Frontiers in clinical diabetes and healthcare最新文献

Objective: To estimate the prevalence of inadequate glycaemic control and identify factors associated with it among people with type 2 diabetes mellitus (T2DM) living in low- and middle-income countries (LMICs).

Methods: A systematic literature search was conducted in the Medline, Embase, CINAHL, PsychINFO, and Global Health databases for articles published between 1 January 2001 and 15 April 2025. Information was descriptively summarised following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The quality of the articles was assessed using the Newcastle-Ottawa Scale. Random effects model was used to obtain the pooled proportion of inadequate glycaemic control. Heterogeneity (I²) was tested, sensitivity analyses were performed, and publication bias was examined using Egger's regression test.

Results: Among 12,985 records, 62 studies from 28 countries involving 176,349 participants were reviewed. The estimated pooled proportion of inadequate glycaemic control (glycosylated haemoglobin [HbA1c] ≥7%) was 69% (95% confidence interval [CI]: 66%-72%, p <0.001, I² = 99.10%), with no publication bias (Egger's test, p = 0.489). A number of factors were associated with inadequate glycaemic control (overall p < 0.001), including education below secondary level (OR: 1.47, 95% CI: 0.98-1.97), rural residence (OR: 1.80, 95% CI: 1.33-2.28), obesity (OR: 1.17, 95% CI: 1.11-1.22), use of oral glucose-lowering drugs and/or insulin (OR: 4.06, 95% CI: 2.58-5.54 and OR: 2.44, 95% CI: 1.70-3.19, respectively), non-adherence to diet (OR: 2.13, 95% CI: 1.33-2.93) and treatment (OR: 2.08, 95% CI: 1.61-2.54), and physical inactivity (OR: 2.15, 95% CI: 1.35-2.95).

Conclusion: More than two-thirds of people with T2DM in LMICs have inadequate glycaemic control. Urgent interventions are needed, focusing on sociodemographic, lifestyle, and treatment-related factors.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD: 42023390577.

Recent literature shows that GLP-1 receptor agonists are highly effective for weight loss and improving metabolic and cardiovascular health, often surpassing the results of lifestyle interventions alone, such as exercise and diet modification. However, long-term weight maintenance is more successful when exercise is included, as stopping GLP-1 therapy alone often leads to weight regain, while exercise helps preserve muscle mass and sustain weight loss. Combining GLP-1 receptor agonists with structured lifestyle changes, especially increased protein intake and strength training, can mitigate muscle loss and enhance overall outcomes. As a result, future obesity management is likely to prioritize integrated approaches that combine pharmacotherapy with lifestyle interventions, rather than replacing lifestyle changes with medication alone.

A diverse range of disorders resulting from various pathophysiological mechanisms are represented by rare forms of diabetes. To date, variants in at least 25 different genes have been identified. Although these forms account for only approximately 6% of all diabetes cases, accurate diagnosis is essential for effective treatment and personalized disease management. Most of these subtypes are monogenic, syndromic, or related to structural abnormalities, providing crucial insights into the genetic and physiological underpinnings of glucose regulation. Clinical clues, such as an early age at onset, the absence of autoantibodies, atypical disease progression, low insulin requirements, and the presence of multi-organ involvement, may indicate a non-classical diabetes phenotype. The classification and recognition of these rare types are clinically significant, especially as advances in genetic technologies continue to expand our understanding of disease mechanisms and therapeutic options. Significantly, the study of rare diabetes forms contributes not only to individualized care but also to the development of novel therapeutic strategies for more common types such as type 1 and type 2 diabetes. The improved understanding of beta-cell function and its genetic regulation through these models has enabled the emergence of precision medicine approaches that extend beyond conventional glycemic control. Mitochondrial diabetes results from mitochondrial defects that impair energy metabolism in pancreatic β-cells, while endoplasmic reticulum (ER) stress-induced by the accumulation of misfolded proteins-triggers β-cell apoptosis. These convergent mechanisms disrupt insulin secretion and glycemic homeostasis, driving diabetes pathogenesis. Elucidating the molecular interplay between mitochondrial dysfunction and ER stress may advance the understanding of disease progression and facilitate the development of targeted therapeutic strategies. This review summarizes the current knowledge on rare forms of diabetes, emphasizing their diagnostic value and therapeutic potential.

Periodontitis, a chronic inflammatory disease of the periodontium, has well-established links to systemic metabolic conditions, particularly diabetes and obesity. Recent research suggests a novel interaction between periodontitis and glucagon-like peptide-1 (GLP-1) pathways, both of which regulate glucose metabolism and inflammation. In this review, we examine the potential bidirectional relationships between periodontitis and GLP-1 signaling and evaluate the therapeutic implications of GLP-1 receptor agonists (GLP-1 RAs) in periodontal disease. A systematic search of PubMed, Embase, and the Cochrane Library identified 52 studies published between 1990 and 2025, ranging from in vitro and animal studies to human clinical and observational research. Findings indicate a multifaceted relationship between GLP-1 pathways and periodontal disease. Periodontitis may impair GLP-1 signaling and exacerbate glucotoxicity and lipotoxicity in individuals with diabetes or obesity. Several periodontopathic bacteria, notably Porphyromonas gingivalis, produce DPP-4-like enzymes that degrade GLP-1 and potentially disrupt glucose regulation. GLP-1 RAs, such as liraglutide and exendin-4, demonstrated anti-inflammatory, osteoprotective, and regenerative effects in preclinical models. Additionally, studies identified host and microbial DPP-4 activity as key mechanistic links between periodontal inflammation and systemic insulin resistance. This review highlights a novel and clinically relevant intersection between periodontitis and GLP-1 biology. GLP-1 RAs and DPP-4 inhibitors may offer dual benefits for metabolic control and periodontal health. Further research is needed to define delivery strategies, assess efficacy across patient populations, and explore the therapeutic targeting of DPP-4 activity in both host and microbial contexts.

