Journal of Diabetes最新文献

{"title":"Global, Regional, and National Prevalence of Chronic Type 2 Diabetic Kidney Disease From 1990 to 2021: A Trend and Health Inequality Analyses Based on the Global Burden of Disease Study 2021","authors":"Yujun He,&nbsp;Xiaoyi Wang,&nbsp;Lu Li,&nbsp;Minhui Liu,&nbsp;Yachao Wu,&nbsp;Ru Chen,&nbsp;Jiujie He,&nbsp;Wei Mai,&nbsp;Xiaojun Li","doi":"10.1111/1753-0407.70098","DOIUrl":"https://doi.org/10.1111/1753-0407.70098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetic kidney disease (DKD) is a prevalent and severe complication of diabetes that significantly impacts global health and quality of life. Most DKD is attributable to type 2 diabetes; therefore, chronic type 2 DKD warrants further examination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To deliver targeted assistance in alleviating the worldwide, regional, and national burden of chronic type 2 DKD, we executed a survey assessing the prevalence of chronic type 2 DKD utilizing the Global Burden of Disease, Injury, and Risk Factors (GBD) database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined the temporal trends of chronic type 2 DKD prevalence over the past 30 years using the 2021 GBD database, analyzed the trends by population, epidemiological change, and aging, and quantified cross-country health inequalities. Additionally, we forecasted the trend during the subsequent two decades.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2021, there were over 107 million cases of chronic type 2 DKD globally, reflecting an 85.11% rise from 58 million cases in 1990. The age-standardized rate (ASR) declined with an estimated annual percentage change of 0.17% per annum. Epidemiological change and population expansion are the primary factors influencing the alterations. The contributions of epidemiological change, population, and aging vary with alterations in the sociodemographic index (SDI). Significant health inequalities were observed across 204 countries and territories, with the slope index of inequality increasing over time. The forecast for the worldwide burden of chronic type 2 DKD from 2020 to 2040 suggests a significant rise in case numbers, while the alterations in ASR remain largely stable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings indicate the significant disease burden of chronic type 2 DKD, necessitating more targeted and effective interventions for its prevention and management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108834","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":"Potential Detrimental Interactions Between Metformin and Supplemental Dietary Fiber in Type 2 Diabetes","authors":"Rosemary M. Hall,&nbsp;Amber Parry-Strong,&nbsp;David O'Sullivan,&nbsp;Jeremy D. Krebs,&nbsp;Olivier Gasser","doi":"10.1111/1753-0407.70101","DOIUrl":"https://doi.org/10.1111/1753-0407.70101","url":null,"abstract":"&lt;p&gt;Higher intakes of dietary fiber have been associated with a reduced risk of developing Type 2 Diabetes (T2DM) and cardiovascular disease [&lt;span&gt;1, 2&lt;/span&gt;]. Fiber supplementation improves overall glycaemia, with reductions in Hba1c and better insulin sensitivity [&lt;span&gt;3&lt;/span&gt;]. However, there is significant reported heterogeneity on the effects of supplemental fiber on glycaemic outcomes for people with T2DM, potentially due to variations in absorption and metabolism. These differences, we believe, are worth examining more closely, especially considering the complexities of the gut microbiome, medications used in T2DM, and the role of the background diet [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In our recent study, we investigated the impact of supplemental fiber on glucose metabolism and glycemic control in people with pre-diabetes and T2DM who had a low habitual fiber intake. We recruited 30 participants with HbA1c levels ranging from 45 to 70 mmol/mol, and provided them with psyllium fiber supplements for 12 weeks.&lt;/p&gt;&lt;p&gt;Although we observed reductions in body mass index (BMI) and improvements in lipid profiles, HbA1c levels did not significantly improve overall. Surprisingly, participants taking metformin alone experienced an increase in HbA1c, while those not taking metformin experienced a slight reduction (Figure 1).