Diabetes & Metabolic Syndrome-Clinical Research & Reviews最新文献_第10页

Prevalence of diabetes and disability among older adults in West Bengal and India: A comparative analysis 西孟加拉邦和印度老年人糖尿病和残疾患病率的比较分析

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2025-04-01 Epub Date: 2025-04-29 DOI: 10.1016/j.dsx.2025.103236

Ujjwal Das , Nishamani Kar , Tomo Riba , Nihar Ranjan Rout

Background

Aging is a heterogeneous process, and older adults are at greater risk of experiencing physical and functional health challenges. This study examines the comparative prevalence of diabetes-related disability among older adults in West Bengal and India.

Methods

Data were drawn from the first wave of the Longitudinal Aging Study in India (2017–18), comprising 72,250 individuals aged 45 years and above, including 3933 respondents from West Bengal. A multistage stratified sampling method was used. Functional disability was assessed using six Activities of Daily Living (ADL) and seven Instrumental Activities of Daily Living (IADL). Logistic regression was used to assess the association between diabetes and disability, and the Blinder–Oaxaca decomposition technique was applied to identify the contribution of various factors to the observed differences.

Results

The prevalence of ADL and IADL difficulties among older adults with diabetes was 24.1 % in West Bengal and 18.9 % at the national level. The risk of disability among diabetic elderly was significantly higher in West Bengal [OR = 6.20 (3.74–10.26) for ADL; OR = 6.71 (4.69–9.61) for IADL] compared to India [OR = 3.92 (1.10–14.03) for ADL; OR = 3.91 (1.17–13.12) for IADL]. Decomposition analysis showed that comorbidity factors accounted for 37 % of the ADL/IADL disability gap between West Bengal and India.

Conclusion

Nearly one-fourth of older adults with diabetes in West Bengal experience ADL limitations. There is urgent need to enhance healthcare services for individuals in West Bengal who are face higher levels of diabetes and disability.

老龄化是一个异质性的过程，老年人经历身体和功能健康挑战的风险更大。本研究考察了西孟加拉邦和印度老年人中糖尿病相关残疾的比较患病率。方法数据来自印度纵向老龄化研究（2017-18）的第一波，包括72,250名45岁及以上的个体，其中包括来自西孟加拉邦的3933名受访者。采用多阶段分层抽样方法。采用6项日常生活活动（ADL）和7项日常生活工具活动（IADL）评估功能障碍。采用Logistic回归评估糖尿病与残疾之间的相关性，并采用Blinder-Oaxaca分解技术确定各因素对观察到的差异的贡献。结果西孟加拉邦老年糖尿病患者ADL和IADL困难患病率为24.1%，全国为18.9%。西孟加拉邦老年糖尿病患者致残风险明显较高[OR = 6.20 (3.74-10.26)；与印度的ADL相比，印度的ADL OR = 6.71 (4.69-9.61) [OR = 3.92 (1.10-14.03)；OR = 3.91（1.17-13.12）。分解分析表明，共病因素占西孟加拉邦和印度之间ADL/IADL残疾差距的37%。结论西孟加拉邦近四分之一的老年糖尿病患者存在ADL限制。在西孟加拉邦，迫切需要加强对糖尿病和残疾水平较高的个人的保健服务。

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引用次数: 0

Highlights of the current issue 本期要点

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2025-03-01 Epub Date: 2025-04-22 DOI: 10.1016/j.dsx.2025.103229

Ningjian Wang , Anoop Misra

引用次数: 0

Collaborative innovations in diabetes self-care for individuals with type 2 diabetes and schizophrenia: A Participatory Design study developing a diagnosis-specific educational manual 2型糖尿病和精神分裂症患者糖尿病自我护理的协作创新：一项开发诊断特定教育手册的参与式设计研究

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2025-03-01 Epub Date: 2025-03-17 DOI: 10.1016/j.dsx.2025.103220

Tanja Juhl Mikkelsen , Dorte Moeller Jensen , Elsebeth Stenager , Mette Juel Rothmann

Background and aims

Individuals with schizophrenia are at high risk of developing type 2 diabetes. This study aimed to develop a tailored solution to address their complex diabetes care needs, based on insights from patients and healthcare professionals, to enhance self-care.

