Diabetes, Obesity & Metabolism最新文献

Aim: This study evaluated the efficacy and safety of empagliflozin 10 and 25 mg compared to placebo as add-on treatment for people with type 2 diabetes mellitus (T2DM) uncontrolled after ≥8 weeks of treatment with metformin and sitagliptin.

Materials and methods: A randomised, double-blind, multicentre, therapeutic confirmatory, phase 3 clinical trial was conducted in 172 patients with T2DM. Participants with glycosylated haemoglobin (HbA1c) levels 7%-10% receiving sitagliptin and metformin were randomised 1:1:1 to empagliflozin 10 mg, empagliflozin 25 mg, or placebo. The primary endpoint was the change in HbA1c from baseline to week 24.

Results: After 24 weeks of treatment, HbA1c levels were significantly decreased in the empagliflozin 10 and 25 mg group versus the placebo group; the adjusted mean differences with empagliflozin 10 and 25 mg versus placebo were -0.7% (95% CI -1.0, -0.4; p <.0001) and -0.8% (95% CI -1.1, -0.5; p <.0001), respectively. Fasting plasma glucose levels were also significantly decreased in both empagliflozin groups compared to the placebo group (both p <.0001). More patients reached HbA1c <7% or <6.5% after 24 weeks in the empagliflozin 10 and 25 mg groups versus the placebo group (both p <.05). Efficacy was maintained in the empagliflozin groups during a 28-week extension period. Empagliflozin add-on was associated with improvements in albuminuria and body weight. The incidence of adverse events was similar across groups; add-on empagliflozin was well tolerated.

Conclusions: These results suggest that coadministration of empagliflozin safely improves glycemic control in Korean patients with T2DM uncontrolled by sitagliptin and metformin.

Aims: To evaluate the prognostic value of serum albumin (ALB), glycated albumin (GA), and the GA-to-ALB ratio (%GA) for survival outcomes in individuals with cardiovascular-kidney-metabolic (CKM) syndrome.

Materials and methods: This study included 4524 adult participants with CKM syndrome stages 0-3 from the National Health and Nutrition Examination Survey (1999-2004), with linked mortality information available through 2019. Multivariable Cox regression models and subgroup analyses were used to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. Restricted cubic spline (RCS) models were used to assess nonlinear associations. Time-dependent ROC curves and random survival forest (RSF) models determined the predictive accuracy of serum ALB, GA, and %GA for survival outcomes.

Results: During the median follow-up of 17.6 years, 1032 deaths occurred, including 281 from cardiovascular-cerebrovascular disease (CCD). Higher %GA was associated with increased risk of all-cause (HR = 1.59; 95% CI: 1.17-2.15) and CCD mortality (HR = 1.94; 95% CI: 1.07-3.53), while higher ALB levels were consistently associated with lower all-cause mortality risk. Absolute GA was not independently associated with either outcome after multivariable adjustment. ROC curve analysis and RSF models revealed that %GA was the most robust marker among the three for long-term mortality risk, with consistent results across 5-, 10-, and 15-year follow-up periods.

Conclusions: This study indicated that higher %GA levels were associated with increased all-cause and CCD mortality risk, supporting the potential predictive value of %GA for the early identification and stratification of mortality risk in CKM stages 0-3.

Aims: To evaluate the accuracy of abdominal fat distribution of subcutaneous (SAT) and visceral adipose tissue (VAT) assessed by ultrasound (US) compared to magnetic resonance imaging (MRI), as the gold standard technique. Additionally, to assess the association between abdominal fat distribution measured by US and metabolic conditions in adults with abdominal obesity.

Materials and methods: A cross-sectional study (ClinicalTrials.gov: NCT05882149) included 113 individuals (65.5% women) with waist circumference ≥102 cm for men and ≥88 cm for women. VAT and SAT were measured by both US and MRI. Diagnostic performance was evaluated using ROC curve analysis.

Results: Participants were (mean ± SD) 52.8 ± 10.9 years old. VAT thickness measured by US showed a strong correlation with MRI (r = 0.82). For prediabetes, US-measured VAT thickness showed fair diagnostic accuracy in women (AUC = 0.71) with a proposed cut-off of 5.87 cm. For metabolic syndrome, US-measured VAT thickness showed poor diagnostic accuracy in women (AUC = 0.69), with a proposed cut-off of 4.83 cm. Also, VAT/SAT ratio (thickness) measured by US showed fair diagnostic accuracy for prediabetes in women (AUC = 0.72), with a proposed cut-off of 3.04, and poor diagnostic accuracy for metabolic syndrome in women (AUC = 0.69), with a proposed cut-off of 2.52.

Conclusions: Ultrasound represents a useful screening tool for VAT thickness evaluation with an easy translation to clinical practice. Particularly, VAT thickness and VAT/SAT ratio (thickness) are positively associated with prediabetes and metabolic syndrome, especially in women.

Aim: To evaluate the association between baseline glycemic status and mortality among patients with cancer and to examine whether these associations differ by stage and cancer type.

