World Journal of Diabetes最新文献

Background: Automated insulin delivery (AID) systems have demonstrated benefits in managing patients with type 2 diabetes (T2D), but data are still limited. Moreover, the efficacy and safety of the AID systems in these patients have been inadequately explored by systematic reviews and meta-analyses.

Aim: To provide a comprehensive understanding of the optimal use of AID in managing insulin-treated outpatients with T2D.

Methods: A systematic search of multiple databases and registries, including MEDLINE, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov, was conducted from inception to May 15, 2025, to identify studies on AID use for outpatients with T2D. The co-primary outcomes were the change in glycated hemoglobin (HbA1c) and continuous glucose monitoring (CGM) metrics. Statistical analyses were conducted using Review Manager Web software with random-effects models and the inverse variance statistical method. The results were presented as mean differences (MDs) or risk ratios (RRs) with 95%CI.

Results: A total of 15 studies with 28985 participants were identified, including 6 randomized trials (n = 748; 3 crossover and 3 parallel-group trials) and 9 single-arm studies. All included randomized trials raised some concerns, and the single-arm studies had serious risks of overall bias. Meta-analysis of randomized trials showed that AID is more effective than the control group in lowering HbA1c (MD: -0.89%, 95%CI: -1.32 to -0.46, P < 0.0001, I ² = 82%). Compared to control interventions, AID use was linked to a higher percentage of time in range (MD: 19.25%, 95%CI: 11.43-27.06, P < 0.00001, I ² = 74%) and a lower percentage of time above range > 10 mmol/L (MD: -19.48%, 95%CI: -27.14 to -11.82, P < 0.00001, I ² = 73%); however, time below range remained similar between the two groups. The mean sensor glucose level was lower in the AID group; however, the coefficient of variation of glucose was the same in both groups. AID use also led to a reduction in insulin dose, but this is not a consistent finding across all study designs. The risks of serious adverse events (AEs) and severe hypoglycemia were similar in both groups; however, AID use raised the risk of device deficiency. Single-arm studies with participants using AID systems also demonstrated reductions in HbA1c (ranging from 0.7% to 2.07%) and improvements in CGM metrics, along with acceptable safety data.

Conclusion: Based on short-term study data, the use of AID systems in outpatients with T2D appears to improve glycemic outcomes and CGM metrics, with no significant AEs. Larger and longer-term randomized controlled trials involving diverse populations, along with a cost-benefit analysis, are needed to guide more informed clinical practice decisions.

Background: The association between the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) and mental health among individuals with type 2 diabetes mellitus (T2DM) has not been thoroughly investigated.

Aim: To examine the link between UHR and symptoms of depression and anxiety in patients with T2DM.

Methods: A cross-sectional analysis was carried out from March 2023 to April 2024, involving participants diagnosed with T2DM. Data on sociodemographic characteristics, clinical parameters, and UHR values were systematically gathered. The Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were utilized to evaluate depressive and anxiety symptoms, respectively. To assess the relationships between UHR and SDS/SAS scores, linear regression models were employed, incorporating adjustments for potential confounding variables. Additionally, smooth curve fitting and threshold effect analyses were conducted to explore potential nonlinear relationships.

Results: A total of 285 patients with T2DM were included. Initial univariate analysis demonstrated a significant positive correlation between elevated UHR levels and higher SDS and SAS scores. Multivariate regression analysis revealed that a one-unit rise in UHR was associated with a 1.13-point increase in SDS scores (95%CI: 0.69-1.58) and a 0.57-point increase in SAS scores (95%CI: 0.20-0.93). After controlling for confounders, UHR remained positively correlated with SDS (β = 1.55, 95%CI: 0.57-2.53) and SAS (β = 0.72, 95%CI: 0.35-1.09). Nonlinear analysis identified critical thresholds at UHR values of 5.02 for SDS and 4.00 for SAS, beyond which the relationships between UHR and psychological symptom scores became markedly stronger (P < 0.05).

Conclusion: Higher UHR levels are significantly linked to exacerbated depressive and anxiety symptoms in patients with T2DM. These results indicate that UHR may function as a promising biomarker to identify individuals at greater risk of mental health complications within this population.

Epicardial adipose tissue (EAT) is an active form of visceral adipose tissue that can affect myocardial function due to shared circulation with the myocardium. Given its rapid metabolic activity, EAT is considered a potential therapeutic target for medications that modulate fat and is a potent marker of metabolic changes including those observed in diabetic cardiomyopathy. Recent investigations propose an association between EAT accumulation and chronic diseases such as type 2 diabetes mellitus (T2DM), atrial fibrillation, and heart failure with preserved ejection fraction. According to the method first described by Iacobellis et al, EAT thickness is identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium, measured in the parasternal short- and long-axis views at end-systole using ultrasound. Ultrasound of EAT is a safe, cost-effective, and readily available tool for cardiometabolic risk assessment. This minireview investigates the current role of echocardiography in the assessment of EAT thickness in patients with T2DM, regardless of the presence of overt heart failure. We also discuss whether changes in EAT thickness may be used as a significant marker of disease progression and if delta EAT thickness could serve as a surrogate of effective therapy.

