Pub Date : 2025-08-02DOI: 10.1007/s00592-025-02562-8
Giuseppe Murdolo, Francesco Gaggia, Eleonora Bianchini, Matteo Monami, Cesare Miranda, Luca Monge, Luigi Uccioli, Mauro Gargiulo, Alessia Scatena, Germano Scevola, Eugenio Stabile, Cristiana Vermigli
Background and aims: Dual pathway inhibition (DPI) with aspirin and low-dose rivaroxaban (LDR) has shown benefits in reducing major adverse cardiovascular (MACEs) and limb (MALEs) events in patients with lower extremity peripheral artery disease (LE-PAD). This study aimed to determine whether DPI is preferable to anti-platelet therapy alone in reducing adverse outcomes in diabetic patients with "symptomatic" LE-PAD and to assess the safety of DPI, specifically bleeding risks. The findings aim to support development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome.
Methods: A Medline and Embase search was conducted through October 31, 2024, to identify RCTs comparing DPI with anti-platelet therapy in diabetic patients with symptomatic LE-PAD. Key efficacy outcomes included MALEs, MACE, and a composite of cardiovascular death, myocardial infarction, ischemic stroke, acute limb ischemia, and major amputation. Safety outcomes primarily focused on major bleeding and fatal/critical organ bleeding. Mantel-Haenzel odds ratios and 95% confidence intervals (MH-OR, 95%CI) were calculated.
Results: From a total 153 items retrieved, 4 studies were assessed for eligibility; however only one study met the inclusion criteria for efficacy and safety outcomes component of the review. Due to lack of disaggregated data, efficacy and safety outcomes were estimated indirectly through proportional calculations. DPI demonstrated a reduced risk of MALEs [MH-OR 0.52; (95% CI 0.26-1.06)], MACE or MALE [MH-OR 0.67; (95% CI 0.45-1.00)], and the overall composite (MH-OR 0.70 [95% CI, 0.46-1.05]) compared to aspirin alone. A similar pattern was observed for MACE [MH-OR 0.70; (95% CI 0.44-1.11)]. While DPI did not significantly increase the risk of major or fatal/critical organ bleeding, a trend towards lower major bleeding rate in favor of aspirin was found. The net clinical benefit favored DPI (MH-OR 0.55 [95%CI, 0.36-0.84]).
Conclusions: In diabetic patients with symptomatic LE-PAD, LDR plus aspirin is preferable to aspirin alone in reducing cardiovascular and limb outcomes, with acceptable bleeding risk.
背景和目的：阿司匹林和低剂量利伐沙班（LDR）的双途径抑制（DPI）在减少下肢外周动脉疾病（LE-PAD）患者的主要不良心血管（mace）和肢体（男性）事件方面显示出益处。本研究旨在确定DPI在减少伴有“症状性”LE-PAD的糖尿病患者的不良结局方面是否优于单独抗血小板治疗，并评估DPI的安全性，特别是出血风险。研究结果旨在支持意大利糖尿病足综合征治疗指南的制定。方法：通过Medline和Embase检索到2024年10月31日，以确定比较DPI与抗血小板治疗对症状性LE-PAD糖尿病患者的rct。主要疗效指标包括男性、MACE、心血管死亡、心肌梗死、缺血性卒中、急性肢体缺血和主要截肢。安全性结果主要集中在大出血和致命/关键器官出血。计算了Mantel-Haenzel比值比和95%置信区间（MH-OR, 95% ci）。结果：从153个检索条目中，4项研究被评估为合格；然而，只有一项研究符合疗效和安全性结果部分的纳入标准。由于缺乏分类数据，疗效和安全性结果通过比例计算间接估计。DPI显示男性的风险降低[MH-OR 0.52；（95% CI 0.26-1.06）]， MACE或MALE [MH-OR 0.67；（95% CI 0.45-1.00）]，与单独服用阿司匹林相比，整体组合（MH-OR 0.70 [95% CI, 0.46-1.05]）。MACE也有类似的模式[MH-OR 0.70；（95% ci 0.44-1.11）]。虽然DPI没有显著增加主要或致命/关键器官出血的风险，但发现阿司匹林有利于降低主要出血率的趋势。净临床获益有利于DPI （MH-OR 0.55 [95%CI, 0.36-0.84]）。结论：在伴有症状性LE-PAD的糖尿病患者中，LDR加阿司匹林在降低心血管和肢体预后方面优于阿司匹林单用，出血风险可接受。
