Zeng F, Song C, Wang C
… +3 more, Li B, Wang H, Dou K
Diabetes Res Clin Pract
· 2026 May · PMID 42128206
·
Publisher ↗
AIMS: Hemodynamically non-significant intermediate coronary lesions, though generally deferred from revascularization, still carry residual cardiovascular risk. Hemoglobin glycation index (HGI) is a novel indicator refle...AIMS: Hemodynamically non-significant intermediate coronary lesions, though generally deferred from revascularization, still carry residual cardiovascular risk. Hemoglobin glycation index (HGI) is a novel indicator reflecting glycemic variability. This study aims to assess the association between HGI and long-term outcomes in these patients. METHODS: We enrolled 5932 patients with intermediate lesions during 2017 and stratified them into three HGI tertiles. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs) over a median 4.91 - year follow-up . RESULTS: During follow-up, 192 (3.2%) MACCEs occurred. A J-shaped association between HGI and 5-year MACCEs after adjustment was confirmed (P for non-linearity = 0.007), with an optimal inflection point of -0.24. Above this threshold, each 1-unit HGI increment significantly elevated MACCEs risk (HR 1.138, 95%CI 1.073-1.207, P < 0.001). The High-HGI group had a 76% higher MACCEs risk versus the Medium-HGI reference (HR 1.761, 95%CI 1.233-2.515, P = 0.002), whereas the Low-HGI group showed a non-significant trend toward higher risk. CONCLUSIONS: HGI has a J-shaped association with MACCEs in patients with intermediate lesions. While a high HGI is a robust independent predictor of adverse events, a low HGI represents a non-significant trend. HGI may serve as a readily accessible biomarker for risk stratification.
Fibroblast growth factor-21 (FGF-21) and growth differentiation factor-15 (GDF-15) are metabolokines associated with insulin resistance in type 2 diabetes, but their pooled diagnostic performance has not been systematica...Fibroblast growth factor-21 (FGF-21) and growth differentiation factor-15 (GDF-15) are metabolokines associated with insulin resistance in type 2 diabetes, but their pooled diagnostic performance has not been systematically established. We conducted a PRISMA-DTA-compliant systematic review and bivariate diagnostic test accuracy meta-analysis to evaluate the accuracy of FGF-21 and GDF-15, individually and in combination, for predicting insulin resistance using the triglyceride-glucose (TyG) index, HOMA-C-peptide, and C-peptide-to-glucose ratio as reference standards. Six databases were searched from January 2015 to March 2025. Fifteen studies involving 14,832 participants were included. Against TyG, FGF-21 showed pooled sensitivity of 82.4% and specificity of 78.9% (AUC 0.88), while GDF-15 demonstrated slightly higher sensitivity of 85.6% and specificity of 82.1% (AUC 0.91). Combined FGF-21 and GDF-15 testing achieved the best overall performance, with sensitivity of 88.9%, specificity of 86.4%, and AUC of 0.94. TyG was the most discriminating reference standard across both biomarkers. These findings support the potential utility of FGF-21 and GDF-15, particularly in combination, as adjunctive laboratory biomarkers for insulin resistance risk stratification in type 2 diabetes.
