To synthesise contemporary evidence on physical activity (PA) levels in people with type two diabetes and lower limb complications (i.e., foot ulcer, peripheral neuropathy [PN], peripheral arterial disease and amputations).
Methods
A scoping review following the JBI methodology was conducted using six databases: Medline, Embase, PubMed, Cochrane Library, SPORTDiscus and CINAHL. We included observational studies that primarily examined PA (all levels and types) in people with diabetes-related lower limb complications. Studies published before December 2024 were included. We excluded reviews, intervention studies, and studies that examined the association between PA and T2DM risks. Findings were collated into tables and figures and reported narratively.
Results
Sixteen studies met the inclusion criteria. Participants were reported to have PN, foot ulcer, peripheral arterial disease, or lower limb amputation. PA was assessed either by questionnaires or activity trackers. PA levels were reported as step count, duration of PA of different intensities, time spent in various postures, gait velocity, step rate and activity score. Mean daily step counts ranged between 1721 (amputation) and 7754 (PN). Mean moderate-intensity PA was reported to be 2 min per day (amputation) to 37 min per day (PN).
Conclusion
People living with diabetes-related lower limb complications engage in low levels of PA. The findings suggest that people with more severe lower limb complications engage in less PA than those with less severe lower limb complications. Future research should standardise PA measurement in individuals with T2DM-related lower limb complications and use the findings of this review to inform tailored, evidence-based recommendations.
{"title":"Exploring Physical Activity in Individuals With Type 2 Diabetes Mellitus and Lower Limb Complications: A Scoping Review","authors":"Bingyan Pang, Hannah Porter, Joanne A. McVeigh","doi":"10.1002/edm2.70084","DOIUrl":"https://doi.org/10.1002/edm2.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To synthesise contemporary evidence on physical activity (PA) levels in people with type two diabetes and lower limb complications (i.e., foot ulcer, peripheral neuropathy [PN], peripheral arterial disease and amputations).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review following the JBI methodology was conducted using six databases: Medline, Embase, PubMed, Cochrane Library, SPORTDiscus and CINAHL. We included observational studies that primarily examined PA (all levels and types) in people with diabetes-related lower limb complications. Studies published before December 2024 were included. We excluded reviews, intervention studies, and studies that examined the association between PA and T2DM risks. Findings were collated into tables and figures and reported narratively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen studies met the inclusion criteria. Participants were reported to have PN, foot ulcer, peripheral arterial disease, or lower limb amputation. PA was assessed either by questionnaires or activity trackers. PA levels were reported as step count, duration of PA of different intensities, time spent in various postures, gait velocity, step rate and activity score. Mean daily step counts ranged between 1721 (amputation) and 7754 (PN). Mean moderate-intensity PA was reported to be 2 min per day (amputation) to 37 min per day (PN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>People living with diabetes-related lower limb complications engage in low levels of PA. The findings suggest that people with more severe lower limb complications engage in less PA than those with less severe lower limb complications. Future research should standardise PA measurement in individuals with T2DM-related lower limb complications and use the findings of this review to inform tailored, evidence-based recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144662899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Moiz Nasir, Syed Husain Farhan, Hasan Mushahid, Syeda Ayesha Shah, Muhammad Hamza Shuja, Adam Bilal Khan, Syed Hassaan Ali, Syed Ahmed Farhan, Azeem Hassan, Jawad Ahmed, Mohammad Hamza, Javed Iqbal
Background
The pathological changes in the lining of blood vessels associated with diabetes are a well-established risk factor for stroke, with some studies suggesting a two times increase in risk compared to non-diabetics.
Methods
Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2019 for ischemic stroke-related mortality in patients with type 2 diabetes mellitus (T2DM). Annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by year, sex, and race/ethnicity.
Results
From 1999 to 2019 there were 18,135 deaths from ischemic stroke in patients with T2DM. The AAMR remained relatively constant from 0.31 in 1999 to 0.32 in 2004, gradually declining to 0.14 in 2014 (APC: −6.74), followed by a rapid increase to 0.44 in 2017 (APC: 53.11). Men showed consistently higher AAMR than women in 1999 (AAMR men: 0.34 vs. women: 0.29) and 2019 (AAMR men: 0.55 vs. women: 0.42). When comparing race, African Americans (AA) presented with a consistently higher AAMR in 1999 (AAMR AA: 0.4 vs. white: 0.29) and in 2019 (AAMR AA: 0.62 vs. white:0.44). Notably, a significant escalation in AAMR occurred from 2014 to 2019, affecting both populations; this trend reached its pinnacle in 2019 (2016 AAMR AA: 0.4 vs. white: 0.26) (2019 AAMR AA: 0.62 vs. white: 0.44).
Conclusion
The findings highlight fluctuating trends in AAMRs with distinct shifts observed after 2014. Noteworthy gender and racial disparities in AAMRs were also evident. The study emphasises the need for ongoing vigilance and focused interventions to address the evolving dynamics of ischaemic stroke-related mortality in the T2DM population.
