The Lancet Diabetes & Endocrinology最新文献

{"title":"Metabolic dysfunction-associated steatotic liver disease: heterogeneous pathomechanisms and effectiveness of metabolism-based treatment","authors":"Norbert Stefan, Hannele Yki-Järvinen, Brent A Neuschwander-Tetri","doi":"10.1016/s2213-8587(24)00318-8","DOIUrl":"https://doi.org/10.1016/s2213-8587(24)00318-8","url":null,"abstract":"The global epidemic of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing worldwide. People with MASLD can progress to cirrhosis and hepatocellular carcinoma and are at increased risk of developing type 2 diabetes, cardiovascular disease, chronic kidney disease, and extrahepatic cancers. Most people with MASLD die from cardiac-related causes. This outcome is attributed to the shared pathogenesis of MASLD and cardiometabolic diseases, involving unhealthy dietary habits, dysfunctional adipose tissue, insulin resistance, and subclinical inflammation. In addition, the steatotic and inflamed liver affects the vasculature and heart via increased glucose production and release of procoagulant factors, dyslipidaemia, and dysregulated release of hepatokines and microRNAs. However, there is substantial heterogeneity in the contributors to the pathophysiology of MASLD, which might influence its rate of progression, its relationship with cardiometabolic diseases, and the response to therapy. The most effective non-pharmacological treatment approaches for people with MASLD include weight loss. Paradoxically, some effective pharmacological approaches to improve liver health in people with MASLD are associated with no change in bodyweight or even with weight gain, and similar response heterogeneity has been observed for changes in cardiometabolic risk factors. In this Review, we address the heterogeneity of MASLD with respect to its pathogenesis, outcomes, and metabolism-based treatment responses. Although there is currently insufficient evidence for the implementation of precision medicine for risk prediction, prevention, and treatment of MASLD, we discuss whether knowledge about this heterogeneity might help achieving this goal in the future.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"29 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The era of GLP-1 receptor agonists: costs versus benefits","authors":"","doi":"10.1016/s2213-8587(24)00376-0","DOIUrl":"https://doi.org/10.1016/s2213-8587(24)00376-0","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"90 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142809729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the US election on diabetes","authors":"Irl B Hirsch, Desmond A Schatz","doi":"10.1016/s2213-8587(24)00370-x","DOIUrl":"https://doi.org/10.1016/s2213-8587(24)00370-x","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"12 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysglycaemia definitions and progression to clinical type 1 diabetes in children with multiple islet autoantibodies","authors":"Sandra Hummel, Melanie Koeger, Ezio Bonifacio, Anette-Gabriele Ziegler","doi":"10.1016/s2213-8587(24)00337-1","DOIUrl":"https://doi.org/10.1016/s2213-8587(24)00337-1","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"15 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142763239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achievement of HbA1c targets: real-world data from international paediatric type 1 diabetes registries","authors":"Beate Karges, Mikael Knip","doi":"10.1016/s2213-8587(24)00311-5","DOIUrl":"https://doi.org/10.1016/s2213-8587(24)00311-5","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"69 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment regimens and glycaemic outcomes in more than 100 000 children with type 1 diabetes (2013–22): a longitudinal analysis of data from paediatric diabetes registries","authors":"Anthony T Zimmermann, Stefanie Lanzinger, Siv Janne Kummernes, Nicolai A Lund-Blix, Reinhard W Holl, Elke Fröhlich-Reiterer, David M Maahs, Osagie Ebekozien, Saketh Rompicherla, Justin T Warner, Saira Pons Perez, Holly Robinson, Maria E Craig, Stephanie Johnson, Karin Akesson, Alexander Thorén, Katarina Eeg-Olofsson, Ajenthen G Ranjan, Mette Madsen, Michael Witsch, Jannet Svensson","doi":"10.1016/s2213-8587(24)00279-1","DOIUrl":"https://doi.org/10.1016/s2213-8587(24)00279-1","url":null,"abstract":"<h3>Background</h3>Advances in paediatric type 1 diabetes management and increased use of diabetes technology have led to improvements in glycaemia, reduced risk of severe hypoglycaemia, and improved quality of life. Since 1993, progressively lower HbA<sub>1c</sub> targets have been set. The aim of this study was to perform a longitudinal analysis of HbA<sub>1c</sub>, treatment regimens, and acute complications between 2013 and 2022 using data from eight national and one international paediatric diabetes registries.