Endocrinology, Diabetes and Metabolism最新文献_第6页

Insights Into the Management of Type 2 Diabetes at Diagnosis in Spain: The NEW2TYPE2 Study 西班牙诊断时2型糖尿病管理的见解：NEW2TYPE2研究

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism

Pub Date : 2025-09-25 DOI: 10.1002/edm2.70095

Concha F. García-Prieto, Fernando Gómez-Peralta, Rocío Villar-Taibo, Sergio Cinza-Sanjurjo, Jennifer Redondo-Antón, Silvia Díaz-Cerezo, Miriam Rubio-de Santos

Introduction

This study analysed the opinions and perceptions of Spanish physicians towards the management of people newly diagnosed with type 2 diabetes (T2D) aged ≤ 65 years.

Methods

Online survey targeting primary care physicians (PCPs) and endocrinologists (members of three national scientific societies) treating people with T2D. Management practices and factors determining prescribed therapies and treatment goals were captured in general and by patient profile. The respondents' perception of the limitations in setting strict glycaemic control objectives and weight loss targets, and the feasibility and impact of possible solutions, were examined.

Results

A total of 105 physicians (60% PCPs, 40% endocrinologists) responded to the survey; 98% of respondents reported following clinical practice guidelines; 53.3% and 27.6% considered stringent glycaemic control to be HbA1c levels of 6.0%–6.5% and 6.5%–7.0%, respectively. In patient profiles with overweight/obesity, > 90% reported setting weight loss goals, with 5%–10% weight loss being the most common target. The most limiting factors for the establishment of stringent glycaemic and weight loss targets were the lack of awareness of self-care of the disease (74.3%) and the cost to the healthcare system of the most effective drugs (72.4%). Training and the implementation of simple protocols and algorithms were the solutions perceived as having the greatest impact and feasibility. Redefining visa criteria was considered the solution with the highest impact.

Conclusions

The results are consistent with clinical practice guidelines' recommendations in Spain, but early and intensive interventions focused on reducing the risk of long-term complications in people with T2D who have longer life expectancy could be promoted at diagnosis.

本研究分析了西班牙医生对≤65岁新诊断的2型糖尿病（T2D）患者管理的看法和看法。方法对治疗T2D患者的初级保健医生（pcp）和内分泌学家（三个国家科学学会的成员）进行在线调查。管理实践和决定规定的治疗和治疗目标的因素被捕获一般和病人的资料。调查了受访者对制定严格的血糖控制目标和减肥目标的局限性的看法，以及可能解决方案的可行性和影响。结果共有105名医生参与调查，其中pcp占60%，内分泌科占40%；98%的答复者报告遵循临床实践指南；53.3%和27.6%的人认为严格的血糖控制是HbA1c水平分别为6.0%-6.5%和6.5%-7.0%。在超重/肥胖患者资料中，90%的患者报告设定了减肥目标，其中最常见的目标是体重减轻5%-10%。制定严格的血糖和减肥目标的最大限制因素是缺乏疾病自我保健意识（74.3%）和最有效药物的医疗保健系统成本（72.4%）。培训和执行简单的协议和算法被认为是影响最大和最可行的解决办法。重新定义签证标准被认为是影响最大的解决方案。结论：该结果与西班牙临床实践指南的建议一致，但可以在诊断时促进早期和强化干预，以降低预期寿命较长的T2D患者的长期并发症风险。

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引用次数: 0

Trends and Disparities in Cancer-Related Mortality Among Adults With Diabetes in the United States: 1999–2019 美国成人糖尿病患者癌症相关死亡率的趋势和差异：1999-2019

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism

Pub Date : 2025-09-25 DOI: 10.1002/edm2.70092

Muhammad Saad, Dua Ali, Taimor Mohammed Khan, Ruqiat Masooma Batool, Muhammad Sameer Arshad, Peter Collins, Raheel Ahmed

Aim

Cancer and diabetes are major public health concerns, with diabetes linked to increased cancer-related mortality. However, national trends and disparities remain underexplored.

Methods

Using CDC WONDER data, we analysed deaths where both diabetes and cancer were listed as causes. Age-adjusted mortality rates (AAMRs) were calculated for diabetic cancer patients aged ≥ 25 years and stratified by demographics and geography. Joinpoint regression estimated annual percent changes (APCs) and average annual percent changes (AAPCs).

Results

From 1999 to 2019, 699,007 cancer-related deaths occurred among individuals with diabetes. The overall AAMR increased from 15.06 to 15.23 per 100,000 (AAPC: +0.07%; p = 0.20), with a rise from 1999 to 2003, a decline from 2003 to 2015, and a resurgence from 2015 to 2019. Men (AAMR: 20.83) had higher mortality than women (AAMR: 11.80). Non-Hispanic Black individuals had the highest AAMRs (23.72), but NH American Indian/Alaska Natives had the largest increase (AAPC: 0.60). The Midwest (AAMR: 17.03) and rural areas (AAMR: 18.70) had the highest mortality, with rural rates rising significantly (AAPC: 0.92). Gastrointestinal cancers were the leading cause (AAMR: 4.31), followed by haematological (AAMR: 1.80), prostate (AAMR: 1.59), and breast cancer (AAMR: 1.38).