Methods

Using a Participatory Design approach, we conducted three workshops and an evaluation, which included focus groups, interviews, and written feedback. Patients, healthcare professionals, and stakeholders actively participated in all stages of the process between May 2022 and December 2023. Iterative processes ensured comprehensive input in idea generation and concept development. Data analysis followed the steps of planning, acting, observing, and reflecting. The study is reported using SRQR framework.

Results

Participants highlighted challenges such as navigating a fragmented healthcare system, undertreatment, and stigma. In response, a tailored educational manual for voluntary mentors was developed. This two-day training program equips mentors to support individuals with type 2 diabetes and schizophrenia, fostering collaboration and bridging the gap between psychiatric and somatic care.

Conclusions

A co-designed approach may enhance diabetes self-care and improve coordination between healthcare sectors.

背景和目的精神分裂症患者发展为2型糖尿病的风险较高。本研究旨在根据患者和医疗保健专业人员的见解，开发一种量身定制的解决方案，以满足他们复杂的糖尿病护理需求，以增强自我保健。方法采用参与式设计方法，我们进行了三次研讨会和一次评估，包括焦点小组、访谈和书面反馈。2022年5月至2023年12月期间，患者、医疗保健专业人员和利益相关者积极参与了该过程的各个阶段。迭代过程确保了在想法产生和概念发展方面的全面投入。数据分析遵循计划、行动、观察、反思的步骤。本研究采用SRQR框架进行报道。结果参与者强调了面临的挑战，如分散的医疗保健系统，治疗不足和耻辱。为此，编写了一份适合志愿导师的教育手册。这个为期两天的培训项目为指导人员提供帮助，帮助患有2型糖尿病和精神分裂症的患者，促进合作，弥合精神科和躯体护理之间的差距。结论联合设计的方法可提高糖尿病患者的自我护理水平，改善医疗保健部门之间的协作。

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引用次数: 0

Genetic variation in targets of antihyperglycemic drugs and inflammatory bowel disease’ risk: A mendelian randomization study 抗高血糖药物靶点的遗传变异与炎症性肠病的风险：一项孟德尔随机研究

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2025-03-01 Epub Date: 2025-02-22 DOI: 10.1016/j.dsx.2025.103204

Jiaxi Zhao , Rong Chen , Mengqi Luo , Quanjing Zhu , Qian Zhao

Aim

Antihyperglycemic drugs have potential therapeutic benefits for inflammatory bowel disease (IBD). We aimed to investigate the association between genetic variations in gene-targeted antihyperglycemic drugs and the risk of IBD.

Methods

Summary statistics for HbA1c data were from the UK Biobank including 344,182 participants. Statistics of IBD were obtained from UK Inflammatory Bowel Disease Genetics. Two Mendelian randomization methods were employed to derive the main findings.

Results

In the SMR analysis, increased expression of genetic variations in SGLT2 inhibitor targets (gene: SLC5A2) was linked to a higher risk of CD (OR: 1.97, P = 0.048). Genetic variation in brain cerebellum tissue of sulfonylurea targets (gene: ABCC8) expression was positively associated with IBD (OR = 1.11, P = 0.000). The genetic variation in the GLP-1RA targets (gene: GLP1R) expression was positively correlated with IBD (OR: 1.45, P = 0.039). The IVW-MR analysis suggested reduced IBD and CD risk with expression of increased genetic variation in the thiazolidinediones targets (gene: PPARG).

Conclusion

Genetic variations in SGLT2 inhibitor targets might be associated with an increased risk of CD. The ABCC8 gene might be linked to IBD, CD, and UC. There might be a positive correlation between genetic variation in the GLP-1RA targets expression and IBD occurrence.