BACKGROUND: Insulin signaling is a central regulator of metabolic homeostasis, controlling glucose uptake, lipid metabolism, protein synthesis, and pancreatic β-cell function. Dysregulation of this pathway contributes to...BACKGROUND: Insulin signaling is a central regulator of metabolic homeostasis, controlling glucose uptake, lipid metabolism, protein synthesis, and pancreatic β-cell function. Dysregulation of this pathway contributes to insulin resistance, obesity, and type 2 diabetes mellitus (T2DM). Long noncoding RNAs (lncRNAs) have emerged as important regulators of gene expression and cellular signaling; however, their roles in modulating insulin signaling remain incompletely understood. OBJECTIVE: This review summarizes current advances in lncRNA-mediated regulation of insulin signaling and its implications in metabolic disease. METHODS: Recent studies examining the roles of lncRNAs in insulin signaling pathways were analyzed, with emphasis on tissue-specific functions and interactions with the insulin receptor/IRS/PI3K/Akt signaling axis. RESULTS: lncRNAs regulate metabolic homeostasis in the liver, adipose tissue, skeletal muscle, and pancreatic β-cells by modulating insulin signaling, glucose transport, lipid metabolism, and β-cell function through transcriptional, post-transcriptional, epigenetic, and signaling mechanisms. Dysregulated lncRNA expression has been linked to insulin resistance and T2DM progression. Although transcriptomic studies have identified numerous insulin-responsive lncRNAs, mechanistic characterization and causal validation remain limited. CONCLUSION: lncRNAs are critical modulators of insulin signaling and metabolic regulation. A deeper understanding of lncRNA-mediated regulatory networks may facilitate the identification of novel biomarkers and therapeutic targets for insulin resistance and T2DM.
Children with type 1 diabetes (T1D) are less likely to meet physical activity guidelines and be physically active than their peers. This scoping review aimed to identify and describe existing physical activity interventi...Children with type 1 diabetes (T1D) are less likely to meet physical activity guidelines and be physically active than their peers. This scoping review aimed to identify and describe existing physical activity interventions for children with T1D. Six databases were systematically searched for peer reviewed articles published in English from the year 2000 until June 1, 2025 Interventions for children with T1D were included if they reported physical activity as an outcome. Intervention details were extracted, and behaviour change techniques (BCTs) were coded using the BCT Taxonomy (v1). Twelve studies were included. Sample sizes ranged from 8 to 42 participants; mean age was 11.70 ± 3.88 years. Median intervention length was 11 weeks. Accelerometry was the most frequently used modality (n = 7) to measure physical activity. Three interventions observed significant improvements in physical activity. All studies reported a range of BCT combinations. On average, a total of 5 BCTs were used (max = 9, min = 3) for each intervention. No clear association was found between BCTs (number and/or type) used and physical activity improvements. This review highlights the paucity of physical activity interventions for children with T1D. Results suggest that certain BCTs may be promising, yet warrant further exploration in subsequent studies.
BACKGROUND: India faces a growing obesity epidemic within the context of persistent undernutrition, creating a dual burden with major cardiometabolic consequences. This population is particularly vulnerable to metabolic...BACKGROUND: India faces a growing obesity epidemic within the context of persistent undernutrition, creating a dual burden with major cardiometabolic consequences. This population is particularly vulnerable to metabolic disease because of the "Asian Indian phenotype," characterized by increased visceral adiposity and higher metabolic risk at lower body mass index thresholds. OBJECTIVE: To review current evidence on the relationship between sleep health, lipid dysregulation, and metabolic dysfunction in the obesity epidemic in India, with emphasis on epidemiology, biologic mechanisms, and implementation relevance. METHODS: PubMed-indexed literature published from 2015 through February 2026 was reviewed, prioritizing India-specific epidemiologic studies, national reports, and policy-relevant publications. International mechanistic studies were included when relevant to biologic plausibility and translational understanding. RESULTS: Obesity in India shows substantial regional and urban-rural variation, while dyslipidemia remains highly prevalent and inadequately controlled, particularly in people with type 2 diabetes mellitus. Sleep disturbances, including short sleep duration, circadian misalignment, shift work, and obstructive sleep apnea, are increasingly recognized as contributors to metabolic dysfunction. Mechanistic evidence suggests that sleep disruption may impair metabolic health through clock gene dysregulation, bile acid-lipid desynchronization, microbiome-derived short-chain fatty acid signaling, inflammation, and neuroendocrine stress pathways. However, India-specific lipidomic, longitudinal, and sleep-focused interventional data remain limited. CONCLUSIONS: Sleep health disturbances appear to be important and potentially modifiable contributors to metabolic dysfunction in India. Improving access to obstructive sleep apnea diagnosis and continuous positive airway pressure therapy, strengthening dyslipidemia management, and integrating sleep health into broader noncommunicable disease frameworks may improve prevention and care in high-risk Indian populations.
