Frontiers in clinical diabetes and healthcare最新文献

Background: Diabetes Mellitus (DM) is a recognized risk factor for the development of acute and chronic heart failure (HF). De Novo HF (DNHF), defined as acute HF occurring in patients with no prior history of HF, is a distinct type which is usually seen in patients with established cardiovascular risk factors such as DM. However, in some cases, DNHF may be the initial manifestation of DM and lead to a new diagnosis of DM during admission for HF symptoms. The incidence of this occurrence is under-recognized in the setting of DNHF. Our study aimed to determine the incidence of newly diagnosed DM in patients presenting with DNHF and to determine any differences in clinical characteristics or short-term outcomes across the spectrum of DM.

Methods: This retrospective cohort study was conducted at the largest advanced HF center in Qatar. All patients admitted with DNHF were grouped as: 1) newly diagnosed DM, 2) pre-existing DM, 3) prediabetes, and 4) no DM. Clinical characteristics and in-hospital/post-discharge outcomes were described. Continuous variables were reported as mean with standard deviation or IQR and categorical variables as frequency distribution with percentage.

Results: Among 260 patients with DNHF, 173 (66.5%) had DM, and 52 (20%) were prediabetic. Newly diagnosed DM was identified in 26 (10%), 147 (56.5%) were known diabetics. Compared with known DM, newly diagnosed patients were predominantly male (92.3% vs. 74.1%), had fewer comorbidities such as hypertension (84.6% vs. 90.5%), coronary artery disease (57.7% vs 79.6%), chronic kidney disease (11.5% vs. 29.9%), had a greater non-ischemic etiology of HF (30.4% vs. 23.2%), and higher prevalence of HFrEF (92.3% vs 70.3%). In-hospital mortality and readmissions were similar across all groups.

Conclusion: Our findings indicate the high burden of dysglycemia (DM and prediabetes) that is present in DNHF patients. Furthermore, DNHF served as the initial clinical presentation of DM or prediabetes in approximately one-third of our patients. This underscores the need for routine metabolic screening in patients presenting with DNHF, as early identification and management of DM is crucial in this population to improve outcomes.

Background: Erectile dysfunction (ED) is highly prevalent among men with type 2 diabetes mellitus (T2DM) and reflects systemic vascular and metabolic dysfunction. Shared mechanisms include endothelial dysfunction, oxidative stress, inflammation, autonomic neuropathy, and hypogonadism. Therefore, ED may function not only as a complication of T2DM but also as an early clinical marker of cardiometabolic disease.

Objective: This narrative review summarizes current evidence on the epidemiology, mechanisms, and cardiometabolic implications of ED in men with T2DM, and evaluates the impact of major cardiometabolic therapies on erectile function. A real-world cohort study was conducted using the TriNetX Global Collaborative Network, a large federated electronic health record database comprising healthcare organizations across multiple countries.

Content: ED is closely linked with hypertension, obesity, dyslipidaemia, heart failure, ischemic heart disease, and stroke in men with T2DM, reflecting shared microvascular and macrovascular diseases. Cohort and real-world studies indicate a strong bidirectional relationship: poor cardiometabolic control worsens erectile function, whereas improvements in glycaemia, weight, blood pressure, and lipids are associated with higher International Index of Erectile Function (IIEF) scores. Using data from the TriNetX Global Collaborative Network, large-scale real-world analyses further demonstrate that the coexistence of ED and T2DM substantially increases cardiovascular risk. In a propensity-score-matched cohort (>200,000 individuals per group), men with ED and T2DM had higher risks of ischemic heart disease (15.7% vs. 11.5%, OR: 1.44; 95% CI 1.41-1.46), stroke (OR 1.45; 95% CI 1.42-1.48), peripheral artery disease (OR 1.38; 95% CI 1.35-1.41), and heart failure (8.4% vs. 4.9%, OR 1.78; 95% CI 1.74-1.81). Conversely, among individuals with T2DM, the presence of ED was associated with increased ischemic heart disease, stroke, and peripheral artery disease. Mechanistic and clinical data suggest heterogeneous treatment effects: GLP-1 receptor agonists and SGLT2 inhibitors show promising vascular benefits with mixed erectile outcomes, whereas ARBs and finerenone appear favorable compared with older agents associated with sexual adverse effects.

Conclusion: ED in T2DM should be regarded as a clinically relevant marker of systemic vascular disease. Routine assessment may enhance cardiovascular risk stratification and motivate earlier, comprehensive risk-factor intervention. Future prospective and randomized studies with erectile function as a predefined endpoint are needed.

Background: Continuous glucose monitoring (CGM) has significantly improved glycaemic management in individuals with diabetes. The Glycaemia Risk Index (GRI) is a composite metric based on CGM data that provides a comprehensive evaluation of glycaemic quality, incorporating both hypoglycaemia and hyperglycaemia. This study evaluated the impact of transitioning from self-monitoring of blood glucose (SMBG) to CGM on GRI in adults with type 1 diabetes (T1D) using multiple daily injection (MDI) insulin therapy.

