Journal of Diabetes最新文献

{"title":"Disease Progression Modeling of Estimated Glomerular Filtration Rate (eGFR): A Pharmacometrics Approach","authors":"Sohail Aziz,&nbsp;Sabariah Noor Harun,&nbsp;Siti Maisharah Sheikh Ghadzi","doi":"10.1111/1753-0407.70104","DOIUrl":"https://doi.org/10.1111/1753-0407.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Estimated glomerular filtration rate (eGFR) is a key clinical marker for assessing kidney complications in type 2 diabetes mellitus (T2DM). This study aimed to develop and validate a disease progression model of eGFR in Malaysian T2DM patients, with and without diabetic nephropathy (DN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective data from 251 patients (3241 observations) were analyzed using NONMEM software. Baseline eGFR was assessed without covariates, and both linear and non-linear models were tested. Model selection was based on the likelihood ratio test (5% significance level), objective function value (OFV), visual predictive check (VPC), relative standard error, and scientific plausibility. External validation was performed using data from 109 patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A linear model best described disease progression, with a baseline eGFR of 84.6 mL/min/1.73 m² and a decline rate of −0.0041 mL/min/1.73 m²/year. Cardiovascular disease (CVD) reduced eGFR by 1.05 mL/min/1.73 m²/year, while fasting blood sugar (FBS) above 7.4 mmol/L correlated with an additional decline of 0.043 mL/min/1.73 m²/year. Angiotensin receptor blockers (ARBs) improved eGFR by 0.4 mL/min/1.73 m²/year, whereas statins and metformin contributed improvements of 0.34 and 0.32 mL/min/1.73 m²/year, respectively. External validation confirmed model consistency with observed data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Glycaemic control and CVD significantly impact eGFR decline. ARBs, statins, and metformin help preserve kidney function. Effective glycaemic management is crucial in slowing kidney deterioration, especially in T2DM patients at risk for DN.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220305","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":"Trends in Pharmacological Treatment of Patients With New Onset Type 2 Diabetes: Usage Patterns in an Evolving Guideline Landscape","authors":"William Hou,&nbsp;Katherine R. Tuttle,&nbsp;Weining Shen,&nbsp;Andrew Reikes,&nbsp;Jonathan H. Watanabe","doi":"10.1111/1753-0407.70108","DOIUrl":"https://doi.org/10.1111/1753-0407.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>In patients with new onset type 2 diabetes, this study aimed to analyze glucose-lowering medication use patterns between 2014 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This retrospective study included adults with incident type 2 diabetes in the University of California Health System between 2014 and 2022. We determined medications used within 1 year of diagnosis and evaluated statistical evidence of use pattern changes via Mann–Kendall trend tests. Four categories of high-risk patients requiring cardio-kidney-metabolic protection were also evaluated in stratified analyses based on 2024 ADA guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 40 150 patients with incident type 2 diabetes, 38.5% initiated glucose-lowering medication within 1 year. Metformin remained the most used medication from 2014 to 2022. From 2014 to 2022, usage of GLP-1 receptor agonists and SGLT-2 inhibitors increased exponentially. GLP-1 receptor agonist use increased from below 2.5%–21%. While SGLT-2 inhibitor use increased from less than 2.5%–14%. This growth coincided with a decline in sulfonylurea usage. Among high-risk, insulin was most prevalent in those with heart failure or chronic kidney disease. However, usage of insulin declined overall in all groups. Utilization of SGLT-2 inhibitors was particularly high in patients with prior heart failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In adults with new onset type 2 diabetes, GLP-1 receptor agonist and SGLT-2 inhibitor utilization has markedly increased, coordinating with evolving guidelines that emphasize cardiovascular and chronic kidney disease management. However, overall adoption rates of these medications remain low based on indicated populations. Sulfonylurea use declined while metformin remains the most frequently initiated treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206933","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":"Taurine Alleviates Pancreatic β-Cell Senescence by Inhibition of p53 Pathway","authors":"Baomin Wang,&nbsp;Ziyan Wang,&nbsp;Yumei Yang,&nbsp;Melody Yuen Man Ho,&nbsp;Runyue Yang,&nbsp;Huizi Yang,&nbsp;Siyi Liu,&nbsp;Huige Lin,&nbsp;Kenneth King Yip Cheng,&nbsp;Xiaomu Li","doi":"10.1111/1753-0407.70100","DOIUrl":"https://doi.org/10.1111/1753-0407.