Journal of Diabetes最新文献

{"title":"Correction to “Letter to the Editor: The Association Between Glycemic Variability and the Risk of Diabetic Retinopathy Progression: A Community-Based Retrospective Cohort Study”","authors":"","doi":"10.1111/1753-0407.70267","DOIUrl":"10.1111/1753-0407.70267","url":null,"abstract":"<p>\u0000 <span>W. Xu</span>, <span>Y. Ma</span>, <span>Q. Yang</span>, et al., “ <span>Letter to the Editor: The Association Between Glycemic Variability and the Risk of Diabetic Retinopathy Progression: A Community-Based Retrospective Cohort Study</span>,” <i>Journal of Diabetes</i> <span>18</span>, no. <span>7</span> (<span>2026</span>): e70250, https://doi.org/10.1111/1753-0407.70250.\u0000 </p><p>Currently the article only lists Wenli Xu as the first author. Yingyan Ma should also have been listed as a first co-author along with Wenli Xu.</p><p>We apologize for this error.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 11","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149331856","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":"Body Mass Index, Cardiometabolic Treatment Patterns and Multifactorial Risk-Factor Control in Chinese Adults With Type 2 Diabetes: A Multicenter Cross-Sectional Study","authors":"Jingya Yan,&nbsp;Wenjia Yang,&nbsp;Xiaoling Cai,&nbsp;Ming Liu,&nbsp;Yanbing Li,&nbsp;Qiuhe Ji,&nbsp;Bo Feng,&nbsp;Nanwei Tong,&nbsp;Linong Ji","doi":"10.1111/1753-0407.70296","DOIUrl":"10.1111/1753-0407.70296","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To examine medication use and simultaneous achievement of glycemic, blood pressure and lipid targets across body mass index (BMI) categories in Chinese adults with Type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This BMI-focused secondary cross-sectional analysis included 8590 adults with evaluable BMI recruited from 60 hospitals in the iCaReMe China Registry. The primary comparison was obesity versus normal weight for simultaneous achievement of HbA1c &lt; 7.0%, blood pressure &lt; 130/80 mmHg and LDL cholesterol &lt; 2.6 mmol/L. Missing data were handled by multiple imputation (20 datasets; 20 iterations per chain), and associations were estimated with center-clustered generalized estimating equations (GEE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort comprised 99 (1.2%) adults with underweight, 2725 (31.7%) normal weight, 3663 (42.6%) overweight, and 2103 (24.5%) obesity. Among 6683 with all three observed components, 332 (5.0%) achieved the composite. Compared with normal weight, the pooled adjusted OR for obesity was 0.55 (95% CI 0.39–0.78); each 1-kg/m² higher BMI was associated with an OR of 0.93 (0.90–0.96). For obesity, component-specific ORs were 0.72 (0.61–0.85) for HbA1c, 0.47 (0.40–0.55) for blood pressure and 1.05 (0.91–1.22) for LDL-C. Sensitivity analyses supported the composite finding, with no evidence of nonlinearity (<i>p</i> = 0.904).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Obesity was associated with lower odds of simultaneous target attainment, with component-specific associations for glycemia and blood pressure but not LDL-C. GLP-1 receptor agonists and SGLT2 inhibitors were used more often at higher BMI; these prescribing patterns do not establish treatment effectiveness.</p>\u0000 \u0000 <p><b>Trial Registration:</b> ChiCTR2300073764.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 11","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13731742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149316490","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":"Exercise-Based Management of Diabetic Cardiomyopathy: Preclinical Mechanisms, Clinical Evidence, and Translational Strategies","authors":"Xiaoya Li,&nbsp;Zhiqiang Wang,&nbsp;Jingjing Liu","doi":"10.1111/1753-0407.70292","DOIUrl":"10.1111/1753-0407.70292","url":null,"abstract":"<p>Diabetic cardiomyopathy is characterized by progressive metabolic dysfunction, myocardial fibrosis, impaired calcium handling, and ventricular remodeling, yet effective strategies for reversing established cardiac injury remain limited. Exercise training has emerged as a promising non-pharmacological approach, although its clinical application is constrained by heterogeneous intervention protocols, inconsistent dose reporting, and limited evidence from well-characterized diabetic cardiomyopathy populations. This narrative review synthesizes current preclinical and clinical evidence on exercise-based management of diabetes-associated myocardial dysfunction, with particular emphasis on underlying mechanisms, exercise prescription, and translational implementation. Experimental studies indicate that exercise may improve myocardial function through enhanced mitochondrial biogenesis and metabolic flexibility, attenuation of oxidative stress and inflammatory-fibrotic signaling, restoration of calcium homeostasis, and regulation of apoptosis, pyroptosis, and microRNA-related pathways. Clinical evidence, derived predominantly from individuals with Type 2 diabetes and subclinical or early cardiac abnormalities, suggests that combined aerobic and resistance training can improve cardiorespiratory fitness, insulin sensitivity, vascular function, and selected indices of left ventricular performance. High-intensity interval training may provide additional benefits in appropriately selected patients, but its safety and effectiveness require individualized assessment. To improve translation, exercise intensity should be reported using physiologically comparable metrics, while treatment response should be evaluated through integrated measures of cardiac imaging, functional capacity, biomarkers, glycemic control, and adverse events. Overall, exercise represents a biologically plausible and clinically relevant adjunctive strategy for diabetic cardiomyopathy, particularly in early-stage disease; however, adequately powered trials in clearly defined patient populations are still needed to establish optimal dose, safety, and long-term cardiovascular benefit.