{"title":"Metabolic Scarring: The Persistent Impact of Past Obesity on Long-Term Metabolic Health Despite Weight Loss","authors":"Ali Hemade, Pascale Salameh","doi":"10.1002/edm2.70086","DOIUrl":"https://doi.org/10.1002/edm2.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Conventional cardiometabolic risk assessment relies primarily on a patient's current body mass index, yet individuals who have lost weight after a period of obesity may continue to harbour elevated metabolic risk. We sought to quantify the persistent impact of past obesity on glycaemic control and to develop a clinical risk score that integrates weight history with current risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a cross-sectional analysis of 15,422 adults (≥ 18 years) from the 2011–2020 NHANES cycles. Participants with complete self-reported weight history (highest adult weight, weight 1 year ago, number of ≥ 5% weight-loss episodes) and measured BMI were included. Metabolic scarring was defined by elevated haemoglobin A1c (HbA1c ≥ 5.7%) or HOMA-IR ≥ 2.5. We applied inverse-probability-weighted logistic regression to estimate the association between prior obesity and current HbA1c, adjusting for confounders. We then refit a survey-weighted logistic model using age per decade, current BMI, weight-history category, sex and race/ethnicity, converting regression coefficients into an integer point-based score. Discrimination was evaluated by survey-weighted area under the receiver-operating characteristic curve (AUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Formerly obese individuals exhibited significantly higher HbA1c than never-obese peers (adjusted <i>β</i> = 0.58%, <i>p</i> < 0.002), indicative of metabolic scarring. The derived risk score ranged from −31 to +90 points (median = 6; IQR = −3 to 16) and achieved an AUC of 0.79 (95% CI 0.77–0.81). Age per decade, BMI, and weight history contributed 4, 1 and up to 4 points, respectively; female sex and Non-Hispanic White race subtracted points. Calibration across predicted-risk deciles was excellent (slope = 0.98).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A history of obesity imparts a lasting glycemic risk that is not captured by current BMI alone. Our metabolic scarring risk score offers a pragmatic tool for identifying individuals at elevated metabolic risk despite weight normalisation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Concerns Regarding Renal Function Claims in Low-Dose Spironolactone Study","authors":"Özant Helvacı, Burçak Cavnar Helvacı","doi":"10.1002/edm2.70085","DOIUrl":"https://doi.org/10.1002/edm2.70085","url":null,"abstract":"<p>We read with interest the study by Amini et al. on low-dose spironolactone in diabetic kidney disease [<span>1</span>]. While we appreciate the authors' investigation of safety at reduced dosing, we believe some aspects of their eGFR interpretation need clarification from a nephrology perspective.</p><p>The authors report a statistically significant increase in eGFR from 71.83 ± 19.09 to 74.25 ± 17.81 mL/min/1.73 m<sup>2</sup> (<i>p</i> = 0.042) and describe this as renal function improvement. This interpretation warrants careful consideration:</p><p>First, creatinine measurement has inherent analytical variability, and small changes in calculated eGFR may not reflect true kidney function changes. The magnitude of change (3.4%) falls within the expected coefficient of variation for creatinine-based eGFR calculations. A systematic review and meta-analysis of 37 studies with 2770 participants demonstrate that eGFR fluctuations of 5.0%–5.2% likely represent analytical noise rather than clinically meaningful change [<span>2</span>]. Such small variations should be interpreted cautiously without confirmatory measurements.</p><p>Second, we note that the concurrent decrease in serum creatinine (1.08 ± 0.23 to 1.01 ± 0.23 mg/dL) is difficult to explain mechanistically, as spironolactone does not enhance creatinine clearance or reduce creatinine generation. Furthermore, mineralocorticoid receptor antagonists characteristically reduce GFR through hemodynamic effects, including afferent arteriole vasoconstriction and decreased glomerular filtration pressure [<span>3</span>]. An increase in eGFR contradicts established pharmacological mechanisms.