Diabetes, Obesity & Metabolism最新文献

{"title":"Biomarkers for cardiovascular–kidney metabolic syndrome: Clinical utility in diagnosis, screening, and treatment","authors":"Kevin Yau MD, David Z. I. Cherney MD, Ayodele Odutayo MD","doi":"10.1111/dom.70044","DOIUrl":"https://doi.org/10.1111/dom.70044","url":null,"abstract":"<p>Diabetes, metabolic disease, chronic kidney disease (CKD), and cardiovascular disease are tightly interlinked and result in significant morbidity globally. Accordingly, the term cardiovascular–kidney–metabolic (CKM) syndrome has now been coined to encompass these conditions and guide the use of preventive strategies.<span><sup>1</sup></span> Biomarkers may serve an important role in CKM conditions and further inform the diagnosis, risk stratification, and treatment decisions.<span><sup>2</sup></span> In this special issue of <i>Diabetes, Obesity, Metabolism</i>, an update on the use of four established biomarkers, such as albuminuria, N-terminal B-type natriuretic peptide, high-sensitivity troponin, and lipoprotein A or Lp(a), is discussed with a focus on their relevance to clinical practice.</p><p>Albuminuria refers to the presence of albumin in the urine and is correlated with adverse kidney and cardiovascular outcomes. In clinical practice, measurement of albuminuria is commonly performed using a spot urine albumin-to-creatinine ratio (UACR), typically obtained from a first-morning void or early morning void, which accounts for the stochastic nature of urine concentration. However, variability in the UACR necessitates repeat measurements to confirm increased albuminuria.</p><p>In this issue, Beernick et al. review the role of albuminuria in screening and guiding treatment for individuals with CKD.<span><sup>3</sup></span> Presently, screening for albuminuria is recommended for at-risk populations including those with diabetes, hypertension and cardiovascular disease. The KDIGO 2024 guidelines further consider that screening may be extended to older individuals, those with a family history of kidney disease or genetic predisposition, and systemic autoimmune conditions.<span><sup>4</sup></span> Given the global burden of CKD, population-wide screening remains under exploration. For example, the THOMAS study demonstrated that home-based screening with UACR was cost-effective.<span><sup>5</sup></span> Whether this approach is feasible at a population-wide scale remains uncertain given that screening for albuminuria even in high-risk populations remains underutilized.<span><sup>6</sup></span></p><p>From a prognostic perspective, reductions in albuminuria predict long-term benefit on kidney function.<span><sup>7</sup></span> This has been demonstrated in trials of sodium-glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and glucagon-like peptide 1 receptor agonists which not only reduce albuminuria but also have been shown to prevent CKD progression.<span><sup>7-11</sup></span> Individuals with the highest degrees of albuminuria may obtain the greatest absolute benefit from these therapies,<span><sup>12</sup></span> and residual albuminuria may identify individuals who warrant additional treatment. The benefit of combination therapy was recently observed in the CONFIDENCE trial which found that the combinat","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":"27 S8","pages":"3-6"},"PeriodicalIF":5.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://dom-pubs.onlinelibrary.wiley.com/doi/epdf/10.1111/dom.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923559","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":"CGM profiling in Roux-en-Y gastric bypass, type 1 diabetes and healthy adults: Unmasking deviations from normoglycaemia.","authors":"Luca Cossu, Andrea Facchinetti, Lia Bally","doi":"10.1111/dom.70059","DOIUrl":"https://doi.org/10.1111/dom.70059","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937270","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 device-based measurement of physical activity with liver fat and stiffness in type 2 diabetes and obesity.","authors":"Ebaa Al-Ozairi, Ameenah Al-Awadhi, Anant Mashankar, Dherar Alroudhan, Dalal Alsaeed, Mohamed Abdalla, Stuart R Gray","doi":"10.1111/dom.70038","DOIUrl":"https://doi.org/10.1111/dom.70038","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937249","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":"Combined liraglutide and metformin therapy in overweight or obese women with polycystic ovary syndrome: A systematic review and meta-analysis.","authors":"Jing Ling, Tiantian Wang, Wenrui Huang, Yuhua Zhen, Mingzi Zhang, Xingzi Fang, Wencong Song, Xuelian Du","doi":"10.1111/dom.70028","DOIUrl":"https://doi.org/10.1111/dom.70028","url":null,"abstract":"<p><strong>Purpose: </strong>Overweight or obese women with polycystic ovary syndrome (PCOS) often experience significant metabolic and hormonal disturbances. This systematic review and meta-analysis evaluated whether liraglutide combined with metformin is more effective than metformin alone in improving glycaemic control, lipid metabolism, body mass index (BMI) and sex hormone profiles in this population.