Frontiers in clinical diabetes and healthcare最新文献

Aims/introduction: This study aimed to evaluate the real-world effectiveness and safety of imeglimin in individuals with type 2 diabetes.

Materials and methods: We retrospectively reviewed 79 individuals (52 men, 27 women) with type 2 diabetes who newly initiated imeglimin (1,000 mg twice daily) and were followed for 12 months at the Central Japan International Medical Center between September 2022 and December 2023. Individuals were stratified by age (<65, 65-74, ≥75 years) and by the presence or absence of biguanide dose reduction at imeglimin initiation. The primary endpoint was the change in HbA1c from baseline to 12 months. Secondary endpoints included the achievement rate of glycemic targets, incidence of adverse events, and changes in body weight, blood pressure, liver and renal function, lipid profile, and uric acid.

Results: HbA1c significantly decreased one month after initiation and the improvement was sustained through 12 months (mean change from baseline -0.8 ± 1.2%). Effectiveness and safety did not differ significantly among age groups. Gastrointestinal symptoms were the most common adverse events (21.5%), with no age-related differences. HbA1c reduction was greater in individuals without biguanide dose reduction compared with those with dose reduction (-1.5 ± 1.7% vs -0.5 ± 0.7%, p=0.019), although adverse event frequency was comparable. Importantly, gastrointestinal disturbances were more frequent when imeglimin was combined with metformin ≥1,000 mg/day (p=0.032). Significant reductions were also observed in body weight, triglycerides, and liver enzymes at 12 months.

Conclusions: Imeglimin demonstrated sustained glycemic effectiveness and favorable tolerability in real-world practice, including among elderly individuals with type 2 diabetes. These findings suggest imeglimin as a valuable therapeutic option for older adults with type 2 diabetes. Caution is warranted when co-administered with high-dose metformin, whereas combination with <1,000 mg/day appears relatively safe.

Background: Adolescence is marked by significant changes. The presence of type 1 and type 2 diabetes mellitus (T1D and T2D) amplifies these challenges, with diabetes being the second most common chronic disease among adolescents worldwide. Adolescents with diabetes are at heightened risk for mental health issues, which escalate the risk of complications. eHealth interventions using Information and Communication Technologies show promise in improving diabetes management and psychological well-being. However, research has predominantly focused on adults, leaving gaps in understanding the efficacy of these interventions for adolescents. Medical management often prioritizes physical health, neglecting psychosocial aspects.

Objective: This meta-analysis aims to provide evidence on eHealth interventions' efficacy in supporting the psychosocial well-being of adolescents with T1D and T2D, and to investigate their impact on Hemoglobin A1c (HbA1c), quality of life, diabetes distress, anxiety, and depression symptoms.

Method: A PRISMA-guided systematic search was conducted. Randomized Controlled Trials (RCTs) regarding eHealth interventions for adolescents with diabetes were included. Data were pooled using Standard Mean Difference (SMD). Outcomes were quality of life and HbA1c. Intervention acceptability was assessed using the Odds Ratio (OR) of dropout rates.

Results: A total of ten RCTs involving only adolescents with T1D (aged 10-22) were included in the analysis. The interventions resulted in significant improvements in quality of life (SMD = 0.73; 95% CI [0.08, 1.38]; k = 6), indicating a moderate positive effect, as well as in satisfaction with life, a subscale of the overall quality of life (SMD = 0.51, 95% CI [0.08, 0.95]; k = 3). For HbA1c levels, however, the effect was small and not statistically significant (SMD = -0.21; 95% CI [-0.69, 0.27]; k = 8). Additionally, the interventions were well accepted, as suggested by the OR of 0.47 (95% CI [-0.07, 1.01]; k = 7), indicating no significant difference in dropout rates between intervention and control groups.