</p><p>Third, previous studies with identical 12.5 mg spironolactone dosing have consistently shown stable or slightly decreased eGFR, not increases. For example, Oiwa et al.'s multicenter randomised controlled trial demonstrated that eGFR remained stable from 64.2 ± 17.6 to 60.2 ± 16.1 mL/min/1.73 m<sup>2</sup> in the spironolactone group while achieving significant albuminuria reduction [<span>4</span>]. This rigorous randomised controlled trial design with proper control group provides higher-quality evidence than the current pre-post intervention study. The present findings are inconsistent with this established pattern from controlled trials.</p><p>Finally, recent evidence from the FIDELITY pooled analysis of finerenone trials demonstrates that cardiovascular and kidney benefits were maintained regardless of acute eGFR changes at month 1, with similar efficacy across patients experiencing > 10% eGFR decline, stable eGFR, or eGFR increases, confirming that early eGFR changes do not correlate with long-term hard outcomes [<span>5</span>]. We suggest focusing on clinically meaningful endpoints rather than over-interpreting short-term eGFR fluctuations.</p><p>We recommend the authors consider adopting more conservative language regarding renal function changes and acknowledge the limitations of short-term eGFR","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144662900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Exploring Physical Activity in Individuals With Type 2 Diabetes Mellitus and Lower Limb Complications: A Scoping Review","authors":"Bingyan Pang, Hannah Porter, Joanne A. McVeigh","doi":"10.1002/edm2.70084","DOIUrl":"https://doi.org/10.1002/edm2.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To synthesise contemporary evidence on physical activity (PA) levels in people with type two diabetes and lower limb complications (i.e., foot ulcer, peripheral neuropathy [PN], peripheral arterial disease and amputations).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review following the JBI methodology was conducted using six databases: Medline, Embase, PubMed, Cochrane Library, SPORTDiscus and CINAHL. We included observational studies that primarily examined PA (all levels and types) in people with diabetes-related lower limb complications. Studies published before December 2024 were included. We excluded reviews, intervention studies, and studies that examined the association between PA and T2DM risks. Findings were collated into tables and figures and reported narratively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen studies met the inclusion criteria. Participants were reported to have PN, foot ulcer, peripheral arterial disease, or lower limb amputation. PA was assessed either by questionnaires or activity trackers. PA levels were reported as step count, duration of PA of different intensities, time spent in various postures, gait velocity, step rate and activity score. Mean daily step counts ranged between 1721 (amputation) and 7754 (PN). Mean moderate-intensity PA was reported to be 2 min per day (amputation) to 37 min per day (PN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>People living with diabetes-related lower limb complications engage in low levels of PA. The findings suggest that people with more severe lower limb complications engage in less PA than those with less severe lower limb complications. Future research should standardise PA measurement in individuals with T2DM-related lower limb complications and use the findings of this review to inform tailored, evidence-based recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144662899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Moiz Nasir, Syed Husain Farhan, Hasan Mushahid, Syeda Ayesha Shah, Muhammad Hamza Shuja, Adam Bilal Khan, Syed Hassaan Ali, Syed Ahmed Farhan, Azeem Hassan, Jawad Ahmed, Mohammad Hamza, Javed Iqbal
