Diabetes management in end-stage kidney disease (ESKD) is complicated by altered insulin pharmacokinetics and glucose metabolism, particularly in the context of hemodialysis (HD). Automated insulin delivery (AID) systems offer dynamic insulin adjustment and may help address these challenges. We present real-world data from nine individuals (five females) with type 1 diabetes and ESKD on HD, median age 38 years (range 33–50). Over a median follow-up of 7 months (range 1.5–25), AID use led to significant improvements in glucose time in range (3.9–10 mmol/l) which increased from 39.7% to 59.8% (P = 0.001), glucose variability decreased from 39.8% to 33.8% (P = 0.01), and HbA1c improved from 78.6 to 56.1 mmol/mol (P = 0.003). Time below range fell from 4.0% to 1.4%, but this was not significant (P = 0.1). AID was well tolerated and implemented with multidisciplinary support. Our findings highlight the potential of AID to improve glycemic control in this high-risk population and the need for further studies in this area.
{"title":"Using automated insulin delivery to address the clinical challenges of glycemic management in people with type 1 diabetes and kidney failure on maintenance hemodialysis","authors":"Panagiotis Pavlou, Monika Reddy, Parizad Avari, Lalantha Leelarathna, Rachael Tan, Tahseen A. Chowdhury, Rebecca Hyslop, Sufyan Hussain, Thomas Johnston, Janaka Karalliedde","doi":"10.1111/jdi.70141","DOIUrl":"https://doi.org/10.1111/jdi.70141","url":null,"abstract":"<p>Diabetes management in end-stage kidney disease (ESKD) is complicated by altered insulin pharmacokinetics and glucose metabolism, particularly in the context of hemodialysis (HD). Automated insulin delivery (AID) systems offer dynamic insulin adjustment and may help address these challenges. We present real-world data from nine individuals (five females) with type 1 diabetes and ESKD on HD, median age 38 years (range 33–50). Over a median follow-up of 7 months (range 1.5–25), AID use led to significant improvements in glucose time in range (3.9–10 mmol/l) which increased from 39.7% to 59.8% (<i>P</i> = 0.001), glucose variability decreased from 39.8% to 33.8% (<i>P</i> = 0.01), and HbA1c improved from 78.6 to 56.1 mmol/mol (<i>P</i> = 0.003). Time below range fell from 4.0% to 1.4%, but this was not significant (<i>P</i> = 0.1). AID was well tolerated and implemented with multidisciplinary support. Our findings highlight the potential of AID to improve glycemic control in this high-risk population and the need for further studies in this area.</p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 11","pages":"2027-2032"},"PeriodicalIF":3.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145406744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the effect of Tai Chi Chuan on balance function in adults 60 years or older with type 2 diabetes and mild cognitive impairment (MCI) in China.
Materials and Methods
This was a three-arm, parallel-group, randomized controlled trial with concealed allocation, assessor blinding, intention-to-treat (ITT), and per-protocol (PP) analysis. 328 adults 60 years or older, with a diagnosis of both type 2 diabetes and MCI, were randomly allocated into Tai Chi Chuan group, fitness walking group, and control group. All three groups were provided with a 30-min diabetes self-management education session, once every 4 weeks, for 24 weeks. In addition, the Tai Chi Chuan group received 24-form simplified Tai Chi Chuan. The fitness walking group received fitness walking training. Both Tai Chi Chuan and fitness walking groups took the training for 60 min/session, three times/week, for 24 weeks in a supervised setting. After completing the 24-week interventions, the participants were encouraged to continue exercise until the 36-week follow-up evaluation. The outcomes were time up and go (TUG) assessments, one leg standing test (OLST), functional reach test (FRT), grip strength, 5 time sit to stand test (5STS), modified fall efficacy scale (MFES), and falls data at baseline, 24 weeks, and 36 weeks follow-up.
Results
At 36 weeks, the Tai Chi Chuan group was significantly more effective in decreasing the TUG-cognitive-motor (mean difference, −0.72; 95% CI −1.37 to −0.06), OLST (eyes-closed, right leg) (mean difference, 1.02; 95% CI 0.24–1.80), FRT (mean difference, 2.00; 95% CI 0.57–3.42), 5STS (mean difference, −0.66; 95% CI −1.28 to −0.04), and MFES (mean difference, 0.36; 95% CI 0.15–0.56) compared with the fitness walking group. The Tai Chi Chuan group showed significantly fewer total falls during 36-week experimental period compared with the fitness walking group. PP analysis demonstrated similar results as the ITT analysis.
Conclusions
Among the older adults with type 2 diabetes and MCI, Tai Chi Chuan was more effective than fitness walking and control at improving balance function and reducing fall risk.