We synthesized the effects of MBIs on psychological outcomes and HbA1c in diabetic patients and conducted subgroup analyses to investigate the sources of heterogeneity. Nine electronic databases were methodically explore...We synthesized the effects of MBIs on psychological outcomes and HbA1c in diabetic patients and conducted subgroup analyses to investigate the sources of heterogeneity. Nine electronic databases were methodically explored from their inception through May 2025. We reviewed studies on the outcomes for individuals with diabetes mellitus who participated in mindfulness-based interventions. A random-effects model was employed to calculate the effect size. The funnel plot, Q statistics, and I2 were employed to assess heterogeneity among studies. Across 24 primary studies (N = 1987), 942 participants engaged in mindfulness-based interventions and 955 functioning as controls. Mean age ranged from 18.3 to 66.3 years. Overall, mindfulness-based interventions showed improvement of HbA1c (Hedges' g = 0.564, 95%Confidence interval, CI, 0.221, 0.908, p = 0.001), stress (g = 1.132, 95%CI 0.551, 1.714, p < 0.001), anxiety (g = 1.321, 95%CI 0.569, 2.072, p = 0.001) and depression (g = 1.059, 95%CI 0.564, 1.555, p < 0.001). MBI format, intention-to-treat analysis, concealed allocation, attrition, funding sources, and a priori analysis were modifiers affecting the effect size. To sum up, mindfulness-based therapies markedly improved HbA1c levels and psychological outcomes, among individuals with diabetes mellitus. Future studies with robust designs are warranted. Healthcare professionals may consider using these therapies to improve psychological outcomes and HbA1c levels in individuals with diabetes mellitus.
Rebelos E, Rossi C, Honka MJ
… +12 more, Raggi F, Moriconi D, Saukko E, Dadson P, Latva-Rasku A, Tuomola N, Kauhanen S, Helmiö M, Salminen P, Mantzoros CS, Nuutila P, Solini A
AIMS: Nephrinuria and podocinuria have been proposed as early markers of podocytopathy. We explored whether nephrin and podocin are expressed in subcutaneous (SAT) and visceral adipose tissue (VAT), and report their dete...AIMS: Nephrinuria and podocinuria have been proposed as early markers of podocytopathy. We explored whether nephrin and podocin are expressed in subcutaneous (SAT) and visceral adipose tissue (VAT), and report their determinants. METHODS: Forty-one subjects with obesity (OS, age: 51 [41-57] yrs, M/F: 6/34) and twenty-nine lean controls (HC, age: 43 [35-51] yrs, M/F: 9/20) were studied. During metabolic bariatric surgery (MBS) VAT and SAT samples were collected. Only SAT samples were collected from HC. VAT samples from lean surgical patients served as an additional comparison group. Nephrin and podocin mRNA and protein expression were assessed in VAT/SAT, and nephrin and podocin levels were measured in plasma and urine. RESULTS: Podocin was not expressed in SAT or VAT. Nephrin mRNA was detected in VAT but not SAT, and nephrin protein expression was higher in OS. In plasma, low levels of nephrin were detected, which were directly associated with insulin sensitivity. Urinary nephrin exhibited an inverse association with insulin sensitivity, which persisted two years after MBS. CONCLUSIONS: Nephrin is ectopically produced in VAT. Circulating and urinary nephrin show opposite associations with insulin sensitivity, compatible with early nephrin loss into the urine and compensatory regulation of VAT derived nephrin. These findings warrant further investigation.
