Diabetes, Obesity & Metabolism最新文献

{"title":"iGlarLixi provides improved early glycaemic control after 12 weeks of treatment compared with basal insulin in Asian people with type 2 diabetes: A post hoc analysis of the LixiLan-O-AP and LixiLan-L-CN studies.","authors":"Lulu Song, Xiaoyong Yuan, Shan Huang, Yawei Zhang, Felipe Lauand, Zhini Wang, Jie Zhang, Qin Du, Lei Kang, Wenying Yang, Xiaohui Guo","doi":"10.1111/dom.16260","DOIUrl":"https://doi.org/10.1111/dom.16260","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate early glycaemic control (glycated haemoglobin [HbA1c] < 7.0% [<53.0 mmol/mol], fasting plasma glucose [FPG] ≤ 7.0 mmol/L or postprandial glucose [PPG] ≤ 10.0 mmol/L) with iGlarLixi versus insulin glargine 100 U/mL (Gla-100) in Asian people with suboptimally controlled type 2 diabetes (T2D) on oral antidiabetic drugs (OADs) in LixiLan-O-AP or basal insulin (BI) ± OADs in LixiLan-L-CN.</p><p><strong>Materials and methods: </strong>This post hoc analysis evaluated changes from baseline to Week 12 in HbA1c, FPG and PPG, hypoglycaemia incidence and the rates of target HbA1c achievement at Weeks 8 and 12. Median time to glycaemic control (i.e., time to 50% achieving target HbA1c, FPG or PPG) was also assessed.</p><p><strong>Results: </strong>At Week 12, mean HbA1c reductions were greater with iGlarLixi versus Gla-100 in LixiLan-O-AP (-1.6% vs. -1.1% [-17.0 vs. -12.0 mmol/mol]) and LixiLan-L-CN (-1.3% vs. -0.5% [-13.9 vs. -5.4 mmol/mol]). PPG reductions were greater with iGlarLixi, while FPG reductions and hypoglycaemia incidence were similar. At Weeks 8 and 12, more participants had achieved target HbA1c or PPG with iGlarLixi versus Gla-100 in both studies. Median time to achieve HbA1c and PPG targets was shorter with iGlarLixi versus Gla-100 in LixiLan-O-AP (85 vs. 126 days and 84 vs. 167 days) and LixiLan-L-CN (85 vs. 239 days and 85 days vs. not estimable); median time to achieve FPG target was similar in LixiLan-O-AP (57 vs. 57 days) and LixiLan-L-CN (29 vs. 30 days).</p><p><strong>Conclusions: </strong>In Asian people with T2D suboptimally controlled on OADs or BI, iGlarLixi provided comprehensive earlier glycaemic control than Gla-100.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514217","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":"Impact of a 12-week personalized dietary intervention on vascular function and cardiovascular risk factors.","authors":"Lisa Wanders, Anouk Gijbels, Gabby B Hul, Edith J M Feskens, Lydia A Afman, Ellen E Blaak, Maria T E Hopman, Gijs H Goossens, Dick H J Thijssen","doi":"10.1111/dom.16261","DOIUrl":"https://doi.org/10.1111/dom.16261","url":null,"abstract":"<p><strong>Aims: </strong>Individuals with liver insulin-resistant (LIR) or muscle insulin-resistant (MIR) phenotypes may respond differently to dietary interventions. Given the interaction between insulin resistance and cardiovascular risk, this sub-analysis of the PERSON study examined whether a personalized diet according to MIR or LIR phenotypes improves vascular function and cardiovascular disease risk factors.</p><p><strong>Materials and methods: </strong>We randomized 119 participants to a 12-week low-fat, high-protein, high-fibre diet (LFHP; may be optimal for LIR) or Mediterranean diet (high in monounsaturated fat, HMUFA; may be optimal for MIR). Randomization linked the insulin-resistant (IR) phenotype to the proposed optimal diet, leading to PhenoDiet A (MIR-HMUFA and LIR-LFHP) and PhenoDiet B (MIR-LFHP and LIR-HMUFA). Before and after the intervention, vascular function (carotid artery reactivity) and cardiovascular risk factors (blood pressure, total cholesterol, HDL-cholesterol and Framingham risk score) were examined. A 7-point oral glucose tolerance test was performed to determine insulin resistance (Matsuda index and HOMA-IR) and disposition index.</p><p><strong>Results: </strong>Following drop-out (n = 18), 101 participants finished the intervention (54 women, 61 ± 7 years, 27.6 [26.4;30.0] kg/m²), with n = 80 available for the primary outcome of vascular function. Overall, the dietary interventions significantly decreased blood pressure, total cholesterol, HDL-cholesterol and the Framingham risk score (all p < 0.05), while vascular function was not affected (p = 0.485). Insulin resistance (p ≤ 0.001), but not disposition index (p = 0.362), was significantly improved after intervention. The Matsuda index (p = 0.078) tended to increase more and total cholesterol (p = 0.052) tended to decrease more in PhenoDiet group B than A, but other changes in outcome parameters were not significantly different between PhenoDiet groups. The LFHP diet resulted in more pronounced improvements in cholesterol, diastolic blood pressure (DBP) and insulin resistance compared with the HMUFA diet (all p < 0.05).