Conclusion: These results underscore the potential of eHealth interventions to enhance the quality of life and satisfaction with life in adolescents with T1D. Future research should continue to explore and refine eHealth interventions, ensuring an integrated approach that addresses both the medical and psychosocial needs of adolescents with diabetes.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021218623.

Background: The correlation between TREM-1 and vascular complications in patients with type 2 diabetes was a subject of debate. This study aimed to investigate the potential correlation between TREM-1 and flow-mediated dilatation (FMD) in patients with type 2 diabetes mellitus.

Methods: In this retrospective cohort research, 201 patients with type 2 patients diabetes were enrolled. The FMD Vascular Endothelial Cell Function Test Instrument was used to evaluate endothelial dysfunction. The serum levels of TREM-1 were measured using enzyme-linked immunosorbent assay. The Spearman correlation test was employed to determine the association between TREM-1 and FMD. Univariable logistic regression analysis was conducted to assess the relationship between TREM-1 and FMD. Additionally, receiver operating characteristic curve analysis was used to determine the TREM-1's predictive value. The statistical significance was evaluated using a two-tailed P-value >0.05.

Results: The study involved dichotomizing diabetic patients into low FMD (n = 138) and high FMD (n = 63) groups. The results showed that serum TREM-1 levels were significantly higher in the low FMD group than in the high FMD group (33.6 vs 58.0 pg/ml, P<0.001). A univariate logistic regression analysis revealed a statistically significant association between FMD and TREM-1 (P<0.05). The area under the curve for the receiver operating characteristic curve for model 1 (TREM-1) analysis was 0.66 (0.58-0.74) (P 0.001). Using the criteria of maximal Youden index, the threshold value for TREM-1 was found to be 38.16 ng/ml. This value showed a sensitivity of 75.4% and a specificity of 54% in predicting endothelial dysfunction in patients with type 2 diabetes mellitus.

Conclusion: Serum TREM-1 levels were associated with FMD, indicating that TREM-1 could be a valuable biomarker for assessing endothelial function in T2DM patients.

Introduction: There are conflicting results and limited data regarding the individual effectiveness of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors and their combined action in preventing type 2 diabetes mellitus (T2DM) in high-risk adults. An updated investigation is warranted. We aimed to explore their effectiveness in preventing T2DM in high-risk patients and assess changes in body weight/body mass index (BMI), glycemic parameters, and safety.

Materials and methods: PubMed, Cochrane Library Central Register of Controlled Trials, and Scopus were searched for eligible randomized controlled trials (RCTs), and a systematic review (SR) and meta-analysis (MA) were conducted. GRADE assessment was conducted for rating the overall certainty of evidence.

Results: All 24,157 participants in 10 GLP-1 RA RCTs were overweight/obese. Compared to placebo, GLP-1 RAs reduced T2DM incidence (OR 0.51; 95% CI 0.28, 0.94; P-value 0.03), and 2.4 mg of semaglutide was overall effective (OR 0.38; 95% CI 0.16, 0.94; P-value < 0.0001). Subgroup analysis indicated effectiveness in patients more than 50 years across the world, in cardiovascular disease, after 100 weeks, and during the post-intervention period. Liraglutide was not overall effective. However, subgroup analyses demonstrated effectiveness for studies that were performed worldwide, for women more than 40 years, at 3.0 mg daily, after 55 weeks of administration, and only during intervention. Exenatide was not effective. Heterogeneity was large (Q 54.56, P-value < 0.0001; I² 84%, 95% CI 74%, 89%), and MA was performed using the random-effects model. Heterogeneity was explained by countries' performance in semaglutide- and liraglutide-based RCTs and participants' mean age, dosage, duration, and post-intervention evaluation in liraglutide-based RCTs. Sensitivity analyses considering studies with post-intervention assessment and studies with the largest sample size and dropout rate more than 5% in semaglutide-based RCTs explain further heterogeneity. The quality of evidence was low. Compared to placebo, GLP-1 RAs reduced weight (kg) and BMI (kg/m²) (mean difference -6.35, P-value < 0.00001 and -2.46, P-value < 0.00001, respectively). Finally, GLP-1 RAs were safe (OR for adverse events 1.01; P-value 0.95).

