Journal of diabetes and its complications最新文献_第9页

Response to letter to the editor regarding “High rate of complications in a real-world cohort of youth with T2D: A multicenter analysis” 回复编辑关于“现实世界中青少年T2D患者的高并发症发生率：一项多中心分析”的信。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-07-22 DOI: 10.1016/j.jdiacomp.2025.109138

Risa M. Wolf , Roomasa Channa , Amy S. Shah

引用次数: 0

Relationship between relative fat mass and coronary artery calcification in patients with type 2 diabetes 2型糖尿病患者相对脂肪量与冠状动脉钙化的关系

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-07-22 DOI: 10.1016/j.jdiacomp.2025.109133

Jingjing Ye , Yu Qin , Li Zhao , Ling Yang , Guoyue Yuan , Meiqing Dai , Shaohua Wang

Aims

Relative fat mass (RFM) is a promising tool for identifying individuals with obesity-related health risks. Given the unclear correlation, we aimed to investigate the association between RFM and coronary artery calcification (CAC) in individuals with T2DM.

Methods

We included hospitalized individuals aged 20–80 years with T2DM (n = 278) in this single-center cross-sectional study. We explored the correlation between RFM and the CAC score (CACS), mechanisms underlying the association between RFM and CAC, and prediction models of coronary artery stenosis (CAS).

Results

Compared to the non-CAC group, the CAC group had a higher RFM. The CACS and RFM were positively correlated. The RFM independently increased the risk of CAC in individuals with T2DM. Using RFM to predict CAC resulted in an area under the curve of 0.598 (95 % CI [0.531–0.664], p < 0.01); RFM was not inferior to visceral fat area for predicting CAC. Insulin resistance, systolic blood pressure, and estimated glomerular filtration rate mediated the association between RFM and CAS with proportions of 9.38 %, 18.82 %, and 11.36 %, respectively.

Conclusions

RFM was associated with CAC in individuals with T2DM. Given its potential role in predicting cardiovascular complications, incorporating RFM into clinical practice may facilitate the prevention and management of cardiovascular complications in T2DM.

目的相对脂肪量（RFM）是一种很有前景的识别肥胖相关健康风险个体的工具。鉴于不明确的相关性，我们旨在研究T2DM患者RFM与冠状动脉钙化（CAC）之间的关系。方法在这项单中心横断面研究中，我们纳入了20-80岁住院的T2DM患者（n = 278）。我们探讨了RFM与CAC评分（CACS）之间的相关性，RFM与CAC之间关联的机制，以及冠状动脉狭窄（CAS）的预测模型。结果与非CAC组相比，CAC组的RFM更高。CACS与RFM呈正相关。RFM单独增加了2型糖尿病患者患CAC的风险。使用RFM预测CAC的曲线下面积为0.598 (95% CI [0.531-0.664], p <；0.01);RFM在预测CAC方面不逊于内脏脂肪面积。胰岛素抵抗、收缩压和估计的肾小球滤过率介导了RFM和CAS之间的关联，其比例分别为9.38%、18.82%和11.36%。结论srfm与T2DM患者的CAC相关。考虑到RFM在预测心血管并发症方面的潜在作用，将RFM纳入临床实践可能有助于预防和管理T2DM心血管并发症。

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引用次数: 0

What type 1 diabetes endotype is most suitable for anti-CD3 antibodies prevention trials? 哪种1型糖尿病内型最适合抗cd3抗体预防试验？

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-07-15 DOI: 10.1016/j.jdiacomp.2025.109132

Roma-Wilson Maria Aurora , Pozzilli Paolo

Type 1 diabetes (T1D) is a heterogeneous autoimmune disease with multiple endotypes, each demonstrating distinct clinical and immunological characteristics. Teplizumab, an anti-CD3 monoclonal antibody, has emerged as a promising immunomodulatory therapy capable of delaying the progression of T1D in individuals with stage 2 disease. However, variability in therapeutic response suggests that certain endotypes may derive greater benefit from treatment. This review evaluates the suitability of different T1D endotypes (T1DE) for teplizumab prevention trials, with a particular focus on early-onset T1DE1 and T1DE2.

Clinical trials demonstrate that individuals under 15 years of age, who demonstrate the highest immune activity, marked by aggressive T-cell infiltration and rapid pancreatic β-cell destruction, experience the most significant delay in disease progression following teplizumab treatment, highlighting the importance of early intervention. Furthermore, shifting individuals from the rapidly progressing T1DE1 trajectory to the more gradual T1DE2 course may extend functional insulin production and improve long-term metabolic outcomes.

