Diabetes & metabolism最新文献

{"title":"Screening for autoimmune atrophic gastritis by serum gastrin measurement in subjects with type 1 diabetes","authors":"Aude Pacheco ,&nbsp;Marc Diedisheim ,&nbsp;Claire Goulvestre ,&nbsp;Laure Alexandre-Heymann ,&nbsp;Roberto Mallone ,&nbsp;Danièle Dubois-Laforgue ,&nbsp;Etienne Larger","doi":"10.1016/j.diabet.2025.101640","DOIUrl":"10.1016/j.diabet.2025.101640","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite associated risk of anemia and gastric cancer, screening for autoimmune atrophic gastritis (AAG) is underperformed in subjects with type 1 diabetes mellitus (T1DM). We measured the predictive value of serum gastrin as a biomarker of gastric atrophy in subjects with T1DM and parietal cell autoantibodies (PCA).</div></div><div><h3>Subjects and Methods</h3><div>PCA measurements were retrospectively retrieved in 1,425 consecutive subjects with T1DM between 2014 and 2018. Screening for AAG was conducted in PCA+ subjects by measuring blood counts, serum ferritin, vitamin B12 and gastrin; and by performing gastroduodenal fibroscopy, with fundic biopsies for histology and <em>Helicobacter pylori</em>. The performance of blood biomarkers of gastric atrophy was analyzed in comparison with the histopathological gold standard.</div></div><div><h3>Results</h3><div>PCA were found in 185/1,425 subjects (13 %). PCA positivity was associated with female sex, older age, longer T1DM duration, and co-occurrence of anti-GAD and anti-thyroperoxydase autoantibodies. Of the 185 PCA+ subjects, 122 (66 %) participated in screening. AAG was found in 69/122 (57 %) subjects and <em>Helicobacter pylori</em> infection in 20/122 (16 %). Compared to PCA+ subjects without gastric atrophy, those with gastric atrophy had more frequently iron deficiency (65 % vs. 18 %, <em>P</em> &lt; 0.0001), and/or vitamin B12 deficiency (57 % vs. 7 %, <em>P</em> &lt; 0.0001); 44/69 (64 %) presented a pre-tumoral lesion and 6 % a tumor. Using a cut-off of 1.2-fold above the upper normal limit, serum gastrin concentration displayed 91 % sensitivity and 82 % specificity at predicting gastric atrophy.</div></div><div><h3>Conclusion</h3><div>In subjects with T1DM and PCA, serum gastrin is a reliable biomarker of gastric atrophy that can be used to select subjects requiring gastroduodenal fibroscopy.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 3","pages":"Article 101640"},"PeriodicalIF":4.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672166","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":"Acute kidney injury is associated with liver-related events in patients with metabolic dysfunction-associated fatty liver disease","authors":"Caoxiang She ,&nbsp;Zhixin Guo ,&nbsp;Yaduan Lin ,&nbsp;Shiyu Zhou ,&nbsp;Mingzhen Pang ,&nbsp;Jiao Liu ,&nbsp;Lisha Cao ,&nbsp;Licong Su ,&nbsp;Yinfang Sun ,&nbsp;Chuyao Fang ,&nbsp;Xian Shao ,&nbsp;Sheng Nie","doi":"10.1016/j.diabet.2025.101639","DOIUrl":"10.1016/j.diabet.2025.101639","url":null,"abstract":"<div><h3>Background</h3><div>Evidence regarding the role of acute kidney injury (AKI) in long-term development of metabolic dysfunction-associated fatty liver disease (MAFLD) is limited. We aimed to investigate the associations between AKI and liver-related events in patients with MAFLD.</div></div><div><h3>Methods</h3><div>This study involved 50,499 Chinese adults with MAFLD from the China Renal Data System (CRDS) database. We identified AKI using patient-level serum creatinine data according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The primary outcome was a composite of liver-related mortality and major adverse liver outcomes. The secondary outcome was an escalation of fibrosis-4 (FIB-4) risk scores. Cox proportional hazard models were performed to assess the association between AKI and the study outcomes.