The association of sleep behaviors with microvascular complications and cardiovascular outcomes in diabetic patients is not clear. Furthermore, serum biomarkers that can be used to evaluate this association have not been characterized. Therefore, this study investigated the association of the overall sleep score with the diabetic complications and the potential underlying serum metabolic biomarkers in patients with type 2 diabetes mellitus (T2DM).
This prospective cohort study included 30 915 T2DM patients without complications from the UK Biobank. The sleep score of the participants was evaluated based on sleep behaviors such as sleep duration, insomnia, snoring, chronotype, and daytime sleepiness. The potential biomarkers, including cystatin C (Cys C), apolipoprotein A (Apo A), C-reactive protein (CRP), albumin, and γ-glutamyl transpeptidase (GGT), were also determined to evaluate their role as potential indicators of the association between the sleep score and the diabetic complications.
Participants with a healthy sleep score of 4–5 had lower risks of microvascular complications (HR = 0.80 [95% CI: 0.72, 0.89]) and cardiovascular outcomes (HR = 0.70 [95% CI: 0.61, 0.81]) compared to those with a sleep score of 0–1. Furthermore, cys C showed the best effects by explaining the associations of overall healthy sleep behaviors with microvascular complications and cardiovascular outcomes by 30.36% and 14.36%, respectively.
Our data showed that healthy sleep behaviors were associated with a reduced risk of diabetic complications. Moreover, serum biomarkers of renal function, lipids, systemic inflammation, and hepatic function partially mediated the relationship between sleep behaviors and diabetic complications.
Dietary alpha-linolenic acid (ALA) regulates lipid metabolism and insulin sensitivity, but few studies have investigated the association between ALA and the risk of mortality among adults with type 2 diabetes (T2D). This study examines whether increasing dietary ALA intake contributes to the long-term survival of adults with T2D.
This cohort study included 9603 participants with T2D, including 7953 adults from the National Health and Nutrition Examination Survey (NHANES; 1999–2018) and 1650 adults from the China Health and Nutrition Survey (CHNS; 1997–2011). Dietary information was collected through 24-h dietary recalls. Cox proportional hazards regression was employed to estimate hazard ratios (HRs) and 95% CIs for mortality from all-cause and cardiovascular disease (CVD).
During 75 535 person-years of follow-up, a total of 2468 deaths were documented. After multivariate adjustment, the pooled HRs (95% CIs) of all-cause mortality were 1.00, 0.87 (0.76–0.99), and 0.79 (0.67–0.94) across tertiles of ALA (ptrend = 0.01). There was a linear inverse relationship between ALA intake and all-cause mortality, demonstrating a 9% (HR: 0.91;95% CI: 0.85_0.97) lower risk of all-cause mortality with each 1 g/day increase of dietary ALA intake in the pooled analysis (pnonlinear > 0.05). In addition, ALA intake was inversely associated with CVD mortality, and HR comparing the highest with the lowest tertile was 0.68 (0.50–0.91; ptrend = 0.01). Consistent results were observed in both the stratified and sensitivity analyses.
Higher dietary ALA intake was associated with a lower risk of all-cause and CVD mortality among adults with T2D.
Hypertension is one of the most common comorbidities associated with diabetes. The standardized diagnosis and treatment of hypertension in diabetic patients, along with achieving blood pressure targets, is of great significance for reducing long-term complications, extending lifespan, and improving quality of life. Recent high-quality multicenter large-sample intervention studies have provided important evidence-based grounds for setting blood pressure targets in diabetic patients. Therefore, based on a comprehensive summary of important domestic and international research literature, and in combination with clinical practice experience, this management guideline is now formulated.
Diabetes represents a significant global health concern, with diabetic cardiomyopathy (DCM) emerging as a primary cause of mortality among individuals with diabetes. Despite the prevalence of DCM, advancements in therapeutic and preventative strategies remain constrained.
Recent studies were reviewed to provide a comprehensive summary of pathogenesis and clinical treatment of DCM, effect of ferroptosis, and potential value of ferroptosis inhibitors in DCM intervention.
A growing body of research indicates that oxidative stress, inflammatory reactions, and other factors play a role in the onset and progression of DCM. Oxidative stress within cardiomyocytes is a primary mechanism implicated in the development of DCM, whereby heightened intracellular reactive oxygen species (ROS) facilitate cell death via ferroptosis. Ferroptosis inhibitors hold great promise as therapeutic agents.
This review provides an overview of the involvement of iron homeostasis regulation, oxidative stress, and ferroptosis in DCM, and the significance of ferroptosis in the prevention and treatment of DCM.
Antibiotics in childhood are commonly used and have been linked to gut microbiome dysbiosis and metabolic disorders. However, direct evidence regarding the association between long-term or recurrent antibiotic use (LRAU) during early life and diabetes was scarce. We performed this study to investigate this association in two population-based studies.
We undertook a prospective analysis encompassing 147 010 participants from the UK Biobank. Cox proportional hazard regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of self-reported LRAU during early life on diabetes risk. We also conducted a case–control study within the Chinese population, in which 263 diabetes cases and 526 controls were matched for age and living location. Odds ratios (ORs) and 95% CI were was calculated using logistic regression models.
We identified 4314 incident cases of type 2 diabetes over 1 840 944 person-years of follow-up in the UK Biobank. LRAU during early life was associated with a 26% higher risk of diabetes after accounting for putative risk factors (HR, 1.26; 95% CI, 1.16–1.37) in the UK biobank. We observed a more evident association between LRAU and an elevated risk of diabetes in the case–control study (OR, 3.32; 95% CI, 2.06–5.38). The primary finding was robust to several subgroup analyses and sensitivity analyses.