Conclusions: GLP-1 RAs may prevent diabetes in high-risk adults and ameliorate body and glycemic factors. Their effectiveness should be considered carefully due to the low quality of evidence. No safety issues were identified. Future investigation is necessary to provide consistency of estimations.

Systematic review registration: OSF Registration, identifier DOI 10.17605/OSF.IO/8XH4.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is rapidly emerging as a major public health challenge in Vietnam, driven by rising rates of obesity, type 2 diabetes, and lifestyle changes. Although it contributes significantly to morbidity, mortality, and economic burden, MAFLD remains under-recognized within national health strategies and is largely neglected in non-communicable disease (NCD) frameworks. This narrative review synthesizes epidemiological, clinical, and health systems data on MAFLD in Vietnam, drawing on studies published between 2015 and 2024 alongside international guidelines to evaluate their relevance in the local healthcare setting. The evidence indicates that MAFLD affects more than one-quarter of urban adults and is steadily increasing in rural populations. Barriers to effective management include limited diagnostic capacity, lack of standardized guidelines, insufficient awareness among clinicians, and underdeveloped multidisciplinary care models. Complications are exacerbated by the coexistence of hepatitis B virus infection and the growing burden of cardiovascular comorbidities. Together, these factors heighten disease severity and accelerate progression to cirrhosis and hepatocellular carcinoma. Given these challenges, urgent multisectoral action is needed. We propose a strategic national roadmap that incorporates MAFLD into NCD policy, expands primary care screening using simple non-invasive tools, and invests in health workforce training to improve early detection and risk stratification. Strengthening multidisciplinary collaboration and leveraging digital health technologies can enhance patient engagement and access to care. Finally, regional cooperation and Vietnam's participation in international clinical trials are essential to accelerate innovation and policy response. In conclusion, MAFLD represents a neglected but pressing public health issue in Vietnam. Proactive and coordinated strategies are required to reduce its long-term health and socioeconomic impact and to position Vietnam as a regional leader in addressing metabolic liver disease.

Introduction: Young adults living with type 1 diabetes face unique challenges as they transition to greater independence, balancing diabetes management in all other dimensions of life. In Sweden, the transfer from pediatric to adult diabetes care at the age of 18 adds to these challenges. This study aimed to translate and evaluate the Swedish version of the T1DAL (Type 1 Diabetes and Life) self-report questionnaire for young adults living with type 1 diabetes.

Method and materials: The T1DAL questionnaire was translated into Swedish and was completed by 191 young adults aged 18-25 who were registered at a diabetes clinic in three Swedish hospitals. An expert group tested content validity. To determine the number of underlying factors, a parallel analysis (PA) was conducted. The questionnaire's latent structure was further examined through exploratory factor analysis, in which the items were constrained to a four-factor solution as recommended and found in the original version.

Results: The content validity index of the total score was 0.94. The response distribution analysis revealed the presence of floor or ceiling effects. An EFA with a four-factor solution was conducted, yielding a Model Fit Measure with a χ² of 326.68 and df = 249, resulting in a cmin/df of 1.31, an RMSEA of 0.04, and a TLI of 0.92. Internal consistency was assessed for the subscales suggested by the factor structure, based on the items that loaded onto each factor. Cronbach's alpha values ranged from 0.75 to 0.89, indicating acceptable to high internal consistency. The four-factor solution explained 45.04% of the total variance.

Conclusion: The Swedish T1DAL questionnaire showed good factorial validity and reliability. The Swedish version requires further testing with potential item reduction; however, it is still expected to be valuable in assessing health-related quality of life among young adults living with type 1 diabetes.

