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}
Pub Date : 2025-11-01DOI: 10.1016/j.dsx.2025.103332
Ana Paula Bravo-Garcia, Evelyn B. Parr
{"title":"Response to letter to the editor by Mondal H et al. “Delayed breakfast in type 2 diabetes: Critical gaps and translation barriers”","authors":"Ana Paula Bravo-Garcia, Evelyn B. Parr","doi":"10.1016/j.dsx.2025.103332","DOIUrl":"10.1016/j.dsx.2025.103332","url":null,"abstract":"","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 11","pages":"Article 103332"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673330","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.2025.103354
Ningjian Wang (Associate Editor) , Anoop Misra (Editor-in-Chief)
{"title":"Highlights of the current issue","authors":"Ningjian Wang (Associate Editor) , Anoop Misra (Editor-in-Chief)","doi":"10.1016/j.dsx.2025.103354","DOIUrl":"10.1016/j.dsx.2025.103354","url":null,"abstract":"","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 11","pages":"Article 103354"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737862","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}
There is considerable evidence regarding the potential risk of hypovitaminosis D for various chronic conditions, including type 2 diabetes mellitus (T2DM). Although India essentially shares a tropical climate, it reports a high prevalence of vitamin D deficiency that is predominant in people with diabetes. This systematic review and meta-analysis were designed to look into the risk factors associated with hypovitaminosis D in diabetic patients from India and assess the prevalence.
Methods
PubMed, Embase, and Cochrane Library were searched systematically for observational studies reporting the serum vitamin D levels of T2DM patients up to September 2024. A random effects model was employed to analyse the pooled prevalence of hypovitaminosis D and its risk factors.
Results
Twelve studies of 8953 patients with diabetes (sample size) were included in the review. The combined prevalence of hypovitaminosis D was 79 % (95 % CI: 75 %–84 %, i2 = 97 %). Mean serum vitamin D level was 17.21 ng/mL (95 % CI: 16.87–17.56 ng/mL). More frequently noted risk factors included duration of diabetes, fatigue, body mass index, and HbA1c levels. However, the findings are limited by substantial heterogeneity, predominance of cross-sectional designs, and a paucity of high-quality, well-controlled studies from India.
Conclusion
Hypovitaminosis D is highly prevalent in Type 2 diabetes mellitus patients in India, with the level highly below optimum thresholds. Routine screening of vitamin D levels and targeted supplementation strategies may further improve metabolic control and reduce complications among this vulnerable population.
{"title":"Prevalence and risk factors of hypovitaminosis D among patients with diabetes mellitus from India: A systematic review and meta-analysis","authors":"Gaurab Bhaduri , Shambo Samrat Samajdar , Subhro Chakraborty , Banshi Saboo , Shashank R. Joshi","doi":"10.1016/j.dsx.2025.103326","DOIUrl":"10.1016/j.dsx.2025.103326","url":null,"abstract":"<div><h3>Background</h3><div>There is considerable evidence regarding the potential risk of hypovitaminosis D for various chronic conditions, including type 2 diabetes mellitus (T2DM). Although India essentially shares a tropical climate, it reports a high prevalence of vitamin D deficiency that is predominant in people with diabetes. This systematic review and meta-analysis were designed to look into the risk factors associated with hypovitaminosis D in diabetic patients from India and assess the prevalence.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Cochrane Library were searched systematically for observational studies reporting the serum vitamin D levels of T2DM patients up to September 2024. A random effects model was employed to analyse the pooled prevalence of hypovitaminosis D and its risk factors.