This paper underscores the need for expanded endotype-specific prevention trials and optimised screening protocols to identify high-risk individuals at the earliest stage. Future research should explore teplizumab's efficacy in younger populations and refine predictive biomarkers to enhance personalised intervention strategies in T1D management.

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

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引用次数: 0

BETTER sleep: Sleep quality among adults living with type 1 diabetes in Canada 更好的睡眠：加拿大成人1型糖尿病患者的睡眠质量

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-07-13 DOI: 10.1016/j.jdiacomp.2025.109137

Lydi-Anne Vézina-Im , Anne-Frédérique Turcotte , Virginie Messier , Stéphane Turcotte , Ariane Brossard , Jacques Pelletier , Tara Nassar , Rémi Rabasa-Lhoret , Anne-Sophie Brazeau

Aims

Identify correlates of poor sleep quality among people living with type 1 diabetes (PwT1D).

Methods

Data were extracted from the BETTER Registry. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Sociodemographic characteristics (age, biological sex, education, income, ethnicity, body mass index); diabetes-related (diabetes duration, glucose monitoring method, treatment type, hypoglycemia awareness); psychological (fear of hypoglycemia, diabetes-related distress and stigma, depression, social support); and behavioral (snacking before bedtime, caffeine, alcohol and cannabis use, moderate-to-vigorous physical activity [MVPA]) variables were tested in multivariate logistic regression analyses for their association with poor sleep quality (PSQI >5).

Results

A total of 1322 PwT1D (mean age: 45.0 ± 15.0 years; 66.9 % female) had sleep data. The mean PSQI score was 6.0 ± 3.4 and 47.3 % had poor sleep quality. Being female (OR = 1.422; 95 % CI: 1.080–1.873), with overweight/obesity (OR = 1.376; 95 % CI: 1.067–1.775), greater fear of hypoglycemia (OR = 1.016; 95 % CI: 1.008–1.023), having moderate-to-severe depression (OR = 6.160; 95 % CI: 4.250–8.929), always snacking before bedtime (OR = 1.706; 95 % CI: 1.124–2.590), using cannabis (OR = 1.578; 95 % CI: 1.152–2.161), and accumulating <150 min/week of MVPA (OR = 1.563; 95 % CI: 1.107–2.203) were correlates of poor sleep quality.

Conclusions

Many PwT1D have poor sleep quality, and their sleep is associated with various sociodemographic, psychological, and behavioral factors.

目的探讨1型糖尿病（PwT1D）患者睡眠质量差的相关因素。方法数据从BETTER Registry中提取。使用匹兹堡睡眠质量指数（PSQI）测量睡眠质量。社会人口特征（年龄、生理性别、教育程度、收入、种族、体重指数）；糖尿病相关（糖尿病病程、血糖监测方法、治疗类型、低血糖认知）；心理（对低血糖的恐惧、糖尿病相关的痛苦和耻辱、抑郁、社会支持）；和行为变量（睡前吃零食、咖啡因、酒精和大麻使用、中高强度体育活动[MVPA]）在多变量logistic回归分析中测试了它们与睡眠质量差的关系（PSQI >5）。结果PwT1D患者共1322例，平均年龄45.0±15.0岁；66.9%女性)有睡眠数据。平均PSQI评分为6.0±3.4分，睡眠质量差的占47.3%。女性(OR = 1.422；95% CI: 1.080-1.873)，超重/肥胖(OR = 1.376；95% CI: 1.067-1.775)，对低血糖的更大恐惧(OR = 1.016；95% CI: 1.008-1.023)，患有中度至重度抑郁症(OR = 6.160；95% CI: 4.250-8.929)，总是在睡前吃零食(OR = 1.706；95% CI: 1.124-2.590)，使用大麻(OR = 1.578；95% CI: 1.152-2.161)，累积150分钟/周的MVPA (OR = 1.563；95% CI: 1.107-2.203)与睡眠质量差相关。结论许多PwT1D患者睡眠质量较差，其睡眠与多种社会人口学、心理和行为因素有关。

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引用次数: 0

Elevated small dense low-density lipoprotein-cholesterol as a risk factor for lower extremity arterial disease in patients with type 2 diabetes mellitus 小密度低密度脂蛋白-胆固醇升高是2型糖尿病患者下肢动脉疾病的危险因素

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-07-12 DOI: 10.1016/j.jdiacomp.2025.109136

Delu Zheng , Chenli Cui

Aims

Small dense low-density lipoprotein-cholesterol (sdLDL-C) is an emerging atherogenic lipid marker, but its association with lower extremity arterial disease (LEAD) in type 2 diabetes mellitus (T2DM) remains underexplored. This study aimed to evaluate whether sdLDL-C independently predicts LEAD risk in T2DM patients.

