Journal of diabetes and its complications最新文献_第8页

Prognostic value of non-alcoholic fatty liver disease, pericoronary fat attenuation index and computed tomography-derived fractional flow reserve in diabetic patients with suspected coronary artery disease 非酒精性脂肪性肝病、冠状动脉周围脂肪衰减指数和ct衍生的分流血流储备在糖尿病疑似冠状动脉疾病患者中的预后价值

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-08 DOI: 10.1016/j.jdiacomp.2025.109216

Ruili Qin , Changqin Jiang , Mengnan Zhang , Xueyan Hou , Xiaoling Tao , Shuang Pan , Zhaoqian Wang

Background

This study aimed to investigate the predictive value of non-alcoholic fatty liver disease (NAFLD), pericoronary fat attenuation index (FAI), and computed tomography-derived fractional flow reserve (CT-FFR) for major adverse cardiovascular events (MACE) in diabetic patients with suspected coronary artery disease.

Methods

This study retrospectively included 466 diabetic patients who underwent coronary computed tomography angiography (CCTA) and non-contrast chest CT from January 2017 to December 2018. The clinical data and imaging parameters of patients were collected. MACE was defined as rehospitalization for unstable angina, non-fatal myocardial infarction, late coronary revascularization, cardiac death, and all-cause mortality.

Results

During a median follow-up of 70 months, 76 patients experienced MACE. NAFLD (hazard ratio [HR] = 2.248; 95 % confidence interval [CI]: 1.362–3.710; P = 0.002), pericoronary FAI > −71.42 HU (HR = 4.063; 95 % CI: 2.316–7.131; P < 0.001), and CT-FFR ≤ 0.80 (HR = 6.023; 95 % CI: 2.567–14.132; P < 0.001) associated with MACE independently. We developed six MACE prediction models: model 1: traditional clinical risk factors; model 2: model 1 + NAFLD; model 3: model 2 + CCTA characteristics; model 4: model 3 + CT-FFR ≤ 0.80; model 5: model 3 + pericoronary FAI > −71.42 HU; model 6: model 5 + CT-FFR ≤ 0.80. The areas under curve of above six models were 0.698, 0.741, 0.861, 0.890, 0.917 and 0.936 respectively.

Conclusions

NAFLD, pericoronary FAI, and CT-FFR were independent predictors of MACE in diabetic patients. The multiparametric model 6 demonstrated the optimal predictive performance for MACE.

背景：本研究旨在探讨非酒精性脂肪性肝病（NAFLD）、冠状动脉周围脂肪衰减指数（FAI）和CT-FFR对疑似冠状动脉疾病的糖尿病患者主要不良心血管事件（MACE）的预测价值。方法：本研究回顾性纳入2017年1月至2018年12月接受冠状动脉计算机断层血管造影（CCTA）和胸部非对比CT检查的466例糖尿病患者。收集患者的临床资料及影像学参数。MACE定义为不稳定心绞痛、非致死性心肌梗死、晚期冠状动脉血运重建术、心源性死亡和全因死亡率的再住院。结果：在中位随访70个月期间，76例患者经历了MACE。NAFLD（风险比[HR] = 2.248； 95%可信区间[CI]: 1.362-3.710; P = 0.002），冠状动脉周围FAI > -71.42 HU (HR = 4.063; 95% CI: 2.316-7.131; P -71.42 HU；模型6：模型5 + CT-FFR≤0.80。上述6个模型的曲线下面积分别为0.698、0.741、0.861、0.890、0.917和0.936。结论：NAFLD、冠状动脉周围FAI和CT-FFR是糖尿病患者MACE的独立预测因子。多参数模型6显示了MACE的最佳预测性能。

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引用次数: 0

Age at type 2 diabetes diagnosis and risk of cancer: Cohort study in over 1 million individuals from the TriNetX US Collaborative Network 2型糖尿病诊断年龄与癌症风险：来自TriNetX美国合作网络的超过100万人的队列研究

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-08 DOI: 10.1016/j.jdiacomp.2025.109210

Tommy Slater , Gema Hernández Ibarburu , Zuzanna Drebert , Joseph Henson , Jonathan Goldney , Francesco Zaccardi , Jack A. Sargeant , Karen Brown , David R. Webb , Dimitris Papamargaritis , Juliana C.N. Chan , Edward W. Gregg , Kamlesh Khunti , Melanie J. Davies , Thomas Yates

Aims

To investigate whether the association between type 2 diabetes diagnosis and relative and absolute risk of obesity-related cancers differs based on age at diabetes diagnosis.

Methods

This retrospective, observational cohort study used data from the US Collaborative Network within the TriNetX database. Individuals with type 2 diabetes were propensity matched – for age, sex, and ethnicity – to individuals without type 2 diabetes. Crude 5-year risks of obesity-related cancer were calculated. Cox proportional-hazards models were used to assess relative rates of obesity-related cancer incidence over five years, comparing individuals with type 2 diabetes in younger (aged ≤40 years; n = 162,691) and middle-older age (aged >40 years; n = 1,616,950), with propensity-matched cohorts without type 2 diabetes.

