The present study aimed to show the pooled effect of a low-carbohydrate high-protein diet (LCHPD) as a practical dietary approach on metabolic factors and anthropometric variables.
Methods and materials
A systematic search based on related keywords was performed from electronic databases, including PubMed, Scopus, Web of Science, and Google Scholar from inception until November 2024. The quality of the articles was evaluated using the Cochrane tool. Statistical analysis was conducted using STATA software.
Results
Sixteen articles were entered into the quantitative analysis. In total, 2915 participants (treatment: 1490 and control: 1425) entered the statistical analysis. Based on the statistical analysis LCHPD had desirable effects on the weight (SMD = −0.27; 95 % CI: −0.35, −0.19), systolic blood pressure (SBP) (SMD = −0.23; 95 % CI: −0.31, −0.25) diastolic blood pressure (DBP) (SMD = −0.12; 95 % CI: −0.21, −0.04), fasting blood sugar (FBG) (SMD = −0.34; 95 % CI: −0.43, −0.24), triglyceride (TG) (SMD = −0.29; 95 % CI: −0.38, −0.19), leptin (SMD = −0.57; 95 % CI: −0.68, −0.46), and, CRP (SMD = −0.38; 95 % CI: −0.49, −0.27), while it impressively increase serum level of total cholesterol (SMD = 0.36; 95 % CI: 0.26, 0.45), adiponectin (SMD = 0.40; 95 % CI: 0.29, 0.52), resistin, and (SMD = 1.08; 95 % CI: 0.96, 1.20). In addition, subgroup analysis was conducted based on the age of participants, duration of treatment, and type of disease.
Conclusion
Overall findings of the present study exhibited that LCHPD had a significant effect on the anthropometric indices, blood pressure, and metabolic factors.
{"title":"The effects of low carbohydrate and high protein diet on the anthropometric indices, blood pressure, metabolic factors, and hormones related to metabolism: A systematic review and meta-analysis","authors":"Marziyeh Najafi , Zahra Hariri , Omid Nikpayam , Amir Hossein Sarvi , Mohammadjavad Pasand , Pardis Noura , Farzad Farajian Nejad","doi":"10.1016/j.dsx.2025.103352","DOIUrl":"10.1016/j.dsx.2025.103352","url":null,"abstract":"<div><h3>Background and aims</h3><div>The present study aimed to show the pooled effect of a low-carbohydrate high-protein diet (LCHPD) as a practical dietary approach on metabolic factors and anthropometric variables.</div></div><div><h3>Methods and materials</h3><div>A systematic search based on related keywords was performed from electronic databases, including PubMed, Scopus, Web of Science, and Google Scholar from inception until November 2024. The quality of the articles was evaluated using the Cochrane tool. Statistical analysis was conducted using STATA software.</div></div><div><h3>Results</h3><div>Sixteen articles were entered into the quantitative analysis. In total, 2915 participants (treatment: 1490 and control: 1425) entered the statistical analysis. Based on the statistical analysis LCHPD had desirable effects on the weight (SMD = −0.27; 95 % CI: −0.35, −0.19), systolic blood pressure (SBP) (SMD = −0.23; 95 % CI: −0.31, −0.25) diastolic blood pressure (DBP) (SMD = −0.12; 95 % CI: −0.21, −0.04), fasting blood sugar (FBG) (SMD = −0.34; 95 % CI: −0.43, −0.24), triglyceride (TG) (SMD = −0.29; 95 % CI: −0.38, −0.19), leptin (SMD = −0.57; 95 % CI: −0.68, −0.46), and, CRP (SMD = −0.38; 95 % CI: −0.49, −0.27), while it impressively increase serum level of total cholesterol (SMD = 0.36; 95 % CI: 0.26, 0.45), adiponectin (SMD = 0.40; 95 % CI: 0.29, 0.52), resistin, and (SMD = 1.08; 95 % CI: 0.96, 1.20). In addition, subgroup analysis was conducted based on the age of participants, duration of treatment, and type of disease.</div></div><div><h3>Conclusion</h3><div>Overall findings of the present study exhibited that LCHPD had a significant effect on the anthropometric indices, blood pressure, and metabolic factors.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 12","pages":"Article 103352"},"PeriodicalIF":3.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.dsx.2025.103355
Maryame Ben Lafqih , Faiçal Ait Lahbib , Kaltoum Boutahar , Hanane Azargui , Rachid Elfatimy , Imane Motaib
Aims
This study assessed the performance of ChatGPT and Gemini in delivering evidence-based, personalized dietary recommendations for diabetes management.
