Diabetes & metabolism最新文献

{"title":"Maternal antibody transfer confounds type 1 diabetes screening in infancy: results from the French TRAKR cohort.","authors":"Sarvenaz Metghalchi, Anna Jones, Elise Bismuth, Jean-Claude Carel, Jacques Beltrand, Agnès Sola-Gazagnes, Etienne Larger, Nathalie Morel, Jean-François Gautier, Jean-Pierre Riveline, Catherine Petit, Alfred Penfornis, Nadine Lucidarme, Emmanuel Cosson, Chloé Amouyal, Jacques Lepercq, François Goffinet, Nelly Briand, Pierre-Yves Ancel, Christian Boitard, Roberto Mallone","doi":"10.1016/j.diabet.2026.101797","DOIUrl":"https://doi.org/10.1016/j.diabet.2026.101797","url":null,"abstract":"<p><strong>Aim: </strong>The optimal age to initiate islet autoantibody (IAb) screening in first-degree relatives of individuals with type 1 diabetes (T1D) remains uncertain. The TRAKR cohort prospectively characterized IAb patterns in newborns of parents with T1D to assess the interpretability of early-life screening.</p><p><strong>Methods: </strong>We analyzed 148 children with available follow-up. Child blood samples were collected at birth and at 8, 18, 30, and 42 months, and parental samples during pregnancy. Insulin (IAA), GAD (GADA), IA-2 (IA-2A), and ZnT8 (ZnT8A) IAbs were measured using bridging ELISAs. Child-mother IAb specificities and longitudinal trajectories were compared.</p><p><strong>Results: </strong>At 8 months, 28/138 children (20.3%) were IAb+, of whom 25/28 (89.3%) had a single IAb and 25/28 (89.3%) had a mother with T1D. Among 21 IAb+ children with maternal IAb results, 18 (85.7%) shared IAb specificity with their mother, predominantly GADA (15/18, 83.3%). All 9 children GADA+ at 8 months with follow-up had GADA+ mothers; 6 seroreverted by 18 months and 1 by 30 months. All 5 children IAA+ at 8 months with follow-up seroreverted by 18 months. Only one child, who seroconverted to IAA and GADA at 18 months, progressed to clinical Stage 3 at 30 months, without ketoacidosis.</p><p><strong>Conclusion: </strong>IAb positivity at 8 months frequently reflects passive maternal antibody transfer rather than endogenous islet autoimmunity. Screening during the first year of life may therefore overestimate child autoimmunity and prompt unnecessary follow-up. Initiating screening at 2 years of age should reduce misclassification while retaining the opportunity to detect early childhood seroconversion.</p>","PeriodicalId":101305,"journal":{"name":"Diabetes & metabolism","volume":" ","pages":"101797"},"PeriodicalIF":4.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond glycaemic control: autoimmune polyglandular syndrome type 3 as an emerging distinct entity rather than a mere comorbidity in paediatric type 1 diabetes.","authors":"Styliani Giza, Vasiliki Rengina Tsinopoulou, Eleni P Kotanidou, Thekla Poukoulidou, Stergianna Ntouma, Kosmas Margaritis, Assimina Galli-Tsinopoulou","doi":"10.1016/j.diabet.2026.101796","DOIUrl":"https://doi.org/10.1016/j.diabet.2026.101796","url":null,"abstract":"<p><strong>Aim: </strong>Autoimmune polyglandular syndrome type 3 (APS-3) is the coexistence of autoimmune thyroid disease (AITD) with type 1 diabetes (T1D) or other autoimmune diseases, after exclusion of adrenal insufficiency. We aimed to evaluate the prevalence, timeline and features of APS-3 in children and adolescents with T1D.</p><p><strong>Methods: </strong>We studied 439 T1D paediatric patients who were diagnosed and followed up over 16 years using annual biochemical and autoantibody profile evaluations.</p><p><strong>Results: </strong>The prevalence of APS-3a (T1D+AITD) was 23.5%, with significant female predominance (54.4%, P = 0.007). The vast majority had Hashimoto's thyroiditis (96.0%), while Graves' disease represented only 4.0%. Coincidence of T1D and AITD diagnosis was recorded in 49.5%. The frequency of diabetic ketoacidosis in patients diagnosed with AITD before the onset of T1D (63.6%) was similar to that in patients with isolated T1D (61.7%). Overlapping of APS-3 subtypes were identified, including celiac disease (n=4), autoimmune hepatitis (n=1), atrophic gastritis (n=1) (APS-3b), vitiligo (n=1), psoriasis (n=1) (APS-3c) and Sjögren's syndrome (n=1) (APS-3d).</p><p><strong>Conclusions: </strong>APS-3a is common in the paediatric T1D population and is often diagnosed at its clinical onset. The overlaps with gastrointestinal and connective tissue pathology highlight the unpredictable natural course of autoimmunity, underscoring the necessity for lifelong regular monitoring.</p>","PeriodicalId":101305,"journal":{"name":"Diabetes & metabolism","volume":" ","pages":"101796"},"PeriodicalIF":4.