Diabetes Research And Clinical Practice[JOURNAL]
Sun
200 papers
Five lipid-inflammation composite indices and obesity-related metabolic disorders, cardiovascular and renal diseases A multi-state trajectory analysis using data from the UK Biobank cohort.
He R, Luo Q, Jin T … +5 more , Liu Q, Shang Y, Fang Z, Jin J, He Q
Diabetes Res Clin Pract · 2026 Jun · PMID 41942013 · Publisher ↗
BACKGROUND: Biomarkers that capture the dynamic transition from obesity to metabolic dysfunction and subsequent cardiorenal disease remain insufficient. This study evaluated stage-specific associations of lipid-inflammat...
BACKGROUND: Biomarkers that capture the dynamic transition from obesity to metabolic dysfunction and subsequent cardiorenal disease remain insufficient. This study evaluated stage-specific associations of lipid-inflammation indices across this continuum. METHODS: We included 109,442 obese adults (UK Biobank) across four stages, obesity (Stage 1), metabolic disorders (Stage 2), cardiorenal disease (Stage 3), and death (Stage 4). Five baseline indices (ApoB/A1-CRP, RCII, NHR, lymphocyte-to-HDL-C, monocyte-to-HDL-C) were evaluated. Markov multistate models were used to estimate transition-specific risks, with Cox regression and restricted cubic spline (RCS) analyses as complementary approaches. RESULTS: During a median follow-up of 15.73 years, 11.14% of participants progressed from Stage 1 to 2, and 25.88% from Stage 2 to 3. In fully adjusted model, ApoB/A1-CRP (HR, 1.07, 95% CI, 1.00-1.14, P = 0.048) and RCII (HR, 1.08, 95% CI, 1.01-1.15, P = 0.017) were significantly associated with Stage 2 to 3 progression. Upon Stage 3 stratification, NHR was primarily associated with mortality following cardiorenal disease onset. RCS analyses indicated significant non-linear associations for ApoB/A1-CRP, RCII, and NHR. RCII demonstrates robustness in sensitivity analysis. CONCLUSIONS: RCII is independently associated with the progression from metabolic disorders to cardiorenal diseases in obesity. It may serve as a clinically biomarker for early risk stratification.
Cardiorenal protective effects of anti-diabetic drugs in early stage Cardiovascular-Kidney-Metabolic Syndrome: A multicenter, time-varying analysis.
Hao WR, Liu JC, Fang YA … +3 more , Hsu MH, Hsiu H, Chen CC
Diabetes Res Clin Pract · 2026 Jun · PMID 41942012 · Publisher ↗
OBJECTIVES: Cardiovascular-kidney-metabolic (CKM) syndrome links metabolic risk factors with cardiorenal complications. However, real-world comparisons of cardiorenal outcomes among different antidiabetic agents (ADAs) i...
OBJECTIVES: Cardiovascular-kidney-metabolic (CKM) syndrome links metabolic risk factors with cardiorenal complications. However, real-world comparisons of cardiorenal outcomes among different antidiabetic agents (ADAs) in early CKM stages remain limited. STUDY DESIGN: We conducted a retrospective cohort study using the Taipei Medical University Clinical Research Database. Adults with newly diagnosed diabetes initiating ADAs between 2016 and 2019 were included. Time-varying Cox proportional hazards models were used to evaluate associations between eight ADA classes-sodium-glucose cotransporter-2 inhibitors (SGLT2i), metformin, sulfonylureas, thiazolidinediones, alpha-glucosidase inhibitors, meglitinides, DPP-4 inhibitors, and insulin-and risks of stroke, acute myocardial infarction (AMI), end-stage renal disease (ESRD), and all-cause mortality. RESULTS: Among 18,467 patients (mean age 61 years), most ADAs were associated with reduced cardiovascular risk compared with non-use. Insulin therapy was associated with increased risks of stroke (adjusted hazard ratio [aHR] 1.65) and AMI (aHR 2.47). Compared with SGLT2i, other ADAs were associated with higher risks of ESRD (aHR 3.62-19.16) and all-cause mortality (aHR 5.80-66.84). The absence of SGLT2i therapy was associated with greater ESRD risk in younger and obese patients. CONCLUSIONS: In early CKM, most ADAs reduce cardiovascular risk, but SGLT2 inhibitors provide superior renal protection and survival benefits.
A prospective evaluation of attitudes, behaviors, and clinical outcomes among Jordanian children and adolescents with type 1 diabetes who fasted during Ramadan: a comparison of the 2021 and 2026 IDF-DAR risk scores.