{"title":"Dual pathway inhibition versus antiplatelet therapy for \"symptomatic\" lower-extremities peripheral artery disease in diabetes mellitus: a systematic review and a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome.","authors":"Giuseppe Murdolo, Francesco Gaggia, Eleonora Bianchini, Matteo Monami, Cesare Miranda, Luca Monge, Luigi Uccioli, Mauro Gargiulo, Alessia Scatena, Germano Scevola, Eugenio Stabile, Cristiana Vermigli","doi":"10.1007/s00592-025-02562-8","DOIUrl":"https://doi.org/10.1007/s00592-025-02562-8","url":null,"abstract":"<p><strong>Background and aims: </strong>Dual pathway inhibition (DPI) with aspirin and low-dose rivaroxaban (LDR) has shown benefits in reducing major adverse cardiovascular (MACEs) and limb (MALEs) events in patients with lower extremity peripheral artery disease (LE-PAD). This study aimed to determine whether DPI is preferable to anti-platelet therapy alone in reducing adverse outcomes in diabetic patients with \"symptomatic\" LE-PAD and to assess the safety of DPI, specifically bleeding risks. The findings aim to support development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome.</p><p><strong>Methods: </strong>A Medline and Embase search was conducted through October 31, 2024, to identify RCTs comparing DPI with anti-platelet therapy in diabetic patients with symptomatic LE-PAD. Key efficacy outcomes included MALEs, MACE, and a composite of cardiovascular death, myocardial infarction, ischemic stroke, acute limb ischemia, and major amputation. Safety outcomes primarily focused on major bleeding and fatal/critical organ bleeding. Mantel-Haenzel odds ratios and 95% confidence intervals (MH-OR, 95%CI) were calculated.</p><p><strong>Results: </strong>From a total 153 items retrieved, 4 studies were assessed for eligibility; however only one study met the inclusion criteria for efficacy and safety outcomes component of the review. Due to lack of disaggregated data, efficacy and safety outcomes were estimated indirectly through proportional calculations. DPI demonstrated a reduced risk of MALEs [MH-OR 0.52; (95% CI 0.26-1.06)], MACE or MALE [MH-OR 0.67; (95% CI 0.45-1.00)], and the overall composite (MH-OR 0.70 [95% CI, 0.46-1.05]) compared to aspirin alone. A similar pattern was observed for MACE [MH-OR 0.70; (95% CI 0.44-1.11)]. While DPI did not significantly increase the risk of major or fatal/critical organ bleeding, a trend towards lower major bleeding rate in favor of aspirin was found. The net clinical benefit favored DPI (MH-OR 0.55 [95%CI, 0.36-0.84]).</p><p><strong>Conclusions: </strong>In diabetic patients with symptomatic LE-PAD, LDR plus aspirin is preferable to aspirin alone in reducing cardiovascular and limb outcomes, with acceptable bleeding risk.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768272","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}
Pub Date : 2025-08-01DOI: 10.1007/s00592-025-02571-7
Yunlan Zhou, Bingqian Zhou, Xing Ke, Yanhui Ma
Aims
Glucokinase activators (GKAs) lower glucose by directly activating glucokinase (GK) or dissociating it from GK regulatory protein (GK-GKRP). Their long-term effects on gastrointestinal (GI) diseases remain unclear. This study explores how two approaches influence GI disorders through metabolic-immune interplay.
Methods
We used genetic variants near GCK and GCKR associated with fasting glucose as proxies for direct GK activation and GK-GKRP dissociation. Using Mendelian Randomization and meta-analysis, we assessed their associations with 20 GI diseases and explored mediation by lipid traits and inflammatory proteins (pQTL). MR-prioritized lipid and immune mediators underwent multi-omics analysis including functional enrichment, protein-protein interaction networks, single-cell RNA sequencing (scRNA-seq) and Cellchat in disease models, investigating metabolic-immune interactions and intercellular signaling.
