Acta Diabetologica最新文献

Aims: Neonatal diabetes mellitus (NDM) occurs before 6-12 months of age and is commonly caused by activating mutations in KCNJ11 (KCNJ11-NDM) or ABCC8. Because of brain expression of these mutant ATP-dependent potassium channels, a spectrum of divergent neurodevelopmental difficulties have been described, including developmental delay, epilepsy, and neonatal diabetes (DEND). However, information on anxiety, social responsiveness, and grit is limited.

Methods: Individuals with KCNJ11-NDM (N = 12) and their unaffected siblings (N = 12) were recruited through the University of Chicago Monogenic Diabetes Registry and participants or their parent/caregiver completedthe Screen for Adult/Child Anxiety Related Disorder (SCAARED/SCARED), the Social Responsiveness Scale, Second Edition (SRS-2), and the Grit Scale.

Results: Mean SRS-2 scores were significantly different between KCNJ11-NDM and sibling controls (P = <0.001 ), with 7/10 affected participants, and 0 /11 siblings, having scores suggestive of autism spectrum disorder (ASD). Differences in anxiety (P = 0.69) and grit (P = 0.46) were not significant when compared to sibling controls; however, 58% (7/12) of KCNJ11-NDM participants and 40% (4/10) of sibling controls had scores indicating an anxiety disorder by either self- or parent-report.

Conclusions: Our results agree with previous studies suggesting significant difficulties with social functioning in KCNJ11-NDM, with 7/10 participants having scores suggestive of ASD, strongly reinforcing the need for early neurodevelopmental screening to allow for prompt support. Our report adds to the knowledge of this population in finding robust grit scores but with a high level of anxiety in both KCNJ11-NDM and unaffected siblings. Although families affected by KCNJ11-NDM may have a high risk of anxiety disorders, it is encouraging that affected and unaffected children exhibit robust self-resiliency that will help support functioning through the challenges of life. Study of additional individuals will help to clarify specific challenges, long-term outcomes, and best approaches for monitoring and support.

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.