Odeh R, Murad H, Hani FB … +6 more , Gharaibeh L, Bdeir L, Sarhan D, Sarhan Z, Alkhalaileh S, Alassaf A
Diabetes Res Clin Pract · 2026 Jun · PMID 41936947 · Publisher ↗
AIM: To describe the ability and fasting behaviors of children and adolescents with type one diabetes, after receiving a pre-Ramadan structured educational program, and correlate their ability to fast with the IDF-DAR ri...
AIM: To describe the ability and fasting behaviors of children and adolescents with type one diabetes, after receiving a pre-Ramadan structured educational program, and correlate their ability to fast with the IDF-DAR risk stratification scores. METHODS: A prospective observational cohort study was conducted at Jordan University Hospital during the month of Ramadan in 2025 using an individualized google form. RESULTS: A total of 46 participants were included, 65.2% were females, median age 14.0 (IQR, 12.4--16.0) years. The median number of days the participants fully fasted was 23.5 (IQ 17.0-29.0). Of the 1380 days of fasting of all participants, 136 days of non-fasting were due to diabetes related causes, while non-diabetes related causes reached 203 days. A significant positive correlation with the number of completed days of fasting was observed with having suhoor between 3:00-6:00 am. No significant associations were found with pre-Ramadan HbA1c, IDF-DAR risk scores (2021 or 2026), frequency of blood glucose monitoring, sensor use, or physical activity. CONCLUSIONS: With structured pre-Ramadan education, most participants were able to fast safely for the majority of Ramadan regardless of their assigned risk category. Suhoor at a later time was associated with more completed fasting days.
Gestational diabetes and subsequent risk of type 2 diabetes and metabolic dysfunction-associated steatotic liver disease in a commercially insured U.S. Pregnancy cohort.
Liu L, Velasquez EE, Ananth CV … +4 more , Nadeau KC, Bondy ML, Nguyen MH, Williams MA
Diabetes Res Clin Pract · 2026 Jun · PMID 41936946 · Publisher ↗
AIMS: Gestational diabetes mellitus (GDM) is a common pregnancy complication and marker of subsequent metabolic risk. Whether GDM increases metabolic dysfunction-associated steatotic liver disease (MASLD) directly or mai...
AIMS: Gestational diabetes mellitus (GDM) is a common pregnancy complication and marker of subsequent metabolic risk. Whether GDM increases metabolic dysfunction-associated steatotic liver disease (MASLD) directly or mainly through progression to type 2 diabetes (T2D) remains unclear. METHODS: Using Merative MarketScan® Commercial Database (2007-2023), we assembled a retrospective cohort of females aged 12-55 years with ≥ 20 gestational weeks and continuous enrollment from 90 days pre-pregnancy through ≥ 1 year postpartum. GDM was identified by ICD codes during pregnancy. Claims-diagnosed T2D and MASLD were ascertained after delivery for up to 15 years. We estimated adjusted hazard ratios (HRs) using Cox models and used a semi-Markov multistate model to quantify direct and T2D-mediated associations. RESULTS: Among 1,363,040 women (mean follow-up 3.1 years), 8.43% had GDM. GDM was associated with incident T2D (adjusted HR 11.96; 95% CI 11.55-12.38) and MASLD (2.29, 2.15-2.43). Multistate models showed a direct GDM-to-MASLD association (2.16, 2.02-2.31) and a dominant indirect pathway through T2D. In model-based counterfactual projections, preventing post-GDM T2D reduced projected 5-year MASLD risk from 13.30% to 0.93% (0.45% without GDM). CONCLUSIONS: In this claims-based cohort, GDM confers increased risk of T2D and MASLD, with most excess MASLD risk acted through T2D. Postpartum strategies prioritizing diabetes prevention may markedly attenuate liver disease burden in this high-risk population.
Comorbidities/cardiovascular risk factors and acute glycaemic emergencies in patients with type 1 and type 2 diabetes: The Australian National Diabetes Audit.
Dawson C, Earnest A, Zomer E … +5 more , Paul E, Pourghaderi AR, Gasevic D, Russell A, Zoungas S
Diabetes Res Clin Pract · 2026 Jun · PMID 41936945 · Publisher ↗
AIMS: The prevalence of diabetes, ageing and comorbidity is increasing. This analysis explores the relationship between comorbidities, risk factors and acute glycaemic emergencies. METHODS: This observational study compr...