&lt;/p&gt;&lt;p&gt;This discrepancy points to a critical issue: the potential interaction between metformin and fiber supplementation. Metformin, the most common medication for T2DM works by reducing hepatic glucose production and improving insulin sensitivity [&lt;span&gt;4&lt;/span&gt;]. However, metformin primarily acts within the gastrointestinal tract, commonly producing gastrointestinal side-effects and may alter gut microbiome, with the potential to directly affect fiber absorption [&lt;span&gt;5&lt;/span&gt;]. Our findings suggest that when combined with fiber supplementation, metformin may impair the metabolic benefits typically associated with fiber, alongside a potential detrimental effect on the glycaemic benefits of metformin.&lt;/p&gt;&lt;p&gt;This phenomenon is consistent with previous research. For example, a study by Tramontana et al. found that a high-fiber diet did not improve HbA1c in 78 patients with T2DM on metformin monotherapy [&lt;span&gt;6&lt;/span&gt;], while other studies observed more promising results when fiber was combined with different medications [&lt;span&gt;7&lt;/span&gt;]. These findings highlight the need for a more nuanced understanding of how dietary fiber interacts with both the gut microbiome and medications like metformin.&lt;/p&gt;&lt;p&gt;Moreover, the gut microbiota's role in metabolism is integral to the overall metabolic benefits. Dietary fiber, especially in the form of psyllium, is fermented by gut bacteria into short-chain fatty acids (SCFAs), which have been shown to improve immune function and reduce inflammation—factors that are crucial in managing T2DM [&lt;span&gt;7, 8&lt;/span&gt;]. However, both metformin and fiber alter the gut microbiome in different ways, and this complex ","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108865","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":"Real-World Persistence and Characteristics of Type 2 Diabetes Patients Prescribed Semaglutide in Scotland","authors":"David Alexander Dickie,&nbsp;Ramil Burden,&nbsp;Alexander C. Miller,&nbsp;Lucy Mackillop,&nbsp;Kevin Heath,&nbsp;Sumit Dutta,&nbsp;Jesse Dawson","doi":"10.1111/1753-0407.70102","DOIUrl":"https://doi.org/10.1111/1753-0407.70102","url":null,"abstract":"&lt;p&gt;People taking glucagon-like peptide-1 receptor agonists (GLP-1s), such as semaglutide, have achieved clinically meaningful weight loss (≥ 5%) in large clinical trials over 24 months [&lt;span&gt;1, 2&lt;/span&gt;]. Weight loss is an important aspect of the management of type 2 diabetes [&lt;span&gt;3&lt;/span&gt;]. Using health records from the NHS Greater Glasgow and Clyde Safe Haven (https://www.nhsggc.scot/staff-recruitment/staff-resources/research-and-innovation/nhsggc-safe-haven/), we aimed to explore real-world persistence with initiated 1 mg/0.74 mL 3 mL semaglutide prefilled injection pens and associated body mass index (BMI) changes among type 2 diabetes patients in Scotland.&lt;/p&gt;&lt;p&gt;There were 37 984 prescriptions for semaglutide (1 mg/0.74 mL 3 mL) prefilled injection pens dispensed to 2293 unique patients with type 2 diabetes between August 2019 and February 2024. Mean patient age was 57.3 ± 11.2 years and 1139 (49.7%) were female. The single largest patient group was middle aged females (33.7%). Most patients (69.5%) were white, and a large majority were from lower socioeconomic backgrounds (73.5%).&lt;/p&gt;&lt;p&gt;Out of 1568 patients with a first semaglutide prescription dispensing date at least 2 years before the end of the reporting period (February 2024), 935 (59.6%) were persistent at 24 months.&lt;/p&gt;&lt;p&gt;Changes in BMI by measurement interval are shown in the Table 1. Twenty-five percent of patients with &gt; 3-month measurement intervals achieved improvement in BMI category, 27% with &gt; 6-month measurement intervals, 28% with &gt; 12-month measurement intervals, and 31% with &gt; 24-month measurement intervals.&lt;/p&gt;&lt;p&gt;We found that a large majority of type 2 diabetes patients prescribed semaglutide in Scotland were from lower socioeconomic backgrounds. Sixty percent of patients persisted with semaglutide at 24 months. Statistically significant reductions in BMI (~1 kg/m&lt;sup&gt;2&lt;/sup&gt;) were observed during measurement intervals from &gt; 3 to &gt; 24 months. Approximately one third of patients achieved improvement in BMI category over &gt; 24 months. These changes are lower than reported in previous clinical trials [&lt;span&gt;2&lt;/span&gt;] and may reflect the healthcare challenges people from lower socioeconomic backgrounds face in the real world.&lt;/p&gt;&lt;p&gt;More research is required to set GLP-1 pricing models reflective of real-world efficacy and persistence. There should be an assessment of services that can support patients with type 2 diabetes, particularly those from lower socioeconomic backgrounds, to persist with and maximize the benefits of semaglutide and other GLP-1 s.