{"title":"Ischemic Stroke Mortality in Type 2 Diabetes in the U.S.: National Trends and Demographic Disparities From 1999 to 2019","authors":"Muhammad Moiz Nasir, Syed Husain Farhan, Hasan Mushahid, Syeda Ayesha Shah, Muhammad Hamza Shuja, Adam Bilal Khan, Syed Hassaan Ali, Syed Ahmed Farhan, Azeem Hassan, Jawad Ahmed, Mohammad Hamza, Javed Iqbal","doi":"10.1002/edm2.70065","DOIUrl":"https://doi.org/10.1002/edm2.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The pathological changes in the lining of blood vessels associated with diabetes are a well-established risk factor for stroke, with some studies suggesting a two times increase in risk compared to non-diabetics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2019 for ischemic stroke-related mortality in patients with type 2 diabetes mellitus (T2DM). Annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by year, sex, and race/ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2019 there were 18,135 deaths from ischemic stroke in patients with T2DM. The AAMR remained relatively constant from 0.31 in 1999 to 0.32 in 2004, gradually declining to 0.14 in 2014 (APC: −6.74), followed by a rapid increase to 0.44 in 2017 (APC: 53.11). Men showed consistently higher AAMR than women in 1999 (AAMR men: 0.34 vs. women: 0.29) and 2019 (AAMR men: 0.55 vs. women: 0.42). When comparing race, African Americans (AA) presented with a consistently higher AAMR in 1999 (AAMR AA: 0.4 vs. white: 0.29) and in 2019 (AAMR AA: 0.62 vs. white:0.44). Notably, a significant escalation in AAMR occurred from 2014 to 2019, affecting both populations; this trend reached its pinnacle in 2019 (2016 AAMR AA: 0.4 vs. white: 0.26) (2019 AAMR AA: 0.62 vs. white: 0.44).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings highlight fluctuating trends in AAMRs with distinct shifts observed after 2014. Noteworthy gender and racial disparities in AAMRs were also evident. The study emphasises the need for ongoing vigilance and focused interventions to address the evolving dynamics of ischaemic stroke-related mortality in the T2DM population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Procalcitonin (PCT) is an effective inflammatory marker for diagnosing infection. We assessed the clinical utility of procalcitonin in diagnosing diabetic foot infections.
Method
This meta-analysis adhered to the PRISMA guidelines. We searched PubMed, Web of Science, Embase and the Cochrane Library for studies on PCT for the diagnosis of diabetic foot published before 1 July 2024. The primary outcome was the standardised mean difference (SMD) in PCT levels between IDFU and non-IDFU groups, with corresponding 95% confidence intervals (CI). The included studies were cross-sectional and cohort studies, so the quality of the literature was assessed using the Newcastle–Ottawa Scale (NOS) evaluation criteria. This study's statistical analyses were conducted solely with STATA 15.0 software.
Result
Ten studies comprising 928 patients were ultimately included. There were six cross-sectional studies and four cohort studies. In total, 532 patients were assigned to the IDFU group and 396 to the non-infected diabetic foot ulcers (NIDFU) group. The relationship between PCT and DFU was evaluated in ten studies, with significant heterogeneity among the included studies (x2 = 54.10, p = 0.00001; I2 = 83.6%). Therefore, a random effects model was used with a pooled standardised mean difference of 0.79 (95% confidence interval [CI]: 0.43–1.14). The Egger experiment results (t = 0.43, p = 0.680) indicated that there was no publication bias. Analysis of sensitivity revealed that the results were reliable. Subgroup analyses identified the area as a significant source of heterogeneity. The random-effects model's meta-regression results revealed that BMI (p = 0.026) and HbA1c (p = 0.016) had a significant impact on the heterogeneity of the association between IDFU and PCT levels.
Conclusion
Our study showed a significant correlation between serum PCT levels and IDFU. Identification and treatment of IDFUs as soon as possible can help reduce amputation and mortality rates.
This systematic review and meta-analysis evaluated the association between serum procalcitonin levels and diabetic foot infections. Ten studies were included, and a random-effects model showed significantly higher procalcitonin levels in infected patients, supporting its role as a potential diagnostic biomarker for early infection detection in dia
降钙素原（PCT）是诊断感染的有效炎症标志物。我们评估了降钙素原在诊断糖尿病足部感染中的临床应用。方法本荟萃分析遵循PRISMA指南。我们检索PubMed、Web of Science、Embase和Cochrane图书馆，检索2024年7月1日前发表的PCT诊断糖尿病足的相关研究。主要结局是IDFU组和非IDFU组之间PCT水平的标准化平均差（SMD），具有相应的95%置信区间（CI）。纳入的研究为横断面和队列研究，因此采用纽卡斯尔-渥太华量表（NOS）评估标准对文献质量进行评估。本研究的统计分析仅使用STATA 15.0软件进行。结果最终纳入10项研究，928例患者。有6项横断面研究和4项队列研究。共有532名患者被分配到IDFU组，396名患者被分配到非感染性糖尿病足溃疡（NIDFU）组。10项研究评估了PCT与DFU之间的关系，纳入的研究之间存在显著的异质性(x2 = 54.10, p = 0.00001；i2 = 83.6%)。因此，采用随机效应模型，合并标准化平均差为0.79（95%可信区间[CI]: 0.43-1.14）。Egger实验结果（t = 0.43, p = 0.680）表明不存在发表偏倚。敏感性分析表明，结果是可靠的。亚组分析确定该地区是异质性的重要来源。随机效应模型的meta回归结果显示，BMI （p = 0.026）和HbA1c （p = 0.016）对IDFU和PCT水平相关性的异质性有显著影响。结论血清PCT水平与IDFU有显著相关性。尽早发现和治疗idfu有助于减少截肢和死亡率。本系统综述和荟萃分析评估了血清降钙素原水平与糖尿病足感染之间的关系。纳入了10项研究，随机效应模型显示感染患者的降钙素原水平显着升高，支持其作为糖尿病足溃疡早期感染检测的潜在诊断生物标志物的作用。