AIMS: Type 2 diabetes (T2D) is associated with increased risks of dementia and stroke with heterogeneity. We aimed to identify data-driven T2D subtypes and examine associations with dementia, stroke, mortality, and brain...AIMS: Type 2 diabetes (T2D) is associated with increased risks of dementia and stroke with heterogeneity. We aimed to identify data-driven T2D subtypes and examine associations with dementia, stroke, mortality, and brain structure. METHODS: In 14,353 UK Biobank participants with T2D (mean age 59.8 years), k-means clustering was applied using age at diagnosis, body mass index, glycated hemoglobin, insulin resistance, systolic blood pressure, and C-reactive protein. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Brain structural measures were analyzed in a subset. RESULTS: Three subtypes emerged: severe obesity-related inflammatory diabetes (SOID), mild metabolic diabetes (MMD, reference), and mild age-related hypertension-predominant diabetes (MARD-H). Versus MMD, SOID showed higher risks of all-cause dementia (HR 1.24, 95% CI 1.01-1.52), vascular dementia (HR 1.42, 95% CI 1.01-1.99), stroke (HR 1.38, 95% CI 1.14-1.68), ischemic stroke (HR 1.48, 95% CI 1.21-1.82), all-cause mortality (HR 1.59, 95% CI 1.45-1.74), and cardiovascular death (HR 1.88, 95% CI 1.59-2.23). MARD-H showed modest relative but highest absolute risks. SOID showed lower gray matter and greater white matter hyperintensity. CONCLUSIONS: T2D subtypes show distinct vascular and neurological risks. The obesity-inflammation subtype carries elevated risks of dementia, stroke, mortality, and adverse brain changes.
AIMS: To investigate: i) the association of sedentary time (ST) and moderate-to-vigorous physical activity (MVPA) during pregnancy with placental interleukin-6 (IL-6) expression and cord venous IL-6 content in women with...AIMS: To investigate: i) the association of sedentary time (ST) and moderate-to-vigorous physical activity (MVPA) during pregnancy with placental interleukin-6 (IL-6) expression and cord venous IL-6 content in women with obesity; and ii) cord venous markers mediating the relationship of ST/MVPA and placental IL-6 with neonatal adiposity. METHODS: Among 134 participants, ST and MVPA were assessed using accelerometry at three gestational periods. Placental IL-6 mRNA was quantified using Nanostring technology. Cord blood concentrations of glucose, leptin, insulin, C-peptide and IL-6 were determined. Neonatal fat percentage was calculated from skinfold measurements. RESULTS: Increasing MVPA from inclusion (<20 weeks) to 24-28 or 35-37 weeks, and reducing ST to 24-28 weeks, were associated with higher IL-6 expression in female placentas (p < 0.05). Increasing MVPA from inclusion to 24-28 weeks was associated with lower cord venous IL-6 levels in male fetuses (p = 0.006). Lower cord glucose and insulin concentrations and insulin resistance mediated the association between increased placental IL-6 and reduced neonatal adiposity (p < 0.05). CONCLUSIONS: In women with obesity, increasing MVPA and reducing ST during pregnancy is associated with higher IL-6 expression in female placentas and lower cord IL-6 in male fetuses. Higher placental IL-6 expression is linked to reduced fetal insulinemia and insulin resistance, contributing to lower neonatal adiposity. TWITTER SUMMARY/SOCIAL MEDIA: In pregnant women with obesity, higher moderate-vigorous physical activity and lower sedentary time upregulate placental IL-6 expression, which in turn is related to lower neonatal adiposity through reduced fetal insulinemia and insulin resistance. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN70595832.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly explored as adjuncts in Type 1 Diabetes Mellitus (T1DM), though concerns regarding hypoglycaemia and diabetic ketoacidosis (DKA) limit their adoption...Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly explored as adjuncts in Type 1 Diabetes Mellitus (T1DM), though concerns regarding hypoglycaemia and diabetic ketoacidosis (DKA) limit their adoption. To comprehensively evaluate their safety, we conducted a systematic review and meta-analysis following PRISMA guidelines. Major databases were searched through June 2025. Outcomes included hypoglycaemia, DKA, gastrointestinal adverse events, and study withdrawals. Twenty-five studies (23 RCTs, 2 observational) were included. Updated pooled data established a neutral risk for overall hypoglycaemia (RR 1.01; Moderate certainty) and serious adverse events (RR 0.89; Moderate certainty). Furthermore, no significant increase was observed for severe hypoglycaemia (RR 0.74; Low certainty) or DKA (RR 0.60; Very Low certainty), though statistical imprecision warrants cautious interpretation. However, GLP-1 RAs significantly increased nausea (RR 2.89) and vomiting (RR 3.10), driving a twofold increase in early treatment withdrawal (RR 2.02; Moderate certainty). Subgroup analysis revealed that overall tolerability significantly improves after six months of therapy. In conclusion, in pooled analyses, GLP-1 RAs were not associated with increased severe hypoglycaemia or DKA, although evidence remains limited. However, a substantial early gastrointestinal burden necessitates cautious patient selection and stepwise dose-titration to maximize patient tolerability and long-term adherence.