&lt;/p&gt;&lt;p&gt;D.A.D., R.B., A.C.M., and J.D. conceived and designed this work; all authors contributed to its interpretation. D.A.D. and J.D. acquired and analyzed the data presented. D.A.D. wrote the initial draft and all authors contributed to editing and review of this manuscript and approved the final version for publication.&lt;/p&gt;&lt;p&gt;D.A.D., R.B., A.C.M., L.M., K.H., and S.D. are employees of Optum, a provi","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108873","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":"Sleep Phenotypes, Genetic Susceptibility, and Risk of Obesity in Patients With Type 2 Diabetes: A National Prospective Cohort Study","authors":"Lei Xi,&nbsp;Li Li,&nbsp;Songbo Fu,&nbsp;Yuancheng Dai,&nbsp;Juan Shi,&nbsp;Yanmei Yu,&nbsp;Ying Peng,&nbsp;Hongmei Qiu,&nbsp;Jinsong Kuang,&nbsp;Hongyun Lu,&nbsp;Huige Shao,&nbsp;Chunlei Yuan,&nbsp;Xiaohu Wang,&nbsp;Ping Zhang,&nbsp;Sheli Li,&nbsp;Yanhui Pan,&nbsp;Ling Hu,&nbsp;Zhigang Zhao,&nbsp;Yunxia Chen,&nbsp;Jian Kuang,&nbsp;Yi Shu,&nbsp;Jinhua Qian,&nbsp;Qibin Mao,&nbsp;Jieji Zhang,&nbsp;Yan Liu,&nbsp;Hong Yang,&nbsp;Zhaoli Yan,&nbsp;Weici Xie,&nbsp;Qian Zhang,&nbsp;Ping Zhang,&nbsp;Hongji Wu,&nbsp;Ling Gao,&nbsp;Yongjun Jin,&nbsp;Ning Xu,&nbsp;Chaoyang Xu,&nbsp;Xiaohui Sun,&nbsp;Zhimin Feng,&nbsp;Qing Zhang,&nbsp;Lin Li,&nbsp;Guang Ning,&nbsp;Yifei Zhang,&nbsp;Yanan Cao,&nbsp;Weiqing Wang","doi":"10.1111/1753-0407.70095","DOIUrl":"https://doi.org/10.1111/1753-0407.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To determine the associations between sleep phenotypes and the risks of specific obesity types and weight gain in patients with type 2 diabetes (T2D), especially in different genetic risk groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a prospective study involving 58 890 participants. Sleep and napping were assessed according to the standardized questionnaire. General and abdominal obesity were defined by BMI or visceral fat area (VFA), respectively. Multivariable Cox regression, stratified, and joint analysis were performed to explore potential correlations. Furthermore, mediation models were constructed to figure out the mediating role of metabolic factors (blood pressure, UACR, and HbA1c).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a median 3.05-year follow-up period, short sleep increased the risk of obesity (HR 1.42, 95% CI 1.17–1.71; 1.33, 1.08–1.65) and weight gain (1.21, 1.09–1.34; 1.17, 1.06–1.29), while long sleep and napping were unrelated to abdominal obesity and weight gain. Mediation analysis showed that systolic blood pressure, UACR, and HbA1c mediated the statistical association between night sleep duration and general obesity with proportions (%) of 7.9, 1.8, and 8.8, respectively. Joint analysis showed both sleep and napping groups had no significance among the low genetic risk group, while long napping, short sleep, and long sleep increased the risk of general obesity in medium to high risk patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Short sleep, long sleep, and long napping increased the risk of general obesity and BMI-defined weight gain, and were more pronounced in the medium to high genetic risk group. Napping was unrelated to abdominal obesity. Metabolic factors partially explain the mechanism between sleep and obesity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144100710","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":"Diabetes and Alzheimer's Disease","authors":"Zachary Bloomgarden","doi":"10.1111/1753-0407.70103","DOIUrl":"https://doi.org/10.1111/1753-0407.70103","url":null,"abstract":"&lt;p&gt;The relationship between diabetes and Alzheimer's Disease (AD) has increasingly been recognized. Diabetes is associated with the doubling of vascular dementia and with a one-third increase in the risk of AD [&lt;span&gt;1&lt;/span&gt;]. AD prevalence and mortality have particularly increased over the past three decades in China, and among women in relation to increases in longevity, with higher levels of glycemia the major attributable risk factor, with further risk associated with cigarette use and obesity [&lt;span&gt;2&lt;/span&gt;], at least in part reflecting the association of all three of these factors with insulin resistance. During this time period, obesity has shown greater attributable risk while smoking has become a weaker risk factor, while other factors including environmental pollutants, nutritional deficiencies, alcohol use, and hypertension appear to be associated with considerably lower population attributable