Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy最新文献

{"title":"Effect of FATmax-Intensity Exercise on Body Composition and Cardiovascular Health in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis.","authors":"Ge Zhao, Teng Keen Khong, Yanqing Yan, Ashril Yusof","doi":"10.2147/DMSO.S619590","DOIUrl":"10.2147/DMSO.S619590","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the effects of exercising at maximal fat oxidation (FATmax) intensity on body composition, cardiorespiratory fitness, and metabolism outcomes in overweight and obese individuals through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) were retrieved from PubMed, Web of Science, CNKI, and the Cochrane Library. Search terms included FATmax or maximal fat oxidation, obesity or overweight, BMI, [Formula: see text], diastolic blood pressure (DBP), systolic blood pressure (SBP), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and homeostasis model assessment of insulin resistance (HOMA-IR). Risk of bias was assessed using Cochrane guidelines and the quality of evidence using GRADE. A random-effects model (Stata 16.0) calculated pooled mean differences for outcomes.</p><p><strong>Results: </strong>18 RCTs were finally analysed. Compared to non-exercising controls, FATmax-intensity exercise improved (i) body composition, including reduced body weight (WMD = -4.43 kg, 95% CI: -5.11, -3.75), fat mass (WMD = -3.68 kg, 95% CI: -4.31, -3.06), waist circumference (WMD = -4.36 cm, 95% CI: -6.73, -1.99), and waist-to-hip ratio (WMD=-0.04, 95% CI: -0.05, -0.03); (ii) cardiorespiratory fitness, evidenced by increased [Formula: see text] (WMD = 3.89 mL/(kg·min), 95% CI: 3.04, 4.74), reduced SBP (WMD = -1.73 mmHg, 95% CI: -6.60, 3.15) and DBP (WMD = -2.10 mmHg, 95% CI: -3.70, -0.49); (iii) metabolism outcomes, such as reduced TG (SMD = -0.80, 95% CI: -1.24, -0.36), TC (SMD = -0.37, 95% CI: -0.72, -0.02), LDL-C (SMD = -0.44, 95% CI:-0.78, -0.10), increased (HDL-C) (SMD = 0.97, 95% CI: 0.64, 1.30) and improved HOMA-IR (SMD = -0.81, 95% CI: -1.44, -0.18). Subgroup analyses suggested that age, sex, and intervention characteristics (eg, duration and frequency) moderated these outcomes to varying degrees.</p><p><strong>Conclusions: </strong>FATmax-intensity exercise confers beneficial effects on body composition, glucose and lipid metabolism, and cardiorespiratory fitness in populations with overweight and obesity. Despite outcome-specific variations and methodological heterogeneity warranting cautious interpretation, FATmax training represents a promising, individualized strategy for cardiometabolic health management.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"619590"},"PeriodicalIF":3.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrinologists' Perspectives on Early Screening for Diabetic Peripheral Neuropathy: A Phenomenological Study in Four Chinese Based Hospitals.","authors":"Haili Zhu, Wanting Xie, Xueqin Zeng, Qing Yuan, Dong Zhu, Ouying Chen, Yan Chen","doi":"10.2147/DMSO.S614369","DOIUrl":"10.2147/DMSO.S614369","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to explore endocrinologists' awareness and current practices regarding early screening for diabetic peripheral neuropathy (DPN), and to further analyze their experiences, barriers, and potential optimization strategies in implementing DPN screening within clinical practice.</p><p><strong>Patients and methods: </strong>Methods: A qualitative study based on Husserl's phenomenological framework was conducted. Twelve endocrinologists (3 male, 9 female; age range 29-47 years; clinical experience 3-23 years) from four tertiary hospitals in China were recruited via purposive sampling. Semi-structured in-depth interviews were used. This phenomenological approach was chosen to explore the lived experiences and subjective perceptions of physicians regarding DPN screening, as quantitative methods cannot capture such contextual richness. Data were analyzed using NVivo 20.0 with Colaizzi's seven-step method.</p><p><strong>Results: </strong>Five major themes and 11 sub-themes were identified: The most predominant finding was that, despite endocrinologists' recognition of the necessity and urgency of early DPN screening, its implementation is critically limited by three interrelated barriers: insufficient physician training and heavy workloads, limitations of screening tools (eg subjectivity of physical exams and high cost of electromyography), and poor patient compliance due to lack of awareness and financial constraints.Other themes included current screening practices and optimization strategies.