Masrouri S, Ebrahimi N, Hasanpour A
… +3 more, Sohrabi B, Azizi F, Hadaegh F
Diabetes Res Clin Pract
· 2026 May · PMID 41881362
·
Publisher ↗
AIMS: To evaluate the prevalence of cardiovascular-kidney-metabolic syndrome (CKM) and its association with cardiovascular disease (CVD) risk across CKM stages in a Middle Eastern population. METHODS: We analyzed data fr...AIMS: To evaluate the prevalence of cardiovascular-kidney-metabolic syndrome (CKM) and its association with cardiovascular disease (CVD) risk across CKM stages in a Middle Eastern population. METHODS: We analyzed data from 7770 CVD-free adults aged 30-79 years. Multivariable Cox models assessed associations of CKM with incident CVD, coronary heart disease (CHD), myocardial infarction (MI), stroke, and CVD mortality. We also evaluated the impact of CKM stage transitions over approximately 3 years on cardiovascular endpoints. RESULTS: Baseline prevalence of CKM stages 0-3 was 11.2%, 12.0%, 72.8%, and 4.0%, respectively. Over a median 19.9 years of follow-up, 1450 CVD events occurred, including 338 CVD deaths. Compared with stage 0, the HRs (95% CIs) for CVD were 2.03 (1.59-2.58) for stage 2 and 2.76 (2.05-3.73) for stage 3; similar associations were observed for CHD, stroke, and MI. For CVD mortality, stage 3 conferred a risk of 2.61 (1.53-4.45). Each 1-stage progression in CKM over ∼ 3 years was associated with 1.40-2.01 times significantly greater risk of endpoints, except for MI. CONCLUSIONS: Nearly 77% of participants were classified in poor CKM stages (2-3), strongly associated with excess cardiovascular risk. These findings highlight the importance of early CKM detection and targeted interventions.
Diabetes Res Clin Pract
· 2026 May · PMID 41875951
·
Publisher ↗
OBJECTIVE: To identify independent risk factors for diabetic peripheral neuropathic pain (DPNP), construct a nomogram prediction model, and quantify the contribution of predictive factors using SHapley Additive exPlanati...OBJECTIVE: To identify independent risk factors for diabetic peripheral neuropathic pain (DPNP), construct a nomogram prediction model, and quantify the contribution of predictive factors using SHapley Additive exPlanations (SHAP) values. METHODS: This retrospective study of 500 type 2 diabetes patients diagnosed DPNP via the Michigan Neuropathy Screening Instrument and clinical evaluation. Predictors were selected using univariate analysis and LASSO regression, with independent risk factors identified by multivariate logistic regression. Nonlinear relationships were assessed using restricted cubic spline (RCS). The nomogram was evaluated using receiver operating characteristic (ROC) curves, precision-recall (PR) curves, calibration plots, and decision curve analysis (DCA). SHAP quantified factor importance. RESULTS: Seven independent risk factors were identified: age, diabetes duration, BMI, smoking history, fasting blood glucose, hyperlipidemia, and AST-highlighting metabolic parameters, especially AST, as key novel contributors. RCS revealed a nonlinear relationship for diabetes duration. The nomogram exhibited strong discrimination (AUCs: 0.863 training, 0.813 validation), good calibration, and strong clinical utility. SHAP confirmed diabetes duration as the most influential predictor. CONCLUSIONS: This nomogram provides an interpretable tool for early DPNP risk prediction. By quantifying individual risk, it enables clinicians to identify high-risk patients and implement personalized preventive strategies, potentially improving outcomes.
Yang A, Pu F, Guo Y
… +5 more, Yang Y, Tang R, Luo Y, Li Q, Yang F
Diabetes Res Clin Pract
· 2026 May · PMID 41875950
·
Publisher ↗
AIMS: To investigate sex-related differences in the association of body fat distribution with hepatic insulin clearance (HIC) in type 2 diabetes mellitus (T2DM), determining whether HIC associates more strongly with stat...AIMS: To investigate sex-related differences in the association of body fat distribution with hepatic insulin clearance (HIC) in type 2 diabetes mellitus (T2DM), determining whether HIC associates more strongly with static hepatic steatosis or visceral adiposity. METHODS: We retrospectively analyzed 234 inpatients with T2DM (146 men, 88 women). Regional and ectopic fat were quantified via deep-learning computed tomography (CT). HIC was derived from oral glucose tolerance tests. Multivariable regression and propensity score matching (PSM) identified independent HIC determinants. RESULTS: Men had larger visceral adipose tissue (VAT) areas; women had higher hepatic fat. VAT was independently associated with systemic insulin resistance. After adjusting for insulin resistance, VAT was positively associated with HIC in women (β = 0.395, P = 0.008), but not men (β = -0.047, P = 0.636). These patterns persisted in the PSM cohort (P for interaction = 0.025), even after additional adjustment for insulin resistance (P for interaction = 0.07). CT-assessed hepatic fat showed no independent association with HIC. CONCLUSIONS: The association between visceral adiposity and HIC is sex-related, with preserved adaptation in women but not in men. Visceral adiposity is more strongly associated with clearance dynamics than static hepatic steatosis, improving the pathophysiological characterization of T2DM.
