Journal of Diabetes Research最新文献

{"title":"Longitudinal Trajectories of Albuminuria and eGFR in Type 2 Diabetes Mellitus: Natural Progression of Diabetic Kidney Disease.","authors":"Xiuqi Qiao, Qingyun Cai, Yanxiang Luo, Lixin Guo, Qi Pan","doi":"10.1155/jdr/9269085","DOIUrl":"10.1155/jdr/9269085","url":null,"abstract":"<p><p><b>Background:</b> This longitudinal cohort study is aimed at examining the natural progression trajectories of diabetic kidney disease (DKD) in Type 2 diabetes mellitus (T2DM), assessing estimated glomerular filtration rate (eGFR) and albuminuria patterns over time. <b>Methods:</b> This longitudinal observational study analyzed 694 hospitalized patients with T2DM, featuring a cohort with a median age of 59.0 years (interquartile range [IQR] 52.2-67.0) and a median diabetes duration of 12.0 years (IQR 6.0-18.0). The baseline population included 258 female participants (37.2%), with longitudinal data collected over a 4.5-year follow-up period conducted between March 2013 and January 2025. DKD was diagnosed per the 2024 ADA Standards of Medical Care in Diabetes. Disease severity stratification employed two validated biomarkers: urinary albumin excretion rate (AER) and eGFR calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. <b>Results:</b> The analytical cohort comprised 421 participants in the urinary AER group and 487 in the eGFR group. Baseline albuminuria stratification revealed 61.3% normoalbuminuria, 36.6% microalbuminuria, and 2.4% macroalbuminuria. Over 4.5 years of follow-up, 9.9% demonstrated albuminuria stage progression. The prevalence of G1, G2, G3, and G4 was 51.4%, 37.7%, 10.5%, and 0.5%, respectively, with 32.5% exhibiting renal function deterioration. Albuminuria progression correlated with smoking, alcohol consumption, elevated baseline thyroid-stimulating hormone (TSH), and increasing waist circumference, while eGFR decline associated with male sex, advanced age, prolonged diabetes duration, and elevated baseline urinary AER. <b>Conclusion:</b> Longitudinal analysis of T2DM patients revealed an escalation in the prevalence of micro- or macroalbuminuria and renal dysfunction. Disease progression predominated over regression across the cohort. Key modifiable risk factors associated with DKD progression included tobacco use, alcohol intake, elevated baseline TSH, increasing waist circumference, male sex, age, prolonged diabetes duration, and elevated baseline urinary AER.</p>","PeriodicalId":15576,"journal":{"name":"Journal of Diabetes Research","volume":"2025 ","pages":"9269085"},"PeriodicalIF":3.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Evaluation of the Impact of a Multidisciplinary One-Year Online Lifestyle Intervention on Type 2 Diabetes Remission in Nonobese Indian Patients.","authors":"Pramod Tripathi, Anagha Vyawahare, Nidhi Kadam, Diptika Tiwari, Baby Sharma, Thejas Kathrikolly, Malhar Ganla, Banshi Saboo","doi":"10.1155/jdr/3783469","DOIUrl":"https://doi.org/10.1155/jdr/3783469","url":null,"abstract":"<p><p><b>Background and Objective:</b> Despite the high prevalence of T2D among nonobese Indians, there is a notable lack of comprehensive lifestyle intervention studies that target this population. This retrospective study was aimed at filling this gap by evaluating the impact of a multidisciplinary 1-year online intensive lifestyle intervention (ILI) on T2D remission in nonobese Indian patients. <b>Methodology:</b> Retrospective data from medical records of 1453 nonobese patients (BMI 18.5-24.9 kg/m²) (aged > 18 years) who participated in a 1-year online subscription-based ILI program at the Freedom from Diabetes Clinic, India, between June 2020 and October 2023 were extracted for analysis. The program included a plant-based diet, physical activity regimens, psychological support, and medical management. Homeostatic model assessment of insulin resistance (HOMA2-IR) and beta cell function (HOMA2%B) were calculated. Remission was defined as maintaining glycated hemoglobin (HbA1C) < 6.5%, measured at least 3 months after cessation of glucose-lowering pharmacotherapy. <b>Results:</b> The study included 1453 patients (72% male), with a median age of 53 years (IQR: 