AIM: Albuminuria reflects early renal injury and may precede type 2 diabetes, particularly among Māori and Pacific adolescents in New Zealand who experience a high burden of severe obesity. Evidence for renal benefits of...AIM: Albuminuria reflects early renal injury and may precede type 2 diabetes, particularly among Māori and Pacific adolescents in New Zealand who experience a high burden of severe obesity. Evidence for renal benefits of bariatric surgery in adolescents is limited. We examined the effect of intensive lifestyle intervention, with or without bariatric surgery, on urine albumin-creatinine ratio (UACR). METHODS: Adolescents aged 15-17 years with BMI ≥ 35 kg/m completed a 12-week very-low-calorie diet (VLCD) programme. Screening HbA1c identified prediabetes or type 2 diabetes, and eligible participants were offered bariatric surgery. UACR was measured at up to 14 time points over 36 months. Longitudinal mixed-effects models assessed trajectories of log-UACR, adjusting for time, surgery status, and weight change, with participant-level random intercepts. RESULTS: Twenty adolescents (11 female; 19 Māori or Pacific; 8 prediabetes and 9 type-2 diabetes) were enrolled; seven underwent surgery. Over follow-up (6-36 months), a significant time × surgery interaction was observed (p < 0.001). At 36-months, surgical participants had an 86 (95% CI 72-92)%, reduction in UACR, whereas non-surgical participants showed no significant change (+2; 95% CI - 7 to + 12)%. CONCLUSIONS: Bariatric surgery combined with lifestyle intervention was associated with sustained reductions in albuminuria, suggesting a potential renoprotective effect in high-risk adolescents.
AIMS: Mobile ecological momentary assessment (mobile-EMA) enables real-time contextualization of glucose excursions, yet compliance rates in adolescents and young adults (AYA) with diabetes has not been estimated. This s...AIMS: Mobile ecological momentary assessment (mobile-EMA) enables real-time contextualization of glucose excursions, yet compliance rates in adolescents and young adults (AYA) with diabetes has not been estimated. This systematic review and meta-analysis evaluated mobile-EMA protocols and participant compliance in this population. METHODS: Ovid MEDLINE, Embase, Web of Science Core Collection, and CINAHL were searched through November 7, 2024. Eligible studies included English-language publications of AYA with type 1 or type 2 diabetes (T1D or T2D) using mobile-EMA. Three reviewers extracted data on protocols and compliance. Of 991 abstracts screened, 57 underwent full-text review and 9 met inclusion criteria. Protocol characteristics and quality reporting were evaluated using the Checklist for Reporting EMA Studies. RESULTS: Across nine studies (N = 703), most used participants' personal smartphones (67%). Common measures included glucose, diabetes self-care, and psychosocial. Nearly all studies used time-based sampling over 4-30 days. The random-effects pooled estimate of compliance was 70% (95% CI: 60-79%). Higher prompting was associated with greater compliance (β = 0.0701, SE = 0.0183, p = 0.009), whereas study length and participant burden were not. CONCLUSIONS: Evidence on mobile-EMA in AYA with diabetes remains limited. Protocol variability and moderate compliance underscore the need to optimize EMA sampling strategies.