As an emerging medical imaging technique, photoacoustic imaging (PAI) holds promise as a significant tool in the field of medical imaging due to its combination of high-resolution optical characteristics and deep penetration acoustic properties. This method non-invasively provides high-contrast biological information imaging and offers substantial advantages in assessing vascular structure and function. The core pathological issue in the clinical diagnosis and treatment of diabetes mellitus is the microvascular and macrovascular complications resulting from hyperglycemia and other factors. However, clinical imaging assessments of vascular lesions are still limited, whereas PAI has demonstrated unique advantages in the early diagnosis, disease monitoring, and therapeutic evaluation of diabetic vascular lesions. PAI not only allows for the calculation of vascular parameters such as vessel diameter and density but also enables real-time monitoring of hemodynamic and blood oxygen saturation dynamics, providing a new approach for the dynamic assessment of diabetic vascular lesions. This article reviews the current research on PAI in diabetic vascular disease, including animal experiments and human studies on microvascular lesions, peripheral vascular disease, diabetic foot, and chronic wounds, showcasing the strengths and limitations of this imaging method to clinicians. This review aims to lay the foundation for further clinical development and application.

[This corrects the article DOI: 10.3389/fcdhc.2025.1682012.].

Background: The increasing prevalence of Type 1 Diabetes Mellitus (T1D) has led to the development of advanced technologies such as Continuous Glucose Monitors (CGMs) and insulin infusion pumps. These devices rely on adhesives to attached to the skin, which can trigger Allergic Contact Dermatitis (ACD) in some individuals. Despite their growing use, data on ACD prevalence among children/adolescents with T1D using adhesive-based medical devices in the United Arab Emirates (UAE) and the Gulf Cooperation Council (GCC) region remains limited. This study aimed to assess the prevalence of ACD in children/adolescents with T1D using CGMs in the UAE, and evaluate the association between device use and ACD. It also explored trends in immune-related comorbidities that could impact glycemic control.

Methods: A cross-sectional observational study was conducted in collaboration with Dubai Diabetes Center (DDC). Medical records of 232 children/adolescents with T1D, receiving care at DDC between January 2020 and January 2023, were analyzed. Descriptive statistics were used to calculate proportions, and ACD prevalence was determined with a 95% Confidence Interval (CI) using Poisson distribution. Fisher's exact test was applied to explore associations between categorical variables.

Results: Among 232 study individuals, 87% (202 out of 232 individuals) used smart medical devices for glucose monitoring. Of these, 16 had a documented history of ACD, indicating a prevalence rate of 7.92% (95% CI: 4.6, 12.54). No statistically significant association was found between smart devices use and ACD development (p-value = 0.581). ACD prevalence was higher among females using adhesives (9.37%) compared to their male counterparts (6.6%).

Conclusion: This study aligns with United Nations' Sustainable Development Goals 3 and 4 by highlighting ACD prevalence among children/adolescents with T1D using CGMs in the UAE. It underscores the need for biomedical manufacturers to disclose adhesive chemical compositions to facilitate the development of safer alternatives. Additionally, healthcare professionals should be educated on dermatological risks associated with adhesive-based devices, enabling them to provide more comprehensive care and improve individual outcomes.

Ferroptosis and pyroptosis are two emerging forms of regulated cell death. The former encompasses cell death by excessive accumulation of lipid hydroperoxides in an iron-dependent way. The latter pertains to inflammation-associated cell death following activation of caspase-1, caspase-11/4/5 through gasdermin D (GSDMD). Recent evidence confirms the implication of ferroptosis and pyroptosis in diabetes mellitus (DM) and its complications, notably diabetic kidney disease (DKD), and also in metabolic-dysfunction associated liver disease (MASLD). The aim of this narrative review was to summarise current experimental evidence on the potential beneficial actions of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in DM and diabetic complications via reduction of ferroptosis and pyroptosis. Data points to their therapeutic potential in DKD and MASLD. Treatment with GLP-1RAs was comparable with ferrostatin-1 (Fer-1), a well-known-ferroptosis inhibitor: ferroptosis-associated markers (e.g. Acyl-CoA Synthetase Long Chain Family Member 4, ASCL4) were decreased and factors alleviating ferroptosis were increased. Similarly, caspase-1, GSDMD, interleukin-1β (IL-1β) and/or nucleotide-binding oligomerization domain, leucine-rich repeat-containing receptor-containing pyrin domain 3 (NLPR3), which induce pyroptosis, were restored following GLP-1RAs therapy. The pleiotropic effects of GLP-1RAs included improvements in inflammatory markers, fibrosis-associated indices, mitochondrial ultrastructure and oxidative stress. Nevertheless, these positive effects mediated by GLP-1RAs are almost exclusively based on experimental models. Therefore, clinical trials are required to explore these promising outcomes in clinical practice.