Results

Absolute risk of developing cancer was greater in individuals with versus without type 2 diabetes. Relative rates of any cancer were greater in younger (HR: 2·01 [95 % CI: 1·85, 2·19]) than middle-older age adults (1·49 [1·48, 1·51]). The highest relative rates in younger adults were observed for corpus uteri (HR: 4·76 [3·51, 6·46]) and pancreatic cancer (4·25 [2·34, 7·72]). Corresponding HRs in middle-older age adults were 1·92 (1·84, 2·01) and 1·75 (1·68, 1·83).

Conclusions

The five-year risk of cancer was higher in those with newly diagnosed type 2 diabetes versus those without. Absolute risk was greater in middle-older age adults, although relative rates were greater amongst younger adults. This persisted across most site-specific cancers, suggesting targeted strategies for early detection and prevention may help younger adults with newly-diagnosed type 2 diabetes reduce lifetime disease burden.

目的：探讨2型糖尿病诊断与肥胖相关癌症的相对和绝对风险之间的关系是否因糖尿病诊断年龄的不同而不同。方法：这项回顾性、观察性队列研究使用的数据来自TriNetX数据库中的美国协作网络。2型糖尿病患者在年龄、性别和种族上与非2型糖尿病患者倾向匹配。粗略计算肥胖相关癌症的5年风险。使用Cox比例风险模型来评估5年内肥胖相关癌症发病率的相对发生率，比较年轻（年龄≤40岁，n = 162,691）和中老年（年龄≤40岁，n = 1,616,950）的2型糖尿病患者与无2型糖尿病的倾向匹配队列。结果：2型糖尿病患者患癌症的绝对风险高于非2型糖尿病患者。任何癌症的相对发病率，年轻人（HR: 2.01 [95% CI: 1.85, 2.19]）高于中老年成年人（HR: 1.49[1.48, 1.51]）。年轻人中相对发病率最高的是子宫（HR: 4.76[3.51, 6.46]）和胰腺癌（HR: 4.25[2.34, 7.72]）。中老年人群相应的hr分别为1.92（1.84、2.01）和1.75（1.68、1.83）。结论：新诊断的2型糖尿病患者的5年癌症风险高于未诊断的患者。中老年人的绝对风险更高，尽管年轻人的相对风险更高。这在大多数部位特异性癌症中持续存在，表明早期发现和预防的有针对性策略可能有助于新诊断的2型糖尿病的年轻人减少终生疾病负担。

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引用次数: 0

Impact of technologies on quality of life in relation to glucose control in patients with type 1 diabetes 技术对1型糖尿病患者血糖控制相关生活质量的影响

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-08 DOI: 10.1016/j.jdiacomp.2025.109215

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

Aim

To assess the effect of insulin delivery and glucose monitoring technologies on quality of life in relation with glucose control in adults with type 1 diabetes (T1D).

Methods

This cross-sectional study included 69 adults with T1D (mean age 39.3 ± 12.1 years; 44.9 % females): 36 on multiple daily insulin injections (MDI) and 33 on continuous subcutaneous insulin infusion (CSII). Patient-reported outcomes were assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQ), Diabetes-Specific Quality of Life Scale (DSQOLS), and SF-36. Glucose control was evaluated using HbA1c and CGM metrics.

Results

Individuals in the CSII group reported higher treatment-related satisfaction (p = 0.004), and better disease acceptance (p = 0.004) compared with individuals on MDI, despite similar age, sex or disease duration (p > 0.34). Time in range (TIR) resulted higher in the CSII group than in the MDI group (p = 0.02), while time below range (TBR) resulted higher in the MDI group compared to CSII (p = 0.03). Individuals reporting high satisfaction scores demonstrated better glucose control metrics compared to those with lower satisfaction levels. The association between satisfaction and TIR was relevant, even after adjusting for treatment modality (p = 0.0003).

Conclusions

Technology may improve quality of life over MDI treatment. Improvement in glucose control may partially account for this effect.

目的探讨胰岛素输送和血糖监测技术对1型糖尿病（T1D）患者生活质量及血糖控制的影响。方法横断研究纳入69例T1D患者（平均年龄39.3±12.1岁，女性占44.9%）：36例每日多次胰岛素注射（MDI）组，33例连续皮下胰岛素输注（CSII）组。采用糖尿病治疗满意度问卷（DTSQ）、糖尿病特异性生活质量量表（DSQOLS）和SF-36对患者报告的结果进行评估。使用HbA1c和CGM指标评估血糖控制。结果与MDI组相比，尽管年龄、性别或病程相似（p > 0.34）， CSII组的个体报告了更高的治疗相关满意度（p = 0.004）和更好的疾病接受度（p = 0.004）。CSII组的范围内时间（TIR）高于MDI组（p = 0.02），而MDI组的范围内时间（TBR）高于CSII组（p = 0.03）。与满意度较低的人相比，满意度高的人表现出更好的血糖控制指标。即使在调整治疗方式后，满意度和TIR之间的关联也是相关的（p = 0.0003）。结论与MDI治疗相比，技术可提高患者的生活质量。血糖控制的改善可能部分解释了这种效果。