Clinical implications: The Swedish T1DAL questionnaire, particularly its domains related to emotional experiences, managing diabetes effectively, and peer relationships outlines the characteristics of young adulthood and can be used to empower the target group, and is expected to be feasible to implement in clinical practice.

Background: With the prevalence of Type 2 Diabetes (T2D) projected to increase, understanding its potential consequences on healthcare systems is crucial for adequately preparing society to address this growing challenge. In 2019, Malmö, Sweden's third-largest city, joined the Cities for Better Health global initiative to tackle the multifaceted challenges associated with T2D, including its significant economic burden on the healthcare system and the broader community. Understanding the economic burden of T2D on the healthcare system will facilitate optimisation of the initiatives undertaken by the programme. Therefore, this study aimed to estimate the costs associated with primary care, hospital care, and work absenteeism due to diabetes-related complications among people with T2D residing in Malmö.

Methods: In order to estimate the cost for the City of Malmö, we expanded a model (Andersson et al., 2020) developed to estimate the cost of T2D on a national level, using retrospective data from 1997-2016. The costs were estimated by using NordDRG weights and national reference prices. Primary care costs for Region Skåne were added to the model. Data on healthcare utilisation, work absence, and socioeconomic factors were collected from Swedish national and regional registers. The method was expanded to include Malmö-specific adjustments for demographics, employment, and education, as well as regional primary care costs.

Results: The prevalence of T2D in Malmö was 5.4%, and diabetes complications were: diabetic retinopathy (49.9%), diabetic kidney disease (19.1%), angina pectoris (13.7%), ischaemic heart disease (10.9%), and myocardial infarction (10.5%). Total excess costs for T2D in primary care were €12.7 million. The lowest primary care excess costs were in the age group 16-34 and the highest in the age group 65-74. Estimated overall hospital-based costs for T2D were €38.8 million, and costs related to macrovascular and microvascular complications were €18.1 million and €16.4 million, respectively. Estimated total cost due to absence from work related to T2D complications was €15.4 million. The complication costs were higher for men, except for neuropathy.

Conclusions: These findings may support city-level healthcare planning and preventive interventions, as Malmö is facing substantial costs both in monetary terms and in reduced quality of life. Younger persons increasingly develop diabetes complications, which needs to be considered when allocating resources for primary prevention, treatment of complications, and municipality costs within a near future.

Aim and objectives: To investigate the Cutaneous Signs of Insulin Resistance, namely acanthosis nigricans (AN) and acrochordon (AC), in individuals with Central Obesity (CO-CSIR) as physical predictors of metabolic syndrome (MetS), underlying adipose tissue pathology, and consequent pathophysiological traits in South Asians.

Methods: In this study, 371 participants were recruited in a tertiary care facility and grouped based on the presence of cutaneous signs (AC and/or AN) and central obesity. Each participant was assessed for MetS, T2D, as well as other demographic, biochemical, and radiological parameters. Additionally, we conducted transcriptome profiling in adipose depots for selected individuals to investigate whether there are modules of co-expressed genes that show a correlation with cutaneous sign(s) and MetS/T2D, in order to decipher the link between these signs and metabolic derangement.

Results: ANOVA analyses revealed significant differences among groups with varying cutaneous signs and W:H ratios, particularly highlighting the combined predictive capability of these markers. Post hoc tests further confirmed these findings, showing substantial differences in MetS, T2D, and HOMA-IR between these groups. Sensitivity-specificity analyses demonstrated that CO-CSIR provides a more balanced and accurate prediction of MetS status compared to either CO or CSIR alone. Furthermore, in predicting MetS status based on the number of MetS components (from 5 to ≥1), it also performed well. WGCNA analysis in visceral fat revealed modules of co-expressed genes significantly correlated with AC and MetS, indicating a link between the adipose tissue molecular pathology and the cutaneous signs.

Conclusion: CO-CSIR is a promising physical sign for predicting MetS and the underlying adipose tissue-driven dysmetabolism in South Asians.