Methods

A cross-sectional study was conducted with 47 healthy controls, 66 T2DM patients, and 120 patients with both T2DM and LEAD. Biochemical markers were compared, and predictive value was assessed using a receiver operating characteristic (ROC) curve. Multivariable logistic regression analyzed the association between sdLDL-C and LEAD after adjusting for conventional risk factors.

Results

sdLDL-C levels were significantly higher in T2DM patients compared to healthy controls (1.06 [0.88–1.25] vs. 0.77 [0.43–1.04] mmol/L, P < 0.001), and even higher in those with both T2DM and LEAD (1.33 [1.17–1.56] mmol/L). sdLDL-C levels were associated with the severity of LEAD and positively correlated with fasting blood glucose, fasting C-peptide, hemoglobin A1c, total cholesterol, triglycerides, LDL-C, apolipoprotein B, and body mass index. ROC analysis yielded an area under the curve of 0.765 (95 % CI: 0.692–0.838, P < 0.0001), indicating good predictive value of sdLDL-C for LEAD in T2DM. Multivariable logistic regression identified sdLDL-C (OR = 7.881, 95%CI: 1.368–45.394, P = 0.021), fasting C-peptide, hemoglobin A1c, apolipoprotein B, diabetes duration, and sedentary lifestyle as significant risk factors for LEAD in T2DM patients.

Conclusions

Elevated sdLDL-C is independently associated with LEAD in T2DM patients and outperforms conventional LDL-C in risk stratification. sdLDL-C may serve as a valuable biomarker for early detection of LEAD in this high-risk population.

目的：小密度低密度脂蛋白-胆固醇（sdLDL-C）是一种新兴的致动脉粥样硬化脂质标志物，但其与2型糖尿病（T2DM）患者下肢动脉疾病（LEAD）的关系仍未得到充分研究。本研究旨在评估sdLDL-C是否能独立预测T2DM患者的LEAD风险。方法采用横断面研究方法，选取健康对照者47例，T2DM患者66例，T2DM合并LEAD患者120例。比较生化指标，并采用受试者工作特征（ROC）曲线评估预测价值。在调整常规危险因素后，多变量logistic回归分析了sdLDL-C与LEAD之间的关系。结果T2DM患者ldl - c水平显著高于健康对照组(1.06 [0.88-1.25]vs. 0.77 [0.43-1.04] mmol/L, P <；而T2DM和LEAD合并的患者更高（1.33 [1.17-1.56]mmol/L）。sdLDL-C水平与铅的严重程度相关，与空腹血糖、空腹c肽、血红蛋白A1c、总胆固醇、甘油三酯、LDL-C、载脂蛋白B和体重指数呈正相关。ROC分析显示曲线下面积为0.765 (95% CI: 0.692-0.838, P <；0.0001)，表明sdLDL-C对T2DM患者的LEAD具有良好的预测价值。多变量logistic回归发现，sdLDL-C （OR = 7.881, 95%CI: 1.368-45.394, P = 0.021）、空腹c肽、糖化血红蛋白、载脂蛋白B、糖尿病病程和久坐生活方式是T2DM患者铅的重要危险因素。结论sdLDL-C升高与T2DM患者的LEAD独立相关，在危险分层上优于常规LDL-C。sdLDL-C可作为这一高危人群早期检测铅的有价值的生物标志物。

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引用次数: 0

The use of fenofibrate in diabetic retinopathy: Narrative review 非诺贝特在糖尿病视网膜病变中的应用：综述

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-07-10 DOI: 10.1016/j.jdiacomp.2025.109135

Harsha A. Dissanayake , Christine A. Kiire , David Preiss , Garry D. Tan

Diabetic retinopathy (DR) is a leading cause of blindness despite advances in treatment and there remains an unmet need for low-cost interventions to prevent and slow the progression of DR. Fenofibrate has shown promise as a useful adjunct in DR management and is licensed for use in the treatment of DR in a few countries. However, the data supporting the use of fenofibrate for the treatment of DR emerged from subsidiary analyses of the FIELD, ACCORD-LIPID and its sub-study ACCORD-EYE trials, which were primarily designed to evaluate cardiovascular outcomes. The recently concluded LENS trial, designed to evaluate the effect of fenofibrate on progression of DR, has shown clear evidence of benefit over medium-term follow-up (i.e., 4–5 years), and confirmed its safety in people with type 1 or type 2 diabetes. These benefits appear to be independent of fenofibrate's lipid lowering effects and are more likely to be mediated via its direct effects on the eye. In this narrative review on the use of fenofibrate in the treatment of DR, we summarise the possible mechanisms of action, existing evidence from randomised trials, and implications for clinical practice and research.

