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Diabetes as a risk factor for invasive meningococcal disease. A meta-analysis of observational studies. 糖尿病是侵袭性脑膜炎球菌病的风险因素。观察性研究荟萃分析。
IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-19 DOI: 10.1007/s00592-024-02418-7
Giovanni Antonio Silverii, Giovanni Gabutti, Silvio Tafuri, Joan Tereziu, Alessandra Clerico, Riccardo Fornengo, Carla Greco, Concetta Irace, Valeria Sordi, Gian Pio Sorice, Massimiliano Cavallo, Maria Chantal Ponziani, Edoardo Mannucci, Ilaria Dicembrini
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引用次数: 0
Fracture events associated with GLP-1 receptor agonists in FDA adverse events reporting system. FDA 不良事件报告系统中与 GLP-1 受体激动剂有关的骨折事件。
IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-18 DOI: 10.1007/s00592-024-02415-w
Yao Xiao, Min Zhou, Wenfeng Xiao

Aims: Diabetes patients are at a higher risk of fractures, and glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been suggested to positively impact on bone metabolism. We aim to provide a comprehensive assessment of fracture events associated with GLP-1RAs based on pharmacovigilance data.

Methods: In this study, fracture-related adverse events (AEs) associated with GLP-1RAs and other commonly used glucose-lowering drugs were identified from Food and Drug Administration Adverse Event Reporting System (FAERS) database (2004-2022). The reporting odds ratio (ROR) and adjusted ROR (adj. ROR) were used to compare the reporting of fracture-related AEs associated with insulin, GLP-1RAs, and Non GLP-1RAs, in patients with diabetes through two scenarios. This involved separately comparing each glucose-lowering drug to all other medications used in diabetic patients and reiterating after excluding insulin cases.

Results: A total of 490,107 AE reports for patients with diabetes were identified and 98, 625 of them were for GLP-1RAs. Among all diabetes drugs, GLP-1RAs had the lowest reporting of any fracture-related AEs [adj. ROR = 0.44 (0.40-0.47)], consistent across osteoporotic fracture [adj. ROR = 0.39 (0.34-0.45)] and hip fracture [adj. ROR = 0.34 (0.28-0.41)]. Among GLP-1RA agents, albiglutide was associated with the lowest adj. ROR [0.11 (0.05-0.21)] for any fracture-related AEs. After excluded all insulin reports, GLP-1RAs retained a significantly lower adj. ROR towards any fracture [adj. ROR = 0.45 (0.40-0.50)], osteoporotic fracture [adj. ROR = 0.44 (0.37-0.52)], and hip fracture [adj. ROR = 0.43 (0.33-0.54)].

Conclusion: In a real-world pharmacovigilance setting, GLP-1RAs were associated with lower reporting of fracture-related AEs, indicating the protective effect of GLP-1RAs against fractures.

目的:糖尿病患者骨折风险较高,而胰高血糖素样肽-1受体激动剂(GLP-1RA)被认为对骨代谢有积极影响。我们旨在根据药物警戒数据对与 GLP-1RA 相关的骨折事件进行全面评估:本研究从食品药品管理局不良事件报告系统(FAERS)数据库(2004-2022年)中发现了与GLP-1RAs和其他常用降糖药物相关的骨折不良事件(AEs)。采用报告几率比(ROR)和调整几率比(adj. ROR),通过两种方案比较糖尿病患者中与胰岛素、GLP-1RA 和非 GLP-1RA 相关的骨折相关不良事件的报告情况。这包括将每种降糖药分别与糖尿病患者使用的所有其他药物进行比较,并在排除胰岛素病例后再次进行比较:结果:共发现了 490,107 份糖尿病患者的 AE 报告,其中 98,625 份报告涉及 GLP-1RA。在所有糖尿病药物中,GLP-1RA 的骨折相关 AE 报告最少[adj. ROR = 0.44 (0.40-0.47)],在骨质疏松性骨折[adj. ROR = 0.39 (0.34-0.45)] 和髋部骨折[adj. ROR = 0.34 (0.28-0.41)]方面也是如此。在 GLP-1RA 药物中,阿必鲁肽的骨折相关 AE 的 adj. ROR [0.11 (0.05-0.21)] 最低。排除所有胰岛素报告后,GLP-1RAs 在任何骨折[adj. ROR = 0.45 (0.40-0.50)]、骨质疏松性骨折[adj. ROR = 0.44 (0.37-0.52)]和髋部骨折[adj. ROR = 0.43 (0.33-0.54)]方面的adj.ROR显著较低:结论:在真实世界的药物警戒环境中,GLP-1RA 与较低的骨折相关 AE 报告有关,表明 GLP-1RA 对骨折具有保护作用。
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引用次数: 0
Successful renal replacement therapy of extreme ertugliflozin and alcohol induced euglycaemic ketoacidosis. 成功治疗极度厄曲酶和酒精诱发的优生酮症酸中毒的肾脏替代疗法。
IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-18 DOI: 10.1007/s00592-024-02417-8
Andreas Holstein, Jonas A Linck, Johann Christoph Blaue, Rainer Högel, David J F Holstein
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引用次数: 0
Association of the triglyceride glucose index with acute renal failure in diabetes mellitus: a cross-sectional study based on participants from the MIMIC-iv database. 甘油三酯葡萄糖指数与糖尿病急性肾衰竭的关系:基于 MIMIC-iv 数据库参与者的横断面研究。
IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-18 DOI: 10.1007/s00592-024-02412-z
Zi-Fan Zhuang, Hong-Rui Lu, Yang Zhou, Qing Ni