目的降血糖药物对炎症性肠病（IBD）具有潜在的治疗效果。我们的目的是研究基因靶向降糖药物的遗传变异与IBD风险之间的关系。方法HbA1c数据汇总统计来自UK Biobank，包括344,182名参与者。IBD的统计数据来自英国炎症性肠病遗传学。采用两种孟德尔随机化方法得出主要研究结果。结果在SMR分析中，SGLT2抑制剂靶点（基因：SLC5A2）基因变异的表达增加与更高的CD风险相关（OR: 1.97, P = 0.048）。磺酰脲靶基因ABCC8在脑小脑组织中的表达与IBD呈正相关（OR = 1.11, P = 0.000）。GLP-1RA靶点（基因：GLP1R）表达的遗传变异与IBD呈正相关（OR: 1.45, P = 0.039）。IVW-MR分析表明，噻唑烷二酮靶基因（基因：PPARG）的遗传变异表达增加，IBD和CD风险降低。结论SGLT2抑制剂靶点的遗传变异可能与CD风险增加有关，ABCC8基因可能与IBD、CD和UC有关。GLP-1RA靶点表达的遗传变异可能与IBD的发生呈正相关。

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引用次数: 0

Consensus guidelines for the diagnosis and management of metabolic dysfunction-associated steatotic liver disease in adult Asian Indians with type 2 diabetes 成年亚洲印度2型糖尿病患者代谢功能障碍相关脂肪变性肝病诊断和治疗的共识指南

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2025-03-01 Epub Date: 2025-03-05 DOI: 10.1016/j.dsx.2025.103209

Anoop Misra , Ashish Kumar , Mohammad Shafi Kuchay , Amerta Ghosh , Seema Gulati , Narendra Singh Choudhary , Deep Dutta , Praveen Sharma , Naval K. Vikram

引用次数: 0

Maternal serum folate status during early pregnancy: Sex-specific association with neonatal adiposity 妊娠早期母体血清叶酸状态：与新生儿肥胖的性别特异性关联

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2025-03-01 Epub Date: 2025-04-01 DOI: 10.1016/j.dsx.2025.103222

Nishanthi Periyathambi , Nithya Sukumar , Yonas Ghebremichael-Weldeselassie , Antonysunil Adaikalakoteswari , Chittaranjan Yajnik , Caroline Fall , Ponnusamy Saravanan

Background & aims

Early pregnancy folate has been associated with GDM and possible adiposity in the newborn. The present study examined associations between maternal early pregnancy folate levels and sex-specific neonatal anthropometry. We further explored possible mediation by maternal glycemia on the association between folate and neonatal adiposity.

Methods

Sub-group data (n = 511) from a UK multi-ethnic early pregnancy longitudinal study (micronutrients in Pregnancy as a Risk factor for gestational Diabetes and Effects on mother and baby; PRiDE) was used. Maternal serum folate was assessed during early pregnancy (Mean ± SD = 12.5 ± 1.6 gestational weeks) and infant anthropometry including skinfold thickness (SFT) and mid-upper arm circumference (MUAC) at birth. Multiple linear regression was performed to analyse the relationship between maternal folate and infant adiposity indices. Interaction analysis was used to identify maternal glucose mediation of this relationship.

Results

Excess folate levels (≥45 nmol/l) were found in 40.3 % pregnant women (n = 206). Early pregnancy folate (1 SD unit) was positively associated with male newborn triceps SFT (std β = 0.17 (95 % CI: 0.06, 0.29; p < 0.05)) after adjusting for key maternal and infant confounders in multiple comparisons using Benjamini-Hochberg procedure. However, no associations were seen in female newborns. No influence of maternal fasting (FPG) and 2-h plasma glucose (2 h-PG) were detected on the association between folate and newborn anthropometry.

Conclusion

Our findings suggest a potential sex-specific influence of maternal folate on infant anthropometric indices. The association between early pregnancy folate on newborn adiposity was not mediated by maternal FPG and/or 2 h-PG at 24–28 weeks.

