Journal of Diabetes最新文献

{"title":"Analysis of HMGCS2 Expression and TG Lipidomics in the Perirenal Adipose Tissue of Obese Diabetic Nephropathy Mice","authors":"Yuhong Huang,&nbsp;Miao Zeng,&nbsp;Mengxue Yang,&nbsp;Xiaodi Zheng,&nbsp;Lulu Jin,&nbsp;Rui Zhang,&nbsp;Yueyue Wu,&nbsp;Fei Li,&nbsp;Bo Yang,&nbsp;Jun Liu","doi":"10.1111/1753-0407.70125","DOIUrl":"https://doi.org/10.1111/1753-0407.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Renal HMGCS2 upregulation is associated with lipid deposition. However, the expression pattern and role of Hmgcs2 in the perirenal adipose tissue (PRAT) is not clear. This study was designed to elucidate the contribution of Hmgcs2 in the pathogenesis of obese diabetic kidney disease mice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>12-week-old db/db (diabetic) and db/m (control) mice were fed high-fat or normal diets, respectively. At 12, 16, and 20 weeks, mice (<i>n</i> = 4/group/timepoint) were euthanized for metabolic profiling (body weight, blood glucose, urinary ACR) and tissue collection (kidney, PRAT). Tissues were analyzed for TNF-α mRNA (qPCR), HMGCS2 expression (IHC/WB/IF), lipid deposition (Oil Red O), and histopathology (HE staining). PRAT triglycerides (colorimetric assay) and lipidomics (UPLC–MS/MS) were assessed. HMGCS2-knockout mice (CRISPR-generated) underwent metabolic tests (OGTT/ITT) before terminal tissue analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>(1) Compared with db/mPRAT, db/db PRAT had significantly enlarged adipocytes and increased TG content. The expression of HMGCS2 in renal and PRAT was significantly greater in db/db mice. (2) Hmgcs2 was equally expressed in db/db renal and PRAT. PRAT expansion increases the inflammatory factor TNF-α, which occurs earlier in PRAT than in renal tissue.(3) Genetic ablation of HMGCS2 in mice significantly decreased renal and PRAT TG accumulation, concomitant with attenuated inflammation. (4) LC–MS/MS analysis revealed that TGs are the main PRAT lipid component. Db/db PRAT TG content was significantly greater than that in db/m. Db/db proximal PRAT TG content is greater than that of the distal region, with seven upregulated TG lipid molecules (TG (38:3)+NH4, TG (50:5)+NH4, TG (52:12e)+Na, TG (56:9e)+H, TG (57:6e)+H, FA (18:1)+H, and ST (m45:3)+NH4), among which TG (38:3) has the highest expression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study strongly suggests that lipids, especially TGs, are deposited in the kidneys and PRAT of DKD mice, with proximal–distal PRAT differences. HMGCS2 may be involved in kidneys and PRAT TG deposition. PRAT-lipid-metabolism-induced inflammation may occur before blood-glucose-related kidney damage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 7","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “Time Trends in Cardiovascular Event Incidence in New-Onset Type 2 Diabetes: A Population-Based Cohort Study From Germany”","authors":"Saraswati Sah,&nbsp;Rachana Mehta,&nbsp;Ranjana Sah","doi":"10.1111/1753-0407.70130","DOIUrl":"https://doi.org/10.1111/1753-0407.70130","url":null,"abstract":"&lt;p&gt;We read with great interest the study by Sarabhai et al., which provides valuable insights into the temporal evolution of cardiovascular events in newly diagnosed type 2 diabetes (T2D) patients in Germany over a 17-year period [&lt;span&gt;1&lt;/span&gt;]. Although the reduction in the 5-year incidence of coronary heart disease (CHD) and transient ischemic attack (TIA) is encouraging, we believe several methodological and conceptual limitations deserve further discussion to contextualize the findings.&lt;/p&gt;&lt;p&gt;First, the study's exclusion of laboratory parameters such as glycated hemoglobin (HbA1c), lipid panels, and renal function significantly constrains the capacity to adjust for the quality of glycemic and metabolic control—central determinants of cardiovascular outcomes in T2D [&lt;span&gt;2, 3&lt;/span&gt;]. Reliance solely on ICD-10 codes, though validated for primary diagnoses, does not differentiate between stable and unstable angina, nor does it account for silent myocardial infarctions, which are prevalent in diabetic populations [&lt;span&gt;4&lt;/span&gt;]. This coding limitation may partially explain the paradoxically unchanged incidence of myocardial infarction (MI) despite improvements in CHD.