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes associated with glucagon-like peptide-1 receptor agonist therapy in patients with peripheral artery disease and diabetes.","authors":"Haitham Abu Khadija, Mohammad Alnees, Ali Abdullah, Kareem Ibraheem, Taha Z Makhlouf, Ramon Cohen, Duha Najajra, Orit Twito, Tal Schiller, Alena Kirzhner","doi":"10.1016/j.diabet.2026.101794","DOIUrl":"https://doi.org/10.1016/j.diabet.2026.101794","url":null,"abstract":"<p><strong>Aim: </strong>Peripheral artery disease (PAD) and diabetes are associated with high risks of limb complications and mortality. Although glucagon-like peptide-1 receptor agonists (GLP1-RAs) improve cardiovascular outcomes, their effect on limb outcomes in PAD remains uncertain.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Clalit Health Services database. Adults with PAD and diabetes were classified according to GLP1-RA dispensing exposure, and inverse probability of treatment weighting was used to balance measured baseline characteristics in the primary analysis. The primary outcome was major adverse limb events (MALE), defined as lower-limb revascularization or amputation. To address potential immortal time bias, all-cause mortality was additionally evaluated using an incident-treatment risk-set approach aligned to the qualifying GLP1-RA exposure date, while sustained GLP1-RA exposure was evaluated for MALE using a time-varying persistent-use model.</p><p><strong>Results: </strong>Among 20,031 patients, 5,960 met the original GLP1-RA exposure definition and 14,071 were classified as non-users. In the original IPTW-weighted analysis, GLP1-RA exposure was associated with lower risks of MALE, revascularization, major amputation, and all-cause mortality. In the time-aligned risk-set analysis, GLP1-RA exposure remained associated with lower all-cause mortality (HR 0.80, 95% CI 0.73-0.88; P < 0.001). In a time-varying analysis of sustained exposure, persistent GLP1-RA use was associated with a lower hazard of MALE (adjusted HR 0.65, 95% CI 0.44-0.94; P = 0.022).</p><p><strong>Conclusion: </strong>In patients with PAD and diabetes, GLP1-RA exposure was associated with favorable clinical outcomes. Time-aligned analyses demonstrated a lower risk of all-cause mortality, while sustained GLP1-RA exposure was associated with lower MALE risk. Given the observational design, these findings should be interpreted as associations rather than causal treatment effects.</p>","PeriodicalId":101305,"journal":{"name":"Diabetes & metabolism","volume":" ","pages":"101794"},"PeriodicalIF":4.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative management of SGLT2 inhibitors: balancing euglycaemic ketoacidosis risk and cardiorenal benefits.","authors":"Keqin Ji, Dongmei Zhang, Yun Zhao, Zhun Zeng, Min Jiang, Jianping Zhang","doi":"10.1016/j.diabet.2026.101793","DOIUrl":"https://doi.org/10.1016/j.diabet.2026.101793","url":null,"abstract":"<p><p>Sodium-glucose cotransporter 2 (SGLT2) inhibitors are established therapies for type 2 diabetes, heart failure, and chronic kidney disease, creating a perioperative need to balance prevention of euglycaemic diabetic ketoacidosis (euDKA) against cardiorenal protection. Fasting, surgical stress, infection, reduced carbohydrate intake, insulin dose reduction, and hypovolaemia can amplify glycosuria and ketogenesis and precipitate euDKA. Most guidelines recommend withholding SGLT2 inhibitors for 3-4 days before elective surgery, although recommendations vary by agent, procedure, fasting duration, diabetes status, and monitoring capacity. Emerging evidence indicates competing perioperative risks and benefits. Inadequate withholding and emergency surgery are associated with high-anion-gap metabolic acidosis and ketoacidosis, whereas observational studies associate preoperative use with lower risks of acute kidney injury and short-term mortality. Heart failure withdrawal studies further suggest that cardiovascular and volume-regulatory benefits may diminish rapidly after interruption. These findings challenge uniform withholding but do not support routine perioperative continuation. Management should be stratified by treatment indication, glycated haemoglobin, insulin dependence, hepatic and kidney function, infection and volume status, surgical urgency and invasiveness, expected fasting duration, and access to ketone and acid-base monitoring. Patients at high metabolic risk generally require an adequate preoperative withholding interval and intensified monitoring, whereas low-risk patients treated primarily for heart failure or chronic kidney disease require individualised multidisciplinary assessment. Future studies should define indication- and risk-based withholding and restart strategies and jointly evaluate euDKA, acute kidney injury, worsening heart failure, myocardial injury, mortality, and postoperative recovery.