Results
Direct GK activation and GK-GKRP dissociation exerted distinct causal effects on GI diseases. GK-GKRP dissociation increased risks of irritable bowel syndrome, Crohn’s disease, ulcerative colitis, beyond its established association with metabolic dysfunction-associated steatotic liver disease (MASLD). Lipid traits and inflammatory proteins interconnected through PPAR and NF-κB signaling, mediating GCKR’s associations with GI diseases. Key mediators such as FGF-21, CSF1, CD40, CXCL9 were localized to disease-specific niches in MASLD and IBD scRNA-seq models, highlighting GCKR-centered metabolic-immune crosstalk. Intercellular communication via CSF, CXCL, CCL, TGFβ, Visfatin, Galectin, and MIF signaling linked immune, parenchymal, and stromal cells in disease pathogenesis.
Conclusions
GK-GKRP dissociation, but not direct GK activation, increases IBD and MASLD risks through metabolic-immune interplay in gut-liver axis. Tailoring GKA therapies for patients with comorbidities is essential.
{"title":"Glucokinase activators contribute to gastrointestinal disease risks through metabolic-immune interplay in the gut-liver axis: insights from a multi-omics study","authors":"Yunlan Zhou, Bingqian Zhou, Xing Ke, Yanhui Ma","doi":"10.1007/s00592-025-02571-7","DOIUrl":"10.1007/s00592-025-02571-7","url":null,"abstract":"<div><h3>Aims</h3><p>Glucokinase activators (GKAs) lower glucose by directly activating glucokinase (GK) or dissociating it from GK regulatory protein (GK-GKRP). Their long-term effects on gastrointestinal (GI) diseases remain unclear. This study explores how two approaches influence GI disorders through metabolic-immune interplay.</p><h3>Methods</h3><p>We used genetic variants near <i>GCK</i> and <i>GCKR</i> associated with fasting glucose as proxies for direct GK activation and GK-GKRP dissociation. Using Mendelian Randomization and meta-analysis, we assessed their associations with 20 GI diseases and explored mediation by lipid traits and inflammatory proteins (pQTL). MR-prioritized lipid and immune mediators underwent multi-omics analysis including functional enrichment, protein-protein interaction networks, single-cell RNA sequencing (scRNA-seq) and Cellchat in disease models, investigating metabolic-immune interactions and intercellular signaling.</p><h3>Results</h3><p>Direct GK activation and GK-GKRP dissociation exerted distinct causal effects on GI diseases. GK-GKRP dissociation increased risks of irritable bowel syndrome, Crohn’s disease, ulcerative colitis, beyond its established association with metabolic dysfunction-associated steatotic liver disease (MASLD). Lipid traits and inflammatory proteins interconnected through PPAR and NF-κB signaling, mediating <i>GCKR</i>’s associations with GI diseases. Key mediators such as FGF-21, CSF1, CD40, CXCL9 were localized to disease-specific niches in MASLD and IBD scRNA-seq models, highlighting <i>GCKR</i>-centered metabolic-immune crosstalk. Intercellular communication via CSF, CXCL, CCL, TGFβ, Visfatin, Galectin, and MIF signaling linked immune, parenchymal, and stromal cells in disease pathogenesis.</p><h3>Conclusions</h3><p>GK-GKRP dissociation, but not direct GK activation, increases IBD and MASLD risks through metabolic-immune interplay in gut-liver axis. Tailoring GKA therapies for patients with comorbidities is essential.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"62 12","pages":"2187 - 2202"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758874","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}
Pub Date : 2025-08-01DOI: 10.1007/s00592-025-02567-3
Miriam Longo, Michela Petrizzo, Paola Caruso, Maria Ida Maiorino, Katherine Esposito
{"title":"Smart insulin pen after pancreatectomy: a successful strategy for managing type 3c diabetes","authors":"Miriam Longo, Michela Petrizzo, Paola Caruso, Maria Ida Maiorino, Katherine Esposito","doi":"10.1007/s00592-025-02567-3","DOIUrl":"10.1007/s00592-025-02567-3","url":null,"abstract":"","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"62 11","pages":"2037 - 2041"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758875","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}
Pub Date : 2025-07-31DOI: 10.1007/s00592-025-02557-5
Xuelin He, Yichen Wu, Guanghui Ying, Min Xia, Qien He, Zhaogui Chen, Qiao Zhang, Li Liu, Xia Liu, Yongtao Li
Background
Diabetic nephropathy (DN) is a prevalent and serious complication of diabetes, characterized by high incidence and significant morbidity. Despite growing evidence that the tricarboxylic acid (TCA) cycle plays a crucial role in DN progression, the diagnostic potential of TCA-related genes has yet to be fully explored.