{"title":"Procalcitonin and Diabetic Foot Ulcer Infections: A Meta-Analysis","authors":"Wenqiang Wang, Peilin Zhou, Xinyu Nie, Qikai Hua","doi":"10.1002/edm2.70066","DOIUrl":"https://doi.org/10.1002/edm2.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Procalcitonin (PCT) is an effective inflammatory marker for diagnosing infection. We assessed the clinical utility of procalcitonin in diagnosing diabetic foot infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This meta-analysis adhered to the PRISMA guidelines. We searched PubMed, Web of Science, Embase and the Cochrane Library for studies on PCT for the diagnosis of diabetic foot published before 1 July 2024. The primary outcome was the standardised mean difference (SMD) in PCT levels between IDFU and non-IDFU groups, with corresponding 95% confidence intervals (CI). The included studies were cross-sectional and cohort studies, so the quality of the literature was assessed using the Newcastle–Ottawa Scale (NOS) evaluation criteria. This study's statistical analyses were conducted solely with STATA 15.0 software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Ten studies comprising 928 patients were ultimately included. There were six cross-sectional studies and four cohort studies. In total, 532 patients were assigned to the IDFU group and 396 to the non-infected diabetic foot ulcers (NIDFU) group. The relationship between PCT and DFU was evaluated in ten studies, with significant heterogeneity among the included studies (<i>x</i><sup>2</sup> = 54.10, <i>p =</i> 0.00001; <i>I</i><sup>2</sup> = 83.6%). Therefore, a random effects model was used with a pooled standardised mean difference of 0.79 (95% confidence interval [CI]: 0.43–1.14). The Egger experiment results (<i>t</i> = 0.43, <i>p</i> = 0.680) indicated that there was no publication bias. Analysis of sensitivity revealed that the results were reliable. Subgroup analyses identified the area as a significant source of heterogeneity. The random-effects model's meta-regression results revealed that BMI (<i>p</i> = 0.026) and HbA1c (<i>p</i> = 0.016) had a significant impact on the heterogeneity of the association between IDFU and PCT levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study showed a significant correlation between serum PCT levels and IDFU. Identification and treatment of IDFUs as soon as possible can help reduce amputation and mortality rates.</p>\u0000 \u0000 <p>This systematic review and meta-analysis evaluated the association between serum procalcitonin levels and diabetic foot infections. Ten studies were included, and a random-effects model showed significantly higher procalcitonin levels in infected patients, supporting its role as a potential diagnostic biomarker for early infection detection in dia","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdallah Hussein, Ameer Awashra, Islam Rajab, Mohammad Bdair, Dawoud Hamdan, Ahmad Nouri, Elaf Khatib, Ghiras Khatib, Nyan Latt
Background
Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) that can progress to cirrhosis and hepatocellular carcinoma (HCC). Obesity is a major risk factor for NASH, and metabolic interventions such as bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been explored for their impact on liver-related outcomes. This study evaluates the comparative effectiveness of BS and GLP-1 RAs in reducing the incidence of new-onset NASH and related hepatic complications.
Methods
This was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, of 35 or greater and without a history of NAFLD/NASH (without cirrhosis) who underwent BS versus GLP-1RA between January 1, 2014 and December 31, 2019, were included. Patients in the BS group were matched with patients in the GLP-1RA group according to age, demographics, comorbidities and medication by using 1:1 propensity matching.
Results
Among 180,022 eligible adults, 143,404 underwent BS, while 36,618 received GLP-1 RA therapy. Following propensity score matching, 33,594 patients in the BS group (mean age 49.1 ± 13.2 years; 72.73% female) were matched to an equal number of individuals in the GLP-1 RA group (mean age 48.9 ± 14.0 years; 72.41% female). Compared to those receiving GLP-1 RA therapy, patients who underwent BS had a significantly lower risk of HCC (HR, 0.304; 95% CI, 0.099–0.931), which showed the strongest protective effect, followed by a substantial reduction in NASH (HR, 0.509; 95% CI, 0.469–0.551). The reduction in liver cirrhosis risk was not statistically significant (HR, 0.865; 95% CI, 0.696–1.075). These associations remained across follow-up periods of 1, 3, 5 and 7 years.
Conclusions
These findings suggest that BS was significantly associated with lower risk of new onset of NASH/NAFLD.