{"title":"Effects of Tai Chi Chuan on balance function in adults 60 years or older with type 2 diabetes and mild cognitive impairment in China: A secondary analysis of a multi-center randomized clinical trial","authors":"Jiawei Qin, Jia Huang, Jue Liu, Yannan Chen, Jia Luo, Liyuan Tao, Zhizhen Liu, Weilin Liu, Ying Xu, Shengxiang Liang, Cong Chen, Qiang Tang, Zhuhong Chen, Shangjie Chen, Lidian Chen, Jing Tao","doi":"10.1111/jdi.70138","DOIUrl":"10.1111/jdi.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To investigate the effect of Tai Chi Chuan on balance function in adults 60 years or older with type 2 diabetes and mild cognitive impairment (MCI) in China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This was a three-arm, parallel-group, randomized controlled trial with concealed allocation, assessor blinding, intention-to-treat (ITT), and per-protocol (PP) analysis. 328 adults 60 years or older, with a diagnosis of both type 2 diabetes and MCI, were randomly allocated into Tai Chi Chuan group, fitness walking group, and control group. All three groups were provided with a 30-min diabetes self-management education session, once every 4 weeks, for 24 weeks. In addition, the Tai Chi Chuan group received 24-form simplified Tai Chi Chuan. The fitness walking group received fitness walking training. Both Tai Chi Chuan and fitness walking groups took the training for 60 min/session, three times/week, for 24 weeks in a supervised setting. After completing the 24-week interventions, the participants were encouraged to continue exercise until the 36-week follow-up evaluation. The outcomes were time up and go (TUG) assessments, one leg standing test (OLST), functional reach test (FRT), grip strength, 5 time sit to stand test (5STS), modified fall efficacy scale (MFES), and falls data at baseline, 24 weeks, and 36 weeks follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 36 weeks, the Tai Chi Chuan group was significantly more effective in decreasing the TUG-cognitive-motor (mean difference, −0.72; 95% CI −1.37 to −0.06), OLST (eyes-closed, right leg) (mean difference, 1.02; 95% CI 0.24–1.80), FRT (mean difference, 2.00; 95% CI 0.57–3.42), 5STS (mean difference, −0.66; 95% CI −1.28 to −0.04), and MFES (mean difference, 0.36; 95% CI 0.15–0.56) compared with the fitness walking group. The Tai Chi Chuan group showed significantly fewer total falls during 36-week experimental period compared with the fitness walking group. PP analysis demonstrated similar results as the ITT analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among the older adults with type 2 diabetes and MCI, Tai Chi Chuan was more effective than fitness walking and control at improving balance function and reducing fall risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 11","pages":"2059-2069"},"PeriodicalIF":3.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Little is known about the effect of diabetologists on perioperative complication risk. Given that colorectal cancer surgery is known to carry a high complication risk among patients with diabetes, this study aimed to examine the association between the presence of diabetologists at the facility level and the risk of perioperative complications during colorectal cancer surgery.
Materials and Methods
In this retrospective cohort study, we sourced the number of board-certified diabetologists from the Japan Diabetes Society and combined it with Diagnosis Procedure Combination (DPC) data, encompassing receipt data from acute care facilities across Japan. We used a modified Poisson model to estimate the risk of perioperative complications associated with the presence of diabetologists by adjusting for potential confounding patient and facility factors.
Results
Analysis included 887 facilities, of which 299 (34%) had no diabetologists. A total of 24,714 patients with diabetes underwent colorectal cancer surgery between April 2018 and March 2019, with a median age of 73 years (interquartile range: 67–79 years) and 16,274 (66%) men. There were 3,165 (13%) perioperative complications. After adjustment, the risk of perioperative complications was 0.86 times (95% confidence interval: 0.77–0.96) lower in centers with at least one diabetologist than in those without a diabetologist.
Conclusions
Our study suggests that the presence of a diabetologist may be important in reducing the risk of perioperative complications during colorectal cancer surgery in patients with diabetes. Future studies factoring in other facility factors and surgical types may be required to further validate our findings.
{"title":"Effectiveness of the presence of diabetologists for perioperative complications in patients with diabetes undergoing colorectal cancer surgery: A nationwide inpatient database in Japan","authors":"Masataka Shikata, Atsushi Goto, Sayuri Shimizu, Nozomu Kamei, Daisuke Chujo, Itaru Endo, Akira Shimada, Kiyohide Fushimi, Kohjiro Ueki, Kazuyuki Tobe","doi":"10.1111/jdi.70139","DOIUrl":"10.1111/jdi.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims/Introduction</h3>\u0000 \u0000 <p>Little is known about the effect of diabetologists on perioperative complication risk. Given that colorectal cancer surgery is known to carry a high complication risk among patients with diabetes, this study aimed to examine the association between the presence of diabetologists at the facility level and the risk of perioperative complications during colorectal cancer surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, we sourced the number of board-certified diabetologists from the Japan Diabetes Society and combined it with Diagnosis Procedure Combination (DPC) data, encompassing receipt data from acute care facilities across Japan. We used a modified Poisson model to estimate the risk of perioperative complications associated with the presence of diabetologists by adjusting for potential confounding patient and facility factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analysis included 887 facilities, of which 299 (34%) had no diabetologists. A total of 24,714 patients with diabetes underwent colorectal cancer surgery between April 2018 and March 2019, with a median age of 73 years (interquartile range: 67–79 years) and 16,274 (66%) men. There were 3,165 (13%) perioperative complications. After adjustment, the risk of perioperative complications was 0.86 times (95% confidence interval: 0.77–0.96) lower in centers with at least one diabetologist than in those without a diabetologist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study suggests that the presence of a diabetologist may be important in reducing the risk of perioperative complications during colorectal cancer surgery in patients with diabetes. Future studies factoring in other facility factors and surgical types may be required to further validate our findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 11","pages":"2101-2110"},"PeriodicalIF":3.