&lt;/p&gt;&lt;p&gt;Second, the use of chronic obstructive pulmonary disease (COPD) as a proxy for smoking status introduces exposure misclassification. Smoking is a potent modifiable risk factor for both MI and ischemic stroke (IS) [&lt;span&gt;5&lt;/span&gt;], and its secular decline in Germany over this period likely contributed to cardiovascular risk reduction. Without direct smoking data, the differential attribution of risk to diabetes-specific interventions versus population-wide trends remains unresolved.&lt;/p&gt;&lt;p&gt;Third, the apparent stability in MI and IS incidence may also be an artifact of cohort composition rather than a true epidemiological plateau. Although the authors matched for age and sex, no stratification by socioeconomic status, regional healthcare access, or medication use—particularly statins and antihypertensives—was undertaken. These variables influence the uptake and effectiveness of cardioprotective interventions [&lt;span&gt;6&lt;/span&gt;]. Furthermore, the analysis does not disaggregate event timing within the five-year follow-up, thereby overlooking early versus late event clustering, which may offer clues about legacy effects from undiagnosed prediabetes.&lt;/p&gt;&lt;p&gt;Fourth, the demographic distribution masks evolving baseline risk. Although mean age and sex proportions remained unchanged, the increased prevalence of hypertension and obesity in the later cohort signals rising baseline cardiovascular risk. Paradoxically, these upward shifts might dilute the observable impact of improved care. Consequently, the unchanged IS and MI rates may reflect counterbalancing effects between therapeutic progress and population-level risk escalation.&lt;/p&gt;&lt;p&gt;Finally, the study's conclusion that CHD and TIA reduction reflects successful diabetes management may overstate causality. CHD includes chronic, often","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 7","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Response to the Comment on “Time Trends in Cardiovascular Event Incidence in New-Onset Type 2 Diabetes: A Population-Based Cohort Study From Germany”","authors":"Theresia Sarabhai,&nbsp;Karel Kostev","doi":"10.1111/1753-0407.70128","DOIUrl":"https://doi.org/10.1111/1753-0407.70128","url":null,"abstract":"&lt;p&gt;We sincerely thank the authors of the comment and appreciate the opportunity to respond to clarify specific aspects of our study.&lt;/p&gt;&lt;p&gt;First of all, we agree that laboratory parameters are key indicators of metabolic control and cardiovascular risk. Although the Disease Analyzer database includes laboratory data from a subset of practices, laboratory values were not consistently available over time and across patients in our cohort. Therefore, we opted not to include them in our analyses. To address this limitation, we adjusted for chronic comorbidities known to be associated with poor metabolic control, such as hypertension, dyslipidemia, and obesity (coded diagnoses). Previous studies demonstrated the validity of the Disease Analyzer database especially for case–control studies focusing on diabetes mellitus [&lt;span&gt;1&lt;/span&gt;]. Furthermore, by focusing on first cardiovascular events in a well-defined incident T2D cohort without prior CVD, we aimed to reduce confounding and improve internal validity despite the absence of uniformly available laboratory markers.&lt;/p&gt;&lt;p&gt;We acknowledge the potential limitations of relying solely on ICD-10 codes, as we stated in the manuscript. However, the Disease Analyzer database has been extensively validated and has demonstrated a high positive predictive value for major cardiovascular diagnoses, including MI [&lt;span&gt;1-3&lt;/span&gt;]. We appreciate the reference by Tsai et al. [&lt;span&gt;4&lt;/span&gt;], which highlights the strong validity of ICD-10-CM codes for identifying AMI subtypes. Although their work confirms excellent performance metrics, our interest was not the subtype but rather the trend in overall MI incidence.