LRAU during early life may increase the risk of type 2 diabetes. Caution should be exercised when prescribing long-term or recurrent antibiotics to children and adolescents.
Research suggests that the wellbeing of caregivers of children with Type 1 Diabetes can influence child health outcomes. Therefore, the aim was to conduct a systematic review and meta-analysis to estimate the effect of psychological interventions for families of children with Type 1 Diabetes on caregiver and child functioning.
A systematic search of the literature identified 58 randomized controlled trials (RCTs) that met inclusion. Study quality was assessed using the Cochrane Risk-of-Bias Tool.
Fifty-one trials had sufficient data to be included in the meta-analysis, analyzing nine variables (caregiver and child psychological distress, diabetes distress, family conflict and child quality of life (QoL), diabetes QoL and blood glucose) over three timepoints (post-intervention, short-term and long-term follow-up). Results from 10 (n = 550), three (n = 347) and 16 RCTs (n = 1631) respectively indicated that psychological interventions significantly reduced caregiver psychological distress post-intervention (SMD = −0.64, 95% CI = −1.15, −0.12), child psychological distress post-intervention (SMD = −0.34, 95% CI = −0.55, −0.31) and child blood glucose at short-term follow-up (SMD = −0.11, 95% CI = −0.21, −0.01), relative to controls.
Participants allocated to controls showed greater reductions in caregiver diabetes family conflict at short-and long-term follow−up than those assigned to psychological interventions. This was explained by significant baseline differences influencing a small number of studies. Studies were highly heterogenous regarding outcome measures, follow-ups, and interventions, with high concerns of bias often observed, reflecting the complexity of real−world clinical practice. Findings are promising. Appropriately powered RCTs with robust randomization are recommended to investigate the significance of effects, whilst considering dose response.
Obesity represents a critical global health challenge, marked by escalating prevalence and comorbidities such as cardiovascular disease, type 2 diabetes, chronic kidney disease, musculoskeletal disorders, and certain cancers [1]. The continuous development of antiobesity medications (AOMs), which demonstrate significant weight loss effects, presents new opportunities for the treatment of obesity [2]. On August 8, 2024, a search of the Informa Database identified a total of 2120 trials for AOMs, indicating that the research on AOMs is active and receiving significant attention.
Over the past 30 years, the number of clinical trials on AOMs has experienced significant fluctuations, peaking in 2023–2024 (Figure 1A). The number of clinical trials entering phases III–IV and phases I–II/III was comparable (48.5% vs. 50.9%), underscoring the development of novel AOMs derived from established therapies. Eventually, a total of 20 indications were identified in these trials, of which the top 10 were listed in Figure 1B. The majority of indications were Non-diabetic overweight or obesity (41.6%), followed closely by Diabetes-related overweight or obesity (41.0%). Among trials targeting non-diabetic overweight or obesity, only 35.6% reached phase III/IV, indicating this field is still in early-stage exploration. Figure 1C illustrates the distribution of clinical trials for AOMs based on their mechanisms of action and targets. Nutrient-stimulated hormone (NuSH) single receptor agonists dominate the landscape, accounting for 26.14% of trials, highlighting their significant research focus. Other AOMs, which target leptin, ghrelin, mitochondrial uncouplers, and growth differentiation factor 15 (GDF15), follow closely at 19.94%. In recent years, as the number of clinical trials on AOMs has steadily increased, the proportion of combined therapies has also risen, suggesting that this will be a future trend (Figure 1D). Recent advancements have been characterized by a surge in clinical trials targeting various mechanisms of action, as depicted in Figure 1E. Glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as a leading class, with Semaglutide and Liraglutide being the most extensively studied drugs classified as NuSH single receptor agonists. Meanwhile, peptides and molecular conjugates with dual-agonist and triple-agonist actions, such as Tirzepatide and Retatrutide, are currently under investigation and appear to have the strongest potential as anti-obesity medications [3]. Advances in incretin biology have driven the development of approved GLP-1 receptor agonists over recent decades. To date, the FDA has approved three NuSH-based AOMs: Liraglutide, Semaglutide, and Tirzepatide.
Additionally, further management of obesity necessitates personalized therapies and multimodal strategies, as long-term maintenance of weight loss is challenging for most people. Combination therapies, like the integration
Emerging evidence suggests the presence of distinct endotypes of Type 1 diabetes mellitus (T1DM): T1DE1 in individuals diagnosed at age < 7 years in contrast to T1DE2 in those diagnosed at ≥ 13 years of age. We aimed to comprehensively explore the phenotypic heterogeneity of T1DM with respect to the age-related endotypes.
This cross-sectional study was conducted in China and involved 1204 children newly diagnosed with T1DM who were admitted to the pediatric department of a tertiary hospital from January 1, 2010 to December 31, 2023. The patients were divided into three age groups: < 7 years (T1DE1), 7–12 years, and ≥ 13 years (T1DE2). A comparison was made among the age groups regarding demographic characteristics, glucose metabolism, β-cell autoimmunity, and metabolic decompensation.
Patients under 7 years exhibited a shorter symptom duration before diagnosis, along with the lowest fasting and postprandial C-peptide and C-peptide to glucose ratio levels and the highest postprandial glucose levels. They also showed the highest insulin autoantibody positivity rate and creatine kinase-MB levels. In contrast, patients aged 13 and older had the highest HbA1c levels and glutamate decarboxylase antibody positivity rate. In addition, this group showed the highest prevalence of TPOAb and TgAb positivity, as well as the largest proportion of abnormal liver function cases.
The study illustrates age-specific phenotypic heterogeneity in pediatric T1DM, indicating the presence of distinct endotypes. Further investigation of these endotypes may offer more evidence for the precise treatment of T1DM.
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