AIMS: The prevalence of diabetes, ageing and comorbidity is increasing. This analysis explores the relationship between comorbidities, risk factors and acute glycaemic emergencies. METHODS: This observational study comprised 24,492 adults with diabetes from the Australian National Diabetes Audit between 2015 and 2022. Cardiovascular risk factors included hypertension, dyslipidaemia, overweight/obesity and smoking. Comorbidities were classified as diabetes-discordant (dementia, depression, malignancy and liver disease) and diabetes-concordant (macrovascular/microvascular diabetes complications). Acute glycaemic emergencies combined diabetic ketoacidosis, hyperosmolar hyperglycaemic state and/or severe hypoglycaemia. We used a mixed effect logistic regression model. RESULTS: Prevalence of acute glycaemic emergencies was 7.1%. Adjusted analyses showed odds of acute glycaemic emergencies were 73% higher for at least one individual 'comorbidity only' (95% CI 1.23 - 2.42, p = 0.001) compared to without comorbidities/risk factors. 'Discordant comorbidities only' group (OR 2.28, 95% CI 1.54 - 3.37, p < 0.001) and 'concordant comorbidities only' group (OR 1.53, 95% CI 1.10 - 2.13, p = 0.011) maintained increased odds. A dose-dependent relationship was found between total number of comorbidities and acute glycaemic emergencies, with > 4 comorbidities having highest odds (OR 3.71, 95% CI 2.95 - 4.67, p < 0.001). CONCLUSION: Patients with diabetes and comorbidities are more likely to experience acute glycaemic emergencies. Findings assist clinicians identify patients who would benefit from targeted education to reduce glycaemic emergencies.
Epidemiology of coeliac disease in children and adolescents with type 1 diabetes: a 13-year population-based study using secondary data sources.
Fontanarosa A, Iommi M, Cesanelli F … +6 more , Pompei A, Pompili M, Carle F, Skrami E, Cherubini V, Gesuita R
Diabetes Res Clin Pract · 2026 Jun · PMID 41935540 · Publisher ↗
AIMS: To study the epidemiology of Coeliac Disease (CD) in the general paediatric population and among children with Type 1 Diabetes (T1D) in a population of Central Italy, and to assess the temporal trends of these two...
AIMS: To study the epidemiology of Coeliac Disease (CD) in the general paediatric population and among children with Type 1 Diabetes (T1D) in a population of Central Italy, and to assess the temporal trends of these two chronic conditions. METHODS: A population-based longitudinal study on children aged < 15 was conducted using Healthcare Utilization Databases of the Marche Region, 2011-2023. Prevalent and incident cohorts of T1D and CD were identified using hospital discharges, drug prescriptions, and healthcare exemption databases. Prevalence ratios (PR), incidence rate ratios (IRR), temporal trends, and cumulative CD risk after T1D diagnosis were assessed with 95% confidence intervals (CI). RESULTS: Overall 13-year period prevalences of T1D and CD were 1.65‰ and 5.28‰, respectively. CD prevalence among children with T1D was 97.7‰, 18-fold higher than in the general population (PR 18.6; 95%CI 14.3-24.0). CD incidence was 65 per 100,000 person-years in the general population and 2,410 per 100,000 person-years among children with newly diagnosed T1D (IRR 37.0; 95%CI 24.7-55.4). The six-year cumulative probability of developing CD in the T1D cohort was 10.3% (95%CI: 6.2%-14.3%). CONCLUSIONS: Children with T1D have a markedly increased risk of CD, particularly in the first years after diagnosis, supporting systematic CD screening in this high-risk population.
Metabolic dysfunction-associated fatty liver disease and the risk of incident chronic kidney disease: A 10-year prospective cohort study.
Cui H, Xu Y, Zhang J … +8 more , Cao Q, Zhang J, Cheng X, Zhang X, Guo H, Wu T, He J, He M
Diabetes Res Clin Pract · 2026 Jun · PMID 41935539 · Publisher ↗
AIMS: To investigate the longitudinal associations of MAFLD with CKD risk. METHODS: A total of 10,817 participants derived from the Dongfeng-Tongji (DFTJ) cohort were classified as non-fatty liver disease (non-FLD), non-...
AIMS: To investigate the longitudinal associations of MAFLD with CKD risk. METHODS: A total of 10,817 participants derived from the Dongfeng-Tongji (DFTJ) cohort were classified as non-fatty liver disease (non-FLD), non-alcoholic fatty liver disease (NAFLD) without metabolic dysfunction (MD), and MAFLD group. The 8,843 participants had qualitatively controlled genotyping data. An estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m was defined as CKD. RESULTS: Among 10,817 individuals, 1,845 participants developed CKD during ten-year of follow-up. The incidence of CKD was 15.8 %, 10.0 %, and 19.9 % among non-FLD, NAFLD without MD, and MAFLD groups, respectively. Compared with non-FLD participants, the risk of CKD significantly increased in MAFLD group, with the multivariable-adjusted odds ratio (OR) and 95 % confidence interval (CI) of 1.25 (1.11-1.40). Moreover, as the number of MAFLD co-existing metabolic dysfunction components increased, the risk of CKD significantly increased (P-trend < 0.001). MAFLD-related genetic risk score (GRS) was positively associated with elevated blood pressure and elevated triglycerides levels (P < 0.05), which mediated 17.8 % and 14.7 % of the association between MAFLD-related GRS and CKD risk, respectively. CONCLUSIONS: CKD risk was associated with MAFLD presence, and gradually increased with the number of MAFLD metabolic components increased. Metabolic diseases might mediate the association between MAFLD-related GRS and CKD risk.
