Hon Jen Wong, Norman H Y Lin, Yao Hao Teo, Brian S Y Yeo, Keith Zhi Xian Toh, Yao Neng Teo, Mark Y Chan, Leonard L L Yeo, Kian Keong Poh, William K F Kong, Pei Chia Eng, Benjamin Y Q Tan, Mayank Dalakoti, Ching-Hui Sia
{"title":"Anti-diabetic effects of GLP-1 receptor agonists on obese and overweight patients across diabetes status, administration routes, treatment duration and baseline characteristics: A systematic review.","authors":"Hon Jen Wong, Norman H Y Lin, Yao Hao Teo, Brian S Y Yeo, Keith Zhi Xian Toh, Yao Neng Teo, Mark Y Chan, Leonard L L Yeo, Kian Keong Poh, William K F Kong, Pei Chia Eng, Benjamin Y Q Tan, Mayank Dalakoti, Ching-Hui Sia","doi":"10.1111/dom.16136","DOIUrl":"https://doi.org/10.1111/dom.16136","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for anti-obesity indications. However, little is known of the comparative effect of GLP-1 RAs and their glycemic impact across the different routes of administration, diabetic statuses and durations of prescription. PubMed, EMBASE and CENTRAL were searched from inception to 13 February 2024. Only randomised controlled trials were included in this systematic review and meta-analysis. Adults aged above 18 years old, who were in the overweight/obesity range, with or without type 2 diabetes mellitus (T2DM) were included. Baseline characteristics and changes in glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) were obtained. GLP1-RAs demonstrated an overall reduction in HbA1c of -0.72% (95% confidence interval [CI] -0.79 to -0.65, p < 0.01) and in FPG of -1.00 mmol/L (95% CI -1.16 to -0.84, p < 0.01). HbA1c reduction in pre-DM patients was -0.44% (95% CI -0.54 to -0.18, p < 0.01). Patients who were followed up for more than a year experienced a smaller reduction of HbA1c. Meta-regression showed that the GLP-1 RAs are more efficacious at higher HbA1c and lower body mass index. Overall, GLP-1 RAs consistently led to a significant reduction in HbA1c at -0.72% and FPG at -1.00 mmol/L. These effects may be equally efficacious in pre-DM patients with obesity and those at lower BMI. With pre-DM and obesity being risk factors for metabolic syndrome, these findings may provide newer perspectives in expanding indications for GLP-1 RA initiation.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890883","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}
Huilin Tang, Bingyu Zhang, Yiwen Lu, William T Donahoo, Naykky Singh Ospina, Pareeta Kotecha, Ying Lu, Jiayi Tong, Steven M Smith, Eric I Rosenberg, Stephen E Kimmel, Jiang Bian, Jingchuan Guo, Yong Chen
{"title":"Assessing the benefit-risk profile of newer glucose-lowering drugs: A systematic review and network meta-analysis of randomized outcome trials.","authors":"Huilin Tang, Bingyu Zhang, Yiwen Lu, William T Donahoo, Naykky Singh Ospina, Pareeta Kotecha, Ying Lu, Jiayi Tong, Steven M Smith, Eric I Rosenberg, Stephen E Kimmel, Jiang Bian, Jingchuan Guo, Yong Chen","doi":"10.1111/dom.16147","DOIUrl":"https://doi.org/10.1111/dom.16147","url":null,"abstract":"<p><strong>Aim: </strong>To comprehensively evaluate the benefits and risks of glucagon-like peptide-1 receptor agonists (GLP-1RA), dipeptidyl peptidase 4 inhibitors (DPP4i), and sodium-glucose cotransporter 2 inhibitors (SGLT2i).</p><p><strong>Materials and methods: </strong>A systematic search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to November 2023 to identify randomized cardiovascular and kidney outcome trials that enrolled adults with type 2 diabetes, heart failure, or chronic kidney disease and compared DPP4i, GLP-1RAs, or SGLT2i to placebo. Twenty-one outcomes (e.g., major adverse cardiovascular events [MACE], stroke, and hospitalization for heart failure [HHF]) were assessed. Data were pooled using population-averaged odds ratios (ORs) with 95% CIs.