Diabetes research and clinical practice最新文献

{"title":"Effect of daily insulin delivery variability on glycemic outcomes in patients with type 1 diabetes mellitus using an automated insulin delivery system","authors":"Giuseppe Papa ,&nbsp;Rossella Cannarella ,&nbsp;Carmelo Gusmano ,&nbsp;Concetta Finocchiaro ,&nbsp;Massimiliano Anzaldi ,&nbsp;Gianfranco Gruttadauria ,&nbsp;Luca Patti ,&nbsp;Donatella Lo Presti ,&nbsp;Salvatore Scirè Calabrisotto ,&nbsp;Rosita A. Condorelli ,&nbsp;Sandro La Vignera ,&nbsp;Aldo E. Calogero","doi":"10.1016/j.diabres.2025.112476","DOIUrl":"10.1016/j.diabres.2025.112476","url":null,"abstract":"<div><h3>Background</h3><div>Automated insulin delivery (AID) systems are central to managing type 1 diabetes mellitus (T1DM), using continuous glucose monitoring (CGM) to adjust basal insulin (BI). Certain systems, such as the MiniMed™ 780G, also provide automated correction boluses (AB), while manual boluses (MB) are administered in response to carbohydrate intake. Despite the adaptive nature of these technologies, the influence of variability in individual insulin delivery components on glycemic outcomes remains insufficiently characterized.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 7,710 patient-days from 257 T1DM patients (236 adults, 21 pediatric) using the MiniMed™ 780G system for over six months. Variability in BI, AB, and MB—measured as BI-V%, AB-V%, and MB-V%—was assessed over 30-day periods and correlated with glycemic metrics including time in range (TIR_70-180), time above/below range (TAR, TBR), glucose coefficient of variation (CV), and glucose management index (GMI). Multivariate and ROC analyses were conducted.</div></div><div><h3>Results</h3><div>Mean TIR_70-180 exceeded 70 % in both groups. AB-V% (36.9 %) was significantly higher than BI-V% (16.8 %) and MB-V% (19.1 %). MB-V% was negatively associated with TIR and positively with TAR, while AB-V% showed the opposite. AB-V% &gt;32.3 % and MB-V% ≤18.2 % predicted achieving TIR &gt; 70 %.</div></div><div><h3>Conclusion</h3><div>Variability in insulin delivery, especially AB and MB, affects glycemic control in T1DM. Monitoring and optimizing these components may improve AID system effectiveness.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"229 ","pages":"Article 112476"},"PeriodicalIF":7.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of OW GLP-1 RAs and other glucose-lowering therapies among Medicare beneficiaries with T2D and ASCVD","authors":"Xi Tan ,&nbsp;Joanna Harton ,&nbsp;Cynthia Gutierrez ,&nbsp;Yuanjie Liang ,&nbsp;Lin Xie ,&nbsp;Chalak Muhammad ,&nbsp;Caroline Swift ,&nbsp;Adam de Havenon","doi":"10.1016/j.diabres.2025.112473","DOIUrl":"10.1016/j.diabres.2025.112473","url":null,"abstract":"<div><h3>Aims</h3><div>To compare the incidence rates for cardiovascular (CV) outcomes and healthcare resource utilization (HCRU) and costs among patients treated with once-weekly (OW) glucagon-like peptide-1 receptor agonists (GLP-1 RAs) compared with other non-insulin glucose lowering therapies (ONIGLTs).</div></div><div><h3>Methods</h3><div>This was an observational cohort study using Medicare fee-for-service claims data (2006–2022). Medicare beneficiaries with T2D and ASCVD treated with OW GLP-1 RAs or ONIGLTs were matched using propensity score matching.</div></div><div><h3>Results</h3><div>Among the total 398,470 Medicare beneficiaries, OW GLP-1 RAs were associated with reduced risk of CV events (hazard ratios [HRs] range: 0.72 to 0.88, P &lt; 0.05 for all) compared with ONIGLTs, in addition to lower HCRU and costs including ASCVD-related total medical visits (incidence rate ratio [95 % CI]: 0.91 [0.90–0.93]; P &lt; 0.001) and total medical costs (mean cost ratio [95 %CI]: 0.88 [0.86–0.91]; P &lt; 0.001). Among OW GLP-1 RAs, semaglutide had the lowest risk of all CV outcomes when compared with SGLT2is (HRs range: 0.80 to 0.85, P &lt; 0.05 for all) and DPP-4is (HRs range: 0.58 to 0.73; P &lt; 0.001 for all).</div></div><div><h3>Conclusion</h3><div>The study findings corroborate current guideline recommendations for GLP-1 RAs in people with T2D and ASCVD, and extend findings to lower HCRU and costs in a real-world setting, most notably for semaglutide.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"229 ","pages":"Article 112473"},"PeriodicalIF":7.