Balducci S, Haxhi J, Mattia L
… +11 more, Vitale M, Pugliese L, Argento G, Sacchetti M, Orlando G, Bollanti L, Di Biase N, Lucisano G, Nicolucci A, Pugliese G, Study to Weigh the Effect of Exercise Training on BONE quality and strength in type 2 diabetes (SWEET-BONE) Investigators
AIMS: To assess the effects of exercise on non-invasive measures of bone health in elderly individuals with type 2 diabetes without osteoporosis. METHODS: In this randomized clinical trial, 200 elderly individuals with t...AIMS: To assess the effects of exercise on non-invasive measures of bone health in elderly individuals with type 2 diabetes without osteoporosis. METHODS: In this randomized clinical trial, 200 elderly individuals with type 2 diabetes without osteoporosis were randomized 1:1 to a two-year, specifically-designed exercise training program (Exercise group) or standard care (Control group). Coprimary outcomes were trabecular bone score (TBS), a surrogate measure of bone quality, and bone mineral density (BMD) at three sites. Secondary outcomes were other bone measures and muscle and physical function parameters. RESULTS: The coprimary endpoints increased in the Exercise group and decreased in the Control group. Significant between-group differences were observed for TBS (mean, 0.016 [95% confidence interval, 0.011-0.021], p < 0.0001, which disappeared after adjusting for abdominal fat indices), and lumbar spine (0.014 [0.005-0.024], p = 0.004), femoral neck (0.017 [0.006-0.028], p = 0.003), and total hip (0.020 [0.010-0.030], p=<0.0001) BMD. Significant between-group differences were observed also for other bone measures, body composition, muscle strength and quality, physical performance, and cardiorespiratory fitness. There were no between-group differences in adverse events. CONCLUSIONS: A two-year exercise training improved several non-invasive measures of bone health, together with muscle and physical function parameters, potentially reducing fracture risk in people with type 2 diabetes.
AIMS: While classical diabetic foot risk factors are well established, their temporal progression remains insufficiently understood, particularly for deformities. Therefore, we aimed to analyze trends in selected diabeti...AIMS: While classical diabetic foot risk factors are well established, their temporal progression remains insufficiently understood, particularly for deformities. Therefore, we aimed to analyze trends in selected diabetic foot risk factors and to design a practical monitoring model for long-term clinical use. METHODS: From 51,001 routine foot examinations at tertiary diabetes clinic (1998-2024), we included 14,436 screenings from 3,049 patients with complete data. Using generalized estimating equations, we modelled the temporal trends in the prevalence of six diabetes-related complications. RESULTS: Loss of Protective Sensation (LOPS) significantly increased the odds (adjusted for age at diagnosis, sex, diabetes type, and duration) of five complications: fat pad atrophy (OR = 2.12), toenail deformity (OR = 2.44), toe deformities (OR = 2.57), callus (OR = 3.66), and xerosis (OR = 2.27). Toenail deformity was the most prevalent complication, while fat pad atrophy showed the steepest relative increase over time. Female sex was a risk factor for specific deformities and fat pad atrophy but protective against xerosis (OR = 0.76). CONCLUSION: The developed models provide clinically actionable risk trajectories, revealing distinct patterns by complication type, LOPS status, and demographic factors. These findings can directly support targeted screening protocols and inform resource allocation.
