Diabetes & metabolism最新文献

{"title":"Safety of sodium-glucose cotransporter 2 inhibitors in kidney transplant recipients with diabetes mellitus","authors":"Talia Diker Cohen ,&nbsp;Amir Polansky ,&nbsp;Idan Bergman ,&nbsp;Gida Ayada ,&nbsp;Tanya Babich ,&nbsp;Amit Akirov ,&nbsp;Tali Steinmetz ,&nbsp;Idit Dotan","doi":"10.1016/j.diabet.2025.101627","DOIUrl":"10.1016/j.diabet.2025.101627","url":null,"abstract":"<div><h3>Aim</h3><div>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are important anti-hyperglycemic medications with reno-protective benefits for patients with diabetic kidney disease. Their utilization in kidney transplant recipients (KTRs) remains underexplored due to safety concerns, particularly regarding urinary tract infections. This study investigates the safety profile of SGLT2i therapy in KTRs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of KTRs with diabetes mellitus, comparing those treated with SGLT2i to those on standard diabetes therapy, monitored over three years at a tertiary center. The primary outcome was a renal composite of dialysis, re-transplantation, acute kidney failure, or acute rejection. Secondary outcomes included urinary tract infections, diabetic ulcers, fractures, amputations, diabetic ketoacidosis, all-cause mortality, and glycemic control.</div></div><div><h3>Results</h3><div>Two hundred forty individuals using SGLT2i (median age 63, 20 % female) were matched with non-users. SGLT2i users had a lower incidence of the composite renal outcome (8.9 vs. 13.3 events per 100 patient-years), but after adjustment for independent predictors, the risk was similar (HR 0.99, 95 % CI 0.65–1.52, <em>P</em> = 0.970). Other outcomes showed comparable or lower risks in SGLT2i users. Glycemic control improved more significantly in SGLT2i users.</div></div><div><h3>Conclusion</h3><div>In KTRs with diabetes, SGLT2i therapy improved glycemic control without increased safety concerns compared to standard treatments. Both groups exhibited similar risks of significant kidney-related events and all-cause mortality. These findings provide crucial insights into the existing limited data concerning this vulnerable population, which faces elevated risks of renal complications and medication-related adverse effects. Ongoing randomized controlled trials will provide additional safety data for SGLT2i in KTRs.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 3","pages":"Article 101627"},"PeriodicalIF":4.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-like peptide 1 receptor agonists and renal outcomes in kidney transplant recipients with diabetes mellitus","authors":"Talia Diker Cohen ,&nbsp;Yaron Rudman ,&nbsp;Adi Turjeman ,&nbsp;Amit Akirov ,&nbsp;Tali Steinmetz ,&nbsp;Bronya Calvarysky ,&nbsp;Idit Dotan","doi":"10.1016/j.diabet.2025.101624","DOIUrl":"10.1016/j.diabet.2025.101624","url":null,"abstract":"<div><h3>Aims</h3><div>Glucagon-like peptide-1 receptor agonists (GLP1-RAs) show reno-protective effects in type 2 diabetes. Limited data is available on their use in post-transplant diabetes mellitus. We aimed to explore the effect of GLP1-RAs on renal outcomes in diabetic kidney transplant recipients (KTR).</div></div><div><h3>Methods</h3><div>We conducted a cohort retrospective study on adult KTR with diabetes mellitus. KTR treated with GLP1-RAs were matched with non-users. The primary outcome was the first occurrence of graft rejection, start of dialysis, re-transplantation or all-cause mortality. Other outcomes included a composite of the first occurrence of a genitourinary infection or all-cause mortality, and all-cause mortality. Metabolic effects of GLP1-RA treatment and risk for biliopancreatic adverse events were also explored.</div></div><div><h3>Results</h3><div>We included 272 patients (69 % males, average age 58.3 ± 11.0 years) with a 3.1-year median follow-up. The use of GLP1-RAs lowered the incidence of the composite renal outcome after adjustment for independent risk factors (114 versus 68 events per 1000-patient years in controls versus GLP1-RA users, HR 0.489, 95 % CI 0.271–0.883). GLP-RA users had improved glycemic control, lipid profile and a decrease in body mass index. The treatment was safe without increased genitourinary infections or biliopancreatic events.</div></div><div><h3>Conclusion</h3><div>The use of GLP1-RAs decreased the risk of a composite outcome of renal dysfunction and mortality, improved metabolic control and showed safety of use in a large cohort of diabetic KTR, suggesting reno-protective effects in this high-risk population. Prospective data is further needed in KTR who are excluded from large RCTs.