Methods
Fifty-two simulated patient cases covering nine diabetes-related categories were analyzed. We evaluated nutritional recommendations from ChatGPT and Gemini using the Analytic Hierarchy Process (AHP), focusing on clinical relevance, alignment with guidelines, personalization, and practicality. Chatbot performance was compared both overall and across diabetes categories.
Results
Gemini (version 1.5 Flash) significantly outperformed ChatGPT (GPT-4) in overall AHP scores (Gemini: 4.34 (IQR 3.85–4.56), ChatGPT: 3.79 (IQR 3.28–4.30), p < 0.001). Gemini performed better in complex cases, particularly chronic kidney disease cases (p = 0.047) and malnutrition or post-bariatric surgery (p = 0.003). No significant differences were observed in other categories (p > 0.05).
Conclusions
Gemini outperformed ChatGPT, showing higher guideline alignment. These findings support refining AI tools for reliable, personalized nutrition in diabetes care.
{"title":"Assessing the quality and guideline-concordance of AI-powered chatbots in nutritional management of diabetes","authors":"Maryame Ben Lafqih , Faiçal Ait Lahbib , Kaltoum Boutahar , Hanane Azargui , Rachid Elfatimy , Imane Motaib","doi":"10.1016/j.dsx.2025.103355","DOIUrl":"10.1016/j.dsx.2025.103355","url":null,"abstract":"<div><h3>Aims</h3><div>This study assessed the performance of ChatGPT and Gemini in delivering evidence-based, personalized dietary recommendations for diabetes management.</div></div><div><h3>Methods</h3><div>Fifty-two simulated patient cases covering nine diabetes-related categories were analyzed. We evaluated nutritional recommendations from ChatGPT and Gemini using the Analytic Hierarchy Process (AHP), focusing on clinical relevance, alignment with guidelines, personalization, and practicality. Chatbot performance was compared both overall and across diabetes categories.</div></div><div><h3>Results</h3><div>Gemini (version 1.5 Flash) significantly outperformed ChatGPT (GPT-4) in overall AHP scores (Gemini: 4.34 (IQR 3.85–4.56), ChatGPT: 3.79 (IQR 3.28–4.30), <em>p</em> < 0.001). Gemini performed better in complex cases, particularly chronic kidney disease cases (<em>p</em> = 0.047) and malnutrition or post-bariatric surgery (<em>p</em> = 0.003). No significant differences were observed in other categories (<em>p</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>Gemini outperformed ChatGPT, showing higher guideline alignment. These findings support refining AI tools for reliable, personalized nutrition in diabetes care.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 12","pages":"Article 103355"},"PeriodicalIF":3.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.dsx.2025.103330
Meng Chen, Lan Xu, Victor W. Zhong
{"title":"Authors’ Reply to Letter to the Editor by Emily N.C. Manoogian et al","authors":"Meng Chen, Lan Xu, Victor W. Zhong","doi":"10.1016/j.dsx.2025.103330","DOIUrl":"10.1016/j.dsx.2025.103330","url":null,"abstract":"","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 12","pages":"Article 103330"},"PeriodicalIF":3.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Use of non-nutritive sweeteners (NNS) is widespread in foods and beverages and are believed to have little to no impact on glucose metabolism. Nonetheless, recent studies have shown sucralose may not be as innocuous as previously thought. This review was conducted to summarize the evidence available on the impact of sucralose on insulin response and sensitivity.