</p><p><strong>Results: </strong>Twenty-six trials enrolling 198 177 participants were included. GLP-1RAs were most effective in lowering the risks of MACE (OR, 0.85, [95% CI, 0.79 to 0.92]) and stroke (0.84 [0.77, 0.91]), but increased the risk of thyroid cancer (1.58 [1.36, 2.50]). SGLT2i showed the greatest benefits in reducing the risk of HHF (0.68 [0.64, 0.73]) and improving composite renal outcomes (0.67 [0.58, 0.77]), but increased the risk of genital infections (3.11 [2.15, 4.50]). DPP4i were associated with a lower risk of certain psychiatric disorders, Parkinson's disease (0.54 [0.32, 0.92]), and amputation (0.70 [0.86, 0.93]), but an increased risk of neuropathy (1.10 [1.02, 1.18]) and pancreatitis (1.63 [1.40, 1.91]). The weighted origami plot suggested that GLP-1RAs were more suitable for reducing macrovascular and microvascular outcomes, while DPP4i might be better for neurodegenerative diseases and cancer concerns.</p><p><strong>Conclusions: </strong>Given the distinct benefit-risk profiles, the selection of glucose-lowering drugs should be individualized based on patient characteristics and risk factors.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890889","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":"Reply to the Letters by Louie and Pereira et al.","authors":"Shoko Hamano, Mika Sawada, Naoto Kubota","doi":"10.1111/dom.16138","DOIUrl":"https://doi.org/10.1111/dom.16138","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890638","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}
Kensaku Fukunaga, Asahiro Morishita, Hitomi Imachi, Kyoko Oura, Seisuke Sato, Toshihiro Kobayashi, Takanobu Saheki, Takafumi Yoshimura, Kurumi Komori, Mai Nakahara, Tomoko Tadokoro, Koji Fujita, Joji Tani, Hideki Kobara, Koji Murao
{"title":"Efficacy of imeglimin in patients with type 2 diabetes mellitus complicated by metabolic dysfunction-associated steatotic liver disease: A multicentre study.","authors":"Kensaku Fukunaga, Asahiro Morishita, Hitomi Imachi, Kyoko Oura, Seisuke Sato, Toshihiro Kobayashi, Takanobu Saheki, Takafumi Yoshimura, Kurumi Komori, Mai Nakahara, Tomoko Tadokoro, Koji Fujita, Joji Tani, Hideki Kobara, Koji Murao","doi":"10.1111/dom.16157","DOIUrl":"https://doi.org/10.1111/dom.16157","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate the effectiveness of imeglimin in improving liver function and fibrosis in patients with type 2 diabetes (T2D) complicated by metabolic dysfunction-associated steatotic liver disease (MASLD).</p><p><strong>Materials and methods: </strong>We conducted a multicentre study involving 80 patients with T2D and MASLD who were treated with or without imeglimin for 24 weeks. We assessed the changes in diabetes-related parameters, including HbA1c, fasting blood glucose, glycoalbumin and C-peptide index. Liver function was monitored using AST, ALT, γ-GTP and liver fibrosis indicators such as Fib-4 index and FibroScan-AST (FAST) score. Liver fat content and stiffness were measured using controlled attenuation parameter and vibration-controlled transient elastography, which were measured using FibroScan.</p><p><strong>Results: </strong>Compared with the control group, imeglimin treatment led to a significant reduction in HbA1c levels, fasting blood glucose and liver-related parameters, including AST, ALT and γ-GTP. Additionally, the Fib-4 index and FAST score, which reflect liver fibrosis and inflammation, were significantly lower in the imeglimin group. Liver fat content and stiffness remained unchanged during the study period.</p><p><strong>Conclusions: </strong>Imeglimin efficaciously improved liver inflammation and fibrosis in patients with T2D and MASLD, with no significant changes in liver fat content or stiffness. These findings suggest that imeglimin is a promising therapeutic drug for the management of MASLD in the context of T2D, warranting further research on its long-term efficacy and mechanisms of action.