</div></div><div><h3>Results</h3><div>Twelve studies of 8953 patients with diabetes (sample size) were included in the review. The combined prevalence of hypovitaminosis D was 79 % (95 % CI: 75 %–84 %, i<sup>2</sup> = 97 %). Mean serum vitamin D level was 17.21 ng/mL (95 % CI: 16.87–17.56 ng/mL). More frequently noted risk factors included duration of diabetes, fatigue, body mass index, and HbA1c levels. However, the findings are limited by substantial heterogeneity, predominance of cross-sectional designs, and a paucity of high-quality, well-controlled studies from India.</div></div><div><h3>Conclusion</h3><div>Hypovitaminosis D is highly prevalent in Type 2 diabetes mellitus patients in India, with the level highly below optimum thresholds. Routine screening of vitamin D levels and targeted supplementation strategies may further improve metabolic control and reduce complications among this vulnerable population.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 10","pages":"Article 103326"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579870","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 : 2025-10-01DOI: 10.1016/j.dsx.2025.103316
Emily N.C. Manoogian , Courtney M. Peterson , Dorothy D. Sears , Mary Playdon , Siobhan Banks , Maxine Bonham , Amandine Chaix , Lisa S. Chow , Adriana Coletta , Rafael De Cabo , Paula Desplats , Charna Dibner , Kelsey Gabel , Sheri L. Johnson , Lance J. Kriegsfeld , Sheetal Hardikar , John A. Hawley , Leonie K. Heilbronn , John Hogenesch , Dara L. James , Tinh-Hai Collet
{"title":"Short-term 24h dietary recalls from observational studies cannot support claims on mortality","authors":"Emily N.C. Manoogian , Courtney M. Peterson , Dorothy D. Sears , Mary Playdon , Siobhan Banks , Maxine Bonham , Amandine Chaix , Lisa S. Chow , Adriana Coletta , Rafael De Cabo , Paula Desplats , Charna Dibner , Kelsey Gabel , Sheri L. Johnson , Lance J. Kriegsfeld , Sheetal Hardikar , John A. Hawley , Leonie K. Heilbronn , John Hogenesch , Dara L. James , Tinh-Hai Collet","doi":"10.1016/j.dsx.2025.103316","DOIUrl":"10.1016/j.dsx.2025.103316","url":null,"abstract":"","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 10","pages":"Article 103316"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145498160","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 : 2025-10-01DOI: 10.1016/j.dsx.2025.103344
Ningjian Wang , Anoop Misra
{"title":"Highlights of the current issue","authors":"Ningjian Wang , Anoop Misra","doi":"10.1016/j.dsx.2025.103344","DOIUrl":"10.1016/j.dsx.2025.103344","url":null,"abstract":"","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 10","pages":"Article 103344"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693821","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 : 2025-10-01DOI: 10.1016/j.dsx.2025.103331
Yusuff Adebayo Adebisi , Chimwemwe Ngoma , Davide Campagna , Antonio Ceriello , Najim Z. Alshahrani , Anoop Misra , Abdul Basit , Cristina Russo , Tadej Battelino , Noel Somasundaram , Muhammad Yazid Jalaludin , Phuong Le Dinh , Yoshifumi Saisho , Magdalena Walicka , Venera Tomaselli , Giulio Cantone , Othmar Moser , Riccardo Polosa
Background
Cigarette smoking is a well-established risk factor for diabetes, but the relationship between e-cigarette use and diabetes remains uncertain. Evidence to date has been drawn almost entirely from North America and Asia, with little information from European populations.
Methods
We conducted a cross-sectional study of 17,854 adults aged 16 years and older from the 2017, 2018, 2019, and 2021 waves of the nationally representative Scottish Health Survey. Diabetes status was based on self-report of doctor-diagnosed diabetes. Participants were classified into six mutually exclusive categories of smoking and e-cigarette use: never users of either cigarettes or e-cigarettes, ex-smokers (former smokers who never used e-cigarettes), current exclusive cigarette smokers, current exclusive e-cigarette users, current dual users, and former e-cigarette users. Weighted prevalence estimates and survey-weighted binary logistic regression models were used to examine associations, adjusting for age group, sex, education, deprivation quintile, ethnicity, alcohol use, physical activity, and hypertension.
