Journal of Diabetes最新文献

Aims

Type 2 Diabetes Mellitus (T2DM) and depression are major public health challenges, with Mexico ranking among the countries with the highest prevalence of both. Research into the bidirectional relationship between the two conditions in Mexico is scarse. This study aims to investigate the prevalence of T2DM and depression, the co-occurrence of these conditions, the strength of their association, and socio-demographic, and geographical factors contributing to their prevalence in Mexico.

Methods

We used data from the 2022 National Health and Nutrition Survey. T2DM was self-report. Depression was assessed using the Center for Epidemiological Studies Depression Scale. Descriptive statistics and multivariate logistic regression models were used to explore the bidirectional relationship and associated factors.

Results

A high prevalence of depressive symptoms (16.7%) and Type 2 Diabetes Mellitus (T2DM, 10.9%) was found in a representative sample for the Mexican population (n =11 913). Participants with T2DM had higher odds of depressive symptoms (OR:1.78, 95 95% CI: 1.48–2.14), and those with depressive symptoms were also more likely to have T2DM (OR:1.97, 95% CI:1.52–2.54) for ages 20–59, and for ages 60+ (OR: 1.63, 95% CI: 1.27–2.09). Women were more likely to report depression than men (OR:2.14, 95% CI:1.83–2.51), and older adults (60+) had over three times higher odds of depression compared to younger adults (OR:3.53, 95% CI:3.00–4.15). Higher education was protective against both conditions, with individuals having high school or higher education showing lower odds of depression (OR:0.41, 95% CI: 0.31–0.53) and T2DM (OR: 0.52, 95% CI: 0.37–0.74).

Conclusions

Integrated strategies to address the co-occurrence of T2DM and depression are needed, particularly among vulnerable and older populations.

Aims

To investigate the effects of combining oral hypoglycemic agents with short-term intensive insulin therapy (SIIT) via continuous subcutaneous insulin infusion (CSII) on glycemic outcomes in adults with newly diagnosed type 2 diabetes mellitus.

Materials and Methods

In this multicenter, open-label trial, 245 participants were randomized to three treatment arms: SIIT for 2 weeks (CSII group), SIIT plus 90-day metformin and pioglitazone (CSII + Met + Pio group), or SIIT plus 90-day sitagliptin (CSII + Sita group). The primary outcome was the 12-month diabetes remission rate. Parameters of glycemic control, β-cell function, and insulin resistance were compared among groups.

Results

The participants had a mean HbA1c of 10.6% ± 2.2%. Compared to the CSII group, both combination groups had lower total daily and pre-meal bolus insulin requirements with higher time in tight target range (TITR) during SIIT, and had significantly greater acute insulin response (AIR) after SIIT. Three months post SIIT, more participants in the CSII + Met + Pio group (78.7%, 59/75) achieved HbA1c < 6.5% compared with the CSII group (59.0%, 46/78; adjusted p < 0.05), but the 12-month diabetes remission rates were similar (p = 0.972).

Conclusions

Oral hypoglycemic agents facilitated SIIT implementation and enhanced transient improvements in glycemic control. However, similar 12-month diabetes remission rates suggest prolonged sequential therapy may be needed for sustained glycemic benefit.

Background

Diabetic foot ulcers (DFU) are severe complications with complex pathogenesis involving inflammation and impaired healing. Taurine, a key antioxidant amino acid, shows therapeutic potential in diabetes, but its role in DFU remains unclear and warrants investigation.

Methods

This integrated multi-omics study analyzed DFU using GEO transcriptomics data (training: GSE68183/GSE80178; validation: GSE37265/GSE134431; scRNA-seq: GSE223964). Limma identified DEGs that intersected with taurine metabolism -related genes. Key modules (MCODE) and a LASSO-based diagnostic signature were established. Immune infiltration was profiled via ssGSEA, CIBERSORT, and MCP-Counter. Regulatory networks (TFs/miRNAs) were predicted (miRNet/NetworkAnalyst), and therapeutic agents were screened (DSigDB). Seurat-processed scRNA-seq defined nine cell types, with CellChat analyzing intercellular communication.

Results

This study identified a three-gene diagnostic signature (HMOX1, MAPK3, TXN) for DFU with near-perfect accuracy (training AUC = 1, validation AUC ≥ 0.98). Multi-omics analyses revealed significant immune dysregulation (increased B cells/CD8⁺T cells/M1 macrophages in DFS), collagen-centric signaling dominance, and two molecular subtypes. Single-cell RNA-seq uncovered cell-type-specific dysfunction: fibroblasts and endothelial cells expanded in DFS, while HMOX1 localized to Mono-macrophages and MAPK3 to endothelium.

Conclusion

This study deeply analyzed DFU immune microenvironment characteristics, intercellular communication networks, and molecular regulatory mechanisms, revealing a dysregulated metabolic–immune repair network framework, providing new insights for understanding DFU pathological mechanisms and developing targeted diagnostic and therapeutic strategies.

