Journal of Diabetes最新文献

{"title":"Hemoglobin Glycation Index and Prognosis in Patients With Acute Myocardial Infarction Without Reduced Left Ventricular Ejection Fraction: A Multicenter Retrospective Cohort Study","authors":"Shangjian Luo,&nbsp;Huan Liu,&nbsp;Xuesong Wen","doi":"10.1111/1753-0407.70257","DOIUrl":"10.1111/1753-0407.70257","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The prognostic value of the hemoglobin glycation index (HGI) in patients with acute myocardial infarction (AMI) without reduced left ventricular ejection fraction (LVEF) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective cohort study included 1706 patients with AMI without reduced LVEF. HGI was calculated as measured HbA1c minus predicted HbA1c. Restricted cubic spline (RCS) analysis was used to evaluate nonlinear associations between HGI and outcomes and identify the cutoff value. Piecewise Cox regression and subgroup analyses were also performed. The primary endpoint was major adverse cardiovascular events (MACEs), defined as a composite of rehospitalization for heart failure (HF), recurrent myocardial infarction (MI), and cardiovascular death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median follow-up was 3.86 (2.30–4.98) years. RCS analysis showed a non-linear association between HGI and adverse outcomes, with a cutoff at −0.174. In patients with HGI ≤ −0.174, higher HGI was associated with lower risks of rehospitalization for HF (HR = 0.600, 95% CI: 0.464–0.776), recurrent MI (HR = 0.599, 95% CI: 0.365–0.983), cardiovascular death (HR = 0.627, 95% CI: 0.458–0.859), all-cause death (HR = 0.552, 95% CI: 0.428–0.713), and MACEs (HR = 0.603, 95% CI: 0.483–0.753) after multivariable adjustment. In contrast, no significant associations were observed in patients with HGI &gt; −0.174 after adjustment. Within the lower-HGI subgroup, severely low HGI was associated with a higher risk of rehospitalization for HF and MACEs compared with mildly low HGI. Subgroup analyses were generally consistent with the main results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In AMI patients without reduced LVEF, HGI showed a non-linear association with adverse outcomes, mainly in the lower-HGI range. These exploratory findings require prospective validation before clinical application.</p>\u0000 \u0000 <p><b>Trial Registration:</b> ClinicalTrials.gov Identifier: NCT04485988 and NCT04564365</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 7","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534698","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":"A Prospective Multicenter Assessment of the Accuracy and Safety of the Yuwell CT3 Real-Time Continuous Glucose Monitoring System in Patients With Diabetes Over 14 Days","authors":"Lingli Zhou,&nbsp;Yufeng Li,&nbsp;Xingguang Zhang,&nbsp;Hongwei Ling,&nbsp;Yibing Lu,&nbsp;Linong Ji","doi":"10.1111/1753-0407.70246","DOIUrl":"10.1111/1753-0407.70246","url":null,"abstract":"&lt;p&gt;To the Editor.&lt;/p&gt;&lt;p&gt;Accurate and timely glucose monitoring is essential for diabetes management to prevent life-threatening hypoglycemia and long-term hyperglycemia-related complications [&lt;span&gt;1, 2&lt;/span&gt;], and to guide treatment adjustments [&lt;span&gt;3&lt;/span&gt;]. Compared with intermittent self-monitoring, real-time continuous glucose monitoring (CGM) provides dynamic glucose profiles and detects otherwise unrecognized glycemic fluctuations [&lt;span&gt;4&lt;/span&gt;]. The CT3 CGM system (Zhejiang POCTech Co. Ltd., Huzhou, China), developed by a company focused on biosensor-based portable medical monitoring systems, is designed to improve signal stability and reduce electrochemical interference. It consists of an enzyme-based sensor, a transmitter, and a mobile app (Figure S1). Interstitial glucose is oxidized by glucose oxidase, generating hydrogen peroxide that is electrochemically detected, with the resulting current proportional to glucose concentration. Data are transmitted via Bluetooth to a smart device, providing real-time glucose readings and alerts for hypo- and hyperglycemia. The system supports flexible wear sites (upper arm or abdomen), is calibration-free, and enables continuous use for up to 14 days. In this study, we evaluated its accuracy, safety, and alarm performance in adults with diabetes using venous blood glucose as the reference.&lt;/p&gt;&lt;p&gt;This prospective, multicenter, self-controlled study (March–May 2022, five Chinese sites) enrolled 71 adults with type 1 or type 2 diabetes (T1D/T2D). Major inclusion criteria included age ≥ 18 years and willingness to wear the device for ≥ 14 days; key exclusions were skin diseases, allergies, bleeding tendency, pregnancy, or recent trial participation. A sample size ≥ 60 (per guidelines) ensured validity for primary outcomes [&lt;span&gt;5&lt;/span&gt;]. Ethical approval (Peking University People's Hospital, No. 2021PHA165-001) and informed consent were obtained.