This study reviews the anti-inflammatory potential of cannabidiol (CBD) in the management of type 1 diabetes (T1D). A comprehensive search was conducted across PubMed, Scopus, and ScienceDirect databases using the terms "type 1 diabetes", "cannabidiol", "anti-inflammatory effect", and "CBD". Articles published between 2005 and 2025 were screened, and studies involving animal models that examined CBD as a therapeutic intervention for T1D and reported on its anti-inflammatory effects were included. Of the 62 retrieved articles, only 6 met the predefined inclusion criteria. Although limited in number, the available studies show promising outcomes. CBD demonstrates potential as an adjuvant therapy for T1D due to its immunomodulatory and anti-inflammatory actions. Nonetheless, further research is required to establish safe and effective clinical application protocols.

Diabetes is a growing global health concern, calling for improved diagnostic and therapeutic strategies. Of the emerging possible biomarkers, microRNA 375 (miR-375) has gained attention for its pivotal role in pancreatic β cell development and function, and its altered blood levels following β cell injury. This review summarizes the current knowledge on the role of miR-375 in insulin regulation, its correlation with diabetes, and its clinical potential. Despite its well-known role in β cell biology, literature analyses have failed to reveal a consistent correlation between the circulating levels of miR-375 and diabetes. A key limitation lies in the lack of β cell specificity of miR-375, along with its modulation by diabetes-related complications, which influences circulating levels of the miRNA. Moreover, the absence of large-scale, standardized clinical studies undermines the comparability of existing data. Despite these limits, the literature analysis clearly indicates the need to expand research into miR-375 modulation strategies in humans, as integrating miR-375 with other diagnostic and therapeutic technologies could enhance its clinical relevance. Such strategies may support more personalized and timely interventions for treating diabetes and its complications, ultimately benefiting patient outcomes and contributing to the sustainability of global healthcare systems.

Background: Dry eye, also known as keratoconjunctival dryness, refers to a group of conditions that lead to eye discomfort and visual dysfunction. Being one of the most common complications of diabetes, it can lead to vision loss and, in severe cases, blindness in patients with diabetes.

Aim: To investigate ocular dryness manifestations, assess corneal neuropathy, and identify associated influencing factors in patients with type 2 diabetes (T2D) complicated with comorbid dry eye syndrome (DES).

Methods: Data from 81 patients with T2D admitted to Xianyang First People's Hospital between January 2022 and June 2023 (18 months) were retrospectively reviewed. Patients were divided into the DES and non-DES groups. Additionally, 50 individuals who concurrently underwent medical examinations served as the control group. Standardized assessments were conducted, including evaluations using the standard patient evaluation of eye dryness (SPEED) tool, noninvasive tear film breakup time (NIBUT) analysis, and Schirmer I test (SIt) determination of wetting length. Under a corneal confocal microscope, subbasal corneal neuropathy evaluations were conducted to determine the density, length, number, and tortuosity of the main nerves. Associations among SPEED scores, NIBUT, SIt results, and subbasal corneal neuropathy parameters in the DES group were examined. The DES and non-DES groups were further analyzed for differences in baseline characteristics, and potential risk factors for DES in patients with T2D were identified by multivariate logistic regression modeling.

Results: The T2D + DES group showed an increase in the SPEED score, along with a decrease in the NIBUT and SIt wetting length, compared with the non-DES and control groups (P < 0.05); however, no marked inter-group differences were noted for fluorescein staining test scores between T2D + DES group and DES group. Compared with the non-DES groups, the DES group exhibited reductions in density, length, and number of the main nerves, as well as an increase in nerve tortuosity (all P < 0.05), and all these changes were more pronounced in the non-DES group than in the DES group (all P < 0.05). In the DES group, the SPEED score demonstrated a significant negative correlation with nerve density and the length and number of the main nerves but a positive correlation with nerve tortuosity. Conversely, both the NIBUT and SIt wetting length showed a positive association with the density and number of the main nerves; however, the SIt wetting length demonstrated an inverse correlation with nerve tortuosity. Multivariate modeling identified several independent risk factors for DES in T2D, such as age, diabetes duration, lacrimal gland dysfunction, and insufficient insulin secretion, as well as fasting blood glucose and glycated hemoglobin.

Conclusion: Patients with T2D are more suscept

Background: The Zhejiang University (ZJU) index has been demonstrated to have notable value in predicting metabolic dysfunction-associated steatotic liver disease (MASLD) within Chinese populations. However, the correlation between the ZJU index and MASLD in type 2 diabetes mellitus (T2DM) patients remains to be elucidated.

Aim: To investigate the association between the ZJU index and MASLD among patients with T2DM.