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>To the Editor,</p><p>We read with great interest the study by Kobayashi <i>et al</i>.<span><sup>1</sup></span>, which retrospectively compared the efficacy and safety of sacubitril/valsartan (SacVal) vs thiazide diuretics (THZ) in patients with type 2 diabetes and poorly controlled blood pressure. It is commendable that the authors tackled the difficult problem of maximizing antihypertensive treatment in patients with high-risk diabetes. Their application of multiple imputation and propensity score weighting offers a solid methodological foundation for comparing actual results. Notably, while both regimens achieved similar blood pressure control, SacVal showed better tolerability and more favorable effects on uric acid, HbA1c, and eGFR decline. The authors conclude that SacVal's superior side effect profile supports its clinical advantage, despite comparable BP outcomes.</p><p>However, several limitations may have skewed these findings. Most importantly, the timing of treatment initiation introduces potential time gap bias. The authors' note: ‘Most patients in the SacVal group started treatment during the coronavirus disease-19 (COVID-19) pandemic, whereas 60% of those in the THZ group started treatment beforehand.’ This temporal imbalance is critical, as the pandemic brought confounding factors such as altered lifestyle habits, reduced clinic access, and increased psychological stress—all of which could independently affect blood pressure, metabolic parameters, and treatment adherence. A large-scale analysis of global clinical trial activity reported a 76.8% decline in new patient screening rates from March to May 2020 compared to the same period in 2019, highlighting the disruptive impact of COVID-19 on trial conduct and patient engagement<span><sup>2</sup></span>. These external influences may have affected outcomes like HbA1c, uric acid, and eGFR, making it difficult to attribute observed differences solely to SacVal's pharmacological effects. Moreover, pandemic-era prescribing patterns and limited follow-up may have artificially improved SacVal's tolerability profile, complicating direct comparisons. The study also reports increased discontinuations in the THZ group post-pandemic but does not clarify whether these were due to drug intolerance or pandemic-related disruptions. This lack of transparency, combined with the exclusion of early SacVal dropouts—patients who discontinued treatment within the first 4 months—may have biased the tolerability findings in favor of SacVal.</p><p>To address these limitations, future analyses should consider time-stratified sensitivity models that adjust for calendar year of treatment initiation. This would help separate pharmacologic effects from pandemic-related confounders. Recent methodological advances have introduced multi-period sensitivity models that relax assumptions of sequential non-confounding, enabling more robust causal inference in longitudinal studies with time-varying treatments and cova
{"title":"Letter to the Editor in response to the article ‘Retrospective analysis of influences of sacubitril/valsartan in patients with diabetes with poorly controlled blood pressure in Japan’","authors":"Daniyal Khalid, Muhammad Saim Siddiqui","doi":"10.1111/jdi.70142","DOIUrl":"10.1111/jdi.70142","url":null,"abstract":"<p>To the Editor,</p><p>We read with great interest the study by Kobayashi <i>et al</i>.<span><sup>1</sup></span>, which retrospectively compared the efficacy and safety of sacubitril/valsartan (SacVal) vs thiazide diuretics (THZ) in patients with type 2 diabetes and poorly controlled blood pressure. It is commendable that the authors tackled the difficult problem of maximizing antihypertensive treatment in patients with high-risk diabetes. Their application of multiple imputation and propensity score weighting offers a solid methodological foundation for comparing actual results. Notably, while both regimens achieved similar blood pressure control, SacVal showed better tolerability and more favorable effects on uric acid, HbA1c, and eGFR decline. The authors conclude that SacVal's superior side effect profile supports its clinical advantage, despite comparable BP outcomes.</p><p>However, several limitations may have skewed these findings. Most importantly, the timing of treatment initiation introduces potential time gap bias. The authors' note: ‘Most patients in the SacVal group started treatment during the coronavirus disease-19 (COVID-19) pandemic, whereas 60% of those in the THZ group started treatment beforehand.’ This temporal imbalance is critical, as the pandemic brought confounding factors such as altered lifestyle habits, reduced clinic access, and increased psychological stress—all of which could independently affect blood pressure, metabolic parameters, and treatment adherence. A large-scale analysis of global clinical trial activity reported a 76.8% decline in new patient screening rates from March to May 2020 compared to the same period in 2019, highlighting the disruptive impact of COVID-19 on trial conduct and patient engagement<span><sup>2</sup></span>. These external influences may have affected outcomes like HbA1c, uric acid, and eGFR, making it difficult to attribute observed differences solely to SacVal's pharmacological effects. Moreover, pandemic-era prescribing patterns and limited follow-up may have artificially improved SacVal's tolerability profile, complicating direct comparisons. The study also reports increased discontinuations in the THZ group post-pandemic but does not clarify whether these were due to drug intolerance or pandemic-related disruptions. This lack of transparency, combined with the exclusion of early SacVal dropouts—patients who discontinued treatment within the first 4 months—may have biased the tolerability findings in favor of SacVal.</p><p>To address these limitations, future analyses should consider time-stratified sensitivity models that adjust for calendar year of treatment initiation. This would help separate pharmacologic effects from pandemic-related confounders. Recent methodological advances have introduced multi-period sensitivity models that relax assumptions of sequential non-confounding, enabling more robust causal inference in longitudinal studies with time-varying treatments and cova","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 11","pages":"2118-2119"},"PeriodicalIF":3.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While both metabolic dysfunction-associated fatty liver disease (MAFLD) and osteoporosis are closely linked to metabolic disorders, their relationship remains controversial. This study aimed to investigate the association between liver fibrosis and femoral neck bone mineral density (BMD) in MAFLD patients with type 2 diabetes mellitus (T2DM-MAFLD) and to evaluate metabolic influences.
