World Journal of Diabetes最新文献

{"title":"Indirect bilirubin is inversely associated with diabetic retinopathy risk and is a potential predictive biomarker.","authors":"Xiao-Ying Lin, Yi-Xuan Zheng, Meng-Meng Liu, Qian Liang, Meng Li, Jing Sui, Wei Qiang, Hui Guo, Bing-Yin Shi, Ming-Qian He","doi":"10.4239/wjd.v16.i9.110590","DOIUrl":"10.4239/wjd.v16.i9.110590","url":null,"abstract":"<p><strong>Background: </strong>Diabetic retinopathy (DR) is a major cause of visual impairment and blindness. However, the current DR biomarkers are insufficient for accurately predicting its onset.</p><p><strong>Aim: </strong>To identify a novel marker for predicting the risk of developing DR in patients with type 2 diabetes mellitus (T2DM).</p><p><strong>Methods: </strong>We conducted a cross-sectional study involving 6993 hospitalized T2DM patients between 2013 and 2020. Patients were divided into two groups: The DR group and the non-DR group. Data were analyzed using univariate, correlation, multivariate, subgroup, and receiver operating characteristic curve analyses.</p><p><strong>Results: </strong>Total bilirubin, indirect bilirubin (IBIL), and direct bilirubin were negatively correlated with the risk of developing DR (<i>P</i> < 0.001). Moreover, these three factors were all positively correlated with clinical indicators related to DR, including the estimated glomerular filtration rate, the albumin/creatinine ratio, and the 1,25-dihydroxyvitamin D₃ level (<i>P</i> < 0.001). After adjusting for multiple variables, greater IBIL levels remained independently associated with a lower risk of developing DR (odds ratio = 0.500; 95% confidence interval: 0.363-0.686; <i>P</i> < 0.001). The optimal IBIL cutoff point for predicting the risk of DR in male patients with elevated diastolic blood pressure was 0.655 μmol/dL (area under the curve = 0.662).</p><p><strong>Conclusion: </strong>These findings suggest that IBIL could be a valuable biomarker for predicting DR risk, offering a noninvasive, cost-effective, and readily available clinical tool for the early identification of high-risk patients. Future multicenter and longitudinal studies are warranted to validate these findings and further explore the biological mechanisms underlying the protective role of IBIL in DR.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 9","pages":"110590"},"PeriodicalIF":4.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114627","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":"β-cell dedifferentiation in type 2 diabetes: Interplay of metabolic stress, endoplasmic reticulum dysfunction, and forkhead box protein O1 inhibition.","authors":"Ashraf Al Madhoun, Fatemah Bahman, Rasheed Ahmad","doi":"10.4239/wjd.v16.i9.109274","DOIUrl":"10.4239/wjd.v16.i9.109274","url":null,"abstract":"<p><p>In this editorial, we highlight the study by Wang <i>et al</i> published in a recent issue of the <i>World Journal of Diabetes</i>. Type 2 diabetes is increasingly recognized as a β-cell dysfunction disorder, with apoptosis and dedifferentiation being key factors in insulin secretion loss. β-cell dedifferentiation is a regression from a mature insulin-secretory phenotype to a progenitor-like state, characterized by the loss of key transcription factors such as pancreatic and duodenal homeobox 1 and MAF bZIP transcription factor A, and the ectopic expression of developmental markers such as neurogenin 3 and aldehyde dehydrogenase 1 family member A3. This editorial discusses the key role of metabolic stress-saturated fatty acids and high glucose-in triggering dedifferentiation through endoplasmic reticulum (ER) stress and repression of the forkhead box protein O1 (FoxO1) transcription factor. The study by Wang <i>et al</i> demonstrated how ER dysfunction and FoxO1 suppression collaborate to destabilize β-cell identity. Notably, evidence suggests that this process can be reversed under certain circumstances, with potential for therapies aiming to redifferentiate β-cells or prevent identity loss. We also outline the therapeutic potential of modulating ER stress pathways, controlling FoxO1 activity, and developing biomarkers to track β-cell plasticity in patients. Overall, β-cell dedifferentiation knowledge and manipulation offer new avenues for the treatment of diabetes by restoring functional β-cell mass.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 9","pages":"109274"},"PeriodicalIF":4.