AIMS: To characterize oral glucose tolerance test (OGTT)-derived metabolic phenotypes in children and adolescents with obesity, focusing on the clinical significance of elevated 1-hour plasma glucose. METHODS: This retro...AIMS: To characterize oral glucose tolerance test (OGTT)-derived metabolic phenotypes in children and adolescents with obesity, focusing on the clinical significance of elevated 1-hour plasma glucose. METHODS: This retrospective study included 726 children and adolescents with obesity who underwent an OGTT at a tertiary center. Participants were classified as NGT-Low (1-hour glucose < 155 mg/dL), NGT-High (≥155 mg/dL), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or advanced dysglycemia. OGTT-derived indices of insulin sensitivity and β-cell function were compared. ROC and multivariable logistic regression analyses identified determinants of dysglycemia. RESULTS: NGT-High showed lower insulin sensitivity (Matsuda index: 1.59 vs. 2.34, p < 0.001) and greater insulin exposure (insulin AUC: 19,845 vs. 13,048 µIU/mL × min, p < 0.001) than NGT-Low. Lower insulinogenic index at 30 min (IGI30), insulinogenic index at 60 min (IGI60), and Insulin Secretion-Sensitivity Index-2 (ISSI-2) indicated early β-cell dysfunction. Delayed insulin peak timing was observed in IGT and advanced dysglycemia groups. Fasting plasma glucose showed the highest discriminatory performance (AUC = 0.797); glycated hemoglobin (HbA1c) and ISSI-2 were independently associated with dysglycemia. CONCLUSIONS: A 1-hour glucose ≥ 155 mg/dL identifies a metabolically distinct phenotype with reduced insulin sensitivity and early β-cell dysfunction despite normal glucose tolerance, supporting 1-hour glucose incorporation into metabolic evaluation of youth with obesity.
Pre-existing diabetes in pregnancy is rising globally and is associated with significant maternal and neonatal health risks, yet optimal dietary strategies remain uncertain. This systematic review evaluated evidence on d...Pre-existing diabetes in pregnancy is rising globally and is associated with significant maternal and neonatal health risks, yet optimal dietary strategies remain uncertain. This systematic review evaluated evidence on dietary components, supplements and dietary patterns during pre-conception and pregnancy in women with pre-existing diabetes. Electronic databases were searched for eligible studies, and risk of bias was assessed using ROB-2, ROBINS-E and ROBINS-I-V2. A random-effects meta-analysis with GRADE assessment was conducted for folic acid supplementation. Twenty-six studies from ten countries met inclusion criteria. Higher diet quality characterised by greater intakes of vegetables, fruits, plant-based proteins, nuts, fish, and lower intakes of processed foods was associated with improved glycaemic outcomes. Low-glycaemic index and DASH dietary patterns, along with carbohydrate counting showed potential benefits, while evidence for low carbohydrate and high-fibre diets was mixed. Associations with gestational weight gain, pre-eclampsia, and neonatal outcomes were inconsistent. Meta-analysis suggested pre-conception folic acid supplementation reduced neural tube defect risk, however the certainty of evidence was very low. Diet quality appears more important than specific macronutrient targets and individualised dietitian led care is essential. Further high-quality research is needed to define optimal dietary approaches for pregnancies complicated by pre-existing diabetes.
BACKGROUND: Garlic (Allium sativum) has been extensively investigated as a potential nutraceutical for improving glycemic control; however, findings from randomized controlled trials (RCTs) remain inconsistent. This syst...BACKGROUND: Garlic (Allium sativum) has been extensively investigated as a potential nutraceutical for improving glycemic control; however, findings from randomized controlled trials (RCTs) remain inconsistent. This systematic review and meta-analysis aimed to evaluate the effects of garlic supplementation on glycemic outcomes. METHODS: A comprehensive search of PubMed, Scopus, and Web of Science Core Collection was conducted up to January 2026 to identify eligible RCTs. Outcomes of interest included fasting blood glucose (FBG), glycated hemoglobin (HbA1c), insulin, and homeostatic model assessment of insulin resistance (HOMA-IR). Subgroup, sensitivity, and meta-regression analyses were performed. Nonlinear dose-response relationships were also assessed. The protocol was registered in PROSPERO (CRD420261298302). RESULTS: Twenty-seven RCTs (n = 1,619 participants) were included. Garlic supplementation significantly reduced FBG (WMD = -2.76 mg/dL; 95% CI: -5.11, -0.41) and HbA1c (WMD = -0.53%; 95% CI: -0.86, -0.20), with no significant effects on insulin (WMD = -1.18 μIU/mL; 95% CI: -2.91, 0.55) or HOMA-IR (WMD = -0.30; 95% CI: -0.72, 0.12). Nonlinear dose-response analysis indicated greater reductions in FBG and insulin at lower doses (≤0.5 g/day). CONCLUSION: Garlic supplementation may lead to modest improvements in glycemic control, particularly in FBG and HbA1c; however, further high-quality RCTs are needed to confirm these findings.