Cardiorenal outcomes of empagliflozin versus dapagliflozin in primary prevention among patients with type 2 diabetes: A nationwide cohort study.
Park S, Jung J, Jeong J … +6 more , Jang MH, Kim YG, Ann SH, Kim SJ, Han S, Park GM
Diabetes Res Clin Pract · 2026 Jun · PMID 41935538 · Publisher ↗
AIMS: While both empagliflozin and dapagliflozin have demonstrated cardiorenal benefits in patients with type 2 diabetes, their comparative effectiveness in patients without established cardiovascular or renal disease re...
AIMS: While both empagliflozin and dapagliflozin have demonstrated cardiorenal benefits in patients with type 2 diabetes, their comparative effectiveness in patients without established cardiovascular or renal disease remains uncertain. METHODS: Using the Korean National Health Insurance Service database, we identified patients with type 2 diabetes who newly initiated either empagliflozin or dapagliflozin and had no prior history of established cardiovascular or renal disease. The primary outcome was defined as the first occurrence of cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure, or progression to end-stage renal disease. The secondary outcomes were major adverse cardiovascular event and individual components of the primary outcome. RESULTS: A total of 135,559 new users of dapagliflozin or empagliflozin were identified. After 1:1 propensity score matching, the risk of the primary outcome was not different significantly between dapagliflozin and empagliflozin (hazard ratio 0.98, 95% confidence interval 0.89-1.09). The risks of secondary outcomes were also comparable. The overall findings were consistent across the several sensitivity analyses. CONCLUSIONS: This nationwide cohort study, empagliflozin and dapagliflozin showed similar effectiveness in preventing cardiorenal outcomes among patients with type 2 diabetes without established cardiovascular or renal disease, supporting their clinical interchangeability for primary prevention in real-world practice.
Association of SGLT2 inhibitors with hematologic malignancies in type 2 diabetes: a target trial emulation study.
Tseng YT, Tsai CS, Restinia M … +3 more , Tseng CW, Chen TY, Li CY
Diabetes Res Clin Pract · 2026 Jun · PMID 41935537 · Publisher ↗
AIMS: To investigate the association between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and the risk of hematologic malignancies compared with dipeptidyl peptidase-4 inhibitors (DPP-4i) in patients with type 2 di...
AIMS: To investigate the association between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and the risk of hematologic malignancies compared with dipeptidyl peptidase-4 inhibitors (DPP-4i) in patients with type 2 diabetes mellitus. METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network (2010-2025), applying a target trial emulation framework. New users of SGLT2i and DPP-4i were balanced using 1:1 propensity score matching (PSM). To ensure robustness, we calculated E-values to assess unmeasured confounding and employed landmark analyses alongside positive and negative outcome controls. RESULTS: In a balanced cohort of 243,852 patients in each group, SGLT2i use was associated with a lower observed risk of incident hematologic malignancies compared with DPP-4i (adjusted hazard ratio [aHR] 0.90; 95% confidence interval [CI], 0.84-0.95). Subtype analyses revealed lower observed risk for leukemia (aHR 0.85; 95% CI, 0.77-0.94) and multiple myeloma (aHR 0.85; 95% CI, 0.75-0.97), while the risk for lymphoma showed a null association (aHR 0.97; 95% CI, 0.89-1.06). Validation analyses using outcome controls and E-values supported the stability of these findings. CONCLUSIONS: SGLT2i use was associated with a lower observed risk of hematologic malignancies compared with DPP-4i, particularly leukemia and multiple myeloma. These findings warrant further investigation.
Meeting time in range and time below range targets is not associated with psychological outcomes in type 1 or insulin-treated type 2 diabetes in the Hypo-METRICS study.
McCarthy A, Zaremba N, Thomas J … +5 more , Pouwer F, Divilly P, Amiel SA, Choudhary P, Hypo-RESOLVE Consortium
Diabetes Res Clin Pract · 2026 Jun · PMID 41933840 · Publisher ↗
Meeting the composite target of time in range (TIR) >70% and time below range (TBR) <4% was not associated with differences in diabetes distress, fear of hypoglycaemia, depression, or anxiety in participants with type 1...