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human factor in the use of automated insulin delivery systems: Real-world effects in children with type 1 diabetes after 2 years of use (AID-A study)","authors":"J. Schneidewind ,&nbsp;S. von Sengbusch ,&nbsp;D. Schmidt ,&nbsp;K. Lange","doi":"10.1016/j.diabres.2025.112477","DOIUrl":"10.1016/j.diabres.2025.112477","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to assess the metabolic effects, changes in daily life, and diabetes burden associated with automated insulin delivery (AID) systems in children in a real-world setting after 2 years of use.</div></div><div><h3>Methods</h3><div>Longitudinal glycaemic data (glycated haemoglobin [HbA1c], time in range [TiR], time below range [TbR], glucose management indicator [GMI]), body mass index (BMI), and AID system usage were collected from 111 children with type 1 diabetes at 12 and 24 months of AID use. After 1 year, adolescents and parents completed questionnaires on diabetes-related distress (P-PAID-C, P-PAID-T, and PAID-T) and experienced changes.</div></div><div><h3>Results</h3><div>Regardless of age or previous therapy, the HbA1c level decreased from 8.1 % (65 mmol/mol) to 7.7 % (61 mmol/mol), TiR increased from 55 % to 64 %, TbR decreased from 2.6 % to 1.8 %, and GMI (7.6 % vs. 7.3 %) improved after 1 year. After 2 years, HbA1c (7.6 % [60 mmol/mol]), TiR (62 %), TbR (1.3 %), and GMI (7.4 %) levels stabilised. Adolescents and parents reported improvements in daily life (i.e. sleep, stress, fear of hypoglycaemia). However, the BMI-SDS scores increased in the first year.</div></div><div><h3>Conclusions</h3><div>AID system use is associated with clinically relevant improvements in glycaemic control and decrease in daily diabetes-related burden on affected children and their parents.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"229 ","pages":"Article 112477"},"PeriodicalIF":7.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimated pulse wave velocity and incident chronic kidney disease: evidence from a prospective cohort and meta-analysis","authors":"Fan Zhang,&nbsp;Yan Bai,&nbsp;Liuyan Huang,&nbsp;Yifei Zhong","doi":"10.1016/j.diabres.2025.112472","DOIUrl":"10.1016/j.diabres.2025.112472","url":null,"abstract":"<div><h3>Aims</h3><div>This study aims to investigate the association between estimated pulse wave velocity (ePWV) and risk of incident chronic kidney disease (CKD).</div></div><div><h3>Methods</h3><div>A total of 3,240 participants aged ≥45 years without baseline CKD were included. Additionally, a meta-analysis of 18 studies involving 209,970 participants was conducted. ePWV was calculated using age and mean arterial pressure, with participants categorized into tertiles: lower (&lt;8.36 m/s), medium (8.36–9.91 m/s), and higher (≥9.92 m/s). Incident CKD was defined as physician-diagnosed CKD or estimated glomerular filtration rate &lt;60 mL/min/1.73 m2 based on cystatin C.</div></div><div><h3>Results</h3><div>During a median follow-up of 9.0 years, 494 participants (15.2 %) developed CKD. After adjusting for potential confounders, compared with the lower-ePWV group, the hazard ratios for CKD were 1.26 (95 % CI, 0.96–1.66) in the medium-ePWV group and 1.53 (95 % CI, 1.07–2.17) in the higher-ePWV group. Each standard deviation increase in ePWV was associated with a 42 % higher risk (HR = 1.42; 95 % CI, 1.23–1.63). Meta-analysis confirmed this association (pooled HR = 1.58; 95 % CI, 1.36–1.83) with evidence of a nonlinear dose–response relationship.</div></div><div><h3>Conclusion</h3><div>Higher ePWV was independently associated with increased risk of incident CKD. These findings suggest that ePWV may serve as a valuable tool for early CKD risk stratification in clinical practice.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"229 ","pages":"Article 112472"},"PeriodicalIF":7.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative analysis identifies novel proteins associated with chronic kidney disease in participants with abnormal glucose metabolism","authors":"Ning Li ,&nbsp;Jingyang Liu ,&nbsp;Guangheng Wu ,&nbsp;Jie Zhang ,&nbsp;Long Liu ,&nbsp;Manqi Zheng ,&nbsp;Haibin Li ,&nbsp;Changwei Li ,&nbsp;Yalu Wen ,&nbsp;Jianguang Ji ,&nbsp;Yang Yu ,&nbsp;Kun Zhao ,&nbsp;Deqiang Zheng","doi":"10.1016/j.diabres.2025.112474","DOIUrl":"10.1016/j.diabres.2025.112474","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;Chronic kidney disease (CKD) is highly prevalent among individuals with abnormal glucose metabolism. However, limited research has specifically investigated CKD-associated proteins within this high-risk population. To address this gap, our study aimed to identify proteins associated with CKD in participants