{"title":"Comparative Effectiveness of Bariatric Surgery Versus GLP-1 Receptor Agonists in Reducing the Risk of New-Onset of NASH: A Retrospective Multinational Cohort Study From North America and Europe","authors":"Abdallah Hussein, Ameer Awashra, Islam Rajab, Mohammad Bdair, Dawoud Hamdan, Ahmad Nouri, Elaf Khatib, Ghiras Khatib, Nyan Latt","doi":"10.1002/edm2.70075","DOIUrl":"https://doi.org/10.1002/edm2.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) that can progress to cirrhosis and hepatocellular carcinoma (HCC). Obesity is a major risk factor for NASH, and metabolic interventions such as bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been explored for their impact on liver-related outcomes. This study evaluates the comparative effectiveness of BS and GLP-1 RAs in reducing the incidence of new-onset NASH and related hepatic complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, of 35 or greater and without a history of NAFLD/NASH (without cirrhosis) who underwent BS versus GLP-1RA between January 1, 2014 and December 31, 2019, were included. Patients in the BS group were matched with patients in the GLP-1RA group according to age, demographics, comorbidities and medication by using 1:1 propensity matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 180,022 eligible adults, 143,404 underwent BS, while 36,618 received GLP-1 RA therapy. Following propensity score matching, 33,594 patients in the BS group (mean age 49.1 ± 13.2 years; 72.73% female) were matched to an equal number of individuals in the GLP-1 RA group (mean age 48.9 ± 14.0 years; 72.41% female). Compared to those receiving GLP-1 RA therapy, patients who underwent BS had a significantly lower risk of HCC (HR, 0.304; 95% CI, 0.099–0.931), which showed the strongest protective effect, followed by a substantial reduction in NASH (HR, 0.509; 95% CI, 0.469–0.551). The reduction in liver cirrhosis risk was not statistically significant (HR, 0.865; 95% CI, 0.696–1.075). These associations remained across follow-up periods of 1, 3, 5 and 7 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings suggest that BS was significantly associated with lower risk of new onset of NASH/NAFLD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background</h3> <p>In several observational studies, vitamins B6, B9, B12, C and 25-hydroxyvitamin D[25(OH)D] concentrations were associated with type 2 diabetes mellitus (T2DM). Although vitamins play a role in the development of type 2 diabetes mellitus (T2DM), their associations remain unclear.</p> </section> <section> <h3> Objective</h3> <p>This study employed Mendelian randomisation (MR) to explore the causal relationships between circulating concentrations of vitamins B6, B9, B12, C, 25-hydroxyvitamin D and T2DM.</p> </section> <section> <h3> Methods</h3> <p>Single-nucleotide polymorphisms (SNPs) linked to vitamin B6, vitamin B9, vitamin B12, vitamin C and 25(OH)D levels were used as instrumental variables (IVs) in this study. We have two outcomes related to T2DM derived from two genome-wide association studies (GWAS). The first study, referenced by PMID: 3417140, encompasses a cohort of 406,831 individuals of European descent. The second study, identified by PMID: 29892013, includes a sample size of 468,298 Europeans.</p> </section> <section> <h3> Results</h3> <p>Both univariable Mendelian randomization (UVMR) and multivariable Mendelian randomization (MVMR) analyses demonstrate that genetically predicted elevated levels of serum 25(OH)D are consistently associated with a reduced risk of T2DM. In the UVMR analyses, A 1-SD increase in genetically predicted serum 25(OH)D levels, the inverse-variance weighted (IVW) <i>p</i> = 3.8 × 10<sup>−7</sup>, <i>p</i><sub><i>fdr</i></sub> = 7.6 × 10<sup>−7</sup>, the odds ratio(OR) of T2DM (GCST90013942) was 0.67, 95% confidence interval (CI): 0.57–0.78. Furthermore, a 1-SD increase in genetically predicted serum 25(OH)D levels was associated with an OR of 0.987 for T2DM (GCST90029024), the IVW <i>p</i> = 1.1 × 10<sup>−4</sup>, <i>p</i><sub><i>fdr</i></sub> = 1.1 × 10<sup>−4</sup> with a 95% CI of 0.981–0.994. In the MVMR analyses, genetically predicted higher serum 25(OH)D levels were associated with a decreased risk of T2DM by the IVW <i>p</i> = 1.2 × 10<sup>−5</sup>, <i>p</i><sub><i>fdr</i></sub> = 5.9 × 10<sup>−5</sup> in GCST90013942 and IVW <i>p</i> = 4.9 × 10<sup>−4</sup>, <i>p</i><sub><i>fdr</i></sub> = 2.5 × 10<sup>−3</sup> in GCST90029024. In contrast, levels of vitamins B6, B9, B12, and C did not domenstrate a significant association with T2DM.</p> </section> <section> <h3> Conclusion</h3> <p>Our research reveals that higher circulating serum 25(OH)D levels reduce the possi
{"title":"Genetically Predicted Serum 25-Hydroxyvitamin D Concentrations in Related to Type 2 Diabetes Mellitus: A Mendelian Randomization Study","authors":"Jin Yang","doi":"10.1002/edm2.70050","DOIUrl":"https://doi.org/10.1002/edm2.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In several observational studies, vitamins B6, B9, B12, C and 25-hydroxyvitamin D[25(OH)D] concentrations were associated with type 2 diabetes mellitus (T2DM). Although vitamins play a role in the development of type 2 diabetes mellitus (T2DM), their associations remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study employed Mendelian randomisation (MR) to explore the causal relationships between circulating concentrations of vitamins B6, B9, B12, C, 25-hydroxyvitamin D and T2DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single-nucleotide polymorphisms (SNPs) linked to vitamin B6, vitamin B9, vitamin B12, vitamin C and 25(OH)D levels were used as instrumental variables (IVs) in this study. We have two outcomes related to T2DM derived from two genome-wide association studies (GWAS). The first study, referenced by PMID: 3417140, encompasses a cohort of 406,831 individuals of European descent. The second study, identified by PMID: 29892013, includes a sample size of 468,298 Europeans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both univariable Mendelian randomization (UVMR) and multivariable Mendelian randomization (MVMR) analyses demonstrate that genetically predicted elevated levels of serum 25(OH)D are consistently associated with a reduced risk of T2DM. In the UVMR analyses, A 1-SD increase in genetically predicted serum 25(OH)D levels, the inverse-variance weighted (IVW) <i>p</i> = 3.8 × 10<sup>−7</sup>, <i>p</i><sub><i>fdr</i></sub> = 7.6 × 10<sup>−7</sup>, the odds ratio(OR) of T2DM (GCST90013942) was 0.67, 95% confidence interval (CI): 0.57–0.78. Furthermore, a 1-SD increase in genetically predicted serum 25(OH)D levels was associated with an OR of 0.987 for T2DM (GCST90029024), the IVW <i>p</i> = 1.1 × 10<sup>−4</sup>, <i>p</i><sub><i>fdr</i></sub> = 1.1 × 10<sup>−4</sup> with a 95% CI of 0.981–0.994. In the MVMR analyses, genetically predicted higher serum 25(OH)D levels were associated with a decreased risk of T2DM by the IVW <i>p</i> = 1.2 × 10<sup>−5</sup>, <i>p</i><sub><i>fdr</i></sub> = 5.9 × 10<sup>−5</sup> in GCST90013942 and IVW <i>p</i> = 4.9 × 10<sup>−4</sup>, <i>p</i><sub><i>fdr</i></sub> = 2.5 × 10<sup>−3</sup> in GCST90029024. In contrast, levels of vitamins B6, B9, B12, and C did not domenstrate a significant association with T2DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our research reveals that higher circulating serum 25(OH)D levels reduce the possi","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The glycated albumin-to-glycated haemoglobin (GA/HbA1c) ratio is a potential marker of glycaemic variability; however, its association with adverse clinical outcomes in type 2 diabetes remains unclear. We aimed to determine whether the GA/HbA1c ratio is a better predictor of mortality and chronic kidney disease (CKD) progression than GA alone in type 2 diabetes.