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引用次数: 0

Nonlinear association of the hemoglobin glycation index with all-cause and cardiovascular mortality: A community-based cohort study 血红蛋白糖化指数与全因死亡率和心血管死亡率的非线性关联：一项基于社区的队列研究

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-07 DOI: 10.1016/j.jdiacomp.2025.109212

Junchen He , Haodong Zhang , Yinxi Tan , Huangda Guo , Hexiang Peng , Yi Zheng , Lunrongyi Tian , Xinru Liu , Yiqun Wu , Xueying Qin , Haiying Gong , Yao Zhao , Weifeng Wu , Tao Wu , Dafang Chen , Yonghua Hu , Mengying Wang

Background

The hemoglobin glycation index (HGI) has been increasingly recognized for predicting cardiovascular outcomes. However, its association with all-cause and cardiovascular disease (CVD) mortality in the general population remains underexplored. This study aimed to investigate the nonlinear relationship between the HGI and mortality, identify risk thresholds, and evaluate HGI's clinical utility for individualized risk stratification.

Methods

4857 participants from the Fangshan Family-based Ischemic Stroke Study in China (FISSIC) were included. Death dates were obtained by reviewing the death certificates until 2024/7/31. During a median follow-up of 8 years, 652 deaths were identified, including 379 deaths due to CVD. HGI was calculated as HGI = Observed hemoglobin A1c (HbA1c) − Predicted HbA1c. Cox proportional hazard regression models and restricted cubic splines were constructed to assess the relationship of HGI with mortality risk.

Results

This study revealed a J-shaped association of HGI with both all-cause and CVD mortality. For all-cause mortality, when HGI was below the threshold point (−0.58), the mortality risk slightly decreased with increasing HGI, with a hazard ratio (HR) of 0.821 (95 %CI: 0.666–1.011, P = 0.064). Conversely, when HGI exceeded −0.58, the mortality risk significantly increased with higher HGI (HR: 1.193, 95 % CI: 1.104–1.289, P < 0.001). CVD mortality exhibited similar threshold effects, with HGI < −0.58 trended toward lower risk (HR: 0.80, 95 %CI: 0.60–1.06, P = 0.114), whereas HGI > −0.58 showed marked risk elevation (HR: 1.23, 95 %CI: 1.11–1.36, P < 0.001).

Conclusion

This study demonstrates a nonlinear relationship of HGI with both all-cause and CVD mortality.

背景：血红蛋白糖化指数（HGI）越来越多地被认为是预测心血管预后的指标。然而，它与普通人群中全因和心血管疾病（CVD）死亡率的关系仍未得到充分探讨。本研究旨在探讨HGI与死亡率之间的非线性关系，确定风险阈值，并评估HGI在个体化风险分层中的临床应用。方法：从房山家庭缺血性脑卒中研究（FISSIC）中纳入4857名参与者。死亡日期是通过审查截至2024/7/31的死亡证明获得的。在中位8年的随访期间，确定了652例死亡，其中379例死于心血管疾病。HGI计算公式为HGI =观察到的血红蛋白A1c (HbA1c) -预测的HbA1c。构建Cox比例风险回归模型和限制三次样条曲线来评估HGI与死亡风险的关系。结果：本研究揭示了HGI与全因死亡率和CVD死亡率呈j型相关。对于全因死亡率，当HGI低于阈值点（-0.58）时，随着HGI的升高，死亡风险略有降低，风险比（HR）为0.821 （95% CI: 0.666 ~ 1.011, P = 0.064）。相反，当HGI超过-0.58时，随着HGI的升高，死亡风险显著增加(HR: 1.193, 95% CI: 1.104 ~ 1.289, P -0.58时，风险显著升高（HR: 1.23, 95% CI: 1.11 ~ 1.36， P）。结论：HGI与全因死亡率和心血管疾病死亡率均存在非线性关系。