&lt;/p&gt;&lt;p&gt;Participants wore four CT3 sensors on bilateral upper arms and abdomen from day 1 and were randomly assigned to one 7-h clinic session on Day 1/2, 7/8, or 14. During sessions, venous blood was collected every 15 min and measured using the Biosen Lactate and Glucose Analyzer (EKF Diagnostics GmbH, Leipzig, Germany), with each value paired to the nearest CGM reading within 5 min. Standardized meals were provided, and glucose levels were not intentionally manipulated. Insertion sites, adverse events, and usability were assessed on the final day.&lt;/p&gt;&lt;p&gt;Outcomes included accuracy (mean absolute relative difference [MARD], %15/15–%30/30, Clarke error grid [CEG], mean absolute difference [MAD], median absolute relative difference [ARD]) and hypo−/hyperglycemia detection and alert rates (sensitivity/specificity). Analyses were performed using R and SAS 9.4.&lt;/p&gt;&lt;p&gt;All 71 participants (54.9% male, mean age 52.65 years [range 19–73]) completed the study; 22.5% had T1D and 77.5% had T2D (Table S1). A total of 8174 matched CGM-EKF glucose pairs were obtained.","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 7","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70246","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434517","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":"Letter to the Editor: The Association Between Glycemic Variability and the Risk of Diabetic Retinopathy Progression: A Community-Based Retrospective Cohort Study","authors":"Wenli Xu,&nbsp;Yingyan Ma,&nbsp;Qinping Yang,&nbsp;Qinghua Yan,&nbsp;Jingyan Tian,&nbsp;Yan Shi,&nbsp;Minna Cheng,&nbsp;Lina Lu","doi":"10.1111/1753-0407.70250","DOIUrl":"10.1111/1753-0407.70250","url":null,"abstract":"&lt;p&gt;Diabetic retinopathy is among the most clinically significant microvascular complications of diabetes and is a leading cause of preventable blindness [&lt;span&gt;1&lt;/span&gt;]. Average glycemic control is an established risk factor [&lt;span&gt;2, 3&lt;/span&gt;], but whether glycemic variability contributes independently to retinal damage remains less clear [&lt;span&gt;4, 5&lt;/span&gt;]. We examined whether long-term variability in HbA1c, derived from serial measurements, was associated with diabetic retinopathy progression in a community-based cohort of patients with type 2 diabetes.&lt;/p&gt;&lt;p&gt;We included 675 adults with type 2 diabetes who underwent fundus examinations in both 2020 and 2023, and who had at least three valid HbA1c measurements during follow-up. Five variability indices were calculated: coefficient of variation, average real variability, successive variation, variability independent of the mean, and HbA1c variability score. Progression was defined as incident retinopathy, progression to proliferative disease, or worsening within non-proliferative stages.&lt;/p&gt;&lt;p&gt;Of 675 participants, 125 experienced diabetic retinopathy progression. All variability indices were numerically higher in the progression group, but only HbA1c variability score differed significantly at baseline. After multivariable adjustment, HbA1c variability score remained independently associated with progression; the other indices did not. In stratified analysis, the association was stronger in patients with diabetes duration of 10 years or less but was not significant in those with longer diseases.&lt;/p&gt;&lt;p&gt;These findings suggest that the frequency of clinically meaningful HbA1c fluctuations may matter more than how large individual swings are. The attenuation of the association with longer diabetes duration may reflect the accumulating burden of structural retinal damage, which by then has likely been shaped by years of prior exposure. If replicated, this would argue that the first decade after diagnosis is a particularly important window for glycemic stabilization—not just lowering means HbA1c but reducing repeated excursions.&lt;/p&gt;&lt;p&gt;Practically, HbA1c variability score can be derived from routine clinical measurements, making it a feasible marker for risk stratification without additional testing. Prospective trials are needed to determine whether reducing glycemic instability translates into slower retinopathy progression.&lt;/p&gt;&lt;p&gt;In summary, long-term HbA1c variability, specifically HbA1c variability score, was independently associated with diabetic retinopathy progression in type 2 diabetes. Glycemic stability, not just glycemic level, may deserve more attention in routine care—particularly early in the disease course.