</p><p><strong>Conclusion: </strong>A 12-week diet improves metabolic and cardiovascular outcomes, but not vascular function in insulin-resistant adults with overweight or obesity. Whilst the LFHP diet resulted in greater improvements in cardiometabolic risk markers than the HMUFA diet, we found no significant differences between the PhenoDiet groups.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514222","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":"What do the guidelines say about use of biosimilar insulin therapy? Simple practical considerations to guide clinicians in different patient subgroups-Sharing Canadian perspectives.","authors":"A Abitbol, L Chu","doi":"10.1111/dom.16278","DOIUrl":"https://doi.org/10.1111/dom.16278","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The rising cost of insulins are significantly impacting health care expenditure, thereby limiting access to treatment for more people affected by diabetes. Fear and misunderstanding of insulin therapy have worsened with the emergence of biosimilar insulins. Biosimilars are not the same as generic medications. Generic medication contains identical ingredients to the reference, whereas biosimilar medication is highly comparable but not necessarily identical to the reference.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There are five biosimilar insulins currently available in Canada: insulin glargine (U-100) as the biosimilar insulins, Basaglar® and Semglee®, insulin lispro (U-100) as the biosimilar insulin, Admelog® and insulin aspart (U-100) as the biosimilar insulins, Trurapi® and Kirsty ™. Recent clinical trials have demonstrated comparable efficacy, safety and immunogenicity for biosimilar insulins compared with reference insulins. The dosing of biosimilar insulins is also the same as the reference for initiating, switching (1:1) and titrating. Regulatory agencies, payors and clinical practice guideline committees are initiating biosimilar initiatives aimed at reducing costs, impacting more patients worldwide. While few studies have evaluated biosimilar insulin use in a real-world clinical practice setting, the descriptive patterns retrieved from the LMC Diabetes Registry reflect the Ontario Ministry of Health's changes in biologic drug policy that were implemented to promote the use of biosimilar insulins.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Many health care providers are largely unfamiliar with biosimilar insulins. This limits the acceptance of biosimilar insulins by patients, as it is related to the comfort of health care providers in educating patients. Tailoring effective conversations to patient needs ensures the best possible therapeutic outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;This review article intends to review the efficacy and safety data from pivotal clinical trials with biosimilar insulins, as well as the regulatory and health economic considerations which underpin the safe and cost-effective use of biosimilar insulin therapy. Biosimilars are not the same as generic medications. Generic medication contains identical ingredients to the reference, whereas biosimilar medication is highly comparable but not necessarily identical to the reference. There are five biosimilar insulins currently available in Canada: insulin glargine (U-100) as the biosimilar insulins, Basaglar® and Semglee®, insulin lispro (U-100) as the biosimilar insulin, Admelog® and insulin aspart (U-100) as the biosimilar insulins, Trurapi® and Kirsty™. Data for biosimilars must be submitted in a stepwise approach to demonstrate similarity to the reference biologic under the following categories: structure & function, human clinical trials, comparative studies evaluating efficacy and safety and manufacturing quality control. Recent c","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514274","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":"Estimating healthcare resource utilisation and cardiovascular events in people with high body mass index and established cardiovascular disease.","authors":"Jonathan Pearson-Stuttard, Mei Sum Chan, Sara Holloway, Kasper Sommer Matthiessen, Andrew Thompson, Silvia Capucci","doi":"10.1111/dom.16271","DOIUrl":"https://doi.org/10.1111/dom.16271","url":null,"abstract":"<p><strong>Aims: </strong>Obesity and its complications contribute to the burden of cardiovascular disease (CVD). Here, we characterised individuals with high body mass index (BMI) and established CVD by assessing healthcare resource utilisation (HCRU) and costs, incidence of cardiovascular (CV) events and mortality.</p><p><strong>Materials and methods: </strong>This was a retrospective open cohort study using UK Discover data (study period: January 2004 to December 2019). Included were individuals aged ≥45 years with BMI ≥ 27 kg/m², without type 1 or type 2 diabetes, and with established CVD (previous myocardial infarction, stroke or peripheral artery disease). Serial annual cross sections were assembled to generate prevalence and incidence cohorts and for mapping of HCRU, costs and the incidence of selected events. CVD and mortality trajectories were modelled using a Markov model. HCRU and costs were layered onto this model to obtain associated trajectories.