尽管在治疗方面取得了进展，但糖尿病视网膜病变（DR）仍是导致失明的主要原因，并且对低成本干预措施的需求仍未得到满足，以预防和减缓DR的进展。非诺贝特已显示出作为DR管理的有用辅助手段的前景，并在一些国家获准用于治疗DR。然而，支持使用非诺贝特治疗DR的数据来自FIELD、accord -脂质及其子研究ACCORD-EYE试验的辅助分析，这些试验主要用于评估心血管结局。最近结束的LENS试验旨在评估非诺贝特对DR进展的影响，在中期随访（即4-5年）中显示出明确的益处证据，并证实其对1型或2型糖尿病患者的安全性。这些益处似乎与非诺贝特的降脂作用无关，更有可能是通过其对眼睛的直接作用来调节的。在这篇关于非诺贝特治疗DR的叙述性综述中，我们总结了可能的作用机制、随机试验的现有证据以及对临床实践和研究的影响。

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引用次数: 0

Letter to the Editor “Glucagon-like Peptide-1 receptor agonists versus dipeptidyl-peptidase 4 inhibitors in advanced chronic kidney disease and end stage kidney disease: Real world effectiveness and persistence of therapy” 致编辑的信“胰高血糖素样肽-1受体激动剂与二肽基肽酶4抑制剂在晚期慢性肾病和终末期肾病中的作用：现实世界的有效性和治疗的持久性”。

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-07-09 DOI: 10.1016/j.jdiacomp.2025.109134

Joaquín Borrás-Blasco , Alejandro Valcuende-Rosique , Silvia Cornejo-Uixeda

引用次数: 0

Contents/Barcode 内容/条形码

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-07-07 DOI: 10.1016/S1056-8727(25)00178-3

引用次数: 0

Degludec insulin versus efsitora insulin in diabetes mellitus management: A systematic review and meta-analysis Degludec胰岛素与efsitora胰岛素在糖尿病治疗中的对比：一项系统综述和荟萃分析

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-07-03 DOI: 10.1016/j.jdiacomp.2025.109115

Helen Michaela de Oliveira , Mariano Gallo Ruelas , Victor Hugo Palhares Flávio-Reis , Ivo Queiroz , Deivyd Vieira Silva Cavalcante , Lucas Mendes Barbosa , Fernanda Valeriano Zamora

Purpose

To compare the efficacy and safety of next-generation basal insulin efsitora versus insulin degludec in managing type 1 and type 2 diabetes.

Methods

We systematically searched PubMed, Embase, and CENTRAL databases until October 2024. This study followed PRISMA guidelines. Statistical analyses were performed using R version 4.4.1. The risk of bias was assessed using the RoB2 tool, and the quality of evidence was evaluated using the GRADE approach. This study was registered in PROSPERO under protocol CRD42024597806.

Results

Six randomized controlled trials involving 2590 patients were included in the analysis. Of these, 1376 (53.13 %) received efsitora insulin. No significant differences were observed between efsitora and degludec in glycemic efficacy outcomes, including HbA1c reduction, fasting blood glucose, weight change, and proportion of patients achieving HbA1c <7 %. Regarding safety outcomes, most endpoints, such as adverse events, injection site reactions, hypersensitivity, severe hypoglycemia, and mortality, were comparable between groups, with no significant subgroup effects. However, subgroup analysis revealed a lower incidence of nocturnal hypoglycemia with efsitora in patients with type 2 diabetes, and a higher rate of serious adverse events in patients with type 1 diabetes, suggesting potential population-specific differences in safety profiles.

Conclusion

Efsitora and degludec insulins show similar overall efficacy and safety in the management of diabetes. However, subgroup analyses indicate that patient-specific factors, such as diabetes type, may influence the risk of certain adverse events. These findings support the importance of individualized insulin selection based on patient characteristics and risk profiles.