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 3","pages":"Article 101624"},"PeriodicalIF":4.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased ferritin levels are associated with incident diabetes after kidney transplantation: A prospective cohort study","authors":"Pien Rawee ,&nbsp;Daan Kremer ,&nbsp;Amarens Van der Vaart ,&nbsp;Daan J Touw ,&nbsp;Peter R Van Dijk ,&nbsp;Martin H de Borst ,&nbsp;Stephan JL Bakker ,&nbsp;Michele F Eisenga","doi":"10.1016/j.diabet.2025.101626","DOIUrl":"10.1016/j.diabet.2025.101626","url":null,"abstract":"<div><h3>Aim</h3><div>Iron is known to play a role in glucose homeostasis, and diabetes is highly prevalent in patients with iron overload. Here, we investigated whether ferritin and hepcidin (as parameters of iron status) are associated with the development of post-transplant diabetes in kidney transplant recipients, a population in which around 10 % is known to have high iron status.</div></div><div><h3>Methods</h3><div>Prospective data from the TransplantLines Insulin Resistance and Inflammation Biobank and Cohort Study from the University Medical Center Groningen, the Netherlands were evaluated, involving stable adult kidney transplant recipients &gt; 1 year after transplantation. Associations between ferritin and hepcidin levels, as markers of iron status, and incident post-transplant diabetes were analyzed by multivariable Cox regression models, followed by the exploration of potential clinical cut-offs of ferritin levels related to the risk of post-transplant diabetes.</div></div><div><h3>Results</h3><div>Of the included 443 kidney transplant recipients (age 50 ± 12 years, 44 % women, median 6.1 [3.0 – 12.1] years after transplantation), 65 kidney transplant recipients (15 %) developed post-transplant diabetes during a median follow-up of 9.6 [6.3 – 10.2] years. In contrast to hepcidin levels, ferritin levels were significantly associated with incident post-transplant diabetes, independent of adjustment for potential confounders (HR per 50 µg/l, 1.08; 95 % CI 1.02 – 1.14). When analyzing specific clinical cut-offs of ferritin levels, kidney transplant recipients with a ferritin &gt; 500 µg/l (n=40) had more than twice the risk of developing post-transplant diabetes, compared to kidney transplant recipients with ferritin &lt; 100 µg/l (HR, 2.81; 95 % CI 1.04 – 7.55).</div></div><div><h3>Conclusions</h3><div>Increased levels of ferritin are independently associated with a higher risk of post-transplant diabetes in kidney transplant recipients. Especially, kidney transplant recipients with ferritin levels &gt; 500 µg/l, seem susceptible to the development of post-transplant diabetes over time.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101626"},"PeriodicalIF":4.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of SGLT2 inhibitors and GLP-1 receptor agonists in preventing Alzheimer's disease, vascular dementia, and other dementia types among patients with type 2 diabetes","authors":"Mingyang Sun ,&nbsp;Xiaoling Wang ,&nbsp;Zhongyuan Lu ,&nbsp;Yitian Yang ,&nbsp;Shuang Lv ,&nbsp;Mengrong Miao ,&nbsp;Wan-Ming Chen ,&nbsp;Szu-Yuan Wu ,&nbsp;Jiaqiang Zhang","doi":"10.1016/j.diabet.2025.101623","DOIUrl":"10.1016/j.diabet.2025.101623","url":null,"abstract":"<div><h3>Background</h3><div>Type 2 diabetes mellitus (T2DM) is associated with an elevated risk of dementia, including Alzheimer's disease (AD) and vascular dementia (VaD). While sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists have shown neuroprotective potential, comparative data on their efficacy in dementia prevention remain scarce.</div></div><div><h3>Methods</h3><div><em>-</em> We conducted a retrospective cohort study using the TriNetX database, including 307,103 SGLT2 inhibitor users and 348,686 GLP-1 receptor agonist users with T2DM. Propensity score matching yielded 221,883 pairs with balanced baseline characteristics. The primary outcome was overall dementia incidence, with secondary outcomes including AD, VaD, and all-cause mortality. Hazard ratios (HRs) were calculated using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>SGLT2 inhibitors were associated with a significantly lower incidence of overall dementia compared to GLP-1 receptor agonists (2.7 % vs. 3.6 %; HR, 0.92; 95 % CI, 0.89–0.95). The risk of VaD (HR, 0.89; 95 % CI, 0.84–0.95) and AD (HR, 0.90; 95 % CI, 0.86–0.94) was also reduced with SGLT2 inhibitors. All-cause mortality was lower in the SGLT2 group (3.6 % vs. 4.6 %; HR, 0.95; 95 % CI, 0.92–0.98). No significant difference was observed in other dementia subtypes (HR, 0.96; 95 % CI, 0.91–1.01).