with abnormal glucose metabolism, potentially informing early detection and targeted therapeutic strategies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We first employed orthogonal partial least squares discriminant analysis (OPLS-DA) to select important proteins and further used Cox proportional hazards models using proteomic data from the UK Biobank to identify candidate proteins associated with CKD in participants with abnormal glucose metabolism. Subsequently, we performed one-sample Mendelian randomization (MR) using individual-level genomic data from the UK Biobank and pQTL summary statistics from the UKB-PPP, applying a two-stage least squares approach. For two-sample MR, we utilized pQTL data from deCODE and CKD GWAS summary statistics derived from the UK Biobank, applying either the Wald ratio or inverse variance weighted (IVW) method. Proteins supported by both observational analyses and at least one MR approach were further evaluated using publicly available databases to determine their novelty. Finally, for proteins consistently identified across all approaches, we assessed tissue specificity, gene expression, and conducted sensitivity analyses to strengthen the robustness of our findings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Through integrated observational and MR analyses, we identified a total of 45 proteins significantly associated with CKD in participants with abnormal glucose metabolism, among which 11 represent novel discoveries: CD300C, CD300LG, CDNF, CDSN, CHRDL1, ENPP6, LEFTY2, MOG, RSPO3, TNFRSF13B, and MYLPF. Notably, ENPP6 emerged with consistent evidence across all analytic approaches. Observational analyses demonstrated a hazard ratio (HR) of 0.75 (95% CI: 0.63–0.89), while one-sample MR revealed an odds ratio (OR) of 0.32 (95% CI: 0.14–0.73), and two-sample MR produced an OR of 0.60 (95% CI: 0.37–0.98), supporting a protective role of ENPP6 in CKD development. Furthermore, ENPP6 displayed kidney-specific expression, particularly within peritubular and proximal tubular cells. These findings were robustly validated through comprehensive sensitivity analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In conclusion, we identified 11 novel proteins associated with CKD in individuals with abnormal glucose metabolism, with ENPP6 emerging as a particularly compelling candidate due to its consistent protective association across multiple analytical approaches. These findings offer promising insights into CKD pathophysiology and highlight ENPP6 as a potential biomarker or therapeutic target. Further research is warranted to elucidate the mechanistic roles of these novel proteins in CKD development and progressio","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"229 ","pages":"Article 112474"},"PeriodicalIF":7.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of low-carbohydrate diets on type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials in Eastern vs. Western populations","authors":"Pichanun Mongkolsucharitkul ,&nbsp;Apinya Surawit ,&nbsp;Apiradee Pimsen ,&nbsp;Siriluk Winitchayothin ,&nbsp;Sureeporn Pumeiam ,&nbsp;Bonggochpass Pinsawas ,&nbsp;Suphawan Ophakas ,&nbsp;Sophida Suta ,&nbsp;Phongthana Pasookhush ,&nbsp;Korapat Mayurasakorn","doi":"10.1016/j.diabres.2025.112464","DOIUrl":"10.1016/j.diabres.2025.112464","url":null,"abstract":"<div><h3>Aims</h3><div>Low-carbohydrate diets (LCDs) have emerged as a potential dietary intervention for managing glycemic control, but their effectiveness across different cultural contexts remains unclear. To evaluate the efficacy of LCDs in managing type 2 diabetes, with attention to cultural context, and to clarify how variability in carbohydrate definitions affects interpretation.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Scopus from inception to 1 August 2024 for randomized controlled trials (RCTs) ≥ 12 weeks in adults with type 2 diabetes. We conducted exploratory analyses by Eastern versus Western setting and dose–response <em>meta</em>-regression using actual carbohydrate intake at the follow-up.</div></div><div><h3>Results</h3><div>Twenty-seven RCTs (n = 2,870; 7 Eastern, 20 Western) were included. Across analyzed time points, no arm sustained carbohydrate intake &lt; 10 % of total energy; therefore, findings generalize to low-to-moderate carbohydrate rather than very-low-carbohydrate. LCDs improved glycemia short-term: HbA1c − 0.29 %, with the largest effect at 3 months. Fasting blood glucose decreased overall (−7.12 mg/dL). Weight loss was greatest at 3 months and attenuated thereafter. At 3 months, lower actual carbohydrate intake was related to larger HbA1c and weight reductions.