World Journal of Diabetes最新文献

{"title":"First metatarsophalangeal joint synovial hypertrophy associated with vitamin D status in type 2 diabetes mellitus: An ultrasound-graded study.","authors":"Qing-Shan Li, Xiao-Hui Xiao, Yu-Ying Cai, Xiao-Peng Xiao, Ping-Xiang Hu, Hong Li","doi":"10.4239/wjd.v16.i7.107019","DOIUrl":"10.4239/wjd.v16.i7.107019","url":null,"abstract":"<p><strong>Background: </strong>The existing semi-quantitative ultrasound grading system inadequately evaluates synovial hypertrophy at the dorsal recess of the first metatarsophalangeal joint (MTPJ). Vitamin D deficiency is prevalent in type 2 diabetes mellitus (T2DM) and may influence joint inflammation. This study hypothesizes that serum 25-hydroxyvitamin D [25(OH)D] levels are inversely associated with synovial hypertrophy severity of the first MTPJ in patients with T2DM.</p><p><strong>Aim: </strong>To refine ultrasound grading for the first MTPJ synovial hypertrophy and investigate its association with vitamin D in T2DM.</p><p><strong>Methods: </strong>This cross-sectional study included 56 patients (112 MTPJs) with T2DM from Shenzhen Traditional Chinese Medicine Hospital. Synovial hypertrophy was evaluated using a refined semi-quantitative ultrasound grading system focusing on the dorsal recess overlying the metatarsal bone. Serum 25(OH)D levels were measured. Logistic regression and threshold analyses assessed associations between vitamin D status and hypertrophy severity.</p><p><strong>Results: </strong>Of 112 joints assessed, 98 exhibited synovial hypertrophy (grade 1: 40; grade 2: 50; grade 3: 8). The refined grading system demonstrated strong intra- and inter-observer reliability (intraclass correlation coefficients = 0.79 and 0.73, respectively). Lower serum 25(OH)D (< 24.3 ng/mL) was independently associated with moderate-to-severe hypertrophy [odds ratio (OR) = 0.83; <i>P</i> = 0.0163]. Vitamin D deficiency significantly increased the likelihood of moderate-to-severe hypertrophy compared with non-deficiency (OR = 3.86; <i>P</i> = 0.0422). Threshold analysis identified 23.8 ng/mL as a critical serum 25(OH)D level, below which each increment reduced moderate-to-severe hypertrophy risk by 21% (OR = 0.79; <i>P</i> = 0.0078).</p><p><strong>Conclusion: </strong>The refined ultrasound grading system demonstrated strong reliability. Serum 25(OH)D may serve as a protective factor against the severity of synovial hypertrophy in T2DM patients with lower 25(OH)D levels.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"107019"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 longer diabetes duration and lower estimated glomerular filtration rate on cardiovascular complications and mortality: A nationwide population-based study.","authors":"Hong Sang Choi, Bongseong Kim, Kyung-Do Han, Sang Heon Suh, Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma, Soo Wan Kim","doi":"10.4239/wjd.v16.i7.107647","DOIUrl":"10.4239/wjd.v16.i7.107647","url":null,"abstract":"<p><strong>Background: </strong>Decreased renal function is a well-known risk factor for cardiovascular diseases (CVD) and death. However, the impact of diabetes duration and the glomerular filtration rate (GFR) on cardiovascular complications in patients with type 2 diabetes has not been well studied.</p><p><strong>Aim: </strong>To investigate the complex impact of longer diabetes duration and GFR on CVD and mortality.</p><p><strong>Methods: </strong>Subjects with diabetes age ≥ 20 years, who underwent health check-ups from 2015 to 2016 were identified in the Korean National Health Insurance Service database. Based on diabetes duration, subjects were grouped into new-onset, < 5 years, 5-9 years, or ≥ 10 years. The new-onset diabetes group [estimated GFR (eGFR): ≥ 90 mL/min/1.73 m²] was the reference group. A Cox proportional hazards model adjusted for potential confounders was used to estimate the risk for myocardial infarction (MI), ischemic stroke (IS), and mortality.</p><p><strong>Results: </strong>During a 3.9-year follow-up of 2105228 patients, 36003 (1.7%) MIs, 46496 (2.2%) ISs, and 73549 (3.5%) deaths were documented. Both longer diabetes duration and lower eGFR were independently associated with higher risks of MI, IS, and mortality, which were further amplified when these factors coexisted. Even patients with new-onset diabetes had elevated MI and IS risk at mildly reduced eGFR (60-90 mL/min/1.73 m²). Mortality risk rose appreciably once eGFR declined below 60 mL/min/1.73 m², particularly in those with longer diabetes duration. eGFR ≥ 90 mL/min/1.73 m² subgroups had higher death risk than eGFR 60-90 mL/min/1.73 m² subgroups regardless of diabetic duration.</p><p><strong>Conclusion: </strong>Increasing diabetes duration and decreasing eGFR are associated with increased risk of MI, IS, and mortality. For cardiovascular risk estimation, diabetes duration should be considered an important risk factor.