Conclusion

Cancer-related mortality in individuals with diabetes has increased, with notable disparities. Targeted interventions, screening, and better diabetes management are essential to reducing risks in high-risk populations.

癌症和糖尿病是主要的公共卫生问题，糖尿病与癌症相关死亡率增加有关。然而，各国的趋势和差异仍未得到充分探讨。方法使用CDC WONDER数据，我们分析了糖尿病和癌症都列为死因的死亡病例。计算年龄≥25岁的糖尿病癌症患者的年龄调整死亡率（AAMRs），并按人口统计学和地理分层。接合点回归估计年变化百分比（APCs）和平均年变化百分比（AAPCs）。从1999年到2019年，糖尿病患者中发生了699,007例癌症相关死亡。总体AAMR从15.06 / 10万上升到15.23 / 10万（AAPC: +0.07%; p = 0.20）， 1999 - 2003年上升，2003 - 2015年下降，2015 - 2019年回升。男性（AAMR: 20.83）的死亡率高于女性（AAMR: 11.80）。非西班牙裔黑人个体的AAPC最高（23.72），但NH美洲印第安人/阿拉斯加原住民的AAPC增幅最大（0.60）。中西部地区（AAMR: 17.03）和农村地区（AAMR: 18.70）的死亡率最高，农村地区的死亡率显著上升（AAPC: 0.92）。胃肠道癌症是主要原因（AAMR: 4.31），其次是血液病（AAMR: 1.80）、前列腺癌（AAMR: 1.59）和乳腺癌（AAMR: 1.38）。结论糖尿病患者的癌症相关死亡率有所增加，但差异显著。有针对性的干预、筛查和更好的糖尿病管理对于降低高危人群的风险至关重要。

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引用次数: 0

Evaluating the Rates of Pancreatitis and Pancreatic Cancer Among GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis of Randomised Controlled Trials 评估GLP-1受体激动剂中胰腺炎和胰腺癌的发生率：随机对照试验的系统回顾和荟萃分析。

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism

Pub Date : 2025-09-23 DOI: 10.1002/edm2.70113

Jimmy Wen, Denise Nadora, Ethan Bernstein, Christiane How-Volkman, Alina Truong, Bethany Joy, Megan Kou, Zohaer Muttalib, Arsh Alam, Eldo Frezza

Aims

This meta-analysis evaluates the rates of pancreatitis/pancreatic cancer among glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in randomised controlled trials (RCTs).

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a systematic search was performed in PubMed, Embase, and Cochrane Library for GLP-1 RA RCTs that evaluated pancreatitis/pancreatic cancer. A meta-analysis was conducted to evaluate this risk; subgroup analysis was performed with and without background medications.

Results

62 studies utilising dulaglutide, exenatide, liraglutide, semaglutide, beinaglutide, retatrutide, or tirzepatide, with 66,232 patients, mean age of 58.3 years (14.4 to 68), and mean follow-up of 43.5 weeks (1 to 198) were included in this study. Meta-analysis showed a significantly increased risk of pancreatitis (RR: 1.44, 95% CI 1.09–1.89, p = 0.009), but not when stratified by background medications (RR: 1.28, 95% CI 0.87–1.87) and without background medications (RR: 1.37, 95% CI 0.91–2.05). Pancreatic cancer and GLP-1 RA use showed no significant association (RR: 1.30, 95% CI 0.86–1.97). However, a significant increase was found with background medications (RR: 1.85, 95% CI 1.05–3.26, p = 0.03), but not without (RR: 0.81, 95% CI 0.43–1.55).

Conclusion

GLP-1 RAs carry a slightly increased risk of pancreatitis, which is not significant when stratified by background medication use. Overall risk for pancreatic cancer was not observed, but a slight association was found when stratified with background medications. However, this difference is likely minimal, given the numerous studies excluded from the meta-analysis where both treatment arms had zero events.