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114810","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":"Comprehensive analysis of risk factors associated with carotid plaque in patients with type 2 diabetes mellitus.","authors":"Lei Shi, Neng-Juan Li","doi":"10.4239/wjd.v16.i8.104180","DOIUrl":"10.4239/wjd.v16.i8.104180","url":null,"abstract":"<p><strong>Background: </strong>Carotid atherosclerosis is a common complication in patients with type 2 diabetes mellitus (T2DM) and is closely associated with an increased risk of cardiovascular events.</p><p><strong>Aim: </strong>To identify the key demographic, clinical, and biochemical factors associated with carotid plaque formation in T2DM patients and evaluate their predictive value.</p><p><strong>Methods: </strong>This retrospective study included 266 T2DM patients (control group, <i>n</i> = 158; observation group, <i>n</i> = 108) recruited between January 2021 and July 2024. Participants underwent carotid ultrasonography to measure intima-media thickness (IMT) and detect carotid plaques. Comprehensive demographic and biochemical data, including age, body mass index (BMI), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), serum creatinine (Scr), urinary albumin-to-creatinine ratio (UACR), and serum uric acid (SUA), were collected. Statistical analyses, including Pearson correlation, logistic regression, and receiver operating characteristic (ROC) curve analysis, were performed to identify and evaluate factors associated with carotid plaque formation.</p><p><strong>Results: </strong>Significant differences in age, BMI, HbA1c, FPG, Scr, UACR, and SUA were observed between groups (all <i>P</i> < 0.05). Pearson correlation analysis showed IMT was positively associated with age, FPG, HbA1c, Scr, UACR, and SUA, and negatively with HDL-C. Multivariate logistic regression identified age (OR = 1.050, 95%CI: 1.015-1.087), FPG (OR = 1.096, 95%CI: 1.006-1.192), HbA1c (OR = 1.234, 95%CI: 1.057-1.445), SBP (OR = 1.018, 95%CI: 1.002-1.034), Scr (OR = 1.029, 95%CI: 1.011-1.046), UACR (OR = 1.024, 95%CI: 1.010-1.037), SUA (OR = 1.006, 95%CI: 1.003-1.009), and HDL-C (OR = 0.329, 95%CI: 0.119-0.917) as independent predictors of IMT (all <i>P</i> < 0.05). ROC analysis showed UACR (AUC = 0.718) and SUA (AUC = 0.651) had predictive value for carotid plaque.</p><p><strong>Conclusion: </strong>This study highlights the multifactorial nature of carotid atherosclerosis in T2DM, with age, BMI, poor glycemic control, renal dysfunction, and metabolic disturbances identified as key risk factors. The findings underscore the importance of comprehensive risk assessment and targeted interventions to prevent vascular complications in this high-risk population.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 8","pages":"104180"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974976","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":"Metabolic score for insulin resistance is associated with adverse cardiovascular events in patients with type 2 diabetes.","authors":"Ying Xin, Na-Ling Peng, Cai-Yan Xin, Jiang-Rong Liao, Xin-Qun Hu, Yi-Heng Dong, Xiang-Yu Zhang","doi":"10.4239/wjd.v16.i8.108671","DOIUrl":"10.4239/wjd.v16.i8.108671","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease represents a major complication in patients with type 2 diabetes mellitus (T2DM), with insulin resistance (IR) recognized as a key underlying pathophysiological mechanism. The metabolic score for IR (METS-IR), a simple, non-invasive, and insulin-independent surrogate marker of IR, has been validated for risk stratification and prognostic assessment in conditions such as hypertension, ischemic cardiomyopathy, and T2DM. Monitoring fluctuations in METS-IR levels among individuals with T2DM may facilitate early identification of elevated cardiovascular risk and inform timely therapeutic adjustments.</p><p><strong>Aim: </strong>To investigate the association between METS-IR and cardiovascular risk in patients with T2DM and to evaluate its potential utility as a predictive biomarker.</p><p><strong>Methods: </strong>This study represents a secondary analysis of a multicenter randomized controlled trial, ultimately including 10191 patients with T2DM aged 40 years to 79 years, with a follow-up duration of approximately 10 years. Baseline METS-IR was calculated using triglycerides, body mass index, high-density lipoprotein cholesterol and fasting plasma glucose. The predictive value of METS-IR for major adverse cardiovascular events (MACEs), all-cause mortality, congestive heart failure, and major coronary heart disease events, was assessed using Cox proportional hazards models, restricted cubic spline analysis, and stratified subgroup analyses. Multivariable adjustments were performed to account for potential confounding factors.