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 11","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149293552","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":"Huaier Attenuates Renal Injury in Type 2 Diabetic Nephropathy by Ameliorating Mitochondrial Dysfunction and Inhibiting Tubular Epithelial Cell Apoptosis","authors":"Yucan Guan,&nbsp;Xiaoying Bai,&nbsp;Xianping Wei,&nbsp;Tao Ding,&nbsp;Ping Luo,&nbsp;Ping Nie","doi":"10.1111/1753-0407.70290","DOIUrl":"10.1111/1753-0407.70290","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetic nephropathy (DN) is a major microvascular complication of Type 2 diabetes, with renal tubular epithelial cells (RTECs) apoptosis playing a pivotal role in its progression. The aqueous extract of <i>Trametes robiniophila</i> Murr. (Huaier) has shown renoprotective effects, but its specific molecular mechanisms in DN remain to be fully elucidated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to investigate the therapeutic effects of Huaier aqueous extract on DN and verify whether its anti-apoptotic mechanism is mediated through the Wnt/β-catenin pathway using the pathway activator SKL2001.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In vivo, KKAy Type 2 diabetic mice were treated with Huaier (5 g/kg/day) for 12 weeks to evaluate renal function and histopathology. In vitro, HK-2 cells were treated with high glucose and palmitate (HG + PA) to induce injury. The Wnt/β-catenin pathway activator SKL2001 was employed to determine if activating this pathway could abolish the protective effects of Huaier.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Bioinformatics analysis indicates that the regulation of apoptosis is the primary mechanism by which Huaier improves DN. In vivo, Huaier reduced UACR and improved renal histopathology in KKAy mice. Consistently, TUNEL staining and molecular analysis confirmed that Huaier significantly suppressed RTECs apoptosis within the renal tissues. In vitro experiments demonstrated that Huaier significantly inhibited HG + PA-induced oxidative stress, mitochondrial dysfunction, and RTECs apoptosis. Notably, the administration of SKL2001 effectively reversed these protective effects, leading to increased β-catenin expression and elevated apoptosis levels despite Huaier treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Huaier aqueous extract mitigates RTECs apoptosis and renal injury in Type 2 diabetic nephropathy by suppressing the Wnt5a/β-catenin signaling pathway.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 11","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70290","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149293489","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":"Correction to “Impact of Imatinib Therapy on Immunometabolism to Promote β-Cell Survival in Diabetes”","authors":"","doi":"10.1111/1753-0407.70294","DOIUrl":"10.1111/1753-0407.70294","url":null,"abstract":"<p>\u0000 <span>S. Kumar</span> and <span>R. Kumari</span>, “ <span>Impact of Imatinib Therapy on Immunometabolism to Promote β-Cell Survival in Diabetes</span>,” <i>Journal of Diabetes</i> <span>18</span>, no. <span>7</span> (<span>2026</span>): e70252.\u0000 </p><p>The affiliation of the corresponding author was incorrect in the original publication. The correct affiliation is: “Independent Researcher, New Orleans, Louisiana, USA” instead of “Department of Microbiology/Immunology, Tulane University, New Orleans, LA, United States.”</p><p>We apologize for this error.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 11","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149293455","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":"Diabetic Peripheral Neuropathy With Low Appendicular Muscle Mass Is Associated With Osteoporosis, Falls, and Fractures","authors":"Biao Zheng,&nbsp;Yongze Zhang,&nbsp;Dan Liang,&nbsp;Ximei Shen,&nbsp;Lingning Huang,&nbsp;Fengying Zhao,&nbsp;Sunjie Yan","doi":"10.1111/1753-0407.70276","DOIUrl":"10.1111/1753-0407.70276","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Diabetic peripheral neuropathy (DPN) and low appendicular muscle mass (LAMM) may jointly contribute to adverse skeletal outcomes, but their combined effects remain unclear. We examined their associations with osteoporosis, falls, and fractures in patients with Type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We explored associations of diabetes and grip strength with skeletal outcomes using SHARE v8.0.0 (327 248 participants). The primary analysis used a cohort of patients with Type 2 diabetes from