Lipohypertrophy, characterized by subcutaneous adipose tissue accumulation at sites of insulin administration, affects 29-76% of insulin-treated people with diabetes (PwD), yet remains underrecognized. This complication...Lipohypertrophy, characterized by subcutaneous adipose tissue accumulation at sites of insulin administration, affects 29-76% of insulin-treated people with diabetes (PwD), yet remains underrecognized. This complication significantly impacts glycemic control through unpredictable insulin absorption, necessitating up to 25% higher insulin doses and increasing care costs. An evidence-informed consensus initiative was warranted to establish recommendations for the screening, prevention, and management of lipohypertrophy. A modified Delphi methodology was employed involving 13 international experts in endocrinology, primary care, and diabetes research. A structured literature review informed five consensus rounds, leading to fifteen statements addressing epidemiology, risk factors, clinical presentation, diagnosis, prevention, management, and education/training/systems. Inadequate injection site rotation was identified as the strongest modifiable risk factor for lipohypertrophy. The panel recommends systematic injection site examination every 6 months during the first 2 years of insulin therapy, then annually, with more frequent screening for high-risk PwD. Standardized examination protocols incorporating visual inspection and systematic palpation were endorsed, with ultrasound reserved for detecting subclinical lipohypertrophy. Prevention strategies emphasize proper education, site rotation, and single-use needle practices. Implementation of consensus recommendations presented here may improve glycemic outcomes, reduce insulin requirements and cost of care, and enhance quality of life for PwD on insulin therapy.
Cognitive frailty, the coexistence of physical frailty and cognitive impairment, is closely linked to diabetes. This bibliometric analysis retrieved 2005-2024 literature from the Web of Science Core Collection and used C...Cognitive frailty, the coexistence of physical frailty and cognitive impairment, is closely linked to diabetes. This bibliometric analysis retrieved 2005-2024 literature from the Web of Science Core Collection and used CiteSpace to analyse publications, authors, institutions and keywords. The total of 175 papers showed steadily rising output. King's College London stood out institutionally, while Pasquale Mone and Gaetano Santulli were the most productive authors, revealing connections among insulin resistance, chronic inflammation and cognitive frailty. Recent keyword bursts focused on cognitive impairment and frailty. Research has turned to integrated clinical syndromes, with shared pathological pathways of insulin resistance and systemic inflammation as major future hotspots.
AIMS: Normal-weight individuals who exhibit cardiometabolic abnormalities similar to those linked to higher body weight (metabolically unhealthy normal-weight, MUNW) are difficult to detect in clinical practice. We exami...AIMS: Normal-weight individuals who exhibit cardiometabolic abnormalities similar to those linked to higher body weight (metabolically unhealthy normal-weight, MUNW) are difficult to detect in clinical practice. We examined factors associated with prevalent and 6-years incident MUNW, and the stability of MUNW over this period. METHODS: We analyzed 2,357 normal-weight adults (BMI ≥ 18.5, <25 kg/m; 18-74 years) from the Hispanic Community Health Study/Study of Latinos, free of cardiometabolic disease at baseline. MUNW was defined as normal weight with ≥ 1 cardiometabolic risk factor (CMRF) based on the harmonized metabolic syndrome criteria. Multivariable models evaluated associations with prevalent and 6-years incident MUNW. RESULTS: At baseline, 43.9% had MUNW, which was associated with lower education, unemployment/retirement, and greater waist circumference (WC). At follow-up, 22.9% of initially metabolically healthy normal-weight participants developed MUNW, with age as the main predictor. Baseline MUNW increased the risk of progressing to metabolically unhealthy overweight/obesity (MUO), even after adjustment for baseline BMI and WC (risk ratios 1.85-2.37; p < 0.0001). Those who remained MUNW after 6 years (44.2 %) accumulated more CMRFs (p < 0.05). CONCLUSIONS: MUNW predicts progression to MUO and is associated with worsening cardiometabolic profiles. Screening metabolic health in normal-weight adults may help prevent weight gain and cardiometabolic risk.