Results
Diabetes prevalence was highest among ex-smokers (11.3 %, 95 % CI: 10.1–12.5). Prevalence was 5.7 % (95 % CI: 5.2–6.2) among never users of either cigarettes or e-cigarettes, 6.2 % (95 % CI: 4.9–7.9) among current exclusive cigarette smokers, 4.9 % (95 % CI: 3.4–7.1) among current exclusive e-cigarette users, 8.3 % (95 % CI: 5.8–11.8) among current dual users, and 5.1 % (95 % CI: 4.1–6.3) among former e-cigarette users. In adjusted models, ex-smokers had 35 % higher odds of diabetes compared with never users of either cigarettes or e-cigarettes (OR = 1.35, 95 % CI = 1.14–1.60, p < 0.001), whereas current exclusive smokers (OR = 0.78, 95 % CI = 0.58–1.03, p = 0.084), current exclusive e-cigarette users (OR = 0.81, 95 % CI = 0.53–1.22, p = 0.309), current dual users (OR = 1.49, 95 % CI = 0.94–2.38, p = 0.091), and former e-cigarette users (OR = 1.00, 95 % CI = 0.78–1.29, p = 0.973) were not significantly different from never users. Sensitivity analyses restricting ex-smokers to those with ≥5 years since cessation and limiting the sample to adults aged ≥45 years reproduced the same pattern of results.
Conclusions
In this nationally representative study of Scottish adults, excess diabetes prevalence was observed among ex-smokers, a pattern that may reflect both reverse causation if individuals quit smoking after diagnosis and the lasting metabolic effects of cumulative smoking exposure. Neither current nor former e-cigarette use was associated with diabetes, and the observed variation in prevalence appeared linked to smoking history rather than e-cigarette use. However, because vaping is relatively recent, further longitudinal research is needed to clarify any long-term risks.
吸烟是糖尿病的一个公认的危险因素，但使用电子烟与糖尿病之间的关系仍不确定。迄今为止的证据几乎全部来自北美和亚洲，很少有来自欧洲人口的信息。方法：我们对2017年、2018年、2019年和2021年具有全国代表性的苏格兰健康调查浪潮中的17,854名16岁及以上的成年人进行了横断面研究。糖尿病状况基于医生诊断糖尿病的自我报告。参与者被分为吸烟和电子烟使用的六个相互排斥的类别：从不使用香烟或电子烟，前吸烟者（从不使用电子烟的前吸烟者），当前独家吸烟者，当前独家电子烟用户，当前双重用户和前电子烟用户。加权患病率估计值和调查加权二元logistic回归模型用于检验相关性，调整了年龄组、性别、教育、贫困五分位数、种族、酒精使用、体育活动和高血压。结果戒烟者糖尿病患病率最高（11.3%,95% CI: 10.1-12.5）。从未吸过香烟或电子烟的人中患病率为5.7% (95% CI: 5.2-6.2)，目前独家吸电子烟的人中患病率为6.2% (95% CI: 4.9 - 7.9)，目前独家吸电子烟的人中患病率为4.9% (95% CI: 3.4-7.1)，目前双重吸电子烟的人中患病率为8.3% (95% CI: 5.8-11.8)，曾经吸过电子烟的人中患病率为5.1% （95% CI: 4.1-6.3）。在调整模型中,抽过烟的机率要高出35%糖尿病而从不香烟或电子烟的用户(or = 1.35, 95% CI -1.60 = 1.14, p & lt; 0.001),而目前独家吸烟者(or = 0.78, 95% CI -1.03 = 0.58, p = 0.084),目前独家烟用户(or = 0.81, 95% CI -1.22 = 0.53, p = 0.309),目前双用户(or = 1.49, 95% CI -2.38 = 0.94, p = 0.091),和前烟用户(or = 1.00, 95% CI -1.29 = 0.78,P = 0.973)与从未使用过的无显著差异。敏感性分析将戒烟者限定为戒烟≥5年的人，并将样本限定为≥45岁的成年人，结果也相同。结论：在这项对苏格兰成年人进行的具有全国代表性的研究中，在戒烟者中观察到糖尿病的患病率过高，这种模式可能反映了个体在诊断后戒烟的反向因果关系和累积吸烟暴露的持久代谢影响。目前和以前的电子烟使用都与糖尿病无关，观察到的患病率变化似乎与吸烟史有关，而不是与电子烟使用有关。然而，由于电子烟是相对较新的，因此需要进一步的纵向研究来阐明任何长期风险。
{"title":"Differential associations between smoking, e-cigarette use, and diabetes prevalence","authors":"Yusuff Adebayo Adebisi , Chimwemwe Ngoma , Davide Campagna , Antonio Ceriello , Najim Z. Alshahrani , Anoop Misra , Abdul Basit , Cristina Russo , Tadej Battelino , Noel Somasundaram , Muhammad Yazid Jalaludin , Phuong Le Dinh , Yoshifumi Saisho , Magdalena Walicka , Venera Tomaselli , Giulio Cantone , Othmar Moser , Riccardo Polosa","doi":"10.1016/j.dsx.2025.103331","DOIUrl":"10.1016/j.dsx.2025.103331","url":null,"abstract":"<div><h3>Background</h3><div>Cigarette smoking is a well-established risk factor for diabetes, but the relationship between e-cigarette use and diabetes remains uncertain. Evidence to date has been drawn almost entirely from North America and Asia, with little information from European populations.