目的比较新一代基础胰岛素与降糖精胰岛素治疗1型和2型糖尿病的疗效和安全性。方法系统检索PubMed、Embase和CENTRAL数据库至2024年10月。本研究遵循PRISMA指南。采用R 4.4.1版本进行统计分析。使用RoB2工具评估偏倚风险，使用GRADE方法评估证据质量。本研究在PROSPERO注册，注册协议为CRD42024597806。结果纳入6项随机对照试验，共2590例患者。其中，1376例（53.13%）接受胰岛素注射。efsitora和degludec在降糖疗效结局方面无显著差异，包括HbA1c降低、空腹血糖、体重变化和达到HbA1c的患者比例7%。关于安全性结局，大多数终点，如不良事件、注射部位反应、过敏、严重低血糖和死亡率，组间具有可比性，没有显著的亚组效应。然而，亚组分析显示，2型糖尿病患者夜间低血糖伴efsitora发生率较低，1型糖尿病患者严重不良事件发生率较高，提示安全性存在潜在的人群特异性差异。结论依西妥拉与降糖糖胰岛素治疗糖尿病的总体疗效和安全性相似。然而，亚组分析表明，患者的特定因素，如糖尿病类型，可能会影响某些不良事件的风险。这些发现支持了根据患者特征和风险概况进行个体化胰岛素选择的重要性。

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引用次数: 0

Evaluation of IDx-DR software for diabetic retinopathy screening in outpatient clinics: Efficacy, safety, and feasibility in a real-world setting IDx-DR软件用于门诊糖尿病视网膜病变筛查的评估：在现实世界环境中的有效性、安全性和可行性

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2025-07-02 DOI: 10.1016/j.jdiacomp.2025.109120

Simone Leonora Huber , Verena Parzer , Bernhard Ludvik , Andreas Pollreisz , Nikolaus Mahnert , Johanna Maria Brix

Aims

This study assessed the IDx-DR software's effectiveness as a diabetic retinopathy (DR) screening tool in a routine outpatient setting. It also evaluated the software's safety and feasibility.

Methods

RA prospectively planned analysis of patients with diabetes was conducted at the diabetes outpatient clinic of a specialized tertiary care center from March 2021 to October 2022. These patients underwent retinal imaging with IDx-DR during routine visits.

Results

The majority of the 996 included patients were female (53.1 %), and the median age was 61.1 years. Notably, 40.2 % had a BMI ≥ 30 kg/m², and 35.8 % were active smokers. DR was detected by IDx-DR in n = 178 (26 %) of patients. 73.1 % of those patients were newly diagnosed with retinopathy without any history of retinopathy in the medical history (p < 0.001). DR patients were older (median 60.4 vs 57.5 years; p = 0.050), had higher HbA1c levels (7.0 % vs. 7.6 %; p < 0.001) and a higher frequency of ophthalmologic check-ups (p = 0.015). In multiple binary logistic regression, use of insulin (OR = 1.735 [1.096; 2.748], p = 0.19) and diabetes duration (medium vs. short: OR = 2.356 [1.36; 4.07], p = 0.002, long vs. short: OR = 1.776 [1.03; 3.06], p = 0.39) independently predicted DR, while age and sex were not significant predictors.

Conclusions

This study supports integrating AI tools like IDx-DR in DR screening. It highlights IDx-DR's utility and efficacy in improving DR detection and patient care, suggesting its potential for broader, cost-effective screening in Austria and possibly elsewhere.

目的：本研究评估IDx-DR软件作为常规门诊糖尿病视网膜病变（DR）筛查工具的有效性。并对软件的安全性和可行性进行了评估。方法对2021年3月至2022年10月在某专科三级保健中心糖尿病门诊就诊的糖尿病患者进行前瞻性计划分析。这些患者在常规就诊期间接受了IDx-DR视网膜成像。结果996例患者以女性为主（53.1%），中位年龄为61.1岁。值得注意的是，40.2%的人BMI≥30 kg/m2, 35.8%的人是活跃吸烟者。在178例（26%）患者中，IDx-DR检测到DR。73.1%的患者新诊断为视网膜病变，病史中无视网膜病变史(p <；0.001)。DR患者年龄较大(中位60.4 vs 57.5岁；p = 0.050)， HbA1c水平较高(7.0% vs 7.6%；p & lt;0.001)和更高的眼科检查频率（p = 0.015）。在多元二元logistic回归中，胰岛素的使用(OR = 1.735 [1.096；2.748], p = 0.19)和糖尿病病程(中vs短：OR = 2.356 [1.36；4.07], p = 0.002,长与短:或= 1.776 (1.03;3.06], p = 0.39)独立预测DR，而年龄和性别无显著预测意义。结论本研究支持将IDx-DR等人工智能工具整合到DR筛查中。它强调了IDx-DR在改善DR检测和患者护理方面的效用和功效，表明它有可能在奥地利和其他地方进行更广泛的、具有成本效益的筛查。

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引用次数: 0