Methods
Evidence on sucralose was searched in MEDLINE and Google scholar databases using search strings that incorporated synonyms of sucralose, insulin, response and sensitivity.
Results
Of the 16 studies that reported impact of sucralose on insulin response, 8 found an increased insulin response following ingestion of sucralose, 7 did not find any impact and 1 found a favorable impact. Of the 8 studies describing the effect of sucralose on insulin sensitivity, 6 reported a decrease, 1 found an increase and the remaining one found no change.
Conclusion
Intervention studies report inconsistent effects of sucralose, with approximately half suggesting adverse impacts on insulin response and sensitivity. A meta-analysis is warranted to quantitatively synthesize the effects of sucralose exposure on insulin metabolism.
{"title":"Association of sucralose consumption with insulin response and sensitivity","authors":"Shada Kodumayil , Ahmed Gebril , Soumya Nair , Insiya Saifudeen , Abrar Alhermi , Najla Shamsi , Naji Alamuddin , Nitya Kumar","doi":"10.1016/j.dsx.2025.103343","DOIUrl":"10.1016/j.dsx.2025.103343","url":null,"abstract":"<div><h3>Background and aim</h3><div>Use of non-nutritive sweeteners (NNS) is widespread in foods and beverages and are believed to have little to no impact on glucose metabolism. Nonetheless, recent studies have shown sucralose may not be as innocuous as previously thought. This review was conducted to summarize the evidence available on the impact of sucralose on insulin response and sensitivity.</div></div><div><h3>Methods</h3><div>Evidence on sucralose was searched in MEDLINE and Google scholar databases using search strings that incorporated synonyms of sucralose, insulin, response and sensitivity.</div></div><div><h3>Results</h3><div>Of the 16 studies that reported impact of sucralose on insulin response, 8 found an increased insulin response following ingestion of sucralose, 7 did not find any impact and 1 found a favorable impact. Of the 8 studies describing the effect of sucralose on insulin sensitivity, 6 reported a decrease, 1 found an increase and the remaining one found no change.</div></div><div><h3>Conclusion</h3><div>Intervention studies report inconsistent effects of sucralose, with approximately half suggesting adverse impacts on insulin response and sensitivity. A meta-analysis is warranted to quantitatively synthesize the effects of sucralose exposure on insulin metabolism.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 12","pages":"Article 103343"},"PeriodicalIF":3.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.dsx.2025.103353
Walter Gaston Espeche , Gustavo Cerri , Julian Minetto , Ezequiel Giordani , Mariano Costa , Sofia Pacho Calvo , Jose Esteba Costa Gil , Martin Salazar
Objective
To determine the prevalence of isolated nocturnal hypertension (INH) in patients with type 2 diabetes (T2D), and secondarily, to assess its frequency in those with normal office blood pressure and not receiving antihypertensive treatment.
Methods
This was a cross-sectional study including patients aged ≥18 years with T2D who underwent 24-h ambulatory blood pressure monitoring (ABPM) between January 2022 and December 2024. INH was defined as mean nocturnal BP ≥ 120/70 mmHg with normal daytime BP (<135/85 mmHg). Office BP was classified into four categories according to European guidelines. Target organ damage (TOD) was assessed in a subsample through echocardiography and urinary albumin-to-creatinine ratio.
Results
A total of 439 patients were included (57.6 % women; mean age 56.5 ± 10.4 years). The prevalence of INH was 21.9 % (95 % CI 0.18–0.26). Among individuals with normal office BP and no antihypertensive treatment (n = 57), INH prevalence was 31.6 %, being the most frequent phenotype of masked hypertension. INH was associated with lower HDL-C, higher triglycerides, and greater evidence of subclinical TOD compared to normotensive patients.