</p><p><strong>Results: </strong>In 2019, annual per-person healthcare costs for individuals with high BMI and established CVD (n = 27 313) were £3364. During 2015-2019, the incidence of major adverse CV events was 2812 per 100,000 person-years; the incidences of all-cause and CV mortality were 2896 and 774 per 100,000 person-years, respectively. Over 2022-2031, this population is projected to accrue estimated healthcare costs of £40.8 million. HCRU trajectory drivers included a history of CV events, older age, and multimorbidity.</p><p><strong>Conclusions: </strong>Owing to a high disease and treatment burden, people with a history of CVD living with high BMI incur substantial healthcare costs and are at risk of mortality.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497653","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":"Illnesses associated with ketosis including diabetic ketoacidosis during very low carbohydrate and ketogenic diets.","authors":"Caroline G P Roberts, Shaminie J Athinarayanan, Robert E Ratner, Guillermo E Umpierrez","doi":"10.1111/dom.16252","DOIUrl":"https://doi.org/10.1111/dom.16252","url":null,"abstract":"<p><strong>Aims: </strong>Ketogenic diets are used by individuals with obesity and type 2 diabetes for improved glycaemic control, reduced appetite and weight loss. However, the risks associated with higher ketone levels, including diabetic ketoacidosis (DKA), in individuals with and without diabetes are not well-documented.</p><p><strong>Materials and methods: </strong>We analysed real world data from a single-centre telemedicine clinic specializing in a very low carbohydrate ketogenic diet (VLCKD) as a lifestyle intervention. Illnesses associated with ketosis (IAK) were defined as beta-hydroxybutyrate (BHB) levels ≥3 mmol/L when patients sought in-person care. We estimated the IAK and DKA incidence rate in individuals with and without type 2 diabetes.</p><p><strong>Results: </strong>In 72 751 patient-years of follow-up, 86 people had IAK (incidence rate 1.18 per 1000 person-years). In 22 347 patient-years of follow-up of people without diabetes, the incidence rate of IAK was 0.04 per 1000 person-years with no DKA cases. In 50 404 patient-years of follow-up in people with type 2 diabetes (PWD), the incidence rates of IAK and of DKA were 1.69 and 1.01 per 1000 person-years, respectively. In 12 763 person-years of follow-up of PWD using SGLT2-inhibitors, the DKA incidence was 2.90 per 1000 patient-years.</p><p><strong>Conclusions: </strong>Very low carbohydrate ketogenic diets are generally safe with low rates of IAK, including DKA, in people with and without type 2 diabetes. The higher incidence of DKA in PWD on VLCKD who are also on SGLT2-inhibitors may be manageable through at-home monitoring of BHB levels.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490275","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":"The challenge of assessing impaired awareness of hypoglycaemia in diabetes in the era of continuous glucose monitoring: A narrative review of evidence and translation into clinical practice.","authors":"Simon A Berry, Alexandros L Liarakos, Vaios Koutroukas, Pratik Choudhary, Emma G Wilmot, Ahmed Iqbal","doi":"10.1111/dom.16284","DOIUrl":"https://doi.org/10.1111/dom.16284","url":null,"abstract":"<p><p>Iatrogenic hypoglycaemia remains a major barrier in diabetes care. Over time, and with repeated hypoglycaemic episodes, the physiological responses to hypoglycaemia can become blunted, resulting in impaired awareness of hypoglycaemia (IAH). In IAH, the onset of cognitive dysfunction precedes the onset of autonomic symptoms, often preventing appropriate self-treatment, thus increasing the frequency of severe hypoglycaemia (SH). Historically, IAH has been assessed with questionnaires, such as the Gold and Clarke scores, which were developed in the 1990s. A stepwise change in diabetes management in the last few decades has been the deployment of continuous glucose monitoring (CGM). CGM allows people with diabetes to set alarms that can warn them of hypoglycaemia or even impending hypoglycaemia, thus providing a degree of 'technological' awareness. This creates a challenge in assessing awareness status, as people may be alerted to low-sensor glucose events before they experience any symptoms. CGM also allows the introduction of new measures of hypoglycaemia exposure such as time below range, which might complement traditional methods of risk assessment. These changes in the field prompt a need for reassessment of the measures of IAH. This narrative review evaluates the current epidemiology of SH and IAH, explores different measures of IAH, and evaluates the relationship between CGM metrics, IAH and SH. We conclude that a clinical approach involving traditional questionnaires, or newer updated alternatives such as the Hypo A-Q awareness scale, combined with CGM metrics and clinical assessment of human factors is recommended in the absence of a clearly superior measure.