Uusitupa M, Valtanen M, Lindström J
… +1 more, Tuomilehto J
Diabetes Res Clin Pract
· 2026 May · PMID 41875949
·
Publisher ↗
AIMS: Lifestyle interventions induce remission in people with type 2 diabetes (T2D) and those with impaired glucose tolerance (IGT). We examined the long-term remission of IGT in the participants of the Finnish Diabetes...AIMS: Lifestyle interventions induce remission in people with type 2 diabetes (T2D) and those with impaired glucose tolerance (IGT). We examined the long-term remission of IGT in the participants of the Finnish Diabetes Prevention Study and evaluated factors predicting remission during extended follow-up. METHODS: 505 participants were included in analyses. The median duration of lifestyle intervention was four years, and follow-up lasted up to 18 years. Remission was defined as normoglycaemia (fasting plasma glucose < 5.6 mmol/L, 2-h post-load glucose < 7.8 mmol/L, HbA1c < 39 mmol/mol). We examined predictors of remission (weight, fat distribution, physical activity, diet, and insulin sensitivity and insulin secretion based on repeated oral glucose tolerance tests). RESULTS: Remission rates were 32% at least once, 13%, 12%, and 11% at year 1, year 3, and the first post-intervention follow-up visit (median 5 years, range 4 - 8 years). Short-term predictors of remission included weight loss, reduction in waist circumference, higher intake of fibre and lower intake of saturated fats, physical activity, enhanced insulin sensitivity, and recovery of insulin secretion. In the longer term, only insulin secretory and sensitivity indices were associated with remission. CONCLUSION: IGT may be normalised in the long term through weight loss and healthier lifestyles choices.
Xiang H, Tang Z, Zhang X
… +11 more, Zhao W, Chen X, Zeng Q, Li X, Zhang M, Cheng S, Gao R, Yang S, Li Q, Cheng Q, Hu J
Diabetes Res Clin Pract
· 2026 May · PMID 41865817
·
Publisher ↗
We aimed to estimate the incidence for overall and individual components of diabetes-related foot disease (DFD), and explore potential heterogeneity across studies. We included patients with diabetes who were free of DFD...We aimed to estimate the incidence for overall and individual components of diabetes-related foot disease (DFD), and explore potential heterogeneity across studies. We included patients with diabetes who were free of DFD from UK Biobank and Chongqing Diabetes Registry (CDR). We defined DFD according to the International Working Group on the Diabetic Foot 2023 criteria. We further performed meta-analyses by integrating results from the two cohorts and 64 cohorts identified from a systematic review of literature, and quantifying the extent of variation in reported incidence rates. The incidence of DFD was 12.81 (95 % confidence interval[CI]: 12.46-13.15) and 24.97 (21.38-28.99) per 1,000 person-year in UK Biobank and CDR, respectively. The pooled estimates were 19.84 (95 %CI: 16.58-23.10) for peripheral neuropathy, 7.32 (6.17-8.47) for foot ulcer, 2.56 (2.20-2.93) for lower-extremity amputation, 2.56 (1.08-4.04) for lower-extremity arterial disease, and 0.81 (0.00-1.74) for gangrene, respectively. Heterogeneity was high across studies (I > 99 %). In conclusion, incidence for DFD exceeds 10 per 1,000 person-year among patients with diabetes, and peripheral neuropathy and foot ulcer are major contributors to incident DFD. These estimates should be interpreted as descriptive summaries of available evidence rather than a single universal incidence, and large heterogeneity underscores the context-specific nature of DFD occurrence.