Aims

To evaluate the feasibility of sodium-glucose cotransporter 2 inhibitors (SGLT2i) as a systemic adjunct for patients with diabetic macular edema (DME) and hypertension.

Materials and Methods

This study encompassed a post hoc analysis of the COMET Trial data, focusing on patients with DME and hypertension, defined by office systolic blood pressure (OSBP) ≥ 140 mmHg or a documented history of hypertension. Participants were randomized to receive either SGLT2i (luseogliflozin) or sulfonylurea (SU, glimepiride). The primary outcome was the treatment burden, quantified by the total number of intravitreal ranibizumab injections (IVRs) over 48 weeks.

Results

Within the OSBP ≥ 140 mmHg subgroup, 14 patients received SGLT2i and 15 received SU. The total number of IVRs was 4.1 ± 3.1 in the SGLT2i group and 6.8 ± 3.1 in the SU group (Cohen's d = 0.87; power = 0.82). The adjusted analysis of covariance further confirmed significantly fewer IVRs in the SGLT2i group (3.3 ± 1.1 vs. 6.2 ± 1.0, p = 0.025). OSBP was significantly reduced in the SGLT2i group at Week 12, but there was no significant difference at Week 48. Office diastolic blood pressure remained consistently lower in the SGLT2i group. No significant differences in IVR frequency were observed in other subgroups.

Conclusions

SGLT2i may help reduce the treatment burden of IVRs in patients with DME and elevated OSBP. The improvements in blood pressure and visual acuity, despite fewer injections, indicate a potential synergistic effect of SGLT2i in managing DME with hypertension. Further investigation is warranted to validate its efficacy as a potential systemic adjunct.

Trial Registration: UMIN000057674.

Background

Diabetic kidney disease (DKD) is characterized by a sustained pro-inflammatory response of the immune system, which leads to renal failure progression and related complications. Emerging evidence suggests that gut microbiota dysregulation may be a pathogenic mediator in DKD, while mechanisms remain unclear. This study aimed to identify differences in the gut microbiota of the DKD group and healthy controls (HC).

Methods

Gut microbiota composition was determined using shotgun metagenomic sequencing on fecal samples; serum cytokines were measured via ELISA, immune phenotypes were detected using flow cytometry.

Results

Significant differences in gut microbiota diversity and richness were observed between patients with DKD and HC, with higher abundances of Enterobacteriaceae, Serratia, and Shigella in the DKD group than in the HC group. Additionally, CD3+ (especially CD4+) T cells were significantly higher in the renal tissue of the DKD group than the HC group. Flow cytometry identified significantly higher circulating levels of NKT cells and CD8+ T cells and lymphocyte ratio in HC than in DKD. CD4+ cells, CD4+ TCM cells, CD8+ TCM cells, and the CD4+/CD8+ cell ratio were significantly higher in the DKD group than in the HC group, as were levels of pro-inflammatory mediators, including IL-6, TNF-α, and sCD14, and expression of the gut barrier dysfunction marker ZO-1.

Conclusions

Gut barrier dysfunction and gut microbiota imbalance may mediate the pro-inflammatory immune phenotype observed in patients with DKD and thereby contribute to DKD progression. These findings underscore the important role of the microbiota–immune axis in the development of DKD.

Background

People with long-term type 1 diabetes have reduced cardiorespiratory fitness (CRF). We aimed to assess the influence of body composition, energy substrate use, and blood glucose control on cardiopulmonary exercise test performance in subjects with uncomplicated, long-term type 1 diabetes.

Methods

Observational, cross-sectional study. Subjects with and without type 1 diabetes, paired by sex and age, underwent treadmill cardiopulmonary exercise test, bioelectrical impedance analysis, indirect calorimetry at rest and during exercise. We used the t-pair test; multivariate linear regression models and mediation analysis were used to evaluate determinants of CRF.

Results

54 cases and 54 controls (52% female) were evaluated. The age was 39 (28–46) years, duration of disease 21 ± 10 years. HbA1c 7.9 (7.3–8.7). The baseline physical activity, resting energy expenditure, respiratory quotient and body composition were similar between groups. VO2max was 32 ± 9.2 versus 39 ± 7.9 mL/kg/min (p < 0.01) for cases and controls. Maximum carbohydrate oxidation was 809 (614–1174) versus 1082 (863–1454) (p < 0.01), respectively. In women 73% and 25% of the effect of diabetes status on VO2max were mediated by carbohydrate oxidation and heart rate reserve, respectively. In men 78% and 57% of the effect of diabetes status on VO2max were mediated by carbohydrate oxidation and phase angle, respectively.

Conclusions

Type 1 diabetes group had an altered CRF with lower carbohydrate oxidation. This suggests altered metabolic flexibility due to low substrate availability that could explain the earlier fatigue during intense exercise. There were different determinants of VO2max in persons with diabetes according to sex.