Background: The triglyceride glucose (TyG) index serves as a dependable surrogate biomarker for evaluating insulin resistance. However, the role of the TyG index in patients with diabetes mellitus who also suffer from acute renal failure warrants further investigation. This study sought to investigate the association between the TyG index and the incidence of acute renal failure in individuals with diabetes.

Methods: This study utilized data from the MIMIC-IV database, categorizing patients into tertiles according to their TyG index. Employing multivariate logistic regression models, we analyzed the relationship between the TyG index and the occurrence of acute renal failure among diabetic patients. To assess non-linear relationships, restricted cubic splines were utilized, and upon detection of non-linearity, a recursive algorithm was implemented to determine inflection points.

Results: The study comprised a total of 1074 participants diagnosed with diabetes mellitus. In the model adjusted for all covariates, the odds ratio (OR) for the association between the TyG index and acute renal failure, accompanied by a 95% confidence interval (CI), was 1.22 (0.82, 1.82), which did not reach statistical significance. However, analysis using restricted cubic splines revealed a U-shaped relationship between the TyG index and acute renal failure, with an inflection point at 9.26. The relationship between the TyG index and acute renal failure was inverse before reaching the inflection point and became directly proportional thereafter, with an OR (95% CI) of 1.86 (1.12, 3.09) after the point.

Conclusion: In individuals diagnosed with diabetes mellitus, our analysis revealed a non-linear relationship between the TyG index and the incidence of acute renal failure. Beyond the inflection point, elevated TyG index levels were markedly linked to a higher prevalence of acute renal failure.

背景:甘油三酯葡萄糖(TyG)指数是评估胰岛素抵抗的可靠替代生物标志物。然而,TyG 指数在同时患有急性肾衰竭的糖尿病患者中的作用值得进一步研究。本研究旨在调查 TyG 指数与糖尿病患者急性肾衰竭发病率之间的关系:本研究利用 MIMIC-IV 数据库中的数据,根据 TyG 指数将患者分为三等分。通过多变量逻辑回归模型,我们分析了TyG指数与糖尿病患者急性肾衰竭发生率之间的关系。为了评估非线性关系,我们使用了限制性立方样条,在检测到非线性时,我们采用了递归算法来确定拐点:结果:该研究共有 1074 名确诊为糖尿病的参与者。在对所有协变量进行调整后的模型中,TyG 指数与急性肾衰竭之间的相关性赔率(OR)为 1.22(0.82,1.82),95% 置信区间(CI)为 1.22(0.82,1.82),未达到统计学意义。然而,使用限制性三次样条进行分析后发现,TyG 指数与急性肾衰竭之间呈 U 型关系,拐点为 9.26。TyG指数与急性肾功能衰竭之间的关系在到达拐点之前呈反比,之后呈正比,拐点之后的OR(95% CI)为1.86(1.12,3.09):我们的分析显示,在确诊为糖尿病的患者中,TyG 指数与急性肾衰竭的发生率之间存在非线性关系。在拐点之后,TyG 指数的升高与急性肾衰竭的发病率明显相关。
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引用次数: 0
Identification of heterozygous mutations of ABCC8 gene responsible for maturity-onset diabetes of the young with exome sequencing. 利用外显子组测序鉴定导致青年成熟型糖尿病的 ABCC8 基因杂合突变。
IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-18 DOI: 10.1007/s00592-024-02410-1
Yanxia Liu, Shuxin Ren, Chaofeng Zhu, Sufang Chen, Huijuan Zhang, Juan Zhang, Jianhua Li, Yanyan Jiang

Background: Although the MODY12 subtype, caused by ABCC8 mutations, is rare, it is highly sensitive to sulfonylureas. The identification of ABCC8 mutations in patients clinically diagnosed with MODY has the ability to contribute to the precise management of diabetes.