Methods
This retrospective cohort analysis included 571 Japanese participants with type 2 diabetes who were stratified into tertiles based on their GA/HbA1c ratio. Cox proportional hazards models assessed associations between the GA/HbA1c ratio and mortality or CKD progression (≥ 30% decline in the estimated glomerular filtration rate [eGFR]), adjusting for age, sex, urinary albumin-to-creatinine ratio, eGFR, body mass index, haemoglobin and serum albumin.
Results
In this cohort, the median age was 67 years, and 53.9% were male. During the median follow-up of 5.4 and 5.3 years for mortality and CKD progression, respectively, 40 (7.0%) participants died and 70 (12.3%) experienced CKD progression. For mortality, the GA/HbA1c ratio demonstrated a U-shaped association: although both the lowest (T1) and highest (T3) tertiles showed higher mortality risks than the middle tertile (T2), this association was significant for only T3 (hazard ratio, 1.46; 95% CI, 1.05–2.04). Neither GA nor HbA1c alone was significantly associated with mortality. For CKD progression, GA alone showed a U-shaped association, with both T1 and T3 exhibiting non-significantly higher risks than T2. Neither the GA/HbA1c ratio nor HbA1c alone was associated with CKD progression.
Conclusions
In individuals with type 2 diabetes, a higher GA/HbA1c ratio was associated with an increased risk of mortality but not with CKD progression. However, given the retrospective design and limited sample size, these findings should be interpreted with caution and confirmed in larger, prospective studies.
{"title":"Association of the Glycated Albumin-to-Glycated Haemoglobin Ratio With Mortality in Type 2 Diabetes: A Retrospective Cohort Analysis","authors":"Tomohito Gohda, Nozomu Kamei, Marenao Tanaka, Masato Furuhashi, Tatsuya Sato, Mitsunobu Kubota, Michiyoshi Sanuki, Risako Mikami, Koji Mizutani, Yusuke Suzuki, Maki Murakoshi","doi":"10.1002/edm2.70072","DOIUrl":"https://doi.org/10.1002/edm2.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The glycated albumin-to-glycated haemoglobin (GA/HbA1c) ratio is a potential marker of glycaemic variability; however, its association with adverse clinical outcomes in type 2 diabetes remains unclear. We aimed to determine whether the GA/HbA1c ratio is a better predictor of mortality and chronic kidney disease (CKD) progression than GA alone in type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort analysis included 571 Japanese participants with type 2 diabetes who were stratified into tertiles based on their GA/HbA1c ratio. Cox proportional hazards models assessed associations between the GA/HbA1c ratio and mortality or CKD progression (≥ 30% decline in the estimated glomerular filtration rate [eGFR]), adjusting for age, sex, urinary albumin-to-creatinine ratio, eGFR, body mass index, haemoglobin and serum albumin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this cohort, the median age was 67 years, and 53.9% were male. During the median follow-up of 5.4 and 5.3 years for mortality and CKD progression, respectively, 40 (7.0%) participants died and 70 (12.3%) experienced CKD progression. For mortality, the GA/HbA1c ratio demonstrated a U-shaped association: although both the lowest (T1) and highest (T3) tertiles showed higher mortality risks than the middle tertile (T2), this association was significant for only T3 (hazard ratio, 1.46; 95% CI, 1.05–2.04). Neither GA nor HbA1c alone was significantly associated with mortality. For CKD progression, GA alone showed a U-shaped association, with both T1 and T3 exhibiting non-significantly higher risks than T2. Neither the GA/HbA1c ratio nor HbA1c alone was associated with CKD progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In individuals with type 2 diabetes, a higher GA/HbA1c ratio was associated with an increased risk of mortality but not with CKD progression. However, given the retrospective design and limited sample size, these findings should be interpreted with caution and confirmed in larger, prospective studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xudan Lou, Na Yi, Yingchun Liu, Yuanyuan Xu, Jieyuzhen Qiu, Xiaoming Tao, Zhijun Bao
Objective
To explore the differential diagnosis for benign and malignant thyroid nodules and the diagnostic value of sleep quality, to construct and validate a risk prediction model, providing the basis for clinical treatment decision for elderly thyroid cancer.
Methods
Clinical data, Pittsburgh Sleep Quality Index (PSQI), and multimodal ultrasound were collected from elderly patients undergoing fine needle aspiration biopsy or thyroid surgery in our department of endocrinology and general surgery. Postoperative pathological results served as the gold standard, binary logistic regression identified significant risk factors, and the receiver-operating characteristic (ROC) curves were plotted to construct and validate the prediction model.