</div></div><div><h3>Results</h3><div>The median age of the patients was 59.17 years, with 54.7% being male. There were 3,711 (7.3%) patients who experienced AKI during hospitalization. A total of 1,660 (3.3%) patients experienced composite liver outcome. Patients with AKI during hospitalization had higher risk of composite liver outcomes (adjusted hazard ratio (aHR) 1.83 [95% confidence interval 1.38;2.41] <em>P</em> &lt; 0.001), especially among those with severe AKI (stage 2/3) (aHR 2.36 [1.57;3.54] <em>P</em> &lt; 0.001). Regarding the secondary outcome, AKI was also associated with an increased risk of escalation of FIB-4 risk scores (aHR 1.28 [1.14;1.44] <em>P</em> &lt; 0.001). These associations remained consistent across various subgroups and sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>AKI was significantly associated with an increased risk of liver-related events among patients with MAFLD. These findings suggest that enhanced vigilance toward AKI may be justifiable in MAFLD patients.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 3","pages":"Article 101639"},"PeriodicalIF":4.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660195","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":"Persistent gaps in the implementation of lipid-lowering therapy in patients with established atherosclerotic cardiovascular disease: A French nationwide study","authors":"Matthieu Wargny ,&nbsp;Thomas Goronflot ,&nbsp;Pierre-Guillaume Piriou ,&nbsp;Mathilde Pouriel ,&nbsp;Alexandre Bastien ,&nbsp;Julie Prax ,&nbsp;Christophe Leux ,&nbsp;Valéry-Pierre Riche ,&nbsp;Jean-Noël Trochu ,&nbsp;Sophie Béliard ,&nbsp;Nadège Costa ,&nbsp;Jean Ferrières ,&nbsp;Stéphanie Duret ,&nbsp;Bertrand Cariou","doi":"10.1016/j.diabet.2025.101638","DOIUrl":"10.1016/j.diabet.2025.101638","url":null,"abstract":"<div><h3>Background</h3><div>According to international guidelines, lowering LDL-cholesterol is the cornerstone of atherosclerotic cardiovascular disease (ASCVD) prevention. However, observational studies have identified current gaps in the implementation of lipid-lowering therapy (LLT). This whole-population study aimed to evaluate the prevalence and determinants of LLT use in ASCVD patients.</div></div><div><h3>Methods</h3><div>Using the national health data system, all French adults with established ASCVD between 2012 and 2021 were identified using specific ICD-10 and/or procedure codes. LLT use was defined as ≥1 dispensing in the last quarter of 2021. Logistic regression was used to identify factors associated with the absence of LLT use.</div></div><div><h3>Findings</h3><div>In 2021, 2,206,305 individuals (4.89 % among 45,082,270 adults) had established ASCVD (mean age: 72.2 years; 36.9 % women), including 56.1 % with coronary artery disease, 40.4 % with cerebrovascular disease, and 14.5 % with revascularized peripheral artery disease (PAD). Among the 2,056,354 patients alive on 31st December 2021, 32.5 % did not receive any LLT, while 64.8 % received a statin (27.0 % a high-intensity statin), 13.0 % a combination of statin and ezetimibe, and 0.25 % a PCSK9 inhibitor. The absence of LLT use was significantly associated with female sex (adjusted odds ratio [aOR]:1.42, 95 %CI, 1.41–1.43); lowest/highest ages: &lt; 50 years (aOR (/65–74 years): 2.23, 95 %CI 2.20–2.27) and ≥ 85 years (aOR: 2.10, 95 %CI 2.08–2.13); and stroke and PAD, compared to myocardial infarction (aOR: 2.21, 95 %CI 2.19–2.23 and 1.88, 95 %CI 1.86–1.91, respectively).</div></div><div><h3>Interpretation</h3><div>In real life, one-third of French ASCVD patients was not regularly treated with LLT, highlighting the urgent need to develop implementation strategies for lipid management.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 3","pages":"Article 101638"},"PeriodicalIF":4.