背景,目的妊娠早期叶酸与GDM和新生儿可能的肥胖有关。本研究调查了孕妇妊娠早期叶酸水平与新生儿性别特异性人体测量之间的关系。我们进一步探讨了母体血糖在叶酸和新生儿肥胖之间可能的中介作用。方法：来自英国多民族妊娠早期纵向研究的亚组数据（n = 511）(孕期微量营养素作为妊娠期糖尿病的危险因素及其对母婴的影响；骄傲)被使用。在妊娠早期（Mean±SD = 12.5±1.6孕周）评估孕妇血清叶酸，并在婴儿出生时进行人体测量，包括皮褶厚度（SFT）和中上臂围（MUAC）。采用多元线性回归分析母体叶酸与婴儿肥胖指数之间的关系。相互作用分析用于确定母体葡萄糖介导这种关系。结果40.3%（206例）孕妇叶酸水平≥45 nmol/l。妊娠早期叶酸（1 SD单位）与男婴三头肌SFT呈正相关(std β = 0.17 (95% CI: 0.06, 0.29；p & lt;0.05))，在使用Benjamini-Hochberg程序调整多重比较中的关键母婴混杂因素后。然而，在女性新生儿中没有发现关联。母体空腹（FPG）和2小时血浆葡萄糖（2 h-PG）未检测到叶酸与新生儿人体测量的关系。结论母体叶酸对婴儿人体测量指标有潜在的性别特异性影响。孕早期叶酸与新生儿肥胖之间的关系不受母体FPG和/或24-28周时2 h-PG的介导。

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引用次数: 0

Comparative efficacy and safety of semaglutide 2.4 mg and tirzepatide 5–15 mg in obesity with or without type 2 diabetes: A systematic review of Phase 3 clinical trials 西马鲁肽2.4 mg和替西帕肽5-15 mg治疗伴有或不伴有2型糖尿病的肥胖的比较疗效和安全性：一项3期临床试验的系统综述

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2025-03-01 Epub Date: 2025-03-08 DOI: 10.1016/j.dsx.2025.103212

Akriti Singh , Awadhesh Kumar Singh , Ritu Singh , Anoop Misra

Background and aims

Both semaglutide 2.4 mg and tirzepatide have been recently approved for chronic use in obesity. There is a lack of literature comparing the efficacy and safety of both these agents in people with obesity/overweight with or without type 2 diabetes (T2D). We systematically reviewed Phase 3 randomized controlled trials (RCTs) conducted with two agents to synthesize the comparative efficacy and safety outcomes.

Methods

We systematically searched PubMed electronic databases until December 15, 2024, using selected keywords and Boolean “AND.” Subsequently, we compared the most closely matched trials conducted with semaglutide 2.4 mg and tirzepatide through an adjusted (if baseline imbalance in treatment outcome modifiers present) or unadjusted (in the absence of baseline imbalance) indirect treatment comparison method.

Results

We identified one trial each of semaglutide 2.4 mg (STEP-1) and tirzepatide 5, 10, and 15 mg (SURMOUNT-1) in obese or overweight people without T2D and one trial each of semaglutide 2.4 mg (STEP-2) and tirzepatide 10 and 15 mg (SURMOUNT-2) in overweight people with T2D that were almost entirely comparable concerning baseline outcome modifier characteristics. Our unadjusted analysis without individual patients' data found relatively higher (4 and 5.4 % additional) weight loss, HbA1c (−0.4 % additional) reduction, and fewer gastrointestinal side effects (GI S/E) with tirzepatide 10 and 15 mg, respectively, than with semaglutide 2.4 mg, in the intention-to-treat analysis.

Conclusion

Tirzepatide 10 and 15 mg are more effective and have fewer GI S/E than semaglutide 2.4 mg. A well-powered head-to-head RCT is currently needed to confirm these findings.