</p><p><strong>Methods: </strong>We systematically searched PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, Weipu, SinoMed and Wanfang Data for randomised controlled trials (RCTs) comparing liraglutide plus metformin to metformin monotherapy in overweight or obese women with PCOS. Primary outcomes included fasting plasma glucose (FPG), 2-h postprandial glucose, HbA1c, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), BMI, sex hormones (luteinising hormone [LH], follicle-stimulating hormone [FSH], total testosterone [TT]) and lipid profiles (total cholesterol [TC], triglycerides [TG], low-density lipoprotein cholesterol [LDL-C] and high-density lipoprotein cholesterol [HDL-C]). Subgroup analyses were conducted by treatment duration, lifestyle intervention and baseline BMI.</p><p><strong>Results: </strong>A total of 19 RCTs involving 1657 women with PCOS were included. Compared to metformin alone, the combination of liraglutide and metformin significantly improved glycaemic metabolism: FPG (standard mean difference = -1.92, 95% confidence interval [CI] [-2.43, -1.41]; I<sup>2</sup> = 95%), 2-h postprandial glucose (-2.87, [-3.70, -2.05]; 97%), HbA1c (-2.91, [-3.84, -1.98]; 96%), HOMA-IR (-2.29, [-2.98, -1.60]; 97%) and fasting insulin (-0.75, [-1.41, -0.09]; 94%). BMI was also significantly reduced (-1.64, [-2.38, -0.89]; 97%). Hormonal indicators improved, including LH (-1.48, [-1.83, -1.14]; 85%), FSH (-1.17, [-1.62, -0.73]; 92%) and TT (-0.66, [-1.30, -0.03]; 95%). In terms of lipid metabolism, reductions were observed in TC (-2.34, [-3.67, -1.01]; 98%), TG (-0.58, [-0.96, -0.21]; 79%) and LDL-C (-0.79, [-1.36, -0.22]; 91%), while HDL-C increased (0.67, [0.21, 1.13]; 83%). Longer treatment duration (≥16 weeks) and lack of lifestyle intervention were associated with greater improvements in insulin resistance and hormone levels. Lipid outcomes were consistent across subgroups, while glycaemic improvements were more notable in overweight versus obese women. Sensitivity analyses supported the robustness of findings. However, the overall certainty of evidence was low due to risk of bias and heterogeneity.</p><p><strong>Conclusion: </strong>The combination of liraglutide and metformin resulted in greater improvements in body weight, blood sugar levels, insulin sensitivity, hormone balance (including LH, FSH and testosterone) and cholesterol profiles. These findings indicate that the combined therapy offers more comprehensive metabolic and hormonal benefits than metformin alone for women with","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937197","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":"Pathophysiology of type 2 diabetes: A focus on the metabolic differences among southeast Asian, Chinese and Indian populations and how this impacts treatment.","authors":"Yuzi Cao, Indah Widyahening, Xiaodong Sun, Sheyu Li","doi":"10.1111/dom.70060","DOIUrl":"https://doi.org/10.1111/dom.70060","url":null,"abstract":"<p><p>The prevalence of type 2 diabetes has been rising in China, India and Southeast Asia for decades, challenging their healthcare systems. With region-specific determinants such as genetics, lifestyle transition and early-life environment, people with type 2 diabetes showed their unique phenotypes, including being, on average, younger in age, with lower BMI but higher percentage body fat mass, higher postprandial glucose and poorer beta-cell function at onset. These features invalidated the implementation of some trial evidence from the Caucasian population when informing guideline recommendations and clinical decision-making. For example, α-glucosidase inhibitors and DPP4 inhibitors, targeting postprandial glucose, showed greater effectiveness and acceptability in Chinese people with type 2 diabetes. The indispensable use of insulin in people with severely impaired beta-cell function is common in China, India and Southeast Asian countries but induces the accumulation of body fat mass, which further worsens the prognosis of the people. GLP-1 receptor agonists show strong weight-lowering effects and cardiovascular protection and provide additional benefits for Asian people compared to Caucasians with the same levels of BMI. Adding GLP-1 receptor agonists to people receiving insulin may neutralise the adverse effect of body weight gain. Clinicians and patients should consider the unique features of the population before making decisions, and policymakers should be aware of the pragmatic determinants during the implementation of the overseas evidence. The adoption of international trials to the region by adjusting their distinct features may improve the relevance of evidence and the treatment response at the individual level.