15), BMI of 23 kg/m² (IQR: 2.2), and diabetes duration of 10.5 years (IQR: 10.4). Postintervention, significant changes were observed, including a reduction in weight (-1.5 kg), fasting blood glucose (-13.2 mg/dL), fasting insulin (-0.4 <i>μ</i>U/mL), HOMA2-IR (-0.07), and HbA1c (-1.2%), along with an increase in HOMA2%B (+3.1) (<i>p</i> < 0.05). Remission was observed in 24% of the patients. The study identified the baseline predictors of remission as being over 40 years of age at onset, having a diabetes duration of less than 6 years, maintaining good glycemic control (HbA1C ≤ 7%), and being drug-naïve. Postintervention factors, such as weight loss and improved beta cell function, were also significant predictors of remission (<i>p</i> < 0.05). <b>Conclusion:</b> These findings suggest that a multidisciplinary lifestyle intervention program can significantly improve glycemic control and promote T2D remission in nonobese Indian patients in a real-world setting, thereby highlighting the importance of early intervention and weight management in this population. <b>Trial Registration:</b> Clinical Trials Registry of India identifier: CTRI/2024/03/064596.</p>","PeriodicalId":15576,"journal":{"name":"Journal of Diabetes Research","volume":"2025 ","pages":"3783469"},"PeriodicalIF":3.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upregulation of SQSTM1 Regulates Ferroptosis and Oxidative Stress in Müller Cells of the Diabetic Neural Retina by Modulating ACSL4.","authors":"Xinlu Li, Bai Li, Defei Feng, Han Hu, Binyang Tang, Jingying Yang, Huaiyan Jiang, Li Li, Xiaojing Dong, Ninghua Ni, Yan Mei","doi":"10.1155/jdr/1924668","DOIUrl":"https://doi.org/10.1155/jdr/1924668","url":null,"abstract":"<p><p>Diabetic retinopathy (DR), a leading cause of vision impairment worldwide, is characterized by early neuronal damage in the retina, termed diabetic neuropathy in the retina (DNR). This condition is marked by neuronal apoptosis and glial activation. Müller glia are retinal cells highly susceptible to diabetic metabolic stress that may undergo ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation. However, the role of ferroptosis in DNR pathogenesis remains undefined. In this study, we investigated Müller cell injury under high-glucose and palmitic acid (HGP) conditions. The retinal tissues were obtained from normal rabbits and alloxan-induced diabetic rabbits. HGP exposure significantly reduced Müller cell viability, induced cell cycle arrest, and elevated proinflammatory cytokines. Ultrastructural analysis revealed mitochondrial damage, accompanied by decreased glutathione (GSH) and increased malondialdehyde (MDA), ferrous iron (Fe²⁺), and reactive oxygen species (ROS) levels. RNA sequencing (RNA-Seq) identified <i>SQSTM1</i> as a ferroptosis-related differentially expressed gene, which was significantly upregulated in HGP-treated cells. In vivo, DNR rabbits exhibited oxidative stress, iron dysregulation, and elevated SQSTM1 expression that colocalized with GFAP⁺ Müller cells. Single-cell RNA-Seq of human proliferative diabetic retinopathy (PDR) retinas confirmed elevated SQSTM1 expression in Müller cells compared to healthy control (HC) retinas. Mechanistically, <i>SQSTM1</i> knockdown attenuated ferroptosis, oxidative stress, and HGP-induced injury, while its overexpression exacerbated ferroptosis via ACSL4 upregulation. Overall, our findings suggest that SQSTM1 may serve as a critical mediator linking Müller cell dysfunction and ferroptosis in DNR pathogenesis, offering a novel potential therapeutic target.</p>","PeriodicalId":15576,"journal":{"name":"Journal of Diabetes Research","volume":"2025 ","pages":"1924668"},"PeriodicalIF":3.