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660197","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":"Practical implementation of automated insulin delivery systems in 2025: A French position statement update","authors":"E Bismuth ,&nbsp;M Joubert ,&nbsp;E Renard ,&nbsp;N Tubiana-Rufi ,&nbsp;L Chaillous ,&nbsp;E Bonnemaison ,&nbsp;H Hanaire ,&nbsp;R Coutant ,&nbsp;P Schaepelynck ,&nbsp;J Beltrand ,&nbsp;Y Reznik ,&nbsp;F Authier ,&nbsp;S Borot ,&nbsp;S Brunot ,&nbsp;C Calvez ,&nbsp;G Charpentier ,&nbsp;F Dalla-Vale ,&nbsp;A Delawoevre ,&nbsp;B Delemer ,&nbsp;A Desserprix ,&nbsp;PY Benhamou","doi":"10.1016/j.diabet.2025.101637","DOIUrl":"10.1016/j.diabet.2025.101637","url":null,"abstract":"<div><div>The advent of automated insulin delivery (AID) systems in 2020 marked a disruptive event in managing type 1 diabetes, benefiting children and adults alike. By 2024, advances in real-world data and research motivated an update to the French consensus on AID systems to expand accessibility, refine guidelines, and optimize patient follow-up.</div><div>AID systems have consistently improved glycemic control by reducing HbA1c, increasing time-in-range (TIR), and minimizing hypoglycemia, with significant benefits even for specific populations such as individuals with poor glycemic control, brittle diabetes, children, very young children, pregnant women, those with insulin resistance or gastroparesis, or after bariatric surgery. Recent studies support the broadening of AID indications for these special situations, also demonstrating safe transitions directly from multiple daily injections. A careful selection of the most appropriate system for these special situations is essential to achieve optimal personalization for each patient.</div><div>Training healthcare professionals and patients remains essential for optimizing AID usage. Updated guidelines emphasize multidisciplinary education, telemonitoring, and individualized follow-up to ensure safety and efficacy.</div><div>The potential of fully automated systems and adjunctive therapies, such as GLP-1 receptor agonists, is being explored alongside promising evidence that AID systems improve glycemic control in type 2 diabetes without increasing hypoglycemia. The future of AID systems lies in innovation and expanding their applicability across diverse patient populations.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 3","pages":"Article 101637"},"PeriodicalIF":4.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618025","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":"Real-world use and effectiveness of tirzepatide among people without evidence of type 2 diabetes in the United States","authors":"Emily R. Hankosky ,&nbsp;Karishma Desai ,&nbsp;Chanadda Chinthammit ,&nbsp;Michael Grabner ,&nbsp;Grace Stockbower ,&nbsp;Xuanyao He ,&nbsp;Donna Mojdami ,&nbsp;Cachet Wenziger ,&nbsp;Theresa Hunter Gibble","doi":"10.1016/j.diabet.2025.101636","DOIUrl":"10.1016/j.diabet.2025.101636","url":null,"abstract":"<div><h3>Aim</h3><div>To understand treatment patterns and effectiveness of tirzepatide among people without type 2 diabetes (T2D) in the US.</div></div><div><h3>Methods</h3><div>This retrospective, observational, descriptive study used the Healthcare Integrated Research Database (index date: first-observed tirzepatide claim; index period: May 13, 2022–May 24, 2023). Key eligibility criteria were: age ≥ 18 years; ≥ 1 tirzepatide claim; no T2D diagnosis codes or glycated hemoglobin ≥ 6.5 %, no anti-diabetes medications (except metformin); and continuous medical/pharmacy enrollment for ≥ 12 months pre-index (Overall cohort). Tirzepatide persistence and utilization (6-months post-index) were assessed among obesity management medication (OMM)-eligible individuals (body mass index [BMI] ≥ 30 kg/m², or ≥ 27 kg/m² with ≥ 1 obesity-related complication [ORC]; OMM-eligible cohort). Tirzepatide effectiveness was assessed among individuals who were OMM-eligible, naive to glucagon-like peptide-1 receptor agonists, and persistent on tirzepatide for ≥6 months (Persistent+GLP-1 naive cohort).