Ziegler D, Fietz C, Keuthage W
… +12 more, Lobmann R, Rett K, Reule C, Rudolf S, Scheper N, Schnell O, Serban PM, Sjomin J, Stirban OA, Strom A, Ströhl J, Jaghutriz BA
AIMS: This non-interventional, prospective, multicenter registry study aimed to assess the real-world management routine and the impact of the severity of neuropathic pain on health-related quality of life in people with...AIMS: This non-interventional, prospective, multicenter registry study aimed to assess the real-world management routine and the impact of the severity of neuropathic pain on health-related quality of life in people with diabetic sensorimotor polyneuropathy (DSPN). METHODS: Participants with possible/probable DSPN (n = 617) from practices or clinics were classified by the numerical pain rating scale into severe/moderate painful DSPN (Group 1;n = 262), mild painful DSPN (Group 2;n = 210), and painless DSPN (Group 3;n = 145). Mandatory assessment of DSPN included pain scales/questionnaires and the Short Form 12 Health Survey (SF-12), while optional assessment comprised point-of-care screening tools. RESULTS: In Group 1, 42% of participants received any pharmacotherapy and 28% received analgesic pharmacotherapy for DSPN. Three different DSPN screening tools were used in 77%, 54%, and 28% of the participants. In multivariate analyses, decreased scores of the physical and mental SF-12 components were most consistently associated with both severe/moderate and mild painful DSPN compared to painless DSPN (P < 0.05). Severe/moderate painful DSPN was also associated with female sex, higher BMI, and longer diabetes duration (P < 0.05). CONCLUSIONS: Although not only severe/moderate but also mild neuropathic pain are powerful risk factors of reduced health-related quality of life, painful DSPN still remains undertreated, whilst screening tools are underutilized in real-world practice.
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are treatment options for Type 2 diabetes (T2D), but their efficacy in patients with heart failure with reduced ejection fraction (HFrEF) remains unclear....BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are treatment options for Type 2 diabetes (T2D), but their efficacy in patients with heart failure with reduced ejection fraction (HFrEF) remains unclear. We evaluated the association of GLP-1 RAs added to guideline-directed medical therapy (GDMT) with all-cause death and hospitalization in patients with HFrEF and T2D. METHODS: We conducted a retrospective cohort study using the TriNetX platform. Patients with HFrEF and T2D were identified between 2018 and 2023 (N = 579,171). Of these, 3,379 received all of GDMTs with GLP-1 RAs, and 14,712 received all of GDMTs without GLP-1 RAs. After propensity score matching, 3,158 patients were included in each group. Primary outcome was all-cause death over 18 months; secondary outcome was hospitalization. RESULTS: All of GDMTs with GLP-1 RAs were associated with a lower risk of all-cause death than all of GDMTs without GLP-1 RAs (10.5 % vs. 14.4 %; hazard ratio [HR], 0.71; 95 % confidence interval [CI], 0.62-0.83). Hospitalization did not differ significantly between groups (63.7 % vs. 60.1 %; HR, 1.05; 95 % CI, 0.98-1.12). CONCLUSION: In patients with HFrEF and T2D, all of GDMTs with GLP-1 RAs were associated with a lower risk of all-cause death than all of GDMTs without GLP-1 RAs.
