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

{"title":"Reply to Comment on \"Prevalence and Correlates of Sleep Problems in Children and Adolescents with Type 1 Diabetes: A Cross-Sectional Study\" [Response to Letter].","authors":"Youssef A Alqahtani, Ayed A Shati, Syed Esam Mahmood","doi":"10.2147/DMSO.S635937","DOIUrl":"10.2147/DMSO.S635937","url":null,"abstract":"","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"635937"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007951","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":"Metabolic Predictors and Diagnostic Performance of Fundus Autofluorescence for Diabetic Macular Edema: A Cross-Sectional Diagnostic Accuracy Study Using Swept-Source Optical Coherence Tomography as Reference Standard.","authors":"Ramzi Amin, Adrian Pratama, Abdul Karim Ansyori, Mohammad Aulia Molid Ogest Putra Calisanie","doi":"10.2147/DMSO.S626077","DOIUrl":"10.2147/DMSO.S626077","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the diagnostic performance of fundus autofluorescence (FAF) imaging for detecting diabetic macular edema (DME) using swept-source optical coherence tomography (SS-OCT) as the reference standard, and to identify metabolic factors associated with FAF detection accuracy in patients with type 2 diabetes mellitus.</p><p><strong>Patients and methods: </strong>This cross-sectional diagnostic accuracy study enrolled 120 eyes from 68 patients with type 2 diabetes mellitus at the Vitreoretina Subdivision, Department of Ophthalmology, RSUP Dr. Mohammad Hoesin, Palembang, Indonesia, between January 2024 and June 2025. All participants underwent comprehensive ophthalmic examination including FAF imaging and en face SS-OCT (DRI OCT Triton Plus, Topcon). Metabolic parameters including glycated hemoglobin (HbA1c), fasting lipid profile, body mass index (BMI), estimated glomerular filtration rate (eGFR), and diabetes duration were recorded. Diagnostic accuracy indices were calculated using 2×2 contingency tables. Multivariate logistic regression identified metabolic predictors of FAF detection concordance with SS-OCT.</p><p><strong>Results: </strong>DME was present in 78 eyes (65.0%) by SS-OCT. FAF demonstrated sensitivity of 73.1% (95% CI: 61.8-82.5%), specificity of 76.2% (95% CI: 61.5-87.2%), positive predictive value of 85.1%, negative predictive value of 60.4%, positive likelihood ratio of 3.07, negative likelihood ratio of 0.35, and diagnostic odds ratio of 8.68. HbA1c ≥8.5% (OR 3.42, 95% CI: 1.28-9.14, p=0.014), diabetes duration ≥10 years (OR 2.87, 95% CI: 1.15-7.16, p=0.024), and BMI ≥30 kg/m² (OR 2.31, 95% CI: 0.94-5.68, p=0.068) were independently associated with FAF-OCT concordance. Center-involved DME showed higher FAF sensitivity (82.4%) compared to non-center-involved DME (55.6%, p=0.012).</p><p><strong>Conclusion: </strong>FAF imaging demonstrates moderate diagnostic accuracy for DME detection, with performance significantly influenced by metabolic status and DME subtype. Integration of metabolic risk stratification may optimize FAF-based screening in diabetic populations.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"626077"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007893","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":"Efficacy and Safety of CagriSema for Metabolic Outcomes: Systematic Review and Pairwise Meta-Analysis of Randomized Controlled Trials.","authors":"Chuhan Shao, Hanmo Lin, Jie Yu, Haiyan Chen, Yaolin Ren, Jing Ren, Yuan Zeng, Yifan Wu, Haoyu Bai, Qian Zhang, Xinhua Xiao","doi":"10.2147/DMSO.S616418","DOIUrl":"10.2147/DMSO.S616418","url":null,"abstract":"<p><strong>Background: </strong>Overweight status, obesity, and diabetes represent significant socioeconomic burdens that require long-term management.</p><p><strong>Methods: </strong>To evaluate the efficacy and safety of dual-agonist CagriSema vs semaglutide monotherapy, cagrilintide monotherapy, and placebo in adults with overweight/obese status and type 2 diabetes, we searched Embase, MEDLINE, PubMed, and the Cochrane Library up to 14 June 2026 for randomized controlled trials (RCTs). Separate pairwise meta-analyses were conducted using random effects models.