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490282","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 individuals without type 2 diabetes: Results from the Optum Market Clarity database.","authors":"Emily R Hankosky, Chanadda Chinthammit, Alexandra Meeks, Ahong Huang, Jennifer M Ward, Donna Mojdami, Theresa Hunter Gibble","doi":"10.1111/dom.16290","DOIUrl":"https://doi.org/10.1111/dom.16290","url":null,"abstract":"<p><strong>Aims: </strong>To understand real-world tirzepatide utilization and effectiveness (change in weight and body mass index [BMI]) among people without type 2 diabetes (T2D) in the United States.</p><p><strong>Materials and methods: </strong>This retrospective, observational study used Optum's de-identified Market Clarity database (index date: first-observed tirzepatide claim; index period: 13 May 2022-30 September 2023). Outcomes were assessed in 3 cohorts: (1) Overall cohort: age ≥18 years; ≥1 tirzepatide claim; no baseline T2D diagnosis codes, anti-diabetes medication use (except metformin) or glycated haemoglobin ≥6.5%; continuous medical and pharmacy enrolment for ≥12 months pre-index. (2) Utilization cohort: all above criteria and anti-obesity medication (AOM)-eligible individuals (BMI ≥30 kg/m², or ≥27 kg/m² with ≥1 obesity-related complication [ORC]) for assessment of tirzepatide utilization (persistence, discontinuation, dose escalation and switching 6 months post-index). (3) Effectiveness cohort: all above criteria and AOM-eligible glucagon-like peptide-1 receptor agonist (GLP-1 RA)-naive individuals persistent on tirzepatide for ≥6 months with pre- and post-index weight and BMI measurements for assessment of tirzepatide effectiveness (mean absolute and percent bodyweight/BMI change from baseline and bodyweight/BMI reduction ≥5%, ≥10%, ≥15% and ≥20%). All analyses were descriptive.</p><p><strong>Results: </strong>Overall cohort included 20,998 individuals (mean age: 47.4 years, female: 74.9%, mean BMI: 36.9 kg/m²). At index, 66.0% of individuals had ≥1 ORC, while 44.4% had ≥2 ORCs. Persistence in the utilization cohort was 55.4%; 30.8% switched to a different AOM/GLP-1 RA analogue or restarted tirzepatide after discontinuation, and by the sixth prescription fill, 74.2% were on <10 mg tirzepatide. Mean weight reduction in the effectiveness cohort was 11.9% at 6 months post-index (≥5%: 85.8%; ≥10%: 61.5%).</p><p><strong>Conclusions: </strong>Real-world evidence suggests multimorbidity is common among tirzepatide initiators. While tirzepatide dose escalation was slower than in clinical trials, individuals achieved weight reduction at 6 months, consistent with clinical trials.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490279","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 depression, traditional risk factor control and genetic risk with incident cardiovascular disease among individuals with prediabetes: A population-based prospective study from UK biobank.","authors":"Zenglei Zhang, Chunqi Wang, Lin Zhao, Zeyu Wang, Xianliang Zhou, Weixian Yang, Xu Meng","doi":"10.1111/dom.16293","DOIUrl":"https://doi.org/10.1111/dom.16293","url":null,"abstract":"<p><strong>Background: </strong>The relationship between depression and cardiovascular disease (CVD) in individuals with prediabetes, its relative importance compared with traditional risk factors and whether genetic risk modifies this association remain unclear.</p><p><strong>Aims: </strong>To explore the potential interactive effects of controlling traditional risk factors and depression on CVD, and to assess how depression compares with traditional risk factors in terms of its relative contribution to CVD risk in individuals with prediabetes.</p><p><strong>Materials and methods: </strong>We analysed a prospective cohort of 42,020 individuals from the UK Biobank, all free of prevalent CVD. Depression was determined using multiple sources to accurately assess the exposure. The five traditional risk factors considered were sleep duration, smoking, blood pressure (BP), low-density lipoprotein (LDL) cholesterol and renal function. We used Cox proportional hazards regression models to examine the associations between depression, risk factor control and CVD events.