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The impact of glycemic variability on the 28-day prognosis of patients with cardiogenic shock with or without diabetes mellitus: A retrospective cohort study 血糖变异性对伴有或不伴有糖尿病的心源性休克患者28天预后的影响:一项回顾性队列研究
IF 3.1 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-08-14 DOI: 10.1016/j.jdiacomp.2025.109151
Jing Tian , Chenming Zhao, Yulu Li, Yi Han
Glycaemic variability (GV) may reflect sharp rises and acute fluctuations in blood glucose, which are associated with adverse cardiovascular events. The aim of this study was to investigate the effect of GV on 28-day outcome in patients with cardiogenic shock (CS) with or without diabetes mellitus (DM).

Methods

This retrospective cohort study adhered to the RECORD (REporting of studies Conducted using Observational Routinely-collected Data) guidelines. We used clinical data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. GV was assessed using the coefficient of variation of blood glucose levels and statistically analysed by dividing patients into three groups according to GV tertiles (GV1, GV2 and GV3), with a primary outcome of 28-day prognosis and secondary outcomes of mechanical ventilation status, length of hospital stay and length of ICU stay.

Results

A total of 1091 patients from the MIMIC-IV database with CS were included, of which a total of 409 (37.49 %) were male patients and 682 (62.51 %) were female patients. Based on GV levels, three groups were classified as GV1 (<16.2 %, n = 318), GV2 (16.2 %–25.3 %, n = 388), and GV3 (>25.3 %, n = 385). According to the Kaplan-Meier curves, the 28-day prognosis was significantly better in GV1 patients than in GV3 [220 (69.2 %) vs. 234 (60.8 %), P = 0.044], and the same was true in the Non-DM subgroup [188 (73.7 %) vs. 108 (61.4 %), P = 0.016]. In a multifactorial COX analysis, GV was significantly associated with the risk of 28-day mortality in patients [HR 1.42, 95 % CI 1.10–1.60, P = 0.012]. In the subgroup analyses, the risk of death was highest in the DM subgroup of patients with GV3 (HR: 1.53, p = 0.003).

Conclusion

GV significantly increases the 28-day risk of death in patients with CS, especially in DM patients. Future optimisation of glucose monitoring techniques and exploration of GV modulation strategies are needed to improve patient prognosis.
What is known about this research topic:
Glycaemic variability (GV) significantly increases the 28-day risk of death in patients with cardiogenic shock (CS).
GV level (16.2 %–25.3 %) was an independent risk factor for 28-day mortality in patients with DM and CS, and GV (>25.3 %) was an independent risk factor for 28-day mortality in Non-DM patients with CS.
What this study adds and its future implications:
More optimal glucose monitoring techniques and GV modulation strategies need to be refined to improve patient outcomes.
血糖变异性(GV)可能反映血糖的急剧上升和急性波动,这与不良心血管事件有关。本研究的目的是探讨GV对合并或不合并糖尿病(DM)的心源性休克(CS)患者28天预后的影响。方法:本回顾性队列研究遵循RECORD(使用观察性常规收集数据进行的研究报告)指南。我们使用重症监护医学信息市场IV (MIMIC-IV)数据库中的临床数据。采用血糖水平变异系数评价GV,根据GV分位数(GV1、GV2和GV3)将患者分为3组,以28天预后为主要指标,机械通气状态、住院时间和ICU住院时间为次要指标,进行统计学分析。结果从MIMIC-IV数据库中共纳入1091例CS患者,其中男性409例(37.49%),女性682例(62.51%)。根据GV水平分为GV1组(< 16.2%, n = 318)、GV2组(16.2% - 25.3%,n = 388)、GV3组(> 25.3%, n = 385)。Kaplan-Meier曲线显示,GV1患者28天预后明显好于GV3患者[220(69.2%)比234 (60.8%),P = 0.044],非dm亚组亦如此[188(73.7%)比108 (61.4%),P = 0.016]。在多因素COX分析中,GV与患者28天死亡风险显著相关[HR 1.42, 95% CI 1.10-1.60, P = 0.012]。在亚组分析中,GV3患者的DM亚组死亡风险最高(HR: 1.53, p = 0.003)。结论:v显著增加CS患者28天死亡风险,尤其是DM患者。未来需要优化血糖监测技术和探索GV调节策略来改善患者预后。关于本研究主题的已知信息:血糖变异性(GV)显著增加心源性休克(CS)患者28天死亡风险。GV水平(16.2% - 25.3%)是糖尿病合并CS患者28天死亡率的独立危险因素,GV (> 25.3%)是非糖尿病合并CS患者28天死亡率的独立危险因素。本研究补充的内容及其未来意义:需要改进更优的葡萄糖监测技术和GV调节策略,以改善患者的预后。
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引用次数: 0
Pericardial fat pad detected on chest X-ray is closely associated with metabolic dysfunction-associated steatotic liver disease and visceral fat accumulation in patients with type 2 diabetes 胸片上发现的心包脂肪垫与2型糖尿病患者代谢功能障碍相关的脂肪变性肝病和内脏脂肪堆积密切相关
IF 3.1 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-08-11 DOI: 10.1016/j.jdiacomp.2025.109150
Kentaro Watanabe, Hidenori Nishioka, Masahiro Takubo, Minami Kosuda, Takeshi Yamamotoya, Taro Saigusa, Hisamitsu Ishihara

Aim

This study aimed to evaluate whether a pericardial fat pad (PFP) detected on chest X-ray can estimate metabolic dysfunction-associated steatotic liver disease (MASLD) and visceral fat accumulation.