</p><p><strong>Results: </strong>The incidence of MACEs increased steadily across higher METS-IR quartiles. After adjusting for multiple confounding factors, hazard ratios comparing the highest to the lowest METS-IR quartile were 1.25 [95% confidence interval (CI): 1.08-1.45] for MACEs, 1.55 (95%CI: 1.23-1.96) for cardiovascular death, 1.39 (95%CI: 1.21-1.59) for all-cause mortality, 2.22 (95%CI: 1.74-2.82) for congestive heart failure, and 1.35 (95%CI: 1.17-1.56) for major coronary heart disease. Restricted cubic spline analysis supported a positive, dose-dependent relationship between rising METS-IR levels and cardiovascular risk. Moreover, adding METS-IR to conventional risk prediction models enhanced their performance, as evidenced by improvements in the C-statistic, net reclassification improvement, and integrated discrimination improvement. Subgroup analyses indicated possible interactions between METS-IR, hemoglobin A1c levels, and aspirin therapy.</p><p><strong>Conclusion: </strong>METS-IR shows a strong correlation with cardiovascular risk in individuals with T2DM. Tracking METS-IR levels could enhance risk assessment and the prediction of cardiovascular events.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 8","pages":"108671"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975049","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":"Hyperglycemia-induced overexpression of CREB3 L3 promotes the epithelial-to-mesenchymal transition in bladder urothelial cells in diabetes mellitus.","authors":"Qing-Guo Wu, Ming-Jin Zhang, Yi-Bi Lan, Chun-Lei Ma, Wei-Jin Fu","doi":"10.4239/wjd.v16.i8.108101","DOIUrl":"10.4239/wjd.v16.i8.108101","url":null,"abstract":"<p><strong>Background: </strong>Diabetic cystopathy (DCP) is a complication affecting the lives of people with diabetes. However, the pathogenesis of DCP is not well known.</p><p><strong>Aim: </strong>To investigate the potential mechanisms by which cAMP-responsive element-binding protein 3 like 3 (CREB3 L3) promotes the occurrence and development of DCP.</p><p><strong>Methods: </strong>High-throughput sequencing was used to analyze differentially expressed genes (DEGs) in bladder urothelium from patients with DCP and healthy controls. Gene enrichment analysis was conducted to assess the biological functions of DEG. Small interfering RNA technology was performed to silence the CREB3 L3 gene in both <i>in vitro</i> and <i>in vivo</i> experiments. Morphological changes in bladder urothelium from a DCP rat model were observed. Immunofluorescence and western blotting assay were performed to determine associated protein expression.</p><p><strong>Results: </strong>We identified significant DEGs through high-throughput sequencing. These genes were primarily enriched in inflammatory activation, epithelial-mesenchymal transition (EMT) and tight junction organization. Upregulated expression of both CREB3 L3 and C-reactive protein (CRP) in bladder urothelium from patients with DCP was accompanied by upregulated EMT markers including N-cadherin and vimentin proteins, but downregulated E-cadherin. Silencing CREB3 L3 attenuated the protein expression of CRP and EMT in SV-HUC-1 urothelial cells under hyperglycemic conditions and in the diabetes mellitus rat model at 4, 8, and 12 weeks. CREB3 L3 knockdown also reversed downregulation of the tight junction proteins occludin and claudin 1.</p><p><strong>Conclusion: </strong>Hyperglycemia induces the upregulation of CREB3 L3 expression, thereby promoting the EMT and impairing tight junctions in bladder urothelial cells. Targeting CREB3 L3 in bladder urothelial cells is likely to be a key approach in preventing and treating DCP.