{"title":"Ischemic Stroke Mortality in Type 2 Diabetes in the U.S.: National Trends and Demographic Disparities From 1999 to 2019","authors":"Muhammad Moiz Nasir, Syed Husain Farhan, Hasan Mushahid, Syeda Ayesha Shah, Muhammad Hamza Shuja, Adam Bilal Khan, Syed Hassaan Ali, Syed Ahmed Farhan, Azeem Hassan, Jawad Ahmed, Mohammad Hamza, Javed Iqbal","doi":"10.1002/edm2.70065","DOIUrl":"https://doi.org/10.1002/edm2.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The pathological changes in the lining of blood vessels associated with diabetes are a well-established risk factor for stroke, with some studies suggesting a two times increase in risk compared to non-diabetics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2019 for ischemic stroke-related mortality in patients with type 2 diabetes mellitus (T2DM). Annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by year, sex, and race/ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2019 there were 18,135 deaths from ischemic stroke in patients with T2DM. The AAMR remained relatively constant from 0.31 in 1999 to 0.32 in 2004, gradually declining to 0.14 in 2014 (APC: −6.74), followed by a rapid increase to 0.44 in 2017 (APC: 53.11). Men showed consistently higher AAMR than women in 1999 (AAMR men: 0.34 vs. women: 0.29) and 2019 (AAMR men: 0.55 vs. women: 0.42). When comparing race, African Americans (AA) presented with a consistently higher AAMR in 1999 (AAMR AA: 0.4 vs. white: 0.29) and in 2019 (AAMR AA: 0.62 vs. white:0.44). Notably, a significant escalation in AAMR occurred from 2014 to 2019, affecting both populations; this trend reached its pinnacle in 2019 (2016 AAMR AA: 0.4 vs. white: 0.26) (2019 AAMR AA: 0.62 vs. white: 0.44).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings highlight fluctuating trends in AAMRs with distinct shifts observed after 2014. Noteworthy gender and racial disparities in AAMRs were also evident. The study emphasises the need for ongoing vigilance and focused interventions to address the evolving dynamics of ischaemic stroke-related mortality in the T2DM population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Procalcitonin and Diabetic Foot Ulcer Infections: A Meta-Analysis","authors":"Wenqiang Wang, Peilin Zhou, Xinyu Nie, Qikai Hua","doi":"10.1002/edm2.70066","DOIUrl":"https://doi.org/10.1002/edm2.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Procalcitonin (PCT) is an effective inflammatory marker for diagnosing infection. We assessed the clinical utility of procalcitonin in diagnosing diabetic foot infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This meta-analysis adhered to the PRISMA guidelines. We searched PubMed, Web of Science, Embase and the Cochrane Library for studies on PCT for the diagnosis of diabetic foot published before 1 July 2024. The primary outcome was the standardised mean difference (SMD) in PCT levels between IDFU and non-IDFU groups, with corresponding 95% confidence intervals (CI). The included studies were cross-sectional and cohort studies, so the quality of the literature was assessed using the Newcastle–Ottawa Scale (NOS) evaluation criteria. This study's statistical analyses were conducted solely with STATA 15.0 software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Ten studies comprising 928 patients were ultimately included. There were six cross-sectional studies and four cohort studies. In total, 532 patients were assigned to the IDFU group and 396 to the non-infected diabetic foot ulcers (NIDFU) group. The relationship between PCT and DFU was evaluated in ten studies, with significant heterogeneity among the included studies (<i>x</i><sup>2</sup> = 54.10, <i>p =</i> 0.00001; <i>I</i><sup>2</sup> = 83.6%). Therefore, a random effects model was used with a pooled standardised mean difference of 0.79 (95% confidence interval [CI]: 0.43–1.14). The Egger experiment results (<i>t</i> = 0.43, <i>p</i> = 0.680) indicated that there was no publication bias. Analysis of sensitivity revealed that the results were reliable. Subgroup analyses identified the area as a significant source of heterogeneity. The random-effects model's meta-regression results revealed that BMI (<i>p</i> = 0.026) and HbA1c (<i>p</i> = 0.016) had a significant impact on the heterogeneity of the association between IDFU and PCT levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study showed a significant correlation between serum PCT levels and IDFU. Identification and treatment of IDFUs as soon as possible can help reduce amputation and mortality rates.</p>\u0000 \u0000 <p>This systematic review and meta-analysis evaluated the association between serum procalcitonin levels and diabetic foot infections. Ten studies were included, and a random-effects model showed significantly higher procalcitonin levels in infected patients, supporting its role as a potential diagnostic biomarker for early infection detection in dia","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdallah Hussein, Ameer Awashra, Islam Rajab, Mohammad Bdair, Dawoud Hamdan, Ahmad Nouri, Elaf Khatib, Ghiras Khatib, Nyan Latt