Materials and Methods
We retrospectively enrolled 569 hospitalized T2DM-MAFLD patients between September 2018 and May 2021. Liver fibrosis was assessed using the Fibrosis-4 score (FIB-4), and femoral neck BMD was measured by dual-energy X-ray absorptiometry. Generalized additive models evaluated non-linear relationships, piecewise linear regression identified threshold effects, and stratified analyses explored metabolic modifiers.
Results
A non-linear, inverted U-shaped relationship was observed between FIB-4 and femoral neck BMD in postmenopausal women and men ≥50 years, with a turning point at FIB-4 = 2.091. Below this threshold, FIB-4 showed a significant positive correlation with femoral neck BMD (β = 0.039, 95%CI: 0.006–0.072, P = 0.020). Above the threshold, the association became negative but non-significant (β = −0.032, 95%CI: −0.075 to 0.011, P = 0.141). Stratified analysis revealed that in patients with triglycerides ≥1.7 mmol/L, FIB-4 was significantly negatively correlated with femoral neck BMD (β = −0.025, 95%CI: −0.048, −0.003), with a significant interaction effect (P = 0.011).
Conclusions
A non-linear association between liver fibrosis and femoral neck BMD was observed in T2DM-MAFLD patients, particularly postmenopausal women and men aged ≥50 years, modulated by serum triglyceride. Hypertriglyceridemia may represent a crucial metabolic risk factor for osteoporosis development in MAFLD patients, suggesting the importance of bone loss screening in this patient population, particularly those with elevated triglycerides.
{"title":"Non-linear relationship between liver fibrosis and femoral neck bone mineral density in metabolic dysfunction-associated fatty liver disease patients with type 2 diabetes mellitus","authors":"Jie Tao, Lin Wang, Honggang Wang, Juan Tan","doi":"10.1111/jdi.70129","DOIUrl":"10.1111/jdi.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>While both metabolic dysfunction-associated fatty liver disease (MAFLD) and osteoporosis are closely linked to metabolic disorders, their relationship remains controversial. This study aimed to investigate the association between liver fibrosis and femoral neck bone mineral density (BMD) in MAFLD patients with type 2 diabetes mellitus (T2DM-MAFLD) and to evaluate metabolic influences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We retrospectively enrolled 569 hospitalized T2DM-MAFLD patients between September 2018 and May 2021. Liver fibrosis was assessed using the Fibrosis-4 score (FIB-4), and femoral neck BMD was measured by dual-energy X-ray absorptiometry. Generalized additive models evaluated non-linear relationships, piecewise linear regression identified threshold effects, and stratified analyses explored metabolic modifiers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A non-linear, inverted U-shaped relationship was observed between FIB-4 and femoral neck BMD in postmenopausal women and men ≥50 years, with a turning point at FIB-4 = 2.091. Below this threshold, FIB-4 showed a significant positive correlation with femoral neck BMD (<i>β</i> = 0.039, 95%CI: 0.006–0.072, <i>P</i> = 0.020). Above the threshold, the association became negative but non-significant (<i>β</i> = −0.032, 95%CI: −0.075 to 0.011, <i>P</i> = 0.141). Stratified analysis revealed that in patients with triglycerides ≥1.7 mmol/L, FIB-4 was significantly negatively correlated with femoral neck BMD (<i>β</i> = −0.025, 95%CI: −0.048, −0.003), with a significant interaction effect (<i>P</i> = 0.011).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A non-linear association between liver fibrosis and femoral neck BMD was observed in T2DM-MAFLD patients, particularly postmenopausal women and men aged ≥50 years, modulated by serum triglyceride. Hypertriglyceridemia may represent a crucial metabolic risk factor for osteoporosis development in MAFLD patients, suggesting the importance of bone loss screening in this patient population, particularly those with elevated triglycerides.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 11","pages":"2082-2091"},"PeriodicalIF":3.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This cross-sectional study was conducted to assess the association of triglyceridemic-waist phenotype, waist-to-height ratio (WHtR), lipid accumulation product (LAP), visceral adiposity index (VAI), and triglyceride-glucose (TyG) index with prediabetes and diabetes (PAD) using data from the Ningxia Cardiovascular Disorders and Related Risk Factors Survey.
Materials and Methods
This study included 10,803 patients. Logistic regression analysis and restricted cubic splines were applied to identify the association between the PAD and each index. The receiver operating characteristic curve was analyzed to identify and compare the discriminative power of different indexes in identifying PAD.
Results
A total of 43.87% patients were diagnosed with prediabetes and 11.75% patients were diagnosed with diabetes. After adjusting for confounders, participants with elevated high triglyceride levels with increased waist circumference (HTGW) were associated with a 2.65-fold (odds ratio [OR] 2.65, 95% confidence interval [95% CI] 2.31–3.03) risk of PAD. Comparing with the lowest quartile, those in the highest quartile of WHtR, LAP, VAI, and TyG index had a significantly increased risk of developing PAD. TyG index (area under the curve [AUC] 0.71, 95% CI 0.70–0.72) was better than WHtR (AUC 0.66, 95% CI 0.65–0.67), LAP (AUC 0.68, 95% CI 0.67–0.69), and VAI (AUC 0.65, 95% CI 0.64–0.66) at predicting the risk of PAD.