Meeting the composite target of time in range (TIR) >70% and time below range (TBR) <4% was not associated with differences in diabetes distress, fear of hypoglycaemia, depression, or anxiety in participants with type 1 (T1D) or insulin-treated type 2 diabetes (T2D) in the Hypo-METRICS study. >50% of all participants reported moderate-to-high diabetes distress, highlighting the need for routine screening.
Disparities in GLP-1 and GIP responses to small intestinal glucose infusion in individuals with well- and poorly-controlled type 2 diabetes.
Sun Y, Xie C, Bound M … +6 more , Jones KL, Horowitz M, Macdonald IA, Young RL, Rayner CK, Wu T
Diabetes Res Clin Pract · 2026 Jun · PMID 41932545 · Publisher ↗
AIMS: Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are key regulators of glucose homeostasis in health and type 2 diabetes (T2D). Whether their secretion is influenced by anteced...
AIMS: Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are key regulators of glucose homeostasis in health and type 2 diabetes (T2D). Whether their secretion is influenced by antecedent glycaemic control in T2D remains unclear. This study compared GLP-1 and GIP responses to intraduodenal glucose infusion between individuals with well- and poorly-controlled T2D. METHODS: 24 diet-controlled participants with T2D (n = 12 with HbA1c < 7.0% and n = 12 with HbA1c > 8.5%) received an intraduodenal infusion of 30 g glucose with 3 g 3-O-methylglucose (3-OMG; a marker of intestinal glucose absorption) over 30 min. Blood glucose was maintained comparably (6.4 ± 0.4 vs. 6.1 ± 0.3 mmol/L) by intravenous insulin. Plasma GIP, GLP-1 and C-peptide and serum 3-OMG were measured at frequent intervals. RESULTS: Basal hormone concentrations were comparable between groups. In response to intraduodenal glucose infusion, the GIP response was greater in the poorly-controlled group (P = 0.02 for time*group interaction), with a trend for higher iAUC compared with well-controlled group (1329.9 ± 163.7 vs. 1009.5 ± 108.3 pmol/L*min, P = 0.12 unadjusted; P = 0.09 adjusted for age, sex and BMI). GLP-1 responses were lower in the poorly-controlled group (P = 0.007 for time*group interaction), with lower iAUC (453.3 ± 110.6 vs. 1037.5 ± 177.1 pmol/L*min, P = 0.01), but this difference became non-significant after adjustment for age, sex and BMI. C-peptide and 3-OMG responses were comparable. CONCLUSIONS: Poor glycaemic control in T2D is associated with a greater GIP, and lower GLP-1, response to small intestinal glucose, independent of intestinal glucose absorption. However, differences in GLP-1 may be influenced by age, sex and BMI, so should be interpreted cautiously and validated in larger cohorts.
Serum glycolipids mediate the link between dietary antioxidants and mortality in metabolic syndrome.
Li A, Liu Y, Chen X … +5 more , Zhou Z, Li D, Kuang Y, Peng J, Ma Q
Diabetes Res Clin Pract · 2026 Jun · PMID 41932544 · Publisher ↗
BACKGROUND: While dietary modifications are increasingly recognized as a strategy to intervene in metabolic syndrome (MetS), the relationship between the composite dietary antioxidant index (CDAI) and long-term health ou...
BACKGROUND: While dietary modifications are increasingly recognized as a strategy to intervene in metabolic syndrome (MetS), the relationship between the composite dietary antioxidant index (CDAI) and long-term health outcomes in MetS populations remains unclear. METHODS: We analyzed data from 2074 adults with MetS in the NHANES (1999-2020). Weighted Cox proportional hazard regression models assessed hazard ratios (HRs) with 95% confidence intervals (CIs). Restricted cubic spline (RCS) curves were used to examine non-linear relationships, and stratified and mediation effect analyses were performed. RESULTS: During a median follow-up of 76.24 months, 225 deaths occurred, including 65 from cardiovascular causes. After adjusting for confounders, participants in the third CDAI quartile had HRs of 0.63 (95% CI: 0.45-0.90, p = 0.025) for all-cause mortality and 0.54 (95% CI: 0.32-0.93, p = 0.023) for cardiovascular mortality, compared to those in the lowest quartile. RCS analysis showed a linear negative association between CDAI and mortality. Stratified analyses supported these findings, with no significant interactions. Mediation analysis revealed that serum glucose and HDL-C cholesterol mediated the relationship between CDAI and mortality. CONCLUSIONS: Higher CDAI is associated with lower all-cause and cardiovascular mortality in MetS patients, potentially mediated through the regulation of glycolipid metabolism.
The oral-gut microbiome axis in diabetes mellitus: a systematic review and emerging clinical perspectives.
