Emerging evidence suggests that the creatinine-to-body weight (Cre/BW) ratio is a predictor for incident diabetes in the Asian population. This study examined the association between Cre/BW ratio and incident diabetes, as well as the relationship between Cre/BW ratio and skeletal muscle and body fat mass in a multiethnic Malaysian cohort.
A total of 13 047 eligible participants were selected from 119 560 The Malaysian Cohort participants. Of these, 750 who developed diabetes were selected as cases, while 3750 controls were chosen randomly from healthy participants. This nested case–control study included 4500 eligible participants from The Malaysian Cohort, with a 1:5 case-to-control ratio. Participants were stratified into four groups based on Cre/BW ratio quartiles. The Cox proportional hazards model evaluated the effect of Cre/BW ratio on developing incident diabetes. The association between Cre/BW ratio and body composition was assessed using the Pearson correlation coefficient.
Of the 13 047 eligible participants followed up over 5.3 years, 5.75% (n = 750) developed diabetes. Diabetes incidence decreased with increasing Cre/BW ratios. The Cre/BW ratio was inversely correlated with diabetes risk (HR: 0.403, 95% CI: 0.315–0.515, p < 0.001). Additionally, males and Indians had a higher risk of developing incident diabetes. A significant correlation was observed between Cre/BW ratio and body fat mass (p < 0.001).
This study reveals an inverse association between the Cre/BW ratio and incident diabetes. It also found a significant moderate correlation between the Cre/BW ratio and body fat mass.
Understanding is limited regarding strategies for addressing missing value when developing and validating models to predict cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). This study aimed to investigate the presence of and approaches to missing data in these prediction models. The MEDLINE electronic database was systematically searched for English-language studies from inception to June 30, 2024. The percentages of missing values, missingness mechanisms, and missing data handling strategies in the included studies were extracted and summarized. This study included 51 articles published between 2001 and 2024, involving 19 studies that focused solely on prediction model development, and 16 and 16 studies that incorporated internal and external validation, respectively. Most articles reported missing data in the development (n = 40/51) and external validation (n = 12/16) stages. Furthermore, the missing data were addressed in 74.5% of development studies and 68.8% of validation studies. Imputation emerged as the predominant method employed for both development (27/40) and validation (7/12) purposes, followed by deletion (17/40 and 4/12, respectively). During the model development phase, the number of studies reported missing data increased from 9 out of 15 before 2016 to 31 out of 36 in 2016 and subsequent years. Although missing values have received much attention in CVD risk prediction models in patients with T2DM, most studies lack adequate reporting on the methodologies used for addressing the missing data. Enhancing the quality assurance of prediction models necessitates heightened clarity and the utilization of suitable methodologies to handle missing data effectively.
Iron is one of the most important elements in brain that may has a direct impact on the stability of central nervous system. The current study devoted to explore the alterations of iron distribution across the whole brain in type 2 diabetes mellitus (T2DM) patients with mild cognitive impairment (MCI).
The quantitative susceptibility mapping (QSM) technique was used to quantify the intracranial iron content of 74 T2DM patients with MCI and 86 T2DM patients with normal cognition (NC). The group comparison was performed by a voxel-based analysis. Then we evaluated the relationships between cognitive indicators and magnetic susceptibility value (MSV) measured by QSM of the significant brain areas, which were set as the regions of interest (ROIs). In addition, we analyzed the moderation effects of grey matter volume (GMV) of the related brain areas and several metabolic and cerebrovascular factors on the associations between MSV of ROIs and cognitive characteristics.
T2DM patients with MCI exhibited a lower MSV in the right middle temporal gyrus (MTG) compared to NC group. And in the MCI group, there were significantly negative correlations between MSV of the right MTG and several memory indexes. Furthermore, the moderation effects of GMV of the whole brain and the bilateral MTG on the relationship between MSV of the right MTG and scores of list recognition were significant.