Conclusions
The HTGW and elevated WHtR, LAP, VAI, and TyG index are associated with a greater risk of PAD. The TyG index is a more favorable anthropometric measure for predicting PAD, but its clinical utility needs to be validated in prospective cohorts, especially in resource-limited areas.
目的：本横断面研究利用宁夏心血管疾病及相关危险因素调查的数据，评估甘油三酯-腰围表型、腰高比（WHtR）、脂质积累产物（LAP）、内脏脂肪指数（VAI）和甘油三酯-葡萄糖（TyG）指数与糖尿病前期和糖尿病（PAD）的关系。材料和方法：本研究纳入10803例患者。应用Logistic回归分析和限制三次样条分析确定PAD与各指标之间的关系。分析受试者工作特征曲线，鉴别并比较不同指标对PAD的鉴别能力。结果：43.87%的患者诊断为糖尿病前期，11.75%的患者诊断为糖尿病。在调整混杂因素后，高甘油三酯水平升高且腰围增加（HTGW）的参与者患PAD的风险为2.65倍（优势比[OR] 2.65, 95%可信区间[95% CI] 2.31-3.03）。与最低四分位数相比，WHtR、LAP、VAI和TyG指数最高四分位数的患者发生PAD的风险显著增加。TyG指数（曲线下面积[AUC] 0.71, 95% CI 0.70-0.72）在预测PAD风险方面优于WHtR （AUC 0.66, 95% CI 0.65-0.67）、LAP （AUC 0.68, 95% CI 0.67-0.69）和VAI （AUC 0.65, 95% CI 0.64-0.66）。结论：HTGW、WHtR、LAP、VAI和TyG指数升高与PAD风险增加相关。TyG指数是预测PAD的更有利的人体测量指标，但其临床效用需要在前瞻性队列中验证，特别是在资源有限的地区。
{"title":"Anthropometric and lipid indices in relation to prediabetes and diabetes: A cross-sectional study in resource-limited areas of northwestern China","authors":"Ling Ma, Yin Cheng, Lanqiqi Wu, Hongjuan Shi, Yining Liu, Jinyu Ma, Huitian Tong, Chao Shi","doi":"10.1111/jdi.70137","DOIUrl":"10.1111/jdi.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This cross-sectional study was conducted to assess the association of triglyceridemic-waist phenotype, waist-to-height ratio (WHtR), lipid accumulation product (LAP), visceral adiposity index (VAI), and triglyceride-glucose (TyG) index with prediabetes and diabetes (PAD) using data from the Ningxia Cardiovascular Disorders and Related Risk Factors Survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This study included 10,803 patients. Logistic regression analysis and restricted cubic splines were applied to identify the association between the PAD and each index. The receiver operating characteristic curve was analyzed to identify and compare the discriminative power of different indexes in identifying PAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 43.87% patients were diagnosed with prediabetes and 11.75% patients were diagnosed with diabetes. After adjusting for confounders, participants with elevated high triglyceride levels with increased waist circumference (HTGW) were associated with a 2.65-fold (odds ratio [OR] 2.65, 95% confidence interval [95% CI] 2.31–3.03) risk of PAD. Comparing with the lowest quartile, those in the highest quartile of WHtR, LAP, VAI, and TyG index had a significantly increased risk of developing PAD. TyG index (area under the curve [AUC] 0.71, 95% CI 0.70–0.72) was better than WHtR (AUC 0.66, 95% CI 0.65–0.67), LAP (AUC 0.68, 95% CI 0.67–0.69), and VAI (AUC 0.65, 95% CI 0.64–0.66) at predicting the risk of PAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The HTGW and elevated WHtR, LAP, VAI, and TyG index are associated with a greater risk of PAD. The TyG index is a more favorable anthropometric measure for predicting PAD, but its clinical utility needs to be validated in prospective cohorts, especially in resource-limited areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 11","pages":"2070-2081"},"PeriodicalIF":3.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Waye-Hann Kang, Norlela Sukor, Nor Azmi Kamaruddin
Introduction
Hypogonadism is common among male patients living with type 2 diabetes mellitus and can be divided into hypergonadotropic hypogonadism (hyper-H) and hypogonadotropic hypogonadism (hypo-H). Hypo-H is strongly linked to insulin resistance and visceral adiposity, while hyper-H in type 2 diabetes mellitus males has not been extensively studied. We aimed to study factors associated with the two subtypes of hypogonadal type 2 diabetes mellitus males in Malaysia, where obesity and poorly controlled diabetes are highly prevalent.
Patients and Methods
We screened 360 type 2 diabetes mellitus males for hypogonadism (H), defined by total testosterone <12 nmol/L, repeated calculated free testosterone <0.255 nmol/L, and Aging Male Symptoms (AMS) scale >26. Subjects were classified into hypogonadotropic hypogonadism (hypo-H) and hypergonadotropic hypogonadism (hyper-H) based on luteinizing hormone (LH) levels. We further analyzed their sociodemographic and clinical parameters in comparison to the control group of eugonadal males.