Diabetes Res Clin Pract
· 2026 Jun · PMID 42379427
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AIMS: To evaluate the independent and combined effects of first-trimester elevated fasting blood glucose (EFBG, FBG ≥ 5.1 mmol/L) and high-normal blood pressure (HNBP, SBP: 120-139 mmHg and/or DBP: 80-89 mmHg) on adverse...AIMS: To evaluate the independent and combined effects of first-trimester elevated fasting blood glucose (EFBG, FBG ≥ 5.1 mmol/L) and high-normal blood pressure (HNBP, SBP: 120-139 mmHg and/or DBP: 80-89 mmHg) on adverse pregnancy outcomes among southern Chinese women with singleton pregnancies. METHODS: This single-center retrospective cohort study enrolled 9,432 women who registered for antenatal care and delivered at the Department of Obstetrics and Gynecology, Guangxi Zhuang Autonomous Region People's Hospital between January 2018 and December 2023. Participants were stratified into four groups according to first-trimester FBG and BP measurements: control group (G1, n = 7,192), isolated EFBG group (G2, n = 784), isolated HNBP group (G3, n = 1,212), and co-exposure group (G4, n = 244). Multivariable logistic regressionwas used to estimate adjusted odds ratios (aOR) for adverse pregnancy outcomes. Additive interactions between EFBG and HNBP were assessed using relative excess risk due to interaction (RERI), attributable proportion (AP), and the synergy index (S), estimated from modified Poisson regression models with bootstrap resampling. RESULTS: Compared with the G1, the G3 had a significantly higher risk of hypertensive disorders of pregnancy (HDP) (aOR = 4.36, 95%CI: 3.51-5.40), and the G2 had a significantly higher risk of gestational diabetes mellitus (GDM) (aOR = 2.40, 95%CI: 2.06-2.81).. The G4 exhibited the highest risk of GDM (aOR = 4.29, 95%CI: 3.24-5.68). However, the additive interaction analysis did not reveal a statistically significant synergistic effect between EFBG and HNBP for GDM (RERI = 0.10, 95% CI: -0.15 to 0.35). The G3 was also associated with increased risk of preterm birth (aOR = 1.92, 95%CI: 1.45-2.55), low birth weight (LBW) (aOR = 2.15, 95%CI: 1.65-2.81), and small for gestational age (SGA) (aOR = 1.28, 95%CI: 1.04-1.57), whereas the G2 was associated with increased risk of large for gestational age (LGA) (aOR = 1.33, 95%CI: 1.06-1.66) and macrosomia (aOR = 1.66, 95%CI: 1.17-2.37). CONCLUSION: First-trimester EFBG and HNBP are independent predictors of distinct adverse pregnancy outcomes. EFBG is associated with metabolic complications (GDM, macrosomia, LGA), while HNBP is associated with vascular complications (HDP, LBW, SGA), isolated diastolic and combined HNBP conferring particularly high HDP risk. Although the co-exposure group had the highest absolute risk of GDM, no significant additive or multiplicative interaction was observed. These findings support combined glucose-blood pressure screening in early pregnancy for risk stratification..
Yan C, Zhao Y, Zhang W
… +9 more, Shi L, Chen G, He Y, She P, Sun J, Wang T, Wu J, Zhang L, Liu P
Diabetes Res Clin Pract
· 2026 Jun · PMID 42379426
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BACKGROUND: The fasting C-peptide index (F-CPI) reflects pancreatic beta-cell function, but its long-term link to vascular phenotype in type 2 diabetes mellitus (T2DM) remains unclear. METHODS: This cohort study followed...BACKGROUND: The fasting C-peptide index (F-CPI) reflects pancreatic beta-cell function, but its long-term link to vascular phenotype in type 2 diabetes mellitus (T2DM) remains unclear. METHODS: This cohort study followed 1,080 T2DM patients for 3.85 years, categorizing them into four vascular phenotypes: vascular health phenotype (VHP), isolated macrovascular phenotype (IMaP), isolated microvascular phenotype (IMiP), combined vascular phenotype (CVP). The study assessed their associations with baseline and dynamic F-CPI trajectories. RESULTS: A higher baseline F-CPI was independently associated with a significantly lower CVP risk (OR = 0.23, P < 0.001), but had no significant link to IMaP or IMiP. Longitudinal data confirmed that a higher cumF-CPI reduced the risks of CVP and IMiP. Poorly controlled F-CPI fluctuation patterns increased both risks. Glycated hemoglobin only partially mediated this protective effect against CVP. Furthermore, fat accumulation significantly weakened the protection of F-CPI against CVP (P < 0.05). Combining outcomes into a single composite endpoint masked these specific associations. CONCLUSION: In T2DM, maintaining high baseline and long-term cumF-CPI was independently associated with reduced CVP risk. Visceral obesity appeared to significantly attenuate this protective association. This suggests the potential clinical value of monitoring F-CPI trajectories and using refined vascular phenotypes for complication risk stratification in T2DM.