Conclusion
INH is highly prevalent in individuals with T2D, especially among those untreated and with normal office BP. Given its association with subclinical TOD and lack of clinical predictors, ABPM should be considered in all T2D patients regardless of office BP values.
目的：了解孤立性夜间高血压（INH）在2型糖尿病（T2D）患者中的患病率，并评估其在正常血压且未接受降压治疗的患者中的发生率。方法：这是一项横断面研究，包括年龄≥18岁的T2D患者，他们在2022年1月至2024年12月接受了24小时动态血压监测（ABPM）。INH定义为平均夜间血压≥120/70 mmHg，日间血压正常(结果：共纳入439例患者（57.6%为女性，平均年龄56.5±10.4岁）。INH患病率为21.9% （95% CI 0.18-0.26）。在办公室血压正常且未接受降压治疗的个体（n = 57）中，INH患病率为31.6%，是隐匿性高血压最常见的表型。与正常血压患者相比，INH与较低的HDL-C、较高的甘油三酯和更大的亚临床TOD证据相关。结论：INH在T2D患者中非常普遍，特别是在未治疗且血压正常的患者中。鉴于ABPM与亚临床TOD的相关性以及缺乏临床预测指标，无论办公室血压值如何，所有T2D患者都应考虑ABPM。
{"title":"Prevalence of isolated nocturnal hypertension among patients with type 2 diabetes mellitus","authors":"Walter Gaston Espeche , Gustavo Cerri , Julian Minetto , Ezequiel Giordani , Mariano Costa , Sofia Pacho Calvo , Jose Esteba Costa Gil , Martin Salazar","doi":"10.1016/j.dsx.2025.103353","DOIUrl":"10.1016/j.dsx.2025.103353","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the prevalence of isolated nocturnal hypertension (INH) in patients with type 2 diabetes (T2D), and secondarily, to assess its frequency in those with normal office blood pressure and not receiving antihypertensive treatment.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study including patients aged ≥18 years with T2D who underwent 24-h ambulatory blood pressure monitoring (ABPM) between January 2022 and December 2024. INH was defined as mean nocturnal BP ≥ 120/70 mmHg with normal daytime BP (<135/85 mmHg). Office BP was classified into four categories according to European guidelines. Target organ damage (TOD) was assessed in a subsample through echocardiography and urinary albumin-to-creatinine ratio.</div></div><div><h3>Results</h3><div>A total of 439 patients were included (57.6 % women; mean age 56.5 ± 10.4 years). The prevalence of INH was 21.9 % (95 % CI 0.18–0.26). Among individuals with normal office BP and no antihypertensive treatment (n = 57), INH prevalence was 31.6 %, being the most frequent phenotype of masked hypertension. INH was associated with lower HDL-C, higher triglycerides, and greater evidence of subclinical TOD compared to normotensive patients.</div></div><div><h3>Conclusion</h3><div>INH is highly prevalent in individuals with T2D, especially among those untreated and with normal office BP. Given its association with subclinical TOD and lack of clinical predictors, ABPM should be considered in all T2D patients regardless of office BP values.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 12","pages":"Article 103353"},"PeriodicalIF":3.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.dsx.2025.103294
Himel Mondal, Anupkumar Dhanvijay
We respond to the article “Modifying the timing of breakfast improves postprandial glycaemia in people with type 2 diabetes: A randomised controlled trial” by Bravo-Garcia et al. While the study introduces an intriguing strategy for postprandial glycemic control, several methodological modification and detailed reporting could be done. Key variables such as participants' sleep-wake timing, daily schedules, and evening routines, which influence glucose metabolism, could be reported. Limited details on medication timing and exercise standardization could be taken care of. Additionally, cultural and socioeconomic factors, particularly in developing countries like India, challenge the practicality of delayed breakfast protocols. The physiological implications of fasting, including the Somogyi effect, warrant further exploration. These highlight the need for more comprehensive studies addressing individual, cultural, and socioeconomic factors to enhance the translational potential of breakfast timing interventions for glycemic control.