Results
55.6% of the 63 hypogonadal subjects have hypo-H. Significant differences in weight (P = 0.001), BMI (P < 0.001), waist circumference (P < 0.001), serum HDL-C (P < 0.001), serum triglycerides (P = 0.001) and TyG index (P < 0.001) were observed between hypo-H and eugonadal males. For hyper-H males, only age differed significantly from eugonadal males (P = 0.034).
Conclusions
Age is significantly associated with hyper-H, while insulin resistance and visceral adiposity are strongly linked to hypo-H. Older and obese Malaysian type 2 diabetes mellitus males, particularly those with coronary artery disease and lower HDL-C levels, are at a higher risk of developing hypogonadism. Diabetic treatments aimed at improving insulin resistance and reducing visceral adiposity could be highly effective for hypogonadal type 2 diabetes mellitus males in Malaysia.
{"title":"Distinct patterns of hypogonadism in a cross-sectional study of Malaysian men with type 2 diabetes mellitus: The role of insulin resistance, visceral adiposity, and aging","authors":"Waye-Hann Kang, Norlela Sukor, Nor Azmi Kamaruddin","doi":"10.1111/jdi.70127","DOIUrl":"10.1111/jdi.70127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hypogonadism is common among male patients living with type 2 diabetes mellitus and can be divided into hypergonadotropic hypogonadism (hyper-H) and hypogonadotropic hypogonadism (hypo-H). Hypo-H is strongly linked to insulin resistance and visceral adiposity, while hyper-H in type 2 diabetes mellitus males has not been extensively studied. We aimed to study factors associated with the two subtypes of hypogonadal type 2 diabetes mellitus males in Malaysia, where obesity and poorly controlled diabetes are highly prevalent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We screened 360 type 2 diabetes mellitus males for hypogonadism (H), defined by total testosterone <12 nmol/L, repeated calculated free testosterone <0.255 nmol/L, and Aging Male Symptoms (AMS) scale >26. Subjects were classified into hypogonadotropic hypogonadism (hypo-H) and hypergonadotropic hypogonadism (hyper-H) based on luteinizing hormone (LH) levels. We further analyzed their sociodemographic and clinical parameters in comparison to the control group of eugonadal males.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>55.6% of the 63 hypogonadal subjects have hypo-H. Significant differences in weight (<i>P =</i> 0.001), BMI (<i>P <</i> 0.001), waist circumference (<i>P <</i> 0.001), serum HDL-C (<i>P <</i> 0.001), serum triglycerides (<i>P =</i> 0.001) and TyG index (<i>P <</i> 0.001) were observed between hypo-H and eugonadal males. For hyper-H males, only age differed significantly from eugonadal males (<i>P</i> = 0.034).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Age is significantly associated with hyper-H, while insulin resistance and visceral adiposity are strongly linked to hypo-H. Older and obese Malaysian type 2 diabetes mellitus males, particularly those with coronary artery disease and lower HDL-C levels, are at a higher risk of developing hypogonadism. Diabetic treatments aimed at improving insulin resistance and reducing visceral adiposity could be highly effective for hypogonadal type 2 diabetes mellitus males in Malaysia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 10","pages":"1881-1889"},"PeriodicalIF":3.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144797748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I recently read with great interest the article by Fujikawa Shingu et al.1 titled, “Clinical features of overt versus diagnosed pre-existing diabetes in pregnancy”. The study offers an interesting viewpoint on the comparison of clinical differences between overt and diagnosed pre-existing diabetes in pregnancy. The authors done an impressive job, but certain methodological elements of the study need further refinement to further strengthen the study's findings.
First, the authors relied on a very small sample size of the pre-existing diabetic group, comprising 61 women compared to 1,084 in the overt diabetes group. This small sample size may restrict statistical power and produce false-positive results. As Hackshaw mentioned in his article that small studies can provide results quickly, they typically do not deliver reliable or precise estimates2.
Second, in the overt group in pregnancy, there was an absence of pre-pregnancy glycemic control data, which could influence the interpretation of perinatal complication risks as mentioned by Wendland et al. in their study regarding the significance of glycemic control before and throughout pregnancy in mitigating risks such as perinatal complications and congenital anomalies. They noted that the WHO and the IADPSG criteria for gestational diabetes mellitus (GDM) have identified women at a slightly elevated risk for adverse pregnancy outcomes3.
Furthermore, no clinical or behavioral confounder data including diet, exercise, and patient's education are mentioned. These factors can significantly influence maternal glycemic control and perinatal outcomes, as mentioned by Xu et al.4 in their article4. Without accounting these confounders, it is difficult to understand contributors to adverse pregnancy outcomes and to interpret the differences observed between the overt and pre-existing diabetes groups.
In conclusion, although the study offers important insights in the medical field, addressing the limitations such as small sample size, absence of pre-pregnancy glycemic data and lack of confounders could enhance the robustness of the findings. We appreciate the author's contribution to this significant topic.
None.
The authors declare no conflict of interest.
Approval of the research protocol: None.
Informed consent: None.
Registry and the registration no. of the study/trial: None.