Methods

Sixty-six patients with type 2 diabetes were categorized on the basis of the presence (n = 40) or absence (n = 26) of PFP on chest X-ray. The visceral fat area (VFA) and visceral-to-subcutaneous fat area ratio (V/S) at the umbilical level were assessed using abdominal computed tomography, whereas the controlled attenuation parameter (CAP) was measured using FibroScan. The fatty liver index (FLI) was estimated using clinical parameters, including body mass index (BMI), blood pressure, and biochemical markers.

Results

Subjects with PFP had a significantly higher BMI and a higher proportion of males. Subjects with PFP demonstrated significantly higher CAP, FLI, VFA, and V/S than those without PFP (P = 0.018, 0.005, < 0.001, and 0.020, respectively). The cutoff values for detecting PFP on chest X-ray were CAP ≥265.5 dB/m, FLI ≥ 30.6, VFA ≥ 118.7 cm2, and V/S ≥ 0.71.

Conclusions

In patients with type 2 diabetes, PFP detected on chest X-ray may serve as an indicator of MASLD and visceral fat accumulation.
目的本研究旨在评估胸片上检测到的心包脂肪垫(PFP)是否可以评估代谢功能障碍相关的脂肪变性肝病(MASLD)和内脏脂肪堆积。方法66例2型糖尿病患者根据胸片上PFP存在(n = 40)或不存在(n = 26)进行分类。使用腹部计算机断层扫描评估脐水平的内脏脂肪面积(VFA)和内脏与皮下脂肪面积比(V/S),而使用纤维扫描测量控制衰减参数(CAP)。使用临床参数,包括体重指数(BMI)、血压和生化指标来估计脂肪肝指数(FLI)。结果PFP患者BMI明显增高,且男性比例较高。PFP患者的CAP、FLI、VFA和V/S均显著高于非PFP患者(P分别为0.018、0.005、<; 0.001和0.020)。胸片检测PFP的截止值为CAP≥265.5 dB/m, FLI≥30.6,VFA≥118.7 cm2, V/S≥0.71。结论在2型糖尿病患者中,胸部x线检查PFP可作为MASLD和内脏脂肪堆积的指标。
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引用次数: 0
Is there a link between dry eye disease and diabetes mellitus? A systematic review and meta-analysis 干眼病和糖尿病之间有联系吗?系统回顾和荟萃分析
IF 3.1 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-08-08 DOI: 10.1016/j.jdiacomp.2025.109149
Kai-Yang Chen , Hoi-Chun Chan , Chi-Ming Chan

Background

Keratoconjunctivitis sicca, or the dry eye disease (DED) is prevalent multifactorial disorder of the tears and ocular surface, which has lately been interested scholars, particularly in establishing its link with diabetes mellitus (DM). This study aimed to evaluate the association between DM and DED through a comprehensive systematic review and meta-analysis of existing published articles, and thus understand the attributed risks for DED development in diabetic patients.

Methods

Four databases, PubMed, Cochrane Library (CENTRAL), Web of Science, and Google Scholar, were electronically searched for relevant publications. Peer-reviewed articles in English language reporting on DED prevalence among diabetic population published over the last 10 years were considered. A random effect model with odds ratio (OR) and risk ratio (RR) and respective confidence intervals were used in our statistical analysis to determine pooled effect sizes.

Results

This study included 23 studies with 5566 participants. Diabetic individuals had a significantly higher prevalence of dry eye disease (DED) than non-diabetics (OR: 2.30 [95 % CI: 1.54–3.43]; RR: 1.69 [95 % CI: 1.28–2.25]). Older age (>50 years), longer diabetes duration (>10 years), and poor glycemic control (HbA1c >7 %) were associated with increased DED risk. Gender-based findings varied, with slightly higher odds in males, though not statistically significant. High heterogeneity (I2 = 72 %) was observed, but sensitivity analyses confirmed result stability. Minimal publication bias was detected. Mechanisms linking diabetes to DED included oxidative stress, inflammation, and neuropathy-related tear dysfunction.