</p><p><strong>Conclusion: </strong>This study indicates that despite the critical role of early DPN screening in diabetes management, its implementation remains constrained by limited healthcare resources, limitations of screening tools, and patient-related barriers, such as awareness and affordability. Therefore, it is recommended to enhance physician training, standardize screening protocols, and improve patient adherence through policy support and health education to promote the widespread adoption of DPN screening.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"614369"},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Specific Associations Between the Testosterone-to-Estradiol Ratio and Metabolic Syndrome Components in Middle-Aged and Elderly Chinese Men.","authors":"Gang Ma, Xiaodong Chen, Yanmei Miao, Xuexia Ji, Zhicheng Qiao","doi":"10.2147/DMSO.S550807","DOIUrl":"10.2147/DMSO.S550807","url":null,"abstract":"<p><strong>Background: </strong>Metabolic syndrome (MetS) is common in aging men, but the age-specific relationship between the testosterone-to-estradiol (T/E2) ratio and metabolic abnormalities remains insufficiently characterized. This study evaluated age-stratified associations between the T/E2 ratio and MetS-related parameters in middle-aged and elderly Chinese men.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included 120 Chinese men aged 46-75 years. Participants were divided into three age groups: 46-55, 56-65, and 66-75 years. Serum testosterone, estradiol, sex hormone-binding globulin (SHBG), anthropometric indices, blood pressure, fasting blood glucose, and lipid profiles were assessed. MetS components were defined according to IDF-based criteria, and TyG index and TyG-BMI were calculated. Age-stratified Pearson correlation analyses were performed, with Spearman correlation and FDR adjustment used for sensitivity analyses.</p><p><strong>Results: </strong>The T/E2 ratio decreased significantly across age groups, while SHBG increased and T/SHBG decreased with age. In the 46-55-year group, the T/E2 ratio was inversely correlated with fasting blood glucose, waist circumference, TyG-BMI, and total MetS points score. In the 66-75-year group, the main inverse association was observed between the T/E2 ratio and triglycerides. No consistent significant associations were observed in the 56-65-year group. Sensitivity analyses showed generally consistent directions for the main associations.</p><p><strong>Conclusions: </strong>The T/E2 ratio shows age-related decline and age-specific associations with selected MetS-related parameters in middle-aged and elderly Chinese men. These findings suggest that the T/E2 ratio may reflect age-related metabolic heterogeneity, but prospective studies are needed to clarify its longitudinal and clinical relevance.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"550807"},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of a Health Belief Model-Based Digital Health Intervention with Glycolipid Metabolism and Health Behaviors in Older Adults with Type 2 Diabetes: A Quasi-Experimental Before-After Study.","authors":"Mengqi Wang, Jiaqi Wang, Jinqiu Liu, Daiqing Li","doi":"10.2147/DMSO.S634248","DOIUrl":"10.2147/DMSO.S634248","url":null,"abstract":"<p><strong>Purpose: </strong>Integrated management of blood glucose and lipids reduces complications in type 2 diabetes mellitus (T2DM). However, few community-based programs combine mobile health (mHealth) technology, Health Belief Model (HBM)-based education, behavioral strategies, and family support within one framework, and evidence in Chinese community settings is limited. We examined whether a 12-month HBM-based intervention was associated with changes in glycolipid metabolism and health behaviors among community-dwelling older adults with T2DM in Tianjin, China.</p><p><strong>Patients and methods: </strong>This quasi-experimental, single-arm, uncontrolled before-after (pre-post) study included 114 T2DM patients (mean age 72.25 ± 5.63 years) managed at a community health service center; no parallel control group was enrolled. Paired samples <i>t</i>-tests and McNemar tests assessed changes in metabolic parameters and categorical health behaviors, respectively.