Diabetes Res Clin Pract
· 2026 Jun · PMID 42373008
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Observational and interventional studies involving individuals aged <20 years with T1D were eligible. Major databases were searched from 1995 to 2024 and risk of bias was assessed using Joanna Briggs Institute critical a...Observational and interventional studies involving individuals aged <20 years with T1D were eligible. Major databases were searched from 1995 to 2024 and risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. Sixty-two studies met the inclusion criteria, involving more than 200,000 participants. No randomized trials or direct comparisons of screening strategies were identified. The mean study prevalence of diabetic retinopathy was 9.5%, with higher prevalence reported in low- and lower-middle-income countries. Most cases occurred after five years of diabetes duration and after 11 years of age, although rare cases were reported earlier. Higher HbA1c levels (≥9%) were associated with increased retinopathy prevalence. Mydriatic screening improved detection compared with non-mydriatic approaches (11.5% vs 4.4%). Only six studies reported screening intervals, all from high-income countries. Sight-threatening retinopathy was rare and largely confined to older adolescents with longer diabetes duration. Findings support current recommendations for screening initiation and highlight the need for prospective studies, particularly in low- and middle-income countries.
Soliman AT, Alyafei F, Khalil A
… +4 more, Kardousha AT, Ahmed S, Alaaraj N, Hamed N
Diabetes Res Clin Pract
· 2026 Jun · PMID 42365860
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Childhood obesity and youth-onset type 2 diabetes mellitus (T2DM) are increasing, highlighting the need for effective treatments beyond lifestyle intervention and metformin. This review systematically evaluated the effic...Childhood obesity and youth-onset type 2 diabetes mellitus (T2DM) are increasing, highlighting the need for effective treatments beyond lifestyle intervention and metformin. This review systematically evaluated the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in children and adolescents with obesity or T2DM. PubMed-indexed studies published from 2000 to 2025 were reviewed, including seven pivotal randomized controlled trials and six meta-analyses involving 901 participants aged 6 to < 18 years. Semaglutide 2.4 mg/week produced the greatest BMI reduction in adolescents with obesity, followed by liraglutide 3.0 mg/day, which also improved BMI SDS in adolescents and younger children. In youth-onset T2DM, liraglutide 1.8 mg/day and dulaglutide significantly improved HbA1c compared with placebo. Weight-reducing agents also improved insulin resistance and modestly reduced triglycerides, while LDL-cholesterol changes were minimal. Gastrointestinal adverse events, mainly nausea and vomiting, were the most frequent and were generally transient and dose dependent. No significant adverse effects on linear growth or pubertal progression were reported. GLP-1 RAs are effective adjuncts for pediatric obesity and T2DM, but longer-term studies are needed to assess cardiovascular safety, bone health, and growth outcomes.
Xiang F, Li M, Li R
… +10 more, Pan X, Pang R, Song L, Wang S, Li Z, Zeng Z, Cao X, Wang Z, Wang Z, Li S
Diabetes Res Clin Pract
· 2026 Jun · PMID 42361856
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AIMS: To investigate 6-year macular microcirculation changes in participants who developed incident type 2 diabetes mellitus (T2DM) during follow-up but had no fundus photography-detectable diabetic retinopathy (DR), and...AIMS: To investigate 6-year macular microcirculation changes in participants who developed incident type 2 diabetes mellitus (T2DM) during follow-up but had no fundus photography-detectable diabetic retinopathy (DR), and to identify factors associated with early microvascular abnormalities. METHODS: This nested case-control study compared participants with incident T2DM without DR with age-matched controls without diabetes. All participants underwent ophthalmic examinations and 6 x 6 mm macular optical coherence tomography angiography at both visits. Vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular zone-related parameters, and foveal density 300 were analyzed using generalized estimating equations. RESULTS: Sixty-eight eyes from 40 participants with incident T2DM and 204 control eyes were included. Both groups showed decreases in SCP and DCP VD over 6 years. Reductions in DCP VD were greater in T2DM eyes than in controls (all P < 0.05). Microvascular abnormalities developed in 23 diabetic eyes and were independently associated with longer diabetes duration. CONCLUSION: Incident T2DM eyes showed greater decline in DCP VD than controls without fundus photography-detectable DR. These findings highlight the importance of early longitudinal monitoring of retinal perfusion in T2DM.