Conclusions

Our study confirmed a significant association between DM and DED prevalence and severity, and diabetic patients exhibit higher DED risks. These risks are pronounced in older adults, particularly those diagnosed with T2DM.”. Hence, early detection and management of DED in diabetic population is a priority to enhance patient's quality of life.
干眼病(DED)是一种常见的泪液和眼表的多因素疾病,近年来引起了学者们的兴趣,特别是与糖尿病(DM)的联系。本研究旨在通过对现有已发表文章的全面系统回顾和荟萃分析,评估糖尿病与DED之间的关系,从而了解糖尿病患者发生DED的归因风险。方法电子检索PubMed、Cochrane Library (CENTRAL)、Web of Science和谷歌Scholar四个数据库,检索相关文献。我们考虑了近10年来发表的关于糖尿病人群DED患病率的英文同行评议文章。我们的统计分析采用随机效应模型,采用优势比(OR)和风险比(RR)及其各自的置信区间来确定合并效应大小。结果本研究纳入23项研究,共5566名受试者。糖尿病患者的干眼病(DED)患病率明显高于非糖尿病患者(OR: 2.30 [95% CI: 1.54-3.43]; RR: 1.69 [95% CI: 1.28-2.25])。年龄较大(50岁)、糖尿病病程较长(10年)和血糖控制不良(糖化血红蛋白7%)与DED风险增加相关。基于性别的调查结果各不相同,男性的几率略高,但没有统计学意义。观察到高异质性(I2 = 72%),但敏感性分析证实了结果的稳定性。极少发现发表偏倚。糖尿病与DED相关的机制包括氧化应激、炎症和神经病变相关的撕裂功能障碍。结论我们的研究证实了糖尿病与DED患病率和严重程度之间存在显著相关性,糖尿病患者发生DED的风险更高。这些风险在老年人中尤为明显,尤其是那些被诊断为2型糖尿病的老年人。”因此,早期发现和处理糖尿病患者的DED是提高患者生活质量的重点。
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引用次数: 0
Semaglutide and the retina: Weighing evidence against concern 西马鲁肽和视网膜:权衡证据反对担忧。
IF 3.1 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-08-05 DOI: 10.1016/j.jdiacomp.2025.109148
Emir Muzurović , Ksenija Zečević , Viviana Maggio , Mohamed El Tanani , Manfredi Rizzo
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引用次数: 0
The health stage of cardiovascular-kidney-metabolic (CKM) syndrome is useful for predicting all-cause mortality in patients with type 2 diabetes: a cohort study in a period prior to the standard use of recent pharmacotherapy 心血管-肾脏代谢综合征的健康阶段对预测2型糖尿病患者的全因死亡率是有用的:一项在近期药物治疗标准使用之前的队列研究
IF 3.1 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-30 DOI: 10.1016/j.jdiacomp.2025.109146
Keitaro Nishizawa , Marenao Tanaka , Tatsuya Sato , Tomohito Gohda , Nozomu Kamei , Maki Murakoshi , Yukinori Akiyama , Wataru Kawaharata , Hiroki Aida , Hidemichi Kouzu , Naoya Yama , Mitsunobu Kubota , Michiyoshi Sanuki , Yusuke Suzuki , Masato Furuhashi

Aim

Cardiovascular-kidney-metabolic (CKM) syndrome is a recently defined systemic condition linking cardiovascular disease, chronic kidney disease and metabolic disorders including type 2 diabetes (T2D). Although the CKM staging has been proposed for integrated risk assessment, its association with all-cause mortality in patients with T2D remains unclear. We investigated the prognosis in patients with T2D assigned by the CKM health stage.

Methods

A total of 632 Japanese patients with T2D were enrolled. The primary endpoint was all-cause death.

Results

The numbers of the recruited patients with stages 2, 3 and 4 were 353 (55.9 %), 116 (18.3 %) and 163 (25.8 %), respectively. During a median follow-up of 64 months (35,327 person-months), 62 patients (9.8 %) died. Kaplan-Meier survival curves analysis showed significant differences in cumulative mortality among CKM health stages (log-rank test: P < 0.001) with higher cumulative mortality in stages 3 and 4 than in stage 2. Multivariable Cox proportional hazard models after adjustment of age, sex, body mass index, current smoking habit, cancer, relevant medications and hemoglobin A1c showed that adjusted hazard ratios (HRs) [95 % confidence intervals] for all-cause death were significantly higher in patients with stages 3 (2.25[1.08–4.69]) and those with stage 4 (2.87[1.41–5.84]) than in those with stage 2 as the reference. After additional adjustment of N-terminal pro-brain natriuretic peptide and estimated glomerular filtration rate among definition criteria for staging, the association of stages with all-cause death remained statistically significant in only stage 4 (2.16[1.02–4.56]).

