Diabetes/Metabolism Research and Reviews最新文献

{"title":"Long-Term Mortality in Diabetic Foot Disease is Higher Than That of Overall Cancer: Results From Three International Cohorts","authors":"Qinglian Zeng,&nbsp;Ziwei Tang,&nbsp;Xiangjun Chen,&nbsp;Linlin Zhan,&nbsp;Victoria Balasubramanian,&nbsp;Zhihao Chen,&nbsp;Manman Du,&nbsp;Qi Zhang,&nbsp;Fei Lian,&nbsp;Xiaoru Zhang,&nbsp;Qing Liang,&nbsp;Wenrui Zhao,&nbsp;Xun Li,&nbsp;Mengyao Zhang,&nbsp;Qifu Li,&nbsp;Shumin Yang,&nbsp;Jinbo Hu,&nbsp;Qingfeng Cheng,&nbsp;Hang Shen","doi":"10.1002/dmrr.70221","DOIUrl":"10.1002/dmrr.70221","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guidelines suggest that the risk of mortality in diabetic foot disease (DFD) is comparable to that of cancer; however, high-quality evidence is lacking. We aimed to compare the mortality of DFD with that of various cancers based on data from international cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We defined DFD according to the IWGDF 2023 guidelines, and cancer was defined based on the ICD-10 codes. We included 527, 1784, and 601 patients with DFD and 1219, 100,643, and 152 patients with cancer from the National Health and Nutrition Examination Survey (NHANES), UK Biobank (UKB), and Chongqing Diabetes Registration (CDR) cohorts, respectively. We compared the risk of mortality between DFD and overall or site-specific cancers in the same cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with DFD showed 38%, 45%, and 499% higher risks of mortality than patients with overall cancer in the NHANES, UKB, and CDR. For site-specific cancer, the risk of mortality was significantly higher in DFD than in skin cancer (hazard ratio 10.69, 95% CI: 1.37–2.07 in NHANSE; 3.8, 3.72–448 in UKB), breast cancer (1.35, 1.0–1.83 in NHANSE; 1.95, 1.67–227 in UKB), and prostate cancer (1.4, 1.8–179 in NHANSE; 2.61, 2.35–289 in UKB). The mortality rate of DFD is similar to that of most types of cancer, such as colon cancer, lymphoma, and kidney cancer, and is lower than that of a minority of cancers, including lung, pancreatic, and liver cancers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with DFD have a higher risk of mortality than overall cancer, particularly skin, breast, and prostate cancers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"42 6","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907767","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":"Redefining Obesity Risk for Heart Failure: Incorporating Morbidity Into the 2024 EASO Framework Definition of Obesity","authors":"Liang Tang,&nbsp;Xianming Tang,&nbsp;Zhenhua Xing,&nbsp;Chenkai Wu","doi":"10.1002/dmrr.70227","DOIUrl":"10.1002/dmrr.70227","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Conventional BMI-based obesity classification fails to capture the metabolic heterogeneity underlying obesity-related heart failure (HF) risk. We evaluated the 2024 European Association for the Study of Obesity (EASO) framework—which integrates central adiposity with medical, functional, and psychological morbidity—to refine HF risk stratification.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among 449,550 UK Biobank participants (median follow-up 15.5 years), we applied three obesity definitions: (1) BMI ≥ 30 kg/m&lt;sup&gt;2&lt;/sup&gt;; (2) the EASO framework, which retains the normal-weight category (BMI 18.5–&lt; 25 kg/m&lt;sup&gt;2&lt;/sup&gt;) and reclassifies individuals with BMI 25–&lt; 30 kg/m&lt;sup&gt;2&lt;/sup&gt; into ‘EASO overweight’ (WHtR &lt; 0.5 and/or absence of morbidity) or ‘EASO new obesity’ (WHtR ≥ 0.5 plus ≥ 1 morbidity), while those with BMI ≥ 30 kg/m&lt;sup&gt;2&lt;/sup&gt; are classified as BMI obesity regardless of morbidity status; and (3) an extended EASO framework that additionally stratifies individuals with BMI ≥ 30 kg/m&lt;sup&gt;2&lt;/sup&gt; by morbidity status. Morbidity was defined per the 2024 EASO consensus criteria as the presence of ≥ 1 medical, functional, or psychological conditions associated with excess adiposity. Cox proportional hazard models estimated hazard ratios (HRs) for incident HF.