Methods: Genetic analysis of two families with MODY were conducted using whole-exome sequencing (WES) and Sanger sequencing. The spatial structures of the mutant proteins were constructed using MODELLER and PyMOL software to provide further evidence of pathogenicity.

Results: The heterozygous missense mutations V357I and R1393H in ABCC8 were found in probands of two unrelated MODY pedigrees, which co-segregated with the hyperglycemic phenotypes in these two pedigrees. Detection of the V357I mutation enabled the proband of family A to successfully transfer from insulin to sulfonylurea (SU). After 3 months of follow-up for the SU trial, the HbA1c level of proband A improved from 12.4% at the initial diagnosis to 7.20%. Proband B was treated with insulin because of pregnancy and poor islet function. In silico analysis indicated that the R1393H mutation resulted in a longer hydrogen bond distance to L1389 and cleavage of carbon-hydrogen bonds to V1395, A1390, and L1389.

Conclusions: We have described two pathogenic missense mutations in ABCC8 in Chinese families with MODY. Our findings support the heterogeneity in the clinical features of MODY12 caused by ABCC8 mutations.

背景:由ABCC8突变引起的MODY12亚型虽然罕见,但对磺脲类药物高度敏感。在临床诊断为 MODY 的患者中鉴定 ABCC8 基因突变有助于糖尿病的精确治疗:方法:利用全外显子组测序(WES)和桑格测序对两个患有 MODY 的家族进行了基因分析。方法:利用全外显子组测序(WES)和桑格测序对两个MODY家族进行了遗传分析,并使用MODELLER和PyMOL软件构建了突变蛋白的空间结构,为致病性提供了进一步的证据:结果:在两个无血缘关系的MODY血统中发现了ABCC8中的杂合错义突变V357I和R1393H,这两个突变与这两个血统中的高血糖表型共存。V357I 基因突变的发现使 A 家系的患者成功地从胰岛素转为磺脲类药物(SU)。经过 3 个月的 SU 试验随访,原发性 A 的 HbA1c 水平从最初诊断时的 12.4% 降至 7.20%。由于怀孕和胰岛功能不佳,原患者 B 接受了胰岛素治疗。硅学分析表明,R1393H 突变导致与 L1389 的氢键距离变长,与 V1395、A1390 和 L1389 的碳氢键断裂:我们描述了中国 MODY 家族中 ABCC8 的两个致病性错义突变。我们的研究结果支持 ABCC8 突变导致的 MODY12 临床特征的异质性。
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引用次数: 0
Autologous cell therapy for ischemic diabetic foot: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome. 缺血性糖尿病足的自体细胞疗法:为制定意大利糖尿病足综合征治疗指南而进行的随机对照试验荟萃分析。
IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-15 DOI: 10.1007/s00592-024-02393-z
Alessia Scatena, Matteo Apicella, Michele Mantuano, Benedetta Ragghianti, Antonio Silverii, Cesare Miranda, Luca Monge, Luigi Uccioli, Germano Scevola, Eugenio Stabile, Mauro Gargiulo, Cristiana Vermigli

Aim: To assess the efficacy and safety of autologous cell therapy (ACT) in patients with ischemic diabetic foot ulcers (DFU). The present meta-analysis was designed to support the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome (DFS).

Methods: A Medline and Embase search were performed up to Feb 1st, 2024 collecting all RCTs including diabetic patients or reporting subgroup analyses on diabetic patients with ischemic foot ulcers comparing ACT with placebo/no therapy/standard of care (SoC), with a duration of at least 26 weeks. Prespecified endpoints were: major amputation (principal) and minor amputation, ulcer healing, time-to-healing, transcutaneous oxygen pressure (TcPO2), ankle-brachial index (ABI), pain, and all-cause mortality (secondary). Any ACT was allowed, irrespective of cell product type and route of administration (intra-arterial and intramuscular).

