健提供者提供了全面而可行的指导。它讨论了糖尿病相关足病护理的不同领域，包括预防、心脏代谢生物标志物、教育、风险分层、并发症检测、疾病分期、治疗选择和不同地理人群的管理考虑。

{"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}

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Journal of diabetes and its complications

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