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study of 17,854 adults aged 16 years and older from the 2017, 2018, 2019, and 2021 waves of the nationally representative Scottish Health Survey. Diabetes status was based on self-report of doctor-diagnosed diabetes. Participants were classified into six mutually exclusive categories of smoking and e-cigarette use: never users of either cigarettes or e-cigarettes, ex-smokers (former smokers who never used e-cigarettes), current exclusive cigarette smokers, current exclusive e-cigarette users, current dual users, and former e-cigarette users. Weighted prevalence estimates and survey-weighted binary logistic regression models were used to examine associations, adjusting for age group, sex, education, deprivation quintile, ethnicity, alcohol use, physical activity, and hypertension.</div></div><div><h3>Results</h3><div>Diabetes prevalence was highest among ex-smokers (11.3 %, 95 % CI: 10.1–12.5). Prevalence was 5.7 % (95 % CI: 5.2–6.2) among never users of either cigarettes or e-cigarettes, 6.2 % (95 % CI: 4.9–7.9) among current exclusive cigarette smokers, 4.9 % (95 % CI: 3.4–7.1) among current exclusive e-cigarette users, 8.3 % (95 % CI: 5.8–11.8) among current dual users, and 5.1 % (95 % CI: 4.1–6.3) among former e-cigarette users. In adjusted models, ex-smokers had 35 % higher odds of diabetes compared with never users of either cigarettes or e-cigarettes (OR = 1.35, 95 % CI = 1.14–1.60, p < 0.001), whereas current exclusive smokers (OR = 0.78, 95 % CI = 0.58–1.03, p = 0.084), current exclusive e-cigarette users (OR = 0.81, 95 % CI = 0.53–1.22, p = 0.309), current dual users (OR = 1.49, 95 % CI = 0.94–2.38, p = 0.091), and former e-cigarette users (OR = 1.00, 95 % CI = 0.78–1.29, p = 0.973) were not significantly different from never users. Sensitivity analyses restricting ex-smokers to those with ≥5 years since cessation and limiting the sample to adults aged ≥45 years reproduced the same pattern of results.</div></div><div><h3>Conclusions</h3><div>In this nationally representative study of Scottish adults, excess diabetes prevalence was observed among ex-smokers, a pattern that may reflect both reverse causation if individuals quit smoking after diagnosis and the lasting metabolic effects of cumulative smoking exposure. Neither current nor former e-cigarette use was associated with diabetes, and the observed variation in prevalence appeared linked to smoking history rather than e-cigarette use. However, because vaping is relatively recent, further longitudinal research is needed to clarify any long-term risks.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 10","pages":"Article 103331"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624734","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 : 2025-10-01DOI: 10.1016/j.dsx.2025.103328
Ali Jafari , Mohammad Amin Karimi , Mahsa Mahmoudinezhad , Fatemeh Razavi , Helia Mardani , Vali Musazadeh
Background and aims
This systematic review and meta-analysis was conducted to evaluate the effects of artichoke supplementation on cardiometabolic health markers in adults.
Methods
A comprehensive literature search of PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials was conducted up to September 2024.