&lt;/p&gt;&lt;p&gt;Indeed, smoking is a critical risk factor. As stated, individual smoking status is not recorded in the Disease Analyzer database. We therefore followed established practice in using COPD as a proxy, recognizing its limitations. As noted in the literature, around 90% of patients with COPD are current or former smokers [&lt;span&gt;5&lt;/span&gt;]. However, not all smokers develop COPD, so COPD cannot fully replace smoking status, but provides an approximate indicator. We clearly acknowledged this limitation in the manuscript. Importantly, smoking prevalence in Germany has declined over the study period, which may have contributed to overall cardiovascular improvements. However, as these trends would influence both diabetic and nondiabetic populations alike, our interpretation focused on diabetes-specific outcomes in a matched T2D cohort.&lt;/p&gt;&lt;p&gt;We agree that socioeconomic status and medication use are important factors. Although these data were not available in sufficient detail in our database, our large, matched cohorts and adjustment for key comorbidities offer valuable insights into temporal patterns. The unchanged MI and IS incidence, despite improvements in CHD and TIA, likely reflects a balance between earlier vascular damage and therapeutic progress. Although we did not stratify events by time since diagno","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 7","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription Medication Expenditures for Patients With Diabetes in the United States: 2012–2021","authors":"Shanshan Li,&nbsp;Shaoxi Pan,&nbsp;Nan Xiao,&nbsp;Shaoxiang Jiang,&nbsp;Gorden G. Liu,&nbsp;Beini Lyu","doi":"10.1111/1753-0407.70106","DOIUrl":"https://doi.org/10.1111/1753-0407.70106","url":null,"abstract":"<p>Glucose-lowering medication expenditures per user by different payers among patients with diabetes.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 7","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Endothelin-1, Kidney Function and Diabetes in Patients With Coronary Artery Disease Underwent Percutaneous Coronary Intervention","authors":"Zixiang Ye,&nbsp;Enmin Xie,&nbsp;Yuan Du,&nbsp;Wenjia Zhang,&nbsp;Kefei Dou","doi":"10.1111/1753-0407.70127","DOIUrl":"https://doi.org/10.1111/1753-0407.70127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to explore the association between plasma big endothelin-1 (ET-1) and major adverse cardiovascular events (MACE) in CAD patients who underwent PCI with a focus on the influence of kidney function and diabetes status in secondary prevention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective cohort of CAD patients underwent PCI and patients with impaired kidney function and diabetes were initially screened and categorized separately, subdivided based on ET-1 levels. The primary outcome was MACE, including all-cause mortality, nonfatal myocardial infarction, unplanned revascularization, and stroke. Statistical analyses included Cox regression, competing risks analysis (competing for non-cardiovascular death), and restricted cubic spline to assess the relationships between ET-1 and MACE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 1344 CAD patients with impaired kidney function and 10,577 CAD patients with DM. During a median follow-up of 3 years, 20% of renal dysfunction patients and 12.9% of DM patients experienced MACE. In CAD patients with renal dysfunction, elevated ET-1 levels were associated with increased MACE risk (adjusted HR 1.333, 95% CI 1.169–1.519, <i>p</i> &lt; 0.001), with those in the highest group and DM showing a 2.134-fold (95% CI, 1.334–3.413, <i>p</i> &lt; 0.001) increased MACE risk. In CAD patients with DM, patients with eGFR ≤ 60 mL/min/1.73 m² and elevated ET-1 levels had a 2.297-fold (95% CI 1.822–2.895) increased risk of MACE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ET-1 offered important prognostic value for CAD patients who underwent PCI, with especially bad prognoses observed in those with elevated ET-1 levels, renal dysfunction, and DM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 7","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on “Association of Serum Total Bilirubin to Cholesterol Ratio With Progression of Chronic Kidney Disease in Patients With Type 2 Diabetes: A Retrospective Cohort Study”","authors":"Tinghua Zhang","doi":"10.1111/1753-0407.70129","DOIUrl":"https://doi.org/10.1111/1753-0407.70129","url":null,"abstract":"<p>Several key factors influencing bilirubin levels and lipid metabolism were not measured or adjusted for in the study. Notably, hemoglobin, which affects bilirubin metabolism [<span>5</span>], was not included in the analysis. Furthermore, longitudinal changes in body mass index (BMI), blood pressure, or albuminuria during follow-up were also not accounted for. These unmeasured confounders may influence the observed association between the TBIL/TC ratio and CKD progression.