</div></div><div><h3>Conclusions</h3><div>LCDs offer modest, short-term metabolic benefits for type 2 diabetes management, but benefits diminish over time. Cultural context may shape responses, underscoring individualized, culturally tailored care.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"229 ","pages":"Article 112464"},"PeriodicalIF":7.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver disease in people with latent autoimmune diabetes in adults (LADA): A cross-sectional study using magnetic resonance elastography","authors":"Ernesto Maddaloni ,&nbsp;Marta Zerunian ,&nbsp;Vincenzo Cardinale ,&nbsp;Annalisa Zurru ,&nbsp;Rocco Amendolara ,&nbsp;Daniela Luverà ,&nbsp;Renata Risi ,&nbsp;Luca D’Onofrio ,&nbsp;Benedetta Masci ,&nbsp;Francesco Covotta ,&nbsp;Damiano Caruso ,&nbsp;Domenico Alvaro ,&nbsp;Andrea Laghi ,&nbsp;Raffaella Buzzetti","doi":"10.1016/j.diabres.2025.112465","DOIUrl":"10.1016/j.diabres.2025.112465","url":null,"abstract":"<div><h3>Aims</h3><div>To investigate liver disease and its risk factors in LADA compared to type 1 (T1D) and type 2 (T2D) diabetes.</div></div><div><h3>Methods</h3><div>Liver magnetic resonance (MR) and MR elastography were used to measure proton density fat fraction (PDFF) and stiffness in 31 people with LADA matched for gender, body mass index (BMI) and disease duration with 31 people with T2D, and for gender, BMI and age with 31 people with T1D. Visceral adipose tissue (VAT) was quantified by DXA.</div></div><div><h3>Results</h3><div>Liver steatosis (PDFF &gt;5.5%) was present in 17 (54.8%), 1 (3.2%) and 0 participants with T2D, LADA and T1D, respectively (p&lt;0.001). Stiffness did not differ among groups. VAT was related to PDFF in the whole population, while BMI was a marker of liver fat content and of liver stiffness only in T2D (interaction p-values: &lt;0.001 and 0.019). HbA1c and VAT associated with liver stiffness differently among diabetes types (interaction p-values: 0.034 and 0.016). Kidney function was inversely associated to liver stiffness in the whole population, without differences by diabetes type.</div></div><div><h3>Conclusions</h3><div>Liver fat accumulates differently in LADA and in T1D compared to T2D, reflecting a different body fat distribution despite a similar BMI. Factors associated with liver stiffness differ among diabetes types.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"229 ","pages":"Article 112465"},"PeriodicalIF":7.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral self-control and glycemic levels in youth with type 1 diabetes: serial mediation by family conflict and self-management behaviors","authors":"Luiza V. Mali ,&nbsp;Jamil A. Malik ,&nbsp;Janine Sanchez ,&nbsp;Jennifer S. Pendley ,&nbsp;Caroline Gillenson ,&nbsp;Kimberly L. Klages ,&nbsp;Amy E. Noser ,&nbsp;Lawrence M. Dolan ,&nbsp;Alan M. Delamater","doi":"10.1016/j.diabres.2025.112463","DOIUrl":"10.1016/j.diabres.2025.112463","url":null,"abstract":"<div><h3>Aims</h3><div>Examine the mediating roles of family conflict (FC) and diabetes self-management behaviors (SMB) in the relationship between behavioral self-control (BSC) and glycemic levels in adolescents with type 1 diabetes (T1D). We predicted that BSC would improve glycemic levels directly and indirectly by decreasing FC and increasing SMB, both cross-sectionally and longitudinally.</div></div><div><h3>Methods</h3><div>172 adolescents (M age = 16 years) with T1D were followed for three years at three medical centers. Blood samples were obtained twice yearly and analyzed for HbA1c in a central laboratory. The Behavioral Self-Control Scale was completed by youth, and the Diabetes Family Conflict Scale and Diabetes Self-Management Profile were completed by youth and parents at baseline, 12, 24, and 36 months.</div></div><div><h3>Results</h3><div>Ten independent models were tested (five for self-reported and five for parent-reported FC and SMB), estimating longitudinal (i.e., baseline BSC → 12-month FC → 24-month SMB → 30 and 36-month HbA1c) and cross-sectional serial mediations for each timepoint. All models supported significant serial mediations indicating that BSC decreases HbA1c through decreased FC and increased SMB.</div></div><div><h3>Conclusions</h3><div>BSC has substantial potential for influencing glycemic levels as it is directly associated with lower HbA1c and helps to optimize glycemic levels by decreasing FC and increasing SMB during late adolescence.