</p><p><strong>Results: </strong>Eight RCTs comprising 6898 participants were included. CagriSema was associated with significantly greater percentage body weight reduction compared to semaglutide [MD -6.60%; 95%CI: -8.51 to -4.68; P<0.0001; I² =82%], cagrilintide [MD -8.15%; 95%CI: -11.40 to -4.89; P<0.0001; I² =95%], and placebo [MD -14.30%; 95%CI: -17.41 to -11.19; P<0.0001; I² =99%]. A greater decrease in the percentage of glycated hemoglobin was also observed for CagriSema than for semaglutide [MD -0.09%; 95%CI: -0.14 to -0.04; P=0.0004; I² =39%], cagrilintide [MD -0.87%; 95% CI -1.48 to -0.26; p = 0.005; I² = 97%], and placebo [MD -1.55%; 95% CI -2.14 to -0.97; p < 0.0001; I² = 99%]. Furthermore, CagriSema achieved significantly greater reductions in absolute body weight, waist circumference and body mass index across all comparators (all p < 0.0001). CagriSema demonstrated better blood pressure control compared with cagrilintide and placebo, with effects comparable to those of semaglutide. Moreover, CagriSema significantly decreased C-reactive protein and improved lipid profiles compared with cagrilintide and placebo. CagriSema increased any adverse events and gastrointestinal adverse events compared with all comparators. Substantial statistical heterogeneity was observed in several continuous outcomes, driven by diverse baseline clinical characteristics and background therapies.</p><p><strong>Conclusion: </strong>Compared with current standard monotherapies and placebos, CagriSema demonstrates superior weight loss, glucose, and lipid control. Key limitations include the relatively small number of eligible trials and the current lack of long-term cardiovascular endpoints.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"616418"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007911","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":"Predictors of Hepatic Steatosis and the Limitations of the FIB-4 Index in Type 2 Diabetes: A Cross-Sectional Study.","authors":"Nesreen A Saadeh, Khaled A Obeidat, Nadeem W Bani Hani, Deaa Darawsheh, Muayad A Alrawashdeh, Abdelrahman K Ahmad, Rawan M Alnatour, Batool Tariq Mayyas, Shaima Ahmad Almomani, Nasr Alrabadi","doi":"10.2147/DMSO.S617292","DOIUrl":"https://doi.org/10.2147/DMSO.S617292","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM). Non-invasive tools (NITs) such as the FIB-4 index, are widely used for risk stratification to identify patients at higher risk of progressive liver disease. This study aimed to assess the utility of the FIB-4 index and identify stronger predictors of MASLD in a T2DM cohort.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted on 186 patients with T2DM. Hepatic steatosis was diagnosed via abdominal ultrasonography, categorizing patients into MASLD (n=100) and non-MASLD (n=86) groups. The FIB-4 index was calculated, and group comparisons were performed. A novel simplified clinical scoring system was constructed to identify independent predictors of ultrasound-confirmed steatosis.</p><p><strong>Results: </strong>Patients with MASLD exhibited significantly higher body mass index (BMI) (P < 0.001), alanine aminotransferase (ALT) (P = 0.005), Aspartate aminotransferase (AST) (P =0.05) and triglycerides (P = 0.034) compared to the non-MASLD group. The multivariate logistic regression analysis established the weight of each clinical marker. The FIB-4 index failed to significantly differentiate between the two groups (P = 0.272).</p><p><strong>Conclusion: </strong>The FIB-4 index demonstrated limited diagnostic utility for MASLD in this T2DM population. Conversely, a newly derived score, incorporating readily available parameters like BMI, ALT, AST, and triglycerides, offers a highly specific, practical alternative for non-invasive MASLD screening in resource-limited primary care settings.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"617292"},"PeriodicalIF":3.5,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988649","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":"Lipid-Associated Macrophages in Obesity: Immunometabolic Programs and Emerging Therapeutic Implications-A Narrative Review.","authors":"Wen Zhang, Bo Zhu, Jianan Xu, Xian Jin, Junfeng Cui","doi":"10.2147/DMSO.S631555","DOIUrl":"10.2147/DMSO.S631555","url":null,"abstract":"<p><p>Obesity-associated adipose tissue inflammation is accompanied by the expansion of macrophage populations enriched in lipid-handling, lysosomal, and phagocytic programs, commonly referred to as lipid-associated macrophages (LAMs). Single-cell and spatial studies support their accumulation in crown-like structures and other lipid-rich adipose tissue niches, with partially conserved LAM-like populations also identified in humans. However, direct functional evidence, particularly in human adipose tissue, remains limited. Experimental studies suggest that LAMs