</p><p>Chen et al. have highlighted the potential of the TBIL/TC ratio as a biomarker for CKD progression in type 2 diabetes. However, the issues of outcome misclassification, medication confounding, and oversimplified threshold analyses necessitate cautious interpretation of their findings. Future studies should aim to: (1) Validate these findings in ambulatory cohorts using KDIGO-endorsed sustained eGFR decline criteria; (2) Integrate time-varying adjustments for nephroprotective medications and account for genetic and environmental confounders; (3) Report absolute risks and conduct decision-curve analyses to better evaluate the clinical utility of the TBIL/TC ratio. Addressing these limitations will help clarify whether the TBIL/TC ratio offers incremental value beyond established renal risk markers.</p><p>Tinghua Zhang: wrote, reviewed, and edited the manuscript. Additionally, he conceptualized the study concept and design.</p><p>The author declares no conflicts of interest.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 7","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin Resistance in Type 1 Diabetes: Concepts and Implications for Therapy","authors":"Zachary Bloomgarden,&nbsp;Domenico Accili","doi":"10.1111/1753-0407.70126","DOIUrl":"https://doi.org/10.1111/1753-0407.70126","url":null,"abstract":"&lt;p&gt;Many people with type 1 diabetes (T1D) appear to develop insulin resistance. In a 6-year post-Diabetes Control and Complications Trial (DCCT) follow-up of intensive treatment participants, comparison of the 61 having a family history of T2D with the 521 not reporting such a history showed BMI increasing by 3.8 versus 2.9 kg/m&lt;sup&gt;2&lt;/sup&gt;, insulin requirement 0.73 versus 0.66 units/kg, and triglyceride 92 versus 76 [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Weight gain appears to be an important mediator of this insulin resistance. In the Pittsburgh Epidemiology of Diabetes Complications Study, adults with T1D had ~25% and 5% likelihood of having BMI 25–30 and ≥ 30, respectively, in 1986, with these figures increasing to ~35% and 25% by 2004 [&lt;span&gt;2&lt;/span&gt;]; in the T1D Exchange Clinic Registry, by 2016–2018 more than two thirds of T1D adults age ≥ 26 were overweight or obese [&lt;span&gt;3&lt;/span&gt;]. Comparing DCCT intensive treatment group participants in the top quartile of weight gain with those in the lower quartiles, insulin dose requirements, HbA1c, triglyceride, and BP were higher at DCCT close and 1- and 6-years post-trial, with those gaining the most weight being twice as likely to satisfy metabolic syndrome criteria at DCCT close, and 6 years later they were four times as likely to have metabolic syndrome [&lt;span&gt;4&lt;/span&gt;]; in addition to the metabolic syndrome, metabolic-associated fatty liver disease affects approximately one in five people with T1D [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Another potential cause of insulin resistance in T1D may be hyperglucagonemia. Along with insulin deficiency, T1D is associated with hyperglucagonemia, with loss of insulin-induced glucagon suppression, and with increased α-cell mass [&lt;span&gt;6&lt;/span&gt;]. Patients with T1D appear insensitive to the glucagon-suppressive effects of glucose and GLP-1, the latter potentially an indirect effect of decreased endogenous insulin secretion or, perhaps, a secondary state of insulin resistance. In addition to its action in increasing hepatic gluconeogenesis and glycogenolysis, glucagon accelerates hepatic amino acid metabolism and ureagenesis, with a potential physiologic