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Pathological Characteristics and Prognosis of Diabetic Nephropathy Patients With Tertiary Lymphoid Structures.","authors":"Yongjie Zhuo, Mengjie Weng, Jiaqun Lin, Xiaoting Wu, Kun Nie, Liyan Yang, Jiong Cui, Jianxin Wan","doi":"10.1155/jdr/6916580","DOIUrl":"https://doi.org/10.1155/jdr/6916580","url":null,"abstract":"<p><p><b>Purpose:</b> Chronic inflammation plays a key role in diabetic nephropathy (DN), yet the impact of tertiary lymphoid structures (TLSs) on disease progression remains poorly understood. This study explored the relationship between TLS maturity and renal outcomes in patients with DN. <b>Methods:</b> This study included 117 biopsy-confirmed DN patients from the First Affiliated Hospital of Fujian Medical University. Patients were grouped based on TLS maturity, as determined by immunohistochemical staining. Clinical, laboratory, and pathological data were gathered, and Cox regression models were applied to assess renal outcome risk factors. Kaplan-Meier curves were constructed to compare renal survival among groups. A web-based model integrating TLS maturity, urinary albumin-to-creatinine ratio (UACR), and renal pathology classification was developed. <b>Results:</b> Mature TLSs were associated with worse renal prognosis, with greater disease progression in the TLS+ group (75.4% vs. 53.3%, <i>p</i> = 0.006). Multivariate Cox regression analysis identified TLS maturity (HR = 1.819, 95% CI: 1.144-2.893, <i>p</i> = 0.011), DN glomerular classification (HR = 1.511, 95% CI: 1.057-2.160, <i>p</i> = 0.024), and UACR (HR = 1.121, 95% CI: 1.038-1.210, <i>p</i> = 0.004) as independent risk factors. The dynamic nomogram demonstrated strong predictive performance. <b>Conclusions:</b> TLS maturity independently predicts renal function decline in DN and may support personalized risk assessment through a web-based model.</p>","PeriodicalId":15576,"journal":{"name":"Journal of Diabetes Research","volume":"2025 ","pages":"6916580"},"PeriodicalIF":3.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Analysis of the Efficacy of Integrated Lifestyle Modifications in Managing Prediabetes in the Indian Population.","authors":"Pramod Tripathi, Diptika Tiwari, Nidhi Kadam, Anagha Vyawahare, Baby Sharma, Thejas Kathrikolly, Malhar Ganla, Banshi Saboo","doi":"10.1155/jdr/6172692","DOIUrl":"https://doi.org/10.1155/jdr/6172692","url":null,"abstract":"<p><p><b>Background:</b> Prediabetes is a growing health concern in India, with a prevalence of 15.3%. This retrospective study was aimed at assessing the effectiveness of an integrated intensive lifestyle intervention (ILI) in Indian patients with prediabetes while exploring sex- and body mass index (BMI)-based differences. <b>Methods:</b> This retrospective study analyzed data from 427 patients with prediabetes (HbA1c: 5.7%-6.4% not on insulin or oral hypoglycemic agents and aged 18-75 years) who underwent a 1-year online ILI program at the Freedom from Diabetes Clinic, India, between 2020 and 2023. The intervention consisted of a personalized plant-based diet, physical activity, psychological support, and medical management. Anthropometric and biochemical data were extracted from the clinical database, and logistic regression was used to identify factors associated with prediabetes remission. <b>Results:</b> At the end of the study, 47.1% of patients achieved prediabetes remission. Significant weight loss and improvements were observed in HbA1c, BMI, fasting blood glucose, fasting insulin, insulin resistance, lipid profile, and blood pressure (<i>p</i> < 0.05). Notably, 34% of patients lost > 10% of their body weight. Females achieved greater reductions in weight and BMI than males (<i>p</i> < 0.001). The BMI stratified analysis revealed higher remission rates in the obesity group (BMI ≥ 25 kg/m²) (49.9%) than in the nonobesity group (BMI 18-24.9 kg/m²) (37.0%) (<i>p</i> = 0.028). The obesity group showed greater improvements in glycemic parameters and insulin resistance than the nonobesity group (<i>p</i> < 0.05). Logistic regression identified age ≤ 50 years (OR: 2.15, 95% CI: 1.42-3.27), endline HOMA-IR < 2.5 (OR: 1.60, 95% CI: 1.01-2.45), and > 10% weight loss (OR: 3.72, 95% CI: 2.34-5.90) as significant factors associated with prediabetes remission. <b>Conclusions:</b> Prediabetes remission was achieved in almost half of the patients, highlighting the effectiveness of a tailored multidisciplinary approach for managing prediabetes in the Indian population. The study showed significant weight loss, improved glycemic control, and better lipid profiles and emphasized the need for personalized strategies for prediabetes management considering factors such as sex and BMI. <b>Trial Registration:</b> Clinical Trials Registry of India identifier: CTRI/2024/03/064596.