Results: Seven studies fulfilled all inclusion criteria, all using intramuscular transplantation as route of administration, but only 2 had a follow-up greater than 26 weeks. Participants treated with ACT had a significantly lower risk of major amputations in comparison with SoC/placebo (MH-OR 0.47 [0.24, 0.92], p = 0.03). ACT was also associated with a significantly higher rate of ulcer healing (MH-OR: 10.1 [3.5, 29.6], p < 0.001), greater increase of TcPO2 and ABI values (WMD: 17.57 [13.02, 22.12], p < 0.001), and reduction of pain (WMD: -1.83 [-2.32, -1.34], p = 0.003).

Conclusions: ACT must be considered as a potential therapy for patients with ischemic diabetic foot ulcers. Further studies are needed to better clarify their role in the treatment and management of DFS.

目的:评估自体细胞疗法(ACT)对缺血性糖尿病足溃疡(DFU)患者的疗效和安全性。本荟萃分析旨在为意大利糖尿病足综合征(DFS)治疗指南的制定提供支持:方法:对截至 2024 年 2 月 1 日的 Medline 和 Embase 进行了检索,收集了所有包括糖尿病患者或报告亚组分析的缺血性足部溃疡糖尿病患者的 RCT 研究,这些研究比较了 ACT 与安慰剂/无治疗/标准护理(SoC),研究持续时间至少为 26 周。预设终点为:大截肢(主要)和小截肢、溃疡愈合、愈合时间、经皮氧压(TcPO2)、踝肱指数(ABI)、疼痛和全因死亡率(次要)。无论细胞产品类型和给药途径(动脉内给药和肌肉注射)如何,均可进行任何 ACT 研究:七项研究符合所有纳入标准,均采用肌肉注射移植作为给药途径,但只有两项研究的随访时间超过 26 周。与SoC/安慰剂相比,接受ACT治疗的参与者发生大截肢的风险明显降低(MH-OR 0.47 [0.24, 0.92],P = 0.03)。ACT 还与明显更高的溃疡愈合率(MH-OR:10.1 [3.5, 29.6],p 2)和 ABI 值(WMD:17.57 [13.02, 22.12],p 结论)有关:必须考虑将 ACT 作为缺血性糖尿病足溃疡患者的一种潜在疗法。为了更好地阐明 ACT 在治疗和管理糖尿病足溃疡中的作用,还需要进一步的研究。
{"title":"Autologous cell therapy for ischemic diabetic foot: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome.","authors":"Alessia Scatena, Matteo Apicella, Michele Mantuano, Benedetta Ragghianti, Antonio Silverii, Cesare Miranda, Luca Monge, Luigi Uccioli, Germano Scevola, Eugenio Stabile, Mauro Gargiulo, Cristiana Vermigli","doi":"10.1007/s00592-024-02393-z","DOIUrl":"https://doi.org/10.1007/s00592-024-02393-z","url":null,"abstract":"<p><strong>Aim: </strong>To assess the efficacy and safety of autologous cell therapy (ACT) in patients with ischemic diabetic foot ulcers (DFU). The present meta-analysis was designed to support the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome (DFS).</p><p><strong>Methods: </strong>A Medline and Embase search were performed up to Feb 1st, 2024 collecting all RCTs including diabetic patients or reporting subgroup analyses on diabetic patients with ischemic foot ulcers comparing ACT with placebo/no therapy/standard of care (SoC), with a duration of at least 26 weeks. Prespecified endpoints were: major amputation (principal) and minor amputation, ulcer healing, time-to-healing, transcutaneous oxygen pressure (TcPO2), ankle-brachial index (ABI), pain, and all-cause mortality (secondary). Any ACT was allowed, irrespective of cell product type and route of administration (intra-arterial and intramuscular).</p><p><strong>Results: </strong>Seven studies fulfilled all inclusion criteria, all using intramuscular transplantation as route of administration, but only 2 had a follow-up greater than 26 weeks. Participants treated with ACT had a significantly lower risk of major amputations in comparison with SoC/placebo (MH-OR 0.47 [0.24, 0.92], p = 0.03). ACT was also associated with a significantly higher rate of ulcer healing (MH-OR: 10.1 [3.5, 29.6], p < 0.001), greater increase of TcPO<sub>2</sub> and ABI values (WMD: 17.57 [13.02, 22.12], p < 0.001), and reduction of pain (WMD: -1.83 [-2.32, -1.34], p = 0.003).</p><p><strong>Conclusions: </strong>ACT must be considered as a potential therapy for patients with ischemic diabetic foot ulcers. Further studies are needed to better clarify their role in the treatment and management of DFS.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The association between plasma lipidome and diabetic microangiopathy: a mendelian randomization study. 血浆脂质体与糖尿病微血管病变之间的关系:一项孟德尔随机研究。
IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-15 DOI: 10.1007/s00592-024-02414-x
Yi Wei, Jiangyi Yu