{"title":"Delayed breakfast in type 2 diabetes: Critical gaps and translation barriers","authors":"Himel Mondal, Anupkumar Dhanvijay","doi":"10.1016/j.dsx.2025.103294","DOIUrl":"10.1016/j.dsx.2025.103294","url":null,"abstract":"<div><div>We respond to the article “Modifying the timing of breakfast improves postprandial glycaemia in people with type 2 diabetes: A randomised controlled trial” by Bravo-Garcia et al. While the study introduces an intriguing strategy for postprandial glycemic control, several methodological modification and detailed reporting could be done. Key variables such as participants' sleep-wake timing, daily schedules, and evening routines, which influence glucose metabolism, could be reported. Limited details on medication timing and exercise standardization could be taken care of. Additionally, cultural and socioeconomic factors, particularly in developing countries like India, challenge the practicality of delayed breakfast protocols. The physiological implications of fasting, including the Somogyi effect, warrant further exploration. These highlight the need for more comprehensive studies addressing individual, cultural, and socioeconomic factors to enhance the translational potential of breakfast timing interventions for glycemic control.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 11","pages":"Article 103294"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aimed to compare the 1-year efficacy and safety of 7.5 mg versus 15 mg pioglitazone in Asian Indian patients with type 2 diabetes due to lack of long-term data in lower doses.
Methods
In this open-label randomized controlled study, 60 patients were assigned to receive either 7.5 mg or 15 mg of pioglitazone daily. Efficacy endpoints included HbA1c, fasting and postprandial venous glucose. Additionally, lipid profile, liver enzymes, and DXA-based body composition, BMD, weight gain, hemoglobin, and adverse events were performed.
Results
Both doses achieved significant HbA1c reduction from baseline (−0.95 % in 7.5 mg, −0.9 % in 15 mg) and postprandial venous glucose (median absolute difference −50 and −46 mg/dl), with non-inferiority of the lower dose. Weight gain occurred in both groups (0.95 kg vs 1.3 kg), mainly due to increased fat mass, with a trend toward greater and earlier gain in the 15 mg arm. Lipid parameters, hepatic enzymes, and body composition parameters were comparable across arms, while there was significant reduction in SGOT and VLDL within individual groups. No significant differences in hypoglycemia, edema, BMD loss, or fractures were observed. The major limitations of the study were open label design, single tertiary care center setting, imperfect randomization in fasting glucose, LDL, and total cholesterol between groups and missing data in DXA scan at follow up.
Conclusion
Pioglitazone 7.5 mg is an effective and well-tolerated alternative to 15 mg in Asian Indian patients with type 2 diabetes.
Clinical trials registry of india registration number
{"title":"Low dose pioglitazone (7.5 mg) provides efficacious glycemic control in Asian Indian patients with poorly controlled diabetes compared to 15 mg: A pilot randomized controlled parallel-group open-label trial over 12 months","authors":"Rohit Barnabas , Shruti Bhide , Saba Samad Memon , Manjiri Karlekar , Chetan Phirke , Saurabh Patil , Vijayadhaarani Sekar , Vyankatesh Shivane , Anurag Lila , Tushar Bandgar","doi":"10.1016/j.dsx.2025.103335","DOIUrl":"10.1016/j.dsx.2025.103335","url":null,"abstract":"<div><h3>Aims</h3><div>We aimed to compare the 1-year efficacy and safety of 7.5 mg versus 15 mg pioglitazone in Asian Indian patients with type 2 diabetes due to lack of long-term data in lower doses.