Methods
This study began by analyzing the GSE131882 dataset to reveal the expression patterns of TCA-related genes in various renal cell types and to identify genes that differ in expression between high and low subgroups. The GSE30122 dataset was then examined to identify genes with differential expression in DN. Single-sample gene set enrichment analysis (ssGSEA) and weighted gene co-expression network analysis (WGCNA) were applied to pinpoint TCA-related gene modules. Following this, multiple machine learning techniques were employed to analyze the TCA gene set that showed differential expression at both cellular and sample levels, allowing us to identify the hub genes. A diagnostic model was constructed, with its effectiveness validated through ROC analysis. The immune landscape of DN was assessed using ssGSEA. GeneMANIA and NetworkAnalyst were also utilized to predict genes with similar functions, as well as miRNAs and transcription factors (TFs) that may regulate these diagnostic genes. Finally, single-cell RNA sequencing (scRNA-seq) data confirmed the expression patterns of these genes.
Results
Two TCA-related genes, HPGD and G6PC, were identified as potential diagnostic markers for DN. ROC analysis demonstrated that these genes and their predictive model exhibited strong diagnostic performance in both training and validation cohorts. Immune landscape analysis revealed a more active immune microenvironment in DN patients compared to controls. Additionally, 59 miRNAs and 15 TFs were predicted to regulate the expression of HPGD and G6PC, along with 20 functionally related genes. scRNA-seq data highlighted that HPGD and G6PC are predominantly expressed in glomerular and proximal tubular cells.
Conclusion
Two reliable TCA-related biomarkers were pinpointed, potentially advancing early diagnosis and management of DN.
{"title":"Identification and validation of tricarboxylic acid cycle-related diagnostic biomarkers for diabetic nephropathy via weighted gene co-expression network analysis and single-cell transcriptome analysis","authors":"Xuelin He, Yichen Wu, Guanghui Ying, Min Xia, Qien He, Zhaogui Chen, Qiao Zhang, Li Liu, Xia Liu, Yongtao Li","doi":"10.1007/s00592-025-02557-5","DOIUrl":"10.1007/s00592-025-02557-5","url":null,"abstract":"<div><h3>Background</h3><p>Diabetic nephropathy (DN) is a prevalent and serious complication of diabetes, characterized by high incidence and significant morbidity. Despite growing evidence that the tricarboxylic acid (TCA) cycle plays a crucial role in DN progression, the diagnostic potential of TCA-related genes has yet to be fully explored.</p><h3>Methods</h3><p>This study began by analyzing the GSE131882 dataset to reveal the expression patterns of TCA-related genes in various renal cell types and to identify genes that differ in expression between high and low subgroups. The GSE30122 dataset was then examined to identify genes with differential expression in DN. Single-sample gene set enrichment analysis (ssGSEA) and weighted gene co-expression network analysis (WGCNA) were applied to pinpoint TCA-related gene modules. Following this, multiple machine learning techniques were employed to analyze the TCA gene set that showed differential expression at both cellular and sample levels, allowing us to identify the hub genes. A diagnostic model was constructed, with its effectiveness validated through ROC analysis. The immune landscape of DN was assessed using ssGSEA. GeneMANIA and NetworkAnalyst were also utilized to predict genes with similar functions, as well as miRNAs and transcription factors (TFs) that may regulate these diagnostic genes. Finally, single-cell RNA sequencing (scRNA-seq) data confirmed the expression patterns of these genes.</p><h3>Results</h3><p>Two TCA-related genes, HPGD and G6PC, were identified as potential diagnostic markers for DN. ROC analysis demonstrated that these genes and their predictive model exhibited strong diagnostic performance in both training and validation cohorts. Immune landscape analysis revealed a more active immune microenvironment in DN patients compared to controls. Additionally, 59 miRNAs and 15 TFs were predicted to regulate the expression of HPGD and G6PC, along with 20 functionally related genes. scRNA-seq data highlighted that HPGD and G6PC are predominantly expressed in glomerular and proximal tubular cells.</p><h3>Conclusion</h3><p>Two reliable TCA-related biomarkers were pinpointed, potentially advancing early diagnosis and management of DN.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"62 12","pages":"2171 - 2185"},"PeriodicalIF":2.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144751997","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}
Background: Diabetic nephropathy (DN) is one of the most abundant microangiopathy complications among diabetic patients. Gut dysbiosis and the correlation with dietary factors in diabetic participants is undeniable. This study aims to evaluate the alteration of intestinal microbiota and its association with dietary indices, including dietary total antioxidant capacity (dTAC), dietary inflammatory index (DII), and alternative healthy eating index (AHEI) scores among healthy controls (HC) and diabetic participants with and without DN.