Background: Current studies have identified severe lipid metabolism diseases in diabetic microangiopathy patients, especially in diabetic kidney disease (DKD), diabetic retinopathy (DR) and diabetic neuropathy (DN), with unclear causal relationships.

Methods: We employed a large-scale dataset containing 179 lipid species as the exposure and large-scale public summary-level datasets of DKD, DR and DN as the outcome. We applied Mendelian randomization (MR) approach to explore causal associations between circulating liposomes and diabetic microangiopathy. A sequence of sensitivity tests was conducted to verify the stability of the MR analysis.

Results: We manifest that diacylglycerol (18:1_18:3) (OR = 0.716, 95%CI = 0.559-0.917, P = 0.008), triacylglycerol (OR:0.741-0.763, P < 0.05) and phosphatidylcholine (OR:0.620-1.247, P < 0.05) have a potential association with DKD. And there is a nominal causal effect of phosphatidylinositol (16:0_18:2) (OR = 0.617, 95%CI = 0.401-0.948, P = 0.028), phosphatidylcholine (OR:0.499-0.672, P < 0.05) and sphingomyelin (OR:0.652-1.850, P < 0.05) to DR. In addition, phosphatidylethanolamine (18:1_0:0) (OR = 0.616, 95%CI = 0.405-0.935, P = 0.023), diacylglycerol (16:0_18:1) (OR = 0.675, 95%CI = 0.463-0.984, P = 0.041) and phosphatidylcholine (OR = 0.720-1.619, P < 0.05) nominally associate with DN. It is noteworthy that plasma lipidome of different structures show different effects.

Conclusion: We establish a possible causal connection between certain plasma lipidome and major diabetic microangiopathies. Implementing intervention strategies targeting different lipid molecules may provide novel approaches for preventing and treating diabetic microangiopathies.

背景:目前的研究发现,糖尿病微血管病变患者,尤其是糖尿病肾病(DKD)、糖尿病视网膜病变(DR)和糖尿病神经病变(DN)患者存在严重的脂质代谢疾病,且因果关系不明确:方法:我们采用了一个包含 179 种脂质的大规模数据集作为暴露,并以 DKD、DR 和 DN 的大规模公共摘要级数据集作为结果。我们采用孟德尔随机化(MR)方法探讨了循环脂质体与糖尿病微血管病变之间的因果关系。我们进行了一系列敏感性测试,以验证 MR 分析的稳定性:结果:我们发现二酰甘油(18:1_18:3)(OR = 0.716,95%CI = 0.559-0.917,P = 0.008)、三酰甘油(OR:0.741-0.763,P 结论:我们确定了循环脂质体与糖尿病微血管病变之间可能存在的因果关系:我们确定了某些血浆脂质体与主要糖尿病微血管病变之间可能存在的因果关系。实施针对不同脂质分子的干预策略可为预防和治疗糖尿病微血管病变提供新的方法。
{"title":"The association between plasma lipidome and diabetic microangiopathy: a mendelian randomization study.","authors":"Yi Wei, Jiangyi Yu","doi":"10.1007/s00592-024-02414-x","DOIUrl":"https://doi.org/10.1007/s00592-024-02414-x","url":null,"abstract":"<p><strong>Background: </strong>Current studies have identified severe lipid metabolism diseases in diabetic microangiopathy patients, especially in diabetic kidney disease (DKD), diabetic retinopathy (DR) and diabetic neuropathy (DN), with unclear causal relationships.</p><p><strong>Methods: </strong>We employed a large-scale dataset containing 179 lipid species as the exposure and large-scale public summary-level datasets of DKD, DR and DN as the outcome. We applied Mendelian randomization (MR) approach to explore causal associations between circulating liposomes and diabetic microangiopathy. A sequence of sensitivity tests was conducted to verify the stability of the MR analysis.</p><p><strong>Results: </strong>We manifest that diacylglycerol (18:1_18:3) (OR = 0.716, 95%CI = 0.559-0.917, P = 0.008), triacylglycerol (OR:0.741-0.763, P < 0.05) and phosphatidylcholine (OR:0.620-1.247, P < 0.05) have a potential association with DKD. And there is a nominal causal effect of phosphatidylinositol (16:0_18:2) (OR = 0.617, 95%CI = 0.401-0.948, P = 0.028), phosphatidylcholine (OR:0.499-0.672, P < 0.05) and sphingomyelin (OR:0.652-1.850, P < 0.05) to DR. In addition, phosphatidylethanolamine (18:1_0:0) (OR = 0.616, 95%CI = 0.405-0.935, P = 0.023), diacylglycerol (16:0_18:1) (OR = 0.675, 95%CI = 0.463-0.984, P = 0.041) and phosphatidylcholine (OR = 0.720-1.619, P < 0.05) nominally associate with DN. It is noteworthy that plasma lipidome of different structures show different effects.</p><p><strong>Conclusion: </strong>We establish a possible causal connection between certain plasma lipidome and major diabetic microangiopathies. Implementing intervention strategies targeting different lipid molecules may provide novel approaches for preventing and treating diabetic microangiopathies.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
J-shaped association of serum uric acid with all-cause and cardiovascular mortality in patients with diabetic kidney disease. 糖尿病肾病患者血清尿酸与全因死亡率和心血管死亡率呈 "J "形关系。
IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-14 DOI: 10.1007/s00592-024-02376-0
Xinxin Zhang, Ziyue Zhang, Liyuan Gao, Bo Huang, Yue Liu, Jingqiu Cui, Junya Jia, Ming Liu