</div></div><div><h3>Methods</h3><div>In this open-label randomized controlled study, 60 patients were assigned to receive either 7.5 mg or 15 mg of pioglitazone daily. Efficacy endpoints included HbA1c, fasting and postprandial venous glucose. Additionally, lipid profile, liver enzymes, and DXA-based body composition, BMD, weight gain, hemoglobin, and adverse events were performed.</div></div><div><h3>Results</h3><div>Both doses achieved significant HbA1c reduction from baseline (−0.95 % in 7.5 mg, −0.9 % in 15 mg) and postprandial venous glucose (median absolute difference −50 and −46 mg/dl), with non-inferiority of the lower dose. Weight gain occurred in both groups (0.95 kg vs 1.3 kg), mainly due to increased fat mass, with a trend toward greater and earlier gain in the 15 mg arm. Lipid parameters, hepatic enzymes, and body composition parameters were comparable across arms, while there was significant reduction in SGOT and VLDL within individual groups. No significant differences in hypoglycemia, edema, BMD loss, or fractures were observed. The major limitations of the study were open label design, single tertiary care center setting, imperfect randomization in fasting glucose, LDL, and total cholesterol between groups and missing data in DXA scan at follow up.</div></div><div><h3>Conclusion</h3><div>Pioglitazone 7.5 mg is an effective and well-tolerated alternative to 15 mg in Asian Indian patients with type 2 diabetes.</div></div><div><h3>Clinical trials registry of india registration number</h3><div>CTRI/2021/09/036149.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 11","pages":"Article 103335"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sodium-glucose co-transporter-2 inhibitor (SGLT2i) with mineralocorticoid receptor antagonist (MRA) combination therapy (SMCT) hypothetically appears feasible and rational, given their complementary mechanisms of action. This systematic review and meta-analysis (SRM) assessed the effectiveness and safety of SMCT compared to either agent alone in CKD.
Methods
Electronic databases were searched for articles evaluating SMCT in CKD as compared to SGLT2i or MRA alone. The primary outcome was percent-change in urine albumin-to-creatinine ratio (UACR%). Secondary outcomes were changes in glomerular filtration-rate (eGFR), UACR>30 % decline, systolic blood pressure (SBP), potassium, total adverse-events (TAEs), severe adverse-events (SAEs), hypotension and acute kidney injury (AKI).
Results
Data from 8 studies (15,583 adults) having age 53–76 years, BMI 28–33 kg/m2, HbA1c 6–8 % and eGFR 32–73 ml/min/1.73 m2 were analyzed. SMCT was associated with significant reduction in UACR % as compared to MRA [MD-12.83 %(95 %CI: 19.49,-6.17); P < 0.001; I2 = 93 %] or SGLT2i [MD-26.30 % (95 %CI: 31.93,-20.68); P < 0.001; I2 = 60 %]. SMCT users had significantly higher chances of >30 % reduction in UACR compared to MRA [OR6.69(95 %CI:2.00,22.43); P = 0.002; I2 = 80 %] or SGLT2i [OR 4.87(95 %CI:1.71,13.83); P < 0.001; I2 = 86 %. SMCT users had significantly lower SBP compared to MRA [MD-5.89 mm-Hg(95 %CI: 9.74,-2.04); P = 0.003; I2 = 0 %] or SGLT2i [MD-3.49 mm-Hg(95 %CI: 6.64,-0.34); P = 0.03; I2 = 0 %]. SMCT users had similar potassium compared to MRA [MD0.08 mmol/L (95 %CI: 0.34,0.50); P = 0.71; I2 = 92 %] but higher compared to SGLT2i [MD0.18 mmol/L (95 %CI:0.07,0.29); P = 0.002; I2 = 48 %]. SMCT users had TAEs and SAEs similar to MRA, but higher TAEs than SGLT2i. SMCT users had death rates similar to MRA [OR0.33(95 % CI:0.09,1.16); P = 0.08; I2 = 0 %] but higher than SGLT2i [OR2.35(95 %CI:1.25,4.40); P = 0.008; I2 = 0 %]. SMCT had no impact on eGFR compared to MRA [MD-0.30 ml/min/1.73 m2 (95 %CI: 3.11, 2.50); P = 0.83; I2 = 0 %] but lower compared to SGLT2i [MD-2.81 ml/min/1.73 m2(95 %CI: 5.06,-0.56); P = 0.01; I2 = 0 %]. The occurrence of hypotension and AKI were similar among study groups.