risk [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Insulin plays a variety of roles in neuronal function and survival, with diabetes increasing AD risk indirectly as a function of underlying brain insulin resistance, leading to impaired cognitive processes and increasing AD susceptibility [&lt;span&gt;3&lt;/span&gt;]. In insulin-resistant states, brain insulin levels rise, leading to reduced insulin-degrading enzyme (IDE) activity. IDE is responsible for clearing Amyloid-beta (Aβ). Aβ monomers play roles in neuronal synaptic activity, but Aβ has a tendency to autoaggregate, with reduction in IDE activity resulting in greater levels of Aβ, promoting plaque formation and contributing to AD pathology from Aβ accumulation, aggregation, and fibril formation [&lt;span&gt;4&lt;/span&gt;]. Tau protein functions by stabilizing neuronal microtubules and plays a role in neuronal cell signaling. Insulin resistance downregulates an insulin signaling pathway, leading to decreased phosphoinositide 3-kinase (PI3K) activity, in turn altering the activity of the serine/threonine kinase Akt pathway, leading to activation of glycogen synthase kinase-3β (GSK-3β). In addition to its function in regulating glycogen synthesis, GSK-3β is an enzyme involved in phosphorylation of tau protein, with hyperphosphorylated tau aggregating to form neurofibrillary tangles [&lt;span&gt;4&lt;/span&gt;]. The typical pathologic findings of AD, then, are exacerbated by insulin resistance, underlying the association of diabetes with AD.&lt;/p&gt;&lt;p&gt;Both among individuals having and not having diabetes, higher average glucose levels are associated with an increased hazard ratio for dementia [&lt;span&gt;5&lt;/span&gt;]. Similarly, higher HbA1c levels are also associated with greater risk of dementia in patients with diabetes [&lt;span&gt;6&lt;/span&gt;]. There may be relationships between diabetes treatment approaches and dementia development. Of concern, sulfonylureas were associated with a higher risk of dementia development than dipeptidyl peptidase 4 inhibitors (DPP4i) [&lt;span&gt;7&lt;/span&gt;]. The glucagon-like protein-1 receptor agonists (GLP-1 RAs) may reduce brain Aβ lev","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091652","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":"Association of Serum Total Bilirubin to Cholesterol Ratio With Progression of Chronic Kidney Disease in Patients With Type 2 Diabetes: A Retrospective Cohort Study","authors":"Yanyan Chen,&nbsp;Shanshan Wang,&nbsp;Hang Guo,&nbsp;Fei Han,&nbsp;Bei Sun,&nbsp;Nan Li,&nbsp;Hongxi Yang,&nbsp;Liming Chen","doi":"10.1111/1753-0407.70097","DOIUrl":"https://doi.org/10.1111/1753-0407.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the influence of the serum total bilirubin to total cholesterol (TBIL/TC) ratio on the progression of chronic kidney disease (CKD) in people with type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>The present retrospective discovery cohort investigated 4282 patients. The exposure was baseline TBIL/TC ratio. The outcome was the first time to progressing CKD, defined by a drop in the estimated glomerular filtration rate (eGFR) category, along with a reduction in eGFR of at least 25% compared to the baseline value. Hazard ratios (HRs) for CKD progression were evaluated based on the Cox proportional hazards approach. Dose–response relationships were conducted using Restricted Cubic Splines (RCS). Additionally, 758 patients were enrolled as an independent validation cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a median observation period of 2.4 years (interquartile range 1.3–3.8 years) within the discovery cohort, 522 individuals showed progression in CKD. The analysis revealed a negative association between the TBIL/TC ratio and the risk of CKD progression, with an adjusted HR of 0.17 and a 95% CI ranging from 0.07 to 0.41. After adjusting for confounding variables, the HRs for the second, third, and fourth quartiles of the TBIL/TC ratio were recorded at 0.61 (95% CI 0.48, 0.78), 0.55 (95% CI 0.42, 0.72), and 0.55 (95% CI 0.41, 0.74), respectively. Analysis with RCS indicated an optimal TBIL/TC ratio threshold of 0.25%. Similar results were also observed in the validation cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A higher TBIL/TC ratio was significantly associated with a reduced risk of CKD progression in patients with type 2 diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939309","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":"Telemedicine's Impact on Diabetes Care During the COVID-19 Pandemic: A Cohort Study in a Large Integrated Healthcare System","authors":"Reysha Patel,&nbsp;Jie Huang,&nbsp;Loretta Hsueh,&nbsp;Anjali Gopalan,&nbsp;Andrea Millman,&nbsp;Isabelle Franklin,&nbsp;Mary Reed","doi":"10.1111/1753-0407.70096","DOIUrl":"https://doi.org/10.1111/1753-0407.