Aims: The association of serum uric acid (SUA) with mortality remains unclear in patients with diabetic kidney disease (DKD). Thus, this prospective cohort study aimed to explore the association of SUA with all-cause and cardiovascular disease (CVD) mortality among patients with DKD in a large, nationally representative sample.

Methods: This cohort study included data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 and the National Death Index mortality data until 31 December 2019. The restricted cubic spline and the Cox proportional hazards regression were conducted to describe the association of SUA with all-cause and CVD mortality and evaluate potential nonlinear associations.

Results: The analysis included 3470 patients with DKD from NHANES 1999-2018. During the follow-up time of 24,633 person-years, we recorded 1489 all-cause deaths, including 542 CVD deaths. We identified a J-shaped association of SUA with all-cause and CVD mortality. The corresponding inflection points were observed at 5.1 and 5.7 mg/dL. When SUA were higher than inflection points, each 1 mg/dL increase in SUA was linked to a 13% and 22% higher risk of all-cause (HR: 1.13; 95% CI: 1.07-1.20;P < 0.001) and CVD (HR: 1.22; 95% CI: 1.06-1.41;P = 0.006) mortality, respectively.

Conclusions: This study indicated the J-shaped association of SUA with all-cause and CVD mortality in patients with DKD. The corresponding inflection points were 5.1 mg/dL for all causes and 5.7 mg/dL for CVD, respectively. More clinical randomized trials are needed to confirm the optimal uric acid-lowering target.