Conclusion

The CKM health staging is useful for predicting all-cause mortality in Japanese patients with T2D.
心血管肾代谢综合征(CKM)是一种最近被定义的系统性疾病,与心血管疾病、慢性肾脏疾病和包括2型糖尿病(T2D)在内的代谢性疾病有关。尽管CKM分期已被提出用于综合风险评估,但其与T2D患者全因死亡率的关系尚不清楚。我们研究了按CKM健康分期划分的T2D患者的预后。方法共纳入632例日本T2D患者。主要终点是全因死亡。结果2期、3期和4期患者分别为353例(55.9%)、116例(18.3%)和163例(25.8%)。在中位随访64个月(35,327人月)期间,62名患者(9.8%)死亡。Kaplan-Meier生存曲线分析显示CKM各健康阶段的累积死亡率存在显著差异(log-rank检验:P <;0.001), 3期和4期的累积死亡率高于2期。调整年龄、性别、体重指数、当前吸烟习惯、癌症、相关药物及血红蛋白A1c等因素后的多变量Cox比例风险模型显示,3期患者(2.25[1.08-4.69])和4期患者(2.87[1.41-5.84])的全因死亡校正风险比(hr)[95%可信区间]明显高于2期患者。在分期定义标准中额外调整n端脑利钠肽前体和肾小球滤过率后,分期与全因死亡的相关性仅在第4期保持统计学意义(2.16[1.02-4.56])。结论CKM健康分期可用于预测日本t2dm患者的全因死亡率。
{"title":"The health stage of cardiovascular-kidney-metabolic (CKM) syndrome is useful for predicting all-cause mortality in patients with type 2 diabetes: a cohort study in a period prior to the standard use of recent pharmacotherapy","authors":"Keitaro Nishizawa ,&nbsp;Marenao Tanaka ,&nbsp;Tatsuya Sato ,&nbsp;Tomohito Gohda ,&nbsp;Nozomu Kamei ,&nbsp;Maki Murakoshi ,&nbsp;Yukinori Akiyama ,&nbsp;Wataru Kawaharata ,&nbsp;Hiroki Aida ,&nbsp;Hidemichi Kouzu ,&nbsp;Naoya Yama ,&nbsp;Mitsunobu Kubota ,&nbsp;Michiyoshi Sanuki ,&nbsp;Yusuke Suzuki ,&nbsp;Masato Furuhashi","doi":"10.1016/j.jdiacomp.2025.109146","DOIUrl":"10.1016/j.jdiacomp.2025.109146","url":null,"abstract":"<div><h3>Aim</h3><div>Cardiovascular-kidney-metabolic (CKM) syndrome is a recently defined systemic condition linking cardiovascular disease, chronic kidney disease and metabolic disorders including type 2 diabetes (T2D). Although the CKM staging has been proposed for integrated risk assessment, its association with all-cause mortality in patients with T2D remains unclear. We investigated the prognosis in patients with T2D assigned by the CKM health stage.</div></div><div><h3>Methods</h3><div>A total of 632 Japanese patients with T2D were enrolled. The primary endpoint was all-cause death.</div></div><div><h3>Results</h3><div>The numbers of the recruited patients with stages 2, 3 and 4 were 353 (55.9 %), 116 (18.3 %) and 163 (25.8 %), respectively. During a median follow-up of 64 months (35,327 person-months), 62 patients (9.8 %) died. Kaplan-Meier survival curves analysis showed significant differences in cumulative mortality among CKM health stages (log-rank test: <em>P</em> &lt; 0.001) with higher cumulative mortality in stages 3 and 4 than in stage 2. Multivariable Cox proportional hazard models after adjustment of age, sex, body mass index, current smoking habit, cancer, relevant medications and hemoglobin A1c showed that adjusted hazard ratios (HRs) [95 % confidence intervals] for all-cause death were significantly higher in patients with stages 3 (2.25[1.08–4.69]) and those with stage 4 (2.87[1.41–5.84]) than in those with stage 2 as the reference. After additional adjustment of N-terminal pro-brain natriuretic peptide and estimated glomerular filtration rate among definition criteria for staging, the association of stages with all-cause death remained statistically significant in only stage 4 (2.16[1.02–4.56]).</div></div><div><h3>Conclusion</h3><div>The CKM health staging is useful for predicting all-cause mortality in Japanese patients with T2D.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 10","pages":"Article 109146"},"PeriodicalIF":3.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781480","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
Predicting the occurrence of DKA following sodium glucose co-transporter-2 inhibitors: An international cohort study 预测葡萄糖共转运蛋白-2抑制剂后DKA的发生:一项国际队列研究
IF 3.1 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-30 DOI: 10.1016/j.jdiacomp.2025.109144
Michael Fralick , Mats C. Højbjerg Lassen , Jagadish Rangrej , Sahar Asgari , Saad Rais , Michael P. Hillmer , Jamie Lee Fritz , Katarina Zorcic , Bruce A. Perkins , Michael Colacci , Tor Biering-Sørensen , Muhammad Mamdani , Kieran R. Campbell

Background

Sodium glucose co-transporter 2 inhibitors (SGLT2i) are associated with a small-magnitude but higher risk of diabetic ketoacidosis (DKA). However, objectively identifying patients at lowest and highest risk of DKA is challenging.

Methods

We developed a prediction model using outpatient prescription data from Ontario, Canada and externally validated it using data from Denmark. We included adults with type 2 diabetes mellitus who were newly prescribed an SGLT2i. Our candidate predictors in the model were based on prior work and included the following: Sex, insulin use, prior DKA, dementia, hemoglobin A1C, and creatinine. Our outcome was 1-year risk of hospitalization with DKA. We calculated a risk score using an adaptation of penalized regression for each patient reported test characteristics in Ontario (derivation cohort) and Denmark (external validation cohort).

Results

We identified 322,135 in Ontario and 43,377 adults in Denmark who had type 2 diabetes mellitus and received an SGLT2i. The absolute risk of DKA within 1-year was 0.28 % (N = 916) in Ontario and 0.23 % (N = 101) in Denmark. Using data from Ontario, the risk score for each variable were as follows: Insulin use = 4 points, A1C > 9 % = 4 points and prior DKA = 19 points. All other variables received zero points. The overall model AUC was 63 % in Ontario and 66 % in Denmark (external validation set). Within Ontario, at a score threshold of zero, the risk of DKA was 0.19 % and the PPV was 0.3 % and the sensitivity was 100 % and similar results were observed in Denmark. For adults with a score of 19 or higher, the risk of DKA was 35-fold higher but false positives were common yielding a PPV of 6.7 % and sensitivity was lower at 3 %. In Denmark, adults with a score of 19 or higher had a risk of 11 % and the PPV was 10.2 % and sensitivity was 5 %.