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890890","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 impact of novel probiotics isolated from the human gut on the gut microbiota and health.","authors":"Robert Caesar","doi":"10.1111/dom.16129","DOIUrl":"https://doi.org/10.1111/dom.16129","url":null,"abstract":"<p><p>The gut microbiota plays a pivotal role in influencing the metabolism and immune responses of the body. A balanced microbial composition promotes metabolic health through various mechanisms, including the production of beneficial metabolites, which help regulate inflammation and support immune functions. In contrast, imbalance in the gut microbiota, known as dysbiosis, can disrupt metabolic processes and increase the risk of developing diseases, such as obesity, type 2 diabetes, and inflammatory disorders. The composition of the gut microbiota is dynamic and can be influenced by environmental factors such as diet, medication, and the consumption of live bacteria. Since the early 1900s, bacteria isolated from food and have been used as probiotics. However, the human gut also offers an enormous reservoir of bacterial strains, and recent advances in microbiota research have led to the discovery of strains with probiotic potentials. These strains, derived from a broad spectrum of microbial taxa, differ in their ecological properties and how they interact with their hosts. For most probiotics bacterial structural components and metabolites, such as short-chain fatty acids, contribute to the maintenance of metabolic and immunological homeostasis by regulating inflammation and reinforcing gut barrier integrity. Metabolites produced by probiotic strains can also be used for bacterial cross-feeding to promote a balanced microbiota. Despite the challenges related to safety, stability, and strain-specific properties, several newly identified strains offer great potential for personalized probiotic interventions, allowing for targeted health strategies.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890703","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}
Alessandro Mantovani, Gianluigi Lunardi, Stefano Bonapace, Agustin E Molinero, Riccardo Morandin, Veronica Fiorio, Giulio Molon, Christopher D Byrne, Giovanni Targher
{"title":"Ceramide-based risk score CERT-1 improves risk prediction for overall mortality and adverse cardiovascular outcomes in patients with and without cardiovascular disease: A prospective cohort study.","authors":"Alessandro Mantovani, Gianluigi Lunardi, Stefano Bonapace, Agustin E Molinero, Riccardo Morandin, Veronica Fiorio, Giulio Molon, Christopher D Byrne, Giovanni Targher","doi":"10.1111/dom.16156","DOIUrl":"https://doi.org/10.1111/dom.16156","url":null,"abstract":"<p><strong>Aims: </strong>Whether the plasma-based ceramide-based risk score CERT1 improves risk prediction for cardiovascular disease (CVD) is uncertain.</p><p><strong>Materials and methods: </strong>Baseline and follow-up data were combined from two cohorts, 334 patients with established/suspected CVD and 196 patients with type 2 diabetes followed for a median of 74 months (interquartile range 54-79 months). For the calculation of CERT1 risk score, we measured four specific plasma ceramides [Cer(d18:1/16:0), Cer(d18:1/18:0) and Cer(d18:1/24:1)] and their ratios to Cer(d18:1/24:0). Based on the CERT1 risk score, patients were split into four risk categories (low, moderate, increased or high risk). The primary outcome was a composite of overall mortality and incident nonfatal CVD outcomes (including myocardial infarction, ischaemic stroke or permanent atrial fibrillation).</p><p><strong>Results: </strong>One hundred and thirty-nine patients developed the primary composite outcome (72 nonfatal CVD outcomes and 67 total deaths) during follow-up. Baseline CERT1 risk categories were significantly associated with the risk of developing the primary composite outcome (adjusted HR for high vs. low-risk category 2.43, 95% CI 1.39-4.22, p = 0.002, and adjusted HR for increased vs. low-risk category 2.16, 95% CI 1.28-3.63, p = 0.004). Receiver operator characteristic curve analysis showed that adding CERT1 risk score to traditional CVD risk factors and pre-existing CVD, improved the discriminatory capability of the regression model for predicting the primary composite outcome (AUROC 0.691 [95% CI 0.674-0.769] vs. 0.722 [95% CI 0.642-0.742], p = 0.0275).</p><p><strong>Conclusions: </strong>The ceramide-based risk score CERT1 risk score improves risk prediction for long-term risk of overall mortality and adverse cardiovascular outcomes in patients with and without CVD.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890915","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}