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937217","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":"Burden of obesity in patients undergoing dialysis, and hopes associated with semaglutide treatment for transplant listing: An interview study.","authors":"Lenka Vanek, Elias Stix, Amelie Kurnikowski, Simon Krenn, Sebastian Mussnig, Janosch Niknam, Manfred Hecking","doi":"10.1111/dom.70011","DOIUrl":"https://doi.org/10.1111/dom.70011","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937231","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":"Metrics that matter: Identifying endpoints for capturing the broad health impacts of prevention of obesity.","authors":"Jonathan Pearson-Stuttard, Sara Holloway, Jamie Kettle, Hugo Harper, Irina Pokhilenko, Manuel Gomes, Louis Garrison, Ricardo Reynoso, Katherine Byrne, Jutta Kloppenborg Heick Skau","doi":"10.1111/dom.70016","DOIUrl":"https://doi.org/10.1111/dom.70016","url":null,"abstract":"<p><strong>Aims: </strong>The link between health and economic prosperity is well established, yet quantifying the value of illness prevention remains challenging due to lack of comprehensive metrics. Obesity exemplifies this issue, having widespread societal and health care impacts but limited prevention funding. Existing metrics often fail to capture broader effects of prevention of obesity. This study aimed to identify key components for a holistic metric to assess obesity and cardiometabolic health progression, better articulating value of prevention.</p><p><strong>Materials and methods: </strong>We conducted a targeted literature review to identify existing individual and composite metrics for prevention in adults, agnostic of disease or risk factor. We categorized endpoints into: (i) holistic composite measures; (ii) user-centred composite measures; (iii) health outcome composite measures; (iv) single clinical endpoints. Metrics were evaluated against eight criteria including holistic outcome, cardiometabolic relevance, data feasibility, geographical generalizability, established outcome, economic modelling methodology, stakeholder relevance and preventive value; alongside semi-structured review from six clinical, health economics and policy experts.</p><p><strong>Results: </strong>Cardiometabolic endpoints numbering 74 were identified: 7 holistic composites, 16 user-centred composites, 31 health-based composites and 20 single clinical endpoints. Five endpoints were shortlisted according to assessment criteria and expert input: waist-to-height ratio, low-density lipoprotein cholesterol, systolic and diastolic blood pressure, blood glucose and the 12-Item Short Form Health Survey (SF-12). These endpoints collectively reflected physiological cardiometabolic risk factors with an adverse association with obesity, while SF-12 provided health-related quality-of-life measurement.</p><p><strong>Conclusions: </strong>We developed a novel framework that shortlisted five key cardiometabolic outcome measures for assessing obesity primary prevention benefits, with potential applications in health economic modelling and public health.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937219","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":"Waist circumference remains the better predictor of insulin resistance compared to 2025 Lancet Commission definition on clinical obesity.","authors":"Han S J Chew, Mayank Dalakoti, Melvin K S Leow, Lijuan Sun, Jia H C Ang, Roger Foo","doi":"10.1111/dom.70052","DOIUrl":"https://doi.org/10.1111/dom.70052","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937267","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":"An MRI study of pancreatic atrophy in children with type 1 diabetes: Heterogeneity, disease duration effects, and progression prediction models.","authors":"Zheng Cai, Meimei Du, Mingxin Chen, Gefei Ni, Yuxuan Wang, Kangyue Chen, Shaoqing Chen, Shuang Meng, Yixuan Hu, Mei Huang, Jiawen Song, Xiaoyan Huang, Zhihan Yan, Kun Liu","doi":"10.1111/dom.70055","DOIUrl":"https://doi.org/10.1111/dom.70055","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the heterogeneity of pancreatic alterations in children with T1D and the effect of disease duration on the pancreas. To develop predictive models based on clinical and imaging parameters at baseline to determine whether pancreatic atrophy will progress at follow-up.