Conclusion

Adults with a score of 0 (that is, simply a lack of DKA history, lack of insulin therapy, and A1c < 9 %) can be reassured that 99.8 % will not experience DKA in the subsequent year. In contrast, for adults with a score of 19 or higher the one-year risk of DKA is approximately 9 %, but false positives and false negatives are common and thus more work is needed to improve the predictive performance of the model.
钠葡萄糖共转运蛋白2抑制剂(SGLT2i)与糖尿病酮症酸中毒(DKA)的小幅度但较高的风险相关。然而,客观地确定DKA风险最低和最高的患者是具有挑战性的。方法利用加拿大安大略省门诊处方数据建立预测模型,并利用丹麦门诊处方数据进行外部验证。我们纳入了新开SGLT2i的成人2型糖尿病患者。我们在模型中的候选预测因子基于先前的工作,包括:性别,胰岛素使用,既往DKA,痴呆,血红蛋白A1C和肌酐。我们的结果是1年的DKA住院风险。我们对安大略(衍生队列)和丹麦(外部验证队列)报告的每个患者的检测特征采用惩罚回归法进行了风险评分。结果:安大略省322,135例和丹麦43,377例2型糖尿病患者接受了SGLT2i治疗。安大略省1年内发生DKA的绝对风险为0.28% (N = 916),丹麦为0.23% (N = 101)。使用安大略省的数据,各变量的风险评分如下:胰岛素使用= 4分,A1C >;9% = 4分,先前DKA = 19分。所有其他变量都得零分。总体模型AUC在安大略省为63%,在丹麦为66%(外部验证集)。在安大略省,评分阈值为0时,DKA的风险为0.19%,PPV为0.3%,敏感性为100%,在丹麦也观察到类似的结果。对于得分为19或更高的成年人,DKA的风险高出35倍,但假阳性很常见,PPV为6.7%,敏感性较低,为3%。在丹麦,得分为19分或更高的成年人患乳腺癌的风险为11%,PPV为10.2%,敏感性为5%。结论:0分成人(即单纯缺乏DKA病史、缺乏胰岛素治疗、A1c <;9%的人可以放心,99.8%的人在接下来的一年里不会经历DKA。相比之下,对于得分为19或更高的成年人,DKA的一年风险约为9%,但假阳性和假阴性是常见的,因此需要更多的工作来提高模型的预测性能。
{"title":"Predicting the occurrence of DKA following sodium glucose co-transporter-2 inhibitors: An international cohort study","authors":"Michael Fralick ,&nbsp;Mats C. Højbjerg Lassen ,&nbsp;Jagadish Rangrej ,&nbsp;Sahar Asgari ,&nbsp;Saad Rais ,&nbsp;Michael P. Hillmer ,&nbsp;Jamie Lee Fritz ,&nbsp;Katarina Zorcic ,&nbsp;Bruce A. Perkins ,&nbsp;Michael Colacci ,&nbsp;Tor Biering-Sørensen ,&nbsp;Muhammad Mamdani ,&nbsp;Kieran R. Campbell","doi":"10.1016/j.jdiacomp.2025.109144","DOIUrl":"10.1016/j.jdiacomp.2025.109144","url":null,"abstract":"<div><h3>Background</h3><div>Sodium glucose co-transporter 2 inhibitors (SGLT2i) are associated with a small-magnitude but higher risk of diabetic ketoacidosis (DKA). However, objectively identifying patients at lowest and highest risk of DKA is challenging.</div></div><div><h3>Methods</h3><div>We developed a prediction model using outpatient prescription data from Ontario, Canada and externally validated it using data from Denmark. We included adults with type 2 diabetes mellitus who were newly prescribed an SGLT2i. Our candidate predictors in the model were based on prior work and included the following: Sex, insulin use, prior DKA, dementia, hemoglobin A1C, and creatinine. Our outcome was 1-year risk of hospitalization with DKA. We calculated a risk score using an adaptation of penalized regression for each patient reported test characteristics in Ontario (derivation cohort) and Denmark (external validation cohort).</div></div><div><h3>Results</h3><div>We identified 322,135 in Ontario and 43,377 adults in Denmark who had type 2 diabetes mellitus and received an SGLT2i. The absolute risk of DKA within 1-year was 0.28 % (N = 916) in Ontario and 0.23 % (N = 101) in Denmark. Using data from Ontario, the risk score for each variable were as follows: Insulin use = 4 points, A1C &gt; 9 % = 4 points and prior DKA = 19 points. All other variables received zero points. The overall model AUC was 63 % in Ontario and 66 % in Denmark (external validation set). Within Ontario, at a score threshold of zero, the risk of DKA was 0.19 % and the PPV was 0.3 % and the sensitivity was 100 % and similar results were observed in Denmark. For adults with a score of 19 or higher, the risk of DKA was 35-fold higher but false positives were common yielding a PPV of 6.7 % and sensitivity was lower at 3 %. In Denmark, adults with a score of 19 or higher had a risk of 11 % and the PPV was 10.2 % and sensitivity was 5 %.</div></div><div><h3>Conclusion</h3><div>Adults with a score of 0 (that is, simply a lack of DKA history, lack of insulin therapy, and A1c &lt; 9 %) can be reassured that 99.8 % will not experience DKA in the subsequent year. In contrast, for adults with a score of 19 or higher the one-year risk of DKA is approximately 9 %, but false positives and false negatives are common and thus more work is needed to improve the predictive performance of the model.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 10","pages":"Article 109144"},"PeriodicalIF":3.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772881","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
Combination of imeglimin and resistance exercise improves mitochondrial function and glucose metabolism in skeletal muscles 结合伊米霉素和抗阻运动改善骨骼肌线粒体功能和葡萄糖代谢
IF 3.1 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-29 DOI: 10.1016/j.jdiacomp.2025.109145