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To examine whether patients exposed to primary care telemedicine (telephone or video) early in the COVID-19 pandemic had higher rates of downstream HbA_1c measurement and improved HbA_1c levels in the second year of the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a cohort of 242,848 Kaiser Permanente Northern California patients with diabetes, we examined associations between early-pandemic patient-initiated telemedicine visits and downstream HbA_1c monitoring and results during the second year of the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adjusted HbA_1c measurement rates were significantly higher among patients with telemedicine exposure in the early-pandemic prior year than those with no visits in the prior year (91.0% testing for patients with video visits, 90.5% for telephone visits, visits, 86.7% for no visits, <i>p</i> &lt; 0.05). Among those with HbA_1c measured, the rates of having an HbA_1c &lt; 8% in the second year of the COVID-19 pandemic were also statistically significantly higher among patients with telemedicine exposure in the early-pandemic prior year than those with no visits in the prior year (68.5% with HbA_1c &lt; 8% for video visits, 67.3% for telephone visits, 66.6% for no visits, <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Access to telephone and video telemedicine throughout the early COVID-19 pandemic was associated with patients' continued engagement in recommended diabetes care. Although our study analyzed telemedicine use during a pandemic, telemedicine visits may continue to support ongoing health care access and positive clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938849","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":"Plantar Tissue Characteristics in People With Diabetes With and Without Peripheral Neuropathy: A Novel Explanatory Model for DPN Risk Assessment","authors":"Yiming Li,&nbsp;Wei Wu,&nbsp;Liyun Xue,&nbsp;Tianyu Zhao,&nbsp;Yucheng Lu,&nbsp;Xiaohui Qiao,&nbsp;Hong Ding","doi":"10.1111/1753-0407.70094","DOIUrl":"https://doi.org/10.1111/1753-0407.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Diabetic peripheral neuropathy (DPN) may affect the biomechanical properties and morphology of the plantar tissue. This study aimed to compare plantar stiffness and thickness in individuals with diabetes with and without DPN and develop a novel explanatory model for DPN risk assessment by integrating these measures with clinical parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials &amp; Methods</h3>\u0000 \u0000 <p>Thirty-two healthy controls and 84 people with diabetes (41 with DPN and 43 without DPN) were included. Shear wave elastography evaluated plantar thickness and stiffness at the heel, hallux, and first and fifth metatarsal heads (1st MTH, 5th MTH). An integrated thickness or stiffness index was generated at multiple locations by principal component analysis (PCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>People with DPN showed a significant increase in plantar thickness (heel, 1st MTH) (<i>p &lt;</i> 0.001) and stiffness (all tested locations) compared to healthy controls (<i>p</i> &lt; 0.05). Moreover, plantar thickness at 1st MTH, plantar stiffness at 5th MTH, and integrated stiffness index generated by PCA were significantly higher in DPN than in the non-DPN group (<i>p</i> &lt; 0.05). A DPN explanatory model was developed using multivariate logistic regression, incorporating the integrated plantar stiffness index, diabetes duration, and gender. The model showed high discriminative ability (AUROC: 97.7%), with an optimal cutoff of 0.56 yielding 92.7% sensitivity and 95.3% specificity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The integrated plantar stiffness index, combined with gender and diabetes duration, offers a novel approach for DPN, providing a noninvasive tool for DPN risk assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914023","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":"Risk Factors, Pathological Changes, and Potential Treatment of Diabetes-Associated Cognitive Dysfunction","authors":"Xiaoyu Meng,&nbsp;Haiyang Du,&nbsp;Danpei Li,&nbsp;Yaming Guo,&nbsp;Peiqiong Luo,&nbsp;Limeng Pan,&nbsp;Ranran Kan,&nbsp;Peng Yu,&nbsp;Yuxi Xiang,&nbsp;Beibei Mao,&nbsp;Yi He,&nbsp;Siyi Wang,&nbsp;Wenjun Li,&nbsp;Yan Yang,&nbsp;Xuefeng Yu","doi":"10.1111/1753-0407.70089","DOIUrl":"https://doi.org/10.1111/1753-0407.