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"229 ","pages":"Article 112463"},"PeriodicalIF":7.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrinologist-led genomic testing for monogenic diabetes in adult diabetes clinics: a feasibility and outcome study","authors":"Devashree Balasingam ,&nbsp;Rosalind Moxham ,&nbsp;Sophie Devery ,&nbsp;Renee Smyth ,&nbsp;Todor Arsov ,&nbsp;Nick Olsen ,&nbsp;Alexander Viardot ,&nbsp;Jerry R Greenfield ,&nbsp;Kathy HC Wu","doi":"10.1016/j.diabres.2025.112456","DOIUrl":"10.1016/j.diabres.2025.112456","url":null,"abstract":"<div><h3>Aims</h3><div>Monogenic diabetes (MGD), such as Maturity-Onset Diabetes of the Young (MODY), is under-recognised and under-diagnosed. Accurate diagnosis of MGD requires genetic testing and has important treatment implications. Integrating MGD testing within diabetes clinics can increase testing uptake and MGD diagnosis. We aimed to explore the feasibility and psychosocial outcomes of endocrinologist-led MGD testing.</div></div><div><h3>Methods</h3><div>Seventy-two adult participants were prospectively identified by endocrinologists from diabetes clinics guided by a set of clinical criteria developed for patient selection. All participants underwent MGD multigene panel testing. Clinical, demographic, and psychosocial data were collected.</div></div><div><h3>Results</h3><div>A diagnosis of MGD was established in 21.4 % of participants. Multivariable analysis identified younger age at diagnosis (p = 0.04), but not lower body mass index (p = 0.18) or positive family history (p = 0.35), as independent predictors of MGD. Patient satisfaction and empowerment were high. Sixty-percent of endocrinologists reported modifying patient management. Lack of clinical guidelines, access and cost of testing were identified barriers to point-of-care MGD testing.</div></div><div><h3>Conclusions</h3><div>Integrating MGD testing into routine diabetes care is feasible and can improve treatment outcomes and patient experience. Endocrinologists reported requiring support to implement MGD testing. Our patient selection criteria can be modified to improve inclusiveness and increase sensitivity in predicting MGD diagnosis.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"229 ","pages":"Article 112456"},"PeriodicalIF":7.4,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beta-hydroxybutyrate ameliorates cardiac fibrosis in diabetic cardiomyopathy rats via regulating macrophage polarization","authors":"Mei He ,&nbsp;Weiguang Luo ,&nbsp;Shuwei Ning ,&nbsp;Yuexin Yu ,&nbsp;Bin Yang ,&nbsp;Zhikun Guo","doi":"10.1016/j.diabres.2025.112461","DOIUrl":"10.1016/j.diabres.2025.112461","url":null,"abstract":"<div><h3>Objective</h3><div>Beta-hydroxybutyrate (BHB) has been demonstrated to enhance cardiac function in patients with diabetic cardiomyopathy (DCM), the underlying mechanism remains unclear.</div></div><div><h3>Methods</h3><div>A DCM rat model was established, BHB was administered via intraperitoneal injection. The therapeutic effects of BHB were assessed based on cardiac function, fasting glucose levels, myocardial fibrosis markers and myocardial macrophage polarization. To elucidate the mechanism of action, co-culture experiments were conducted using cardiac fibroblasts and peritoneal macrophages to evaluate collagen expression in fibroblasts and macrophage polarization under BHB treatment.</div></div><div><h3>Results</h3><div>BHB improved cardiac function in DCM rats, reduced fasting glucose levels, alleviated cardiac fibrosis and modulated macrophage polarization. After BHB treatment, the proportion of M1 macrophages decreased while that of M2 macrophages increased in the myocardium of DCM rats. Cardiac fibroblasts isolated from neonatal rats, when co-cultured with peritoneal macrophages under high-glucose conditions, exhibited altered macrophage polarization and collagen expression. High-glucose conditions promoted an increase in M1 macrophages and a decrease in M2 macrophages. BHB treatment reversed this trend by reducing M1 macrophages and promoting M2 macrophage polarization.</div></div><div><h3>Conclusions</h3><div>We show that BHB mitigates cardiac fibrosis in DCM rats by promoting M2 macrophage polarization. BHB may be a useful therapeutic approach for DCM treatment.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"229 ","pages":"Article 112461"},"PeriodicalIF":7.4,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}