Hajime Ishiguro , Keitaro Minato , Keiya Iwaasa , Sijia Wu , Guo Antao , Takumu Tsuchida , Tatsuya Suwabe , Takayuki Katagiri , Hiroshi Suzuki , Masayoshi Masuko , Ken-ichi Watanabe , Takashi Ushiki , Hirohito Sone
The diabetes medication imeglimin, which operates through a novel mechanism of action and resistance training (RT), a significant exercise therapy, effectively enhances mitochondrial function in skeletal muscles and regulates blood glucose levels. However, the efficacy of the combination therapy remains unclear.
The combination of imeglimin and RT enhanced mitochondrial function, reduced inflammatory cytokine levels, and upregulated the expression of anti-inflammatory and antioxidant-related genes as determined by RT-PCR. Additionally, there was an increase in the protein expression of peroxisome proliferator-activated receptor gamma coactivator 1-α (PGC1-α), a crucial regulator of mitochondrial biogenesis and glucose metabolism. This was accompanied by elevated levels of sirtuins (Sirt) 1 and 3, which positively regulate PGC1-α activity, as well as an increase in nicotinamide adenine dinucleotide (NAD+) levels, which are involved in Sirt1 and Sirt3 activity. Furthermore, an increase in the phosphorylation rate of protein kinase B (Akt), which plays a role in insulin signaling, and upregulation of glucose transporter type 4 (GLUT4), which is involved in glucose uptake, were observed.
These findings suggest that the combination of imeglimin and RT is a promising therapeutic approach to enhance mitochondrial function and glucose metabolic capacity.
糖尿病药物伊米明通过一种新的作用机制和抗阻训练(RT),一种重要的运动疗法,有效地增强骨骼肌线粒体功能并调节血糖水平。然而,联合治疗的疗效尚不清楚。通过RT- pcr检测,伊米霉素和RT联合使用可增强线粒体功能,降低炎症细胞因子水平,上调抗炎和抗氧化相关基因的表达。此外,过氧化物酶体增殖物激活受体γ辅助激活因子1-α (PGC1-α)的蛋白表达增加,PGC1-α是线粒体生物发生和葡萄糖代谢的关键调节因子。这伴随着sirtuins (Sirt) 1和3水平的升高,sirtuins (Sirt) 1和3积极调节PGC1-α活性,以及烟酰胺腺嘌呤二核苷酸(NAD+)水平的增加,这与Sirt1和Sirt3活性有关。此外,研究还发现,参与胰岛素信号传导的蛋白激酶B (Akt)磷酸化率升高,参与葡萄糖摄取的葡萄糖转运蛋白4型(GLUT4)上调。这些发现表明,伊米霉素和RT联合使用是一种很有前景的治疗方法,可以增强线粒体功能和葡萄糖代谢能力。
{"title":"Combination of imeglimin and resistance exercise improves mitochondrial function and glucose metabolism in skeletal muscles","authors":"Hajime Ishiguro ,&nbsp;Keitaro Minato ,&nbsp;Keiya Iwaasa ,&nbsp;Sijia Wu ,&nbsp;Guo Antao ,&nbsp;Takumu Tsuchida ,&nbsp;Tatsuya Suwabe ,&nbsp;Takayuki Katagiri ,&nbsp;Hiroshi Suzuki ,&nbsp;Masayoshi Masuko ,&nbsp;Ken-ichi Watanabe ,&nbsp;Takashi Ushiki ,&nbsp;Hirohito Sone","doi":"10.1016/j.jdiacomp.2025.109145","DOIUrl":"10.1016/j.jdiacomp.2025.109145","url":null,"abstract":"<div><div>The diabetes medication imeglimin, which operates through a novel mechanism of action and resistance training (RT), a significant exercise therapy, effectively enhances mitochondrial function in skeletal muscles and regulates blood glucose levels. However, the efficacy of the combination therapy remains unclear.</div><div>The combination of imeglimin and RT enhanced mitochondrial function, reduced inflammatory cytokine levels, and upregulated the expression of anti-inflammatory and antioxidant-related genes as determined by RT-PCR. Additionally, there was an increase in the protein expression of peroxisome proliferator-activated receptor gamma coactivator 1-α (PGC1-α), a crucial regulator of mitochondrial biogenesis and glucose metabolism. This was accompanied by elevated levels of sirtuins (Sirt) 1 and 3, which positively regulate PGC1-α activity, as well as an increase in nicotinamide adenine dinucleotide (NAD<sup>+</sup>) levels, which are involved in Sirt1 and Sirt3 activity. Furthermore, an increase in the phosphorylation rate of protein kinase B (Akt), which plays a role in insulin signaling, and upregulation of glucose transporter type 4 (GLUT4), which is involved in glucose uptake, were observed.</div><div>These findings suggest that the combination of imeglimin and RT is a promising therapeutic approach to enhance mitochondrial function and glucose metabolic capacity.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 10","pages":"Article 109145"},"PeriodicalIF":3.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738471","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 interplay between psychological well-being, diabetes-related distress, and glycemic control: A continuous glucose monitoring analysis from a population of adolescents with type 1 diabetes 心理健康、糖尿病相关痛苦和血糖控制之间的相互作用:一项来自1型糖尿病青少年人群的连续血糖监测分析
IF 3.1 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-26 DOI: 10.1016/j.jdiacomp.2025.109142
Bruno Bombaci , Stefano Passanisi , Alessandro Longo , Sara Aramnejad , Federica Rigano , Maria Cristina Marzà , Tania Formica , Maria Pecoraro , Fortunato Lombardo , Giuseppina Salzano