目的:糖尿病肾病(DKD)患者血清尿酸(SUA)与死亡率的关系仍不明确。因此,这项前瞻性队列研究旨在通过具有全国代表性的大样本,探讨糖尿病肾脏病患者的血清尿酸与全因死亡率和心血管疾病(CVD)死亡率之间的关系:这项队列研究纳入了1999-2018年美国国家健康与营养调查(NHANES)的数据以及截至2019年12月31日的美国国家死亡指数死亡率数据。采用限制性三次样条回归和 Cox 比例危险度回归来描述 SUA 与全因死亡率和心血管疾病死亡率的关系,并评估潜在的非线性关系:分析纳入了来自1999-2018年NHANES的3470名DKD患者。在24633人年的随访期间,我们记录了1489例全因死亡,其中包括542例心血管疾病死亡。我们发现 SUA 与全因死亡率和心血管疾病死亡率呈 "J "形关联。相应的拐点出现在 5.1 和 5.7 mg/dL。当 SUA 高于拐点时,SUA 每增加 1 毫克/分升,全因死亡风险分别增加 13% 和 22% (HR:1.13;95% CI:1.07-1.20;P 结论:SUA 与心血管疾病死亡呈 J 型关系:该研究表明,SUA 与 DKD 患者的全因死亡率和心血管疾病死亡率呈 "J "形关系。相应的拐点分别为:全因死亡率为 5.1 mg/dL,心血管疾病死亡率为 5.7 mg/dL。需要更多的临床随机试验来确认最佳降尿酸目标。
{"title":"J-shaped association of serum uric acid with all-cause and cardiovascular mortality in patients with diabetic kidney disease.","authors":"Xinxin Zhang, Ziyue Zhang, Liyuan Gao, Bo Huang, Yue Liu, Jingqiu Cui, Junya Jia, Ming Liu","doi":"10.1007/s00592-024-02376-0","DOIUrl":"https://doi.org/10.1007/s00592-024-02376-0","url":null,"abstract":"<p><strong>Aims: </strong>The association of serum uric acid (SUA) with mortality remains unclear in patients with diabetic kidney disease (DKD). Thus, this prospective cohort study aimed to explore the association of SUA with all-cause and cardiovascular disease (CVD) mortality among patients with DKD in a large, nationally representative sample.</p><p><strong>Methods: </strong>This cohort study included data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 and the National Death Index mortality data until 31 December 2019. The restricted cubic spline and the Cox proportional hazards regression were conducted to describe the association of SUA with all-cause and CVD mortality and evaluate potential nonlinear associations.</p><p><strong>Results: </strong>The analysis included 3470 patients with DKD from NHANES 1999-2018. During the follow-up time of 24,633 person-years, we recorded 1489 all-cause deaths, including 542 CVD deaths. We identified a J-shaped association of SUA with all-cause and CVD mortality. The corresponding inflection points were observed at 5.1 and 5.7 mg/dL. When SUA were higher than inflection points, each 1 mg/dL increase in SUA was linked to a 13% and 22% higher risk of all-cause (HR: 1.13; 95% CI: 1.07-1.20;P < 0.001) and CVD (HR: 1.22; 95% CI: 1.06-1.41;P = 0.006) mortality, respectively.</p><p><strong>Conclusions: </strong>This study indicated the J-shaped association of SUA with all-cause and CVD mortality in patients with DKD. The corresponding inflection points were 5.1 mg/dL for all causes and 5.7 mg/dL for CVD, respectively. More clinical randomized trials are needed to confirm the optimal uric acid-lowering target.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development and external validation of a machine learning model to predict diabetic nephropathy in T1DM patients in the real-world. 开发机器学习模型并进行外部验证,以预测真实世界中 T1DM 患者的糖尿病肾病。
IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-11 DOI: 10.1007/s00592-024-02404-z
Zouxi Du, Xiaoning Liu, Jiayu Li, Hang Min, Yuhu Ma, Wenting Hua, Leyuan Zhang, Yue Zhang, Mengmeng Shang, Hui Chen, Hong Yin, Limin Tian

Aims: Studies on machine learning (ML) for the prediction of diabetic nephropathy (DN) in type 1 diabetes mellitus (T1DM) patients are rare. This study focused on the development and external validation of an explainable ML model to predict the risk of DN among individuals with T1DM.

Methods: This was a retrospective, multicenter study conducted across 19 hospitals in Gansu Province, China (No: 2022-473). In total, 1368 patients were eligible for analysis among 1633 collected T1DM patients from January 2016 to December 2023. Recursive feature elimination using random forest and fivefold cross-validation was conducted to identify key features. Among the 12 initial ML algorithms, the optimal ML model was developed and validated externally in a distinct population, and its predictive outcomes were explained via the SHapley additive exPlanations method, which offered personalized decision insights.

Results: Among the 1368 T1DM patients, 324 had DN. The extreme gradient boosting (XGBoost) model, which achieved optimal performance with an AUC of 83% (95% confidence interval [CI]: 76‒89), was selected to predict the risk of DN among T1DM patients. The DN predictive model included variables such as T1DM duration, postprandial glucose (PPG), systolic blood pressure (SBP), glycated hemoglobin (HbA1c), serum creatinine (Scr) and low-density lipoprotein cholesterol (LDL-C). External validation confirmed the reliability of the model, with an AUC of 76% (95% CI: 70‒82).

Conclusions: The ML prediction tool has potential for advancing early and precise identification of the risk of DN among T1DM patients. Although successful external validation indicated that the developed model can provide a promising strategy for clinical adoption and help improve patient outcomes through timely and accurate risk assessment, additional prospective data and further validation in diverse populations are necessary.