</div></div><div><h3>Results</h3><div>The overall cohort included 4,177 individuals with mean age 46.0 years, 75.6 % female, and mean BMI 37.1 kg/m². At baseline, 73.8 % of individuals had ≥ 1 ORC while 51.0 % had ≥ 2 ORCs. Persistence in the OMM-eligible cohort was 73.8 %; by the sixth prescription fill, 56.2 % were receiving &lt; 10 mg tirzepatide. Individuals in the Persistent+GLP-1 naive cohort with pre- and post-index weight and BMI measurements (<em>n</em> = 200) achieved mean weight reduction of 12.9 % at 6-months post-index (≥ 5 %: 88.5 %; ≥ 10 %: 69.0 %).</div></div><div><h3>Conclusion</h3><div>Real-world evidence suggests multimorbidity among tirzepatide initiators, slower tirzepatide dose escalation than in clinical trials, and clinically meaningful weight reduction among people persisting on tirzepatide for ≥ 6 months.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 3","pages":"Article 101636"},"PeriodicalIF":4.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589161","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":"Advancing type 1 diabetes treatment: A breakthrough in stem cell therapy","authors":"Zainab Anfaal,&nbsp;Zmarak Ahmed Khan","doi":"10.1016/j.diabet.2025.101635","DOIUrl":"10.1016/j.diabet.2025.101635","url":null,"abstract":"<div><div>Type 1 diabetes, an autoimmune condition leading to insulin deficiency, has long relied on intensive insulin therapy for management. A groundbreaking clinical trial has demonstrated the potential of chemically induced pluripotent stem cell (CiPSC)-derived islets to revolutionize treatment. By using patient-specific islets, this approach minimizes rejection risk and reduces reliance on immunosuppressants. A 25-year-old patient achieved insulin-independent glycemic control with successful islet engraftment and improved glucose regulation. While the use of immunosuppressants in the study limits insights into autoimmune responses, the trial underscores a significant leap in managing type 1 diabetes, paving the way for personalized regenerative therapies.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 3","pages":"Article 101635"},"PeriodicalIF":4.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589018","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":"Association of daily sleep duration with risk of metabolic dysfunction-associated steatotic liver disease and adverse liver outcomes","authors":"Qian Wang ,&nbsp;Huiyi Chen ,&nbsp;Huiling Deng ,&nbsp;Minyi Zhang ,&nbsp;Haoyue Hu ,&nbsp;Haotong Ouyang ,&nbsp;Lien Ma ,&nbsp;Ruiyan Liu ,&nbsp;Jian Sun ,&nbsp;Guifang Hu ,&nbsp;Kaifeng Wang","doi":"10.1016/j.diabet.2025.101628","DOIUrl":"10.1016/j.diabet.2025.101628","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease worldwide, leading to substantial disease burden globally. Whether sleep duration is associated with the risk of MASLD, cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality remains underexplored.</div></div><div><h3>Methods</h3><div>A total of 489,261 middle-aged and older adults from the UK Biobank without prior liver diseases were included. The primary outcome was MASLD, with secondary outcomes, including cirrhosis, HCC, and liver-related mortality ascertained through linked hospital records and death registries. Sleep duration was self-reported at baseline survey and categorized into ≤ 5, 6, 7, 8 and ≥ 9 hours.