T2DM patients with MCI had a temporary decreased iron content in the right MTG, which may partially compensate for cognitive impairment.
Trial Registration: The study was registered at Clinicaltrials.gov (NCT02738671)
Pancreatic islet transplantation is a crucial treatment for managing type 1 diabetes (T1D) in clinical settings. However, the limited availability of human cadaveric islet donors and the need for ongoing administration of immunosuppressive agents post-transplantation hinder the widespread use of this treatment. Stem cell-derived islet organoids have emerged as an effective alternative to primary human islets. Nevertheless, implementing this cell replacement therapy still requires chronic immune suppression, which may result in life-long side effects. To address these challenges, innovations such as encapsulation devices, universal stem cells, and immunomodulatory strategies are being developed to mitigate immune rejection and prolong the function of the transplant. This review outlines the contemporary challenges in pancreatic β cell therapy, particularly immune rejection, and recent progress in immune-isolation devices, hypoimmunogenic stem cells, and immune regulation of transplants. A comprehensive evaluation of the advantages and limitations of these approaches will contribute to improved future clinical investigations. With these promising advancements, the application of pancreatic β cell therapy holds the potential to effectively treat T1D and benefit a larger population of T1D patients.
To investigate the associations of tea consumption with all-cause and cause-specific mortality among type 2 diabetes mellitus (T2DM) Chinese patients.
The present study included 15 718 participants from the Comprehensive Research on the Prevention and Control of Diabetes between 2013 and 2014 in Jiangsu, China. Information on tea consumption (including frequency, amount, and duration) was collected at baseline using interviewer-administered questionnaires. Death data were identified by linkage to the Death Certificate System. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
During a median follow-up of 9.77 (9.69, 9.82) years, 3046 deaths were documented, including 922 from cardiovascular disease (CVD) and 736 from cancer. Compared with nonconsumers, regular tea consumption (≥ 3 times/week, 1 cup/day, > 30 years) was associated with reduced all-cause mortality risk in T2DM, with HRs (95% CIs) of 0.82 (0.74, 0.91), 0.80 (0.72, 0.89), and 0.77 (0.68, 0.86). For cardiovascular mortality, the HRs (95% CIs) were 0.79 (0.65, 0.96), 0.72 (0.59, 0.89), and 0.75 (0.60, 0.93). The exposure-response relationship suggested that consuming 4 g/day may offer the most evident health benefits.
Among Chinese T2DM patients, higher tea frequency and amount intake were associated with lower risk of all-cause and CVD mortality. It is suggested that consuming 4 g/day of tea could potentially serve as an intervention target. These findings suggest that tea consumption can be a part of a healthy diet for T2DM patients.
To determine the value of lymphocyte subsets and granulocyte/monocyte surface markers in predicting the risk of post-acute pancreatitis diabetes (PPDM-A).
This study included 308 in patients with acute pancreatitis (AP). The markers of granulocytes and monocytes and lymphocyte subsets were detected by flow cytometry, and the fluorescence intensity, absolute count and percentage were obtained. Based on the occurrence of diabetes after AP, patients were divided into two groups: PPDM-A and PPNG-A (post-acute pancreatitis with normal glucose). Correlations between granulocyte and monocyte surface markers and lymphocyte subsets were analyzed. Binary logistic regression was used to analyze the potential influencing factors of PPDM-A.
Compared with patients with PPNG-A, patients with PPDM-A tend to be younger (p < 0.001) and have a higher proportion of fatty liver, recurrent pancreatitis, and hyperlipidemic pancreatitis. The results of linear regression showed that B% was negatively correlated with MFI of HLA-DR on monocytes (R2 = 0.145, p < 0.001), B% was positively correlated with CD10−NEUT% (R2 = 0.291, p < 0.001), and MFI of HLA-DR on monocytes was negatively correlated with CD10−NEUT% (R2 = 0.457, p < 0.001). Multivariate logistic regression analysis revealed that age, serous effusion, fatty liver, recurrent pancreatitis, and B% were independent risk factors for the occurrence of PPDM-A.