feedback circuit in which amino acids such as alanine increase glucagon secretion, with glucagon then reducing amino acid levels; disruption of the liver–α-cell axis may cause hyperaminoacidemia and hyperglucagonemia, which may in turn contribute to hyperglycemia [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Insulin resistance becomes present early in the course of T1D [&lt;span&gt;8&lt;/span&gt;]. The insulin resistance in T1D is not explained by body mass index, body fat percentage, visceral fat, plasma lipids, or physical activity, and is also not fully explained by the degree of hyperglycemia [&lt;span&gt;9&lt;/span&gt;]. An additional cause of insulin resistance may be the hyperinsulinemia associated with peripheral insulin administration [&lt;span&gt;10&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Insulin resistance in people with T1D appears, like that in type 2 diabetes, to be associated with the development o","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 7","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Liver Transplantation on Anti-Glycaemic Agents in Patients With Pre-Existing Diabetes Mellitus: A Population-Based Cohort Study","authors":"Amy Coulden,&nbsp;Christina Antza,&nbsp;Orighomisan Awala,&nbsp;Nihit Shah,&nbsp;Leelavathy Kandaswamy,&nbsp;Ananda Nahar,&nbsp;Angela Phillips,&nbsp;Sneha Upadhyaya,&nbsp;Ayesha Asif,&nbsp;Zara Khan,&nbsp;Feaz Babwah,&nbsp;Matthew Armstrong,&nbsp;Samiul Mostaf,&nbsp;Wasim Hanif","doi":"10.1111/1753-0407.70088","DOIUrl":"https://doi.org/10.1111/1753-0407.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anecdotally, patients with diabetes mellitus after undertaking a liver transplant have reported improved glycaemic control and reduced insulin requirements, compared to other organ transplants where glycaemic control often worsens. This study aimed to evaluate possible changes in anti-glycaemic agent requirements pre- and post-liver transplantation and correlate them with the immunosuppression used and the reason for transplant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this observational, retrospective study, we investigated 258 adults with pre-existing diabetes mellitus who underwent liver transplant from October 2009 to January 2020 at a tertiary UK center. We compared pre- and post-transplant insulin treatment requirements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age was 56 years, and the median duration of diabetes was 96 months. From a subgroup of 100 patients (38.8%) using insulin therapy, there was a reduction in insulin requirements from 60.5 ± 44.6 units/day before transplant to 51.1 ± 31.2 units/day at 1 month post-transplantation (15.5%, <i>p</i> = 0.02), 43.4 ± 29.5 units/day at 3 months post-transplantation (28.2%, <i>p</i> &lt; 0.0001) and 33.6 ± 29.7 units/day at 6 months post-transplantation (44.4%, <i>p</i> &lt; 0.0001). There was a significant correlation between the difference in insulin requirement before and 6 months post-transplant and the tacrolimus dose used as immunosuppressive therapy post-liver transplant. There was no correlation with the use of other immunosuppressive therapies and change in insulin requirement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Insulin requirements significantly reduced post-liver transplant by almost 50%, despite initiation of immunosuppressive therapy. This is one of the first studies showing this effect, highlighting the role of the liver in regulating glucose metabolism, insulin utilization, and insulin resistance. Pooled data from other specialist centers need to be examined.