Chantal Mathieu, Concetta Irace, Emma G Wilmot, Bassil Akra, Stefano Del Prato, Martin Cuesta, Peter Adolfsson, Tomasz Klupa, Eric Renard, Tadej Battelino
{"title":"Minimum expectations for market authorization of continuous glucose monitoring devices in Europe-'eCGM' compliance status.","authors":"Chantal Mathieu, Concetta Irace, Emma G Wilmot, Bassil Akra, Stefano Del Prato, Martin Cuesta, Peter Adolfsson, Tomasz Klupa, Eric Renard, Tadej Battelino","doi":"10.1111/dom.16153","DOIUrl":"https://doi.org/10.1111/dom.16153","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890636","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}
Jan Borysowski, Danuta Kłosowska, Leszek Pączek, Michał Ordak, Edward Franek
{"title":"Exclusion of older persons from randomized controlled trials in type 2 diabetes: A cross-sectional study.","authors":"Jan Borysowski, Danuta Kłosowska, Leszek Pączek, Michał Ordak, Edward Franek","doi":"10.1111/dom.16137","DOIUrl":"https://doi.org/10.1111/dom.16137","url":null,"abstract":"<p><strong>Background: </strong>Prevalence of type 2 diabetes increases with age. Both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) promote the enrollment of older patients to randomized controlled trials (RCTs) in diabetes. The objective of this study was to assess the eligibility criteria limiting the inclusion of older adults to RCTs in type 2 diabetes.</p><p><strong>Materials and methods: </strong>This cross-sectional analysis of ClinicalTrials.gov included phase 2, 3 and 4 RCTs of drugs and biologicals, with enrollment ≥100, registered at ClinicalTrials.gov and started from 2014 through 2023.</p><p><strong>Results: </strong>A total of 278/594 (46.8%) trials had a limit of 90 years of age or less (primary outcome). The odds of the age limits were higher in RCTs funded from non-commercial sources (adjusted odds ratio (aOR), 2.83, 95% confidence interval (CI), 1.77-4.52; p < 0.001) and phase 2 trials (aOR, 2.38; 95% CI, 1.49-3.81; p < 0.001). A total of 542/594 (91.2%) trials had other relevant exclusion criteria, mostly those concerning comorbidities common in older patients (secondary outcome). However, none of the RCTs excluded patients with frailty which is a key factor determining the prognosis of older patients with diabetes. Only two trials enrolled solely older persons.</p><p><strong>Conclusions: </strong>Most RCTs in type 2 diabetes have the eligibility criteria limiting the enrollment of older patients. The age limits should be eliminated and patients should be excluded based on scientifically justified criteria especially those concerning comorbidities and frailty. Moreover, the benefits and harms of new drugs in older patients with multimorbidity and/or frailty should be assessed in dedicated phase 4 trials.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Efficacy of imeglimin treatment versus metformin dose escalation on glycemic control in subjects with type 2 diabetes treated with a dipeptidyl peptidase-4 inhibitor plus low-dose metformin: A multicenter, prospective, randomized, open-label, parallel-group comparison study (MEGMI study).","authors":"Akihiro Takahashi, Hiroshi Nomoto, Hiroki Yokoyama, Kei Yokozeki, Sho Furusawa, Yuki Oe, Reina Kameda, Shinichiro Kawata, Arina Miyoshi, So Nagai, Aika Miya, Hiraku Kameda, Akinobu Nakamura, Tatsuya Atsumi","doi":"10.1111/dom.16150","DOIUrl":"https://doi.org/10.1111/dom.16150","url":null,"abstract":"<p><strong>Aims: </strong>To compare the efficacy of adding imeglimin versus that of metformin dose escalation on glycemic control in subjects with type 2 diabetes treated with a dipeptidyl peptidase-4 inhibitor plus low-dose metformin (500-1000 mg/day).