Millán AL, Rojo M, Duarte A
… +3 more, Pérez H, López AP, Frechtel GD
Diabetes Res Clin Pract
· 2026 Jun · PMID 42361855
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AIMS: This study evaluated telomere length (TL) as a biomarker of cumulative metabolic dysfunction. We assessed the association between TL and Metabolic Syndrome (MS), its individual components, and their clustering, whi...AIMS: This study evaluated telomere length (TL) as a biomarker of cumulative metabolic dysfunction. We assessed the association between TL and Metabolic Syndrome (MS), its individual components, and their clustering, while comparing obesity phenotypes to evaluate TL's utility in stratifying biological risk during the transition to metabolic impairment. METHODS: In 331 participants, TL was measured by qPCR. Associations were analyzed using three incremental linear regression models (unadjusted, age/sex-adjusted, and fully adjusted). TL was compared across three groups: Normal Weight (NW0), Metabolically Healthy Obesity (MHO), and Obesity with MS (OMS). RESULTS: MS diagnosis was robustly associated with shorter TL in the fully adjusted model (p < 0.001). Central adiposity and dyslipidemia were the primary drivers of attrition. A non-linear pattern emerged regarding cumulative burden of MS components: TL significantly shortened with the first three components but showed no further reduction with four or five. TL was different between phenotypes; MHO subjects exhibited significantly shorter TL than NW0 (p = 0.005) but longer than OMS group (p = 0.025). CONCLUSIONS: The non-linear pattern of attrition and differences in TL across NW0, MHO, and OSM phenotypes suggest that TL captures the systemic biological impact of metabolic clustering rather than the additive effect of individual risk factors.
Kondyli M, Siwy J, Jaimes Campos MA
… +10 more, Amann K, Beige J, Keller F, Mischak H, Frantzi M, Wendt R, Rossing P, Rupprecht H, Catanese L, Jankowski V
Diabetes Res Clin Pract
· 2026 Jun · PMID 42361854
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AIMS: Risk stratification in diabetic kidney disease is challenging. Identifying nodular diabetic nephropathy (NDN), the most specific histological feature of diabetic nephropathy (DN), associated with poor prognosis, cu...AIMS: Risk stratification in diabetic kidney disease is challenging. Identifying nodular diabetic nephropathy (NDN), the most specific histological feature of diabetic nephropathy (DN), associated with poor prognosis, currently requires kidney biopsy. We aimed to identify urinary peptide biomarkers distinguishing NDN from other chronic kidney disease etiologies in diabetes (nNDN). METHODS: In this case-control study, urinary peptide profiles from biopsy-proven DN patients (43 NDN, 38 nNDN) were analyzed using capillary electrophoresis-mass spectrometry. Real patient data were combined with synthetic datasets generated using a Gaussian copula approach and divided into discovery and validation cohorts. Differential peptides were identified by Wilcoxon testing with Benjamini-Hochberg correction, and combined into a support vector machine model. RESULTS: In the discovery cohort, 207 peptides were significantly altered. NDN was characterized by reduced collagen fragments and increased fibrinogen, apolipoprotein A-IV, and α1-antitrypsin peptides. The 99-peptide classifier (NDN99) discriminated NDN from nNDN with an AUC of 0.87 (combined validation) and 0.79 (real-patient validation). NDN99 predicted major adverse kidney events (MAKE; death, kidney failure, or 40% eGFR loss), and outperformed histology (HR = 2.9, p = 0.0006 vs HR = 1.9, p = 0.04). CONCLUSIONS: Urinary peptide signatures enable non-invasive discrimination of NDN and predict MAKE, potentially complementing kidney biopsy for subtype identification and risk stratification in DN.
Diabetes Res Clin Pract
· 2026 Jun · PMID 42361853
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BACKGROUND: Early-stage cardiovascular-kidney-metabolic (CKM) syndrome is associated with increased heart disease and stroke risk. The triglyceride-glucose (TyG) index and Frailty Index (FI) predict CKM-related outcomes,...BACKGROUND: Early-stage cardiovascular-kidney-metabolic (CKM) syndrome is associated with increased heart disease and stroke risk. The triglyceride-glucose (TyG) index and Frailty Index (FI) predict CKM-related outcomes, but their combined longitudinal burden remains unclear. METHODS: This study included 4,341 adults aged ≥ 45 years with CKM stages 0-3 from CHARLS. Cumulative TyGFI (cumTyGFI) was calculated as the area under the curve using 2011-2012 and 2015 TyGFI measurements, and TyGFI trajectories were identified using k-means clustering. Incident heart disease and stroke in 2018 were assessed using multivariable logistic regression and incremental predictive metrics. RESULTS: During follow-up, 593 heart disease and 293 stroke events occurred. Each 1-unit increase in cumTyGFI was associated with higher odds of heart disease (OR 1.71) and stroke (OR 1.81). The high-rising trajectory class showed the highest odds of both outcomes (heart disease OR 2.54; stroke OR 3.12). Adding cumTyGFI improved prediction (NRI 0.4853/0.5731; IDI 0.0345/0.0285; all P < 0.001). SHAP identified cumTyGFI, BMI, and age as leading contributors. CONCLUSIONS: cumTyGFI and TyGFI trajectories improved risk stratification for heart disease and stroke in early-stage CKM syndrome.