may participate in lipid sequestration, efferocytosis, lysosomal processing, and inflammatory regulation, although their net effects appear to vary according to species, adipose depot, metabolic stage, and experimental model. The proposed transition from an adaptive lipid-buffering state to a chronically inflammatory state should therefore be regarded as a context-dependent working model rather than an established temporal sequence. This narrative review critically examines how LAMs are defined, distinguishes direct adipose LAM evidence from findings extrapolated from broader macrophage systems, and integrates lipid metabolism, bioenergetic remodeling, inflammatory signaling, and therapeutic evidence within an explicit evidence hierarchy. Current interventions act mainly through broader macrophage, adipose tissue, or systemic metabolic pathways, and no selective LAM-targeted therapy is currently available. Further translation will require robust human LAM definitions, longitudinal functional studies, reliable biomarkers, and strategies that modify detrimental LAM-associated functions without disrupting beneficial macrophage activities.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"631555"},"PeriodicalIF":3.5,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988555","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":"New Insights into the Role of Mitochondrial Dysfunction in Diabetic Kidney Disease in the Omics Era.","authors":"Xiao Ke Liu, Xiao Lan Zhou, Wen Rui Xia","doi":"10.2147/DMSO.S622389","DOIUrl":"https://doi.org/10.2147/DMSO.S622389","url":null,"abstract":"<p><p>Diabetic kidney disease (DKD) is a major microvascular complication of diabetes and the leading cause of end-stage renal disease worldwide. Accumulating evidence identifies mitochondrial dysfunction as a central driver of DKD progression by linking metabolic reprogramming, oxidative stress, and inflammatory responses. Recent advances in spatial omics, genomics, transcriptomics, proteomics, metabolomics, and microbiome analyses have enabled the characterization of cell-specific and dynamic alterations in mitochondrial function and their interactions with the renal microenvironment. Integrative analyses across these molecular layers have revealed key mechanisms involving mitochondrial quality control, metabolic reprogramming, and inflammatory signaling, while identifying potential biomarkers and therapeutic targets. Furthermore, these approaches have provided mechanistic insights into the renoprotective effects of conventional therapies and bioactive compounds from traditional Chinese medicine. This integrative review synthesizes current evidence to clarify the role of mitochondrial dysfunction in DKD pathogenesis and discusses emerging opportunities for biomarker discovery and precision therapeutics.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"622389"},"PeriodicalIF":3.5,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988637","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":"eGFR- and Potassium-Guided Stewardship of SGLT2 Inhibitors and Finerenone in Albuminuric Chronic Kidney Disease Associated with Type 2 Diabetes.","authors":"Chen Su, Xumin Li, Shuang Wang, Dan Liu","doi":"10.2147/DMSO.S621958","DOIUrl":"10.2147/DMSO.S621958","url":null,"abstract":"<p><p>Albuminuric chronic kidney disease (CKD) associated with type 2 diabetes remains a high-risk condition despite long-standing renin-angiotensin system (RAS) inhibition. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and finerenone provide complementary kidney and cardiovascular protection through distinct hemodynamic, tubular, inflammatory, and fibrotic mechanisms. The Phase 2, randomized, double-blind Combination Effect of Finerenone and Empagliflozin in Participants with Chronic Kidney Disease and Type 2 Diabetes Using a Urinary Albumin-to-Creatinine Ratio Endpoint (CONFIDENCE) trial subsequently showed that simultaneous finerenone-empagliflozin initiation produced greater short-term albuminuria reduction than either monotherapy, but this biomarker benefit does not establish hard-outcome superiority or define the optimal sequencing strategy. This narrative review proposes a stewardship framework guided by estimated glomerular filtration rate (eGFR) and potassium for adults with albuminuric type 2 diabetes-associated CKD in whom SGLT2 inhibitors and finerenone are being implemented on a RAS-inhibition background. The review emphasizes that kidney protection depends not only on prescribing effective therapies, but