</div></div><div><h3>Conclusions</h3><div>In this large, real-world cohort, SGLT2 inhibitors demonstrated superior efficacy over GLP-1 receptor agonists in reducing the risks of overall dementia, VaD, and AD among patients with T2DM. These findings support the preferential use of SGLT2 inhibitors in mitigating dementia risk in this population, though randomized controlled trials are warranted for confirmation.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101623"},"PeriodicalIF":4.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous glucose monitoring‑derived time in range and CV are associated with elevated risk of adverse kidney outcomes for patients with type 2 diabetes","authors":"Qin Zhang ,&nbsp;Shucai Xiao ,&nbsp;Fang Zou ,&nbsp;Xiaojuan Jiao ,&nbsp;Yunfeng Shen","doi":"10.1016/j.diabet.2025.101616","DOIUrl":"10.1016/j.diabet.2025.101616","url":null,"abstract":"<div><div>Current guidelines recommend assessing glycemic control using continuous glucose monitoring (CGM), which provides a comprehensive glycemic profile to supplement HbA1c measurement. However, the association between CGM-derived metrics and risk of adverse kidney outcomes is not entirely clear. This retrospective cohort study included 1274 patients with type 2 diabetes hospitalized from July 2020 to December 2022, with a median follow-up time of 923 days. Monitor using CGM at baseline and evaluate renal function indicators of participants at baseline and end of follow-up. Multiple CGM-derived metrics, particularly time in range (TIR) and glucose coefficient of variation (CV), were calculated from 3-day glucose profiles obtained from CGM. Relevant clinical data was collected from clinical records and/or patient interviews. The primary outcome was chronic-kidney-disease (CKD) progression. Secondary outcomes included worsening of albuminuria and, all-cause mortality and major-adverse-cardiac-events(MACE). Multivariate regression models were employed to analyze the association between CGM-derived indices, particularly TIR and CV, and the risk of adverse kidney outcomes. We demonstrated that the lower TIR categories had a remarkably increased risk of CKD progression, with a HR per 10 % increment of 0.90 (95 %CI:0.83–0.91). Conversely, higher CV was positively related to the subsequent risk of CKD progression, with an HR per 10 % increment of 1.30 (95 %CI:1.07–1.59). These results were consistent across various subgroups and sensitivity analyses. This study found that TIR and CV are significantly associated with CKD progression, proteinuria deterioration, all-cause mortality, and the risk of MACE. These findings have elasticity in adjusting for multiple covariates and have been confirmed in different subgroups and sensitivity analyses.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101616"},"PeriodicalIF":4.6,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of pharmacological treatments for gestational diabetes: a systematic review comparing metformin with glibenclamide and insulin","authors":"Louise Bodier ,&nbsp;Maela Le Lous ,&nbsp;Hélène Isly ,&nbsp;Christèle Derrien ,&nbsp;Patricia Vaduva","doi":"10.1016/j.diabet.2025.101622","DOIUrl":"10.1016/j.diabet.2025.101622","url":null,"abstract":"<div><h3>Aim</h3><div>Gestational diabetes, characterized by impaired glucose tolerance occurring or diagnosed during pregnancy, is a significant public health concern. When lifestyle and dietary measures fail (30 % of women), insulin is the standard treatment. Oral antidiabetic agents, such as metformin (Glucophage) and glibenclamide, could provide a promising alternative. The aim here was to evaluate the effectiveness and safety of these treatments in gestational diabetes.</div></div><div><h3>Methods</h3><div>This study is based on a systematic literature review. A keyword search for \"metformin (Glucophage),\" \"glibenclamide,\" \"pregnancy,\" and \"gestational diabetes\" was conducted in the PubMed and Google Scholar databases from 2013 to 2023.</div></div><div><h3>Results</h3><div>A total of 45 studies were selected and analyzed. metformin (Glucophage) appears to offer a combination of effectiveness in glycemic control and maternal and neonatal safety. Compared to insulin, it reduces maternal weight gain, lowers maternal hypoglycemia rates, and shows a tendency to reduce gestational hypertension and preeclampsia. Additionally, infants born to mothers on metformin (Glucophage) are less likely to be macrosomic, experience fewer neonatal hypoglycemic episodes, and require fewer admissions to intensive care units. On the other hand, glibenclamide seems effective in glycemic control but is associated with higher rates of macrosomia and neonatal hypoglycemia.