{"title":"Nonlinear association of the hemoglobin glycation index with all-cause and cardiovascular mortality: A community-based cohort study","authors":"Junchen He , Haodong Zhang , Yinxi Tan , Huangda Guo , Hexiang Peng , Yi Zheng , Lunrongyi Tian , Xinru Liu , Yiqun Wu , Xueying Qin , Haiying Gong , Yao Zhao , Weifeng Wu , Tao Wu , Dafang Chen , Yonghua Hu , Mengying Wang","doi":"10.1016/j.jdiacomp.2025.109212","DOIUrl":"10.1016/j.jdiacomp.2025.109212","url":null,"abstract":"<div><h3>Background</h3><div>The hemoglobin glycation index (HGI) has been increasingly recognized for predicting cardiovascular outcomes. However, its association with all-cause and cardiovascular disease (CVD) mortality in the general population remains underexplored. This study aimed to investigate the nonlinear relationship between the HGI and mortality, identify risk thresholds, and evaluate HGI's clinical utility for individualized risk stratification.</div></div><div><h3>Methods</h3><div>4857 participants from the Fangshan Family-based Ischemic Stroke Study in China (FISSIC) were included. Death dates were obtained by reviewing the death certificates until 2024/7/31. During a median follow-up of 8 years, 652 deaths were identified, including 379 deaths due to CVD. HGI was calculated as <em>HGI = Observed hemoglobin A1c (HbA1c) − Predicted HbA1c</em>. Cox proportional hazard regression models and restricted cubic splines were constructed to assess the relationship of HGI with mortality risk.</div></div><div><h3>Results</h3><div>This study revealed a J-shaped association of HGI with both all-cause and CVD mortality. For all-cause mortality, when HGI was below the threshold point (−0.58), the mortality risk slightly decreased with increasing HGI, with a hazard ratio (HR) of 0.821 (95 %CI: 0.666–1.011, <em>P</em> = 0.064). Conversely, when HGI exceeded −0.58, the mortality risk significantly increased with higher HGI (HR: 1.193, 95 % CI: 1.104–1.289, <em>P</em> < 0.001). CVD mortality exhibited similar threshold effects, with HGI < −0.58 trended toward lower risk (HR: 0.80, 95 %CI: 0.60–1.06, <em>P</em> = 0.114), whereas HGI > −0.58 showed marked risk elevation (HR: 1.23, 95 %CI: 1.11–1.36, <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>This study demonstrates a nonlinear relationship of HGI with both all-cause and CVD mortality.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 1","pages":"Article 109212"},"PeriodicalIF":3.1,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495746","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 miR-200 family in type 2 diabetes: therapeutic and biomarker perspectives miR-200家族在2型糖尿病中的作用：治疗和生物标志物的观点

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-06 DOI: 10.1016/j.jdiacomp.2025.109211

Toluwalope Esther Ajonijebu , Sithandiwe Eunice Mazibuko-Mbeje

MicroRNAs (miRNAs) are critical regulators of gene expression and have emerged as promising biomarkers and therapeutic targets in type 2 diabetes (T2D). Among them, the miR-200 family (miR-200a, miR-200b, miR-200c, miR-141, and miR-429) plays key roles in insulin sensitivity, pancreatic β-cell survival, and inflammation. Dysregulation of miR-200a/b and miR-200c has been linked to insulin resistance and β-cell apoptosis, although findings are context dependent, with miR-200c showing both protective and deleterious effects. Therapeutic approaches include the use of antagomiRs to inhibit miR-200a/b (to improve insulin sensitivity) and miR-200c mimics at physiological/ moderate level (to enhance β-cell resilience under oxidative stress). Advances in nanoparticle delivery systems (liposomes, micelles, dendrimers) and chemical modifications such as 2′-O-methyl, 2′-O-methoxyethyl, and locked nucleic acids have improved stability and efficacy, though barriers remain in achieving tissue specificity and minimizing immune activation. In addition to therapy, miR-200 family members are attractive non-invasive biomarkers, with recent studies reporting encouraging sensitivity and specificity for early T2D detection and monitoring of disease progression. However, major challenges persist, including delivery barriers, long-term safety concerns, and limited validation in large, multi-ethnic human cohorts. This review synthesizes current evidence on the dual potential therapeutic strategies of miR-200 inhibition and mimicry, evaluates their biomarker utility, and highlights future directions needed to overcome translational gaps. By addressing these limitations, miR-200-based strategies hold potential to advance toward clinical application in T2D.

MicroRNAs （miRNAs）是基因表达的关键调控因子，已成为2型糖尿病（T2D）有前景的生物标志物和治疗靶点。其中，miR-200家族（miR-200a、miR-200b、miR-200c、miR-141和miR-429）在胰岛素敏感性、胰腺β细胞存活和炎症中起关键作用。miR-200a/b和miR-200c的失调与胰岛素抵抗和β细胞凋亡有关，尽管研究结果依赖于环境，miR-200c显示出保护和有害作用。治疗方法包括使用拮抗剂在生理/中等水平抑制miR-200a/b（改善胰岛素敏感性）和miR-200c模拟物（增强氧化应激下β细胞的恢复能力）。纳米颗粒递送系统（脂质体、胶束、树突大分子）和化学修饰（如2'- o -甲基、2'- o -甲氧基乙基和锁定核酸）的进步提高了稳定性和有效性，尽管在实现组织特异性和最小化免疫激活方面仍然存在障碍。除了治疗之外，miR-200家族成员是有吸引力的非侵入性生物标志物，最近的研究报告了早期T2D检测和疾病进展监测的令人鼓舞的敏感性和特异性。然而，主要的挑战仍然存在，包括递送障碍、长期安全问题以及在大型多种族人群中的有限验证。这篇综述综合了目前关于miR-200抑制和模仿的双重潜在治疗策略的证据，评估了它们的生物标志物效用，并强调了克服翻译空白所需的未来方向。通过解决这些局限性，基于mir -200的策略有可能在T2D的临床应用中取得进展。

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引用次数: 0

Empagliflozin versus metformin for glucose variability and metabolic outcomes in drug-naïve type 2 diabetes: The EMPA-FIT study 恩格列净与二甲双胍对drug-naïve 2型糖尿病的葡萄糖变异性和代谢结果：EMPA-FIT研究