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetes is a prevalent public health issue worldwide, and the cognitive dysfunction and subsequent dementia caused by it seriously affect the quality of life of patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Recent studies were reviewed to provide a comprehensive summary of the risk factors, pathogenesis, pathological changes and potential drug treatments for diabetes-related cognitive dysfunction (DACD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Several risk factors contribute to DACD, including hyperglycemia, hypoglycemia, blood sugar fluctuations, hyperinsulinemia, aging, and others. Among them, modifiable risk factors for DACD include blood glucose control, physical activity, diet, smoking, and hypertension management, while non-modifiable risk factors include age, genetic predisposition, sex, and duration of diabetes. At the present, the pathogenesis of DACD mainly includes insulin resistance, neuroinflammation, vascular disorders, oxidative stress, and neurotransmitter disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this review, we provide a comprehensive summary of the risk factors, pathogenesis, pathological changes and potential drug treatments for DACD, providing information from multiple perspectives for its prevention and management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883951","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":"Response to Commentary on “A Population-Based Correlation Analysis Between Hemoglobin A1c and Hemoglobin Levels”","authors":"Tingyu Zhang,&nbsp;Bin Cui","doi":"10.1111/1753-0407.70086","DOIUrl":"https://doi.org/10.1111/1753-0407.70086","url":null,"abstract":"<p>We appreciate the author's attention to our study [<span>1</span>] and their detailed comments. To address their questions and help the readers better understand this research, we would like to provide the following explanation of our study's process.</p><p>A study titled “Altitudes and Hemoglobin A1c Value” conducted by my colleagues was published in 2024 [<span>2</span>]. Their analysis, which included 95 052 individuals across 162 sites in China, revealed a positive correlation between altitude above 2500 m and HbA1c levels, while no such correlation was observed at altitudes below 2500 m. Due to the lack of data on hemoglobin concentrations and red blood cell counts, their study could not provide more in-depth results. Fortunately, our team had some data suitable for further investigation. We selected two cities with altitudes below 2500 m: Kunming (1891 m) and Chengdu (503 m). The hemoglobin concentration in Kunming (mean: 158.73 g/L, SD: 16.36) was higher than in Chengdu (mean: 145.44 g/L, SD: 16.82). There was no difference in HbA1c levels between two groups, with Kunming showing a mean of 5.40 (SD: 0.48) and Chengdu 5.41 (SD: 0.41).</p><p>Although hemoglobin levels in the two cities differ, they remain within the normal reference range. Moreover, residents of both cities shared similar lifestyles and socio-economic conditions; we combined the data to analyze the effects of gender and age. We employed the Generalized Additive Model (GAM) for our analysis, as it effectively captures nonlinear relationships and allows us to focus on trends and patterns. Notably, Figure D reveals a significant gender-based difference in the relationship between HbA1c and age. The HbA1c curve for women shows a distinctive turning point around age 45, which prompted our further investigation in Figures C and D. In Figure D, the disparity in HbA1c levels between women above and below the age of 45 is likely influenced by menopause and changes in estrogen levels. Unfortunately, our dataset does not include estrogen-related data, preventing further analyses in this direction. However, a previous study indicated that estrogen therapy in postmenopausal women with type 1 or type 2 diabetes can reduce HbA1c and fasting glucose levels, which supports our findings [<span>3</span>].</p><p>We acknowledge that our analysis has limitations regarding the types and scope of the real-world clinical data. Therefore, the findings presented in this article underscore the need for more epidemiological studies with rigorous system design to achieve more reliable conclusions.</p><p>T.Z. and B.C. drafted and revised the manuscript.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883949","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}