also on maintaining exposure through initiation, monitoring, temporary interruption, de-escalation, and re-initiation. A modest early eGFR decline after SGLT2 inhibitor initiation usually reflects a functional hemodynamic response and should not be treated in isolation as drug-related kidney injury. By contrast, finerenone-associated hyperkalemia requires baseline risk stratification, early potassium surveillance, correction of reversible triggers, and structured re-challenge when feasible. Simultaneous initiation may be appropriate in patients with persistent albuminuria, stable eGFR, normal or low-normal potassium, and reliable monitoring access, whereas sequential initiation is often more suitable when potassium risk, hemodynamic instability, or follow-up uncertainty is present. Future studies should move beyond short-term urine albumin-to-creatinine ratio (UACR) lowering to evaluate clinical kidney and cardiovascular outcomes, treatment persistence, potassium-event trajectories, re-initiation after temporary interruption, and implementation fidelity in routine care.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"621958"},"PeriodicalIF":3.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966931","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":"Effects of Acetylcholine on Endothelial Function and Nitric Oxide Levels in Patients with Type 2 Diabetes Mellitus: A Randomized Sham-Controlled Study.","authors":"Ibrahim Ismail Abuzaid, Hassan M Abdelnour, Abdulmajeed R Almalty, Nermeen K Bleedy, Sobhy Mahmoud Aly, Mahmoud Sabry Asal, Abdelrazak A Ahmed, Reham Abdelrazek","doi":"10.2147/DMSO.S575700","DOIUrl":"10.2147/DMSO.S575700","url":null,"abstract":"<p><strong>Background: </strong>Peripheral neuropathy is a prevalent neurological disorder with multiple etiologies. Nerve damage frequently occurs due to prolonged high blood sugar levels and diabetes. Peripheral nerve fiber impairment, mediated mainly through dysregulation of Nitric Oxide Synthase (NOS) activity, induces irreversible structural damage. Acetylcholine induces vasodilation by stimulating endothelial nitric oxide (NO) production, which relaxes smooth muscle, and by triggering a nerve axon reflex. This reflex releases neuropeptides like substance P, which further dilate vessels and prompt histamine release. This study aims to evaluate the effects of Acetylcholine (Ach) iontophoresis as a vasodilator on endothelial NOS activity to develop a non-invasive transdermal treatment that is effective and devoid of systemic adverse side effects.</p><p><strong>Methods: </strong>Eighty patients, both male and female, diagnosed with type 2 Diabetes Mellitus were randomly assigned to two groups. The experimental group (A) underwent iontophoresis using acetylcholine for 15 min three times a week for four weeks. The control group (B) underwent 15-minute sessions of sham iontophoresis three times a week for four weeks. Nitric oxide levels and nerve conduction studies of peripheral nerves were assessed pre and post-treatment for both groups.</p><p><strong>Results: </strong>The study demonstrated a statistically significant improvement in endothelium-dependent vasodilation and Nitric Oxide (NO) levels in Group A compared to Group B. However, no significant differences were observed between the groups in terms of electrophysiological outcomes for peripheral nerves and muscles, both pre- and post-treatment.</p><p><strong>Conclusion: </strong>Repeated acetylcholine iontophoresis significantly improved microvascular function, increasing nitric oxide release and tissue perfusion in patients with diabetic neuropathy. While no immediate changes in peripheral nerve conduction were observed, the intervention shows promise as an adjunctive strategy for supporting microvascular health in diabetic neuropathic complications.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"575700"},"PeriodicalIF":3.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966999","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":"Body Mass Index Outperforms Triglyceride-Glucose Index in Predicting MAFLD in Type 2 Diabetes: A Cross-Sectional Mediation and Interaction Analysis.","authors":"Zhenzhen Sun, Li Yang, Nan Wang, Jie Wang, Xiaozhen Zhu, Xiqiao Zhou","doi":"10.2147/DMSO.S612508","DOIUrl":"10.2147/DMSO.S612508","url":null,"abstract":"<p><strong>Background: </strong>The interplay between body mass index (BMI) and triglyceride-glucose (TyG) has yet to be systematically investigated on metabolic dysfunction-associated fatty liver disease (MAFLD) in type 2 diabetes mellitus (T2DM). This knowledge gap regarding the specific nature of their combined effects limits our ability to develop precise risk stratification algorithms and targeted intervention strategies.