Methods: This cross-sectional study was conducted on hospitalised patients diagnosed with T2DM. Anthropometric measurements, laboratory data, and ultrasound results were initially collected from all patients. The ZJU index was subsequently calculated. Regression analysis was then used to explore risk factors affecting MASLD, and the optimal ZJU index cut-off value for diagnosing MASLD was determined using restricted cubic spline analysis. Finally, a new model for predicting MASLD in T2DM patients based on the ZJU index was constructed. This model was based on the risk factors identified by regression analysis, and the area under curve values were calculated. The validity and reliability of the models were then compared with each other.

Results: A total of 688 patients with T2DM were included in this study. A significant positive correlation was identified between the ZJU index and the development of MASLD. Furthermore, the results of the restricted cubic spline analysis showed a non-linear association between ZJU index and MASLD. The ZJU value of 38.87 was identified as the key threshold for diagnosing MASLD. The new predictive model, which was developed by regression analysis, demonstrated a higher diagnostic value for MASLD and exhibited good accuracy in comparison with metabolic indices alone (area under curve = 0.76, 95% confidence interval: 0.72-0.80).

Conclusion: The ZJU index has been shown to be linked to the risk of developing MASLD, and the new model constructed has been shown to possess good predictive value.

Diabetic foot ulcer is the most prevalent and serious lower-limb complication among individuals with diabetes, and it significantly contributes to the incidence of non-traumatic amputations. The repeated failure of diabetic wounds to heal can result in diabetic foot ulcers, inflicting considerable physical suffering and imposing substantial economic burdens on both patients and global healthcare systems because of the complexity and high costs of treatment. The mechanisms underlying the impaired healing of diabetic wounds are intricate and incompletely understood. Histone deacetylases (HDACs) are critical epigenetic regulators that catalyze the removal of acetyl or acyl groups from lysine residues in proteins, thereby modulating various biological processes, including transcription, apoptosis, and metabolism. Nevertheless, the precise roles of HDACs in diabetic wound healing remain largely unexplored. Thus, the current review describes the pivotal roles of HDACs in diabetic wound healing, focusing on their regulation of inflammatory responses, vascular dysfunction, and epithelial renewal, which are critical events in wound healing. Furthermore, we discuss the therapeutic potential of HDAC inhibitors and propose future directions for clinical application.

Type 2 diabetes markedly elevates fracture risk despite normal or high bone mineral density, a paradox reflecting qualitative skeletal deficits rather than loss of mass. Chronic hyperglycemia fosters the accumulation of advanced glycation end products in bone; their nonenzymatic crosslinks stiffen type I collagen, impair mineralization, and erode mechanical strength. By engaging the receptor for advanced glycation end products, these adducts activate nuclear factorκB and mitogen-activated protein kinase cascades, amplifying oxidative stress, inflammation, osteoblast dysfunction, and osteoclastogenesis. This review synthesizes epidemiological data from type 1 and type 2 diabetes, highlights the limits of densitybased skeletal assessment, and details the molecular pathology of the glycation-collagen axis. It also appraises antiglycation therapies, including formation inhibitors, crosslink breakers and receptor antagonists, with a particular focus on sodium-glucose cotransporter 2 inhibitors that couple glycemic control with modulation of the glycation pathway. By integrating recent basic and clinical advances, we propose a mechanistic framework for diabetic bone disease and outline strategies to mitigate glycationdriven skeletal fragility.

Background: Type 2 diabetes mellitus (T2DM) is increasing rapidly in Pakistan, especially among socioeconomically disadvantaged populations. While clinical care remains central, social determinants such as poverty, gender norms, and mistrust in healthcare critically shape disease outcomes.

Aim: To synthesize qualitative evidence on how these factors influence the experience and management of T2DM in Pakistan.

Methods: Following PRISMA guidelines, a systematic review of qualitative studies published between 2000 and 2025 was conducted on February 25, 2025 using PubMed, CINAHL, MEDLINE Plus, and PakMediNet. Eleven studies exploring socioeconomic influences on T2DM care and self-management in Pakistan were included. Thematic synthesis was used to identify key patterns. Quality was appraised using the Joanna Briggs Institute Checklist for Qualitative Research.

Results: Three major themes were identified: (1) Economic insecurity. High cost of treatment, poor rural infrastructure, and food insecurity hinder access and adherence; (2) Sociocultural and gender norms. Restricted mobility of females, family control over health decisions, and fatalistic beliefs delay care; and (3) Knowledge gaps and mistrust. A lack of culturally appropriate education, reliance on traditional remedies, and distrust in public health systems reduce compliance. These intersecting barriers collectively impede effective diabetes management.

Conclusion: T2DM in Pakistan is driven by entrenched social and economic barriers. Addressing it requires culturally sensitive, equity-oriented strategies that go beyond biomedical models. Policy reforms should focus on affordability, rural outreach, and inclusive health education. Future research should engage marginalized voices through participatory methods.