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 8","pages":"108101"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975072","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":"Role of alternative oral therapy for the management of wet age-related macular degeneration and proliferative diabetic retinopathy.","authors":"Shweta Walia, Arvind Kumar Morya, Srishti Khullar, Sarita Aggarwal, Rajwinder Kaur","doi":"10.4239/wjd.v16.i8.109231","DOIUrl":"10.4239/wjd.v16.i8.109231","url":null,"abstract":"<p><p>Proliferative diabetic retinopathy (PDR) affects approximately 6% of diabetic patients globally. The overall prevalence of diabetic retinopathy is around 22%. Wet age-related macular degeneration (ARMD), the sight-threatening type of ARMD, affects approximately 1.2%-1.3% of the general population and represents 15% of total ARMD cases. While intravitreal anti-vascular endothelial growth factor injections are still the mainstay therapy, there are a few challenges, such as frequent administration, cost burden, and compliance barriers that prompt the need for exploration into systemic oral alternative drugs like fenofibrate, candesartan, and vorolanib. These oral therapies have the advantage of being non-invasive and systemically accessible with few logistical burdens. This review highlights current evidence supporting the use of oral therapies in PDR and wet ARMD management, along with practical limitations and future prospects.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 8","pages":"109231"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975139","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":"Performance of flash continuous glucose monitoring and glycemic marker correlations in Chinese pregnant women with non-type 1 diabetes.","authors":"Ling Lyu, Yi-Ling Huang, Yu Huang, Ze-Yu Wu, Fan Ping, Yu-Xiu Li","doi":"10.4239/wjd.v16.i8.106967","DOIUrl":"10.4239/wjd.v16.i8.106967","url":null,"abstract":"<p><strong>Background: </strong>Maternal diabetes significantly increases the risk of adverse maternal and neonatal outcomes. Traditional self-monitoring of blood glucose is often invasive and limited in its ability to capture glycemic variability. Flash continuous glucose monitoring (FCGM) offers a promising alternative; however, its reliability and correlation with biochemical markers such as hemoglobin A1c (HbA1c) and glycated albumin (GA) in pregnant women with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) remain underexplored.</p><p><strong>Aim: </strong>To evaluate the performance of the FreeStyle Libre H FCGM against plasma glucose and its correlations with HbA1c and GA.</p><p><strong>Methods: </strong>This prospective observational study involved 152 pregnant women with GDM or T2DM, with intermittent collection of venous plasma glucose, HbA1c, GA, and concurrent FCGM data at regular intervals at a single center. Relationships were evaluated using restricted cubic spline and mixed-effects models. Receiver operating characteristic curve analysis was performed to compare the ability of HbA1c and GA to detect suboptimal glycemic control.</p><p><strong>Results: </strong>Analysis of 507 FCGM-plasma glucose pairs revealed an overall mean absolute relative difference of 7.96%. Mean absolute relative differences were 9.22%, 7.75%, and 4.15% for low (3.5-4.4 mmol/L), medium (4.5-7.8 mmol/L), and high (7.9-13 mmol/L) glucose levels, respectively. Most values fell within zone A or zone B on the Clarke and Parkes Error Grids. Bland-Altman analysis indicated a slight underestimation by FCGM (-0.121 mmol/L). Restricted cubic spline analysis revealed significant linear or nonlinear associations between HbA1c/GA and mean glucose, time in range, time above range, and coefficient of variation, but not time below range. Both HbA1c and GA were influenced by gestational age and pregestational body mass index. Receiver operating characteristic analysis showed that HbA1c had comparable or superior performance to GA in detecting suboptimal glycemic control based on FCGM-derived thresholds.</p><p><strong>Conclusion: </strong>The FCGM system served as a validated reference for evaluating glycemic markers in pregnant women with T2DM and GDM. HbA1c reliably assessed average glycemia, while GA provided complementary insight.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 8","pages":"106967"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065908","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":"<i>WFS1</i> gene mutation associated with pediatric diabetes mellitus and congenital deafness: A case report.","authors":"Ai-Min Gao, Wan-Ling Deng, Xin-Ping Yang, Wan-Yue Wu, Chun-Yuan Ma, Yu Liu","doi":"10.4239/wjd.v16.i8.108946","DOIUrl":"10.4239/wjd.v16.i8.108946","url":null,"abstract":"<p><strong>Background: </strong>Wolfram syndrome is a rare autosomal recessive genetic disorder characterized by early-onset diabetes and progressive neurodegeneration, most notably sensorineural hearing loss and optic atrophy. Because its initial manifestations are usually similar to those of type 1 diabetes, the diagnosis may be delayed until other manifestations appear. Pathogenic variations of the <i>WFS1</i> gene can disrupt endoplasmic reticulum function and cellular homeostasis, but the complete mutation spectrum of <i>WFS1</i> has not been fully determined. Early identification of monogenic diabetes caused by Wolfram syndrome is of vital importance, as it enables the provision of targeted multidisciplinary care and genetic counseling for affected families.