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"107647"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intervention effect of combined resistance and aerobic exercise on type 2 diabetes: A meta-analysis.","authors":"Jiang-Chen Ma, Song Shu, Tian-Xiao Chen, Hui-Jing Bai, Ya Yang, Xiao-Wei Ding","doi":"10.4239/wjd.v16.i7.108121","DOIUrl":"10.4239/wjd.v16.i7.108121","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Type 2 diabetes mellitus (T2DM), a chronic metabolic disease with a high global incidence, has become a serious public health challenge. China has the largest number of T2DM patients worldwide, imposing a significant economic burden on the healthcare system. T2DM is closely associated with insulin resistance, impaired pancreatic B cell function, and disordered glucose and lipid metabolism, which can lead to various complications, reducing patients' quality of life and increasing the risk of disability and death. Thus, finding effective preventive and intervention measures is crucial. Exercise therapy, a key part of diabetes management, has gained attention in recent years, with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Systematic searches were conducted using PubMed, EMBASE, Cochrane Library, and Chinese databases for relevant randomized controlled trials (RCTs). The inclusion criteria were participants aged ≥ 18 years with T2DM and the intervention involved combined resistance and aerobic exercise for ≥ 8 weeks. The primary outcome indicators were fasting blood glucose, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), glycated hemoglobin A1c (HbA1c), and total cholesterol (TC) levels. Data analysis was performed using RevMan software, and the interventional effects were assessed using weighted mean differences or standardized mean differences (SMD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Six RCTs meeting the inclusion criteria were included, with a total sample size of 366 participants. The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM. Specific results were as follows: (1) For fasting blood glucose, combined exercise was more effective than aerobic exercise alone [SMD = 1.22; 95% confidence interval (95%CI): 0.70, 1.74; &lt;i&gt;P&lt;/i&gt; &lt; 0.00001]; (2) LDL-C levels were significantly reduced by the combined intervention (SMD = 1.45; 95%CI: 1.18-1.72; &lt;i&gt;P&lt;/i&gt; &lt; 0.00001); (3) The combined intervention significantly increased HDL-C levels (SMD = 1.42; 95%CI: 0.98-1.87; &lt;i&gt;P&lt;/i&gt; &lt; 0.00001); (4) The combined intervention significantly reduced TG levels (SMD = 1.12; 95%CI: 0.85-1.39; &lt;i&gt;P&lt;/i&gt; &lt; 0.00001; (5) No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group (SMD = -0.03; 95%CI: -1.09 to 1.04; &lt;i&gt;P&lt;/i&gt; &lt; 0.00001); and (6) The combined exercise intervention group significantly reduced TC levels (SMD = 2.66; 95%CI: 1.93-3.38; &lt;i&gt;P&lt;/i&gt; &lt; 0.00001). The subgroup analysis results sugges","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"108121"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing insulin requirements in using continuous subcutaneous insulin infusion or multiple daily injections in type 2 diabetes.","authors":"Ruo-Man Sun, De-Xing Dai, Feng Xu, Ya-Li Ling, Zhong-Jian Xie","doi":"10.4239/wjd.v16.i7.106470","DOIUrl":"10.4239/wjd.v16.i7.106470","url":null,"abstract":"<p><strong>Background: </strong>Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion (CSII) require a lower dose of insulin than those treated with multiple daily injections (MDIs). However, it is unclear whether this is also the case for patients with type 2 diabetes mellitus (T2DM).</p><p><strong>Aim: </strong>To compare insulin dosage requirements between CSII and MDI in T2DM, identifying influencing factors associated with both therapeutic modalities.</p><p><strong>Methods: </strong>A total of 954 patients with T2DM were divided into two groups: CSII and MDI groups. The total daily insulin dose (TDD), TDD <i>per</i> kilogram <i>per</i> day (TDD/kg), and ratio of total basal insulin dose to TDD (%TBa) required to achieve the target blood glucose levels were compared between the two groups. In addition, factors affecting insulin dosage were analyzed in both groups of patients.</p><p><strong>Results: </strong>Compared to the CSII group, the MDI group required a higher TDD [median (interquartile)]: 30.00 (24.00, 38.00) U/day <i>vs</i> 26.40 (21.60, 32.40) U/day; <i>P</i> < 0.01, TDD/kg and %TBa. In the MDI group and CSII groups, an increase in TDD was independently associated with an increase in body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c).</p><p><strong>Conclusion: </strong>Patients with T2DM receiving CSII treatment require a lower dose of insulin to achieve good glycemic control. BMI, WC, FPG, and HbA1c are the main factors affecting insulin dosage.