Materials and methods: We performed a nationwide cohort study using the Korean Cancer Public Library Database (K-CURE), which integrates national cancer registry, health screening, and cause-of-death records. A total of 671 366 adults newly diagnosed with one of 24 cancers between 2013 and 2019 were classified as normal glucose tolerance (NGT), impaired fasting glucose (IFG), or diabetes mellitus (DM). Multivariable Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause, cancer-specific, cardiovascular, and respiratory mortality. Analyses were stratified by Surveillance, Epidemiology, and End Results stage and cancer type, with sensitivity analyses applying 1-, 3-, and 5-year lag periods.

Results: Over a mean follow-up of 3.5 years, 171 104 deaths occurred. Compared with NGT, DM was associated with higher risks of all-cause (HR 1.34, 95% CI 1.32-1.35), cancer-specific (HR 1.31, 95% CI 1.30-1.33), cardiovascular (HR 1.46, 95% CI 1.35-1.58), and respiratory mortality (HR 1.43, 95% CI 1.30-1.56). IFG was associated with modestly increased risks of all-cause (HR 1.06, 95% CI 1.05-1.08) and cancer-specific mortality (HR 1.07, 95% CI 1.05-1.08). Stage-stratified analyses demonstrated the strongest associations in localised cancers with attenuation in advanced stages.

Conclusions: DM and IFG were linked to poorer survival after cancer diagnosis, with the greatest impact in early-stage disease. These findings support integrating metabolic risk assessment and management into survivorship care.

Aims: The burden of type 1 diabetes (T1D)-related chronic kidney disease (CKD) continues to grow and demands attention. We aim to determine the global prevalence of CKD in T1D.

Materials and methods: PubMed, Embase, Cochrane Library and Web of Science were searched from database inception to 23 May 2025. Grey literature and reference lists of relevant articles were also retrieved. Observational studies with at least 100 participants reporting the prevalence of CKD in T1D were included. In line with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, data from eligible studies were extracted by two independent reviewers using a standardised form, with risk of bias assessed. A random-effects model was applied for the meta-analysis. The primary outcome was the pooled prevalence. Secondary outcomes included the pooled prevalence stratified by study design, region, age, diabetes duration and glycated haemoglobin (HbA_1c), along with separate univariable meta-regressions for diabetes duration and for HbA_1c.

Results: Our search identified 2187 studies; 19 met criteria and were included in the meta-analysis. The overall pooled prevalence of CKD in T1D from 1 371 533 individuals was 22.3% (95% CI 18.9%-26.0%). Regional analysis showed the highest prevalence in the Americas (27.0%, 95% CI 21.8%-33.0%) and the lowest in Europe (19.4%, 95% CI 15.0%-24.7%). The prevalence was higher in adults (20.5%, 95% CI 18.0%-23.3%) than in adolescents (10.5%, 95% CI 7.4%-14.8%), in those with diabetes duration ≥10 years (21.8%, 95% CI 16.9%-27.7%) than in those with a shorter duration (16.4%, 95% CI 15.5%-17.3%), and in those with HbA_1c ≥ 8% (27.7%, 95% CI 21.8%-34.6%) than in those with better glycemic control (17.9%, 95% CI 13.8%-22.9%). Meta-regression revealed a significant association between CKD prevalence in T1D and higher HbA_1c levels. High heterogeneity was observed among studies, with no studies at high risk of bias.

Conclusions: Our study found a high prevalence of CKD in T1D, and poor glycemic control increases the prevalence. Regular screening in T1D is necessary to reduce the risk of severe kidney disease.

Aims: Those with young-onset type-2 diabetes (YOD), diagnosed before age of 40 years, experience heightened risk of complications. The economic burden extends beyond medical costs, impacting work productivity.

Materials and methods: Chinese patients with YOD were recruited between June 2023 and April 2024 in the Precision Medicine to redefine Insulin Secretion and Monogenic diabetes Trial in Hong Kong (NCT04049149). Presenteeism and absenteeism were measured using the World Health Organization Health and Performance Questionnaire.

Results: Of the 639 invited participants, 603 (94%) completed the questionnaire, with 444 employed participants with type-2 diabetes (40.1% female, 80.4% 40-50 years, 32.9% 5-10 years with diabetes, 53.3% hemoglobin A1c (HbA1c) <7.0%, 75.2% low-density lipoprotein cholesterol <2.6 mmol/L, 42.3% body mass index ≥25 < 30 kg/m²). Participants reported mean presenteeism score of 7.34/10, 93.9% experiencing productivity loss with 0.48 mean sick days. Increased productivity was associated with females, child care, flexible work schedules and higher salary. Reduced productivity was related to, albuminuria, use of lipid-lowering medications and more sick leaves. With approximately 38 700 patients with YOD in Hong Kong, territory-wide productivity losses are projected to reach US$444 million annually (presenteeism: US$419 million, absenteeism: US$25 million).

Conclusions: This study is the first to quantify productivity costs in Chinese patients with YOD, highlighting the need for work place policies, intensive treatment and management strategies to enhance support for individuals with YOD.