Aims

This study aims to explore the relationships between glucose control, psychological well-being, and diabetes-related distress in a population of adolescents with T1D.

Methods

We conducted a cross-sectional study on adolescents with T1D attending a Pediatric Diabetes Unit. Demographic, clinical, and glycemic data were collected, including continuous glucose monitoring (CGM) metrics. Psychological well-being was assessed using the PERMA-Profiler, while diabetes-related distress was measured using the Problem Areas in Diabetes-Teen Version (PAID-T) questionnaire.

Results

Among 133 enrolled adolescents, those with HbA1c ≤ 7 % exhibited significantly higher well-being scores (p = 0.007) and lower distress scores (p = 0.035). Higher time in range was positively associated with well-being (p = 0.002), while glycemic variability negatively impacted psychological outcomes (p = 0.023). Female sex (p = 0.021), longer disease duration (p = 0.022), and the absence of insulin pump therapy (p = 0.032) were significantly associated to higher diabetes-related distress.

Conclusions

Glycemic control is closely related to psychological well-being of adolescents living with T1D. The adoption of diabetes technologies may play a crucial role in reducing diabetes-related distress. Future longitudinal studies should investigate the impact of psychological interventions on CGM outcomes and overall quality of life in adolescents with T1D.
目的本研究旨在探讨青少年T1D患者的血糖控制、心理健康和糖尿病相关困扰之间的关系。方法:我们对在儿科糖尿病病房就诊的青少年T1D患者进行了横断面研究。收集了人口统计学、临床和血糖数据,包括连续血糖监测(CGM)指标。心理健康使用PERMA-Profiler进行评估,而与糖尿病相关的痛苦使用糖尿病青少年版问题领域(PAID-T)问卷进行测量。结果在133名入组青少年中,HbA1c≤7%的青少年表现出较高的幸福感得分(p = 0.007)和较低的痛苦得分(p = 0.035)。在范围内停留的时间越长,幸福感越高(p = 0.002),而血糖变异性对心理结果有负面影响(p = 0.023)。女性(p = 0.021)、病程较长(p = 0.022)和缺乏胰岛素泵治疗(p = 0.032)与较高的糖尿病相关焦虑显著相关。结论青少年糖尿病患者血糖控制与心理健康密切相关。糖尿病技术的采用可能在减少糖尿病相关痛苦方面发挥关键作用。未来的纵向研究应该调查心理干预对青少年T1D患者CGM结局和整体生活质量的影响。
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引用次数: 0
The role of artificial intelligence in diabetic retinopathy screening in type 1 diabetes: A systematic review 人工智能在1型糖尿病视网膜病变筛查中的作用:系统综述
IF 3.1 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-25 DOI: 10.1016/j.jdiacomp.2025.109139
Francesco Sacchini , Stefano Mancin , Giovanni Cangelosi , Sara Morales Palomares , Gabriele Caggianelli , Francesco Gravante , Fabio Petrelli

Background/objectives

Diabetic retinopathy (DR) is one of the leading causes of blindness in adults worldwide and represents a critical complication in both type 1 (T1D) and type 2 (T2D) diabetes. Artificial Intelligence (AI) offers a promising opportunity to enhance both the accuracy of screening and the efficiency of ongoing care management, assisting healthcare providers in mitigating the incidence and complications of DR.

Methods

Systematic review of the literature was conducted following PRISMA guidelines. Searches were performed using PubMed-Medline, Scopus, and Embase databases, with the protocol registered on the Open Science Framework (OSF) database: (doi.org/10.17605/OSF.IO/TJ9UH). A predefined search strategy utilizing Boolean operators was applied, and two researchers independently selected articles, with a third resolving any discrepancies.

Results

Of the 2127 articles identified, 8 studies were included. The results highlighted that AI is particularly effective in enhancing the DR screening process in patients with T1D, offering rapid and reliable analysis. Healthcare providers reported positive feedback, noting its significant contribution to improving patient management.