{"title":"Letter to editor in response to “Clinical features of overt versus diagnosed pre-existing diabetes in pregnancy”","authors":"Adnan Memon, Zareen Gull","doi":"10.1111/jdi.70136","DOIUrl":"10.1111/jdi.70136","url":null,"abstract":"<p>Dear Editor,</p><p>I recently read with great interest the article by Fujikawa Shingu <i>et al</i>.<span><sup>1</sup></span> titled, “Clinical features of overt versus diagnosed pre-existing diabetes in pregnancy”. The study offers an interesting viewpoint on the comparison of clinical differences between overt and diagnosed pre-existing diabetes in pregnancy. The authors done an impressive job, but certain methodological elements of the study need further refinement to further strengthen the study's findings.</p><p>First, the authors relied on a very small sample size of the pre-existing diabetic group, comprising 61 women compared to 1,084 in the overt diabetes group. This small sample size may restrict statistical power and produce false-positive results. As Hackshaw mentioned in his article that small studies can provide results quickly, they typically do not deliver reliable or precise estimates<span><sup>2</sup></span>.</p><p>Second, in the overt group in pregnancy, there was an absence of pre-pregnancy glycemic control data, which could influence the interpretation of perinatal complication risks as mentioned by Wendland <i>et al</i>. in their study regarding the significance of glycemic control before and throughout pregnancy in mitigating risks such as perinatal complications and congenital anomalies. They noted that the WHO and the IADPSG criteria for gestational diabetes mellitus (GDM) have identified women at a slightly elevated risk for adverse pregnancy outcomes<span><sup>3</sup></span>.</p><p>Furthermore, no clinical or behavioral confounder data including diet, exercise, and patient's education are mentioned. These factors can significantly influence maternal glycemic control and perinatal outcomes, as mentioned by Xu <i>et al</i>.<span><sup>4</sup></span> in their article<span><sup>4</sup></span>. Without accounting these confounders, it is difficult to understand contributors to adverse pregnancy outcomes and to interpret the differences observed between the overt and pre-existing diabetes groups.</p><p>In conclusion, although the study offers important insights in the medical field, addressing the limitations such as small sample size, absence of pre-pregnancy glycemic data and lack of confounders could enhance the robustness of the findings. We appreciate the author's contribution to this significant topic.</p><p>None.</p><p>The authors declare no conflict of interest.</p><p>Approval of the research protocol: None.</p><p>Informed consent: None.</p><p>Registry and the registration no. of the study/trial: None.</p><p>Animal studies: None.</p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Md Kamruzzaman, Jessica A. Marathe, Karen L. Jones, Matthew A. Borg, Michael Horowitz, Scott R. Clark, Chinmay S. Marathe
Introduction
While the bidirectional relationship between depression and diabetes is well recognized, the outcome of studies evaluating the potential for sex disparity, especially in low-to-middle-income (LMIC) South Asian countries, is unexplored. We evaluated sex differences in the relationship between depressive symptoms and glycemic control in individuals with type 2 diabetes in Bangladesh.
Methods
1,485 unselected individuals with, and 228 without, type 2 diabetes completed the PHQ-9 (depression screening questionnaire), and sociodemographic and clinical data were obtained. The PHQ-9 scores were categorized as mild (5–10), moderate (10–15), moderately severe (15–20), and severe (≥20) depressive symptoms, with scores ≥10 indicating clinically relevant symptoms. Descriptive statistics and ordinal and binary logistic regression analyses were performed.
Results
In individuals with type 2 diabetes, mean HbA1c was 9.8 ± 0.1%, with no difference between sexes (9.9 ± 0.1% vs 9.7 ± 0.2%, P = 0.39). The overall mean PHQ-9 score was 8.5 ± 0.2, with females exhibiting higher scores (9.5 ± 0.2 vs 7.1 ± 0.2, P < 0.001). Depressive symptoms correlated with older age, lower education level, longer diabetes duration (>5 years: OR: 1.5, 95% CI: 1.1–2.3), suboptimal (HbA1c 7–9%: OR: 1.8, 95% CI: 1.1–3.2), and poorer glycemic control (HbA1c ≥9%: OR, 1.7; 95% CI, 1.1–2.9). Suboptimal (OR: 2.2, 95% CI: 1.1–4.3) or poor (OR: 2.5, 95% CI: 1.3–4.9) glycemic control and diabetes duration of 1–5 years (OR: 1.9, 95% CI: 1.2–3.0) and >5 years (OR: 2.4, 95% CI: 1.5–3.9) were associated with an increased likelihood of mild-to-severe depressive symptoms in females, but not in males.
Conclusion
The association of depressive symptoms and poor glycemic control in type 2 diabetes in South Asians is stronger in females.