Nee GW, Agrawal K, Dalan R … +4 more , Kasahara K, Xiang Darren LY, Ali Y, Wong S
Diabetes Res Clin Pract · 2026 May · PMID 41921761 · Publisher ↗
Emerging evidence suggests that diabetes mellitus (DM) is not only a metabolic disorder but also a mucosal disease shaped by microbial interactions across body niches. This review synthesizes current evidence on the oral...
Emerging evidence suggests that diabetes mellitus (DM) is not only a metabolic disorder but also a mucosal disease shaped by microbial interactions across body niches. This review synthesizes current evidence on the oral-gut microbiome axis in DM, focusing on microbial transmission, functional overlap, and clinical relevance. A systematic search of six databases identified studies profiling paired oral and gut microbiomes in individuals with diabetes. Across included studies, consistent findings demonstrate concurrent dysbiosis in both niches. Notably, oral-associated taxa such as Streptococcus, Prevotella, Fusobacterium, and Porphyromonas were detected in the gut, suggesting ectopic colonization and inter-niche microbial transmission. Functional analyses revealed shared disruptions in key metabolic pathways, including short-chain fatty acid production and glycine betaine metabolism, with downstream effects on inflammation and insulin resistance. These microbial alterations correlated with established clinical markers such as HbA1c, fasting glucose, and inflammatory indices. Emerging machine-learning models integrating oral and gut microbiota demonstrated promising diagnostic performance (AUC > 0.83). Collectively, these findings support a potential bidirectional oral-gut axis associated with metabolic dysregulation in DM. Despite limitations including cross-sectional design and heterogeneity, this axis represents a novel target for biomarker development and therapeutic intervention. Future longitudinal and interventional studies are required to determine causal relationships and clinical utility.
Trends in respiratory mortality among older U.S. adults with diabetes, 1999-2023.
Wang Y, Guo N
Diabetes Res Clin Pract · 2026 May · PMID 41916479 · Publisher ↗
AIMS: To evaluate trends in respiratory-related deaths among U.S. adults aged ≥ 65 years with diabetes mellitus listed as a contributing cause of death. METHODS: Using nationally representative mortality data from 1999 t...
AIMS: To evaluate trends in respiratory-related deaths among U.S. adults aged ≥ 65 years with diabetes mellitus listed as a contributing cause of death. METHODS: Using nationally representative mortality data from 1999 to 2023, we evaluated trends in respiratory-related deaths among U.S. adults aged ≥ 65 years with diabetes mellitus listed as a contributing cause of death. Age-adjusted mortality rates (AAMRs) were calculated, and temporal trends were assessed using Joinpoint regression. RESULTS: Over this 25-year period, the age-adjusted mortality rate (AAMR) for respiratory diseases remained relatively stable (from 29.24 to 31.21 per 100,000; average annual percent change [AAPC]: 0.19%), though their relative contribution to overall mortality increased, with respiratory diseases rising from the 9th to the 6th leading cause of death. Joinpoint regression identified two statistically significant temporal segments: an initial rise from 1999 to 2005 (APC: +2.60%, 95% CI: 0.60 to 4.63; P < 0.05), followed by a sustained decline from 2005 to 2023 (APC: -0.60%, 95% CI: -0.92 to - 0.28; P < 0.001). Chronic lower respiratory diseases were the leading cause, followed by pneumonia and interstitial lung diseases. Mortality was consistently higher among men, with substantial geographic variation. CONCLUSIONS: These findings highlight evolving respiratory mortality patterns and underscore the importance of continued surveillance and targeted prevention strategies for older adults with diabetes.
Early prediction of insulin requirement in gestational diabetes using a parsimonious LASSO model and a point-based risk score.
Greco D, Scibetta S, Giambanco L … +3 more , Iannone V, Calvo L, Corrao S
Diabetes Res Clin Pract · 2026 May · PMID 41912039 · Publisher ↗
AIMS: This study developed and validated a practical prediction model to forecast insulin requirements in pregnant women with gestational diabetes mellitus (GDM). METHODS: A retrospective single-center cohort of 490 cons...
AIMS: This study developed and validated a practical prediction model to forecast insulin requirements in pregnant women with gestational diabetes mellitus (GDM). METHODS: A retrospective single-center cohort of 490 consecutive women with GDM was analyzed. The primary outcome was insulin therapy initiation based on routine clinical decisions. Candidate predictors were collected at the first visit. LASSO logistic regression with 10-fold cross-validation was used for model development, excluding underweight women (BMI < 18.5 kg/m) and incomplete cases. Coefficients were converted into a point score (scaling factor 0.25). Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and likelihood ratios defined clinically actionable categories. RESULTS: Insulin therapy was initiated in 11.0% of women. The derivation sample included 403 women (43 receiving insulin). Five predictors were selected: BMI category, ethnic risk background, chronic hypertension, medically assisted reproduction, and number of abnormal oral glucose tolerance test values. The model showed good discrimination (AUC 0.7755, 95% CI 0.695-0.853), excellent calibration (slope 1.02), and low Brier score (0.082). Scores ≥ 14 identified high-risk patients (LR + 11.7). CONCLUSIONS: This LASSO-derived score using readily available variables accurately predicts insulin need in GDM, potentially facilitating risk-stratified management in community settings.