目的：本荟萃分析评估随机对照试验（rct）中胰高血糖素样肽-1受体激动剂（GLP-1 RAs）中胰腺炎/胰腺癌的发生率。方法：根据系统评价和荟萃分析的首选报告项目（PRISMA），在PubMed， Embase和Cochrane Library中进行系统搜索，以评估胰腺炎/胰腺癌的GLP-1 RA随机对照试验。进行了一项荟萃分析来评估这种风险；在有和没有背景药物的情况下进行亚组分析。结果：本研究纳入了杜拉鲁肽、艾塞那肽、利拉鲁肽、西马鲁肽、贝那鲁肽、利特鲁肽或替西帕肽的62项研究，66,232例患者，平均年龄58.3岁（14.4 ~ 68岁），平均随访时间43.5周（1 ~ 198周）。荟萃分析显示，胰腺炎的风险显著增加（RR: 1.44, 95% CI 1.09-1.89, p = 0.009），但按背景药物分层（RR: 1.28, 95% CI 0.87-1.87）和无背景药物分层（RR: 1.37, 95% CI 0.91-2.05）时无显著增加。胰腺癌与GLP-1 RA的使用无显著相关性（RR: 1.30, 95% CI: 0.86-1.97）。然而，有背景药物治疗的患者死亡率显著增加（RR: 1.85, 95% CI 1.05-3.26, p = 0.03），但没有背景药物治疗的患者死亡率显著增加（RR: 0.81, 95% CI 0.43-1.55）。结论：GLP-1 RAs携带的胰腺炎风险略有增加，但按背景用药分层不明显。胰腺癌的总体风险没有被观察到，但是当与背景药物分层时发现了轻微的关联。然而，这种差异可能很小，因为在meta分析中排除了许多两个治疗组均为零事件的研究。

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引用次数: 0

Unveiling Molecular Mechanisms Underlying Obesity-Associated Systemic Lupus Erythematosus 揭示肥胖相关系统性红斑狼疮的分子机制

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism

Pub Date : 2025-09-21 DOI: 10.1002/edm2.70077

Roshvin Kailashnath Pillai, Rishvini Kailashnath Pillai, Vinibha Rajakumari Illankovan, Vinod Balasubramaniam, A. M. Alabsi, Anupam Biswas, Hari Kumar Darnal, Saminathan Kayarohanam, Madhan Kumar Soutallu Janakiram, Vetriselvan Subramaniyan

Background

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily affecting women of childbearing age, characterised by relapsing inflammation across multiple organ systems. Its aetiology involves genetic and environmental factors that trigger immune dysregulation, leading to the excessive release of autoantibodies.

Objective

This study discusses the pathogenesis, diagnosis, management and emerging therapeutic targets in SLE, with a focus on metabolic reprogramming and the role of obesity.

Methods

Diagnosis is based on clinical and laboratory findings, with the EULAR and ACR criteria being the most advanced. SLE management requires individualised treatment, addressing the severity and organs affected.

Results

SLE presents with symptoms ranging from mild skin rashes to severe conditions like pulmonary hypertension and kidney failure. Advances in care have improved outcomes, with 80%–90% of patients achieving normal life expectancy with proper treatment. Metabolic reprogramming in immune cells is crucial to SLE pathogenesis, as altered glycolysis and fatty acid oxidation contribute to inflammation.

Discussion

Obesity is recognised to aggravate SLE by fostering chronic inflammation, immunological dysregulation and dysbiosis of the gut microbiota. These situations may exacerbate autoimmunity, especially in genetically predisposed individuals. It is suggested that obesity significantly contributes to the pathogenesis of SLE, and additional study should investigate metabolic therapy aimed at obesity and microbiota to re-establish immunological equilibrium and mitigate disease development.

Conclusion

Targeting metabolic pathways may offer new therapeutic options for improved disease management. Particular abnormalities in gut microbiota, characterised by reduced diversity and an increase in pro-inflammatory species, influence obesity-related immunological dysregulation in systemic lupus erythematosus and may present new therapeutic targets.

系统性红斑狼疮（SLE）是一种慢性自身免疫性疾病，主要影响育龄妇女，其特征是多器官系统炎症复发。其病因涉及遗传和环境因素，触发免疫失调，导致自身抗体的过度释放。目的探讨SLE的发病机制、诊断、治疗和新出现的治疗靶点，重点探讨代谢重编程和肥胖的作用。方法诊断依据临床和实验室检查结果，以EULAR和ACR标准最为先进。SLE管理需要个体化治疗，针对严重程度和受影响的器官。结果SLE的症状从轻微的皮疹到严重的肺动脉高压和肾衰竭。护理方面的进步改善了结果，80%-90%的患者在接受适当治疗后达到正常预期寿命。免疫细胞的代谢重编程对SLE的发病机制至关重要，因为糖酵解和脂肪酸氧化的改变会导致炎症。肥胖被认为通过促进慢性炎症、免疫失调和肠道微生物群失调而加重SLE。这些情况可能会加剧自身免疫，特别是在遗传易感个体中。提示肥胖在SLE发病机制中起着重要作用，需要进一步研究针对肥胖和微生物群的代谢治疗，以重建免疫平衡，减缓疾病发展。结论靶向代谢途径可能为改善疾病管理提供新的治疗选择。肠道微生物群的特殊异常，以多样性减少和促炎物种增加为特征，影响系统性红斑狼疮中与肥胖相关的免疫失调，并可能提供新的治疗靶点。