Sadore AA, Agho KE, Fentie EA
… +1 more, Osuagwu UL
Diabetes Res Clin Pract
· 2026 May · PMID 41862004
·
Publisher ↗
Gestational Diabetes Mellitus (GDM) is a major public health problem. This study aimed to conduct a systematic review and meta-analysis to identify the factors associated with GDM in Low- and Middle-Income Countries (LMI...Gestational Diabetes Mellitus (GDM) is a major public health problem. This study aimed to conduct a systematic review and meta-analysis to identify the factors associated with GDM in Low- and Middle-Income Countries (LMICs). Seven electronic databases (PubMed, CINAHL, PsycINFO, Scopus, EMBASE, CABI and Google Scholar) were systematically searched for eligible observational studies published in LMICs between 2015 and August 2025. Statistical heterogeneity was evaluated using the I statistic, and a random-effects model was applied to calculate pooled estimates. The protocol was pre-registered on PROSPERO (CRD420251247717). Forty-seven studies met the inclusion criteria and contributed 116 factor-specific effect estimates. The pooled analysis demonstrated that several factors were significantly associated with increased risk of GDM. These included maternal age ≥ 30, multiparity, urban residence, pre-pregnancy obesity BMI ≥ 25 kg/m, family history of diabetes, history of gestational diabetes mellitus (GDM), pre-hypertension, preeclampsia, polycystic ovarian syndrome (PCOS) and physical inactivity. This study found that advanced maternal age, pre-pregnancy obesity, family history of diabetes, prior GDM, pre-hypertension, preeclampsia, and PCOS are key factors associated with GDM in LMICs. These findings highlight the need for prevention and screening strategies integrated within maternal pregnant health programs for many LMICs.
Al-Abdulrazzaq D, Lazinger S, Raicevic M
… +8 more, Simmons K, Berka B, Slavcheva O, Schweiger DS, Vasilakis IA, Richmond E, Kotanidou E, AlKandari H
Diabetes Res Clin Pract
· 2026 May · PMID 41856331
·
Publisher ↗
AIMS: This study aims to report on the global differences in the prevalence of thyroid autoimmunity and hypothyroidism among children with T1D registered in the SWEET database and identifying the associated characteristi...AIMS: This study aims to report on the global differences in the prevalence of thyroid autoimmunity and hypothyroidism among children with T1D registered in the SWEET database and identifying the associated characteristics. METHODS: Children aged ≤18 years registered with T1D in the SWEET database between 2012-2022, and with information on thyroid autoimmunity/disease screening, have been included in the study. RESULTS: Among the total of children registered, 19,225 children had fulfilled the inclusion criteria. The prevalence of positive thyroid autoimmunity and hypothyroidism in the study cohort was 13.2% and 9.9% respectively. The adjusted prevalence of thyroid autoimmunity and hypothyroidism were highest in South America at 16.3%, 95% CI 13.1-20.1 and 17.1%, 95% CI 13.9-21.0 respectively. Age, gender and geographical region were identified as a predictive factor for the development of thyroid autoimmunity and hypothyroidism within the study cohort. Diabetes duration and BMI-Z scores were additional predictive factors for the development of hypothyroidism. CONCLUSION: Future research should clarify the genetic and environmental factors underlying regional disparities in thyroid autoimmunity and disease among children with T1D. Region-specific, evidence-based screening strategies tailored to local prevalence and risk profiles are needed to optimize early detection and clinical outcomes.
Diabetes Res Clin Pract
· 2026 May · PMID 41856330
·
Full text
This retrospective study assessed barriers to CGM use among 100 adults with type 2 diabetes receiving endocrinology care. Patient preference was the most common reason for non-use (n = 47). Nearly half of patients had no...This retrospective study assessed barriers to CGM use among 100 adults with type 2 diabetes receiving endocrinology care. Patient preference was the most common reason for non-use (n = 47). Nearly half of patients had no CGM discussion documented (n = 42), and financial (n = 9) and phone compatibility (n = 2) barriers were less common.