</p><p><strong>Results: </strong>Over a median follow-up of 13.1 years, 5865 individuals developed CVD, including 4764 cases of coronary heart disease and 1415 strokes. Compared with controlling 4-5 risk factors, both depression and controlling 0-1 risk factor significantly increased the risk of CVD in individuals with prediabetes. The corresponding multivariable-adjusted hazard ratios (95% CI) for CVD were 1.18 (1.09-1.28) and 1.44 (1.29-1.60), respectively. Depression ranked second in predicting CVD among the selected risk factors. A synergistic effect between depression and risk factor control was observed for CVD, with a relative excess risk due to interaction of 0.16 (0.06-0.26). Furthermore, these associations were independent of the genetic susceptibility to CVD.</p><p><strong>Conclusions: </strong>Among individuals with prediabetes, both depression and suboptimal control of traditional risk factors are associated with an increased risk of CVD, independent of genetic susceptibility.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490295","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 normal range of urinary albumin-to-creatinine ratio with all-cause mortality among diabetic adults with preserved kidney function: National Health and Nutrition Examination Survey (NHANES) 2003-2018.","authors":"Xiaoxia Pang, Wenchao Dan, Lan Lin, Huimei Li, Xiangrong Rao, Shen Li","doi":"10.1111/dom.16269","DOIUrl":"https://doi.org/10.1111/dom.16269","url":null,"abstract":"<p><strong>Aim: </strong>To ascertain the connection between normal-range urinary albumin-to-creatinine ratio (UACR) and all-cause mortality (ACM) among diabetic adults with preserved eGFR.</p><p><strong>Methods: </strong>We used data from the 2003-2018 National Health and Nutrition Examination Survey. Nationally representative cross-sectional survey data linked with mortality outcomes from the National Death Index. Restricted cubic spline curves (RCS) and multivariable Cox regression models alongside subgroup analyses were utilised for estimating hazard ratios (HRs) and 95% confidence intervals (Cls) for UACR-ACM interplay, adjusting for demographic, socioeconomic, biochemical, medication and medical history factors. The UACR's predictive accuracy for survival outcomes was determined through receiver operating characteristic analysis.</p><p><strong>Results: </strong>The RCS regression analysis showcased that there was no significant evidence to support a nonlinear relationship between normal-range UACR and ACM (p = 0.080 for nonlinearity) in participants with diabetes mellitus (DM). In the model 2 adjusted for multiple confounding variables, the HR for ACM was 1.22 (95% CI, 1.06-1.40) per 10 mg/g raise in continuous UACR and 1.50 (95%CI, 1.18-1.91) for the high UACR tertile compared to the low. Kaplan-Meier analysis showed significantly lower survival rates in the medium and high UACR groups (p < 0.001). Subgroup analysis manifested a significant UACR-body mass index (BMI) interaction (p = 0.033 for interaction).</p><p><strong>Conclusions: </strong>In DM adults without overt kidney dysfunction, elevated normal-range UACR was independently related to escalated ACM, particularly in those with normal BMI. To conclude, we underscore the significance of early risk assessment in DM patients with normal-range albuminuria, even without overt kidney dysfunction.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497583","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":"Time in range-A new gold standard in type 2 diabetes research?","authors":"Ashni Goshrani, Rose Lin, David O'Neal, Elif I Ekinci","doi":"10.1111/dom.16279","DOIUrl":"https://doi.org/10.1111/dom.16279","url":null,"abstract":"<p><p>Glycated haemoglobin (HbA1c) is currently the gold standard outcome measure for type 2 diabetes trials. Time in range is a continuous glucose monitoring (CGM) metric defined as the proportion of time in euglycemia (3.9-10.0 mmol/L) and may be valuable not only in type 1 diabetes clinical trials but also as an endpoint in type 2 diabetes trials. This narrative review aimed to assess the relative merits of time in range versus HbA1c as outcome measures for type 2 diabetes studies. It reviews the strengths and limitations of time in range as an outcome measure and evaluates studies in type 2 diabetes that have used time in range as a primary or secondary outcome measure. A literature search was conducted on PubMed and MEDLINE databases using key terms \"time in range\" AND \"diabetes\" OR \"type 2 diabetes mellitus\". Further evidence was obtained from relevant references of retrieved articles. Literature search identified 247 papers, of which 110 were included in this review. These included a broad range of articles, including 45 randomized trials using time in range as an outcome measure in patients with type 2 diabetes, as well as papers validating time in range. Time in range provides valuable and clinically relevant information and should be used as an important endpoint in type 2 diabetes in clinical trial settings, in conjunction with HbA1c.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497662","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}