{"title":"The relationship between depressive symptoms and glycemic control is stronger in women with type 2 diabetes in South Asians: Results from a cross-sectional multicenter study","authors":"Md Kamruzzaman, Jessica A. Marathe, Karen L. Jones, Matthew A. Borg, Michael Horowitz, Scott R. Clark, Chinmay S. Marathe","doi":"10.1111/jdi.70134","DOIUrl":"10.1111/jdi.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While the bidirectional relationship between depression and diabetes is well recognized, the outcome of studies evaluating the potential for sex disparity, especially in low-to-middle-income (LMIC) South Asian countries, is unexplored. We evaluated sex differences in the relationship between depressive symptoms and glycemic control in individuals with type 2 diabetes in Bangladesh.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>1,485 unselected individuals with, and 228 without, type 2 diabetes completed the PHQ-9 (depression screening questionnaire), and sociodemographic and clinical data were obtained. The PHQ-9 scores were categorized as mild (5–10), moderate (10–15), moderately severe (15–20), and severe (≥20) depressive symptoms, with scores ≥10 indicating clinically relevant symptoms. Descriptive statistics and ordinal and binary logistic regression analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In individuals with type 2 diabetes, mean HbA1c was 9.8 ± 0.1%, with no difference between sexes (9.9 ± 0.1% vs 9.7 ± 0.2%, <i>P</i> = 0.39). The overall mean PHQ-9 score was 8.5 ± 0.2, with females exhibiting higher scores (9.5 ± 0.2 vs 7.1 ± 0.2, <i>P</i> < 0.001). Depressive symptoms correlated with older age, lower education level, longer diabetes duration (>5 years: OR: 1.5, 95% CI: 1.1–2.3), suboptimal (HbA1c 7–9%: OR: 1.8, 95% CI: 1.1–3.2), and poorer glycemic control (HbA1c ≥9%: OR, 1.7; 95% CI, 1.1–2.9). Suboptimal (OR: 2.2, 95% CI: 1.1–4.3) or poor (OR: 2.5, 95% CI: 1.3–4.9) glycemic control and diabetes duration of 1–5 years (OR: 1.9, 95% CI: 1.2–3.0) and >5 years (OR: 2.4, 95% CI: 1.5–3.9) were associated with an increased likelihood of mild-to-severe depressive symptoms in females, but not in males.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The association of depressive symptoms and poor glycemic control in type 2 diabetes in South Asians is stronger in females.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 10","pages":"1950-1959"},"PeriodicalIF":3.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yiming Hua, Ze Chen, Lele Cheng, Ning Ding, Yifei Xie, Hao Wu, Huaizhi Jing, Yu Xu, Yue Wu, Beidi Lan
Background
The triglyceride glucose-body mass index (TyG-BMI) has emerged as a predictor of complications in patients with heart failure (HF). While elevated TyG-BMI levels have been linked to adverse outcomes in HF patients, their predictive value for acute kidney injury (AKI) risk remains unclear. This study aimed to examine the association between TyG-BMI and the incidence of AKI in patients with HF.
METHODS
Data were obtained from the Medical Information Mart for Intensive Care-IV version 3.1 (MIMIC-IV v3.1) and the eICU Collaborative Research Database version 2.0 (eICU-CRD v2.0). The primary outcome was the occurrence of AKI, with secondary outcomes including the need for renal replacement therapy (RRT) and in-hospital mortality. Kaplan–Meier survival analysis, restricted cubic spline modeling, and Cox proportional hazards regression models were used to assess the associations between TyG-BMI and clinical outcomes.
Results
The study included 1,250 patients from MIMIC-IV and 2,300 patients from eICU-CRD. Patients with higher TyG-BMI levels had a significantly higher cumulative incidence of AKI and increased rates of RRT use and in-hospital mortality. After adjusting for potential confounders, higher TyG-BMI remained independently associated with an increased risk of AKI among HF patients in multivariable models.
Conclusion
This multicenter analysis demonstrates that higher TyG-BMI levels are associated with an increased risk of AKI, greater need for RRT, and higher in-hospital mortality in patients with HF. TyG-BMI may serve as a useful marker for early risk stratification and prognostic assessment in this population. Further prospective studies are needed to validate these findings.
{"title":"TyG-BMI index as a valuable risk of acute kidney injury in patients with heart failure: Insights from the MIMIC-IV and eICU cohorts","authors":"Yiming Hua, Ze Chen, Lele Cheng, Ning Ding, Yifei Xie, Hao Wu, Huaizhi Jing, Yu Xu, Yue Wu, Beidi Lan","doi":"10.1111/jdi.70133","DOIUrl":"10.1111/jdi.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The triglyceride glucose-body mass index (TyG-BMI) has emerged as a predictor of complications in patients with heart failure (HF). While elevated TyG-BMI levels have been linked to adverse outcomes in HF patients, their predictive value for acute kidney injury (AKI) risk remains unclear. This study aimed to examine the association between TyG-BMI and the incidence of AKI in patients with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> METHODS</h3>\u0000 \u0000 <p>Data were obtained from the Medical Information Mart for Intensive Care-IV version 3.1 (MIMIC-IV v3.1) and the eICU Collaborative Research Database version 2.0 (eICU-CRD v2.0). The primary outcome was the occurrence of AKI, with secondary outcomes including the need for renal replacement therapy (RRT) and in-hospital mortality. Kaplan–Meier survival analysis, restricted cubic spline modeling, and Cox proportional hazards regression models were used to assess the associations between TyG-BMI and clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 1,250 patients from MIMIC-IV and 2,300 patients from eICU-CRD. Patients with higher TyG-BMI levels had a significantly higher cumulative incidence of AKI and increased rates of RRT use and in-hospital mortality. After adjusting for potential confounders, higher TyG-BMI remained independently associated with an increased risk of AKI among HF patients in multivariable models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This multicenter analysis demonstrates that higher TyG-BMI levels are associated with an increased risk of AKI, greater need for RRT, and higher in-hospital mortality in patients with HF. TyG-BMI may serve as a useful marker for early risk stratification and prognostic assessment in this population. Further prospective studies are needed to validate these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 10","pages":"1844-1858"},"PeriodicalIF":3.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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