{"title":"Unveiling Molecular Mechanisms Underlying Obesity-Associated Systemic Lupus Erythematosus","authors":"Roshvin Kailashnath Pillai, Rishvini Kailashnath Pillai, Vinibha Rajakumari Illankovan, Vinod Balasubramaniam, A. M. Alabsi, Anupam Biswas, Hari Kumar Darnal, Saminathan Kayarohanam, Madhan Kumar Soutallu Janakiram, Vetriselvan Subramaniyan","doi":"10.1002/edm2.70077","DOIUrl":"https://doi.org/10.1002/edm2.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily affecting women of childbearing age, characterised by relapsing inflammation across multiple organ systems. Its aetiology involves genetic and environmental factors that trigger immune dysregulation, leading to the excessive release of autoantibodies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study discusses the pathogenesis, diagnosis, management and emerging therapeutic targets in SLE, with a focus on metabolic reprogramming and the role of obesity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Diagnosis is based on clinical and laboratory findings, with the EULAR and ACR criteria being the most advanced. SLE management requires individualised treatment, addressing the severity and organs affected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SLE presents with symptoms ranging from mild skin rashes to severe conditions like pulmonary hypertension and kidney failure. Advances in care have improved outcomes, with 80%–90% of patients achieving normal life expectancy with proper treatment. Metabolic reprogramming in immune cells is crucial to SLE pathogenesis, as altered glycolysis and fatty acid oxidation contribute to inflammation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Obesity is recognised to aggravate SLE by fostering chronic inflammation, immunological dysregulation and dysbiosis of the gut microbiota. These situations may exacerbate autoimmunity, especially in genetically predisposed individuals. It is suggested that obesity significantly contributes to the pathogenesis of SLE, and additional study should investigate metabolic therapy aimed at obesity and microbiota to re-establish immunological equilibrium and mitigate disease development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Targeting metabolic pathways may offer new therapeutic options for improved disease management. Particular abnormalities in gut microbiota, characterised by reduced diversity and an increase in pro-inflammatory species, influence obesity-related immunological dysregulation in systemic lupus erythematosus and may present new therapeutic targets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110699","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}

引用次数: 0

CAMKK1 in Obesity and Type 2 Diabetes Mellitus: Evidence of Interaction With Appetite-Regulating, Metabolic and Inflammatory Factors 肥胖和2型糖尿病中的CAMKK1：与食欲调节、代谢和炎症因子相互作用的证据

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism

Pub Date : 2025-09-18 DOI: 10.1002/edm2.70109

Livio Tarchi, Lorenzo Bonacchi, Andrea Di Santo, Paolo Rovero, Chiara Sassoli, Rachele Garella, Roberta Squecco, Gianluca Villa, Romina Nassini, Francesco De Logu, Valdo Ricca, Giovanni Castellini

Introduction

Calcium/calmodulin-dependent protein kinase kinase 1 (CAMKK1) regulates energy homeostasis through AMP-activated protein kinase (AMPK). CAMKK1 has been implicated in appetite and satiety regulation; however, its role in obesity or type 2 diabetes mellitus (T2DM) remains unexplored. In this cross-sectional study, the primary aim was to confirm whether CAMKK1 is elevated in individuals with diabetes. The secondary aim was to investigate CAMKK1's molecular correlates.

Methods

CAMKK1 serum levels in individuals with obesity (n = 3,061), patients with T2DM (n = 4,910) and controls (n = 44,257) were retrieved and compared (age, body mass index—BMI and sex-adjusted ANCOVA). Pearson correlation coefficients and linear regression coefficients (age and BMI-adjusted) were computed. The moderation effect of diagnostic groups was also assessed. The interaction between factors was explored by mixed graphical models.

Results

CAMKK1 was elevated in patients with T2DM, in comparison to both individuals with obesity and controls (post hoc comparison, Tukey-adjusted p = 0.010 and p = 0.044, respectively). Across diagnostic groups, positive associations were observed between CAMKK1 and AMPK (min β > 0.400, max p < 0.001) or TNFα (min > β 0.070, max p < 0.001). A positive association with leptin (β = 0.010, p = 0.002) and ghrelin (β = 0.005, p = 0.048) was observed only within controls. Multivariate multivariable models confirmed that specific interactions between factors were disrupted in patients with T2DM (p < 0.001).

Conclusion

These findings provide new insights into the role of CAMKK1 in obesity and T2DM. Future research may further explore CAMKK1's interplay with inflammatory pathways.

钙/钙调素依赖性蛋白激酶1 （CAMKK1）通过amp活化蛋白激酶（AMPK）调节能量稳态。CAMKK1与食欲和饱腹感调节有关；然而，其在肥胖或2型糖尿病（T2DM）中的作用尚不清楚。在这项横断面研究中，主要目的是确认CAMKK1是否在糖尿病患者中升高。第二个目的是研究CAMKK1的分子相关性。方法：检索并比较肥胖（n = 3061）、T2DM （n = 4910）和对照组（n = 44257）的CAMKK1血清水平（年龄、体重指数- bmi和性别校正ANCOVA）。计算Pearson相关系数和线性回归系数（年龄和bmi调整后）。对诊断组的调节效果也进行了评估。通过混合图形模型探讨了各因素之间的相互作用。结果：与肥胖和对照组相比，T2DM患者的CAMKK1升高（事后比较，经tukey校正p = 0.010和p = 0.044）。在诊断组中，CAMKK1和AMPK呈正相关（min β > 0.400, max p β 0.070, max p）。结论：这些发现为CAMKK1在肥胖和T2DM中的作用提供了新的见解。未来的研究可能会进一步探索CAMKK1与炎症途径的相互作用。

