This study determined the association of the glycaemia risk index (GRI), a novel comprehensive metric derived from continuous glucose monitoring (CGM), and atherosclerosis in patients with type 2 diabetes (T2DM).
We evaluated the relationship between GRI and intima-media thickness (IMT), gray-scale median (GSM), tissue characteristics of the carotid artery wall, and brachial-ankle pulse wave velocity (baPWV), using baseline data from a multicenter prospective cohort study of 1000 Japanese patients with T2DM free of cardiovascular disease (CVD).
The study subjects were 999 patients (age: 64.6 ± 9.6 years, mean ± SD, 60.9% males, body mass index: 24.6 ± 3.9 kg/m2, HbA1c 7.1% ± 0.8%, TIR 78.9% ± 18.6%) with T2DM (duration of 12.9 ± 8.5 years). A higher GRI was associated with a longer duration of diabetes, a higher HbA1c level, a mean glucose level, and baPWV, and lower mean GSM. No association was noted between GRI and mean IMT. GRI was significantly associated with mean GSM (regression coefficient, β = −0.1277; 95% confidence interval: CI: −0.2165 to −0.0390, p = 0.005) and baPWV (regression coefficient, β = −3.1568; 95% CI: 1.5058 to 4.8079, p < 0.001) after adjustment for various cardiovascular risk factors.
GRI is a potentially useful predictor of atherosclerosis in patients with T2DM. Our findings suggest that GRI, a marker of the risk of hypoglycaemia and hyperglycaemia, may serve as a clinically useful tool for the assessment of the risk of CVD in patients with T2DM, independent of the classical cardiovascular risk factors.
To verify sex differences of GLP-1RAs for weight reduction.
We searched RCTs reporting weight change by sex from PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials registries. Meta-regression was performed to evaluate the association between weight reduction and sex differences. Subgroup analyses were stratified by individual GLP-1RA medications, dose, treatment duration, indication, type of control, background treatment, and baseline weight. The study protocol was registered (CRD42023480167).
Fourteen studies covering dulaglutide, exenatide, liraglutide, semaglutide, and retatrutide were included in this study. The meta-analysis showed that females lost more weight than males (MD 1.04 kg [95% CIs 0.70–1.38]; MD 1.69% [95% CI 0.78–2.61]). The pooled results of GLP-1RAs indicated similar results (MD 0.88 kg [95% CIs 0.67–1.09]). Meta-regression illustrated that substantial weight reduction was significantly relevant to greater gender differences (β = −0.19 [95% CIs −0.29 to −0.09]). Subgroup analysis demonstrated that indications for weight reduction increased the gender difference in weight reduction (MD 4.21 kg [95% CIs 1.75–6.67]). Background treatment, dose, duration of treatment, baseline weight, and type of control had no subgroup differences in the sex difference in weight reduction of GLP-1RAs. Dulaglutide (MD 0.88 kg [95% CIs 0.63–1.12]) and semaglutide (MD 1.04 kg [95% CIs 0.45–1.63]) showed statistically significant differences in weight reduction between males and females. No gender difference was observed in the exenatide subgroup analysis.
Females lost more weight than males when treated with GLP-1RAs for weight reduction. The sex difference in weight reduction became more pronounced as the degree of weight reduction increased. Indications for obesity could magnify this sex difference.
A relationship between frailty index (FI) and metabolic diseases (MDs) has been reported in previous observational studies. However, the causality between them remains unclear. This study aimed to examine the causal effect of FI on MDs.
We performed a bidirectional two-sample Mendelian randomization (MR) study. A recent large-scale genome-wide association study (GWAS) provided available data associated with FI, and summary statistics on eight MDs were collected from the IEU OpenGWAS database. Inverse variance weighted (IVW) was used as the main analysis to estimate causal effects, together with MR pleiotropy residual sum and outlier (MR-PRESSO), MR-Egger, Cochran's Q test, pleiotropy test, leave-one-out method, and MR Steiger analysis were used in the sensitivity analyses.