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Wenli Xu:&lt;/b&gt; conceptualization, methodology, investigation, software, formal analysis, writing – original draft, visualization. &lt;b&gt;Yingyan Ma:&lt;/b&gt; conceptualization, investigation, data curation, writing – review and editing. &lt;b&gt;Qinping Yang:&lt;/b&gt; conceptualization, method","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 7","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434512","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":"Aldosterone Synthase Inhibition in Diabetes and Cardiorenal Metabolic Disease","authors":"Zachary Bloomgarden","doi":"10.1111/1753-0407.70253","DOIUrl":"10.1111/1753-0407.70253","url":null,"abstract":"&lt;p&gt;For clinicians caring for people with diabetes, hypertension, chronic kidney disease (CKD), and heart failure, the renin–angiotensin–aldosterone system (RAAS) should not be considered a single therapeutic axis defined only by angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs). The RAAS is a biological network in which angiotensin II, renin, aldosterone synthesis, and mineralocorticoid receptor (MR) activation contribute differently to blood pressure, albuminuria, fibrosis, and cardiovascular-kidney-metabolic (CKM) risk. ACE inhibitors and ARBs remain foundational in albuminuric diabetic kidney disease, while beta blockers and direct renin inhibitors illustrate that RAAS-adjacent pharmacology does not necessarily produce broad cardiorenal-metabolic benefit. MR antagonists, particularly finerenone, have established aldosterone/MR activation as an outcome-relevant target in Type 2 diabetes (T2D) with CKD and in heart failure with mildly reduced or preserved ejection fraction. Aldosterone synthase inhibitors, also described as aldosterone-reducing inhibitors, now add an upstream strategy: reduction of aldosterone production through CYP11B2 inhibition. Recent trials with baxdrostat, lorundrostat, and vicadrostat support clinically meaningful blood pressure or albuminuria effects. The role of aldosterone synthase inhibition should at present be considered complementary to outcome-proven agents such as ACEi, ARB, beta-blocker, or MRAs Table 1.&lt;/p&gt;&lt;p&gt;Diabetes care has shifted from glucose control alone to the prevention of cardiovascular, renal, and metabolic complications as a shared clinical endpoint. The CKM framework captures what clinicians observe daily: Diabetes, obesity, CKD, hypertension, and heart failure do not progress independently, but reinforce one another through hemodynamic stress, sodium retention, inflammation, endothelial dysfunction, and fibrosis [&lt;span&gt;20&lt;/span&gt;]. Current diabetes standards continue to place RAAS inhibition at the center of CKD risk management, particularly in patients with hypertension and albuminuria, while adding SGLT2 inhibitors, GLP-1 receptor agonists, and nonsteroidal MR antagonism to reduce residual risk [&lt;span&gt;2&lt;/span&gt;]. The mechanistic question is no longer whether the RAAS matters in diabetes; it is which portion of the RAAS is dominant for a given individual, and how precisely it should be targeted.&lt;/p&gt;&lt;p&gt;This question is of clinical importance in the setting of the movement of aldosterone biology from background physiology to active therapeutic territory. For decades, diabetic kidney disease and hypertension were treated mainly through reduction of angiotensin II signaling. That strategy remains proven. Yet many patients with diabetes and CKD have persistent albuminuria, uncontrolled or resistant hypertension, volume expansion, low-renin physiology, or heart failure despite ACEi or ARB therapy. In these settings, persistent aldosterone production, aldosterone bre","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 7","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70253","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417105","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":"Clinical Characteristics of Diabetic Cardiovascular Autonomic Neuropathy in Korean Individuals With Type 2 Diabetes","authors":"Seon Mee Kang,&nbsp;Kyong Hye Joung,&nbsp;Chong Hwa Kim,&nbsp;Jae-Seung Yun,&nbsp;Jong Chul Won,&nbsp;Jae Hyuk Lee,&nbsp;Chang Won Lee,&nbsp;Hyuk-Sang Kwon,&nbsp;Ie Byung Park,&nbsp;Tae Sun Park","doi":"10.1111/1753-0407.70245","DOIUrl":"10.1111/1753-0407.70245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to evaluate the prevalence, clinical characteristics, and factors associated with cardiovascular autonomic neuropathy (CAN) in Korean individuals with long-standing