Results
Among 763 enrolled patients (566 benign and 197 malignant), multivariate analysis revealed independent risk factors: TPOAB positive, daytime dysfunction, PSQI > 7, irregular nodule shape, calcification, blood flow, high elasticity scores, and low contrast enhancement. The area under the curve (AUC) for the combined model was 0.860, significantly higher than models using multimodal ultrasound alone (AUC = 0.824) or multimodal ultrasound with TPOAB (AUC = 0.831), p < 0.05. The nomogram-based prediction model demonstrated excellent discrimination, calibration, and clinical utility in internal and external validation.
Conclusions
Integrating sleep quality assessment with multimodal ultrasound assisted in the differentiation of thyroid nodules in the elderly, thus may improve the preoperative diagnostic levels. Risk prediction model in a nomogram format provided an intuitive and reliable tool for clinical decision-making.
{"title":"Risk Prediction Model for Elderly Differentiated Thyroid Cancer Based on Combined Sleep Quality Assessment and Multimodal Ultrasound","authors":"Xudan Lou, Na Yi, Yingchun Liu, Yuanyuan Xu, Jieyuzhen Qiu, Xiaoming Tao, Zhijun Bao","doi":"10.1002/edm2.70073","DOIUrl":"https://doi.org/10.1002/edm2.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the differential diagnosis for benign and malignant thyroid nodules and the diagnostic value of sleep quality, to construct and validate a risk prediction model, providing the basis for clinical treatment decision for elderly thyroid cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical data, Pittsburgh Sleep Quality Index (PSQI), and multimodal ultrasound were collected from elderly patients undergoing fine needle aspiration biopsy or thyroid surgery in our department of endocrinology and general surgery. Postoperative pathological results served as the gold standard, binary logistic regression identified significant risk factors, and the receiver-operating characteristic (ROC) curves were plotted to construct and validate the prediction model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 763 enrolled patients (566 benign and 197 malignant), multivariate analysis revealed independent risk factors: TPOAB positive, daytime dysfunction, PSQI > 7, irregular nodule shape, calcification, blood flow, high elasticity scores, and low contrast enhancement. The area under the curve (AUC) for the combined model was 0.860, significantly higher than models using multimodal ultrasound alone (AUC = 0.824) or multimodal ultrasound with TPOAB (AUC = 0.831), <i>p</i> < 0.05. The nomogram-based prediction model demonstrated excellent discrimination, calibration, and clinical utility in internal and external validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrating sleep quality assessment with multimodal ultrasound assisted in the differentiation of thyroid nodules in the elderly, thus may improve the preoperative diagnostic levels. Risk prediction model in a nomogram format provided an intuitive and reliable tool for clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to compare the gut microbiome (GM) composition, serum inflammatory markers and faecal short-chain fatty acids among individuals with type 1 and type 2 diabetes mellitus (DM) and healthy controls.
Methods
This case–control study examined 49 subjects with type 2 DM, 21 with type 1 DM and 40 healthy controls. Blood and faecal samples were collected. Serum inflammatory markers, including CRP, IL-1β, IL-6, TNF-α and IFN-γ, were measured using enzyme-linked immunosorbent assays (ELISA). Bacterial populations were quantified using RT-qPCR and NGS. Faecal metabolites were analysed using gas chromatography.
Results
Simpson's alpha diversity was higher among types 1 and 2 DM than in the control. The frequency of the bacterial genera Gemmiger, Dorea, Collinsella, Escherichia/Shigella, Dialister, Coprococcus, Achromobacter, Intestinimonas and Allisonella in type 2 DM was higher than in the control, and the frequency of the genera Romboutsia and Clostridium was decreased in type 2 DM. The frequency of the Prevotella, Bacteroides and Faecalibacterium genera in type 1 DM was lower than in the other groups. Acetate, propionate and butyrate levels were significantly higher in type 2 DM patients compared to the other groups. Participants with diabetes had significantly higher hs-CRP, IL1-β, TNF, IL-6 and IFG levels compared to the controls. Compared to healthy controls, both T1DM and T2DM patients showed a significant increase in the abundance of the Lactobacillus genus (p = 0.01) and a decrease in Faecalibacterium (p = 0.02). Additionally, serum levels of IL-6 and TNF-α were significantly elevated in T2DM patients (p = 0.003 and p = 0.005, respectively). Faecal levels of butyrate were significantly reduced in both diabetic groups compared to the controls (p = 0.004).
Conclusion
By determining the GM alterations in patients with diabetes, interventional strategies could be designed to modulate the GM composition as an adjunctive therapy in diabetes.