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pancreatic β-cells function deteriorates during aging, leading to increased risk of type 2 diabetes. We and others previously demonstrated that p53 activation triggers β-cell senescence and dysfunction in aging, but how its activity is controlled remains incompletely understood. Metabolites are not only by-products of metabolic pathways but also function as messengers to regulate various biological pathways. Taurine, a non-proteinogenic amino acid derived from cysteine, has demonstrated anti-aging effects in multiple cell types and tissues. Nevertheless, its role in β-cell senescence remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Untargeted metabolomic analysis was used to determine differential metabolites in pancreatic islets of mice during aging. In vitro, β-cell lines MIN6 and INS-1E were treated with taurine and its transporter inhibitor, followed by measurement of senescence-related markers. Multiple experimental techniques, such as LC–MS/MS, co-immunoprecipitation, DARTS analysis, and LiP-MS, were used to study the mechanistic actions of taurine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Untargeted metabolomic analysis showed that taurine and taurocholic acid were significantly upregulated in aged islets. Pretreatment with taurine inhibited naturally aging, chemically induced senescent and inflammatory program, oxidative stress, and defective insulin secretion in pancreatic β-cells. SLC6A6 transporter was required to mediate exogenous taurine uptake, and inhibition of SLC6A6 abolished the anti-senescent effects of taurine. Taurine bound with CKDN2AIP and inhibited its interaction with p53, thereby promoting p53 degradation and suppressing the p53-dependent senescent program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that increasing β-cell taurine uptake might be a feasible approach to preserve β-cell function by targeting the p53-dependent senescent response.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144197211","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":"Time Trends in Cardiovascular Event Incidence in New-Onset Type 2 Diabetes: A Population-Based Cohort Study From Germany","authors":"Theresia Sarabhai,&nbsp;Karel Kostev","doi":"10.1111/1753-0407.70099","DOIUrl":"https://doi.org/10.1111/1753-0407.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Events of cardiovascular disease (CVD) remain a critical concern in patients with Type 2 diabetes mellitus (T2D). Over 17 years, this study analyzed time changes in the 5-year incidence of myocardial infarction (MI), chronic coronary heart disease (CHD), transient ischemic attack (TIA), and ischemic stroke (IS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study was conducted using the Disease Analyzer database, including patients aged ≥ 18 years with at least 12 months of no prior CVD with new-onset T2D in 2001–2006 (<i>n</i> = 10 162) and in 2013–2018 (<i>n</i> = 30 486), matched 1:3 by age and sex. Kaplan–Meier survival analysis estimated the 5-year cumulative incidence of the outcomes. Multivariable Cox regression models assessed temporal changes, adjusted for comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of CHD and TIA significantly declined in 2013–2018 compared to 2001–2006, with HRs of 0.68 (95% CI: 0.63–0.73; <i>p</i> &lt; 0.001) and 0.63 (95% CI: 0.52–0.76; <i>p</i> &lt; 0.001), respectively. Reductions were more pronounced in women and older patients. Surprisingly, MI incidence showed only a trend of reduction (HR: 0.82; 95% CI: 0.68–0.99; <i>p</i> = 0.045) and IS incidence was not different (HR: 0.97; 95% CI: 0.85–1.12; <i>p</i> = 0.722) between time periods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study is the first to report time trends in CVD incidence in new-onset T2D in Germany. From 2001 to 2018, the 5-year incidence of CHD and TIA decreased in new-onset T2D, reflecting demographic-specific advancements in diabetes and cardiovascular care. However, the stable incidence of IS and MI underscores a persistent challenge in prevention strategies in patients with prediabetes and T2D.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190835","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":"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}