BACKGROUND: Pediatric obesity is associated with early-onset cardiometabolic disorders related to metabolic syndrome (MetS), including insulin resistance (IR) and type 2 diabetes (T2DM). Mitochondrial dysfunction plays a...BACKGROUND: Pediatric obesity is associated with early-onset cardiometabolic disorders related to metabolic syndrome (MetS), including insulin resistance (IR) and type 2 diabetes (T2DM). Mitochondrial dysfunction plays a key role in their pathogenesis, but evidence on mitochondrial health in children and adolescents with obesity remains limited. METHODS: In this cross-sectional study, mitochondrial oxygen consumption rates (OCR, pmol/min/3 × 10 cells) and ATP production (pmol ATP/min/3 × 10 cells) were assessed using extracellular flux analysis in peripheral blood mononuclear cells (PBMCs) from 212 children and adolescents (6-18 years) with obesity, stratified by pubertal stage and degree of IR or T2DM. RESULTS: In the prepubertal group, IR participants had higher total (126.82 ± 7.92 vs. 109.38 ± 35.31, p = 0.028) and mitochondrial (86.04 ± 20.29 vs. 73.84 ± 23.55, p = 0.028) ATP production than insulin-sensitive (IS) peers. Postpubertal adolescents with T2DM showed lower basal OCR (14.21 ± 4.03 vs. 19.61 ± 7.51, p = 0.049), ATP-linked OCR (11.51 ± 3.69 vs. 16.90 ± 6.83, p = 0.016), and mitochondrial ATP production (64.35 ± 34.39 vs. 91.63 ± 34.92, p = 0.040) compared to IS, as well as lower coupling efficiency than the IR group (80.11 ± 8.87 vs. 86.70 ± 5.14 %, p = 0.002). CONCLUSION: PBMC-based mitochondrial bioenergetic profiling suggests mitochondrial differences across different stages of IS, IR, and T2DM in pediatric obesity and may serve as a minimally invasive biomarker of early metabolic impairment.
AIMS: This study aimed to examine the associations of social determinants of health (SDOH) with transitions from health to first cardio-renal-metabolic disease (FCRMD), progression to cardio-renal-metabolic multimorbidit...AIMS: This study aimed to examine the associations of social determinants of health (SDOH) with transitions from health to first cardio-renal-metabolic disease (FCRMD), progression to cardio-renal-metabolic multimorbidity (CRMM), and all-cause death among community-dwelling Chinese adults. METHODS: In this community-based prospective cohort study, 93,058 participants without FCRMD at enrollment were selected from the China PEACE Million Persons Project. SDOH comprised five components (economic stability, educational attainment, health care access, social support, and residential area) and was categorized as favorable, medium, or unfavorable. CRMM was defined as the presence of at least two of three conditions: cardiovascular disease, type 2 diabetes, and chronic kidney disease. Associations of SDOH with transitions along the CRMM progression trajectory were examined using multistate models, with transition-specific hazard ratios (HRs) and 95% confidence intervals (CIs) reported. RESULTS: Over a median follow-up of 5.04 years, 13,471 participants developed FCRMD (incidence rate, 32.03 per 1,000 person-years), and 2,885 progressed to CRMM (incidence rate, 105.18 per 1,000 person-years). Compared with the favorable SDOH group, the unfavorable SDOH group had higher hazards of transitions from health to FCRMD (HR, 1.23; 95% CI, 1.12-1.36), from FCRMD to CRMM (HR, 1.28; 95% CI, 1.05-1.55), and from CRMM to death (HR, 2.94; 95% CI, 1.74-4.97). Among SDOH components, educational attainment and social support showed the most consistent associations throughout the progression of CRMM. CONCLUSION: Our findings underscore the importance of integrating SDOH assessment into CRMM risk stratification and management, with targeted resource allocation toward socially disadvantaged groups.
Koue-Chon-Lim J, Beyene HB, Giles C
… +12 more, Treiber G, Mellett NA, Liang A, Cinel M, Couret D, Cogne M, Meilhac O, Simonson M, Veeren B, Meikle PJ, Nobécourt E, Huynh K
AIMS: Familial Partial Lipodystrophy type 2 (FPLD2) is a severe form of metabolic syndrome associated with marked insulin resistance and complications like lipoatrophic diabetes. The aim of this study was to use lipidomi...AIMS: Familial Partial Lipodystrophy type 2 (FPLD2) is a severe form of metabolic syndrome associated with marked insulin resistance and complications like lipoatrophic diabetes. The aim of this study was to use lipidomics to better understand metabolic complications in FPLD2 and the benefit of the lipidomic-derived metabolic BMI score (mBMI) to characterize metabolic risk. METHODS: A total of 115 adults with FPLD2 due to the LMNA 'Reunionese' variant and 289 unaffected age and sex matched adults were enrolled. Lipidomic analysis (787 lipid species) was performed using liquid chromatography-tandem mass spectrometry. RESULTS: For FPLD2 subjects, among the 181 significant lipids species, ceramides, triglycerides, diacylglycerol were higher and plasmalogen, phosphatidylcholine, sphingolipids were lower regarding the control group (P < 0.05). The lipidomic signature of type 2 diabetes was reproduced in the control group with type 2 diabetes but also in lipoatrophic diabetes. We found mBMI was higher in the FPLD2 group especially individuals whose BMI fell within the normal range. CONCLUSION: Lipidomic analyses reveal different species in control and FPLD2 groups, and the signature for type 2 diabetes coincide with the one for lipoatrophic diabetes. Moreover, the mBMI can be useful to assess metabolic health in FPLD2, especially individuals with normal BMI.