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The EASO framework reclassified 15.6% of conventionally overweight individuals as obese, increasing the obesity prevalence from 24.5% to 40.1%. Compared with normal-weight individuals, the EASO overweight group (BMI 25–&lt; 30 kg/m&lt;sup&gt;2&lt;/sup&gt; without central adiposity or morbidity) exhibited the lowest HF risk (HR 0.84, 95% CI 0.80–0.89), confirming that overweight per se confers no excess risk in the absence of morbidity. By contrast, EASO new obesity (BMI 25–&lt; 30 kg/m&lt;sup&gt;2&lt;/sup&gt; with central adiposity and ≥ 1 morbidity; HR 1.32, 95% CI 1.25–1.39) demonstrated that morbidity presence—not BMI threshold—drives elevated HF risk within the overweight range. BMI obesity (BMI ≥ 30 kg/m&lt;sup&gt;2&lt;/sup&gt;) yielded the highest summary HR (1.62, 95% CI 1.53–1.71), reflecting its compositional enrichment with high-morbidity individuals rather than superior risk discrimination. In the extended framework, morbidity status produced a consistent vertical upward shift in HF risk across all adiposity categories, establishing phenotypic characterisation beyond anthropometric thresholds as the key determinant of HF vulnerability.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The EASO framework refines HF","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"42 6","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907717","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":"Clinical Severity of Diabetic Ketoacidosis by SGLT2 Inhibitors Use: A Retrospective Observational Study","authors":"Mor Naaman,&nbsp;Tamar Fisher-Negev,&nbsp;Genya Aharon-Hananel,&nbsp;Tehila Harel,&nbsp;Avivit Cahn","doi":"10.1002/dmrr.70226","DOIUrl":"10.1002/dmrr.70226","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Sodium glucose cotransporter 2 inhibitors (SGLT2i) are commonly used glucose lowering agents with established cardiac and kidney benefits. Diabetic ketoacidosis (DKA) is a rare complication associated with their use, which entails significant morbidity and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This retrospective observational study included patients with diabetes (any) admitted with DKA to a large tertiary hospital. Demographic, clinical and laboratory data were extracted from electronic medical records. Outcomes included DKA severity as determined by nadir pH, duration of stay, need for intensive care (ICU) and inpatient mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline SGLT2i use was documented in 27/191 patients (14.1%). SGLT2i users had lower nadir pH (7.08 ± 0.15 vs. 7.15 ± 0.12, <i>p</i> = 0.006) and were more likely to have severe DKA (29.6% vs. 12.2%, <i>p</i> = 0.007). After adjusting for multiple covariates, SGLT2i use remained independently associated with DKA severity. ICU admission and hospitalisation duration did not differ between the groups. Inpatient mortality occurred in 3/27 users and 3/164 non-users, while the composite outcome of mortality and/or ICU admission was similar (74.1% vs. 72.0%, <i>p</i> = 0.819). Findings remained consistent after excluding patients with new-onset diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among patients hospitalised with DKA in a large tertiary centre, SGLT2i use was associated with a more severe biochemical presentation, reflected by a lower nadir pH. The observed difference in inpatient mortality was based on few events and should be interpreted cautiously.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"42 6","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907762","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":"Latent Cardiometabolic Phenotypes and Their Sociodemographic Correlates Among US Adults: A Cross-Sectional Latent Class Analysis Using NHANES (2011–2018) Data","authors":"Greeshma Unnikrishnan,&nbsp;Abhinav Singh,&nbsp;K. R. Harijith","doi":"10.1002/dmrr.70225","DOIUrl":"10.1002/dmrr.70225","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The study aims to identify distinct cardiometabolic phenotypes based on multiple metabolic risk indicators, assess their associations with sociodemographic characteristics, and evaluate income-related differences through cardiometabolic risk using decomposition methods to quantify the contribution of observed factors to these disparities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A cross-sectional analytical study was conducted using National Health and Nutrition Examination Survey (NHANES) 2011–2018 data. Adults aged 20 years and above