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"106470"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations of glycated hemoglobin and emerging biomarkers for diabetes care after bariatric surgery.","authors":"Uchenna Esther Okpete, Haewon Byeon","doi":"10.4239/wjd.v16.i7.107928","DOIUrl":"10.4239/wjd.v16.i7.107928","url":null,"abstract":"<p><p>Bariatric surgery significantly improves glycemic control and can lead to type 2 diabetes remission. However, the reliability of glycated hemoglobin (HbA1c) as a type 2 diabetes biomarker post-surgery can be confounded by conditions such as anemia and gastrointestinal complications. Hence, we explored the use of alternative biomarkers such as glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), and insulin-like growth factor binding protein-1 (IGFBP-1) to monitor glycemic control more effectively in post-bariatric surgery patients. Measuring GA and 1,5-AG levels can detect glycemic variability more sensitively than HbA1c, especially under non-fasting conditions. GA shows promise for short-term monitoring post-surgery while 1,5-AG could be useful for real-time glucose monitoring. IGFBP-1 can be used to monitor metabolic improvement and to predict HbA1c normalization. However, challenges in assay standardization and cost remain significant barriers to their clinical adoption. Although these biomarkers could offer a more personalized approach to glucose monitoring (thereby addressing the limitations of utilizing HbA1c in this endeavor in post-bariatric surgery patients), this would require overcoming technical, logistical, and cost-related challenges. While using GA, 1,5-AG, and IGFBP-1 shows promise for glycemic monitoring, further research and validation are crucial for their routine clinical implementation, especially in the context of diabetes management post-bariatric surgery.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"107928"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological management of type 2 diabetes mellitus in children and adolescents: A systematic review and network meta-analysis.","authors":"Charles A Gagnon, Katherine Buchanan, Jill M Deaver, Jessica A Schmitt, Ian M Lahart, Sahana Shetty, Ambika P Ashraf, Joseph M Pappachan","doi":"10.4239/wjd.v16.i7.106890","DOIUrl":"10.4239/wjd.v16.i7.106890","url":null,"abstract":"<p><strong>Background: </strong>The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is increasing, yet there is limited information on the available pharmacological interventions to combat T2DM and prevent associated comorbidities.</p><p><strong>Aim: </strong>To assess the effectiveness of current pharmacological treatments in managing T2DM in children and adolescents. The protocol of the study was registered in PROSPERO (CRD42022382165).</p><p><strong>Methods: </strong>Searches were performed in PubMed, EMBASE, Scopus, and ClinicalTrials.gov for publications between 1990 to September 2024 without language restrictions. Randomized control trials (RCTs) of pharmacotherapy in children and adolescents with T2DM (aged < 19 years) were included. The primary outcome was a change in glycated hemoglobin (HbA1c) from baseline to follow-up. Secondary outcomes were changes in body weight, body mass index (BMI), total cholesterol, triglycerides, high density lipoprotein, and low-density lipoprotein from baseline, and incidence of adverse events during study periods. Screening, full-text review, data extraction, and assessments of risk of bias were done by two reviewers. Conflicts on each step were resolved by a third reviewer. Data analysis was performed using Review Manager Version 6.5 (RevMan 6.5) and 'R' software <i>via</i> RStudio, 'meta' and 'netmeta'.</p><p><strong>Results: </strong>A total of 12 studies having low to moderate risk of bias with 1658 participants, and follow-up duration 12-52 weeks were included. In our network meta-analysis, compared to control(s), the reduction of HbA1c was significantly larger for dulaglutide [mean difference (MD), 95% confidence interval: -1.20, -2.12 to -0.28], followed by dapagliflozin (-0.94, -1.44 to -0.44), liraglutide (-0.91, -1.37 to -0.45), empagliflozin (-0.87, -1.40 to -0.34), exenatide (-0.59, -1.07 to -0.11) and linagliptin (-0.45, -0.87 to -0.02) while other drugs had little or no effect. While liraglutide was associated with a change in body weight [MD -2.41 (-4.68, -0.14) kg], no other drug treatment was associated with significant changes in body weight, BMI, and lipids. Apart from level 1 hypoglycemia with liraglutide [risk difference (RD): 0.20, 0.04-0.37] and minor adverse events with dulaglutide (RD: 0.24, 0.08-0.40), no other treatment was associated with excess risk of hypoglycemia or minor or major adverse events.</p><p><strong>Conclusion: </strong>Pharmacotherapy of T2DM with dulaglutide, dapagliflozin, liraglutide, empagliflozin, exenatide, and linagliptin in children is associated with modest reduction of HbA1c. Larger RCTs with longer follow-up durations are needed to guide better therapeutic decision making.