Iseme-Ondiek R, Muia A, Shabani JS
… +7 more, Mucheru S, Gathu C, Gitonga E, Mutisya R, Kioko P, Safipour J, Witthöft C
Diabetes Res Clin Pract
· 2026 May · PMID 41856329
·
Publisher ↗
AIMS: Cardiometabolic abnormalities such as obesity, hypertension, and dyslipidemia are rising globally and straining health systems. This study assessed the burden of cardiometabolic risk factors among prediabetic adult...AIMS: Cardiometabolic abnormalities such as obesity, hypertension, and dyslipidemia are rising globally and straining health systems. This study assessed the burden of cardiometabolic risk factors among prediabetic adults in Kenya. METHODS: We analyzed baseline data from the Fermented Foods and Prediabetes Randomized Controlled Trial, which recruited adults with prediabetes (HbA1c 39-46 mmol/mol; 5.7%-6.4%) from Aga Khan University Hospital outreach clinics in five Kenyan counties. Standardized questionnaires and clinical assessments were conducted, with HbA1c measured via turbidimetric inhibition immunoassay. Data were managed in REDCap and analyzed in Stata v13. Poisson regression identified factors associated with co-occurrence of cardiometabolic risk factors. RESULTS: Of 210 participants (mean age 44.1 years; 60.5% female), 96.2% had at least one additional metabolic abnormality alongside prediabetes, including 16.7% with normal BMI. Excess weight was present in 83.3% and elevated blood pressure in 77.1%. In adjusted analyses, age was independently associated with a higher number of cardiometabolic risk factors (IRR = 1.013; 95% CI: 1.005-1.021; p = 0.002). CONCLUSION: Prediabetic adults in Kenya exhibit a high clustering of cardiometabolic abnormalities, highlighting elevated risk of type 2 diabetes, cardiovascular disease, and premature mortality. Comprehensive interventions should target glucose, weight, blood pressure, lipids, and lifestyle factors.
Sureshkumar P, Kumar SS, Anusree E
… +2 more, Cheriyan J, Masood A
Diabetes Res Clin Pract
· 2026 May · PMID 41856328
·
Publisher ↗
Glycated hemoglobin (HbA1c) is a cornerstone of diabetes diagnosis and management. For most individuals, HbA1c remains reliable; however clinically significant discordance between HbA1c levels and actual blood glucose va...Glycated hemoglobin (HbA1c) is a cornerstone of diabetes diagnosis and management. For most individuals, HbA1c remains reliable; however clinically significant discordance between HbA1c levels and actual blood glucose values occurs in defined subpopulations with specific confounding conditions (e.g., anemia, hemoglobinopathies, chronic kidney disease). This narrative review synthesizes current evidence on the multifactorial etiology and clinical consequences of HbA1c-glycemia mismatch. We highlight biological variability, hematological conditions, systemic diseases, and analytical factors that contribute to this discrepancy. The review emphasizes that recognizing these limitations is crucial to avoid clinical misjudgment, such as inappropriate treatment escalation or dangerous therapeutic inertia. We advocate for a systematic diagnostic approach when discordance is suspected, including evaluation for confounders and alternative biomarkers such as fructosamine, and critically, the integration of continuous glucose monitoring (CGM). When CGM is utilized, a comprehensive assessment of glycemic control should incorporate the full panel of consensus metrics- Time-in-Range (TIR), Time-Below-Range (TBR), Glycemic Variability (GV), and the Glucose Management Indicator (GMI). However, CGM systems have their own limitations, including inter-sensor variability and differences between device models, which must be considered when interpreting discordance. This review aims to equip clinicians with the knowledge to navigate HbA1c discordance, promoting personalized, safe, and equitable diabetes care.
Douglas LJ, Gamble GD, Harding JE
… +3 more, Samuel D, Eagleton CL, Crowther CA
Diabetes Res Clin Pract
· 2026 May · PMID 41839267
·
Publisher ↗
AIMS: To assess adherence to recommended diabetes screening after birth in women with gestational diabetes mellitus (GDM), to compare adherence to screening between women allocated tight or less tight glycaemic targets i...AIMS: To assess adherence to recommended diabetes screening after birth in women with gestational diabetes mellitus (GDM), to compare adherence to screening between women allocated tight or less tight glycaemic targets in pregnancy, to compare cardiometabolic outcomes in women with high and low adherence to screening, and to identify predictors for low adherence. METHODS: Data from 314 women who consented to the TARGET 4.5 Year Follow-Up were obtained from hospital records, community laboratories, general practice records and a maternal health questionnaire. RESULTS: Mean overall adherence to diabetes screening was 46.9% (95% confidence interval 43.8 to 50.0). Women allocated tight glycaemic targets in pregnancy were more likely to have high overall adherence to screening (≥75% of recommended HbA1c measurements) than women allocated less tight targets (40/162, 24.7% versus 22/152, 14.5%, p = 0.02). Metabolic syndrome and class 2 obesity were detected more often in women with high screening adherence than low adherence. No independent predictors for low adherence were identified. CONCLUSIONS: Adherence to recommended diabetes screening after GDM was low, with women allocated to tight compared with less tight glycaemic targets having higher adherence. Future research should investigate how to modify care for women with GDM to encourage diabetes screening after birth.