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引用次数: 0

Diagnostic Performance of Machine Learning Algorithms for Predicting Heart Failure in Diabetic Patients: A Systematic Review and Meta-Analysis 预测糖尿病患者心力衰竭的机器学习算法的诊断性能：系统回顾和荟萃分析。

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism

Pub Date : 2025-09-18 DOI: 10.1002/edm2.70111

Pooya Eini, Peyman Eini, Homa Serpoush, Mohammad Rezayee

Background

Heart failure is a significant complication in diabetic patients, and machine learning algorithms offer potential for early prediction. This systematic review and meta-analysis evaluated the diagnostic performance of ML models in predicting HF among diabetic patients.

Methods

We searched PubMed, Web of Science, Embase, ProQuest, and Scopus, identifying 2830 articles. After deduplication and screening, 16 studies were included, with 7 providing data for meta-analysis. Study quality was assessed using PROBAST+AI. A bivariate random-effects model (Stata, midas, metadta) pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR) for best-performing algorithms, with subgroup analyses. Heterogeneity (I²) and publication bias were assessed.

Results

This meta-analysis of seven studies evaluating machine learning models for heart failure detection demonstrated a pooled sensitivity of 84% (95% CI: 0.75–0.90), specificity of 86% (95% CI: 0.56–0.97), and an area under the ROC curve of 0.90 (95% CI: 0.87–0.93). The pooled positive likelihood ratio was 6.6 (95% CI: 1.2–35.9), and the negative likelihood ratio was 0.17 (95% CI: 0.08–0.36), with a diagnostic odds ratio of 39 (95% CI: 4–423). Significant heterogeneity was observed, primarily related to differences in study populations, machine learning algorithms, dataset sizes, and validation methods. No significant publication bias was detected.

Conclusion

Machine learning models demonstrate promising diagnostic accuracy for heart failure detection and have the potential to support early diagnosis and risk assessment in clinical practice. However, considerable heterogeneity across studies and limited external validation highlight the need for standardised development, prospective validation, and improved interpretability of ML models to ensure their effective integration into healthcare systems.

背景：心力衰竭是糖尿病患者的重要并发症，机器学习算法为早期预测提供了潜力。本系统综述和荟萃分析评估了ML模型在预测糖尿病患者心衰方面的诊断性能。方法：检索PubMed， Web of Science, Embase, ProQuest, Scopus，共2830篇。经过重复数据删除和筛选，共纳入16项研究，其中7项为meta分析提供数据。采用PROBAST+AI评估研究质量。双变量随机效应模型（Stata, midas, metadta）汇集了最佳算法的敏感性，特异性，似然比和诊断优势比（DOR），并进行了亚组分析。评估异质性（I2）和发表偏倚。结果：这项荟萃分析了7项评估机器学习模型用于心力衰竭检测的研究，结果表明，总灵敏度为84% (95% CI: 0.75-0.90)，特异性为86% (95% CI: 0.56-0.97)， ROC曲线下面积为0.90 （95% CI: 0.87-0.93）。合并阳性似然比为6.6 (95% CI: 1.2-35.9)，阴性似然比为0.17 (95% CI: 0.08-0.36)，诊断优势比为39 （95% CI: 4-423）。观察到显著的异质性，主要与研究人群、机器学习算法、数据集大小和验证方法的差异有关。未发现显著的发表偏倚。结论：机器学习模型在心力衰竭检测中显示出有希望的诊断准确性，并有可能在临床实践中支持早期诊断和风险评估。然而，研究之间的相当大的异质性和有限的外部验证突出了标准化开发、前瞻性验证和改进ML模型的可解释性的需要，以确保它们有效地集成到医疗保健系统中。

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引用次数: 0

Revisiting the Obesity–Anaemia Paradox: Inflammation and Iron Homeostasis in the BMI–Haemoglobin Relationship 重新审视肥胖-贫血悖论：bmi -血红蛋白关系中的炎症和铁稳态。

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism

Pub Date : 2025-09-18 DOI: 10.1002/edm2.70110

Ali Hemade, Pascale Salameh

Background

Obesity and anaemia are global epidemics with complex, overlapping pathophysiology. While excess adiposity is known to induce chronic inflammation that disrupts iron homeostasis, multiple population studies paradoxically report higher haemoglobin levels and lower anaemia prevalence among obese individuals. The nonlinear and potentially suppressive role of inflammation in this relationship remains understudied.