Islet autoantibody profiles at diagnosis of childhood type 1 Diabetes: Age-Dependent heterogeneity and clinical implications.
Lehavi M, Gil Margolis M, Yakobovich-Gavan M … +4 more , Weizman S, Tenenbaum A, Phillip M, Oron T
Diabetes Res Clin Pract · 2026 May · PMID 41905412 · Publisher ↗
AIMS: Type 1 diabetes (T1D) exhibits age-dependent autoimmune heterogeneity. We examined islet autoantibody (IA) profiles at the time of childhood diagnosis and their clinical significance. METHODS: We analyzed IA status...
AIMS: Type 1 diabetes (T1D) exhibits age-dependent autoimmune heterogeneity. We examined islet autoantibody (IA) profiles at the time of childhood diagnosis and their clinical significance. METHODS: We analyzed IA status at diagnosis in a large population-based cohort of children with newly diagnosed T1D. The participants were stratified by age at diagnosis (1-6, 6-12, and > 12 years), and the number and combinations of IA were examined in relation to age and clinical presentation. Group comparisons were performed using appropriate statistical tests. RESULTS: Pronounced age-dependent heterogeneity in IA profiles was observed. Younger children were significantly more likely to present with multiple autoantibodies, frequently including insulin autoantibody (IAA), whereas older children were more commonly single-autoantibody positive, predominantly glutamic acid decarboxylase (GADA). Age-related patterns were observed in specific autoantibody combinations. Single-autoantibody positivity was not associated with milder clinical presentation, and metabolic severity at diagnosis was largely independent of the number or combination of autoantibodies. CONCLUSIONS: IA profiles at diagnosis demonstrate marked age-dependent heterogeneity with significant clinical meaning. Single-autoantibody positivity and antibody negativity were common, particularly among older children. Age-informed interpretation of autoantibody status is essential and has implications for clinical assessment and population-based screening strategies.
Metabolic signatures of lipid dysregulation and inflammation characterize pancreatic cancer risk in type 2 diabetes mellitus and improve risk stratification: a prospective cohort study.
Xiang S, Nie H, Li J … +5 more , Li Y, Li Y, Liu S, Che X, Du Y
Diabetes Res Clin Pract · 2026 May · PMID 41905411 · Publisher ↗
BACKGROUND: Type 2 diabetes mellitus (T2DM) increases pancreatic cancer (PC) risk, but specific metabolic mechanisms and effective risk stratification tools remain lacking. We aimed to identify metabolic features statist...
BACKGROUND: Type 2 diabetes mellitus (T2DM) increases pancreatic cancer (PC) risk, but specific metabolic mechanisms and effective risk stratification tools remain lacking. We aimed to identify metabolic features statistically accounting for this risk and construct a metabolic risk score (MRS). METHODS: We analyzed 445,931 UK Biobank participants with NMR metabolomics, excluding early PC cases to minimize reverse causality. Cox models estimated associations and calculated the proportion of the T2DM-PC association statistically accounted for by metabolites. LASSO regression constructed the MRS within the T2DM sub-cohort. RESULTS: Over a 13.6-year follow-up, T2DM increased PC risk (HR 1.40, 95% CI 1.18-1.67). We identified 30 candidate metabolites statistically accounting for a significant proportion of this association, primarily reflecting lipid dysregulation (triglyceride-enriched VLDL) and inflammation (GlycA). The derived MRS stratified long-term PC risk (highest vs. lowest tertile HR 1.79). Integrating the MRS with clinical factors provided incremental improvement in 15-year prediction, increasing the AUC from 72.3% to 75.8% (P < 0.001). CONCLUSION: Lipid dysregulation and inflammation statistically account for a substantial proportion of the T2DM-PC association. The MRS captures these molecular alterations, serving as a preliminary tool to improve long-term PC risk stratification, which warrants rigorous external validation before clinical application.
Peripheral nerve enlargement in patients with diabetic sensorimotor polyneuropathy: A systematic review and meta-analysis.
Boers N, Hahn B, Eligh AM … +3 more , Jongen IC, Rinkel WD, Coert JH
Diabetes Res Clin Pract · 2026 May · PMID 41887584 · Publisher ↗
This study aimed to summarize evidence on peripheral nerve enlargement in patients with diabetes, with and without diabetic sensorimotor polyneuropathy (DSP), compared with healthy controls. PubMed and Embase were system...