</p><p><strong>Results: </strong>All glucose and lipid parameters improved (all P < 0.0001). The primary outcomes changed as follows: HbA1c -0.63% points (95% CI -0.80 to -0.46), 2-hour postprandial glucose -5.16 mmol/L (95% CI -5.54 to -4.78), and triglycerides -2.61 mmol/L (95% CI -2.82 to -2.40). Fasting plasma glucose, total cholesterol, and LDL-cholesterol also decreased (Tables 3 and 4). Medication adherence rose from 73.68% to 86.84% (P = 0.013), disease knowledge from 50.88% to 76.32%, and regular exercise from 28.95% to 61.40% (both P < 0.0001); smoking and alcohol use were unchanged.</p><p><strong>Conclusion: </strong>The HBM-based digital health intervention was associated with improved glycolipid metabolism and health behaviors in this cohort. Because the single-arm design lacked a control group and concurrent changes in glucose- and lipid-lowering medications were not recorded, all metabolic improvements - and the large triglyceride reduction in particular - may partly reflect pharmacological intensification; randomized controlled trials are needed to confirm these findings.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"634248"},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explainable Artificial Intelligence for Early Diabetic Kidney Disease Risk Profiling in Type 2 Diabetes: Translational Readiness and Clinical Boundaries.","authors":"Tianqiang Wu, Wenpin Cai, Zihan Guan, Zhixiang Li","doi":"10.2147/DMSO.S624805","DOIUrl":"10.2147/DMSO.S624805","url":null,"abstract":"<p><strong>Purpose: </strong>Early kidney-risk profiling in type 2 diabetes is difficult because albuminuria, estimated glomerular filtration rate, comorbidity, and care access capture different aspects of diabetic kidney disease. This review examines where explainable artificial intelligence may support clinically defensible kidney-risk profiling.</p><p><strong>Methods: </strong>This narrative review used structured searches of PubMed, Semantic Scholar, and OpenAlex using kidney, diabetes, and artificial intelligence/explainability terms, supplemented by citation chasing and full-text assessment of key records. Broad query returns were documented for PubMed (600) and Semantic Scholar (956). Records were screened for topic fit and prioritized for clinical relevance to kidney-risk tasks, endpoint validity, explainability, validation, calibration, missing-data handling, fairness, and workflow relevance; 18 clinically relevant evidence records were retained for detailed synthesis in Supplementary Table 1.</p><p><strong>Results: </strong>Evidence was organized by clinical task: occult or early diabetic kidney disease detection, incident kidney disease prediction, progression and referral forecasting, retinal and multimodal profiling, and equity-aware risk assessment. Current studies show promising discrimination and increasing use of explanation methods, calibration, decision-curve analysis, web tools, and external or temporal validation. Persistent limits include heterogeneous endpoints, diagnostic circularity, uneven external validation, sparse workflow evidence, and limited fairness or uncertainty reporting.</p><p><strong>Conclusion: </strong>Explainable artificial intelligence is best viewed as a risk-stratification, communication, and audit layer within guideline-based care, not as a standalone diagnostic or treatment-decision system.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"624805"},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluate the Risk Factors of Mild Cognitive Impairment (MCI) in Patients with Type 2 Diabetes Mellitus (T2DM): A Cross-Sectional Study.","authors":"Yanning Cao, Cong Lei, Jianhui Liu, Nan Wu, Qiaoqiao Zhang, Xiaohang Zuo, Wenli Lei, Na Wang, Lamei Xu, Peijun Mao, Jie Li, Jianfang Fu","doi":"10.2147/DMSO.S604088","DOIUrl":"10.2147/DMSO.S604088","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To explore the potential incremental value of metabolic-inflammatory and insulin-resistance indices for diagnosing mild cognitive impairment (MCI) in type 2 diabetes (T2DM), and to furnish new candidate tools and insights for the risk stratification and early recognition of diabetes-related cognitive dysfunction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional, observational study was jointly conducted by two tertiary endocrine centers in northwestern China. A uniform assessment of cognitive status was performed using the Chinese versions of the Montreal Cognitive Assessment (MoCA). MCI was defined as MoCA &lt; 26. Baseline clinical characteristics, metabolic-inflammatory parameters and insulin-resistance