Methods

We analysed adults aged 18–64 from the 2015–2023 National Health and Nutrition Examination Survey (NHANES). Haemoglobin was modelled as a function of body-mass index (BMI) using survey-weighted linear regression with restricted cubic splines. Interactions with log-transformed CRP were assessed, and ferritin was corrected for inflammation using BRINDA regression-residual methods. Causal mediation analysis decomposed the total effect of BMI on haemoglobin into indirect (mediated by CRP) and direct effects. Secondary models examined anaemia (Hb < 13.0 g/dL in men, < 12.0 g/dL in women) using logistic regression.

Results

Haemoglobin increased steeply across lower BMI ranges but plateaued above 30 kg/m² (p-nonlinearity < 0.001). The haemoglobin–BMI curve flattened significantly at higher CRP levels, with strong evidence of interaction (p-interaction < 0.001). Mediation analysis showed that CRP significantly suppressed the BMI–haemoglobin relationship (ACME = −0.044 g/dL, p < 0.001; ADE = 0.216 g/dL, p < 0.001). In contrast, BRINDA-adjusted ferritin mediated < 2% of the association. Logistic models showed that anaemia risk declined sharply with increasing BMI but rose consistently with CRP. Anaemia mediation analysis revealed suppression as well (ACME > 0; ADE < 0), precluding interpretation of proportion mediated.

Conclusions

BMI is positively associated with haemoglobin in a non-linear, CRP-dependent fashion. Inflammation significantly suppresses the haematologic benefit of excess adiposity, while inflammation-adjusted ferritin plays a minimal mediating role. These findings underscore the importance of modelling non-linearity and correcting iron biomarkers for inflammation when studying obesity-related anaemia.

背景：肥胖和贫血是具有复杂、重叠病理生理的全球性流行病。虽然已知过度肥胖会引起慢性炎症，破坏铁体内平衡，但多项人口研究矛盾地报告肥胖个体的血红蛋白水平较高，贫血患病率较低。炎症在这种关系中的非线性和潜在抑制作用仍未得到充分研究。方法：我们分析了2015-2023年国家健康与营养调查（NHANES）中18-64岁的成年人。血红蛋白被建模为身体质量指数（BMI）的函数，使用调查加权线性回归限制三次样条。评估与对数转换CRP的相互作用，并使用BRINDA回归残余法校正铁蛋白的炎症。因果中介分析将BMI对血红蛋白的总影响分为间接影响（由CRP介导）和直接影响。二级模型检查贫血(Hb结果：血红蛋白在较低BMI范围内急剧增加，但在30 kg/m2以上趋于稳定（p非线性0）；ADE结论：BMI与血红蛋白以非线性、crp依赖的方式正相关。炎症显著抑制过度肥胖的血液学益处，而炎症调节的铁蛋白起最小的中介作用。这些发现强调了在研究肥胖相关贫血时建模非线性和校正炎症铁生物标志物的重要性。

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引用次数: 0

Plasma Fatty Acid Profiles Modulate PPARγ Expression in Adipose Tissue: A Lipidomic Insight Into Obesity-Related Metabolic Dysregulation 血浆脂肪酸谱调节脂肪组织中PPARγ的表达：脂质组学对肥胖相关代谢失调的洞察。

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism

Pub Date : 2025-09-18 DOI: 10.1002/edm2.70080

Maryam Sanoie, Farshad Teymoori, Raziyeh Abooshahab, Mahdi Akbarzadeh, Golaleh Asghari, Emad Yuzbashian, Mehdi Hedayati, Alireza Khalaj, Maryam Zarkesh

Aim

This study aimed to investigate the relationship between plasma fatty acids (FAs), FA-derived factors and PPARγ expression in visceral and subcutaneous adipose tissues (VAT and SAT) of obese and nonobese adults.

Methods

This cross-sectional study involved 167 adults aged 19 to 65. Samples of VAT and SAT were obtained during elective abdominal surgeries. Participants were divided into two groups: nonobese (BMI < 30 kg/m²) and obese (BMI ≥ 30 kg/m²). Anthropometric and biochemical measurements were taken, and plasma fatty acids (FAs) were analysed using gas chromatography flame ionisation detection (GC/FID). PPARγ mRNA levels were measured through real-time RT-qPCR.

Results

Obese individuals had higher PPARγ gene expression in both VAT and SAT compared to nonobese participants (p < 0.001). Eighteen FFAs and three new FA-derived factors were identified in both groups, accounting for 69% of the variance in nonobese individuals and 71% in obese individuals. After adjusting for confounding factors, saturated FA (SFA) was associated with PPARγ expression in the SAT of the nonobese group (β = −0.12, p = 0.019). Additionally, total FAs (β = −0.02, p = 0.017), SFA (β = −0.06, p = 0.048), monounsaturated FA (MUFA) (β = −0.08, p = 0.020), polyunsaturated FA (PUFA) (β = −0.03, p = 0.039) and omega-6 FA (β = −0.03, p = 0.040) were associated with VAT PPARγ expression among obese individuals. Conversely, an inverse correlation was observed between factor I of FAs and SAT PPARγ expression in nonobese individuals (β = −0.15; p = 0.027).