Methods: Secondary analyses were conducted in 125 adults with T1D from the randomised GOLD trial. Participants alternated between CGM and SMBG for two 26-week periods, separated by a 17-week wash-out. The GRI was calculated on a 0-100 scale from CGM data and categorised into five risk zones. Associations between baseline characteristics and participant-reported outcomes such as diabetes-related behaviours, lifestyle, psychological characteristics, and changes in GRI were also explored.

Results: Transitioning from SMBG to CGM significantly reduced the overall GRI by 9.8 units (95% CI -13.3, -6.3), with decreases in both hypoglycaemia (-1.8, 95% CI -2.4, -1.2) and hyperglycaemia (-2.8, 95% CI -5.3, -0.4) components. GRI zone classification was maintained or improved in 85.4% (105/123, P <.001) of participants. The GRI correlated moderately with TIR (r = -0.47, 95% CI -0.60, -0.32), but standardised effect sizes were larger for GRI than for TIR (-0.5 [95% CI -0.72, -0.34] vs. 0.2 [95% CI 0.00, 0.37]). Exploratory analyses suggested that self-reported psychosocial traits influenced GRI changes: thoroughness was linked to greater reductions in hypoglycaemia risk, whereas distractibility, self-described laziness, and carbohydrate counting training were associated with smaller improvements.

Conclusion: Switching from SMBG to CGM significantly improved GRI in adults with T1D on MDI therapy. Compared with TIR, GRI demonstrated greater responsiveness to treatment-related changes. As a composite metric that integrates both hypo- and hyperglycaemia, GRI may serve as a valuable endpoint for evaluating interventions and as a complementary measure in clinical practice.

Hyperglycemia in pregnancy (HIP), encompassing gestational diabetes mellitus (GDM) and pre-gestational diabetes mellitus (PGDM), constitutes a growing clinical challenge, impacting approximately 23 million live births annually worldwide and conferring substantial maternal and fetal risks. This mini-review evaluates mobile health (mHealth) applications for HIP management, focusing on glycemic monitoring, nutritional interventions, physical activity promotion, insulin dose titration, and postpartum surveillance. Reviewed applications facilitate data collection from glucometers and continuous glucose monitoring systems, deliver graphical analytics, tailored recommendations, artificial intelligence-driven coaching, and secure remote data exchange with healthcare professionals, thereby increasing patient adherence, glycemic regulation, and perinatal outcomes, including reductions in HbA1c, neonatal birthweight, and caesarean section rates. Key benefits include enhanced patient empowerment, streamlined telemedicine, and psychosocial support, supported by trials demonstrating superior glycemic indices and reduced hyperglycemic excursions. Nonetheless, challenges persist, including heterogeneous clinical validation, socioeconomic-digital disparities, data security imperatives, and the absence of comprehensive integrated platforms. Future perspectives focus on developing digital systems that combine sensors, artificial intelligence, and online clinics. These systems aim to improve coordinated care for women with HIP, make treatment more effective, enhance user satisfaction, and help healthcare providers use resources efficiently.

Objective: To investigate the prevalence of diabetic kidney disease (DKD) and identify its associated factors among rural patients with type 2 diabetes mellitus (T2DM) in Guangxi, China.

Methods: A multistage stratified random sampling method was applied. Five cities across Guangxi (Nanning, Guilin, Hechi, Chongzuo, and Yulin) were randomly selected, followed by three counties in each city, yielding 15 counties in total. One hospital from each county was chosen, and patients with T2DM were recruited for questionnaires and laboratory testing. Descriptive epidemiological methods were used to calculate the prevalence of DKD. Univariate and multivariate logistic regression analyses were performed to identify associated factors.

Results: A total of 2,178 rural patients with T2DM were included (1,204 men and 974 women; mean age 63.25 ± 12.71 years; mean disease duration 7.96 ± 4.07 years). The HbA1c control rate was 22.68%, and the prevalence of DKD was 23.32% (95% CI: 21.6% to 25.1%; 508/2,178). Logistic regression analysis showed that higher diabetes knowledge levels were protective against DKD (OR = 0.936, 95% CI: 0.891-0.984). Independent associated factors. included elevated HbA1c (OR = 1.530, 95% CI: 1.389-1.686), serum creatinine (OR = 1.037, 95% CI: 1.033-1.041), uric acid (OR = 1.005, 95% CI: 1.004-1.007), and triglycerides (OR = 1.190, 95% CI: 1.010-1.403).

Conclusion: The prevalence of DKD among rural patients with T2DM in Guangxi is relatively high. Enhancing diabetes-related knowledge and strengthening the monitoring and control of HbA1c, lipid profiles, creatinine, and uric acid may help reduce the risk of DKD and improve patient outcomes.

Background: While several environmental and perinatal factors have been associated with the development of autism spectrum disorder (ASD), there is still much to uncover. In this study, we investigated the possible association between gestational diabetes mellitus (GDM), a condition that is becoming more widespread worldwide, and the risk of ASD.