Dao TP, Lung WC, Yang YZ
… +5 more, Chu WM, Tsan YT, Chen HY, Chen PC, Ho WC
Diabetes Res Clin Pract
· 2026 Jun · PMID 42086086
·
Publisher ↗
We conducted a systematic review and network meta-analysis to examine the overall and comparative cardiovascular outcomes of bexagliflozin, ertugliflozin, and sotagliflozin in type 2 diabetes patients. We included phase...We conducted a systematic review and network meta-analysis to examine the overall and comparative cardiovascular outcomes of bexagliflozin, ertugliflozin, and sotagliflozin in type 2 diabetes patients. We included phase 3 or higher randomized controlled trials sourced from four databases: ClinicalTrials.gov, PubMed, Cochrane CENTRAL and Embase. A random-effects model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The primary endpoint was a composite of cardiovascular death or hospitalization for heart failure. The secondary endpoints were cardiovascular death, hospitalization for heart failure and all-cause mortality. Compared with placebo, bexagliflozin, ertugliflozin and sotagliflozin reduced composite cardiovascular death or hospitalization for heart failure (OR, 0.66 [95% CI 0.48-0.89]), hospitalization for heart failure (OR, 0.62 [0.55-0.70]) and acute coronary syndrome (OR, 0.35 [0.16-0.77]). No significant differences were observed among the three drugs for primary and secondary outcomes, although bexagliflozin (OR, 0.39 [0.16-0.94]) and sotagliflozin (OR, 0.41 [0.23-0.72]) had lower risks of myocardial infarction than did ertugliflozin. In conclusion, bexagliflozin, ertugliflozin, and sotagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure. Bexagliflozin and sotagliflozin may offer additional benefits in preventing the risk of myocardial infarction.
AIMS: High plantar pressure is associated with diabetic foot ulcer (DFU) development; however, previous studies are limited to a 'snapshot' plantar pressure measurement taken at study onset or post-DFU healing. The aim o...AIMS: High plantar pressure is associated with diabetic foot ulcer (DFU) development; however, previous studies are limited to a 'snapshot' plantar pressure measurement taken at study onset or post-DFU healing. The aim of this prospective study was to provide a unique insight into sustained plantar pressures developed during the three months preceding ulceration. METHODS: Forty-six patients with diabetic peripheral neuropathy and DFU history wore an intelligent insole system, which continuously assessed plantar pressure for 18-months or until ulceration. Sustained pressure parameters in the three months preceding DFU were compared between feet that developed DFU and those remaining ulcer-free, using multilevel binary logistic regression analysis. RESULTS: Twelve feet ulcerated, all under the forefoot. DFU feet experienced more minutes of sustained plantar pressure [19(95%CI,0.86-37, P = 0.04)] and more 'bouts' of sustained pressure [0.64(0.024-1.3, P = 0.042)] at the forefoot region during the three months preceding DFU, compared to ulcer-free feet. CONCLUSIONS: Plantar pressures during daily activities were continuously measured in the three months preceding DFU using an intelligent insole system, with a greater number of minutes and bouts of sustained plantar pressure preceding DFU development. Daily monitoring of sustained pressure areas, using insole systems, may prove useful for preventing DFU development.