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-05 DOI: 10.1016/j.jdiacomp.2025.109214

Soo Lim , Cheol Young Park , In Kyung Jeong , Ji Sung Yoon , Sang Yong Kim , Eun Seok Kang , Junghyun Noh , Kyu Yeon Hur , Sungrae Kim

Aims

Sodium-glucose cotransporter-2 (SGLT2) inhibitors offer cardiovascular and renal benefits beyond glycemic control. However, their effect on glucose variability (GV) in drug-naïve individuals with type 2 diabetes (T2D) is not well established. This study compared the effects of empagliflozin versus metformin on GV and metabolic outcomes.

Methods

In this multicenter, open-label, randomized study, 46 drug-naïve adults with T2D (HbA1c 6.5 %–10.0 %) received empagliflozin (10 mg/day; n = 23) or metformin (1000 mg/day; n = 23) for 12 weeks. The primary outcome was change in mean amplitude of glucose excursions (MAGE), assessed by continuous glucose monitoring. Secondary outcomes included standard deviation of glucose, time-in-range (TIR), metabolic parameters, and safety.

Results

At Week 12, empagliflozin significantly reduced MAGE (−19.58 mg/dL; 95 % CI: −30.62, −8.53) compared with metformin (−4.33 mg/dL; 95 % CI: −7.98, −0.68) (n = 19 vs. n = 18, respectively). TIR improved in both groups, with no significant between-group differences. Empagliflozin treatment led to greater reductions in body weight and waist circumference, along with increases in HDL-cholesterol and decreases in triglyceride and uric acid levels. The decrease in HbA1c from baseline was greater in the empagliflozin group (−1.15 % [95 % CI: −1.44, −0.85]) than in the metformin group (−0.78 % [95 % CI: −1.02, −0.54]), resulting in a statistically significant between-group difference (p = 0.049). Adverse events were mild and comparable between groups.

Conclusions

Empagliflozin significantly reduced GV and provided additional metabolic benefits in drug-naïve individuals with T2D. These findings support its potential utility in early diabetes management, particularly in targeting glycemic variability.

目的：钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂除了血糖控制外，还对心血管和肾脏有益。然而，它们对drug-naïve 2型糖尿病（T2D）患者血糖变异性（GV）的影响尚未得到很好的证实。本研究比较了恩格列净与二甲双胍对GV和代谢结果的影响。方法：在这项多中心、开放标签、随机研究中，46名drug-naïve T2D成人（HbA1c 6.5% - 10.0%）接受了恩格列清（10mg /天，n = 23）或二甲双胍（1000mg /天，n = 23）治疗12周。主要终点是葡萄糖漂移平均幅度（MAGE）的变化，通过连续血糖监测来评估。次要结局包括葡萄糖标准偏差、时间范围（TIR）、代谢参数和安全性。结果：在第12周，与二甲双胍（-4.33 mg/dL; 95% CI: -7.98, -0.68）相比，恩格列净显著降低了MAGE (-19.58 mg/dL; 95% CI: -30.62, -8.53) （n = 19 vs. n = 18）。两组的TIR均有改善，组间无显著差异。恩格列净治疗导致体重和腰围的显著减少，高密度脂蛋白胆固醇的增加，甘油三酯和尿酸水平的降低。依帕列净组HbA1c较基线下降幅度（- 1.15% [95% CI: -1.44, -0.85]）大于二甲双胍组（- 0.78% [95% CI: -1.02, -0.54]），组间差异有统计学意义（p = 0.049）。组间不良事件轻微且具有可比性。结论：恩帕列净显著降低了drug-naïve T2D患者的GV，并提供了额外的代谢益处。这些发现支持其在早期糖尿病管理中的潜在效用，特别是针对血糖变异性。

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引用次数: 0

Efficacy and safety of finerenone in Asian patients with type 2 diabetes and chronic kidney disease: A FIDELITY analysis by baseline kidney function 芬尼酮在亚洲2型糖尿病合并慢性肾病患者中的疗效和安全性：基线肾功能的FIDELITY分析

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-04 DOI: 10.1016/j.jdiacomp.2025.109213

Shigehiro Katayama , Stefan D Anker , Dalong Zhu , SungGyun Kim , Ming-Ju Wu , Daiji Kawanami , Peter Rossing , Luis Miguel Ruilope , Christiane Ahlers , Meike Brinker , Amaninder Mann , Yunjing Tian , Satoshi Yamashita , Bertram Pitt , on behalf of the FIDELIO-DKD and FIGARO-DKD Investigators

Aims

Define the effect of finerenone on kidney function within the overall FIDELITY Asian subpopulation.

Methods

This FIDELITY pooled subanalysis assessed the following outcomes in the Asian subpopulation: chronic estimated glomerular filtration rate (eGFR) slope, urine albumin-to-creatinine ratio (UACR) from baseline to month 4, time to UACR regression, and safety.