Methods: The participants were categorized into type 2 diabetes mellitus (T2DM) group, DN group, and HC group. The intestinal microbiota was assessed using a quantitative real-time polymerase chain reaction (qPCR) method targeting the bacterial 16 S rRNA gene. Dietary data were obtained using a 168-item semi-quantitative food frequency questionnaire (FFQ).
Results: A higher level of Escherichia, Prevotella, Facalibacterium, and Bacteroides was observed among the HC group than the T2DM and DN individuals. Higher AHEI was observed in the DN group than T2DM group. Lower DII was seen among the T2DM group compared to the HC and DN groups. dTAC index had no significant differences between the studied groups. Furthermore, in the HC group, dTAC showed a marginally significant positive correlation with Bacteroides. dTAC was negatively correlated with Lactobacillus in T2DM subjects. In the whole studied population, a marginally significant positive correlation between Prevotella and dTAC and DII was observed.
Conclusions: Alterations in the intestinal microbiota were observed in participants suffering from T2DM and DN. Furthermore, some intestinal microbiota were associated with AHEI, DII, and dTAC dietary indices.
{"title":"Preliminary investigation on the association of dietary total antioxidant capacity, alternative healthy eating index, and dietary inflammatory index with intestinal microbiota in patients with diabetic nephropathy.","authors":"Fatemeh Zali, Solaleh Emamgholipour, Akram Vatannejad, Seyed Dawood Mousavi Nasab, Abdorrahim Absalan, Hanieh-Sadat Ejtahed, Ensieh Nasli-Esfahani, Nayebali Ahmadi, Seyed Davar Siadat, Parvin Pasalar, Farideh Razi, Fataneh Esmaeili","doi":"10.1007/s00592-025-02568-2","DOIUrl":"10.1007/s00592-025-02568-2","url":null,"abstract":"<p><strong>Background: </strong>Diabetic nephropathy (DN) is one of the most abundant microangiopathy complications among diabetic patients. Gut dysbiosis and the correlation with dietary factors in diabetic participants is undeniable. This study aims to evaluate the alteration of intestinal microbiota and its association with dietary indices, including dietary total antioxidant capacity (dTAC), dietary inflammatory index (DII), and alternative healthy eating index (AHEI) scores among healthy controls (HC) and diabetic participants with and without DN.</p><p><strong>Methods: </strong>The participants were categorized into type 2 diabetes mellitus (T2DM) group, DN group, and HC group. The intestinal microbiota was assessed using a quantitative real-time polymerase chain reaction (qPCR) method targeting the bacterial 16 S rRNA gene. Dietary data were obtained using a 168-item semi-quantitative food frequency questionnaire (FFQ).</p><p><strong>Results: </strong>A higher level of Escherichia, Prevotella, Facalibacterium, and Bacteroides was observed among the HC group than the T2DM and DN individuals. Higher AHEI was observed in the DN group than T2DM group. Lower DII was seen among the T2DM group compared to the HC and DN groups. dTAC index had no significant differences between the studied groups. Furthermore, in the HC group, dTAC showed a marginally significant positive correlation with Bacteroides. dTAC was negatively correlated with Lactobacillus in T2DM subjects. In the whole studied population, a marginally significant positive correlation between Prevotella and dTAC and DII was observed.</p><p><strong>Conclusions: </strong>Alterations in the intestinal microbiota were observed in participants suffering from T2DM and DN. Furthermore, some intestinal microbiota were associated with AHEI, DII, and dTAC dietary indices.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144751998","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}
Pub Date : 2025-07-30DOI: 10.1007/s00592-025-02572-6
Miaojin Hu, Michael H. Le, Yee Hui Yeo, Karn Wijarnpreecha, Alisa Likhitsup, Donghee Kim, Vincent L. Chen
Background
Diabetes is a leading cause of morbidity and mortality in the United States. We aimed to characterize secular trends in diabetes prevalence, control of glucose and associated comorbidities, and medication use.