</p>","PeriodicalId":15576,"journal":{"name":"Journal of Diabetes Research","volume":"2025 ","pages":"6172692"},"PeriodicalIF":3.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Diabetes and Site-Specific Cancer Risk: A Population-Based Cohort Study on the Differential Role of Metabolic Profiles.","authors":"Sarah Tsz Yui Yau, Chi Tim Hung, Eman Yee Man Leung, Ka Chun Chong, Albert Lee, Eng Kiong Yeoh","doi":"10.1155/jdr/1271189","DOIUrl":"10.1155/jdr/1271189","url":null,"abstract":"<p><p>This study is aimed at investigating (i) whether diabetes is associated with each site-specific cancer and (ii) whether metabolic factors (lipids and liver enzyme) are differentially linked to different site-specific cancers by diabetes status. A retrospective cohort study was performed using electronic health records of Hong Kong. Patients who utilized public healthcare services between the year 1997 and 2021 with complete laboratory records and no cancer history were included. Patients were followed up until December 31, 2021. The associations with each site-specific cancer (colon and rectum, liver, pancreas, bladder, kidney, stomach, and lung) were assessed using Cox regression. A total of 197,906 patients were included. Patients with primarily Type 2 diabetes had a higher risk of developing liver and pancreatic cancers (aHRs for liver: 1.39, 95% CI = 1.11-1.75; pancreas: 2.04, 95% CI = 1.40-2.96) when compared to those without diabetes. Each 1 mmol/L increase in fasting glucose was associated with a 4% and 8% elevated risk of developing liver and pancreatic cancers, respectively. In general, lower lipids were linked to an increased risk of several malignancies (liver, pancreas, kidney, and stomach). In conclusion, diabetes is associated with an elevated risk of liver and pancreatic cancers. Baseline lipids and liver enzyme could be differentially linked to the risk of cancers at different organ sites by diabetes status.</p>","PeriodicalId":15576,"journal":{"name":"Journal of Diabetes Research","volume":"2025 ","pages":"1271189"},"PeriodicalIF":3.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Serum Lycopene Concentrations and Diabetic Kidney Disease in the Elderly With Diabetes Mellitus: A Cross-Sectional Study From the NHANES Database.","authors":"Shumin Bao, Wenyi Zhu, Guojuan Zhang","doi":"10.1155/jdr/4481506","DOIUrl":"10.1155/jdr/4481506","url":null,"abstract":"<p><p>This study is aimed at assessing the association between serum lycopene and its isomers with diabetic kidney disease (DKD) in order patients with diabetes mellitus (DM). Utilizing a cross-sectional design, data were extracted from the National Health and Nutrition Examination Surveys (NHANES) cycles 2003-2006 and 2017-2018. Metrics including serum lycopene, urinary albumin to creatinine ratio, and estimated glomerular filtration rate were collected. Weighted univariate and multivariate logistic regression models were conducted to explore the associations between serum lycopene isomers and DKD in order patients with DM. Subgroup analyses were conducted by different genders, complications, and medical history. A total of 960 order patients with DM were included, of whom 470 (48.96%) had DKD. After covariate adjustment, we found a <i>cis</i>-lycopene concentration range of 8.60-13.19 <i>μ</i>g/dL (Q1-Q2) was associated with lower odds of DKD (OR = 0.53, 95% CI: 0.28-0.98). This association was particularly evident among males (OR = 0.48, 95% CI: 0.25-0.93), patients with a history of hypertension (OR = 0.48, 95% CI: 0.24-0.97), patients with dyslipidemia (OR = 0.52, 95% CI: 0.27-0.99), and those without the angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) use (OR = 0.55, 95% CI; 0.31-0.99). No significant associations were observed between total lycopene, translycopene, and DKD. These findings suggest serum <i>cis</i>-lycopene may be a potential modifiable biomarker for DKD prevention in high-risk elderly populations. Concentrations may improve renal health among the elderly DM patients. Maintaining optimal <i>cis</i>-lycopene levels through dietary interventions may complement conventional renoprotective strategies. Further prospective studies are warranted to establish causal relationships and evaluate targeted lycopene supplementation regimens.