</div></div><div><h3>Conclusion</h3><div>Metformin (Glucophage) appears to be a promising alternative to insulin for treating gestational diabetes, while uncertainties remain regarding the safety of glibenclamide.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101622"},"PeriodicalIF":4.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycemia Risk Index (GRI) and international glucose targets before and 6 months after initiation of hybrid closed loop system in the CIRDIA, a French multisite out-of-hospital center","authors":"Sylvie Picard ,&nbsp;Blandine Courbebaisse ,&nbsp;Joëlle Dupont ,&nbsp;Fabienne Amiot-Chapoutot ,&nbsp;Emmanuelle Lecornet-Sokol ,&nbsp;Estelle Personeni ,&nbsp;François Mougel ,&nbsp;Clara Bouché ,&nbsp;Françoise Giroud ,&nbsp;Sandrine Lablanche ,&nbsp;Sophie Borot","doi":"10.1016/j.diabet.2025.101617","DOIUrl":"10.1016/j.diabet.2025.101617","url":null,"abstract":"<div><h3>Aims</h3><div>To analyze in a population of persons with type 1 diabetes (PwT1D) ambulatory glucose profile (AGP) parameters – including glycemia risk index (GRI) – for six months after hybrid closed loop (HCL) initiation in a multisite out-of-hospital French center (CIRDIA). We calculated the percentage of people reaching glucose targets and determined a GRI threshold that could identify patients reaching targets.</div></div><div><h3>Methods</h3><div>This was a retrospective study conducted in the CIRDIA, a multisite (<em>n</em>=7) out-of-hospital HCL initiation center. AGP metrics for the 14 previous days were manually extracted from HCL platforms at initiation (M0), 3 ± 1 months (M3) and 6 ± 1 months (M6). PwT1D were considered as reaching efficacy and safety targets (EST) if time-in-range was &gt; 70 %, GMI was &lt; 7 %, time-below-range (TBR)^&lt;70 was &lt; 4 % and TBR^&lt;54 was &lt; 1 %. GRI was calculated and ROC analyses were performed to set a GRI threshold that could identify patients reaching EST.</div></div><div><h3>Results</h3><div>Six-month data were available for 136 persons. The percentage of PwT1D reaching glucose targets at respectively M0, M3 and M6 were for EST: 6.6 %, 40.4 % and 39.7 %. GRI decreased from 56.0 ± 20.9 to 30.1 ± 14.1 and 30.6 ± 13.8. ROC analyses showed that the best GRI value to detect patients who reached EST was GRI &lt;26. A threshold set at this level had very good specificity (92 %) and negative predictive value (93 %) to identify those who do need further intensive support with HCL.</div></div><div><h3>Conclusion</h3><div>Setting a GRI threshold at 26 could be helpful to detect with a single number, potentially automatically calculated by CGM platforms, PwT1D who require further support.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101617"},"PeriodicalIF":4.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143369769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lp(a) concentration and polymorphic size are not associated with new onset diabetes in individuals with prediabetes","authors":"Maxime Carpentier ,&nbsp;Matthieu Wargny ,&nbsp;Mikaël Croyal ,&nbsp;Cédric Le May ,&nbsp;Sarra Smati ,&nbsp;Edith Bigot-Corbel ,&nbsp;Samy Hadjadj ,&nbsp;Bertrand Cariou","doi":"10.1016/j.diabet.2025.101621","DOIUrl":"10.1016/j.diabet.2025.101621","url":null,"abstract":"<div><h3>Aim</h3><div>Observational studies in the general population suggest that low concentrations of lipoprotein (a) [Lp(a)] are associated with an increased risk of type 2 diabetes. Here, we aim to determine whether Lp(a) plasma concentration and Kringle-IV (K-IV) repeat polymorphism were associated with new-onset diabetes (NOD) in individuals with prediabetes.</div></div><div><h3>Methods</h3><div>IT-DIAB is an observational, prospective study including 303 participants with impaired fasting glucose (fasting plasma glucose [FPG]: 110–125 mg/dl) followed annually for 5 years. The primary endpoint was the development of NOD, defined as a first FPG value ≥ 126 mg/dl during follow-up. Lp(a) concentrations were measured by immunoturbidimetry, apo(a) concentrations and the number of K-IV domains by mass spectrometry. Survival analyses for NOD were modeled using Kaplan-Meier curves and a multivariable Cox model, after binarization on threshold values of Lp(a) or K-IV.