Pandey A, Badruddeen, Akhtar J
… +3 more, Khan MI, Ahmad M, Islam A
Diabetes Res Clin Pract
· 2026 May · PMID 41833781
·
Publisher ↗
Diabetic nephropathy (DN) is a chronic renal complication characterized by persistent proteinuria, glomerular hypertrophy, impaired filtration capacity, and progressive renal fibrosis, ultimately leading to a gradual dec...Diabetic nephropathy (DN) is a chronic renal complication characterized by persistent proteinuria, glomerular hypertrophy, impaired filtration capacity, and progressive renal fibrosis, ultimately leading to a gradual decline in kidney function. DN remains one of the leading causes of end-stage renal disease worldwide, contributing substantially to morbidity and mortality. Although the precise etiology of DN is not fully elucidated, its development is closely linked to prolonged hyperglycemia, renal hyperfiltration, accumulation of advanced glycation end products (AGEs), activation of pro-inflammatory cytokines, and oxidative stress-mediated injury. These pathogenic events involve multiple diabetes-associated pathways, including protein kinase C activation and increased reactive oxygen species (ROS) generation. O-linked β-N-acetylglucosamine (O-GlcNAc) modification is a dynamic post-translational protein modification that is significantly upregulated in DN and plays a critical role in regulating cellular signaling pathways associated with disease initiation and progression. This review summarizes current evidence on the role of O-GlcNAcylation in modulating molecular mechanisms underlying DN. Furthermore, Angiopoietin-like 4 (ANGPTL4) has emerged as a key regulator of lipid metabolism through inhibition of lipoprotein lipase and interactions with integrins, influencing vascular permeability, oxidative stress, and tissue remodeling. Increasing evidence suggests that ANGPTL4 plays a pivotal role in DN onset and progression.
Okoro C, Zhou TL, van der Kallen CJ
… +7 more, Koster A, Sutedja NA, Berendschot TT, de Galan BE, P M Eussen SJ, Schram MT, Kroon AA
Diabetes Res Clin Pract
· 2026 May · PMID 41833780
·
Publisher ↗
AIMS: Diabetic neuropathy is a frequent complication of type 2 diabetes, yet the relationship between cardiovascular risk factor control and neuropathy remains unclear. We investigated the association between the number...AIMS: Diabetic neuropathy is a frequent complication of type 2 diabetes, yet the relationship between cardiovascular risk factor control and neuropathy remains unclear. We investigated the association between the number of risk factors within guideline-recommended targets and neuropathy in type 2 diabetes. METHODS: In The Maastricht Study, neuropathy was assessed in 3,764 participants (845 with type 2 diabetes; 2,919 without diabetes) using measures of autonomic, sensory, peripheral nerve function, and neuropathic pain. Participants were categorized by the number of eight risk factors within target (HbA1c, blood pressure, BMI, lipids, albuminuria, smoking, physical activity, and diet). Logistic regression estimated odds of neuropathy across strata of risk factors within target. RESULTS: Neuropathy prevalence was 7.8% in individuals with type 2 diabetes and 1.3% in those without diabetes. More risk factors on target were associated with lower odds of neuropathy. Compared with individuals with normal glucose metabolism, adjusted odds ratios were 14.86 (95% CI 7.67-28.82) for 0-2, 3.18 (95% CI 2.01-5.04) for 3-5 and 1.07 (95% CI 0.25-4.56) for 6-8 risk factors on target. CONCLUSIONS: Achieving ≥6 risk factors on target was associated with neuropathy prevalence similar to individuals without diabetes, suggesting comprehensive risk factor control may help prevent neuropathy.