Methods: A population-based retrospective cohort study was conducted using data from a tertiary referral hospital and affiliated community clinics. ASD diagnoses were identified through centralized outpatient and hospital records and were established by qualified specialists in accordance with DSM-5 criteria during long-term childhood follow-up. The incidence of ASD in offspring was compared between pregnancies complicated by GDM, categorized as A1 (diet-controlled) or A2 (requiring pharmacologic treatment), and pregnancies without GDM. Cumulative incidence of ASD was estimated using Kaplan-Meier survival analysis, and a Cox proportional hazards model was applied to adjust for potential confounders.

Results: Among 115,063 deliveries included in the study, 3,461 (3.0%) were complicated by GDM A1 and 1,164 (1.0%) by GDM A2. Overall, 767 offspring were diagnosed with ASD during childhood. Univariate analysis demonstrated a statistically significant association between GDM severity and ASD incidence (1.5% for GDM A2, 1.0% for GDM A1, and 0.6% for no GDM; p<0.001). Kaplan-Meier analysis demonstrated a significant difference in cumulative ASD incidence across GDM subtypes (log-rank p<0.001). However, after adjustment for confounders in a multivariable Cox model, neither GDM A1 nor GDM A2 was statistically significantly associated with ASD risk (aHR 1.18, 95% CI 0.83-1.66; aHR 1.56, 95% CI 0.95-2.56, respectively).

Conclusion: Our findings suggest no statistically significant association between GDM and ASD in offspring after adjustment.

Type 2 diabetes mellitus (T2DM) is considered a chronic, progressive and irreversible condition; however, evidence accumulated over the past decade demonstrates that remission of this disease can be achieved through targeted nutritional interventions. This mini review aims to synthesize current data regarding nutritional interventions that may lead to T2DM remission, with emphasis on the underlying mechanisms, clinical outcomes and implications for both research and clinical practice. Evidence supporting the role of structured dietary strategies, including low-energy diets, the Mediterranean dietary pattern, ketogenic approaches, and time-restricted eating, in improving glycemic control and facilitating remission is analyzed, mainly through the reduction of ectopic fat and the improvement of insulin sensitivity. Remission is more likely in individuals with a short duration of diabetes, a more favorable initial glycemic status, and significant and sustained weight loss, particularly when visceral and hepatic fat are reduced. Beyond weight loss, emerging data suggest that meal timing, macronutrient quality, and adherence to nutritional interventions play important modulatory roles. Despite promising results, current evidence is limited by heterogeneity in remission definitions, short follow-up periods, and difficulties related to implementation in real-world clinical practice and long-term sustainability. Nevertheless, there are insufficient data regarding predictors of relapse and the safety of nutritional interventions in vulnerable populations. In the future, research should prioritize long-term randomized studies primarily oriented toward remission and using personalized nutritional interventions. Therefore, nutrition-induced T2DM remission represents a feasible and clinically relevant therapeutic objective, with the potential to redefine current management strategies under the application of individualized, multidisciplinary, and long-term recommendations.

Diabetic foot ulcer (DFU) is a common and debilitating complication of diabetes mellitus, representing a significant clinical challenge. This article delves into the intricate pathophysiology underlying DFU, aiming to enhance our understanding of this complex wound healing process. We explore the interplay of multifactorial aspects, including peripheral neuropathy, vascular insufficiency, and impaired immune response, which contribute to the development and progression of DFU. Moreover, the dysregulation of key cellular and molecular mechanisms involved in inflammation, angiogenesis, extracellular matrix remodeling, and infection are examined. A comprehensive understanding of the pathophysiology of DFU including oxidative stress, neuropathy, dysregulated angiogenesis, impaired immune response, and key molecular pathways supports the development of targeted therapeutic strategies beyond current treatments to improve wound healing, reduce complications, and enhance patient quality of care.

Background: Psychosocial person-reported outcome measurements (PROMs) may assist monitoring, screening and support in routine care for people with type 1 diabetes (PWDs). However, recommended PROM sets are either too limited in covered domains, too time-consuming, or too general to fit type 1 diabetes (T1D) clinical practice. We propose an alternative approach to PROM assessment in routine daily T1D care (Diabeter-PROM study) that is maximally relevant and minimally burdensome for PWDs and healthcare professionals (HCPs). We identify single index questions indicating the need for more in-depth assessment, thereby aligning total assessment length more closely with individual needs.

Methods: Scientist-practitioners identified twelve key psychosocial domains based on literature review, clinical experience and discussion with PWDs: general quality of life, mood, anxiety, diabetes-specific worries, impact, disturbed eating behaviour, self-efficacy, self-esteem, social support/interaction, resiliency, stigma and satisfaction with care. These domains will be divided over three observational mixed-method sub-studies. Through purposive-sampled interviews and panels, HCPs and PWDs (> 10 per sub study) co-determine candidate index questions for each domain. These are then included in three separate cross sectional questionnaire batteries with existing PROMs. Each will be completed by ≥200 PWDs from our clinic. Per domain, the optimal index question and most informative in-depth item set are determined using statistics (test characteristics, item response) and clinical interpretation.

Discussion: We describe the exploration of an alternative way of PROM assessments, adapted to use in regular T1D care. After determining the most suitable index questions, we will apply this system in our daily diabetes practice, taking end-user needs into account and facilitating sustainable PROM implementation in routine care.