</p><p><strong>Case summary: </strong>A 2-year-old Han Chinese girl was admitted with a 1-month history of polydipsia, polyuria, and polyphagia, and was diagnosed with diabetic ketoacidosis and impaired insulin secretion. Sensorineural hearing loss was also detected. Whole-exome sequencing identified a previously unreported heterozygous mutation, <i>WFS1 c.986T>C</i> (<i>p.Phe329Ser</i>), in the patient and her father, confirming the diagnosis of Wolfram syndrome. Bioinformatic analysis supported the likely pathogenicity of this mutation<i>. In silico</i> pathogenicity predictors (REVEL, SIFT, PolyPhen-2, MutationTaster, and GERP+) supported a deleterious effect on wolframin structure and function. The patient was initially treated with intravenous insulin and fluid resuscitation, then transitioned to a basal-bolus insulin regimen. Glycemic control was subsequently maintained with continuous subcutaneous insulin infusion and intermittent subcutaneous injections. At the 1- and 6-month follow-ups, blood glucose remained well controlled (hemoglobin A1c: 5.89% and 6.58%, respectively), with no evidence of organ dysfunction or further complications.</p><p><strong>Conclusion: </strong>This case identifies <i>WFS1 c.986T>C (p.Phe329Ser)</i> as a novel pathogenic variant causing Wolfram syndrome. It highlights the importance of early genetic testing in pediatric patients with atypical diabetes presentations to enable timely diagnosis, individualized therapy, and comprehensive family support.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 8","pages":"108946"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974907","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":"Gut dysbiosis, low-grade inflammation, and renal impairment severity in elderly diabetic nephropathy.","authors":"Yan-Ping Shi, Zhang-Lei Pan, Jing Zhang, Ling-Yu Xue, Ming-Qiang Li","doi":"10.4239/wjd.v16.i8.108245","DOIUrl":"10.4239/wjd.v16.i8.108245","url":null,"abstract":"<p><strong>Background: </strong>The specific mechanism of diabetic nephropathy (DN) has not been fully elucidated, and more and more evidence shows that the development of DN is related to intestinal flora imbalance and micro-inflammatory state process, and this mechanism urgently needs to be further clarified by relevant research.</p><p><strong>Aim: </strong>To investigate the correlation between intestinal microbiota dysbiosis, low-grade inflammatory status, renal function impairment, and disease severity in older patients with DN, in order to provide a basis for the prevention and therapeutic intervention of DN.</p><p><strong>Methods: </strong>We enrolled 167 older patients with DN, diagnosed in the Department of Nephrology between June 2020 and June 2023. Eighty-five patients with type 2 diabetes mellitus (without DN) were enrolled to serve as the control group. A one-year follow-up observation was conducted. We compared the differences in gut microbiota composition, levels of inflammatory markers, and renal function indicators between the two groups, and the characteristics of gut microbiota and the changing patterns of inflammatory markers across different stages of disease progression.</p><p><strong>Results: </strong>In the DN group, the Chao, Ace, and Shannon indices were significantly lower, while the Simpson index was significantly higher than the control group. The relative abundances of <i>Bacteroides</i> and <i>Bifidobacterium</i> were significantly lower, whereas the relative abundances of <i>Clostridium, Butyricimonas, Klebsiella, Enterococcus, Veillonella</i>, and <i>Megamonas</i> were significantly higher than those in the control group (<i>P</i> < 0.05). Estimated glomerular filtration rate was positively correlated with the Chao, Ace, and Shannon diversity indices of the gut microbiota, as well as with the relative abundances of <i>Bacteroides, Bifidobacterium</i>, and <i>Akkermansia</i>, and was negatively correlated with the relative abundances of <i>Clostridium, Klebsiella,</i> and <i>Enterococcus</i> (<i>P</i> < 0.05). Logistic regression analysis indicated that lower Chao, Ace, and Shannon indices and higher Simpson