Our study has first confirmed the correlation between PPDM-A and lymphocyte subsets and CD10−NEUT%. Furthermore we indicated that age, fatty liver, serous effusion, recurrent AP, and B% were independent risk factors for PPDM-A. The mechanism of granulocyte and monocyte surface markers and B lymphocytes on PPDM-A is worthy of study. This would help clarify the pathogenesis of PPDM-A at the cellular level and potentially provide new strategies for immunotherapy and even disease prevention. [Correction added on 24 January 2025, after first online publication: the third subtitle in Abstract section has been changed to ‘Results’.]
Provide an evidence-based basis for the selection of cardiovascular benefit drugs in Type 2 diabetes mellitus (T2DM) patients with cardiovascular disease (CVD).
Conduct a comprehensive search of all relevant literature from PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials.gov from their establishment until December 13, 2023, and select randomized controlled trials (RCTs) that meet the pre-established inclusion and exclusion criteria. Use the Cochrane bias risk assessment tool to evaluate the quality of the included literature. Use R 4.3.2 software to conduct network meta-analysis for drug category comparison.
A total of 24 large-scale randomized controlled trials (RCTs) were included, including 19 intervention measures, and 172 803 patients participated in the study. The results of the network meta-analysis show that: GLP1RA (OR 0.89, 95% CI 0.81–0.97) and SGLT2i (OR 0.91, 95% CI 0.83–0.99) can reduce the occurrence of major adverse cardiovascular events (MACE), GLP1RA (OR 0.88, 95% CI 0.79–0.97) and SGLT2i (OR 0.89, 95% CI 0.81–0.99) reduced the risk of cardiovascular death. SGLT2i (OR 0.68, 95% CI 0.62–0.75) reduced the occurrence of hospitalization for heart failure, GLP1RA (OR 0.88, 95% CI 0.81–0.97) and SGLT2i (OR 0.89, 95% CI 0.80–0.97) reduced the occurrence of all-cause death.
In the comparison of new hypoglycemic drug classes, GLP1RA and SGLT2i reduced MACE, cardiovascular mortality and all-cause mortality in T2DM patients with CVD, with no significant difference in efficacy, and DPP4i was noninferior to placebo. Only GLP1RA reduced the risk of nonfatal stroke, and only SGLT2i reduced the risk of HHF.
Type 2 diabetes mellitus (T2DM) contributes to the heavy burden, but there lacks latest and comprehensive global research on the burden of T2DM attributable to low physical activity (LPA). This study aimed to quantify the global and regional burden of T2DM attributable to LPA from 1990 to 2021.
We utilized data including disability-adjusted life years (DALYs), mortality, age-standardized disability-adjusted life years (ASDR), and age-standardized mortality rates (ASMR) from the Global Burden of Disease (GBD) 2021. We assessed the burden across different ages, genders, and sociodemographic index (SDI). Joinpoint regression analysis was applied to estimated average annual percent change (AAPC).
Between 1990 and 2021, DALYs and mortality of T2DM attributable to LPA increased rapidly. There was an increase in the ASDR and ASMR, with AAPC of 1.09 (95% CI: 1.03–1.16) and 0.32 (95% CI: 0.2–0.43), which was increased faster in males. Low-middle SDI countries have the highest ASDR and highest ASMR. The global PAF for ASDR and ASMR in 2021 is 7.38% and 9.45%. A U-shaped drift pattern was observed in most SDI quintiles in APC model. Population growth is a major contributor to the burden of T2DM, especially in countries with low SDI. Epidemiological changes also play an important role in DALYs and mortality. A negative correlation existed between SDI and both ASMR and ASDR.
Between 1990 and 2021, there was a marked rise in the global burden of T2DM associated with LPA. The findings lay the groundwork for informed decision-making a public health and healthcare delivery.
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