目的:有关机器学习(ML)预测1型糖尿病(T1DM)患者糖尿病肾病(DN)的研究很少见。本研究的重点是开发一种可解释的 ML 模型并进行外部验证,以预测 T1DM 患者的 DN 风险:这是一项回顾性多中心研究,在中国甘肃省的 19 家医院进行(编号:2022-473)。在2016年1月至2023年12月收集的1633名T1DM患者中,共有1368名患者符合分析条件。利用随机森林和五倍交叉验证进行递归特征消除,以确定关键特征。在12种初始ML算法中,开发了最佳ML模型,并在不同人群中进行了外部验证,其预测结果通过SHapley加法前计划方法进行了解释,从而提供了个性化的决策见解:在 1368 名 T1DM 患者中,有 324 人患有 DN。极端梯度提升(XGBoost)模型的AUC为83%(95%置信区间[CI]:76-89),达到最佳性能,被用于预测T1DM患者的DN风险。DN 预测模型包括 T1DM 病程、餐后血糖 (PPG)、收缩压 (SBP)、糖化血红蛋白 (HbA1c)、血清肌酐 (Scr) 和低密度脂蛋白胆固醇 (LDL-C) 等变量。外部验证证实了模型的可靠性,AUC 为 76%(95% CI:70-82):ML预测工具具有推动早期精确识别T1DM患者DN风险的潜力。虽然成功的外部验证表明所开发的模型可以为临床应用提供一种有前景的策略,并通过及时准确的风险评估帮助改善患者的预后,但还需要更多的前瞻性数据和在不同人群中的进一步验证。
{"title":"Development and external validation of a machine learning model to predict diabetic nephropathy in T1DM patients in the real-world.","authors":"Zouxi Du, Xiaoning Liu, Jiayu Li, Hang Min, Yuhu Ma, Wenting Hua, Leyuan Zhang, Yue Zhang, Mengmeng Shang, Hui Chen, Hong Yin, Limin Tian","doi":"10.1007/s00592-024-02404-z","DOIUrl":"https://doi.org/10.1007/s00592-024-02404-z","url":null,"abstract":"<p><strong>Aims: </strong>Studies on machine learning (ML) for the prediction of diabetic nephropathy (DN) in type 1 diabetes mellitus (T1DM) patients are rare. This study focused on the development and external validation of an explainable ML model to predict the risk of DN among individuals with T1DM.</p><p><strong>Methods: </strong>This was a retrospective, multicenter study conducted across 19 hospitals in Gansu Province, China (No: 2022-473). In total, 1368 patients were eligible for analysis among 1633 collected T1DM patients from January 2016 to December 2023. Recursive feature elimination using random forest and fivefold cross-validation was conducted to identify key features. Among the 12 initial ML algorithms, the optimal ML model was developed and validated externally in a distinct population, and its predictive outcomes were explained via the SHapley additive exPlanations method, which offered personalized decision insights.</p><p><strong>Results: </strong>Among the 1368 T1DM patients, 324 had DN. The extreme gradient boosting (XGBoost) model, which achieved optimal performance with an AUC of 83% (95% confidence interval [CI]: 76‒89), was selected to predict the risk of DN among T1DM patients. The DN predictive model included variables such as T1DM duration, postprandial glucose (PPG), systolic blood pressure (SBP), glycated hemoglobin (HbA1c), serum creatinine (Scr) and low-density lipoprotein cholesterol (LDL-C). External validation confirmed the reliability of the model, with an AUC of 76% (95% CI: 70‒82).</p><p><strong>Conclusions: </strong>The ML prediction tool has potential for advancing early and precise identification of the risk of DN among T1DM patients. Although successful external validation indicated that the developed model can provide a promising strategy for clinical adoption and help improve patient outcomes through timely and accurate risk assessment, additional prospective data and further validation in diverse populations are necessary.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correction: SARS-CoV-2 booster vaccination does not worsen glycemia in people with type 1 diabetes using insulin pumps: an observational study. 更正:使用胰岛素泵的 1 型糖尿病患者接种 SARS-CoV-2 加强型疫苗不会恶化血糖:一项观察性研究。
IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-11 DOI: 10.1007/s00592-024-02382-2
Braden Engelbogen, Laura Donaldson, Sybil A McAuley, Spiros Fourlanos
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Acta Diabetologica
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