Xu X, Qiu S, Wu T
… +5 more, Wang W, Liu Y, He M, Sun Z, Yuan Y
Diabetes Res Clin Pract
· 2026 May · PMID 41819451
·
Publisher ↗
Microvascular disease has traditionally been regarded as a defining complication of diabetes, responsible for major clinical outcomes including retinopathy, nephropathy, neuropathy, and limb amputation. Existing framewor...Microvascular disease has traditionally been regarded as a defining complication of diabetes, responsible for major clinical outcomes including retinopathy, nephropathy, neuropathy, and limb amputation. Existing frameworks have largely attributed microvascular injury to chronic hyperglycaemia, mediated through pathways such as advanced glycation end product formation, protein kinase C activation, and oxidative stress. While these mechanisms are well established, a predominantly glucose-centric paradigm may incompletely capture the complexity of microvascular pathology. Accumulating evidence indicates that microvascular abnormalities are also prevalent in individuals without diabetes and may arise across a continuum of metabolic dysfunction. Epidemiological studies and clinical trials further suggest that intensive glucose lowering alone does not fully eliminate the risk of microvascular complications, highlighting the importance of non-glycaemic contributors, including hypertension, dyslipidaemia, insulin resistance, adiposity, and chronic inflammation. Notably, these metabolic disturbances may precede overt hyperglycaemia and provide earlier signals of vascular vulnerability. These observations have direct clinical relevance for diabetologists, as they suggest that microvascular injury may develop during prediabetes or earlier stages of metabolic dysfunction, with important implications for early screening and risk stratification in diabetes-oriented clinical practice. In this review, we propose the concept of metabolic microvascular disease (MMD), which reframes microvascular pathology as a systemic consequence of metabolic dysregulation rather than a complication confined to diabetes. We synthesise evidence of microvascular disease across populations with and without diabetes, summarise shared and distinct pathogenic mechanisms, and outline a pragmatic framework to support early clinical recognition and research stratification. Finally, we discuss the clinical and public health implications of adopting a metabolic perspective, emphasising the need for prevention strategies that extend beyond glucose-lowering to include comprehensive metabolic risk management.
Ahmad S, Sul HH, Danpanichkul P
… +1 more, Souza M
Diabetes Res Clin Pract
· 2026 Jun · PMID 41813520
·
Publisher ↗
High intrapancreatic fat deposition (IPFD), or fatty pancreas disease (FPD), has been increasingly recognized as a major driver in the pathogenesis of type 2 diabetes mellitus (T2DM). This meta-analysis aims to quantify...High intrapancreatic fat deposition (IPFD), or fatty pancreas disease (FPD), has been increasingly recognized as a major driver in the pathogenesis of type 2 diabetes mellitus (T2DM). This meta-analysis aims to quantify the prevalence of FPD in people with T2DM. We searched PubMed and Embase databases until October 27, 2025, for observational studies that reported data on FPD prevalence in people with T2DM. A generalized linear mixed model was used to estimate pooled prevalence. In total, 12 studies (6,369 individuals) were included. The pooled prevalence of FPD in T2DM was 54.28% (95% CI 37.70 to 69.96). Subgroup analyses indicated that the prevalence of FPD tended to be lower in Asian than European studies (42.85% vs. 69.19%, p = 0.06) and was higher in smaller studies (<100 individuals: 67.55%) and in clinic/hospital-based settings (57.90%). No significant differences were observed in the prevalence of FPD when stratified by IPFD measurement method or median study year of enrollment. Approximately half of patients with T2DM have concomitant FPD, indicating a substantial yet underrecognized metabolic burden. These findings call for multidisciplinary efforts to better define the role of IPFD within the T2DM phenotype and to develop strategies for the prevention and monitoring of FPD in this population.
Frimpong J, Browne A, Martin W
… +2 more, Kaushik P, Friedrichs LG
Diabetes Res Clin Pract
· 2026 May · PMID 41812907
·
Full text
AIMS: Basal metabolic rate (BMR) and energy imbalance are determinants of diabetes. We assessed the BMR-associated risk for diabetes in a large cohort. METHODS: Cox proportional models estimated hazard ratios (HR) for su...AIMS: Basal metabolic rate (BMR) and energy imbalance are determinants of diabetes. We assessed the BMR-associated risk for diabetes in a large cohort. METHODS: Cox proportional models estimated hazard ratios (HR) for subsequent diabetes and its complications with estimated BMR among diabetes-free participants. The mediating role of vascular-metabolic biomarkers were assessed. FINDINGS: Among 341,790 participants aged 55.7 ± 8.1 years, the mean (standard deviation [SD]) estimated BMR was 1849 (234) kcal/day in men and 1340 (147) kcal/day in women. Over 12 years follow-up, 4,626 cases of diabetes accrued. Higher estimated BMR showed positive associations with diabetes, with each SD higher estimated BMR associated with a 55% increase in diabetes risk (HR 1.54, 95% confidence interval [CI] 1.49-1.59 in men; HR 1.56, 1.49-1.62 in women), and a substantive risk for cardiac complications among those with diabetes (1.71, 1.55-1.89 in men; 1.78, 1.56-2.03 in women), diabetic coma, ketoacidosis and glycaemic disturbances (1.18, 0.99-1.42 in men; 1.35, 1.21-1.50 in women), and stroke (1.27, 1.08-1.50 in men; 1.41, 1.14-1.76 in women). Glycated haemoglobin, triglycerides, high-density-cholesterol, Cystatin-C and C-reactive protein explained 10-30% of these associations. CONCLUSION: Estimated elevated BMR was strongly positively associated with risk for diabetes and its complications, suggesting to re-evaluate the role of BMR, in addition to BMI, in diabetes research.