{"title":"The Comparison of the Gut Microbiome Composition, Serum Inflammatory Markers and Faecal Short-Chain Fatty Acids Among Individuals With Type 1 and 2 Diabetes Mellitus With Healthy Controls: A Case–Control Study","authors":"Hossein Yarmohammadi, Masood Soltanipur, Mahdi Rezaei, Hanieh-Sadat Ejtahed, Maedeh Raei, Alireza Razavi, Seyed Mohsen Mirhosseini, Mehrangiz Zangeneh, Delaram Doroud, Abolfazl Fateh, Seyedalireza Seyed Siamdoust, Seyed Davar Siadat","doi":"10.1002/edm2.70071","DOIUrl":"https://doi.org/10.1002/edm2.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to compare the gut microbiome (GM) composition, serum inflammatory markers and faecal short-chain fatty acids among individuals with type 1 and type 2 diabetes mellitus (DM) and healthy controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This case–control study examined 49 subjects with type 2 DM, 21 with type 1 DM and 40 healthy controls. Blood and faecal samples were collected. Serum inflammatory markers, including CRP, IL-1β, IL-6, TNF-α and IFN-γ, were measured using enzyme-linked immunosorbent assays (ELISA). Bacterial populations were quantified using RT-qPCR and NGS. Faecal metabolites were analysed using gas chromatography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Simpson's alpha diversity was higher among types 1 and 2 DM than in the control. The frequency of the bacterial genera <i>Gemmiger</i>, <i>Dorea</i>, <i>Collinsella</i>, <i>Escherichia/Shigella</i>, <i>Dialister</i>, <i>Coprococcus</i>, <i>Achromobacter</i>, <i>Intestinimonas</i> and <i>Allisonella</i> in type 2 DM was higher than in the control, and the frequency of the genera <i>Romboutsia</i> and <i>Clostridium</i> was decreased in type 2 DM. The frequency of the <i>Prevotella</i>, <i>Bacteroides</i> and <i>Faecalibacterium</i> genera in type 1 DM was lower than in the other groups. Acetate, propionate and butyrate levels were significantly higher in type 2 DM patients compared to the other groups. Participants with diabetes had significantly higher hs-CRP, IL1-β, TNF, IL-6 and IFG levels compared to the controls. Compared to healthy controls, both T1DM and T2DM patients showed a significant increase in the abundance of the <i>Lactobacillus</i> genus (<i>p</i> = 0.01) and a decrease in <i>Faecalibacterium</i> (<i>p</i> = 0.02). Additionally, serum levels of IL-6 and TNF-α were significantly elevated in T2DM patients (<i>p</i> = 0.003 and <i>p</i> = 0.005, respectively). Faecal levels of butyrate were significantly reduced in both diabetic groups compared to the controls (<i>p</i> = 0.004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>By determining the GM alterations in patients with diabetes, interventional strategies could be designed to modulate the GM composition as an adjunctive therapy in diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Khaled A. Obeidat, Nesreen A. Saadeh, Renad Msameh, Ajwad Obeidat, Omar Mar'ey, Ahmad Bakkar, Qutaiba Manasrah
Background
Hypocalcemia is a common event after parathyroidectomy for primary hyperparathyroidism (PHPT). This study aimed to explore the incidence of hypocalcemia, determine risk factors, and identify serum biomarkers associated with the development of this condition.
Methods
A retrospective study that included 116 patients with PHPT who underwent parathyroidectomy at a tertiary care facility in Jordan over 16 years (2006–2022) in this study. Patients were classified as having postoperative hypocalcemia if they developed serum calcium levels < 2.15 mmol/L within the first week following parathyroidectomy. Logistic regression analysis was performed to determine predictors of hypocalcemia. Spearman's rank correlation coefficient and ROC curves were used to assess relationships between variables as well as determine cutoffs for these predictors.
Results
Of the 116 patients studied, 57.7% developed hypocalcemia after parathyroidectomy. High preoperative alkaline phosphatase (ALP), low preoperative corrected calcium, high preoperative parathyroid (PTH), and younger age were shown to be significantly higher in patients who developed hypocalcemia after parathyroidectomy. Multivariate logistic regression showed a low preoperative corrected calcium level was an independent predictor of postoperative hypocalcemia (p = 0.036). A high level of preoperative alkaline phosphatase was also considered an independent predictor of hypocalcemia development (OR = 1.007, 95% CI: 1.002–1.012). Patients who had pre-operative ALP less than 208.5 U/L were unlikely to develop postoperative hypocalcemia.
Conclusion
Our study identified higher preoperative ALP, lower pre-operative corrected calcium, higher pre-operative PTH levels, and younger age as risk factors for postoperative hypocalcemia. Preoperative ALP and preoperative corrected calcium were shown to be independent predictors of hypocalcemia development.
{"title":"Predictors of Hypocalcemia Post Parathyroidectomy for Primary Hyperparathyroidism; a Single Center Study","authors":"Khaled A. Obeidat, Nesreen A. Saadeh, Renad Msameh, Ajwad Obeidat, Omar Mar'ey, Ahmad Bakkar, Qutaiba Manasrah","doi":"10.1002/edm2.70070","DOIUrl":"https://doi.org/10.1002/edm2.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypocalcemia is a common event after parathyroidectomy for primary hyperparathyroidism (PHPT). This study aimed to explore the incidence of hypocalcemia, determine risk factors, and identify serum biomarkers associated with the development of this condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study that included 116 patients with PHPT who underwent parathyroidectomy at a tertiary care facility in Jordan over 16 years (2006–2022) in this study. Patients were classified as having postoperative hypocalcemia if they developed serum calcium levels < 2.15 mmol/L within the first week following parathyroidectomy. Logistic regression analysis was performed to determine predictors of hypocalcemia. Spearman's rank correlation coefficient and ROC curves were used to assess relationships between variables as well as determine cutoffs for these predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 116 patients studied, 57.7% developed hypocalcemia after parathyroidectomy. High preoperative alkaline phosphatase (ALP), low preoperative corrected calcium, high preoperative parathyroid (PTH), and younger age were shown to be significantly higher in patients who developed hypocalcemia after parathyroidectomy. Multivariate logistic regression showed a low preoperative corrected calcium level was an independent predictor of postoperative hypocalcemia (<i>p</i> = 0.036). A high level of preoperative alkaline phosphatase was also considered an independent predictor of hypocalcemia development (OR = 1.007, 95% CI: 1.002–1.012). Patients who had pre-operative ALP less than 208.5 U/L were unlikely to develop postoperative hypocalcemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study identified higher preoperative ALP, lower pre-operative corrected calcium, higher pre-operative PTH levels, and younger age as risk factors for postoperative hypocalcemia. Preoperative ALP and preoperative corrected calcium were shown to be independent predictors of hypocalcemia development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saaed Abunada, Sheela Bai, Usha Kumari, F. N. U. Nancy, Areeba Khan, Nikeeta Bai, F. N. U. Shevani, Anusha Bai, Shah Dev, Noshad Zain ul Abiddin, F. N. U. Umer, Abdul Manan, Sadia Habib Bhutto, Salih Abdella Yusuf
Introduction
Once-weekly basal insulin Fc (BIF) offers a promising alternative to daily basal insulin by reducing injection burden while maintaining glycaemic control. However, comprehensive comparisons with insulin degludec regarding continuous glucose monitoring (CGM) metrics and hypoglycaemia outcomes remain limited. This meta-analysis evaluates these critical parameters.