with complete cardiometabolic biomarker data were included. Six cardiometabolic indicators including waist circumference, systolic blood pressure, fasting plasma glucose, glycated haemoglobin, triglycerides, and high-density lipoprotein cholesterol were used to derive latent phenotypes using latent class analysis. Multinomial logistic regression examined associations between sociodemographic factors and phenotype membership. Oaxaca-Blinder decomposition analysis assessed income-related disparities in the high cardiometabolic risk phenotype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 7733 participants were included in the analysis. A three class model demonstrated optimal fit and identified metabolically healthy (54.9%), hypertension-hyperglycemia (33.1%) and high cardiometabolic risk (11.9%) phenotypes. The high-risk phenotype exhibited elevated probabilities of obesity, dyslipidemia and glycaemic abnormalities. Increasing age, male sex, lower income and lower educational attainment were significantly associated with high risk phenotype membership. Decomposition analysis demonstrated modest income-related disparities, with waist circumference and education contributing the largest explained components.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cardiometabolic risk among U.S. adults clusters into three distinct phenotypes associated with sociodemographic and metabolic determinants. These findings highlight the need for integrated strategies targeting early metabolic dysregulation and broader social determinants of health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"42 6","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867219","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":"Global Epidemiology of Diabetic Foot: A Systematic Review and Meta-Analysis","authors":"Massimo Carollo,&nbsp;Ylenia Ingrasciotta,&nbsp;Salvatore Crisafulli,&nbsp;Francesco Maccarrone,&nbsp;Daniela Pellegrino,&nbsp;Alberto Francescon,&nbsp;Edoardo Mannucci,&nbsp;Andrea Fontana,&nbsp;Gianluca Trifirò","doi":"10.1002/dmrr.70223","DOIUrl":"10.1002/dmrr.70223","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Diabetic foot (DF) disease, including ulcerations, amputations, and infections, represents a major cause of morbidity and mortality in individuals with diabetes mellitus (DM). Despite their substantial clinical, social, and economic burden, robust global epidemiological estimates remain limited due to fragmented evidence and heterogeneous methodologies. This systematic review and meta-analysis aimed to provide reliable pooled estimates of incidence and prevalence of DF disease, to explore geographic and demographic variations, and to assess the types of data sources available for epidemiological research.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Following PRISMA guidelines (PROSPERO registration CRD42025640944), PubMed, Embase, CINAHL Plus, and Cochrane Library were systematically searched from inception to December 21, 2024, for observational studies in adults (≥ 18 years) with DM reporting epidemiological measures of DF disease. Data extraction and quality appraisal (Joanna Briggs Institute checklists) were independently performed by four reviewers. Random-effects meta-analyses were conducted using generalised linear mixed-effects models to calculate pooled complication-specific prevalence and incidence rates among patients with diabetes. Heterogeneity among study estimates was assessed using Cochran's Q test, I&lt;sup&gt;2&lt;/sup&gt; statistic, and the between-study variance (&lt;i&gt;τ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;). To identify sources of heterogeneity, meta-regression analyses were performed considering study-level covariates (modifiers).