index were associated with an increased risk of developing DN. After one year of follow-up, patients in the progression group exhibited a significantly greater decrease in Chao, Ace, and Shannon indices and a greater increase in Simpson index than the stable group. The reduction in the relative abundances of <i>Bacteroides, Clostridium, Bifidobacterium,</i> and <i>Butyricimonas</i>, as well as the increase in <i>Klebsiella, Enterococcus, Veillonella,</i> and <i>Megamona</i>s, were significantly more pronounced in the progression group than in the stable group (<i>P</i> < 0.05). Regression analysis indicated that greater declines in Chao, Ace, and Shannon indices and <i>Bacteroides</i> relative abundance, along with greater increases in Simpson index and <i>Enterococcus</i> relative abundance, were associated wi","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 8","pages":"108245"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975125","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":"Persistently high and fluctuating trajectories of total and somatic depressive symptoms increase diabetes risk: Two prospective cohort studies.","authors":"Xue-Lun Zou, Chang Zhou","doi":"10.4239/wjd.v16.i8.106683","DOIUrl":"10.4239/wjd.v16.i8.106683","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Depression is a significant risk factor for diabetes, particularly type 2 diabetes. However, depressive symptoms differ from clinical depression. Previous research has not fully considered the relationship between the trajectory of depressive symptoms and the risk of developing diabetes over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To investigate the association between depressive symptoms, their trajectories, and the risk of developing diabetes in two prospective cohort studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In the first phase we analyzed the association between depressive symptoms and the risk of developing diabetes separately using the Health and Retirement Study (HRS). Depressive symptom trajectories were assessed by examining changes in depressive symptoms at baseline and again 8 years later. We then identified specific depressive symptom trajectories that increased the risk of diabetes in the second phase. Finally, we confirmed the association between depressive symptoms and their trajectories with diabetes risk using the English Longitudinal Study of Ageing (ELSA) as a validation study. Depressive symptom trajectories were categorized into five states based on changes in the modified 8-item Center for Epidemiological Studies-Depression scores: Persistently high; increasing; fluctuating; decreasing; and persistently low. Diabetes mellitus was defined as self-reported, physician-diagnosed diabetes. Cox proportional hazards models were used to assess hazard ratios (HR) and 95% confidence intervals (CI), adjusting for potential confounders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the first phase a total of 27658 participants were included (HRS: 18633, ELSA: 9025), among whom 6582 had depressive symptoms (HRS: 4547, ELSA: 2035), 6407 had somatic depressive symptoms (HRS: 4414, ELSA: 1993), and 26415 had cognitive-affective depressive symptoms (HRS: 17755, ELSA: 8660). We found that overall depressive symptoms (HRS: HR = 1.14, 95%CI: 1.07-1.22; ELSA: HR = 1.18, 95%CI: 1.03-1.34) and somatic depressive symptoms (HRS: HR = 1.14, 95%CI: 1.07-1.22; ELSA: HR = 1.25, 95%CI: 1.10-1.42) increased the risk of diabetes, while cognitive depressive symptoms were not associated with diabetes risk. Over an 8-year follow-up we identified 19729 trajectories of overall, somatic, and cognitive-affective depressive symptoms (HRS: 13918, ELSA: 5811). In the second phase we found that persistently high (HRS: HR = 1.22, 95%CI: 1.06-1.40, ELSA: HR = 1.54, 95%CI: 1.16-2.05 in total and HRS: HR = 1.24, 95%CI: 1.07-1.43, ELSA: HR = 1.79, 95%CI: 1.36-2.35 in somatic) and fluctuating (HRS: HR = 1.09, 95%CI: 1.01-1.17, ELSA: HR = 1.33, 95%CI: 1.14-1.55 in total and HRS: HR = 1.10, 95%CI: 1.02-1.18, ELSA: HR = 1.31, 95%CI: 1.13-1.53 in somatic) trajectories of overall and somatic depressive symptoms increased the risk of diabetes, while increasing trajectories may also raise diabetes risk. However, decreasing trajectories were not associated with diabet","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 8","pages":"106683"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065939","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}