背景和目的：西马鲁肽2.4 mg和替西帕肽最近都被批准用于肥胖症的慢性治疗。目前缺乏文献比较这两种药物对伴有或不伴有2型糖尿病（T2D）的肥胖/超重患者的疗效和安全性。我们系统地回顾了两种药物进行的3期随机对照试验（rct），以综合比较疗效和安全性结果。方法系统检索PubMed电子数据库，检索时间截止到2024年12月15日。随后，我们通过调整（如果治疗结果调节因子存在基线不平衡）或未调整（在没有基线不平衡的情况下）间接治疗比较方法，比较了使用semaglutide 2.4 mg和tizepatide进行的最密切匹配的试验。结果：我们确定了在肥胖或超重无T2D患者中分别使用塞马鲁肽2.4 mg （STEP-1）和替西肽5、10和15 mg （SURMOUNT-1）的一项试验，以及在超重合并T2D患者中分别使用塞马鲁肽2.4 mg （STEP-2）和替西肽10和15 mg （SURMOUNT-2）的一项试验，这些试验在基线结局调节因子特征上几乎完全可比较。在意向治疗分析中，我们在没有个体患者数据的未经调整分析中发现，与西马鲁肽2.4 mg相比，替西帕肽10和15 mg的体重减轻相对较高（增加4%和5.4%），HbA1c降低（增加- 0.4%），胃肠道副作用（GI S/E）更少。结论替西帕肽10和15 mg比西马鲁肽2.4 mg更有效，GI S/E更低。目前需要一项强有力的头对头随机对照试验来证实这些发现。

{"title":"Comparative efficacy and safety of semaglutide 2.4 mg and tirzepatide 5–15 mg in obesity with or without type 2 diabetes: A systematic review of Phase 3 clinical trials","authors":"Akriti Singh , Awadhesh Kumar Singh , Ritu Singh , Anoop Misra","doi":"10.1016/j.dsx.2025.103212","DOIUrl":"10.1016/j.dsx.2025.103212","url":null,"abstract":"<div><h3>Background and aims</h3><div>Both semaglutide 2.4 mg and tirzepatide have been recently approved for chronic use in obesity. There is a lack of literature comparing the efficacy and safety of both these agents in people with obesity/overweight with or without type 2 diabetes (T2D). We systematically reviewed Phase 3 randomized controlled trials (RCTs) conducted with two agents to synthesize the comparative efficacy and safety outcomes.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed electronic databases until December 15, 2024, using selected keywords and Boolean “AND.” Subsequently, we compared the most closely matched trials conducted with semaglutide 2.4 mg and tirzepatide through an adjusted (if baseline imbalance in treatment outcome modifiers present) or unadjusted (in the absence of baseline imbalance) indirect treatment comparison method.</div></div><div><h3>Results</h3><div>We identified one trial each of semaglutide 2.4 mg (STEP-1) and tirzepatide 5, 10, and 15 mg (SURMOUNT-1) in obese or overweight people without T2D and one trial each of semaglutide 2.4 mg (STEP-2) and tirzepatide 10 and 15 mg (SURMOUNT-2) in overweight people with T2D that were almost entirely comparable concerning baseline outcome modifier characteristics. Our unadjusted analysis without individual patients' data found relatively higher (4 and 5.4 % additional) weight loss, HbA1c (−0.4 % additional) reduction, and fewer gastrointestinal side effects (GI S/E) with tirzepatide 10 and 15 mg, respectively, than with semaglutide 2.4 mg, in the intention-to-treat analysis.</div></div><div><h3>Conclusion</h3><div>Tirzepatide 10 and 15 mg are more effective and have fewer GI S/E than semaglutide 2.4 mg. A well-powered head-to-head RCT is currently needed to confirm these findings.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 3","pages":"Article 103212"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619681","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}

引用次数: 0

How can we best support insulin self-titration in type 2 diabetes patients: A systematic review and network meta-analysis 我们如何才能最好地支持2型糖尿病患者的胰岛素自我滴定：一项系统综述和网络荟萃分析

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2025-03-01 Epub Date: 2025-03-27 DOI: 10.1016/j.dsx.2025.103221

Panitan Pitak , Kansak Boonpattharatthiti , Anjana Fuangchan , Ines Krass , Teerapon Dhippayom

Introduction

The efficacy of insulin self-titration in type 2 diabetes (T2D) varies by support strategy. This study aimed to identify the effects of different insulin self-titration support strategies in patients with T2D.