indices were systematically compared between groups. Candidate predictors were first compressed via Lasso regression; key retained variables were then used to develop a binary logistic prediction model. The model's discrimination was assessed via ROC curves, and its calibration was evaluated by the Hosmer‑Lemeshow test combined with calibration plots. Decision-curve analysis (DCA) and clinical impact curves (CIC) were further employed to quantify net benefit and reclassification across a range of risk thresholds, providing a comprehensive appraisal of the model's clinical utility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 293 patients with type 2 diabetes mellitus, of whom 187 (63.8%) had mild cognitive impairment (MoCA&lt;26). Compared with the 106 cognitively normal controls, the T2DM-MCI group were older, had fewer years of education and a lower proportion of higher education (all p&lt;0.05). The prevalence of diabetic nephropathy (32.6% vs 18.9%, p = 0.006) and previous cerebral infarction (29.9% vs 10.4%, p &lt; 0.001) was significantly higher, while diabetic peripheral neuropathy and carotid atherosclerosis showed borderline differences (p ≈ 0.06). Concurrently, inflammatory-metabolic burden increased across the board-NMLR, PHR, BRI, ABSI, WWI and LAP were all elevated (p ≤ 0.048)-and adiposity index RFM together with insulin-resistance markers TyG-WtHR and HOMA-IR also rose (p ≤ 0.017). Notably, Lasso regression identified WWI, RFM, and TyG-WtHR as candidate markers. However, none of these variables achieved statistical significance in the subsequent multivariable Logistic regression (all p&gt;0.05). This finding suggests that novel anthropometric and metabolic indices may be linked to cognitive decline primarily through indirect pathways associated with traditional risk factors, offering new mechanistic insights into the obesity-metabolism-cognition axis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Univariate analysis revealed that WWI, RFM, and TyG-WtHR were significantly correlated with cognitive decline (&lt;i&gt;r&lt;/i&gt;=0.232, 0.194, and 0.154, respectively; all p&lt;0.01). Incorporation of these three readily obtainable anthropometric and laboratory parameters into the baseline clinical model increased the area under the ","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"604088"},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitochondrial Dysfunction in Type 2 Diabetes and Metabolic Syndrome: Mechanisms, Biomarkers, and Emerging Therapies.","authors":"Hamzah M Alghzawi, Salma Younas, Sweta Sahu, Soha Farooq, Muhammad Nafees, Saleh Mohammed","doi":"10.2147/DMSO.S627029","DOIUrl":"10.2147/DMSO.S627029","url":null,"abstract":"<p><strong>Background: </strong>Mitochondrial dysfunction is increasingly recognized as a bidirectional component of type 2 diabetes (T2D) and metabolic syndrome, linking nutrient excess, lipotoxicity, oxidative stress, inflammation, impaired insulin signaling, and pancreatic β-cell failure. However, its causal position and clinical actionability remain uncertain because mitochondrial abnormalities vary by tissue, disease stage, and metabolic phenotype.</p><p><strong>Objective: </strong>To critically synthesize mechanistic, biomarker, imaging, and therapeutic evidence concerning mitochondrial dysfunction in T2D and metabolic syndrome, with emphasis on evidence maturity and clinical translation.</p><p><strong>Methods: </strong>We conducted a structured narrative review of preclinical, translational, and clinical literature published primarily from 2015 through 2025. The search intentionally included established glucose-lowering therapies and selected mitochondria-directed agents and was not intended to be exhaustive. Because this was not a systematic review, no PRISMA flow diagram, formal risk-of-bias assessment, or standardized evidence grading was performed.</p><p><strong>Results: </strong>Mitochondrial abnormalities in T2D include impaired oxidative phosphorylation, excessive reactive oxygen species, altered fission-fusion and mitophagy, disrupted calcium handling, metabolic inflexibility, and β-cell bioenergetic failure. The evidence supports a bidirectional model in which inherited susceptibility, aging, nutrient overload, visceral adiposity, lipotoxicity, and inflammation can impair mitochondria, while mitochondrial stress further amplifies insulin resistance and organ dysfunction. Candidate biomarkers and imaging methods remain predominantly research tools because specificity, assay standardization, validated thresholds, and prospective clinical utility are limited. Exercise, weight reduction, GLP-1 receptor agonists, and SGLT2 inhibitors have established clinical benefits and may improve mitochondrial biology indirectly or directly; in contrast, NAD⁺ precursors, targeted antioxidants, mitophagy enhancers, and other dedicated mitochondrial modulators remain investigational, with target engagement generally exceeding demonstrated glycemic benefit.