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"106890"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking the diabetes-depression cycle: Exploring shared mechanisms, neuroinflammation, and emerging interventions for metabolic-mood comorbidities.","authors":"Cheng Luo, Xian-Mei Yu, Mei-Qi Zeng, Cheng-Zheng Duan, Shi-Yu Xu, Chun-Yan Zhu, Zhi-Gang Zheng, Da Sun, Jian Fang, Dong-Juan He","doi":"10.4239/wjd.v16.i7.107406","DOIUrl":"10.4239/wjd.v16.i7.107406","url":null,"abstract":"<p><p>This article explores the bidirectional relationship between type 2 diabetes mellitus (T2DM) and depression, focusing on their shared pathophysiological mechanisms, including immune-inflammatory responses, gut-brain axis dysregulation, metabolic abnormalities, and neuroendocrine modulation. Research indicates that T2DM contributes to anxiety and depression through chronic low-grade inflammation, insulin resistance, gut microbiota imbalance, and hyperactivation of the hypothalamic-pituitary-adrenal axis. Conversely, depression may increase the risk of T2DM <i>via</i> lifestyle disruption, immune activation, and neurotransmitter imbalance. Additionally, metabolic pathway disturbances - such as reduced adiponectin, impaired insulin signaling, and altered amino acid metabolism - may influence mood regulation and cognition. The article further examines emerging therapeutic strategies targeting these shared mechanisms, including anti-inflammatory treatments, gut microbiota modulation, hypothalamic-pituitary-adrenal axis interventions, metabolic therapies (<i>e.g.</i>, glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors), and multidisciplinary integrative management. Emphasizing the multisystem nature of diabetes-depression comorbidity, this work highlights the importance of incorporating mental health strategies into diabetes care to optimize outcomes and enhance patient quality of life.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"107406"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive ability of lipid indices for large-for-gestational-age infants in pregnant females with gestational diabetes mellitus.","authors":"Lan-Lan Xiang, Jie Feng, Shu-Yu Li, Yi-Tian Zhu, Ya-Jun Chen, Tian-Ying Zhong, Ye-Fei Zhu, Yu Zeng","doi":"10.4239/wjd.v16.i7.104306","DOIUrl":"10.4239/wjd.v16.i7.104306","url":null,"abstract":"<p><strong>Background: </strong>The primary complication associated with gestational diabetes mellitus (GDM) is delivery of an infant that is large for gestational age (LGA). Epidemiological findings have demonstrated that irregular lipid metabolism significantly contributes to insulin resistance, a key pathophysiological mechanism in GDM. However, the correlation between various lipid indices and the probability of delivering LGA infants remains inconsistent.</p><p><strong>Aim: </strong>To explore the relationships between lipid indices and the possibility of having LGA infants among GDM-affected pregnant females.</p><p><strong>Methods: </strong>Binary logistic regression methods were employed to evaluate the odds ratios and corresponding 95% confidence intervals for LGA according to five lipid indices. Restricted cubic spline models were applied to investigate dose-response relationships. The association between lipid indices and the risk of delivering LGA infants was further investigated among different subgroups. Receiver operating characteristic curves were utilized to assess the diagnostic performance of lipid indices.</p><p><strong>Results: </strong>Across crude and adjusted models, females with lipid indices in the upper two tertiles presented a markedly elevated risk of delivering LGA infants compared with the lowest tertile category. Conversely, high-density lipoprotein cholesterol levels demonstrated the contrary trend. Restricted cubic spline analyses revealed linear associations between the five lipid indices, except triglyceride levels, and the prevalence of LGA. The subgroup analysis highlighted that the correlation between lipid indices and the probability of LGA was inconsistent. The five lipid indices presented significant diagnostic efficacy, as indicated by receiver operating characteristic curve areas.</p><p><strong>Conclusion: </strong>Our research demonstrated that lipid indices were effective predictors of the incidence of LGA infants in GDM-affected pregnancies irrespective of potential confounding factors.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"104306"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive model and risk analysis for outcomes in diabetic foot ulcer using eXtreme Gradient Boosting algorithm and SHapley Additive exPlanation.","authors":"Lei Gao, Zi-Xuan Liu, Jiang-Ning Wang","doi":"10.4239/wjd.v16.i7.104789","DOIUrl":"10.4239/wjd.v16.i7.104789","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot ulcer (DFU) is a serious and destructive complication of diabetes, which has a high amputation rate and carries a huge social burden. Early detection of risk factors and intervention are essential to reduce amputation rates. With the development of artificial intelligence technology, efficient interpretable predictive models can be generated in clinical practice to improve DFU care.