<h3>Methods</h3>In this longitudinal analysis, we obtained data from the Australasian Diabetes Data Network, Czech National Childhood Diabetes Register, Danish Registry of Childhood and Adolescent Diabetes, Diabetes Prospective Follow-up Registry, Norwegian Childhood Diabetes Registry, England and Wales' National Paediatric Diabetes Audit, Swedish Childhood Diabetes Registry, T1D Exchange Quality Improvement Collaborative, and the SWEET initiative. All children (aged ≤18 years) with type 1 diabetes with a duration of longer than 3 months were included. Investigators compared data from 2013 to 2022; analyses performed on data were pre-defined and conducted separately by each respective registry. Data on demographics, HbA<sub>1c</sub>, treatment regimen, and event rates of diabetic ketoacidosis and severe hypoglycaemia were collected. ANOVA was performed to compare means between registries and years. Joinpoint regression analysis was used to study significant breakpoints in temporal trends.<h3>Findings</h3>In 2022, data were available for 109 494 children from the national registries and 35 590 from SWEET. Between 2013 and 2022, the aggregated mean HbA<sub>1c</sub> decreased from 8·2% (95% CI 8·1–8·3%; 66·5 mmol/mol [65·2–67·7]) to 7·6% (7·5–7·7; 59·4mmol/mol [58·2–60·5]), and the proportion of participants who had achieved HbA<sub>1c</sub> targets of less than 7% (<53 mmol/mol) increased from 19·0% to 38·8% (p<0·0001). In 2013, the aggregate event rate of severe hypoglycaemia rate was 3·0 events per 100 person-years (95% CI 2·0–4·9) compared with 1·7 events per 100 person-years (1·0–2·7) in 2022. In 2013, the aggregate event rate of diabetic ketoacidosis was 3·1 events per 100 person-years (95% CI 2·0–4·8) compared with 2·2 events per 100 person-years (1·4–3·4) in 2022. The proportion of participants with insulin pump use increased from 42·9% (95% CI 40·4–45·5) in 2013 to 60·2% (95% CI 57·9–62·6) in 2022 (mean difference 17·3% [13·8–20·7]; p<0·0001), and the proportion of participants using continuous glucose monitoring (CGM) increased from 18·7% (95% CI 9·5–28·0) in 2016 to 81·7% (73·0–90·4) in 2022 (mean difference 63·0% [50·3–75·7]; p<0·0001).<h3>Interpretation</h3>Between 2013 and 2022, glycaemic outcomes have improved, parallel to increased use of diabetes technology. Many children had HbA<sub>1c</sub> higher than the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2022 target. Reassuringly, despite ","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"10 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medications for obesity as preventatives: a public and patient safety issue","authors":"Stuart W Flint, Adrian Brown, Verónica Vázquez-Velázquez, Jonathan M Hazlehurst","doi":"10.1016/s2213-8587(24)00319-x","DOIUrl":"https://doi.org/10.1016/s2213-8587(24)00319-x","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"182 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Diabetes Endocrinol 2024; published online Nov 12. https://doi.org/10.1016/S2213-8587(24)00283-3","authors":"","doi":"10.1016/s2213-8587(24)00368-1","DOIUrl":"https://doi.org/10.1016/s2213-8587(24)00368-1","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"69 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to reframe the disease staging system for type 1 diabetes","authors":"Laura M Jacobsen, Mark A Atkinson, Jay M Sosenko, Stephen E Gitelman","doi":"10.1016/s2213-8587(24)00239-0","DOIUrl":"https://doi.org/10.1016/s2213-8587(24)00239-0","url":null,"abstract":"In 2015, introduction of a disease staging system offered a framework for benchmarking progression to clinical type 1 diabetes. This model, based on islet autoantibodies (stage 1) and dysglycaemia (stage 2) before type 1 diabetes diagnosis (stage 3), has facilitated screening and identification of people at risk. Yet, there are many limitations to this model as the stages combine a very heterogeneous group of individuals; do not have high specificity