Methods
This was a retrospective analysis of National Health and Nutrition Examination Series data from 2001 to 2023. We focused on three outcomes: (1) prevalence of diabetes defined by known diagnosis, hemoglobin A1c ≥ 6.5%, or fasting glucose ≥ 126 mg/dL, and among individuals with diabetes (2) control of glucose levels, low-density lipoprotein, and blood pressure and (3) medication therapy. Predictors were cycle (year) and demographics, specifically age, sex, race/ethnicity, educational level, and household income.
Results
We included 27,437 participants of whom 3467 had diagnosed diabetes and an additional 1602 had undiagnosed diabetes. Diabetes prevalence increased from 10.0% in 2001–2002 to 15.1% in 2021–2023 and was higher in men versus women, and Hispanic/Latino or non-Hispanic Black vs. non-Hispanic White participants. Glycemic control declined over time, from 61.5 to 44.9% having hemoglobin A1c < 7% in 2001–2002 vs. 2021–2023; control was lower in younger participants and those with lower educational attainment. Lipid control improved over time but remained poor: 73.1% had low-density lipoprotein ≥ 70 mg/dL in 2017–2020, and only half of these individuals were taking a statin. There were no significant changes over time in blood pressure control, with 44–56% having blood pressure ≥ 130/80 mmHg. Other than lower lipid control in women, we did not observe differences in control of lipids or blood pressure, or in medication treatment, based on sex and race/ethnicity.
Discussion
Diabetes has increased in prevalence from 2001 to 2023 and management of hyperglycemia and associated risk factors remains inadequate.
{"title":"Diabetes prevalence and management patterns in US adults, 2001–2023","authors":"Miaojin Hu, Michael H. Le, Yee Hui Yeo, Karn Wijarnpreecha, Alisa Likhitsup, Donghee Kim, Vincent L. Chen","doi":"10.1007/s00592-025-02572-6","DOIUrl":"10.1007/s00592-025-02572-6","url":null,"abstract":"<div><h3>Background</h3><p>Diabetes is a leading cause of morbidity and mortality in the United States. We aimed to characterize secular trends in diabetes prevalence, control of glucose and associated comorbidities, and medication use.</p><h3>Methods</h3><p>This was a retrospective analysis of National Health and Nutrition Examination Series data from 2001 to 2023. We focused on three outcomes: (1) prevalence of diabetes defined by known diagnosis, hemoglobin A1c ≥ 6.5%, or fasting glucose ≥ 126 mg/dL, and among individuals with diabetes (2) control of glucose levels, low-density lipoprotein, and blood pressure and (3) medication therapy. Predictors were cycle (year) and demographics, specifically age, sex, race/ethnicity, educational level, and household income.</p><h3>Results</h3><p>We included 27,437 participants of whom 3467 had diagnosed diabetes and an additional 1602 had undiagnosed diabetes. Diabetes prevalence increased from 10.0% in 2001–2002 to 15.1% in 2021–2023 and was higher in men versus women, and Hispanic/Latino or non-Hispanic Black vs. non-Hispanic White participants. Glycemic control declined over time, from 61.5 to 44.9% having hemoglobin A1c < 7% in 2001–2002 vs. 2021–2023; control was lower in younger participants and those with lower educational attainment. Lipid control improved over time but remained poor: 73.1% had low-density lipoprotein ≥ 70 mg/dL in 2017–2020, and only half of these individuals were taking a statin. There were no significant changes over time in blood pressure control, with 44–56% having blood pressure ≥ 130/80 mmHg. Other than lower lipid control in women, we did not observe differences in control of lipids or blood pressure, or in medication treatment, based on sex and race/ethnicity.</p><h3>Discussion</h3><p>Diabetes has increased in prevalence from 2001 to 2023 and management of hyperglycemia and associated risk factors remains inadequate.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"62 12","pages":"2159 - 2170"},"PeriodicalIF":2.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-025-02572-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740806","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}
Pub Date : 2025-07-30DOI: 10.1007/s00592-025-02558-4
Davide Catarinella, Costanza Festorazzi, Rossana Caldara, Lorenzo Piemonti
{"title":"Long-term follow-up of pancreatic islet transplantation in a patient with Wolfram syndrome: a case report","authors":"Davide Catarinella, Costanza Festorazzi, Rossana Caldara, Lorenzo Piemonti","doi":"10.1007/s00592-025-02558-4","DOIUrl":"10.1007/s00592-025-02558-4","url":null,"abstract":"","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"62 11","pages":"2031 - 2035"},"PeriodicalIF":2.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-025-02558-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740807","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}
There is varied phenotypic presentations of diabetic striatopathy (DS), traditionally characterized by hyperglycemia, acute-onset choreoballism, and/or specific neuroimaging findings. Emerging evidence indicates that DS may coexist with stroke, complicating diagnosis and treatment, as both conditions can influence each other’s progression.