the First Affiliated Hospital of Fujian Medical University. LAMM was defined using dual-energy X-ray absorptiometry-derived appendicular skeletal muscle mass index. Associations of clinically diagnosed DPN, LAMM, and their coexistence with osteoporosis, falls, and fractures were evaluated using logistic regression and Cox survival models. Exploratory serum antibody omics was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In SHARE, grip strength was inversely associated with all three outcomes. In the local cohort, coexisting DPN and LAMM were associated with higher odds of osteoporosis (OR 2.151, 95% CI 1.645–2.805), falls (OR 4.667, 95% CI 3.406–6.376), and fractures (OR 2.416, 95% CI 1.367–3.515; all <i>p</i> &lt; 0.001). Cox analyses showed higher hazards of osteoporosis (HR 3.410, 95% CI 1.579–7.362; <i>p</i> = 0.002) and falls (HR 4.385, 95% CI 1.838–10.459; <i>p</i> &lt; 0.001), but not fractures (HR 0.708, 95% CI 0.187–2.675; <i>p</i> = 0.611). Antibody omics suggested a reactivity profile involving endoplasmic reticulum protein processing and neurodegeneration-related pathways.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Coexisting DPN and LAMM were associated with higher odds of all three skeletal outcomes and higher longitudinal hazards of osteoporosis and falls, but not fractures. The exploratory omics findings require functional validation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 11","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13715079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149284315","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":"Kidney Protection, Obesity Treatment, and Multiorgan Biology: When More Therapy Is—And Is Not—Better","authors":"Zachary T. Bloomgarden,&nbsp;Yehuda Handelsman","doi":"10.1111/1753-0407.70284","DOIUrl":"10.1111/1753-0407.70284","url":null,"abstract":"<p>The first commentary in this series considered why HiD is best understood as a systems-oriented care model rather than a new organ-based specialty. This second commentary focuses on two areas in which that model is especially important: chronic kidney disease (CKD) and obesity. The kidney sessions emphasized multi-mechanism protection and the proper interpretation of the early eGFR dip; the obesity sessions shifted attention from the amount of weight lost toward the quality, durability, and functional consequences of weight loss.</p><p>Across both areas, the central caution is similar. A plausible mechanism, a biomarker change, a DEXA finding, or a projected additive effect is not the same as an outcomes trial. New therapies should be welcomed when they add clinically meaningful benefit, but novelty alone should not displace effective, less expensive, and better-established approaches.</p><p>\u0000 \u0000 </p><p>The most useful direction is therefore not maximal treatment by default, but earlier identification of dominant risks, selection of complementary mechanisms, planned monitoring and attention to function, affordability and persistence. The third commentary turns to cross-cutting biology, artificial intelligence and digital health, asking whether richer phenotyping can improve implementation without creating a new layer of overdiagnosis and information overload.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 10","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13681345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149226816","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":"Txnip/PDK4-Mediated Hyperdependence on Fatty-Acid Oxidation Amplifies Susceptibility of Diabetic Myocardium to Ischemia–Reperfusion Damage","authors":"Zheng Zeng,&nbsp;Wei Shi,&nbsp;Yuxuan He,&nbsp;Yue Wang,&nbsp;Cong Pu,&nbsp;Jingtong Tan,&nbsp;Hai Guo,&nbsp;Haiping Ma","doi":"10.1111/1753-0407.70277","DOIUrl":"10.1111/1753-0407.70277","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Undergoing perioperative ischemia-reperfusion injury (I/RI), the prevalence of adverse cardiac events is high due to increased myocardial vulnerability in diabetic patients. However, the specific mechanisms of increased myocardial vulnerability in diabetes are still unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the specific mechanisms underlying increased myocardial vulnerability in diabetes and to explore potential myocardial protective strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, we repeatedly verified through single-cell sequencing, fluorescence in situ staining, metabonomics, and animal experiments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Here we show for the first time that the cardiomyocyte subtype (C6 cardiomyocyte) is a cardiomyocyte characterized by myocardial contraction, and the reduction of its number and metabolic heterogeneity is the basis of myocardial ischemia-reperfusion injury in diabetes. Among them, TXNIP/PDK4 mediated metabolic reprogramming is an important reason for myocardial vulnerability in diabetes, and through regulating TXNIP/PDK4, we optimize myocardial energy metabolism. It can significantly improve the vulnerability of diabetes myocardium, play a good role in myocardial protection, and has clinical transformation potential.