{"title":"Comparative Effectiveness of Bariatric Surgery Versus GLP-1 Receptor Agonists in Reducing the Risk of New-Onset of NASH: A Retrospective Multinational Cohort Study From North America and Europe","authors":"Abdallah Hussein, Ameer Awashra, Islam Rajab, Mohammad Bdair, Dawoud Hamdan, Ahmad Nouri, Elaf Khatib, Ghiras Khatib, Nyan Latt","doi":"10.1002/edm2.70075","DOIUrl":"https://doi.org/10.1002/edm2.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) that can progress to cirrhosis and hepatocellular carcinoma (HCC). Obesity is a major risk factor for NASH, and metabolic interventions such as bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been explored for their impact on liver-related outcomes. This study evaluates the comparative effectiveness of BS and GLP-1 RAs in reducing the incidence of new-onset NASH and related hepatic complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, of 35 or greater and without a history of NAFLD/NASH (without cirrhosis) who underwent BS versus GLP-1RA between January 1, 2014 and December 31, 2019, were included. Patients in the BS group were matched with patients in the GLP-1RA group according to age, demographics, comorbidities and medication by using 1:1 propensity matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 180,022 eligible adults, 143,404 underwent BS, while 36,618 received GLP-1 RA therapy. Following propensity score matching, 33,594 patients in the BS group (mean age 49.1 ± 13.2 years; 72.73% female) were matched to an equal number of individuals in the GLP-1 RA group (mean age 48.9 ± 14.0 years; 72.41% female). Compared to those receiving GLP-1 RA therapy, patients who underwent BS had a significantly lower risk of HCC (HR, 0.304; 95% CI, 0.099–0.931), which showed the strongest protective effect, followed by a substantial reduction in NASH (HR, 0.509; 95% CI, 0.469–0.551). The reduction in liver cirrhosis risk was not statistically significant (HR, 0.865; 95% CI, 0.696–1.075). These associations remained across follow-up periods of 1, 3, 5 and 7 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings suggest that BS was significantly associated with lower risk of new onset of NASH/NAFLD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Genetically Predicted Serum 25-Hydroxyvitamin D Concentrations in Related to Type 2 Diabetes Mellitus: A Mendelian Randomization Study","authors":"Jin Yang","doi":"10.1002/edm2.70050","DOIUrl":"https://doi.org/10.1002/edm2.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In several observational studies, vitamins B6, B9, B12, C and 25-hydroxyvitamin D[25(OH)D] concentrations were associated with type 2 diabetes mellitus (T2DM). Although vitamins play a role in the development of type 2 diabetes mellitus (T2DM), their associations remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study employed Mendelian randomisation (MR) to explore the causal relationships between circulating concentrations of vitamins B6, B9, B12, C, 25-hydroxyvitamin D and T2DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single-nucleotide polymorphisms (SNPs) linked to vitamin B6, vitamin B9, vitamin B12, vitamin C and 25(OH)D levels were used as instrumental variables (IVs) in this study. We have two outcomes related to T2DM derived from two genome-wide association studies (GWAS). The first study, referenced by PMID: 3417140, encompasses a cohort of 406,831 individuals of European descent. The second study, identified by PMID: 29892013, includes a sample size of 468,298 Europeans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both univariable Mendelian randomization (UVMR) and multivariable Mendelian randomization (MVMR) analyses demonstrate that genetically predicted elevated levels of serum 25(OH)D are consistently associated with a reduced risk of T2DM. In the UVMR analyses, A 1-SD increase in genetically predicted serum 25(OH)D levels, the inverse-variance weighted (IVW) <i>p</i> = 3.8 × 