</p>","PeriodicalId":101305,"journal":{"name":"Diabetes & metabolism","volume":" ","pages":"101793"},"PeriodicalIF":4.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient outcomes of diabetic ketoacidosis complicating pancreatic cancer: a national inpatient sample analysis.","authors":"Rushi Shah, Tanisha Vora","doi":"10.1016/j.diabet.2026.101786","DOIUrl":"10.1016/j.diabet.2026.101786","url":null,"abstract":"<p><strong>Aims: </strong>Pancreatic cancer disrupts islet cell function producing pancreatogenic diabetes, which may precipitate diabetic ketoacidosis (DKA). No national study has characterized DKA prevalence or outcomes among pancreatic cancer hospitalizations. We aimed to address this gap using the National Inpatient Sample (NIS).</p><p><strong>Methods: </strong>We analyzed using NIS 2021-2023. Adult pancreatic cancer hospitalizations (ICD-10-CM C25) were stratified by concurrent DKA (E08.1-E13.1). The primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), mechanical ventilation, septic shock, cardiac arrest, ICU, venous thromboembolism, palliative care consultation, length of stay, and total charges. Multivariable logistic regression adjusted for age, sex, race/ethnicity, income quartile, primary payer, Elixhauser comorbidity category, DM type, and hospital characteristics.</p><p><strong>Results: </strong>Of 218,815 pancreatic cancer hospitalizations, 0.95% (n ≈ 2075) had concurrent DKA. 86.3% had Type 2 DM, while fewer than 2% had type 3c DM. DKA patients were younger, more likely Black (21.9%vs. 14.2%), and had higher comorbidity burden. After multivariable adjustment, DKA independently predicted mortality (aOR 1.76, 95% CI 1.30-2.38), AKI (aOR 3.09, 95% CI 2.49-3.83), mechanical ventilation (aOR 2.78, 95% CI 1.92-4.03), ICU (aOR 2.49, 95% CI 1.90-3.27), septic shock (aOR 2.53, 95% CI 1.86-3.43), and cardiac arrest (aOR 2.40, 95% CI 1.33-4.34).</p><p><strong>Conclusion: </strong>DKA complicates approximately 1% of US pancreatic cancer hospitalizations and independently predicts doubled mortality and markedly greater critical care utilization. Black patients and lower socioeconomic groups are disproportionately affected, identifying high-risk subgroups for targeted glycemic surveillance.</p>","PeriodicalId":101305,"journal":{"name":"Diabetes & metabolism","volume":" ","pages":"101786"},"PeriodicalIF":4.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SGLT2 inhibitor and urothelial carcinoma incidence in type 2 diabetes patients.","authors":"Yu-Chuan Lu, Chao-Hsiang Chang, Chen-Hsun Ho, Jian-Hua Hong, Huei-Ming Yeh, Yi-Huei Chang, Po-Jen Hsiao, Chi-Shun Lien, Laing-You Wu, Chi-Jung Chung","doi":"10.1016/j.diabet.2025.101694","DOIUrl":"10.1016/j.diabet.2025.101694","url":null,"abstract":"<p><strong>Aims: </strong>The association between sodium glucose cotransporter-2 (SGLT2) inhibitors and the risk of urothelial carcinoma (UC) remains controversial. This study aimed to investigate this relationship in Asian populations where upper tract urothelial carcinoma (UTUC) is prevalent.</p><p><strong>Methods: </strong>Using Taiwan's National Health Insurance Database from 2016 to 2021, we conducted a nationwide cohort study comparing SGLT2 (n = 150,278) and dipeptidyl peptidase-4 (DPP4) inhibitor users (n = 363,178). Inverse probability of treatment weighting was applied to balance baseline characteristics, including demographics, comorbidities, and concurrent medications. Cumulative drug days were used to evaluate medication exposure. The primary outcome was the incidence of UC, including bladder cancer and UTUC. To avoid reverse causation and consider cancer latency, outcomes were assessed starting one year after treatment initiation.</p><p><strong>Results: </strong>During a mean follow-up of 2.62 years, we found no significant association between the use of SGLT2 inhibitors as a class and the risk of UC compared to DPP4 inhibitors (adjusted hazard ratio = 0.99, 95 % confidence interval: 0.77-1.27). This null association was consistent for both bladder cancer and UTUC. Furthermore, no significant associations were observed when analyses were stratified by individual drug type or cumulative drug days. Although some trends were noted in exploratory sensitivity analyses, no findings remained robustly significant after accounting for multiple comparisons.