Our MR study demonstrated for the first time that elevated FI was causally associated with an increased risk of MDs including obesity (odds ratio [OR] = 1.78; 95% confidence interval [CI]: 1.17–2.70; p = 0.0075), T2DM (OR = 1.67; 95% CI: 1.24–2.24; p = 6.95 × 10−4), gout (OR = 2.45; 95% CI: 1.29–4.64; p = 0.006), hypothyroidism (OR = 1.96; 95% CI: 1.47–2.60; p = 3.47 × 10−6), and HTN (OR = 2.17; 95% CI: 1.72–2.74; p = 5.25 × 10−11). However, no causal association was found between FI and osteoporosis, vitamin D deficiency, and hyperthyroidism.
Our findings support a causal relationship between FI and multiple MDs. This is crucial for the prevention of associated MDs in patients with frailty.
The aim of this study was to investigate the relationship between SAF and CHD in the general population of China and to assess the feasibility of SAF used as a predictor of CHD.
This study was nested within the prospective study REACTION (Cancer Risk Assessment in Chinese Diabetic Population) which included a total of 5806 eligible participants from two communities located in urban Beijing in 2018. SAF were measured using a fluorescence detector (DM Scan). CHD was the study endpoint and was determined by a face-to-face clinical survey. Pearson's correlation analysis, linear regression analysis, and binary logistic regression analysis were used to examine the association between SAF and CHD.
The overall prevalence of CHD in the general population was 12.1%. Logistic analysis showed that after full adjustment for confounding factors, the risk of CHD increased significantly with increasing lnSAF quartiles (p-trend < 0.05). Compared to Q1 group, the multivariate adjusted ORs of Q2 and Q3 groups were 1.071 (0.817, 1.404), 1.025 (0.781, 1.344), respectively, and the OR was markedly increased at Q4 (OR = 1.377 [1.043, 1.817]). When lnSAF was a continuous variable, the risk of CHD increased with the elevation of lnSAF level. Stratified analysis showed that in subgroups with overweight (24–28 kg/m2), eGFR < 60 mL/min/1.73 m2, and diabetes mellitus (DM), lnSAF was still significantly correlated with CHD.
In Chinese general population, higher lnSAF is independently associated with increased risk of CHD, and noninvasive SAF holds the potential to be a biomarker for CHD risk evaluation and stratification.
A comprehensive epidemiological investigation of the coexistence between diabetes and stroke/TIA in China is urged.
Data from the Chinese Stroke Center Alliance program, a nationwide multi-center registry study, were used to detect the prevalence, awareness, treatment, and control of diabetes among stroke/TIA. The distribution of diagnosed and undiagnosed diabetes and prediabetes among stroke/TIA patients was investigated, the medical care around diabetes and their respective risk predictors were analyzed, and the association of all above diabetes characteristics with in-hospital death was evaluated using multi-variable Cox regression models.
Of 980 625 patients included, 308 426 (31.5%) had prediabetes, while 365 052 (37.2%) had diabetes, with nearly a third of them undiagnosed (112 969, 30.9%). Of residual aware diabetic patients, 59.0% were treated, with 27.3% controlled. Compared to Han ethnicity, Zhuang ethnicity had a lower prevalence of diabetes (37.3% vs. 35.1%) but were less aware (69.4% vs. 56.5%), treated (59.4% vs. 47.8%), and controlled (27.4% vs. 26.0%). Patients with prediabetes, diagnosed, and undiagnosed diabetes had increasingly higher risks of in-hospital death (adjusted HR [95% CI]: 1.47 [1.35–1.60]; 2.15 [1.97–2.34]; 4.20 [3.87–4.56], all p < 0.001). Unaware and untreated diabetes were independently associated with in-hospital death (adjusted HR [95% CI]: 1.99 [1.85–2.14]; 2.84 [2.63–3.07, both p < 0.001]). Compared with controlled diabetes, those with uncontrolled diabetes had a lower risk of in-hospital death (adjusted HR [95% CI]: 0.77[0.68–0.88], p < 0.001).
The findings indicate that over two-thirds of stroke/TIA patients are exposed to diabetes in China, causing higher in-hospital mortality, which should be screened and intervened early.
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