10<sup>−7</sup>, <i>p</i><sub><i>fdr</i></sub> = 7.6 × 10<sup>−7</sup>, the odds ratio(OR) of T2DM (GCST90013942) was 0.67, 95% confidence interval (CI): 0.57–0.78. Furthermore, a 1-SD increase in genetically predicted serum 25(OH)D levels was associated with an OR of 0.987 for T2DM (GCST90029024), the IVW <i>p</i> = 1.1 × 10<sup>−4</sup>, <i>p</i><sub><i>fdr</i></sub> = 1.1 × 10<sup>−4</sup> with a 95% CI of 0.981–0.994. In the MVMR analyses, genetically predicted higher serum 25(OH)D levels were associated with a decreased risk of T2DM by the IVW <i>p</i> = 1.2 × 10<sup>−5</sup>, <i>p</i><sub><i>fdr</i></sub> = 5.9 × 10<sup>−5</sup> in GCST90013942 and IVW <i>p</i> = 4.9 × 10<sup>−4</sup>, <i>p</i><sub><i>fdr</i></sub> = 2.5 × 10<sup>−3</sup> in GCST90029024. In contrast, levels of vitamins B6, B9, B12, and C did not domenstrate a significant association with T2DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our research reveals that higher circulating serum 25(OH)D levels reduce the possi","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association of the Glycated Albumin-to-Glycated Haemoglobin Ratio With Mortality in Type 2 Diabetes: A Retrospective Cohort Analysis","authors":"Tomohito Gohda, Nozomu Kamei, Marenao Tanaka, Masato Furuhashi, Tatsuya Sato, Mitsunobu Kubota, Michiyoshi Sanuki, Risako Mikami, Koji Mizutani, Yusuke Suzuki, Maki Murakoshi","doi":"10.1002/edm2.70072","DOIUrl":"https://doi.org/10.1002/edm2.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The glycated albumin-to-glycated haemoglobin (GA/HbA1c) ratio is a potential marker of glycaemic variability; however, its association with adverse clinical outcomes in type 2 diabetes remains unclear. We aimed to determine whether the GA/HbA1c ratio is a better predictor of mortality and chronic kidney disease (CKD) progression than GA alone in type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort analysis included 571 Japanese participants with type 2 diabetes who were stratified into tertiles based on their GA/HbA1c ratio. Cox proportional hazards models assessed associations between the GA/HbA1c ratio and mortality or CKD progression (≥ 30% decline in the estimated glomerular filtration rate [eGFR]), adjusting for age, sex, urinary albumin-to-creatinine ratio, eGFR, body mass index, haemoglobin and serum albumin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this cohort, the median age was 67 years, and 53.9% were male. During the median follow-up of 5.4 and 5.3 years for mortality and CKD progression, respectively, 40 (7.0%) participants died and 70 (12.3%) experienced CKD progression. For mortality, the GA/HbA1c ratio demonstrated a U-shaped association: although both the lowest (T1) and highest (T3) tertiles showed higher mortality risks than the middle tertile (T2), this association was significant for only T3 (hazard ratio, 1.46; 95% CI, 1.05–2.04). Neither GA nor HbA1c alone was significantly associated with mortality. For CKD progression, GA alone showed a U-shaped association, with both T1 and T3 exhibiting non-significantly higher risks than T2. Neither the GA/HbA1c ratio nor HbA1c alone was associated with CKD progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In individuals with type 2 diabetes, a higher GA/HbA1c ratio was associated with an increased risk of mortality but not with CKD progression. However, given the retrospective design and limited sample size, these findings should be interpreted with caution and confirmed in larger, prospective studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xudan Lou, Na Yi, Yingchun Liu, Yuanyuan Xu, Jieyuzhen Qiu, Xiaoming Tao, Zhijun Bao
{"title":"Risk Prediction Model for Elderly Differentiated Thyroid Cancer Based on Combined Sleep Quality Assessment and Multimodal Ultrasound","authors":"Xudan Lou, Na Yi, Yingchun Liu, Yuanyuan Xu, Jieyuzhen Qiu, Xiaoming Tao, Zhijun Bao","doi":"10.1002/edm2.70073","DOIUrl":"https://doi.org/10.1002/edm2.