Conclusion
SMCT is more effective than MRA or SGLT2i alone in reducing urine protein loss in CKD. SMCT has side-effects profile like MRAs, which is higher than SGLT2i.
{"title":"Impact of sodium-glucose co-transporter-2 inhibitor combined with mineralocorticoid receptor antagonist therapy versus either agent alone in individuals with chronic kidney disease: A systematic review and meta-analysis","authors":"Deep Dutta , A.B.M. Kamrul-Hasan , Sweekruti Jena , Kunal Mahajan , Anoop Misra","doi":"10.1016/j.dsx.2025.103334","DOIUrl":"10.1016/j.dsx.2025.103334","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose co-transporter-2 inhibitor (SGLT2i) with mineralocorticoid receptor antagonist (MRA) combination therapy (SMCT) hypothetically appears feasible and rational, given their complementary mechanisms of action. This systematic review and meta-analysis (SRM) assessed the effectiveness and safety of SMCT compared to either agent alone in CKD.</div></div><div><h3>Methods</h3><div>Electronic databases were searched for articles evaluating SMCT in CKD as compared to SGLT2i or MRA alone. The primary outcome was percent-change in urine albumin-to-creatinine ratio (UACR%). Secondary outcomes were changes in glomerular filtration-rate (eGFR), UACR>30 % decline, systolic blood pressure (SBP), potassium, total adverse-events (TAEs), severe adverse-events (SAEs), hypotension and acute kidney injury (AKI).</div></div><div><h3>Results</h3><div>Data from 8 studies (15,583 adults) having age 53–76 years, BMI 28–33 kg/m<sup>2</sup>, HbA1c 6–8 % and eGFR 32–73 ml/min/1.73 m<sup>2</sup> were analyzed. SMCT was associated with significant reduction in UACR % as compared to MRA [MD-12.83 %(95 %CI: 19.49,-6.17); P < 0.001; I<sup>2</sup> = 93 %] or SGLT2i [MD-26.30 % (95 %CI: 31.93,-20.68); P < 0.001; I<sup>2</sup> = 60 %]. SMCT users had significantly higher chances of >30 % reduction in UACR compared to MRA [OR6.69(95 %CI:2.00,22.43); P = 0.002; I<sup>2</sup> = 80 %] or SGLT2i [OR 4.87(95 %CI:1.71,13.83); P < 0.001; I<sup>2</sup> = 86 %. SMCT users had significantly lower SBP compared to MRA [MD-5.89 mm-Hg(95 %CI: 9.74,-2.04); P = 0.003; I<sup>2</sup> = 0 %] or SGLT2i [MD-3.49 mm-Hg(95 %CI: 6.64,-0.34); P = 0.03; I<sup>2</sup> = 0 %]. SMCT users had similar potassium compared to MRA [MD0.08 mmol/L (95 %CI: 0.34,0.50); P = 0.71; I<sup>2</sup> = 92 %] but higher compared to SGLT2i [MD0.18 mmol/L (95 %CI:0.07,0.29); P = 0.002; I<sup>2</sup> = 48 %]. SMCT users had TAEs and SAEs similar to MRA, but higher TAEs than SGLT2i. SMCT users had death rates similar to MRA [OR0.33(95 % CI:0.09,1.16); P = 0.08; I<sup>2</sup> = 0 %] but higher than SGLT2i [OR2.35(95 %CI:1.25,4.40); P = 0.008; I<sup>2</sup> = 0 %]. SMCT had no impact on eGFR compared to MRA [MD-0.30 ml/min/1.73 m<sup>2</sup> (95 %CI: 3.11, 2.50); P = 0.83; I<sup>2</sup> = 0 %] but lower compared to SGLT2i [MD-2.81 ml/min/1.73 m<sup>2</sup>(95 %CI: 5.06,-0.56); P = 0.01; I<sup>2</sup> = 0 %]. The occurrence of hypotension and AKI were similar among study groups.</div></div><div><h3>Conclusion</h3><div>SMCT is more effective than MRA or SGLT2i alone in reducing urine protein loss in CKD. SMCT has side-effects profile like MRAs, which is higher than SGLT2i.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 11","pages":"Article 103334"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.dsx.2025.103333
Shuai Lin , Ruxin Liu , Guodong Zhong , Peilin Lyu , Li Liu , Bing Zhang , Juan Xu , Yanlin Li
Aim
Diabetic kidney disease is a major cause of chronic and end-stage kidney disease. East Asia, home to one-third of the world's people living with diabetes, is undergoing rapid demographic and metabolic transitions.