</p><p><strong>Conclusion: </strong>SGLT2 inhibitor use was not associated with an increased risk of UC, with potential protective associations in specific subgroups requiring further investigation.</p>","PeriodicalId":101305,"journal":{"name":"Diabetes & metabolism","volume":" ","pages":"101694"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intact fish skin graft for deep diabetic foot ulcers: results from the KEREFISH randomized controlled trial.","authors":"Dured Dardari, Louis Potier, Ariane Sultan, Maud Francois, Jocelyne M'Bemba, Benjamin Bouillet, Lucy Chaillous, Laurence Kessler, Aurélie Carlier, Abdulkader Jalek, Ayoub Sbaa, Hilmar Kjartansson, Baldur Tumi Baldursson, Guillaume Charpentier, John C Lantis","doi":"10.1016/j.diabet.2025.101691","DOIUrl":"10.1016/j.diabet.2025.101691","url":null,"abstract":"<p><strong>Introduction: </strong>The main objective : To assess the efficacy of Intact fish skin graft (IFSG) for the closure of University of Texas (UT) Grade 2 and 3 Diabetic foot ulcers (DFUs) versus local standard of care (SOC).</p><p><strong>Methods: </strong>In the French subgroup of a multinational randomized trial, 180 (179 in primary endpoint analysis) patients with UT grade 2 and 3 DFUs (8 centers) were randomized to receive IFSG or SOC, that adhered to the International Working Group on the Diabetic Foot (IWGDF) guidelines. Primary endpoint was complete epithelialization at 16 weeks. Secondary endpoints were healing curve, percentage of wounds healed to 80 % or more in an average of 16 weeks, percentage healed at 20 weeks.</p><p><strong>Results: </strong>The primary endpoint was 41.6 % closure rate in IFSG group versus 22.2 % in SOC group (P = 0.0053). In the intent to treat analysis (ITT), there was a statistically significant difference (P < 0.05) in mean relative wound area between the IFSG and SOC arms at weeks 6.The proportion of patients with complete epithelialization at 20 weeks was 2.11 times higher in the IFSG group than in the SOC group. For those patients that healed a median of 7 graft applications was required.</p><p><strong>Conclusions: </strong>In France, the addition of IFSG to the care plan of patients with deep diabetic foot wounds improved the closure rate by 41.6 % in IFSG group versus 22.2 % in SOC.</p>","PeriodicalId":101305,"journal":{"name":"Diabetes & metabolism","volume":" ","pages":"101691"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the link between different types of maternal diabetes and the onset of autism spectrum disorders.","authors":"Wenyu Shao, Yichun Su, Jiayin Liu, Yu Long Liu, Jinghui Zhao, Xiaotang Fan","doi":"10.1016/j.diabet.2024.101543","DOIUrl":"https://doi.org/10.1016/j.diabet.2024.101543","url":null,"abstract":"<p><p>Autism spectrum disorders (ASD) encompass a collection of neurodevelopmental disorders that exhibit impaired social interactions and repetitive stereotypic behaviors. Although the exact cause of these disorders remains unknown, it is widely accepted that both genetic and environmental factors contribute to their onset and progression. Recent studies have highlighted the potential negative impact of maternal diabetes on embryonic neurodevelopment, suggesting that intrauterine hyperglycemia could pose an additional risk to early brain development and contribute to the development of ASD. This paper presents a comprehensive analysis of the current research on the relationship between various forms of maternal diabetes, such as type 1 diabetes mellitus, type 2 diabetes mellitus, and gestational diabetes mellitus, and the likelihood of ASD in offspring. The study elucidates the potential mechanisms through which maternal hyperglycemia affects fetal development, involving metabolic hormones, immune dysregulation, heightened oxidative stress, and epigenetic alterations. The findings of this review offer valuable insights for potential preventive measures and evidence-based interventions targeting ASD.</p>","PeriodicalId":101305,"journal":{"name":"Diabetes & metabolism","volume":" ","pages":"101543"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steatotic liver disease, MASLD and risk of chronic kidney disease.","authors":"Josh Bilson, A. Mantovani, Christopher D. Byrne, G. Targher","doi":"10.1016/j.diabet.2023.101506","DOIUrl":"https://doi.org/10.1016/j.diabet.2023.101506","url":null,"abstract":"","PeriodicalId":101305,"journal":{"name":"Diabetes & metabolism","volume":"329 ","pages":"101506"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139013463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}