</p>","PeriodicalId":15576,"journal":{"name":"Journal of Diabetes Research","volume":"2025 ","pages":"4481506"},"PeriodicalIF":3.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could Pancreatic Islet Transplantation Outcome Be Impacted by Overestimating Islet Volume? Insights From a Serial Section Study.","authors":"Praveen Kumar Ravi, Sashikanta Swain, Abhijit Sahu, Sipra Rout, Appakalai N Balamurugan, Pravash Ranjan Mishra","doi":"10.1155/jdr/8940783","DOIUrl":"10.1155/jdr/8940783","url":null,"abstract":"<p><p><b>Introduction:</b> The outcome of pancreatic islet transplantation surgery is influenced by factors like islet volume, purity, and dimensions. Single paraffin section measurement may underestimate islet diameter. Researchers have identified limitations in measuring islet equivalent quantity. This study quantified maximum islet diameter using serial sections and compared it with paraffin sections. We also evaluated actual islet volume and compared it with IEQ based on diameter measurements. <b>Materials and Methods:</b> This study utilized pancreatic tissue from six adult human samples. Serial sections were stained immunohistochemically using anti-synaptophysin antibody. Islets were identified and measured using serial sections to determine their diameter and volume. The maximum average diameter across sections was used to calculate the islet diameter. Islet volume was calculated by summing areas across sections and correcting for section thickness and interval. We compared the calculated IEQ based on the diameter and volume. <b>Results:</b> The study revealed significant discrepancies between pancreatic islet diameter measured from single paraffin sections and those determined from serial sections. The mean sectional diameter was 23.37% smaller than the actual diameter (<i>p</i> < 0.0001), with larger islets showing a more significant underestimation. IEQ based on diameter was overestimated by 87.51% compared to IEQ based on actual volume, with large islets contributing significantly to this discrepancy (111.7%). <b>Conclusions:</b> Single paraffin section analyses underestimate islet dimensions, especially for islets > 125<i> μ</i>m in diameter. Using conversion factors from this study provides accurate size assessments. To enhance transplantation accuracy, it is essential to use robust size calculations rather than binning. Using the islet diameter tends to overestimate their volume, particularly when the islet index is ≥ 1 (as most islets are larger than 150 <i>μ</i>m in diameter). This overestimation increases the risk of unfavorable transplantation outcomes. Thus, IEQ should be adjusted to the upper range when the islet index is ≥ 1, accounting for the potential overestimation of islet volume.</p>","PeriodicalId":15576,"journal":{"name":"Journal of Diabetes Research","volume":"2025 ","pages":"8940783"},"PeriodicalIF":3.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring-Enhanced eConsult Improves Clinical Outcomes in Adults Living With Diabetes in a Safety Net Primary Care Setting.","authors":"Samantha M Siskind, Ryanne Dymek, Kathryn L Fantasia, Katelyn O'Brien, Devin W Steenkamp","doi":"10.1155/jdr/5547910","DOIUrl":"10.1155/jdr/5547910","url":null,"abstract":"<p><p><b>Background:</b> There is a shortage of endocrinologists providing diabetes care. Electronic consultation (eConsult) improves access to subspecialty care, but the evaluation of CGM-enhanced eConsults in routine clinical practice has not been reported. We evaluated clinical outcomes after implementing a CGM-enhanced eConsult program in a safety-net hospital primary care clinic. <b>Methods:</b> We completed a retrospective observational study assessing the clinical impact of the eConsult program. Participants included 67 adults (≥ 18 years) living with diabetes, receiving primary care at Boston Medical Center (mean age 65 years, 40.3% male, 79.1% Black, and 92.5% Type 2 