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 10","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13681344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149226813","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":"Detection and Risk Prediction of Diabetes Related Kidney Disease Using Retinal Images: A Systematic Review and Meta-Analysis","authors":"Samuel Ato Gyasi Otabir,&nbsp;Teketo Kassaw Tegegne,&nbsp;Paul Nderitu,&nbsp;Jiangtao Wang,&nbsp;Jonathan E. Shaw,&nbsp;David Owens,&nbsp;Rebecca Thomas,&nbsp;Robyn Jennifer Tapp,&nbsp;Ralph Maddison","doi":"10.1111/1753-0407.70271","DOIUrl":"10.1111/1753-0407.70271","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to determine the effectiveness of deep learning models for detecting and predicting diabetes related kidney disease (DRKD) using two-dimensional retinal images.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted across eight databases from inception to July 14, 2026. Eligible cross-sectional and longitudinal studies assessed deep learning models for DRKD detection or prediction using retinal images alone, clinical data alone, or hybrid models. Data on study design, model development, validation, and performance metrics were extracted, with study quality appraised using QUADAS-2 and post hoc, PROBAST+AI. Results were synthesized narratively, with random effects meta analysis for hybrid models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 367 studies, six met inclusion criteria. Three cross-sectional studies of hybrid models contributed to the meta-analysis for DRKD detection, yielding pooled AUC 0.88, sensitivity 0.80, and specificity 0.81, though heterogeneity was high (I2 93.7%–99.8%). Three further studies were synthesized narratively rather than pooled: two cross-sectional studies used more severe or narrower CKD case definitions (AUC 0.86 and 0.96 respectively), and only one longitudinal study predicted the 5-year risk of DRKD (AUC 0.81, sensitivity 0.70, and specificity 0.77). External validation showed hybrid models consistently outperformed retinal-only (ΔAUC 0.03–0.11), but their advantage over clinical-only models was inconsistent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Deep learning models may be useful for detecting and predicting DRKD from retinal images, with or without clinical data. However, the small number of heterogenous studies restricts generalizability. Future work should prioritize robust model development, and validation using large, diverse populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 10","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219825","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":"Prognostic Value of Sudomotor Small-Fiber Function and Large Nerves for Accelerated Renal Decline in Type 2 Diabetes: A Real-World Cohort Study","authors":"Qingyun Cai,&nbsp;Xiuqi Qiao,&nbsp;Sijia Fei,&nbsp;Yanxiang Luo,&nbsp;Lixin Guo,&nbsp;Qi Pan","doi":"10.1111/1753-0407.70286","DOIUrl":"10.1111/1753-0407.70286","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate the longitudinal prognostic value of small- and large-fiber peripheral nerve assessments for accelerated renal decline in patients with Type 2 diabetes (T2D).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An initial cross-sectional analysis evaluated concurrent neuro-renal associations, while a subsequent longitudinal cohort assessed accelerated renal progression (eGFR loss &gt; 3 mL/min/1.73 m²/year) using paired baseline and follow-up data. Prognostic predictors were selected via LASSO regression. Model utility was assessed using area under the curve (AUC), net reclassification improvement (NRI), and decision curve analysis (DCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cross-sectional sudomotor small-fiber dysfunction accurately mirrored concurrent renal impairment (<i>β</i> = 0.18, 95% CI: 0.10–0.26, <i>p</i> &lt; 0.001). Longitudinally, ESCF demonstrated no independent prognostic value for accelerated renal decline, and its apparent longitudinal association with future eGFR was completely attenuated after adjusting for baseline renal function. LASSO regression retained right peroneal motor amplitude, serum albumin, platelet count, and SGLT2i use as robust prognostic factors. Notably, subgroup analyses revealed this large-nerve predictive capacity was significant primarily in patients with established DKD (<i>p</i> for interaction = 0.006). Incorporating this neurofunctional phenotype into standard clinical models yielded a modest AUC improvement but achieved a clinically relevant continuous NRI of 30.35%, successfully recalibrating risk profiles. DCA confirmed a superior net clinical benefit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A distinct prognostic dissociation exists within the diabetic neuro-renal axis. Sudomotor small-fiber dysfunction primarily reflects established microvascular impairment, whereas large motor nerve degeneration demonstrates independent prognostic value for future accelerated renal decline. Incorporating this neurofunctional phenotype into traditional clinical models yields substantial individualized risk reclassification, thereby potentially aiding in identifying high-risk individuals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 10","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149222845","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}