Results

In total, 2858 (22.0 %) participants included in FIDELITY were Asian. Chronic eGFR slope was reduced with finerenone compared with placebo in the Asian subpopulation; least-squares mean between-group difference was 1.08 mL/min/1.73 m² (95 % confidence interval 0.53–1.63; p = 0.0002). Greater reductions in chronic eGFR slope were also observed for finerenone compared with placebo when analyzed according to baseline UACR. Finerenone treatment reduced UACR from baseline to month 4 by 34 %. This treatment effect was seen regardless of baseline eGFR, systolic blood pressure, glycated hemoglobin, body mass index, sodium-glucose co-transporter-2 inhibitor use, and glucagon-like peptide-1 receptor agonist use. Regression from high to normal albuminuria was seen in 39.5 % of all Asian participants treated with finerenone versus 14.8 % receiving placebo. Treatment-emergent adverse events were similar between finerenone and placebo, and hyperkalemia was manageable.

Conclusion

Finerenone slows eGFR decline and lowers UACR in Asian participants with chronic kidney disease and type 2 diabetes.

Trial registration number: FIDELIO-DKD (NCT02540993); FIGARO-DKD (NCT02545049).

目的：确定精芬烯酮对全亚洲富达亚群肾功能的影响。方法：本FIDELITY合并亚群分析评估了亚洲亚群的以下结果：慢性肾小球滤过率（eGFR）斜率，从基线到第4个月的尿白蛋白与肌酐比（UACR），时间到UACR的回归，以及安全性。结果：总共有2858名（22.0%）受试者是亚洲人。在亚洲亚群中，与安慰剂相比，细芬烯酮降低了慢性eGFR斜率；最小二乘平均组间差异为1.08 mL/min/1.73 m2（95%置信区间0.53 ~ 1.63;p = 0.0002）。根据基线UACR分析，与安慰剂相比，芬尼酮的慢性eGFR斜率降低幅度更大。芬那酮治疗使UACR从基线到第4个月降低了34%。无论基线eGFR、收缩压、糖化血红蛋白、体重指数、钠-葡萄糖共转运蛋白-2抑制剂的使用，以及胰高血糖素样肽-1受体激动剂的使用，都可以看到这种治疗效果。39.5%的亚洲受试者接受芬尼酮治疗后，蛋白尿从高水平恢复到正常水平，而接受安慰剂治疗的受试者为14.8%。治疗中出现的不良事件在芬尼酮和安慰剂之间相似，高钾血症是可控的。结论：在亚洲慢性肾病和2型糖尿病患者中，Finerenone减缓eGFR下降并降低UACR。试验注册号：FIDELIO-DKD (NCT02540993)；FIGARO-DKD (NCT02545049)。

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引用次数: 0

Identification of biomarkers to predict renal function decline and its deceleration in patients with type 2 diabetes and diabetic kidney disease 2型糖尿病和糖尿病肾病患者肾功能下降及其减缓的生物标志物鉴定

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-11-01 DOI: 10.1016/j.jdiacomp.2025.109208

Motonobu Nishimura , Kazuya Yonezawa , Morio Sawamura , Tsuyoshi Tanaka , Yuichi Yamamoto , Hideki Taki , Masako Hatao , Masaya Takeda , Kazuyuki Hida , Junko Koide , Miho Saito , Nobuyuki Koriyama , Tomokazu Watanabe , Ryo Nakajima , Yoshiharu Hoshiyama

Aims

This study aimed to identify noninvasive biomarkers for predicting the effectiveness of multifactorial management in individual cases of diabetic kidney disease (DKD).

Methods

This multicenter, retrospective–prospective observational study included patients with type 2 diabetes and DKD. Candidate biomarkers were evaluated within 1 year of enrollment. Deceleration in the rate of decline in the estimated glomerular filtration rate (eGFR) was defined as an indicator of prognostic improvement in DKD. The correlation between candidate biomarkers and baseline eGFR, as well as with eGFR decline, was analyzed. Furthermore, candidate biomarkers were compared between the groups with and without a deceleration in eGFR decline.

Results

Serum soluble thrombomodulin (sTM) levels, urinary liver-type fatty acid-binding protein excretion, kidney size, and renal surface irregularities were found to be independently associated with baseline eGFR. Serum sTM levels and urinary type IV collagen excretion were independently associated with eGFR decline. Furthermore, the eGFR decline rate during the first 2 years of the observation period was independently associated with the later deceleration of eGFR decline. Additionally, the probability of deceleration in eGFR decline was higher among patients who experienced a more rapid eGFR decline early in the observation period. However, a biomarker that could predict the likelihood of deceleration in eGFR decline could not be identified.

Conclusions

We identified four noninvasive biomarkers that independently correlated with the eGFR, among which urinary type IV collagen excretion and serum sTM levels were particularly useful in predicting eGFR decline.