</p><p><strong>Conclusion: </strong>Mitochondrial dysfunction is best understood as a context-dependent driver, consequence, and amplifier of metabolic disease rather than a universal single cause. Translation will require standardized biomarker panels, noninvasive phenotyping, adequately powered randomized trials with longer follow-up, and prospective identification of patients whose mitochondrial phenotype is likely to be treatment-responsive.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"627029"},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twenty-Four-Week UACR Response Trajectories and Clinical Correlates of Residual Albuminuria in Diabetic Kidney Disease During Finerenone Therapy: A Real-World Longitudinal Study.","authors":"Yang Zhang, Qin Zhu, Chaochao Wang, Xiaoqiao Cai, Shengfen Lin, Beibei Ding, Xingyu Zhu, Yongqiang Lin","doi":"10.2147/DMSO.S638418","DOIUrl":"10.2147/DMSO.S638418","url":null,"abstract":"<p><strong>Background: </strong>After finerenone therapy, some patients with diabetic kidney disease (DKD) continue to have residual albuminuria. A single time-point change in urinary albumin-to-creatinine ratio (UACR) may not fully capture response heterogeneity in real-world practice. This study aimed to identify 24-week baseline-corrected UACR response trajectories in patients with DKD and residual albuminuria during finerenone therapy and to examine associated clinical factors.</p><p><strong>Methods: </strong>This single-center retrospective real-world longitudinal cohort study included 136 patients with DKD who had residual albuminuria after at least 4 weeks of finerenone therapy and available longitudinal UACR data. Based on multi-time-point log(UACR_t/UACR_baseline) data over 24 weeks, latent class mixed models were used to identify UACR response trajectories and analyze clinical factors associated with the persistent residual albuminuria trajectory.</p><p><strong>Results: </strong>Three UACR response trajectories were identified: favorable response in 43 patients (31.6%), partial response in 62 patients (45.6%), and persistent residual albuminuria in 31 patients (22.8%); the latter 2 patterns accounted for 68.4% of the selected residual-albuminuria cohort. The median relative changes in UACR at week 24 were -51.6%, -24.8%, and -4.9%, respectively. Higher HbA1c was associated with higher estimated odds of the persistent residual albuminuria trajectory (OR, 1.46; 95% CI, 1.07-2.00). The estimated directions for systolic blood pressure and sodium-glucose cotransporter 2 (SGLT2) inhibitor use were consistent, although uncertainty remained in extended or selected sensitivity analyses. Week-24 eGFR changes did not differ clearly across trajectories, and continuous UACR change was not clearly associated with eGFR change.</p><p><strong>Conclusion: </strong>Patients with DKD and residual albuminuria during finerenone therapy showed distinct 24-week UACR response trajectories. Trajectory analysis provides exploratory real-world evidence for dynamic risk stratification, but the identified patterns and clinical correlates require validation in larger, prospective, multicenter cohorts with longer follow-up.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"638418"},"PeriodicalIF":3.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13594514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unsupervised Machine Learning of Intrapancreatic Fat Deposition Reveals Distinct Clinical Phenotypes: A CT Study.","authors":"Wenlu Zong, Yuning Chu, Yingjie Guo, Pin Meng, Chen Hao, Xiaoyan Yin, Zibin Tian, Xiaoyu Li","doi":"10.2147/DMSO.S638230","DOIUrl":"10.2147/DMSO.S638230","url":null,"abstract":"<p><strong>Introduction: </strong>Intrapancreatic fat deposition (IPFD) is an ectopic fat phenotype associated with metabolic abnormalities. However, the clinical heterogeneity of IPFD in relation to generalized adiposity remains insufficiently characterized. This study aimed to explore clinical profiles associated with IPFD using unsupervised clustering and characterize their metabolic features.