</p><p><strong>Purpose: </strong>This study aimed to investigate the independent and synergistic roles of BMI and TyG in MAFLD development among T2DM patients.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 816 T2DM patients recruited from the Affiliated Hospital of Nanjing University of Chinese Medicine. MAFLD was diagnosed via Fibroscan. Dose-response relationships were assessed using restricted cubic splines (RCS). Multiplicative and additive interactions were evaluated using logistic regression models. Causal mediation analysis quantified the proportion of the BMI-MAFLD association mediated by TyG. Predictive performance was compared using receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>Among 816 participants, 528 (64.7%) had MAFLD. RCS confirmed linear positive associations of BMI and TyG with MAFLD. Compared to those with BMI <24 kg/m², patients with BMI ≥28 kg/m² had an adjusted odds ratio (aOR) of 6.94 (95% CI: 2.59-18.6). The highest TyG quartile had an aOR of 3.23 (95% CI: 1.08-9.64) vs the lowest. Mediation analysis suggested that TyG explained 7.5% of the observed association between BMI and MAFLD. Significant multiplicative interaction was observed (P < 0.05), whereas additive interaction was not significant. ROC analysis demonstrated that TyG had inferior discriminative ability (AUC: 0.679) compared to BMI (AUC: 0.784), with combined models (AUC: 0.796) providing minimal incremental value over BMI alone in identifying MAFLD.</p><p><strong>Conclusion: </strong>In T2DM, BMI exhibited a stronger association with MAFLD risk than TyG, with TyG accounting for a portion of this association but providing limited incremental improvement in discriminative ability.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"612508"},"PeriodicalIF":3.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976056","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":"Psychometric Evaluation of the Persian Version of a Self-Care Evaluation Instrument to Prevent Diabetic Foot in Iranian Patients Predominantly with Type 2 Diabetes Mellitus (P-ISPDF).","authors":"Elaheh Ghods, Razieh Bandari, Ali Montazeri","doi":"10.2147/DMSO.S603987","DOIUrl":"10.2147/DMSO.S603987","url":null,"abstract":"<p><strong>Objective: </strong>To translate and psychometrically validate the Persian version of the Instrument for Self-care in Preventing Diabetic Foot (P-ISPDF) as a reliable, culturally appropriate tool for assessing foot-specific self-care behaviors among Persian-speaking adults, predominantly those with type 2 diabetes mellitus.</p><p><strong>Methods: </strong>The ISPDF was translated using a forward-backward procedure, followed by expert review (n=5) and cognitive debriefing with patients (n=10). A split-sample design was used: exploratory factor analysis (EFA; n=289) and a series of confirmatory factor analyses (CFAs), including first-order, second-order, and a hierarchical general-factor model in an independent sample (n=250). Items were rated on a 5-point Likert scale (1-5). Reliability (Cronbach's alpha, McDonald's omega, intraclass correlation coefficient [ICC]) and validity (EFA, CFA) were evaluated using SPSS 25, AMOS 24, and JASP.</p><p><strong>Results: </strong>EFA supported a three-factor structure: self-care maintenance (10 items), monitoring (9 items), and management (7 items). The hierarchical measurement model showed good fit (<i>χ</i> ²/<i>df</i>=2.80, CFI=0.974, TLI=0.954, RMSEA=0.060). Cronbach's alpha was 0.93 for the total scale, with subscale alphas ranging from 0.81 to 0.92. Test-retest reliability was excellent (two-way mixed-effects, absolute agreement ICCs 0.93-0.98 with 95% CIs reported).</p><p><strong>Conclusion: </strong>The P-ISPDF demonstrated strong reliability and preliminary structural validity. However, due to mixed evidence regarding convergent validity and the absence of external validation, the findings should be interpreted with caution. Further psychometric refinement and longitudinal studies are needed to establish its clinical utility.</p>","PeriodicalId":11116,"journal":{"name":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy","volume":"19 ","pages":"603987"},"PeriodicalIF":3.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905335","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}