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Eighty-nine studies were included (18 prospective cohorts, 33 retrospective cohorts, 38 cross-sectional), enrolling between 92 and 29,650,811 participants, with data from Europe (&lt;i&gt;N&lt;/i&gt; = 29, 32.6%), Asia (&lt;i&gt;N&lt;/i&gt; = 25, 28.1%), Africa (&lt;i&gt;N&lt;/i&gt; = 16, 18.0%), America (&lt;i&gt;N&lt;/i&gt; = 16, 18.0%), and Oceania (&lt;i&gt;N&lt;/i&gt; = 3, 3.4%). Pooled global incidence rates were 10.93 cases/1000 person-years (95% CI, 6.67–17.91) for ulcerations, 3.58 (95% CI, 1.93–6.63) for amputations, and 19.11 (95% CI, 4.81–75.97) for infections. Pooled prevalence estimates were 54.57 cases/1000 persons (95% CI, 37.63–78.52) for active ulcerations, 72.63 (95% CI, 48.21–108.02) for past ulcerations, 14.75 (95% CI, 9.52–22.77) for amputations, and 39.17 (95% CI, 6.81–195.07) for infections. Substantial heterogeneity (I&lt;sup&gt;2&lt;/sup&gt; &gt; 90%) was observed, with significant modifiers including geographical region, diabetic foot identification method, data source, study setting, age, diabetes duration, and length of follow-up. Rates in America and Africa were generally above the global","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"42 6","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867244","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":"B Lymphocytes in Latent Autoimmune Diabetes in Adults: From Autoimmune Activation to Immunometabolic Heterogeneity and Precision Therapeutic Perspectives","authors":"Moncef Zouali","doi":"10.1002/dmrr.70224","DOIUrl":"10.1002/dmrr.70224","url":null,"abstract":"<p>Latent autoimmune diabetes in adults (LADA) is a heterogeneous form of autoimmune diabetes characterised by adult onset, the presence of islet autoantibodies, and a slower progression to insulin dependence compared with classical type 1 diabetes. Positioned at the interface of type 1 and type 2 diabetes, LADA arises from complex interactions among genetic susceptibility, immune dysregulation, and metabolic stress. While autoreactive T cells are recognized as central mediators of β-cell destruction, accumulating evidence indicates that B lymphocytes play a broader and dynamic role in disease pathogenesis than previously appreciated. Beyond autoantibody production, B cells contribute to LADA through antigen presentation, cytokine secretion, and regulation of T cell responses, thereby amplifying autoimmune circuits within pancreatic islets. Emerging studies further demonstrate perturbations in circulating B cell subsets, including expansion of memory B cells and plasmablasts and impairment of regulatory B cells. However, whether these alterations represent primary drivers of disease progression or secondary responses to ongoing β-cell injury remains unresolved. In parallel, immunometabolic stress and β-cell dysfunction promote neoantigen formation and may shape B cell activation and selection, linking metabolic perturbations to adaptive immune dysregulation. Together, these findings support a model in which B lymphocytes act as both effector and regulatory components within a dynamic immunometabolic network that determines disease heterogeneity and progression. Recent advances in molecular profiling have further revealed distinct LADA endotypes, particularly stratified by glutamic acid decarboxylase antibody levels, suggesting divergent autoimmune and metabolic contributions across patient subgroups. These insights provide a rationale for precision medicine approaches and highlight B lymphocyte-targeted interventions as potential, although still investigational, therapeutic strategies aimed at preserving residual β-cell function.</p>","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"42 6","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/dmrr.70224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841930","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":"Left Ventricular Global Longitudinal Strain as a Marker of Subclinical Myocardial Dysfunction in Youths With Type 1 Diabetes Mellitus: An Updated Systematic Review and Meta-Analysis","authors":"Athina Stamati,&nbsp;Georgia Sotiriou,&nbsp;Elpida Emmanoulidou-Fotoulaki,&nbsp;Nikoleta Printza,&nbsp;Maria Kavga,&nbsp;Athanasios Christoforidis","doi":"10.1002/dmrr.70220","DOIUrl":"10.1002/dmrr.70220","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To assess Left Ventricular Global Longitudinal Strain (LV GLS) in youths with type 1 diabetes mellitus (T1DM) compared with healthy controls, as a marker of subclinical myocardial dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE, the Cochrane Library, Scopus and the Web of Science up to November 2025 for studies comparing speckle-tracking-derived LV GLS in paediatric T1DM and healthy controls. Random-effects meta-analyses focused on two-dimensional LV GLS, with exploratory three-dimensional analyses, vendor-based subgroup analyses and meta-regression for age, diabetes duration and HbA1c.