Yang CC, Wu JY, Cheng YY
… +6 more, Chang HY, Wang SH, Feng IC, Kuo HT, Yu ML, Chang WT
Diabetes Res Clin Pract
· 2026 May · PMID 41802676
·
Publisher ↗
BACKGROUND: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes (T2D) are at high cardiovascular risk. Whether glucagon-like peptide-1 receptor agonists (GLP-1 RAs) provide...BACKGROUND: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes (T2D) are at high cardiovascular risk. Whether glucagon-like peptide-1 receptor agonists (GLP-1 RAs) provide cardiovascular protection comparable to sodium-glucose cotransporter-2 inhibitors (SGLT2is) remain uncertain. METHODS: Using the TriNetX global health research network, we conducted a retrospective cohort study of adults with MASLD and T2D initiating GLP-1 RAs or SGLT2is between 2017 and 2025. Propensity score matching balanced demographics, comorbidities, medications, and laboratory variables. Outcomes were analyzed using Cox proportional-hazards models, Kaplan-Meier curves, landmark analyses, negative control outcomes, and E-value estimation. Target-trial emulation principles were applied to reduce immortal-time and confounding bias. RESULTS: After matching, 52,094 patients were included (mean age 58.5 years; 49.7% women) with a median follow-up of 3.0 years. GLP-1 RA use was associated with a lower risk of major adverse cardiovascular and cerebrovascular events compared with SGLT2is (HR 0.86, 95% CI 0.80-0.92; p < 0.001). Risks of heart failure, myocardial infarction, stroke, and all-cause mortality were also significantly reduced. Results were consistent across sensitivity analyses. CONCLUSIONS: Among patients with MASLD and T2D, GLP-1 RA therapy was associated with a lower risk of cardiovascular events than SGLT2is, providing real-world comparative evidence in this population.
Diabetes Res Clin Pract
· 2026 May · PMID 41794136
·
Publisher ↗
AIMS: This study aimed to evaluate the prognostic potential of circulating inflammatory biomarkers, specifically hsCRP, IL-6, TNF-α, and CD163, for predicting diabetic retinopathy (DR) in adults with recently diagnosed t...AIMS: This study aimed to evaluate the prognostic potential of circulating inflammatory biomarkers, specifically hsCRP, IL-6, TNF-α, and CD163, for predicting diabetic retinopathy (DR) in adults with recently diagnosed type 2 diabetes. METHODS: A prospective cohort of 3,363 individuals from the Danish Centre for Strategic Research in Type 2 Diabetes was followed prospectively (median follow-up of nine years). Baseline concentrations of four biomarkers were measured, and DR outcomes were assessed. Logistic regressions were used to evaluate associations with DR presence at baseline, while Cox regressions were used to analyze the development and progression of DR, adjusting for potential confounders, including HbA1c. RESULTS: No associations were observed between baseline concentrations of inflammatory biomarkers and DR presence, development, or progression over time. When comparing the highest quartile to the lowest quartile for a given biomarker in adjusted models, the hazard ratios (95% CI) for the development or progression of DR were: hsCRP 0.76 (0.55-1.03), IL-6 0.84 (0.62-1.14), TNF-α 1.03 (0.76-1.40), and CD163 0.84 (0.62-1.14). CONCLUSIONS: Our results indicate that systemic inflammatory biomarkers may not serve as reliable predictors for DR in early-stage type 2 diabetes. These findings contrast with prior cross-sectional studies suggesting a role for systemic low-grade inflammation in DR development. Inflammatory biomarkers. Diabetic retinopathy.