</div></div><div><h3>Results</h3><div>Among the participants, 113 (37%) developed NOD during follow-up. The concentrations of Lp(a) and the number of K-IV domains were not significantly different according to NOD status. Similarly, the percentage of patients with a non-detectable (≤ 7 nmol/l) or elevated (&gt;125 nmol/l) Lp(a) concentration was similar between those with or without NOD: 68.1 vs 63.7% (<em>P</em> = 0.46) and 8.8 vs 8.9% (<em>P</em> &gt; 0.99), respectively. Kaplan-Meier curves and Cox models did not show any association between Lp(a) concentration (threshold 7 nmol/l and 125 nmol/l) or number of K-IV domain (threshold 23) and the risk of NOD.</div></div><div><h3>Conclusion</h3><div>In a high-risk population, Lp(a) concentration or polymorphic size do not appear to be substantially associated with type 2 diabetes risk.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101621"},"PeriodicalIF":4.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early use of hybrid closed-loop following total pancreaticoduodenectomy","authors":"Alice Larroumet ,&nbsp;Arthur Marichez ,&nbsp;Marion Camoin ,&nbsp;Laurence Baillet-Blanco ,&nbsp;Jean-Philippe Adam ,&nbsp;Christophe Laurent ,&nbsp;Vincent Rigalleau ,&nbsp;Kamel Mohammedi ,&nbsp;Laurence Chiche","doi":"10.1016/j.diabet.2025.101619","DOIUrl":"10.1016/j.diabet.2025.101619","url":null,"abstract":"<div><div>Diabetes secondary to total pancreaticoduodenectomy (TP) is challenging to manage due to high glycemic variability and risk of hypoglycemia, in a frail population. We report the case of four patients with no prior diabetes who underwent TP. Three of four patients needed artificial nutritional support. Hybrid closed-loop (HCL) insulin therapy was initiated within 12 weeks of surgery. After 90 days of HCL treatment, continuous glucose measurement showed a 70.4 ± 11.8 % time in range (versus 43 ± 6.5 % before HCL); 0.2 ± 0.2 % time below range (versus 0.6 ± 0.5 % before HCL); 23.8 ± 9.1 % time above range 180–250 mg/dl (versus 22.9 ± 6.1 % before HCL); 4.2 ± 2.5 % time above range &gt; 250 mg/dl (versus 33.8 ± 3.9 % before HCL). The glucose management indicator improved from 8.5 ± 0.6 % to 6.9 ± 0.6 %. There was no severe hypoglycemia or need for unplanned medical attention. Early post-operative use of HCL allowed our patients to achieve safely optimal glycemic control after TP.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101619"},"PeriodicalIF":4.6,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical frailty, genetic predisposition, and type 2 diabetes mellitus","authors":"Zhenyi Xu ,&nbsp;Ruilang Lin ,&nbsp;Xueying Ji ,&nbsp;Chen Huang ,&nbsp;Ce Wang ,&nbsp;Yongfu Yu ,&nbsp;Zhijun Bao","doi":"10.1016/j.diabet.2025.101618","DOIUrl":"10.1016/j.diabet.2025.101618","url":null,"abstract":"<div><h3>Aim</h3><div>To examine the association between frailty and incident type 2 diabetes mellitus (T2DM), considering the joint effect of multimorbidity and genetic risk.</div></div><div><h3>Methods</h3><div>The study included 429,022 individuals in the UK Biobank. We used Cox regression with hazard ratio (HR) and 95 % confidence interval (CI) to 1) evaluate the associations of frailty with incident T2DM, 2) explore whether frailty and multimorbidity would have a joint effect, and 3) assess whether the associations were modified by genetic risk.</div></div><div><h3>Results</h3><div>Compared with non-frail individuals, prefrail and frail individuals were at higher risk of T2DM: HR[95 %CI] = 1.42 [1.38;1.47] for prefrailty and 1.81[1.70;1.92] for frailty. Five frailty components were associated with increased risk of T2DM: HR[95 %CI] = 1.21[1.17;1.26] for weight loss, 1.35[1.30;1.40] for exhaustion, 1.31[1.26;1.37] for low physical activity, 1.27[1.20;1.33] for low grip strength, and 1.47[1.41;1.52] for slow gait speed. The increased risks were more pronounced among frail individuals with more than three morbidities: HR[95 %CI] = 4.10[3.76;4.46]. Frail individuals at high genetic risk had a four and a half-fold greater risk of T2DM compared with non-frail individuals at low genetic risk: HR[95 %CI] = 4.54[4.14;4.97].</div></div><div><h3>Conclusion</h3><div>Frailty was associated with increased risk of T2DM, especially in individuals with higher number of morbidities and high genetic risk. Frailty may be an independent risk factor for T2DM and targeted strategies to prevent and manage frailty would contribute to reducing the risk of T2DM.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101618"},"PeriodicalIF":4.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}