</p><p><strong>Aim: </strong>To develop and validate an interpretable model for predicting amputation risk in DFU patients.</p><p><strong>Methods: </strong>This retrospective study collected basic data from 599 patients with DFU in Beijing Shijitan Hospital between January 2015 and June 2024. The data set was randomly divided into a training set and test set with fivefold cross-validation. Three binary variable models were built with the eXtreme Gradient Boosting (XGBoost) algorithm to input risk factors that predict amputation probability. The model performance was optimized by adjusting the super parameters. The predictive performance of the three models was expressed by sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC). Visualization of the prediction results was realized through SHapley Additive exPlanation (SHAP).</p><p><strong>Results: </strong>A total of 157 (26.2%) patients underwent minor amputation during hospitalization and 50 (8.3%) had major amputation. All three XGBoost models demonstrated good discriminative ability, with AUC values > 0.7. The model for predicting major amputation achieved the highest performance [AUC = 0.977, 95% confidence interval (CI): 0.956-0.998], followed by the minor amputation model (AUC = 0.800, 95%CI: 0.762-0.838) and the non-amputation model (AUC = 0.772, 95%CI: 0.730-0.814). Feature importance ranking of the three models revealed the risk factors for minor and major amputation. Wagner grade 4/5, osteomyelitis, and high C-reactive protein were all considered important predictive variables.</p><p><strong>Conclusion: </strong>XGBoost effectively predicts diabetic foot amputation risk and provides interpretable insights to support personalized treatment decisions.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"104789"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-glucose co-transporter 2 inhibitors improve insulin resistance and β-cell function in type 2 diabetes: A meta-analysis.","authors":"Shang-Yu Chai, Ru-Ya Zhang, Zhi-Yuan Ning, Yi-Man Zheng, Rajpathak Swapnil, Li-Nong Ji","doi":"10.4239/wjd.v16.i7.107335","DOIUrl":"10.4239/wjd.v16.i7.107335","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 (SGLT2) inhibitors are widely used for the treatment of type 2 diabetes (T2D).</p><p><strong>Aim: </strong>To evaluate the influence of SGLT2 inhibitors on homeostasis model assessment of insulin resistance (HOMA-IR) and β-cell function (HOMA-β) in patients with T2D in a meta-analysis.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) comparing SGLT2 inhibitors to placebo in T2D patients, with a minimum treatment duration of 12 weeks, were searched using the PubMed, EMBASE, and Cochrane Library databases. Risk of bias was assessed using the Cochrane Risk of Bias Tool, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Changes in HOMA-IR and HOMA-β were the outcomes analyzed. Meta-analyses were performed using a random-effects model by incorporating the potential influences of heterogeneity.</p><p><strong>Results: </strong>Of 1388 articles identified, 24 RCTs met the inclusion criteria. 23 of the included studies were double-blind RCTs with low risk of bias. Pooled results including 2272 patients showed that SGLT2 inhibitors significantly reduced HOMA-IR compared to placebo [mean difference (MD) = -0.81, 95% confidence interval (CI): -1.11 to -0.52, <i>P</i> < 0.001; <i>I</i> ² = 82%], indicating reduced insulin resistance. Additionally, meta-analysis with 2845 patients suggested that SGLT2 inhibitors significantly increased HOMA-β (MD = 7.90, 95%CI: 5.44-10.37, <i>P</i> < 0.001; <i>I</i> ² = 74%) compared to placebo in patients with T2D, indicating improved β-cell function. Based on GRADE assessment, the certainty of evidence was rated moderate for both outcomes due to heterogeneity. Subgroup analyses showed that HOMA-β increased more substantially in non-Asian studies than in Asian studies (<i>P</i> for subgroup difference < 0.01). Subgroup analyses according to the individual medications of SGLT2 inhibitors all showed significant improvement of HOMA-IR and HOMA-β (<i>P</i> all < 0.05). No significant publication bias was detected (<i>P</i> for Egger's test all > 0.05).</p><p><strong>Conclusion: </strong>SGLT2 inhibitors are associated with improvements in insulin resistance and β-cell function in patients with T2D, although the certainty of evidence is moderate due to heterogeneity.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"107335"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}