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the differential diagnosis for benign and malignant thyroid nodules and the diagnostic value of sleep quality, to construct and validate a risk prediction model, providing the basis for clinical treatment decision for elderly thyroid cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical data, Pittsburgh Sleep Quality Index (PSQI), and multimodal ultrasound were collected from elderly patients undergoing fine needle aspiration biopsy or thyroid surgery in our department of endocrinology and general surgery. Postoperative pathological results served as the gold standard, binary logistic regression identified significant risk factors, and the receiver-operating characteristic (ROC) curves were plotted to construct and validate the prediction model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 763 enrolled patients (566 benign and 197 malignant), multivariate analysis revealed independent risk factors: TPOAB positive, daytime dysfunction, PSQI > 7, irregular nodule shape, calcification, blood flow, high elasticity scores, and low contrast enhancement. The area under the curve (AUC) for the combined model was 0.860, significantly higher than models using multimodal ultrasound alone (AUC = 0.824) or multimodal ultrasound with TPOAB (AUC = 0.831), <i>p</i> < 0.05. The nomogram-based prediction model demonstrated excellent discrimination, calibration, and clinical utility in internal and external validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrating sleep quality assessment with multimodal ultrasound assisted in the differentiation of thyroid nodules in the elderly, thus may improve the preoperative diagnostic levels. Risk prediction model in a nomogram format provided an intuitive and reliable tool for clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Comparison of the Gut Microbiome Composition, Serum Inflammatory Markers and Faecal Short-Chain Fatty Acids Among Individuals With Type 1 and 2 Diabetes Mellitus With Healthy Controls: A Case–Control Study","authors":"Hossein Yarmohammadi, Masood Soltanipur, Mahdi Rezaei, Hanieh-Sadat Ejtahed, Maedeh Raei, Alireza Razavi, Seyed Mohsen Mirhosseini, Mehrangiz Zangeneh, Delaram Doroud, Abolfazl Fateh, Seyedalireza Seyed Siamdoust, Seyed Davar Siadat","doi":"10.1002/edm2.70071","DOIUrl":"https://doi.org/10.1002/edm2.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to compare the gut microbiome (GM) composition, serum inflammatory markers and faecal short-chain fatty acids among individuals with type 1 and type 2 diabetes mellitus (DM) and healthy controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This case–control study examined 49 subjects with type 2 DM, 21 with type 1 DM and 40 healthy controls. Blood and faecal samples were collected. Serum inflammatory markers, including CRP, IL-1β, IL-6, TNF-α and IFN-γ, were measured using enzyme-linked immunosorbent assays (ELISA). Bacterial populations were quantified using RT-qPCR and NGS. Faecal metabolites were analysed using gas chromatography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Simpson's alpha diversity was higher among types 1 and 2 DM than in the control. The frequency of the bacterial genera <i>Gemmiger</i>, <i>Dorea</i>, <i>Collinsella</i>, <i>Escherichia/Shigella</i>, <i>Dialister</i>, <i>Coprococcus</i>, <i>Achromobacter</i>, <i>Intestinimonas</i> and <i>Allisonella</i> in type 2 DM was higher than in the control, and the frequency of the genera <i>Romboutsia</i> and <i>Clostridium</i> was decreased in type 2 DM. The frequency of the <i>Prevotella</i>, <i>Bacteroides</i> and <i>Faecalibacterium</i> genera in type 1 DM was lower than in the other groups. Acetate, propionate and butyrate levels were significantly higher in type 2 DM patients compared to the other groups. Participants with diabetes had significantly higher hs-CRP, IL1-β, TNF, IL-6 and IFG levels compared to the controls. Compared to healthy controls, both T1DM and T2DM patients showed a significant increase in the abundance of the <i>Lactobacillus</i> genus (<i>p</i> = 0.01) and a decrease in <i>Faecalibacterium</i> (<i>p</i> = 0.02). Additionally, serum levels of IL-6 and TNF-α were significantly elevated in T2DM patients (<i>p</i> = 0.003 and <i>p</i> = 0.005, respectively). Faecal levels of butyrate were significantly reduced in both diabetic groups compared to the controls (<i>p</i> = 0.004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>By determining the GM alterations in patients with diabetes, interventional strategies could be designed to modulate the GM composition as an adjunctive therapy in diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}