for type 1 diabetes; can occur without persistence (ie, reversion to an earlier risk stage); and exclude age and other influential risk factors. The current staging system also infers that individuals at risk of type 1 diabetes progress linearly from stage 1 to stage 2 and subsequently stage 3, whereas such movements are often more complex. With the approval of teplizumab by the US Food and Drug Administration in 2022 to delay type 1 diabetes in people at stage 2, there is a need to refine the definition and accuracy of type 1 diabetes staging. Theoretically, we propose that a type 1 diabetes risk calculator should incorporate any available demographic, genetic, autoantibody, metabolic, and immune data that could be continuously updated. Additionally, we call to action for the field to increase the breadth of knowledge regarding type 1 diabetes risk in non-relatives, adults, and individuals from minority populations.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"24 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes: a meta-analysis of randomised controlled trials","authors":"Sunil V Badve, Anika Bilal, Matthew M Y Lee, Naveed Sattar, Hertzel C Gerstein, Christian T Ruff, John J V McMurray, Peter Rossing, George Bakris, Kenneth W Mahaffey, Johannes F E Mann, Helen M Colhoun, Katherine R Tuttle, Richard E Pratley, Vlado Perkovic","doi":"10.1016/s2213-8587(24)00271-7","DOIUrl":"https://doi.org/10.1016/s2213-8587(24)00271-7","url":null,"abstract":"<h3>Background</h3>GLP-1 receptor agonists reduce the risk of major adverse cardiovascular events (MACE) and can also have kidney benefits. However, whether GLP-1 receptor agonists improve clinically important kidney outcomes remains uncertain. We aimed to comprehensively assess the effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes by performing a meta-analysis of randomised controlled trials.<h3>Methods</h3>For this meta-analysis, we searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for randomised controlled trials that included at least 500 participants with type 2 diabetes, compared a GLP-1 receptor agonist with placebo with at least 12 months of follow-up, and reported a primary clinical kidney or cardiovascular outcome, from database inception to March 26, 2024. Post hoc, we included the SELECT trial (<span><span>NCT03574597</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>), which enrolled participants with cardiovascular disease and a BMI of 27 kg/m<sup>2</sup> or more without diabetes. Study-level summary data were extracted independently by two authors for inclusion in this random-effects analysis. The main kidney outcome was a composite outcome, consisting of kidney failure (kidney replacement therapy or a persistent estimated glomerular filtration rate [eGFR] <15 mL/min per 1·73 m<sup>2</sup>), a sustained reduction in eGFR by at least 50% or the nearest equivalent, or death from kidney failure. The main cardiovascular outcome was MACE, consisting of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. This study is registered with PROSPERO, CRD42024528864.<h3>Findings</h3>Of the 5140 records identified through the literature search, 11 trials, involving 85 373 participants (29 386 female, 55 987 male), were included in the meta-analysis. In participants with type 2 diabetes (67 769), GLP-1 receptor agonists reduced the composite kidney outcome by 18% compared with placebo (hazard ratio [HR] 0·82, 95% CI 0·73–0·93; <em>I</em><sup>2</sup> =26·41%), kidney failure by 16% (HR 0·84, 0·72–0·99; <em>I</em><sup>2</sup> =0%), MACE by 13% (HR 0·87, 0·81–0·93; <em>I</em><sup>2</sup> =49·75%), and all-cause death by 12% (HR 0·88, 0·83–0·93; <em>I</em><sup>2</sup> =0%). The effect on the composite kidney outcome (HR 0·81, 95% CI 0·72–0·92; <em>I</em><sup>2</sup> =23·11%), kidney failure (HR 0·84, 0·72–0·98; <em>I</em><sup>2</sup> =0%), MACE (HR 0·86, 0·80–0·92; <em>I</em><sup>2</sup> =48·9%), and all-cause death (HR 0·87, 0·82–0·91; <em>I</em><sup>2</sup> =0%) was similar when the SELECT trial was included, with no evidence of heterogeneity between this trial and those including participants with type 2 diabetes (p<sub>heterogeneity</sub> >0·05). There was no difference in the risk of serious advers","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"8 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142713194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}