Rákóczi G, Csányi D, Molontay R
… +6 more, Agócs G, Szentes BL, Lee J, Rancz A, Hegyi P, Sipter E
Diabetes Res Clin Pract
· 2026 Jun · PMID 42349688
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AIMS: Prediabetes classification based on hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) shows substantial discordance, potentially limiting early identification of individuals at metabolic risk. We evaluated wh...AIMS: Prediabetes classification based on hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) shows substantial discordance, potentially limiting early identification of individuals at metabolic risk. We evaluated whether continuous glucose monitoring (CGM) metrics can classify prediabetes with performance approaching that of HbA1c and FPG. METHODS: We conducted a cross-sectional analysis of 1,883 participants from the Human Phenotype Project with concurrent CGM, HbA1c, and FPG data. Individual CGM metrics were evaluated across four ADA-based laboratory reference definitions, and a combined model incorporating six clinically selected CGM metrics was additionally assessed. Discrimination was quantified using the area under the receiver operating characteristic curve (AUC). RESULTS: HbA1c- and FPG-based classifications showed marked discordance, with only 9.5% of participants meeting both prediabetes criteria. Several CGM metrics demonstrated classification performance approaching that of laboratory markers (AUC range 0.645-0.677). Discrimination improved when prediabetes was defined by both criteria, but no single marker achieved high performance independently. CONCLUSIONS: CGM metrics achieve classification performance approaching conventional laboratory markers while capturing complementary aspects of glycemic regulation. These findings support CGM as a complementary rather than standalone tool alongside conventional markers, particularly when laboratory results are discordant. Prospective studies incorporating oral glucose tolerance testing and longitudinal outcomes are warranted.
Abuqwider J, Pasolli E, Scidà G
… +8 more, Corrado A, Vitale M, Giosuè A, Filippis F, Ercolini D, Annuzzi G, Rivellese AA, Bozzetto L
Diabetes Res Clin Pract
· 2026 Jun · PMID 42341885
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AIMS: To examine the associations between ultra-processed food (UPF) intake, glycemic control, cardiovascular risk factors, and gut microbiome in adults with type 1 diabetes (T1D). METHODS: In 253 adults with T1D, diet w...AIMS: To examine the associations between ultra-processed food (UPF) intake, glycemic control, cardiovascular risk factors, and gut microbiome in adults with type 1 diabetes (T1D). METHODS: In 253 adults with T1D, diet was assessed using the EPIC food-frequency questionnaire, and UPFs classified according to NOVA. Evaluations included lipid profile, HbA1c, and continuous glucose monitoring metrics. In a subgroup (n = 103), gut microbiota composition/function was analyzed using shotgun metagenomic sequencing and beta-diversity assessed by PERMANOVA. Associations were examined using multivariable regression models adjusted for age and Mediterranean diet adherence. RESULTS: Mean UPF intake was 15.5 % of total food intake. Higher UPF intake was independently associated with higher triglycerides (β per 20 g/1000 kcal = 3.62 mg/dL; 95 %CI 1.16-6.08) and lower HDL-cholesterol (β = - 0.98 mg/dL; 95 %CI - 1.72 to - 0.24). Sugar/artificially sweetened beverages were positively associated with triglycerides and animal-based UPFs inversely associated with HDL cholesterol. In participants on multiple daily injections or open-loop systems, ready-to-eat mixed dishes were positively associated with HbA1c. Microbiome beta-diversity significantly differed according to UPF intake. Triglycerides positively associated with microbial pathways (ketogluconate, tetrapyrrole, and acetate metabolism). CONCLUSION: Higher UPF intake was associated with atherogenic dyslipidemia, poorer glycemic control in selected groups, and gut microbiome alterations in adults with T1D. The study was registered at ClinicalTrials.gov with the identifier NCT05936242.