type 2 diabetes mellitus (T2DM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 876 participants with long-standing T2DM were enrolled in this multicenter cross-sectional study. CAN was evaluated using standard cardiovascular autonomic reflex tests (CARTs) and corrected QT interval (QTc), with additional heart rate variability (HRV) analysis. CAN severity was classified as early, definite, or severe. Multivariable logistic regression analysis was performed to identify factors independently associated with CAN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CAN was detected in 88.4% of participants. Individuals with CAN showed reduced HRV indices and prolonged QTc intervals. Multivariable analysis revealed advanced age (OR = 1.062; 95% CI: 1.035–1.091; <i>p</i> &lt; 0.0001) and higher systolic blood pressure (OR = 1.036; 95% CI: 1.022–1.051; <i>p</i> &lt; 0.0001) as factors independently associated with CAN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CAN is highly prevalent among Korean individuals with long-standing T2DM. Older age and elevated systolic blood pressure were independently associated with CAN, highlighting the importance of routine CAN screening and careful blood pressure management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 7","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417147","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 vs. Randomized Trial Evidence for Incretin-Based Therapies: A Narrative Review","authors":"Zachary Bloomgarden","doi":"10.1111/1753-0407.70248","DOIUrl":"10.1111/1753-0407.70248","url":null,"abstract":"<p>Incretin-based therapies have transformed the management of obesity and type 2 diabetes (T2D). Pivotal randomized controlled trials (RCTs) report substantial weight loss and glycemic improvements; the extent to which these translate to clinical populations remains uncertain. Seven 2026-published RCT meta-analyses (comprising 127 RCTs and 58 976 participants) were compared with 26 real-world studies identified through structured PubMed search. Primary outcomes were body weight loss and HbA1c reduction; secondary outcomes included major adverse cardiovascular events (MACE), neurological end-points, and safety. The comparison is descriptive. For T2D, real-world semaglutide achieved 4.7–10.5 kg weight loss (6–12 months) and 1.0–1.3 percentage-point HbA1c reductions, lower than RCT meta-analytic estimates (tirzepatide mean difference [MD] −9.55% vs. placebo). Without diabetes, real-world persister analyses (SHAPE study: semaglutide −14.1%, tirzepatide −16.5%) approximated per-protocol RCT estimates (semaglutide −14.9%, tirzepatide 15 mg −20.9%), whereas intention-to-treat real-world estimates were substantially lower. Just 13% of semaglutide users reached 2.4 mg and 25.9% of tirzepatide users reached 15 mg. Real-world cardiovascular data showed 20%–46% MACE reductions, broadly consistent with the RCT reduction. Differences between T2D and non-T2D populations likely reflect channeling bias and differential follow-up. Real-world incretin-based therapy effectiveness is broadly consistent with RCT efficacy when dose attainment is accounted for. High discontinuation rates (20%–50% within 1 year) and prior GLP-1 RA exposure track with the observed efficacy gap. Clinicians can expect RCT-level outcomes in patients who tolerate and persist with target doses. Head-to-head cardiovascular outcome trials comparing tirzepatide and semaglutide in non-diabetic populations are needed.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 7","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70248","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403032","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 Retinopathy Severity and Heart Failure Outcomes in Type 2 Diabetes Mellitus","authors":"Feng-Ching Shen,&nbsp;Pei-Kang Liu,&nbsp;Yi-Chen Huang,&nbsp;Teng-Hui Huang,&nbsp;Ming-Yen Lin,&nbsp;Yi-Hsueh Liu,&nbsp;Tien-Chi Huang,&nbsp;Mei-Chuan Kuo,&nbsp;Yi-Wen Chiu,&nbsp;Shang-Jyh Hwang,&nbsp;Yi-Ting Lin,&nbsp;Ping-Hsun Wu","doi":"10.1111/1753-0407.70235","DOIUrl":"10.1111/1753-0407.70235","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The precise link between diabetic retinopathy and incident heart failure remains unclear, largely limited by a lack of echocardiographic data. This study evaluated how the clinical severity of retinopathy relates to incident heart failure and baseline cardiac function in individuals with type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study (2005–2021) included adults with type 2 diabetes receiving structured management and color fundus imaging. Retinopathy was classified as absent, mild nonproliferative, or moderate-to-severe