</div></div><div><h3>Results</h3><div>During a median (IQR) follow-up of 13.8 (1.5) years, 7,133 MASLD, 5,527 cirrhosis, 1,126 HCC, and 1,125 liver-related mortality cases were identified. After adjusting for potential confounders, the HRs [95% CIs] of MASLD were 1.44 [1.32;1.57], 1.17 [1.09;1.24], 1.00 (reference), 1.05 [0.99;1.11] and 1.35 [1.24;1.46] for ≤ 5, 6, 7, 8 and ≥ 9 hours of sleep duration, respectively. Similar trends were also observed for cirrhosis, HCC, and liver-related mortality. In addition, the U-shaped association between sleep duration and MASLD was more pronounced among participants without abnormal body mass index (overweight and obese), hypertension or insomnia (<em>P</em> for interaction &lt;0.05).</div></div><div><h3>Conclusions</h3><div>Both short and long sleep duration are associated with an increased risk of MASLD, cirrhosis, HCC, and liver-related mortality. Maintaining a moderate sleep duration of 7 to 8 hours per day could be crucial to prevent against this escalating public health concern.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 3","pages":"Article 101628"},"PeriodicalIF":4.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472733","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":"Semaglutide 2.4 mg in French people living with Class 3 obesity and comorbidities: Baseline characteristics and real-world safety data","authors":"Emmanuel Disse ,&nbsp;Judith Aron-Wisnewsky ,&nbsp;David Jacobi ,&nbsp;Karine Clément ,&nbsp;Martine Laville ,&nbsp;Cyril Gauthier ,&nbsp;François Pattou ,&nbsp;Julie Molleville ,&nbsp;Melissa Akerib ,&nbsp;Lysiane Jubin ,&nbsp;Blandine Gatta-Cherifi ,&nbsp;Bénédicte Gaborit ,&nbsp;Emilie Montastier ,&nbsp;Fabien Stenard ,&nbsp;Claire Carette ,&nbsp;Najate Achamrah ,&nbsp;Antoine Avignon ,&nbsp;Sébastien Czernichow","doi":"10.1016/j.diabet.2025.101625","DOIUrl":"10.1016/j.diabet.2025.101625","url":null,"abstract":"<div><h3>Aim</h3><div><em>-</em> To describe baseline characteristics and safety data of real-world use of semaglutide 2.4 mg.</div></div><div><h3>Methods</h3><div><em>-</em> Patients with a body mass index (BMI) ≥40 kg/m² and at least one of the following treated weight-related comorbidities (WRC: hypertension, dyslipidemia, obstructive sleep apnea, cardiovascular disease) were eligible to receive treatment through Temporary Utilization Authorization (TUA: March to June 2022) or Early Access Program (EAP: July 2022 to October 2023). Data were collected according to Health Authorities’ requirements. Only descriptive statistics were used.</div></div><div><h3>Results</h3><div><em>-</em> Overall, 5,797 (62.8%) treatment requests were sent by sites specialized in obesity management. In total, 478 and 8,568 patients were treated within TUA and EAP cohorts respectively, with mean follow-up durations of 1.2 and 4.5 months, respectively. Mean (SD) BMI was 48.9 (9.7) and 47.0 (7.4) kg/m², respectively. Age ranged from 18 to 81 years. In the EAP, 57.4%, 26.5%, 12.3% and 3.7% of patients had 1, 2, 3 and 4 WRC. In addition, 15.5% had type 2 diabetes, 18.1% reported depression and 15.4% had osteoarthritis. In the EAP, 247 (2.9%) patients discontinued treatment after a median time of 2.8 months (IQR: 1.2–5.1), mainly due to adverse events (AEs) (47.0%). During TUA, 3 patients discontinued due to AEs. Pancreatitis was reported in 7 cases overall.</div></div><div><h3>Conclusion</h3><div><em>-</em> The high number of treatment prescriptions in a short period highlights the high unmet medical need. No new safety concerns were identified in this population with severe obesity treated in a real-world setting.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 3","pages":"Article 101625"},"PeriodicalIF":4.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143461562","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":"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}