diabetes). Demographic, clinical, and CGM data were analyzed from the medical record and Abbott's LibreView and Dexcom's Clarity web-based applications. Descriptive outcomes within 6 months post-eConsult included time to eConsult completion, hemoglobin A1c (HbA1c) change, medication adjustments, CGM prescription rates, and CGM-derived hypoglycemic metrics. <b>Results:</b> Mean time to eConsult completion was 5.8 days. Endocrinologist recommendations were implemented in 86.6% of patients at the first primary care visit post-eConsult and in 94.0% of patients within 6 months. Within 6 months, HbA1c was unchanged (mean change 0.2% ± 0.4%). Relative to baseline, sulfonylurea prescription decreased 55.6%. The percentage of those prescribed basal insulin was unchanged, but basal insulin doses decreased in 41.8% of patients. Bolus insulin prescription increased 56.3% relative to baseline. Absolute CGM prescriptions increased from 2.9% at baseline to 49.3%. In 11 CGM users with sufficient CGM data for interpretation at 6 months, Level 1 hypoglycemia (54-69 mg/dL) decreased by 2% and Level 2 hypoglycemia (< 54 mg/dL) decreased by 0.7%. <b>Conclusion:</b> In adults living with diabetes cared for in a safety-net hospital, CGM-enhanced eConsult provides timely access to endocrinologist expertise, recommendations are widely implemented by primary care clinicians, and guideline-directed modern diabetes therapeutic use increases, including a 17-fold increase in personal CGM prescriptions.</p>","PeriodicalId":15576,"journal":{"name":"Journal of Diabetes Research","volume":"2025 ","pages":"5547910"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acylated Ghrelin Mediates the Link Between <i>Akkermansia</i> Abundance and Insulin Resistance in Type 2 Diabetes.","authors":"Zhen Zhang, Xi Jiang, Li Zhang, Ying Feng, Jiahao Tang, Yuan Xu, Yunchong Guo, Peng Yun, Fangping Li","doi":"10.1155/jdr/4051518","DOIUrl":"10.1155/jdr/4051518","url":null,"abstract":"<p><p><b>Aims:</b> This mediation analysis was aimed at examining whether ghrelin mediates the association between gut microbiota and glucose metabolic indices. <b>Materials and Methods:</b> Fifty-five patients with newly diagnosed Type 2 diabetes mellitus (T2DM) and 40 healthy controls (HCs) were included. Serum ghrelin levels were measured by ELISA. Fecal 16S rRNA gene sequencing was performed, and gut microbiota differences were assessed using linear discriminant analysis effect size (LEfSe). The relative abundance values of differential bacteria were extracted to correlate with ghrelin and glucose metabolic indices. Mediation analysis was conducted to evaluate ghrelin's effect on the relationship between bacterial abundance and glucose metabolic indices. <b>Results:</b> Acylated ghrelin (AG) levels were significantly elevated in the T2DM group and showed positive correlations with glycated hemoglobin (HbA1c), fasting blood glucose (FBG), C-peptide (CP), and homeostasis model assessment of insulin resistance (HOMA-IR). Microbial analysis revealed decreased abundances of <i>Akkermansia</i>, <i>Lachnospira</i>, and <i>Phocaeicola</i>, but increased abundances of <i>Enterobacter</i>, <i>Escherichia</i>, <i>Megamonas</i>, <i>Segatella</i>, <i>Streptococcus</i>, and <i>Leyella</i> in T2DM. AG levels were negatively correlated with <i>Akkermansia</i> abundance. HbA1c and FBG showed positive correlations with <i>Enterobacter</i>, <i>Segatella</i>, and <i>Leyella</i> abundances, but negative correlations with <i>Akkermansia</i>, <i>Lachnospira</i>, and <i>Phocaeicola</i> abundances. HOMA-IR was positively correlated with <i>Segatella</i>, <i>Leyella</i>, and <i>Streptococcus</i> abundances, but negatively correlated with <i>Akkermansia</i> and <i>Lachnospira</i> abundances. Mediation analysis demonstrated that serum AG partially mediated the association between <i>Akkermansia</i> abundance and both HOMA-IR (26.15%) and HbA1c (27.91%). <b>Conclusions:</b> AG mediated the relationship between <i>Akkermansia</i> abundance and HOMA-IR as well as HbA1c.</p>","PeriodicalId":15576,"journal":{"name":"Journal of Diabetes Research","volume":"2025 ","pages":"4051518"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}