Methods

PubMed, EMBASE, CENTRAL, and EBSCO Open Dissertations were searched from inception to January 2023. Randomized controlled trials (RCTs) on T2D patients that reported HbA1c reduction of insulin self-titration supports were included. The interventions were classified based on the following components: dosage guidance (DG), non-dosage guidance (NDG) and empowerment. The pooled estimates were presented as mean differences (MDs) and risk ratios (RRs) with 95 % confidence interval (CI) using a random-effects model. The certainty of evidence was evaluated utilizing the CINeMA online platform.

Results

Seventeen RCTs (13,528 participants) were included. Compared with usual care (UC), the greatest reduction in HbA1c was observed in patients receiving dosage guidance/Empowerment (MD −1.20; 95 %CI: −2.33,−0.07), with moderate certainty of evidence. Lesser HbA1c reduction, MD [95 % CI], were observed in other support strategies when compared with usual care as follows: −0.97 [−1.24,−0.69] in non-dosage guidance/Empowerment, −0.42 [−0.60,−0.24] in dosage guidance, and −0.31 [−0.58,−0.03] in non-dosage guidance. The risk of severe hypoglycemia was not significantly difference among all support strategies, with very low certainty.

Conclusions

Incorporating patient empowerment into insulin self-titration support strategy, either dosage or non-dosage guidance, is more effective in lowering HbA1c.

胰岛素自我滴定治疗2型糖尿病（T2D）的疗效因支持策略而异。本研究旨在确定不同胰岛素自我滴定支持策略对t2dm患者的影响。方法检索spubmed、EMBASE、CENTRAL和EBSCO自建校至2023年1月的开放论文。随机对照试验（RCTs）中t2dm患者报告HbA1c降低胰岛素自我滴定支持。干预措施按剂量指导（DG）、非剂量指导（NDG）和授权（empowerment）三部分进行分类。使用随机效应模型，汇总估计以95%置信区间（CI）的平均差异（md）和风险比（rr）表示。利用CINeMA在线平台评估证据的确定性。结果纳入17项随机对照试验（rct），共13528名受试者。与常规护理（UC）相比，接受剂量指导/授权的患者HbA1c降低幅度最大(MD - 1.20；95% CI:−2.33,−0.07)，证据确定性中等。与常规护理相比，其他支持策略的HbA1c降低幅度较小，MD [95% CI]如下：非剂量指导/赋权组为- 0.97[- 1.24,- 0.69]，剂量指导组为- 0.42[- 0.60,- 0.24]，非剂量指导组为- 0.31[- 0.58,- 0.03]。严重低血糖的风险在各支持策略间无显著差异，确定性极低。结论将患者授权纳入胰岛素自我滴定支持策略，无论是剂量指导还是非剂量指导，都能更有效地降低HbA1c。