</p><p><strong>Materials and methods: </strong>In this multicentre, open-labelled, prospective, randomized, parallel-group comparison study, the addition of imeglimin (2000 mg/day) or metformin escalation was applied for 24 weeks in eligible subjects. The primary endpoint was the mean change in glycated haemoglobin (HbA1c) over 24 weeks. As the secondary endpoints, the occurrence of adverse events, changes in metabolic parameters, biomarkers and factors associated with HbA1c improvement were analysed.</p><p><strong>Results: </strong>Seventy-three eligible subjects were enrolled. Of them, 65 participants comprised the full analysis set. At 24 weeks, the addition of imeglimin (n = 33) resulted in greater improvement in HbA1c compared with metformin dose escalation (n = 32) (from 7.61 ± 0.48% to 6.93 ± 0.49% in imeglimin and from 7.56 ± 0.61% to 7.09 ± 0.56% in metformin escalation; change difference: -0.21% [95% confidence interval: -0.41%, -0.01%] [p = 0.038]); however, seven subjects in the imeglimin group discontinued imeglimin because of serious adverse events on gastrointestinal tract. In intra-group pre/post comparisons, imeglimin treatment significantly reduced body weight and improved liver enzyme elevation. There was a significant correlation between improvement levels of HbA1c and indicators of fatty liver disease in the imeglimin group.</p><p><strong>Conclusions: </strong>Imeglimin in combination with a dipeptidyl peptidase-4 inhibitor and low-dose metformin improved HbA1c compared with metformin dose escalation.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890626","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}
Xuan Zhao, Xiaoli Xu, Siyu Wang, Xiaoyun Zhang, Ruizhi Zheng, Kan Wang, Yu Xiang, Tiange Wang, Zhiyun Zhao, Mian Li, Jie Zheng, Min Xu, Jieli Lu, Yufang Bi, Yu Xu
{"title":"Heterogeneous blood pressure treatment effects on cognitive decline in type 2 diabetes: A machine learning analysis of a randomized clinical trial.","authors":"Xuan Zhao, Xiaoli Xu, Siyu Wang, Xiaoyun Zhang, Ruizhi Zheng, Kan Wang, Yu Xiang, Tiange Wang, Zhiyun Zhao, Mian Li, Jie Zheng, Min Xu, Jieli Lu, Yufang Bi, Yu Xu","doi":"10.1111/dom.16145","DOIUrl":"https://doi.org/10.1111/dom.16145","url":null,"abstract":"<p><strong>Aim: </strong>We aimed to identify the characteristics of patients with diabetes who can derive cognitive benefits from intensive blood pressure (BP) treatment using machine learning methods.</p><p><strong>Materials and methods: </strong>Using data from the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) study, 1349 patients with type 2 diabetes who underwent BP treatment (intensive treatment targeting a systolic BP <120 mmHg vs. standard treatment targeting <140 mmHg) were included in the machine learning analysis. Seventy-nine variables correlated with diabetes and cognitive function were used to build the causal forest and causal tree models for identifying heterogeneous BP treatment effects on cognitive decline.</p><p><strong>Results: </strong>Our analyses identified four variables including urinary albumin-to-creatinine ratio (UACR, mg/g), Framingham 10-year cardiovascular risk score (FRS, %), triglycerides (TG, mmol/L) and diabetes duration, that categorized the participants into five subgroups with different risk benefits for cognitive decline from BP treatments. Subgroup 1 (UACR ≥65 mg/g) had an absolute risk reduction (ARR) of 15.36% (95% CI, 5.01%-25.46%) from intensive versus standard BP treatment (hazard ratio [HR], 0.36; 95% CI, 0.18-0.73). Subgroup 2 (UACR <65 mg/g, FRS ≥26%, TG <2.3 mmol/L and diabetes duration ≥9 years) had an ARR of 14.74% (95% CI, 4.56%-24.59%) from intensive versus standard BP treatment (HR, 0.34; 95% CI, 0.15-0.77). No significant benefits were found for other subgroups.</p><p><strong>Conclusions: </strong>Patients with type 2 diabetes with high UACR, or with low UACR and low TG, but high predicted cardiovascular risk and long diabetes duration were likely to derive cognitive benefits from intensive BP treatment.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890629","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}