</p><p><strong>Methods: </strong>In this retrospective, single-center cross-sectional study, 558 adults undergoing non-contrast abdominal computed tomography were included. K-means clustering was performed using age, body mass index (BMI), pancreas-to-spleen attenuation difference, fasting plasma glucose (FPG), and triglyceride (TG) levels. Clinical characteristics, metabolic comorbidities, and circulating biomarkers were compared across the derived exploratory clusters.</p><p><strong>Results: </strong>Three exploratory clinical phenotypes were identified: an obesity-dominant cluster (n=140), an FPD-like cluster characterized by greater IPFD (n=182), and a reference cluster (n=236). The FPD-like cluster showed the lowest pancreas-to-spleen attenuation difference, older age, and lower BMI than the obesity-dominant cluster. In contrast, the obesity-dominant cluster showed stronger associations with metabolic dysfunction-associated steatotic liver disease and higher uric acid levels. Free fatty acid concentrations were highest in the FPD-like cluster. Differences in glycemic and lipid-related characteristics should be interpreted cautiously because FPG and TG were included as clustering variables.</p><p><strong>Conclusion: </strong>In this exploratory cross-sectional analysis, a cluster characterized by greater IPFD, older age, and lower BMI than the obesity-dominant cluster was associated with less favorable metabolic characteristics. These findings suggest that IPFD may provide complementary information beyond BMI-based assessment; however, the identified clusters should be considered exploratory clinical profiles rather than validated biological subtypes. External validation in independent populations and longitudinal studies are required to confirm their reproducibility and clinical relevance.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"638230"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Specific Predictive Value of Obesity-Related Indicators for Diabetic Kidney Disease in Type 2 Diabetes Mellitus.","authors":"Jing Mao, Shijun Gong, Jing Jin, Yajuan Tan, Ling Zeng, Quan Zhou, Fang Yu, Haifeng Zhou, Huilin Lu, Shenglian Gan","doi":"10.2147/DMSO.S573854","DOIUrl":"10.2147/DMSO.S573854","url":null,"abstract":"<p><strong>Purpose: </strong>Obesity is a significant risk factor for diabetic kidney disease (DKD). However, the relationship between obesity-related indicators and DKD is controversial. The aim of this study was to investigate the gender-specific differences in predictive performance of eight obesity-related indicators concerning DKD risk among type 2 diabetes mellitus (T2DM) patients.</p><p><strong>Methods: </strong>This cross-sectional study analyzed data from 1586 T2DM patients aged 18-80 years. The exposure variables included body mass index (BMI), triglyceride-glucose index (TyG), Chinese visceral adiposity index (CVAI), visceral adiposity index (VAI), and TyG-related composite indicators, which are TyG-waist circumference (TyG-WC), TyG-body mass index (TyG-BMI), TyG-waist-hip ratio (TyG-WHpR), and TyG-waist-height ratio (TyG-WHtR). Point-biserial correlation analysis, multivariate logistic regression, receiver operating characteristic (ROC) curve, subgroup analyses, and interaction tests were used to explore the correlation between these indicators and DKD.</p><p><strong>Results: </strong>The prevalence of DKD in the studied T2DM patients was 37.3%. All eight obesity-related indicators were independently and positively associated with DKD. TyG-BMI had the largest AUC (0.6195) for predicting DKD in males, with a cut-off value of 53.3250. TyG-WHtR had the highest AUC (0.6213) for DKD in females, with a cut-off value of 1.0234. TyG-WHtR was more strongly associated with DKD in T2DM patients with systolic blood pressure (SBP) ≥ 140 mmHg, according to subgroup analysis (P for interaction = 0.0265).</p><p><strong>Conclusion: </strong>The optimal predictors of DKD in T2DM patients were gender-specific: TyG-BMI in males and TyG-WHtR in females. TyG-WHtR should be closely monitored in female T2DM patients (especially those with SBP ≥ 140 mmHg) to enable early identification and intervention for DKD risk. These gender-specific indices may provide preliminary evidence for early DKD risk stratification.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"573854"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}