Materials and methods
Two cases of DS with concurrent stroke at a single center and 15 similar previously published cases have been analyzed. The detailed evaluation included demographics, symptomatology, glycemic data, neuroimaging, management, and prognosis. Appropriate descriptive statistical analyses have been performed.
Results
This study demonstrates how stroke symptoms and involuntary movements can coexist and interact. Four distinct phenotypes of the “stroke-striatopathy model” have been identified. It raises the possibility of patients with DS being at risk of imminent cerebrovascular events rather than being a mere bystander.
Conclusion
The study underscores the necessity for ongoing monitoring of DS patients for potential cerebrovascular incidents and the implications for clinical management and long-term patient outcomes.
{"title":"Striatopathy and stroke in diabetes: insights from two cases and literature review","authors":"Subhankar Chatterjee, Samya Sengupta, Ritwik Ghosh, Shambaditya Das, Alak Pandit, Souvik Dubey","doi":"10.1007/s00592-025-02566-4","DOIUrl":"10.1007/s00592-025-02566-4","url":null,"abstract":"<div><h3>Introduction</h3><p>There is varied phenotypic presentations of diabetic striatopathy (DS), traditionally characterized by hyperglycemia, acute-onset choreoballism, and/or specific neuroimaging findings. Emerging evidence indicates that DS may coexist with stroke, complicating diagnosis and treatment, as both conditions can influence each other’s progression.</p><h3>Materials and methods</h3><p>Two cases of DS with concurrent stroke at a single center and 15 similar previously published cases have been analyzed. The detailed evaluation included demographics, symptomatology, glycemic data, neuroimaging, management, and prognosis. Appropriate descriptive statistical analyses have been performed.</p><h3>Results</h3><p>This study demonstrates how stroke symptoms and involuntary movements can coexist and interact. Four distinct phenotypes of the “stroke-striatopathy model” have been identified. It raises the possibility of patients with DS being at risk of imminent cerebrovascular events rather than being a mere bystander.</p><h3>Conclusion</h3><p>The study underscores the necessity for ongoing monitoring of DS patients for potential cerebrovascular incidents and the implications for clinical management and long-term patient outcomes.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"62 12","pages":"2145 - 2158"},"PeriodicalIF":2.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740808","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}
Pub Date : 2025-07-30DOI: 10.1007/s00592-025-02563-7
Sandra Herranz-Antolín, Sofía Ramos-Garrido, Verónica Esteban-Monge, Clara Coton-Batres, María Covadonga López-Virgos, Silvia Lallena-Pérez, Miguel Torralba
Objetive
To analyze the Time in Tight Range (TITR) (70–140 mg/dL) and assess their possible differences according to Time Below Range (TBR) in a cohort of type 1 diabetes mellitus people with Múltiple Daily Injections.
Patients and methods
355 adult users of Continuous Glucose Monitoring (CGM) with at least a HbA1c during the period October 1, 2023-October 1, 2024, and glucose data in the 90 days prior were included.