Results
Artichoke supplementation significantly reduced body mass index (WMD = −0.51 kg/m2, 95 % CI: 0.93 to −0.09) and waist circumference (WMD = −1.21 cm, 95 % CI: 2.24 to −0.17), while its effects on body weight and hip circumference were not statistically significant. Blood pressure outcomes revealed significant reductions in both systolic (WMD = −2.49 mmHg, 95 % CI: 4.33 to −0.65) and diastolic (WMD = −1.53 mmHg, 95 % CI: 3.01 to −0.05) pressures. Significant lipid profile improvements were observed in total cholesterol (WMD = −12.29 mg/dL, 95 % CI: 19.92 to −4.65), low-density lipoprotein cholesterol (WMD = −10.31 mg/dL, 95 % CI: 18.57 to −2.04), and triglycerides (WMD = −12.85 mg/dL, 95 % CI: 24.77 to −0.93), with no significant effect on high-density lipoprotein cholesterol. Regarding glycemic indices, insulin (WMD = −1.83 mU/L, 95 % CI: 3.33 to −0.32) and homeostatic model assessment for insulin resistance (WMD = −0.92, 95 % CI: 1.33 to −0.51) were significantly reduced, whereas fasting blood glucose and HbA1c were unaffected. Among liver function markers, alanine aminotransferase (WMD = −8.47 U/L, 95 % CI: 14.71 to −2.23) and alkaline phosphatase (WMD = −7.86 U/L, 95 % CI: 15.26 to −0.45) were significantly reduced, while aspartate aminotransferase showed a borderline non-significant effect. No significant change was observed in creatinine levels.
Conclusion
Artichoke supplementation may offer modest but significant improvements in several cardiometabolic risk markers.
{"title":"Artichoke and cardiometabolic health: A systematic and meta-analytic synthesis of current evidence","authors":"Ali Jafari , Mohammad Amin Karimi , Mahsa Mahmoudinezhad , Fatemeh Razavi , Helia Mardani , Vali Musazadeh","doi":"10.1016/j.dsx.2025.103328","DOIUrl":"10.1016/j.dsx.2025.103328","url":null,"abstract":"<div><h3>Background and aims</h3><div>This systematic review and meta-analysis was conducted to evaluate the effects of artichoke supplementation on cardiometabolic health markers in adults.</div></div><div><h3>Methods</h3><div>A comprehensive literature search of PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials was conducted up to September 2024.</div></div><div><h3>Results</h3><div>Artichoke supplementation significantly reduced body mass index (WMD = −0.51 kg/m<sup>2</sup>, 95 % CI: 0.93 to −0.09) and waist circumference (WMD = −1.21 cm, 95 % CI: 2.24 to −0.17), while its effects on body weight and hip circumference were not statistically significant. Blood pressure outcomes revealed significant reductions in both systolic (WMD = −2.49 mmHg, 95 % CI: 4.33 to −0.65) and diastolic (WMD = −1.53 mmHg, 95 % CI: 3.01 to −0.05) pressures. Significant lipid profile improvements were observed in total cholesterol (WMD = −12.29 mg/dL, 95 % CI: 19.92 to −4.65), low-density lipoprotein cholesterol (WMD = −10.31 mg/dL, 95 % CI: 18.57 to −2.04), and triglycerides (WMD = −12.85 mg/dL, 95 % CI: 24.77 to −0.93), with no significant effect on high-density lipoprotein cholesterol. Regarding glycemic indices, insulin (WMD = −1.83 mU/L, 95 % CI: 3.33 to −0.32) and homeostatic model assessment for insulin resistance (WMD = −0.92, 95 % CI: 1.33 to −0.51) were significantly reduced, whereas fasting blood glucose and HbA1c were unaffected. Among liver function markers, alanine aminotransferase (WMD = −8.47 U/L, 95 % CI: 14.71 to −2.23) and alkaline phosphatase (WMD = −7.86 U/L, 95 % CI: 15.26 to −0.45) were significantly reduced, while aspartate aminotransferase showed a borderline non-significant effect. No significant change was observed in creatinine levels.</div></div><div><h3>Conclusion</h3><div>Artichoke supplementation may offer modest but significant improvements in several cardiometabolic risk markers.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 10","pages":"Article 103328"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575120","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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