Methods
Using Global Burden of Disease 2023 data, we assessed diabetic kidney disease burden in China, Japan, the Republic of Korea, the Democratic People's Republic of Korea, and Mongolia from 1990 to 2023, and projected trends to 2038. We analyzed incidence, prevalence, mortality, and disability-adjusted life years, separated demographic and epidemiologic effects, and applied time-series forecasting.
Results
East Asia showed moderate prevalence but low mortality compared with global levels, with pronounced differences between countries. China showed rising incidence and falling mortality; Japan and Mongolia exhibited ageing-related rebounds; Korea stabilized; and the Democratic People's Republic of Korea remained largely unchanged. Metabolic risks—especially high blood glucose and obesity—were the leading contributors. Ageing was the dominant driver of increases in cases and deaths, partly offset by epidemiologic gains. Forecasts to 2038 indicate persistent heterogeneity.
Conclusions
Diabetic kidney disease in East Asia reflects the shift toward chronic metabolic disease, with rising burden despite improved survival. Strengthening early detection and expanding access to kidney-protective therapy are essential to reduce future impact.
{"title":"Burden and trends of diabetic kidney disease in East Asia, 1990–2038: An analysis of the global burden of disease study 2023","authors":"Shuai Lin , Ruxin Liu , Guodong Zhong , Peilin Lyu , Li Liu , Bing Zhang , Juan Xu , Yanlin Li","doi":"10.1016/j.dsx.2025.103333","DOIUrl":"10.1016/j.dsx.2025.103333","url":null,"abstract":"<div><h3>Aim</h3><div>Diabetic kidney disease is a major cause of chronic and end-stage kidney disease. East Asia, home to one-third of the world's people living with diabetes, is undergoing rapid demographic and metabolic transitions.</div></div><div><h3>Methods</h3><div>Using Global Burden of Disease 2023 data, we assessed diabetic kidney disease burden in China, Japan, the Republic of Korea, the Democratic People's Republic of Korea, and Mongolia from 1990 to 2023, and projected trends to 2038. We analyzed incidence, prevalence, mortality, and disability-adjusted life years, separated demographic and epidemiologic effects, and applied time-series forecasting.</div></div><div><h3>Results</h3><div>East Asia showed moderate prevalence but low mortality compared with global levels, with pronounced differences between countries. China showed rising incidence and falling mortality; Japan and Mongolia exhibited ageing-related rebounds; Korea stabilized; and the Democratic People's Republic of Korea remained largely unchanged. Metabolic risks—especially high blood glucose and obesity—were the leading contributors. Ageing was the dominant driver of increases in cases and deaths, partly offset by epidemiologic gains. Forecasts to 2038 indicate persistent heterogeneity.</div></div><div><h3>Conclusions</h3><div>Diabetic kidney disease in East Asia reflects the shift toward chronic metabolic disease, with rising burden despite improved survival. Strengthening early detection and expanding access to kidney-protective therapy are essential to reduce future impact.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 11","pages":"Article 103333"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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