{"title":"How can we best support insulin self-titration in type 2 diabetes patients: A systematic review and network meta-analysis","authors":"Panitan Pitak , Kansak Boonpattharatthiti , Anjana Fuangchan , Ines Krass , Teerapon Dhippayom","doi":"10.1016/j.dsx.2025.103221","DOIUrl":"10.1016/j.dsx.2025.103221","url":null,"abstract":"<div><h3>Introduction</h3><div>The efficacy of insulin self-titration in type 2 diabetes (T2D) varies by support strategy. This study aimed to identify the effects of different insulin self-titration support strategies in patients with T2D.</div></div><div><h3>Methods</h3><div>PubMed, EMBASE, CENTRAL, and EBSCO Open Dissertations were searched from inception to January 2023. Randomized controlled trials (RCTs) on T2D patients that reported HbA1c reduction of insulin self-titration supports were included. The interventions were classified based on the following components: dosage guidance (DG), non-dosage guidance (NDG) and empowerment. The pooled estimates were presented as mean differences (MDs) and risk ratios (RRs) with 95 % confidence interval (CI) using a random-effects model. The certainty of evidence was evaluated utilizing the CINeMA online platform.</div></div><div><h3>Results</h3><div>Seventeen RCTs (13,528 participants) were included. Compared with usual care (UC), the greatest reduction in HbA1c was observed in patients receiving dosage guidance/Empowerment (MD −1.20; 95 %CI: −2.33,−0.07), with moderate certainty of evidence. Lesser HbA1c reduction, MD [95 % CI], were observed in other support strategies when compared with usual care as follows: −0.97 [−1.24,−0.69] in non-dosage guidance/Empowerment, −0.42 [−0.60,−0.24] in dosage guidance, and −0.31 [−0.58,−0.03] in non-dosage guidance. The risk of severe hypoglycemia was not significantly difference among all support strategies, with very low certainty.</div></div><div><h3>Conclusions</h3><div>Incorporating patient empowerment into insulin self-titration support strategy, either dosage or non-dosage guidance, is more effective in lowering HbA1c.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 3","pages":"Article 103221"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820646","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}

引用次数: 0

Efficacy of Frequency Rhythmic Electrical Modulated System (FREMS) in the treatment of diabetic neuropathy: A systematic review and meta-analysis of randomized controlled trials 频率节律性电调制系统（FREMS）治疗糖尿病神经病变的疗效：随机对照试验的系统回顾和荟萃分析

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2025-03-01 Epub Date: 2025-03-27 DOI: 10.1016/j.dsx.2025.103223

Alireza Azarboo , Parisa Fallahtafti , Amin Javidan , Negar Zareshahi , Hossein Souri Giglou , Shabboo Moayyed , Amirhossein Ghaseminejad-Raeini , Mahboobeh Hemmatabadi

Background

Painful diabetic peripheral neuropathy (DPN) is a debilitating complication of diabetes with limited treatment options. Frequency Rhythmic Electrical Modulated System (FREMS), a non-invasive electrotherapy, has shown promise in symptom management.

Methods

Databases, including PubMed, Scopus, and Embase were searched until October 2024. Randomized controlled trials (RCTs) involving adults with DPN comparing FREMS with control were included. Data on Visual Analog Scale (VAS) scores and nerve conduction were extracted. Standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed using RoB 2. Heterogeneity was quantified via I² statistics, with sensitivity analyses and publication bias evaluation.

Results

Five RCTs (333 participants) were included. Meta-analysis indicated that FREMS significantly reduced daytime VAS pain scores post-treatment (SMD -0.56, 95 % CI -0.82 to −0.29, I² = 4 %) and at follow-up (SMD -0.47, 95 % CI -0.73 to −0.21, I² = 0 %). Night-time VAS pain scores also improved post-treatment (SMD -0.54, 95 % CI -0.80 to −0.27, I² = 44 %) and at follow-up (SMD -0.38, 95 % CI -0.65 to −0.12, I² = 1 %). FREMS improved motor nerve conduction but showed no effect on sensory conduction or microvascular blood flow.

Conclusion

FREMS effectively reduces DPN pain with sustained benefits and a favorable safety profile. Further research should standardize treatment protocols and assess long-term outcomes for clinical integration.