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty studies met the inclusion criteria. Eighteen studies (1086 youths with T1DM, 935 controls) were included in the primary 2D LV GLS analysis. Compared with controls, youth with T1DM had significantly impaired 2D LV GLS (mean difference −2.87%, 95% CI −4.03 to −1.71), with substantial heterogeneity (I² = 96.2%). Exploratory 3D GLS analysis with three studies showed no significant between-group differences, and meta-regression revealed no associations with age, diabetes duration or HbA1c.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Children and adolescents with T1DM show impaired left ventricular longitudinal deformation despite preserved conventional systolic indices, indicating early subclinical myocardial dysfunction. However, given the substantial heterogeneity and low certainty of current evidence, future standardized longitudinal studies are warranted. Ultimately, with the increasing use of speckle-tracking echocardiography, GLS may serve as a valuable tool for cardiovascular risk stratification in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"42 6","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814177","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":"How Do Poverty, Insurance, and Government Assistance Impact Diabetic Foot Ulcer Outcomes? A Scoping Review","authors":"Jamie N. LaMantia,&nbsp;Devan McClain,&nbsp;Abigail Daniele,&nbsp;Michael S. Conte,&nbsp;Maya Fayfman,&nbsp;Alisha Oropallo,&nbsp;Marcos C. Schechter,&nbsp;Cathie Spino,&nbsp;Wen Ye,&nbsp;James C. Iannuzzi,&nbsp;Meghan B. Brennan","doi":"10.1002/dmrr.70219","DOIUrl":"https://doi.org/10.1002/dmrr.70219","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The social drivers of diabetic foot disease (SDDFD) impact ulcer incidence and outcomes, but <i>how</i> is relatively unknown. We aimed to build a conceptual model positing how three SDDFD—poverty, insurance, and government assistance—influence outcomes for patients with diabetic foot ulcers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>To inform the model, we conducted a scoping review of studies linking poverty, insurance, and/or government assistance with diabetic foot ulcer outcomes using Levac and colleagues' 6-stage framework, the Preferred Reporting Items for Systematic Review and Meta-analysis extension for scoping reviews, and the SPIDER tool. We searched PubMed, CINAHL, and Embase for original research articles set in the United States and published between 1 January 2005 and 7 November 2025. We excluded those published in a language other than English, case reports, abstracts, and studies of other SDDFD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data from 35 included studies informed our conceptual model, depicting a complex causal pathway between SDDFD and outcomes, often mediated by healthcare system factors and moderated by patients' abilities to adhere to healthcare recommendations. Multidisciplinary teams might ameliorate the risk of amputations associated with poverty, lack of insurance, or qualifying for government assistance. Additionally, the model highlights reinforcing feedback loops, both positive and negative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our model can be used to inform mediation and moderation analyses and help avoid collider-conditioning bias during statistical analyses. It can help identify potential points of intervention within the healthcare system for those working to dampen the negative effects of SDDFD on outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"42 6","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/dmrr.70219","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148785165","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":"Predictive Value for Preeclampsia of sFlt-1:PlGF Ratio in Pregnancy Complicated by Gestational Diabetes","authors":"Fabrizia Citro,&nbsp;Cristina Bianchi,&nbsp;Francesca Nicolì,&nbsp;Michele Aragona,&nbsp;Giovanni De Gennaro,&nbsp;Stefano Del Prato,&nbsp;Giuseppe Penno,&nbsp;Alessandra Bertolotto,&nbsp;Lorella Battini","doi":"10.1002/dmrr.70217","DOIUrl":"https://doi.org/10.1002/dmrr.70217","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Gestational