Methods
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing once-weekly BIF with once-daily insulin degludec in type 1 and type 2 diabetes. Outcomes included CGM-derived glycaemic variability, time in range, time above/below range and hypoglycaemia event rates. Data were pooled using random-effects models, with heterogeneity assessed via I2 statistics.
Results
Five RCTs (n = 2427) were included. BIF demonstrated comparable glycaemic variability (within-day CV: MD = 0.06, p = 0.90; between-day CV: MD = -0.26, p = 0.30) and Time in range (MD = 0.56, p = 0.27) versus degludec. However, BIF increased time spent in the mild hypoglycaemia range (54–69 mg/dL) (MD = 0.30, p = 0.0004) and clinically significant hypoglycaemia event rates (rate ratio = 1.20, p < 0.00001). Severe hypoglycaemia event rates were higher with BIF (rate ratio = 3.34, p < 0.0001). Nocturnal hypoglycaemia and time above range (> 250 mg/dL) did not differ significantly.
Conclusion
Once-weekly BIF provides similar overall glycaemic control to insulin degludec but with increased time in mild hypoglycaemia and higher event rates of clinically significant and severe hypoglycaemia. These findings highlight the need for individualised dosing and monitoring when transitioning to weekly insulin regimens.
每周一次的基础胰岛素Fc （BIF）提供了一种有希望的替代每日基础胰岛素的方法，减少了注射负担，同时保持了血糖控制。然而，在持续血糖监测（CGM）指标和低血糖结局方面，与降糖糖胰岛素的综合比较仍然有限。本荟萃分析评估了这些关键参数。方法：我们对1型和2型糖尿病患者的随机对照试验（rct）进行了系统回顾和荟萃分析，比较了每周一次的BIF和每天一次的降糖糖胰岛素。结果包括cgm衍生的血糖变异性、在范围内的时间、高于/低于范围的时间和低血糖事件发生率。采用随机效应模型汇总数据，通过I2统计量评估异质性。结果共纳入5项rct （n = 2427）。BIF表现出相当的血糖变异性(日内CV: MD = 0.06, p = 0.90；日间CV: MD = -0.26, p = 0.30)和范围内时间（MD = 0.56, p = 0.27）。然而，BIF增加了轻度低血糖范围（54-69 mg/dL）的时间（MD = 0.30, p = 0.0004）和临床显著低血糖事件发生率（比率比= 1.20,p < 0.00001）。BIF组严重低血糖事件发生率较高（比率比= 3.34,p < 0.0001）。夜间低血糖和时间高于范围（> 250 mg/dL）无显著差异。结论每周一次BIF与降糖糖胰岛素的总体血糖控制效果相似，但轻度低血糖的时间延长，临床显著性和重度低血糖的发生率更高。这些发现强调了在过渡到每周胰岛素治疗方案时个体化给药和监测的必要性。
{"title":"Continuous Glucose Monitoring and Hypoglycaemia Metrics With Once-Weekly Basal Insulin Fc Versus Insulin Degludec: A Systematic Review and Meta-Analysis","authors":"Saaed Abunada, Sheela Bai, Usha Kumari, F. N. U. Nancy, Areeba Khan, Nikeeta Bai, F. N. U. Shevani, Anusha Bai, Shah Dev, Noshad Zain ul Abiddin, F. N. U. Umer, Abdul Manan, Sadia Habib Bhutto, Salih Abdella Yusuf","doi":"10.1002/edm2.70067","DOIUrl":"https://doi.org/10.1002/edm2.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Once-weekly basal insulin Fc (BIF) offers a promising alternative to daily basal insulin by reducing injection burden while maintaining glycaemic control. However, comprehensive comparisons with insulin degludec regarding continuous glucose monitoring (CGM) metrics and hypoglycaemia outcomes remain limited. This meta-analysis evaluates these critical parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing once-weekly BIF with once-daily insulin degludec in type 1 and type 2 diabetes. Outcomes included CGM-derived glycaemic variability, time in range, time above/below range and hypoglycaemia event rates. Data were pooled using random-effects models, with heterogeneity assessed via <i>I</i><sup>2</sup> statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five RCTs (<i>n</i> = 2427) were included. BIF demonstrated comparable glycaemic variability (within-day CV: MD = 0.06, <i>p</i> = 0.90; between-day CV: MD = -0.26, <i>p</i> = 0.30) and Time in range (MD = 0.56, <i>p</i> = 0.27) versus degludec. However, BIF increased time spent in the mild hypoglycaemia range (54–69 mg/dL) (MD = 0.30, <i>p</i> = 0.0004) and clinically significant hypoglycaemia event rates (rate ratio = 1.20, <i>p</i> < 0.00001). Severe hypoglycaemia event rates were higher with BIF (rate ratio = 3.34, <i>p</i> < 0.0001). Nocturnal hypoglycaemia and time above range (> 250 mg/dL) did not differ significantly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Once-weekly BIF provides similar overall glycaemic control to insulin degludec but with increased time in mild hypoglycaemia and higher event rates of clinically significant and severe hypoglycaemia. These findings highlight the need for individualised dosing and monitoring when transitioning to weekly insulin regimens.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号