nonproliferative to proliferative. A specific subcohort received baseline transthoracic echocardiography. Relationships between cardiac function parameters and retinal damage were assessed using ordinal logistic regression with inverse probability weighting. Incident heart failure risk was determined utilizing Cox proportional hazards and Poisson regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 21 773 participants, heart failure was independently associated with advanced retinopathy (OR, 1.23). After inverse probability weighting (IPW), associations with systolic dysfunction (unweighted OR, 1.96; IPW-adjusted OR, 2.01) and diastolic dysfunction were significant, with the latter explicitly unmasked by IPW (unweighted OR, 1.08 vs. IPW-adjusted OR, 1.17). The risk for incident heart failure escalated alongside progressive retinal damage. Compared to patients presenting without retinopathy, the adjusted incidence rate ratios were 1.64 for the mild group and 1.86 for those with moderate-to-severe or proliferative disease, an association partially mediated by renal function decline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Diabetic retinopathy severity associates with systolic and diastolic dysfunction and is an independent risk factor for incident heart failure in type 2 diabetes. Routine retinal evaluation serves as a practical clinical indicator for assessing systemic microvascular damage and cardiovascular risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 7","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70235","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374005","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":"Impact of Imatinib Therapy on Immunometabolism to Promote β-Cell Survival in Diabetes","authors":"Sandeep Kumar,&nbsp;Reena Kumari","doi":"10.1111/1753-0407.70252","DOIUrl":"10.1111/1753-0407.70252","url":null,"abstract":"&lt;p&gt;Diabetes mellitus is characterized by progressive pancreatic β-cell dysfunction, chronic low-grade inflammation, oxidative stress, mitochondrial impairment, and systemic metabolic dysregulation [&lt;span&gt;1-3&lt;/span&gt;]. Although currently available therapies effectively improve glycemic control, they fail to adequately preserve endogenous β-cell mass and prevent long-term disease progression [&lt;span&gt;4&lt;/span&gt;]. Increasing evidence suggests that targeting immune metabolic signaling pathways may provide disease-modifying therapeutic benefits by simultaneously modulating inflammatory responses and cellular metabolic homeostasis [&lt;span&gt;5, 6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Tyrosine kinase inhibitor imatinib has emerged as a promising therapeutic target for anti-leukemic activity [&lt;span&gt;7&lt;/span&gt;]. Beyond its direct effects on pancreatic β-cells, imatinib also exerts broad immune metabolic actions that target several key pathogenic mechanisms underlying diabetes [&lt;span&gt;8&lt;/span&gt;]. Studies have demonstrated that imatinib improves peripheral insulin sensitivity, suppresses pro-inflammatory cytokine production, and attenuates chronic inflammatory signaling pathways that contribute to insulin resistance and β-cell dysfunction [&lt;span&gt;9, 10&lt;/span&gt;]. Inhibition of c-Abl, PDGFR, and related tyrosine kinases reduces inflammatory stress, fibrosis, and tissue remodeling in metabolic organs, thereby improving systemic glucose homeostasis [&lt;span&gt;11, 12&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Recent evidence indicates that imatinib induces a mild inhibition of mitochondrial respiration, leading to activation of AMP-activated protein kinase (AMPK), a master regulator of metabolic homeostasis. AMPK activation subsequently suppresses thioredoxin-interacting protein (TXNIP), reduces oxidative and endoplasmic reticulum stress, enhances autophagic responses, and protects β-cells from apoptosis. In both experimental models and human islets, these effects preserve β-cell viability and functional capacity under diabetogenic conditions [&lt;span&gt;13&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Imatinib exerts pleiotropic protective effects on pancreatic β-cells through coordinated regulation of inflammatory, stress-response, and metabolic signaling pathways [&lt;span&gt;14, 15&lt;/span&gt;]. Imatinib suppresses M1 macrophage polarization, pro-inflammatory cytokine production (TNF-α, IFN-γ, and IL-1β), and Th1/Th17-mediated immune responses while promoting an anti-inflammatory M2 macrophage phenotype, thereby reducing local and systemic inflammation and reduce β-cell death [&lt;span&gt;16, 17&lt;/span&gt;]. At the cellular level, inhibition of c-Abl signaling attenuates