Results
Age 46.9 years (SD 13.6); 57.2% male; time of evolution 21.6 years (SD 12.6). Mean TITR was 38.4% (SD 14.6) and 20.3% had a TITR ≥ 50%. The correlation TITR-TIR was strong (β = 0.83; CI 95% 0.8–0.87; R [2] Adjusted 0.89; p < 0.001) and varied according to TBR [TBR < 4% group (β = 0.81; CI 95% 0.78 to 0.85; R [2] Adjusted 0.9; p < 0.001) vs. TBR ≥ 4% (β = 0.9; CI 95% 0.86 to 0.94; R [2] Adjusted 0.93; p < 0.001)]. The variables independently associated with TITR in patient with TBR < 4% were HbA1c (β = -9.58; CI 95% -10.88 to -8.29; p < 0.001) and Coefficient of Variation (CV) (β = -0.38; CI 95% -0.66 to -0.11; p = 0.007). However, in those with TBR ≥ 4% were male gender (β = 2.86; CI 95% 0.26 to 5.45; p = 0.031), HbA1c (β = -7.53; CI 95% -9.1 to -5.96; p < 0.001) and CV (β = -0.69; CI 95% -1.01 to -0.37; p < 0.001).
Conclusions
The correlation between TITR and TIR and the factors that were independently associated with TITR differ depending on the TBR.
{"title":"Time in Tight Range (TITR) stratified by Time Below Range (TBR) in a cohort of patients with type 1 Diabetes Mellitus and Multiple Daily Injections. A real-life study","authors":"Sandra Herranz-Antolín, Sofía Ramos-Garrido, Verónica Esteban-Monge, Clara Coton-Batres, María Covadonga López-Virgos, Silvia Lallena-Pérez, Miguel Torralba","doi":"10.1007/s00592-025-02563-7","DOIUrl":"10.1007/s00592-025-02563-7","url":null,"abstract":"<div><h3>Objetive</h3><p>To analyze the Time in Tight Range (TITR) (70–140 mg/dL) and assess their possible differences according to Time Below Range (TBR) in a cohort of type 1 diabetes mellitus people with Múltiple Daily Injections.</p><h3>Patients and methods</h3><p>355 adult users of Continuous Glucose Monitoring (CGM) with at least a HbA1c during the period October 1, 2023-October 1, 2024, and glucose data in the 90 days prior were included.</p><h3>Results</h3><p>Age 46.9 years (SD 13.6); 57.2% male; time of evolution 21.6 years (SD 12.6). Mean TITR was 38.4% (SD 14.6) and 20.3% had a TITR ≥ 50%. The correlation TITR-TIR was strong (β = 0.83; CI 95% 0.8–0.87; R [2] Adjusted 0.89; <i>p</i> < 0.001) and varied according to TBR [TBR < 4% group (β = 0.81; CI 95% 0.78 to 0.85; R [2] Adjusted 0.9; <i>p</i> < 0.001) vs. TBR ≥ 4% (β = 0.9; CI 95% 0.86 to 0.94; R [2] Adjusted 0.93; <i>p</i> < 0.001)]. The variables independently associated with TITR in patient with TBR < 4% were HbA1c (β = -9.58; CI 95% -10.88 to -8.29; <i>p</i> < 0.001) and Coefficient of Variation (CV) (β = -0.38; CI 95% -0.66 to -0.11; <i>p</i> = 0.007). However, in those with TBR ≥ 4% were male gender (β = 2.86; CI 95% 0.26 to 5.45; <i>p</i> = 0.031), HbA1c (β = -7.53; CI 95% -9.1 to -5.96; <i>p</i> < 0.001) and CV (β = -0.69; CI 95% -1.01 to -0.37; <i>p</i> < 0.001).</p><h3>Conclusions</h3><p>The correlation between TITR and TIR and the factors that were independently associated with TITR differ depending on the TBR.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"62 12","pages":"2137 - 2144"},"PeriodicalIF":2.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740809","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}
Pub Date : 2025-07-24DOI: 10.1007/s00592-025-02550-y
Jean-Louis Montastruc
{"title":"Drugs used in diabetes, statins and the risk of rhabdomyolysis reporting: a disproportionality analysis in the world health organization’s pharmacovigilance database","authors":"Jean-Louis Montastruc","doi":"10.1007/s00592-025-02550-y","DOIUrl":"10.1007/s00592-025-02550-y","url":null,"abstract":"","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"62 10","pages":"1821 - 1823"},"PeriodicalIF":2.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697312","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}
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