This study aimed to summarize evidence on peripheral nerve enlargement in patients with diabetes, with and without diabetic sensorimotor polyneuropathy (DSP), compared with healthy controls. PubMed and Embase were systematically searched for ultrasound studies measuring the cross-sectional area (CSA) of peripheral nerves in patients with diabetes with and without DSP. The primary outcome was the weighted inter-group mean difference in CSA at all reported upper- and lower extremity sites. Forty-seven studies were identified, of which 41 were included in the meta-analyses. Patients with diabetes without DSP showed significantly larger CSA values than healthy controls at 3 of 11 anatomical locations, all located in the lower extremity. Patients with diabetes and DSP demonstrated increased CSA compared with controls at 9 of 14 sites, particularly at distal compression sites of the median and tibial nerves. Compared with patients with diabetes without DSP, those with DSP had significantly larger CSA values at 14 of 21 sites, with the greatest difference observed 4-5 cm proximal to the medial malleolus (pooled mean difference + 5.26 mm, 95% CI 0.94-9.57). In conclusion, peripheral nerve CSA is increased in diabetes and further enlarged in the presence of DSP, with the largest effects at distal compression sites.
Association of the visceral adiposity index with prediabetes remission to normoglycemia in middle-aged and older Chinese adults: a prospective cohort study.
Wu F, Wang L, Peng Q … +7 more , Yi L, Yang J, Xiong Y, Jiang B, Chen L, Fu A, Wang J
Diabetes Res Clin Pract · 2026 May · PMID 41887583 · Publisher ↗
BACKGROUND: Prediabetes is a critical window for T2DM prevention, yet the Visceral Adiposity Index's (VAI) role in prediabetes remission is unclear. METHODS: This longitudinal study analyzed 2,859 middle-aged and older p...
BACKGROUND: Prediabetes is a critical window for T2DM prevention, yet the Visceral Adiposity Index's (VAI) role in prediabetes remission is unclear. METHODS: This longitudinal study analyzed 2,859 middle-aged and older prediabetic participants from the CHARLS database. Prediabetes remission was defined as returning to normoglycemia at a single five-year follow-up assessment. Multivariable logistic regression and restricted cubic spline (RCS) models were employed to examine the association between VAI and prediabetes remission. RESULTS: At the five-year follow-up point, 56.28% of participants were in remission. After adjusting for confounders, VAI was significantly negatively associated with remission (OR = 0.960, P = 0.017). RCS analyses demonstrated an "L-shaped" nonlinear relationship (P for nonlinearity < 0.001) with an inflection-point threshold of 2.157. Below this threshold, lower VAI was associated with markedly higher odds of remission at follow-up, whereas above it, the association was no longer statistically significant. Subgroup analyses indicated that VAI had stronger predictive performance among individuals aged 60-70 years. CONCLUSIONS: VAI is a key metabolic indicator associated with prediabetes remission, with lower visceral adiposity levels being linked to a higher probability of remission. The threshold of 2.157 identified in this study serves as a potential reference value for risk stratification, warranting further validation in future prospective clinical trials.
Quality of life and factors affecting glycemic control in adolescents with Type 1 diabetes: a cross-sectional study.
Simsek A, Aydın DB, Çubukcu E … +2 more , Ar I, Can E
Diabetes Res Clin Pract · 2026 May · PMID 41881363 · Publisher ↗
AIMS: Type 1 diabetes is one of the most common chronic diseases in childhood and has a significant impact on children's quality of life. The aim of this study was to evaluate the factors affecting the quality of life an...
AIMS: Type 1 diabetes is one of the most common chronic diseases in childhood and has a significant impact on children's quality of life. The aim of this study was to evaluate the factors affecting the quality of life and glycemic control of adolescents with type 1 diabetes. METHODS: This descriptive and cross-sectional study was conducted in pediatric endocrinology outpatient clinics of three hospitals in Turkey between January 2023 and January 2024. The descriptive information form, clinical data including blood glucose and glycated hemoglobin levels were obtained from medical records, and Pediatric Quality of Life Scale (PedsQL) were used as data collection tools. RESULTS: A total of 217 adolescents (average age = 14) participated in the study. The mean PedsQL total score was 43.8 ± 14.6. Scale scores were significantly affected by factors such as HbA1c level (p = 0.000), regular physical activity (p = 0.016), carbohydrate counting (p = 0.018), sharing diabetes with friends (p = 0.019), and education level (p = 0.008). Scale score was found to be lower in individuals with HbA1c ≥ 7.5. CONCLUSION: The quality of life of adolescents with type 1 diabetes is affected by multidimensional factors, including not only glycemic control but also individual education, social support, and physical activity. Therefore, a holistic care model should be developed.
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