Acta Diabetologica最新文献

Aims: Continuous glucose monitoring (CGM) benefits pregnant women with type 1 or type 2 diabetes, but its role in gestational diabetes (GDM) remains uncertain. We aimed to compare the effects of CGM with self-monitoring of blood glucose (SMBG) on glycemic, maternal, and neonatal outcomes in women with GDM.

Methods: We compared CGM with SMBG in women with GDM through a systematic search across randomized controlled trials (RCTs) in PubMed, Cochrane Library, Embase, and Scopus. We evaluated glycemic, maternal and neonatal outcomes using a random-effects model.

Results: Eleven RCTs (n = 1225) met inclusion criteria. The use of CGM increased the likelihood of achieving appropriate maternal weight gain (RR 1.37, 95% CI 1.02 to 1.82; I² = 0%) and reduced mean neonatal birth weight (MD - 122.79 g, 95% CI - 189.78 to - 55.79; I² = 0%). CGM use did not change maternal time in range (TIR), time above range (TAR), time below range (TBR), glycated hemoglobin, gestational hypertension, cesarean delivery, macrosomia, preterm delivery, neonatal hypoglycemia, or neonatal intensive care unit admissions.

Conclusions: In women with GDM, the use of CGM improved the likelihood of appropriate maternal weight gain and lowered neonatal birth weight compared with SMBG, but it did not improve overall glycemic control or other maternal and fetal outcomes.

Trial registration: PROSPERO CRD420251044960 (registered 2025).

Objective: Long-term exposure to air pollution and the presence of depressive symptoms have been associated with an increased prevalence of cardio-metabolic multimorbidity (CMM). However, their associations with CMM among middle-aged and older adults in China remain underexplored. This study aimed to examine the associations of air pollution exposure and depressive symptoms with CMM, and test for potential interactions between these factors, providing evidence to inform public health strategies.

Methods: This cross-sectional study analyzes health data from 8,192 residents aged 45 and older from the 2015 China Health and Retirement Longitudinal Study (CHARLS). CMM is defined as the presence of multiple conditions, including heart disease, diabetes, hypertension, and stroke. Depressive symptoms were assessed using a standardized self-report scale, and air pollution exposure was estimated using satellite-based spatiotemporal models, including PM₁, PM_2.5, PM₁₀, SO₂, NO₂, and O₃. Generalized Linear Models (GLM) were used to examine the relationship between air pollution, depressive symptoms, and CMM. Interaction analysis tested whether depressive symptoms modified the association between air pollution and CMM. Sensitivity analysis was conducted using air pollution data from different time windows to validate the robustness of the results, and multiple imputation was employed to handle missing data.

Results: The prevalence of CMM in this study was 15.82%. PM_2.5, PM₁₀, and SO₂ significantly increased the risk of CMM, with ORs of 1.140 (95% CI: 1.073, 1.211, P < 0.01), 1.192 (95% CI: 1.124, 1.265, P < 0.01), and 1.154 (95% CI: 1.089, 1.223, P < 0.01), respectively. After adjusting for sociodemographic and lifestyle factors, these associations remained statistically significant. Depressive symptoms were independently associated with an increased risk of CMM (P < 0.01). No statistically significant interaction between depressive symptoms and air pollutants was observed (all P-interaction > 0.05), indicating that these two factors exert independent effects on CMM risk.

Conclusion: Long-term exposure to air pollution, particularly PM_2.5, PM₁₀, and SO₂, was significantly associated with a higher risk of CMM. Depressive symptoms were also independently linked to increased CMM risk. Although we hypothesized potential synergistic effects, statistical analyses revealed no significant interaction between depressive symptoms and air pollutants (all P-interaction > 0.05), indicating that these factors operate through independent pathways. Integrating both air quality control and mental health interventions into chronic disease prevention strategies could help reduce the overall CMM burden.

Background: Patients with diabetes mellitus are at high risk for coronary artery disease and frequently undergo coronary artery bypass grafting (CABG). Off-pump CABG (OPCAB) has been proposed to reduce perioperative complications compared with on-pump CABG (ONCAB), but long-term outcomes remain uncertain.

Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 and Cochrane guidelines. Five databases were searched through May 2025 for randomized trials and observational cohorts comparing OPCAB and ONCAB in adults with diabetes. Risk of bias was assessed using RoB-2 and ROBINS-I, and evidence quality was graded with GRADE.

Results: Seventeen studies were included. No significant differences were observed in 30-day (RR = 0.82, 95% CI: 0.51-1.31; I² = 64%), 1-year (RR = 0.93, 95% CI: 0.56-1.55; I² = 65.6%), or 5-year mortality (RR = 1.09, 95% CI: 0.78-1.53; I² = 58.8%). Randomized data suggested a possible increase in late mortality with OPCAB. OPCAB was associated with lower rates of cerebrovascular events, pulmonary complications, reoperation for bleeding, prolonged ventilation, and intensive care unit stay. No differences were found in myocardial infarction, renal failure, atrial fibrillation, or sternal wound infection. Incomplete revascularization occurred more frequently with OPCAB (RR = 1.96, 95% CI: 1.28-3.0).

Conclusions: In diabetic patients undergoing CABG, OPCAB may reduce postoperative morbidity without altering overall survival. These findings underscore the need to balance perioperative benefits against potential long-term risks when selecting the surgical approach.

Aims: Aimed to investigate the associations of serum urate with all-cause and cause-specific mortality in diabetes and to assess whether estimated glomerular filtration rate (eGFR) mediates these associations.

Methods: We analyzed 18,809 UK Biobank participants with diabetes, free of CVD or cancer at baseline, followed for a median of 13.5 (12.8-14.4) years. Cox and Fine-Gray models estimated mortality risks, restricted cubic splines assessed nonlinear associations, and Aalen additive hazards models evaluated mediation.

Results: During follow-up, 2984 deaths occurred (739 CVD, 1065 cancer). Compared with the lowest urate quartile (< 4.6 mg/dL), participants in the highest quartile (> 6.3 mg/dL) had significantly higher risks of all-cause mortality (HR = 1.329, 95% CI 1.190-1.485), CVD mortality (HR = 1.391, 95% CI 1.115-1.736), cancer mortality (HR = 1.258, 95% CI 1.042-1.518), and other-cause mortality (HR = 1.245, 95% CI 1.042-1.487). A J-shaped association was observed, with all-cause mortality rising above 5.4 mg/dL of urate. Sex-stratified analyses revealed higher inflection points in males than females (7.2 mg/dL vs. 5.7 mg/dL). Mediation analysis indicated that eGFR explained 36.4% of the association between urate and all-cause mortality, with an indirect effect of 10 (95% CI 4.5-15.2) events per 1,000 person-years.

Conclusions: Elevated serum urate, even within the normal range, was independently associated with all-cause and cause-specific mortality in diabetes, partly mediated by reduced eGFR. These findings support considering subclinical hyperuricemia in risk stratification, especially among individuals with early-stage diabetes and preserved metabolic and renal function.