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 7","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Different Types of Diabetic Autonomic Neuropathy With Left Ventricular Diastolic Dysfunction in Patients With Type 2 Diabetes: A Cross-Sectional Study","authors":"Ruixue Feng,&nbsp;Donge Yan,&nbsp;Mingxin Bai,&nbsp;Xingwu Ran,&nbsp;Dawei Chen,&nbsp;Chun Wang,&nbsp;Lihong Chen,&nbsp;Shuang Lin,&nbsp;Sen He,&nbsp;Yan Liu,&nbsp;Murong Wu,&nbsp;Zhiyi Lei,&nbsp;Yun Gao","doi":"10.1111/1753-0407.70124","DOIUrl":"https://doi.org/10.1111/1753-0407.70124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To investigate the association between different categories of diabetic autonomic neuropathy (DAN) and left ventricular diastolic dysfunction (LVDD) in patients with type 2 diabetes mellitus (T2DM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study of 3440 participants with T2DM recruited in Diabetic Foot Care Center of West China Hospital, Sichuan University from January 2016 to February 2024. LVDD was assessed via echocardiography, defined as an average E/e′ ratio &gt; 14. Twenty-four hour Holter ECG, postvoid residual volume (PVR) examinations, and gastric emptying scintigraphy were employed to evaluate cardiac autonomic dysfunction, diabetic neurogenic bladder (DNB), and diabetic gastrointestinal autonomic neuropathy (DGAN), respectively. Logistic regression and propensity score matching (PSM) analyses were employed to examine the associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Severe cardiac autonomic dysfunction (SDNN &lt; 50 ms) was independently associated with LVDD, with odds ratios (OR) 1.731 (95% CI: 1.103–2.719, <i>p</i> = 0,018) after adjustment for potential confounding factors. LVDD tended to be independently associated with DNB (OR 1.356; 95% CI [0.992, 1.856]; <i>p</i> = 0.056). PSM analysis further validated the independent associations of SDNN &lt; 50 ms (OR 1.587, 95% CI 1.028, 2.450, <i>p</i> = 0.037) and DNB (OR 1.454, 95% CI 1.011, 2.090, <i>p</i> = 0.043). However, DGAN was not independently associated with LVDD. Additionally, women had a higher risk of LVDD compared to men (OR 1.995, 95% CI 1.379, 2.885, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Severe (SDNN &lt; 50 ms), rather than mild–moderate, cardiac autonomic dysfunction, and DNB are independently associated with LVDD in individuals with T2DM. Additionally, women have a higher risk of LVDD than men.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 7","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, Regional, and National Epidemiology of Vision Impairment due to Diabetic Retinopathy Among Working-Age Population, 1990–2021","authors":"Yang Meng,&nbsp;Yuan Liu,&nbsp;Runping Duan,&nbsp;Baoyi Liu,&nbsp;Zhuangling Lin,&nbsp;Yuan Ma,&nbsp;Lan Jiang,&nbsp;Zijian Qin,&nbsp;Tao Li","doi":"10.1111/1753-0407.70121","DOIUrl":"https://doi.org/10.1111/1753-0407.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To evaluate the global, regional, and national trends of vision impairment associated with diabetic retinopathy (DR) in the working-age population (20–65 years) from 1990 to 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a population-based analysis using data from the Global Burden of Disease Study 2021. Vision impairment was defined as low vision (Snellen visual acuity of &lt; 6/18 to ≥ 3/60) and blindness (Snellen visual acuity of &lt; 3/60 or central visual field &lt; 10°). The burden of DR-related vision impairment, that is, prevalence and years lived with disability (YLD), was analyzed by sex, age, location, and sociodemographic index (SDI). A Bayesian age-period-cohort analysis was employed to forecast the future burden up to 2035.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1990 to 2021, the global prevalence rate and YLD rate of DR-related vision impairment increased significantly. In 2021, 2.85 million prevalent cases and 250 117 YLDs were reported, representing 2.8-fold and 3.0-fold increases compared to 1990, respectively. South Asia and China were identified as the most severely burdened region and country in 2021, respectively. Throughout 1990–2021, females consistently bore a greater burden than males. In terms of SDI, the burden was predominantly concentrated in middle-SDI countries. Predictive analysis suggests a continued increase in the number of patients and YLDs by 2035.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Globally, there has been a substantial increase in the burden of DR-related vision impairment among working-age individuals, with disparities observed in terms of sex, location, and SDI. Given the projected worsening of this burden, targeted interventions are needed to address this global health challenge.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 7","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}