Conclusions

The integration of AI into DR care pathways shows substantial potential for improving early diagnosis and disease management, particularly for patients with T1D. Further research is required to optimize AI implementation and ensure its positive and sustainable impact on public health.
背景/目的糖尿病视网膜病变(DR)是全球成年人失明的主要原因之一,是1型(T1D)和2型(T2D)糖尿病的重要并发症。人工智能(AI)提供了一个很有希望的机会来提高筛查的准确性和持续护理管理的效率,帮助医疗保健提供者减少dr的发生率和并发症。方法按照PRISMA指南对文献进行系统的回顾。使用PubMed-Medline、Scopus和Embase数据库进行搜索,协议注册在开放科学框架(OSF)数据库:(doi.org/10.17605/OSF.IO/TJ9UH)。应用了使用布尔运算符的预定义搜索策略,两位研究人员独立选择文章,第三位研究人员解决任何差异。结果在纳入的2127篇文献中,纳入了8项研究。结果强调,人工智能在加强T1D患者的DR筛查过程中特别有效,提供了快速可靠的分析。医疗保健提供者报告了积极的反馈,指出其对改善患者管理的重大贡献。结论:人工智能与DR护理途径的整合显示出改善早期诊断和疾病管理的巨大潜力,特别是对于T1D患者。需要进一步研究以优化人工智能的实施并确保其对公共卫生产生积极和可持续的影响。
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引用次数: 0
Effect of colchicine on platelet aggregation in patients with type 2 diabetes: Results from a randomized placebo-controlled trial 秋水仙碱对2型糖尿病患者血小板聚集的影响:一项随机安慰剂对照试验的结果
IF 2.9 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2025-07-25 DOI: 10.1016/j.jdiacomp.2025.109141
Jonathan M. Baier , Kristian L. Funck , Liv Vernstrøm , Søren Gullaksen , Per L. Poulsen , Esben Laugesen

Background

Patients with type 2 diabetes face an increased risk of cardiovascular disease (CVD), partly due to a prothrombotic state with increased platelet reactivity. Colchicine, an anti-inflammatory drug, has shown promise in reducing cardiovascular events, but its effects on platelet function remain unclear. This trial evaluated the effect of low-dose colchicine on platelet aggregation and platelet activation indices in patients with type 2 diabetes.

Methods

In this double-blind, randomized, placebo-controlled trial, 100 participants with type 2 diabetes and previous CVD or a least one cardiovascular risk factor were randomized in a 1:1 ratio to receive either colchicine (0.5 mg/day) or placebo for 26 weeks. Platelet aggregation was assessed using multiple electrode aggregometry expressed as aggregation units (AU) × minutes (mins). Adenosine diphosphate (ADP), arachidonic acid (AA), and thrombin-receptor-activating peptide (TRAP) were used as agonists.

Results

A total of 95 participants completed the trial. After 26 weeks, no significant differences were observed between the colchicine and placebo groups in platelet aggregation induced by ADP (ΔADP-aggregation: 49, 95 % CI: −15;113 AU x mins, p = 0.08), AA (ΔAA-aggregation: −4, 95 % CI: −24;16 %, p = 0.69), or TRAP (ΔTRAP-aggregation: −3, 95 % CI: −11;4 %, p = 0.39). Similarly, no between-group differences were found in platelet parameters, including platelet count mean platelet volume, and immature platelet fraction.

Conclusions

Low-dose colchicine did not significantly alter platelet aggregation or platelet activation indices in patients with type 2 diabetes. These findings suggest that colchicine's cardioprotective effects are not mediated through direct effects on platelet function.

Clinical trial registration information

EudraCT-no.: 2021-003525-30
Link: https://www.clinicaltrialsregister.eu/ctr-search/trial/2021-003525-30/DK
背景:2型糖尿病患者患心血管疾病(CVD)的风险增加,部分原因是血小板反应性增高的血栓形成前状态。秋水仙碱是一种抗炎药物,在减少心血管事件方面有希望,但它对血小板功能的影响尚不清楚。本试验评估了低剂量秋水仙碱对2型糖尿病患者血小板聚集和血小板活化指标的影响。方法在这项双盲、随机、安慰剂对照试验中,100名患有2型糖尿病和既往心血管疾病或至少一种心血管危险因素的参与者按1:1的比例随机接受秋水仙碱(0.5 mg/天)或安慰剂治疗26周。血小板聚集用多电极聚集法评估,聚集单位(AU) ×分钟(min)。二磷酸腺苷(ADP)、花生四烯酸(AA)和凝血酶受体激活肽(TRAP)作为激动剂。结果共有95名参与者完成了试验。26周后,在ADP (ΔADP-aggregation: 49, 95% CI:−15;113 AU x min, p = 0.08)、AA (ΔAA-aggregation:−4,95% CI:−24;16%,p = 0.69)或TRAP (ΔTRAP-aggregation:−3,95% CI:−11;4%,p = 0.39)诱导的血小板聚集方面,秋水仙碱组与安慰剂组之间无显著差异。同样,各组间的血小板参数,包括血小板计数、平均血小板体积和未成熟血小板分数均无差异。结论慢剂量秋水仙碱对2型糖尿病患者血小板聚集和血小板活化指标无显著影响。这些发现表明秋水仙碱的心脏保护作用不是通过直接影响血小板功能介导的。临床试验注册信息链接:https://www.clinicaltrialsregister.eu/ctr-search/trial/2021-003525-30/DK
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引用次数: 0
期刊
Journal of diabetes and its complications
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