endoplasmic reticulum (ER) stress and suppresses PERK, IRE1α, and ATF6 activation, preventing CHOP-mediated apoptosis. Concurrently, imatinib disrupts the c-Abl–SHIP2 interaction, enhancing PI3K/Akt signaling, β-catenin accumulation, and ERK1/2 activation, which collectively support β-cell survival, proliferation, and regeneration [&lt;span&gt;18-20&lt;/span&gt;]. Imatinib also induces mild mitochondrial stress, resulting in re","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 7","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70252","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148349919","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":"Clonal Hematopoiesis and Type 2 Diabetes: A Narrative Review","authors":"Jian-Jun Liu,&nbsp;Sylvia Liu,&nbsp;Resham L. Gurung,&nbsp;Su Chi Lim,&nbsp;Rajkumar Dorajoo","doi":"10.1111/1753-0407.70251","DOIUrl":"10.1111/1753-0407.70251","url":null,"abstract":"<p>Clonal hematopoiesis (CH) refers to an expanded clonal hematopoietic cell population due to acquired mutations conferring a selective growth advantage. Once considered a premalignant hematological state, CH has now been causally associated with cardiovascular diseases (CVDs) and several aging-related clinical conditions. Emerging evidence suggests that CH is at the intersection of aging and metabolic disorders. CH carriers exhibit a higher risk of Type 2 diabetes, potentially through the obesity–inflammation–insulin resistance axis. Moreover, CH confers a higher risk of CVD and is associated with a poorer prognosis in patients with diabetes compared to noncarriers. In addition, CH has been associated with the development of microvascular complications, including retinopathy and kidney disease in patients with diabetes, although inconsistent findings exist. Preclinical studies found that antidiabetic medication metformin might slow down clonal expansion of CH, while clinical data suggest that anti-inflammatory medications confer better clinical outcomes for certain CH carriers, although their relevance for patients with diabetes remains to be elucidated. In this narrative review, we also briefly discuss the barriers to clinical adoption of CH detection and highlight the knowledge gaps that should be addressed in future work.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 7","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70251","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350154","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":"Multimorbidity and the Number of Conditions Increase With the Duration of Type 1 Diabetes and Associate With Increased Mortality","authors":"Anni Ylinen,&nbsp;Stefan Mutter,&nbsp;Stefanie Hägg-Holmberg,&nbsp;Susanna Satuli-Autere,&nbsp;Valma Harjutsalo,&nbsp;Per-Henrik Groop,&nbsp;Lena M. Thorn,&nbsp;the FinnDiane Study Group","doi":"10.1111/1753-0407.70249","DOIUrl":"10.1111/1753-0407.70249","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Multimorbidity in type 1 diabetes has previously not been studied in detail. Therefore, we aimed to assess the prevalence of multimorbidity and its association with mortality in type 1 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational follow-up study includes 4069 individuals with type 1 diabetes from the Finnish Diabetic Nephropathy study. The prevalence of multimorbidity (coexistence of two or more chronic conditions) was based on 32 conditions at baseline. Conditions were grouped into three subcategories: vascular comorbidities, autoimmune disorders, and other conditions. Hazard ratios (HR) for all-cause mortality were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of multimorbidity was 60.4% and increased with age and especially diabetes duration. Multimorbidity was associated with increased risk of mortality, HR 6.0 (95% CI 4.6–7.8), <i>p</i> &lt; 0.001. The HR for mortality increased by each additional condition and was 37.9 (95% CI 25.7–56.0) in those with ≥eight conditions. Vascular comorbidities and other conditions were associated with increased mortality, HRs 5.9 (4.4–7.9) and 3.8 (2.4–5.9), <i>p</i> &lt; 0.001, separately, and in combination, HR 11.2 (8.3–15.2), <i>p</i> &lt; 0.001. Autoimmune disorders did not influence mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multimorbidity in type 1 diabetes is common and is associated with increased mortality. Comprehensive evaluation of all additional conditions is needed to tailor treatment individually.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"18 6","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70249","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148269543","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}