Conclusion

These findings suggest that alterations in plasma FA profiles are associated with PPARγ gene expression, particularly in obese individuals. This fact highlights the potential role of dietary FAs in metabolic regulation and health issues related to obesity.

目的：本研究旨在探讨肥胖和非肥胖成人血浆脂肪酸（FAs）、fa衍生因子与内脏和皮下脂肪组织（VAT和SAT）中PPARγ表达的关系。方法：这项横断面研究涉及167名年龄在19至65岁之间的成年人。在选择性腹部手术中获得VAT和SAT样本。参与者被分为两组：非肥胖（BMI 2）和肥胖（BMI≥30 kg/m2）。进行了人体测量和生化测量，并使用气相色谱火焰电离检测（GC/FID）分析了血浆脂肪酸（FAs）。通过实时RT-qPCR检测PPARγ mRNA水平。结果：与非肥胖参与者相比，肥胖个体在VAT和SAT中都有更高的PPARγ基因表达(p结论：这些发现表明血浆FA谱的改变与PPARγ基因表达有关，特别是在肥胖个体中。这一事实强调了膳食FAs在代谢调节和与肥胖相关的健康问题中的潜在作用。

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引用次数: 0

Erectile Dysfunction in Diabetes Mellitus: A Comprehensive Narrative Review of Pathophysiology, Genetic Association Studies and Therapeutic Approaches 糖尿病的勃起功能障碍：病理生理学、遗传关联研究和治疗方法的综合综述。

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism

Pub Date : 2025-09-17 DOI: 10.1002/edm2.70099

Boštjan Hostnik, Gašper Tonin, Andrej Janež, Jasna Klen

<div> <section> <h3> Introduction</h3> <p>Erectile dysfunction (ED) is a highly prevalent complication of diabetes mellitus (DM), significantly impairing quality of life and psychosocial well-being. The prevalence of ED is estimated to be over 3.5 times higher in men with diabetes mellitus compared to those without. The aetiology of diabetic ED is multifactorial, stemming from complex diabetes mellitus-related systemic changes. The pathophysiology of diabetic ED involves interacting pathways, including endothelial dysfunction, accelerated atherosclerosis, autonomic and peripheral neuropathy, structural penile changes, hormonal imbalances, and psychological factors.</p> </section> <section> <h3> Methods</h3> <p>A review of the literature was conducted to examine the pathophysiological mechanisms, genetic associations, and treatment modalities related to diabetic ED. Particular attention was given to studies exploring pharmacogenetics and emerging therapeutic interventions.</p> </section> <section> <h3> Results</h3> <p>Management is multimodal, including lifestyle changes, counselling, and pharmacological agents (primarily phosphodiesterase type 5 inhibitors (PDE5Is)), but treatment response varies. Genetic studies have identified associations between ED risk/severity and polymorphisms in several candidate genes, including <i>NOS3</i> (G894T, T786C, VNTR), <i>ARG1/ARG2</i> (influencing nitric oxide substrate availability), ACE (I/D polymorphism), <i>AR</i> (CAG repeat length affecting androgen sensitivity), and <i>VEGF</i> (promoter polymorphisms). Pharmacogenetic studies suggest that polymorphisms in <i>NOS3</i>, <i>AR</i>, and <i>VEGF</i> may predict response to PDE5Is or testosterone therapy, while <i>ARG1/ARG2</i> variations might guide future arginase-targeted therapies. Emerging treatments like low-intensity shockwave therapy, platelet-rich plasma, gene therapy, and stem cell therapy show promise but require more robust evidence.</p> </section> <section> <h3> Conclusions</h3> <p>Diabetic ED is a complex condition driven by multiple pathophysiological mechanisms often influenced by an underlying genetic predisposition. Understanding the interplay between pathophysiology and genetics is crucial for developing personalised treatment strategies. While current therapies offer benefits, variability in response highlights the need for tailored approaches. Further research, especially large-scale pharmacogenetic studies and randomised controlled trials for emerging therapies, is essential to identify reliable biomarkers, optimise treatment selection, a