目的：本研究旨在确定非侵入性生物标志物，以预测糖尿病肾病（DKD）多因素管理的有效性。方法：这项多中心、回顾性-前瞻性观察性研究纳入了2型糖尿病和DKD患者。候选生物标志物在入组1年内进行评估。估计肾小球滤过率（eGFR）下降速度的减慢被定义为DKD预后改善的指标。分析候选生物标志物与基线eGFR以及与eGFR下降之间的相关性。此外，将候选生物标志物在eGFR下降是否减慢的组之间进行比较。结果：血清可溶性血栓调节素（sTM）水平、尿肝型脂肪酸结合蛋白排泄、肾脏大小和肾表面不规则性被发现与基线eGFR独立相关。血清sTM水平和尿IV型胶原蛋白排泄与eGFR下降独立相关。此外，观察期前2年的eGFR下降速率与后期eGFR下降减速独立相关。此外，在观察早期eGFR下降较快的患者中，eGFR下降减速的可能性更高。然而，一种能够预测eGFR下降减速可能性的生物标志物尚未被确定。结论：我们确定了四种与eGFR独立相关的无创生物标志物，其中尿IV型胶原蛋白排泄和血清sTM水平在预测eGFR下降方面特别有用。

{"title":"Identification of biomarkers to predict renal function decline and its deceleration in patients with type 2 diabetes and diabetic kidney disease","authors":"Motonobu Nishimura , Kazuya Yonezawa , Morio Sawamura , Tsuyoshi Tanaka , Yuichi Yamamoto , Hideki Taki , Masako Hatao , Masaya Takeda , Kazuyuki Hida , Junko Koide , Miho Saito , Nobuyuki Koriyama , Tomokazu Watanabe , Ryo Nakajima , Yoshiharu Hoshiyama","doi":"10.1016/j.jdiacomp.2025.109208","DOIUrl":"10.1016/j.jdiacomp.2025.109208","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to identify noninvasive biomarkers for predicting the effectiveness of multifactorial management in individual cases of diabetic kidney disease (DKD).</div></div><div><h3>Methods</h3><div>This multicenter, retrospective–prospective observational study included patients with type 2 diabetes and DKD. Candidate biomarkers were evaluated within 1 year of enrollment. Deceleration in the rate of decline in the estimated glomerular filtration rate (eGFR) was defined as an indicator of prognostic improvement in DKD. The correlation between candidate biomarkers and baseline eGFR, as well as with eGFR decline, was analyzed. Furthermore, candidate biomarkers were compared between the groups with and without a deceleration in eGFR decline.</div></div><div><h3>Results</h3><div>Serum soluble thrombomodulin (sTM) levels, urinary liver-type fatty acid-binding protein excretion, kidney size, and renal surface irregularities were found to be independently associated with baseline eGFR. Serum sTM levels and urinary type IV collagen excretion were independently associated with eGFR decline. Furthermore, the eGFR decline rate during the first 2 years of the observation period was independently associated with the later deceleration of eGFR decline. Additionally, the probability of deceleration in eGFR decline was higher among patients who experienced a more rapid eGFR decline early in the observation period. However, a biomarker that could predict the likelihood of deceleration in eGFR decline could not be identified.</div></div><div><h3>Conclusions</h3><div>We identified four noninvasive biomarkers that independently correlated with the eGFR, among which urinary type IV collagen excretion and serum sTM levels were particularly useful in predicting eGFR decline.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"40 1","pages":"Article 109208"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458822","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

Glycemia, management and outcomes of pregnant women with maturity-onset diabetes of the young – a single-center case series 血糖，管理和结局的孕妇与成熟发作的年轻糖尿病-单中心病例系列。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-10-24 DOI: 10.1016/j.jdiacomp.2025.109206

Isabella Lindegaard Jørgensen , Anne Cathrine Baun Thuesen , Tine Dalsgaard Clausen , Lene Ringholm , Elisabeth R. Mathiesen , Torben Hansen , Peter Damm

Aims

At Rigshospitalet, Copenhagen, Denmark, pregnancy management for women with GCK-MODY is guided by markedly elevated glucose levels and fetal overgrowth, while management for women with HNF1A-MODY follows guidelines for type 1 and type 2 diabetes. We aimed to evaluate current treatment strategies for pregnant women with GCK- or HNF1A-MODY.

Methods

We conducted a retrospective population-based cohort study of 18 consecutive pregnancies in 11 women with GCK-MODY and 17 consecutive pregnancies in 11 women with HNF1A-MODY, matched with 140 pregnancies in 133 women with type 2 diabetes, referred to Rigshospitalet, Copenhagen, between June 2011 and December 2023. Glycemia, pregnancy- and perinatal outcomes were compared using generalized estimating equation models.

Results

In pregnancies in women with GCK-MODY, median HbA1c levels remained stable from early in pregnancy (< 20 weeks) to late in pregnancy (45 to 46 mmol/mol), while decreasing in pregnancies in women with HNF1A-MODY (41 to 37 mmol/mol) and type 2 diabetes (47 to 41 mmol/mol). The prevalence of hypertensive disorders (5.6 vs. 35.0 %), preterm delivery (0 % vs. 17.9 %), and large for gestational age (16.7 % vs. 35.7 %), were lower in pregnancies in women with GCK-MODY compared to type 2 diabetes, though not statistically significant. Pregnancy- and perinatal outcomes were comparable between pregnancies in women with HNF1A-MODY and type 2 diabetes.