diabetes (GDM) and preeclampsia (PE) are major complications of pregnancy. The ratio of soluble Fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF) may predict the short-term absence of PE in pregnant women with clinically suspected PE. The aim of this study was to determine the role of placental angiogenic factors in predicting PE risk in women with pregnancies complicated by GDM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>In this prospective observational study, pregnant women were enrolled at the time of screening for GDM. sFlt-1 and PlGF were measured at 24–28, 28–32 and 35–37 weeks of gestation. Univariate and multivariate analysis were used to investigate risk factors for PE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 398 women, 213 (53.5%) had GDM and 18 (5%) developed PE (67% with GDM). GDM women developing PE had significantly lower levels of PlGF at 24–28, 28–32 and 35–37 gestational weeks, and higher sFlt1 and sFlt1/PlGF at 28–32 and 35–37 gestational weeks compared with GDM women without PE. On a multivariate analysis, PlGF and sFlt1/PlGF were associated with PE, regardless of other clinical data. A sFlt1/PlGF ratio &gt; 38 at 28–32 gestational weeks identified GDM women at risk of developing PE within the ensuing 4 weeks, with 100% sensitivity and good specificity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In women with GDM, the sFlt1/PlGF ratio can identify those at higher risk of PE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>NCT04877119: 2021-04-29</p>\u0000 </section>\u0000 </div>","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"42 6","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/dmrr.70217","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784921","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":"When Glycaemic Control Comes Too Fast: Treatment-Induced Neuropathy of Diabetes and Charcot Neuro-Osteoarthropathy as Emerging Iatrogenic Complications of Rapid Metabolic Correction","authors":"Dured Dardari","doi":"10.1002/dmrr.70210","DOIUrl":"https://doi.org/10.1002/dmrr.70210","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose of Review</h3>\u0000 \u0000 <p>Diabetes therapeutics can lower glycated haemoglobin (HbA1c) by several percentage points within weeks. While long-term microvascular risk is reduced by improved glycaemia, abrupt metabolic transitions may destabilise tissues adapted to chronic hyperglycemia. We review treatment-induced neuropathy of diabetes (TIND) and active Charcot neuro-osteoarthropathy (CNO) as two neurovascular complications reported after rapid glycaemic correction, and we propose a unifying ‘metabolic tempo’ framework for prevention and early detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Recent Findings</h3>\u0000 \u0000 <p>TIND is an acute, painful small-fibre and autonomic neuropathy occurring within 2–8 weeks after large HbA1c reductions, frequently coinciding with early worsening of retinopathy and nephropathy. Human in vivo nerve imaging demonstrates epineurial arteriovenous shunting and proliferative, leaky microvessels, supporting a microvascular dysregulation/ischaemia-reperfusion model. For CNO, causal evidence linking rapid glycaemic improvement to disease onset remains limited and mainly observational; however, multiple case reports (including pregnancy, post-transplantation, and major weight loss contexts) and retrospective cohorts suggest that major glycaemic ‘deceleration’ may cluster in the months preceding active CNO in susceptible patients with long-standing neuropathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>Rapid glycaemic correction should not be avoided when urgently needed, but ‘tempo-aware’ strategies may be warranted in microvascularly fragile patients (very high baseline HbA1c, established neuropathy/retinopathy, kidney disease, or major weight loss). We outline pragmatic risk stratification, surveillance, and interdisciplinary pathways (neurology-podiatry-ophthalmology-nephrology) to reduce delayed diagnosis and prevent deformity and disability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"42 6","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/dmrr.70210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784920","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}