</p><p><strong>Methods: </strong>This retrospective study included 90 children with T1D and 82 control children. Clinical and pancreatic imaging data were analysed for between-group comparisons and within-group correlations. Linear mixed-effect models were used to analyse the dynamic changes in pancreatic MRI parameters in 35 children with T1D, and predictive models were developed to evaluate the pancreatic atrophy progression.</p><p><strong>Results: </strong>Compared with the control children, those with T1D exhibited lower pancreatic volume, pancreatic volume index (PVI), diameters of the pancreatic head, body, and tail, pancreatic surface area, and pancreatic margin regularity score but a higher pancreatic surface area-to-volume ratio. PVI and pancreatic surface area were reduced in the duration ≥3 years subgroup compared with the duration <3 years. Pancreatic head diameter and pancreatic surface area were lower in the poor glycaemic control subgroup compared with the good glycaemic control subgroup. Pancreatic surface area decreased in the age at diagnosis <8 years subgroup compared with the age at diagnosis ≥8 years subgroup. PVI and pancreatic head diameter progressively decreased with disease duration. For predicting the progression of pancreatic atrophy, the AUC value was 0.736 for the combined clinical and MR parametric model.</p><p><strong>Conclusion: </strong>Children with T1D exhibit altered pancreatic size and morphology, with heterogeneity in pancreatic atrophy. Pancreatic atrophy progressed at follow-up compared to baseline, and disease duration exacerbated these pancreatic alterations. An integrated model can effectively predict pancreatic atrophy progression.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937206","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":"Hybrid closed-loop systems in UK type 1 diabetes care: National survey of healthcare professional awareness, confidence, and training needs.","authors":"Ananthi Anandhakrishnan, Alexandros L Liarakos, Ketan Dhatariya, Geraldine Gallen, Pratik Choudhary, Alistair Lumb, Emma G Wilmot, Sufyan Hussain","doi":"10.1111/dom.70027","DOIUrl":"https://doi.org/10.1111/dom.70027","url":null,"abstract":"<p><strong>Aims: </strong>Hybrid closed-loop (HCL) systems significantly improve glycaemia and have become the standard of care for type 1 diabetes (T1D), leading to the recent widescale implementation programme in England and Wales. Limited data exist regarding UK healthcare professionals' (HCPs) confidence and experience with commercially available HCL systems. This survey aimed to evaluate UK HCPs' awareness, confidence, and training needs concerning commercial HCL systems.</p><p><strong>Materials and methods: </strong>A national survey, developed in collaboration with the Association of British Clinical Diabetologists' Diabetes Technology Network (ABCD-DTN-UK), was distributed to adult and paediatric diabetes care teams. Data were collected between July and November 2024 and analysed descriptively, stratified by professional roles and care settings.</p><p><strong>Results: </strong>Responses from 637 HCPs (42.4% diabetes specialist nurses, 24.5% endocrinologists, 16.6% dieticians, 12.7% endocrinology residents) across 135 healthcare organisations in the UK revealed high overall awareness regarding HCL initiation and safety. Awareness varied significantly by role, with endocrinologists and diabetes nurse specialists reporting greater familiarity than endocrinology residents (p < 0.001). Confidence in system-specific use varied, with notably lower confidence in pregnancy-specific CamAPSFx-based systems. 41% of respondents involved in pregnancy care reported no confidence in advising on these systems, with 7% reporting no access to any CamAPSFx-based system. A majority (73.3%) expressed interest in additional training, favouring remotely accessible modules (52.3%).</p><p><strong>Conclusions: </strong>This survey highlights encouraging overall confidence and awareness of commercial HCL systems among UK HCPs, reflecting successful recent educational initiatives. However, significant gaps, particularly concerning pregnancy-licensed systems and variable exposure to specific HCL systems, identify clear training needs. Addressing these will be crucial in ensuring equitable and effective HCL implementation of systems licensed for use across the lifespan of an individual with T1D and across diverse clinical settings.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937363","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}