疼痛性糖尿病周围神经病变（DPN）是糖尿病的一种衰弱性并发症，治疗选择有限。频率节律电调制系统（FREMS）是一种非侵入性电疗，在症状治疗中显示出前景。方法检索PubMed、Scopus、Embase等数据库至2024年10月。纳入随机对照试验（RCTs），将成年DPN患者的FREMS与对照组进行比较。提取视觉模拟评分（VAS）和神经传导数据。95%置信区间（ci）的标准化平均差异（SMDs）使用随机效应模型进行汇总。偏倚风险采用RoB 2进行评估。异质性通过I2统计量化，并进行敏感性分析和发表偏倚评价。结果共纳入5项随机对照试验（rct），共333名受试者。meta分析显示，FREMS显著降低了治疗后（SMD -0.56, 95% CI -0.82至- 0.29,I2 = 4%）和随访时（SMD -0.47, 95% CI -0.73至- 0.21,I2 = 0%）的日间VAS疼痛评分。夜间VAS疼痛评分在治疗后（SMD -0.54, 95% CI -0.80至- 0.27,I2 = 44%）和随访时（SMD -0.38, 95% CI -0.65至- 0.12,I2 = 1%）也有所改善。FREMS改善运动神经传导，但对感觉传导和微血管血流无影响。结论frems可有效减轻DPN疼痛，具有持续的疗效和良好的安全性。进一步的研究应使治疗方案标准化，并评估临床整合的长期结果。

{"title":"Efficacy of Frequency Rhythmic Electrical Modulated System (FREMS) in the treatment of diabetic neuropathy: A systematic review and meta-analysis of randomized controlled trials","authors":"Alireza Azarboo , Parisa Fallahtafti , Amin Javidan , Negar Zareshahi , Hossein Souri Giglou , Shabboo Moayyed , Amirhossein Ghaseminejad-Raeini , Mahboobeh Hemmatabadi","doi":"10.1016/j.dsx.2025.103223","DOIUrl":"10.1016/j.dsx.2025.103223","url":null,"abstract":"<div><h3>Background</h3><div>Painful diabetic peripheral neuropathy (DPN) is a debilitating complication of diabetes with limited treatment options. Frequency Rhythmic Electrical Modulated System (FREMS), a non-invasive electrotherapy, has shown promise in symptom management.</div></div><div><h3>Methods</h3><div>Databases, including PubMed, Scopus, and Embase were searched until October 2024. Randomized controlled trials (RCTs) involving adults with DPN comparing FREMS with control were included. Data on Visual Analog Scale (VAS) scores and nerve conduction were extracted. Standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed using RoB 2. Heterogeneity was quantified via I<sup>2</sup> statistics, with sensitivity analyses and publication bias evaluation.</div></div><div><h3>Results</h3><div>Five RCTs (333 participants) were included. Meta-analysis indicated that FREMS significantly reduced daytime VAS pain scores post-treatment (SMD -0.56, 95 % CI -0.82 to −0.29, I<sup>2</sup> = 4 %) and at follow-up (SMD -0.47, 95 % CI -0.73 to −0.21, I<sup>2</sup> = 0 %). Night-time VAS pain scores also improved post-treatment (SMD -0.54, 95 % CI -0.80 to −0.27, I<sup>2</sup> = 44 %) and at follow-up (SMD -0.38, 95 % CI -0.65 to −0.12, I<sup>2</sup> = 1 %). FREMS improved motor nerve conduction but showed no effect on sensory conduction or microvascular blood flow.</div></div><div><h3>Conclusion</h3><div>FREMS effectively reduces DPN pain with sustained benefits and a favorable safety profile. Further research should standardize treatment protocols and assess long-term outcomes for clinical integration.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 3","pages":"Article 103223"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746744","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}

引用次数: 0

Response to the Letter to the Editor regarding “The impact of food-based dietary strategies on achieving type 2 diabetes remission: A systematic review” 关于“以食物为基础的饮食策略对实现2型糖尿病缓解的影响：一项系统综述”的致编辑信的回复

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2025-03-01 Epub Date: 2025-01-20 DOI: 10.1016/j.dsx.2025.103189

Hadis Mozaffari , Annalijn I. Conklin

引用次数: 0