勃起功能障碍（ED）是糖尿病（DM）的一种非常普遍的并发症，严重影响生活质量和社会心理健康。据估计，男性糖尿病患者的ED患病率是非糖尿病患者的3.5倍。糖尿病性ED的病因是多因素的，源于复杂的糖尿病相关的全身改变。糖尿病性ED的病理生理涉及相互作用的途径，包括内皮功能障碍、动脉粥样硬化加速、自主神经和周围神经病变、阴茎结构改变、激素失衡和心理因素。方法：回顾文献，探讨与糖尿病性ED相关的病理生理机制、遗传关联和治疗方式。特别关注药物遗传学和新兴治疗干预措施的研究。结果：治疗是多模式的，包括改变生活方式、咨询和药物（主要是磷酸二酯酶5型抑制剂（PDE5Is）），但治疗反应各不相同。遗传学研究已经确定了ED风险/严重程度与几种候选基因多态性之间的关联，包括NOS3 （G894T、T786C、VNTR）、ARG1/ARG2（影响一氧化氮底物可用性）、ACE （I/D多态性）、AR（影响雄激素敏感性的CAG重复长度）和VEGF（启动子多态性）。药物遗传学研究表明，NOS3、AR和VEGF的多态性可能预测PDE5Is或睾酮治疗的反应，而ARG1/ARG2的变异可能指导未来精氨酸酶靶向治疗。新兴疗法如低强度冲击波疗法、富血小板血浆疗法、基因疗法和干细胞疗法显示出希望，但需要更有力的证据。结论：糖尿病性ED是一种由多种病理生理机制驱动的复杂疾病，通常受潜在遗传易感性的影响。了解病理生理学和遗传学之间的相互作用对于制定个性化治疗策略至关重要。虽然目前的治疗方法提供了好处，但反应的可变性突出了定制方法的必要性。进一步的研究，特别是针对新兴疗法的大规模药物遗传学研究和随机对照试验，对于确定可靠的生物标志物、优化治疗选择和改善男性糖尿病性ED的预后至关重要。

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引用次数: 0

Intentional Weight Loss and Associated Cancer Incidence Among People With Overweight or Obesity: A Systematic Literature Review 超重或肥胖人群有意减肥和相关癌症发病率：系统文献综述

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism

Pub Date : 2025-09-13 DOI: 10.1002/edm2.70104

Chi-Yin Liao, David Schapiro, Donna Mojdami, Kristin M. Sheffield, Meredith M. Hoog, Raghuvir Keni, Wambui Grace Gathirua-Mwangi, Hong Kan

Aims

While obesity is linked to increased cancer risk, evidence on the impact of intentional weight loss on obesity-associated cancers (OACs) is limited. A systematic literature review (SLR) was conducted to assess the association between intentional weight loss and cancer incidence, including overall cancers and 13 OACs, from recent observational studies and clinical trials.

Methods

Studies published between January 2019 and May 2023 were searched within MEDLINE, EMBASE, and CENTRAL. Studies assessing the relationship between intentional weight loss, defined as weight reduction via metabolic-bariatric surgery (MBS) or lifestyle interventions, and cancer incidence were included. A dual independent review process was used to screen 1954 abstracts and 84 full-text articles, and to extract data from 18 full studies. All discrepancies were resolved by another reviewer.

Results

Of the 18 studies included, 17 studies were observational, focusing on MBS as the method for achieving weight reduction. One randomised controlled trial examined the effect of intensive lifestyle intervention on weight reduction and found no significant association between intentional weight loss and cancer risk. Intentional weight loss was associated with decreased cancer incidence in 71.4% (n = 5/7) of studies for all cancers and 66.7% (n = 4/6) of studies for OACs, with reported risk reductions of 11% to 33% and 11% to 41%, respectively. For specific OACs, a greater number of studies indicated that weight reduction was associated with reduced occurrence of endometrial (4/4, 100%, 31%–53% risk reduction), female breast (5/9, 55.6%, 19%–50% risk reduction) and colorectal (4/7, 57.1%, 20%–60% risk reduction) cancers.

Conclusions

This SLR highlights the potential cancer risk-reduction benefit of weight reduction for people with obesity.

虽然肥胖与癌症风险增加有关，但有意减肥对肥胖相关癌症（OACs）影响的证据有限。我们进行了一项系统的文献综述（SLR），从最近的观察性研究和临床试验中评估有意减肥与癌症发病率之间的关系，包括总体癌症和13种OACs。方法在MEDLINE、EMBASE和CENTRAL中检索2019年1月至2023年5月发表的研究。评估有意减肥（定义为通过代谢减肥手术（MBS）或生活方式干预来减轻体重）与癌症发病率之间关系的研究被纳入其中。采用双重独立审查程序筛选1954篇摘要和84篇全文文章，并从18篇完整研究中提取数据。所有差异均由另一位审稿人解决。结果纳入的18项研究中，17项研究为观察性研究，重点关注MBS作为实现减肥的方法。一项随机对照试验检查了强化生活方式干预对减肥的影响，发现有意减肥与癌症风险之间没有显著关联。在所有癌症的研究中，71.4% （n = 5/7）和66.7% （n = 4/6）的OACs研究中，有意减肥与癌症发病率降低相关，报告的风险分别降低11%至33%和11%至41%。对于特定的oac，更多的研究表明，体重减轻与子宫内膜癌（4/ 4,100%，31%-53%风险降低）、女性乳腺癌（5/ 9,55.6%，19%-50%风险降低）和结直肠癌（4/ 7,57.1%，20%-60%风险降低）的发生率降低相关。结论：该单反研究强调了肥胖人群通过减肥降低癌症风险的潜在益处。

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引用次数: 0