Conclusions

In women with GCK-MODY, pregnancy outcomes were reassuring supporting the current treatment strategy. In women with HNF1A-MODY, guidelines for type 1 and type 2 diabetes resulted in glycemic control within target and pregnancy outcomes similar to type 2 diabetes.

目的：在丹麦哥本哈根的Rigshospitalet， gckmody妇女的妊娠管理以血糖水平明显升高和胎儿过度生长为指导，而HNF1A-MODY妇女的管理遵循1型和2型糖尿病的指导方针。我们的目的是评估GCK-或HNF1A-MODY孕妇的当前治疗策略。方法：在2011年6月至2023年12月期间，我们进行了一项基于人群的回顾性队列研究，纳入了11名gcg - mody患者的18次连续妊娠和11名HNF1A-MODY患者的17次连续妊娠，并与哥本哈根Rigshospitalet的133名2型糖尿病患者的140次妊娠相匹配。使用广义估计方程模型比较血糖、妊娠和围产期结局。结果：在GCK-MODY患者的妊娠中，HbA1c水平中位数从妊娠早期（< 20周）到妊娠后期（45 ~ 46 mmol/mol）保持稳定，而在HNF1A-MODY患者（41 ~ 37 mmol/mol）和2型糖尿病患者（47 ~ 41 mmol/mol）的妊娠中保持下降。与2型糖尿病患者相比，GCK-MODY患者妊娠期间高血压疾病（5.6% vs. 35.0%）、早产（0% vs. 17.9%）和胎龄大（16.7% vs. 35.7%）的患病率较低，但无统计学意义。HNF1A-MODY和2型糖尿病孕妇的妊娠和围产期结局具有可比性。结论：在患有GCK-MODY的妇女中，妊娠结局令人放心，支持当前的治疗策略。在患有HNF1A-MODY的女性中，1型和2型糖尿病的指南导致血糖控制在目标范围内，妊娠结局与2型糖尿病相似。

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引用次数: 0

Data-driven subtypes of newly diagnosed youth-onset type 2 diabetes in the USA 美国新诊断的青年发病2型糖尿病的数据驱动亚型

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-10-23 DOI: 10.1016/j.jdiacomp.2025.109207

Jiali Guo , Zhongyu Li , Rodrigo M. Carrillo-Larco , Daniel S. Hsia , Jessica L. Harding , Mohammed K. Ali , Jithin Sam Varghese

Aims

To identify subtypes of newly diagnosed youth-onset T2D using cluster analysis.

Methods

A cross-sectional study included participants with T2D (duration ≤1 year) aged 10–19 years from the SEARCH for Diabetes in Youth Study (n = 304; 47.4 %) and aged 10–17 years from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (n = 337; 52.6 %) study before intervention allocation. We examined variables available in routine clinical practice. Main outcomes were data-driven subtypes identified using k-means clustering.

Results

Among 641 participants with youth-onset T2D, 58.2 % were female. The analysis revealed three youth-onset subtypes: 48.5 % had obesity-related T2D (yOD), 18.7 % had insulin deficient T2D (yIDD), and 32.7 % had insulin resistant T2D (yIRD). The yOD subtype was characterized by high BMI and low HbA1c. The yIDD exhibited low fasting C-peptide levels, high HDL cholesterol, and high HbA1c. The yIRD subtype had high BMI, high fasting C-peptide, and high blood pressures compared to other subtypes. A higher prevalence of distal symmetric polyneuropathy was observed at diagnosis among yIDD and yIRD subtypes, relative to the yOD subtype.

Conclusions

Three subtypes of youth-onset T2D were identified with different clinical characteristics. Management of youth-onset T2D may require tailored strategies by subtype.

目的：通过聚类分析确定新诊断的青年发病T2D亚型。方法：一项横断面研究纳入了干预分配前10-19岁的T2D（持续时间≤1年）参与者（n = 304; 47.4%）和10-17岁的参与者（n = 337; 52.6%），参与者来自青年糖尿病搜索研究（SEARCH for Diabetes in Youth study）。我们检查了常规临床实践中可用的变量。主要结果是使用k-means聚类确定的数据驱动亚型。结果：641例青年发病T2D患者中，58.2%为女性。分析揭示了三种青年发病亚型：48.5%为肥胖相关T2D (yOD)， 18.7%为胰岛素缺乏型T2D (yIDD)， 32.7%为胰岛素抵抗型T2D （yIRD）。yOD亚型以高BMI和低HbA1c为特征。yIDD表现出低空腹c肽水平，高HDL胆固醇和高HbA1c。与其他亚型相比，yIRD亚型具有高BMI，高空腹c肽和高血压。相对于yOD亚型，yIDD和yIRD亚型在诊断时观察到远端对称多神经病变的患病率更高。结论：青年发病T2D可分为三种亚型，各有不同的临床特征。青年发病T2D的管理可能需要根据亚型量身定制的策略。

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引用次数: 0