Diabetes-Metabolism Research and Reviews最新文献

{"title":"Professional Stakeholders' Perspectives on Early Screening for Type 1 Diabetes in Children: A Systematic Review.","authors":"Francesca Gatti, Bianca M Milazzo, Lauren M Quinn, Antonio Catarinella, Gaia Perego, Francesca Milano, Karin Lange, Sheila Greenfield, Renuka Dias, Jurgen Vercauteren, Adya Rao, Aymeric Mahieu, Carmen Hurtado Del Pozo, Valentina E Di Mattei, Katharine Barnard, Chantal Mathieu, Parth Narendran, Emanuele Bosi, Olga Boiko","doi":"10.1002/dmrr.70240","DOIUrl":"https://doi.org/10.1002/dmrr.70240","url":null,"abstract":"<p><p>Early screening for type 1 diabetes (T1D) is receiving increasing attention as presymptomatic screening initiatives and disease-modifying therapies continue to expand. However, the perspectives of professional stakeholders, who play a pivotal role in implementation, patient engagement, and health system preparedness, have not been systematically synthesised. We conducted a systematic review to examine professional views on paediatric early T1D screening. Following PRISMA guidelines, six databases (Medline, Embase, Scopus, CINAHL, PsycINFO, ASSIA) and grey literature were searched through January 2026. Twelve studies met the inclusion criteria, predominantly involving paediatricians and diabetes specialists; nurses, genetic counsellors, policymakers, and other healthcare professionals were represented in few studies. Methodological appraisal using the Mixed Methods Appraisal Tool (MMAT) identified recurring limitations in sample representativeness and potential nonresponse bias. Given the heterogeneity and primarily descriptive nature of the study design and outcomes, findings were synthesised narratively. Professional perspectives varied according to the population targeted, professional group studied, screening scenario, and the implementation context. Where directly compared, support was greater for at-risk than for general-population screening. Reported benefits included diabetic ketoacidosis (DKA) prevention, earlier clinical engagement, and improved preparedness for families. However, concerns persisted regarding psychosocial burden, workforce capacity, and unclear referral and follow-up pathways. More favourable evaluations were reported in some structured programmes, although these findings may reflect reliance on existing infrastructures and targeted participant selection. By consolidating previously fragmented evidence, this review identifies recurring clinical, psychosocial, and organisational considerations relevant to paediatric T1D screening. These findings primarily reflect clinical perspectives and indicate conditional rather than uniform support. Further studies should evaluate how standardised pathways, professional training, and integrated psychosocial support affect the feasibility and acceptability of screening across different healthcare contexts.</p>","PeriodicalId":48934,"journal":{"name":"Diabetes-Metabolism Research and Reviews","volume":"42 7","pages":"e70240"},"PeriodicalIF":6.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and Long-Term HbA_1c Variability Are Additively Associated With Increased Risk of Cardiovascular-Renal Outcomes, Severe Hypoglycaemia and Mortality in Type-2 Diabetes.","authors":"Kelly T C Wong, Edith W K Chow, Eric S H Lau, Chun Kwan O, Alice P S Kong, Ronald C W Ma, Andrea O Y Luk, Elaine Y K Chow, Yun Kwok Wing, Juliana C N Chan, Juliana N M Lui","doi":"10.1002/dmrr.70222","DOIUrl":"10.1002/dmrr.70222","url":null,"abstract":"<p><strong>Aims: </strong>Depression and long-term HbA_1c variability are associated with adverse outcomes in type-2 diabetes (T2D), which may be related to suboptimal self-management practices and health-related quality of life (HRQoL).</p><p><strong>Materials and methods: </strong>In the prospective Hong Kong Diabetes Register (2013-2019), we estimated the independent and joint associations of depression and HbA_1c variability with outcomes. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9) with a validated Chinese cut-off score ≥ 7. The HbA_1c variability score (HVS) was expressed as the percentage of HbA_1c, which varied by 0.5% compared to the preceding value.</p><p><strong>Results: </strong>Amongst 5657 Chinese patients with T2D [58.7% male, age (mean ± SD): 58.47 ± 10.62 years, duration of diabetes: 10.63 ± 8.19 years and time-weighted HbA_1c: 7.44% ± 1.04%], 13.3% had depression. After full adjustment, depression was associated with increased risk of cardiovascular disease (CVD) [adjusted hazard ratio (aHR): 1.79 (95% CI: 1.15-2.79); p = 0.010], whereas high HVS (≥ median, 42.9%) was associated with increased risks of chronic kidney disease (CKD) [1.49 (1.21-1.82); p < 0.001] and severe hypoglycaemia (SH) [1.93 (1.22-3.07); p = 0.005]. The depression-high-HVS group had the highest aHR for CKD, which was attenuated from 1.90 (1.41-2.56) to 1.74 (1.25-2.44), and that for all-cause mortality from 2.00 (1.33-3.01) to 1.72 (1.06-2.78) after adjustment for self-management practices and HRQoL.</p><p><strong>Conclusions: </strong>Depression and high HVS are independently and differentially associated with adverse events, with the depression-high-HVS group having the worst outcomes, which were modulated by self-management and HRQoL, calling for systematic screening of depression and holistic management aimed at avoiding fluctuating glycaemic control in T2D.</p>","PeriodicalId":48934,"journal":{"name":"Diabetes-Metabolism Research and Reviews","volume":"42 6","pages":"e70222"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disordered Eating Behaviours and Associated Factors Among People With Type 1 Diabetes: A Cross-Sectional Study in Spain-D1ANAS Project.","authors":"Lorena Botella-Juan, Inmaculada Aguilera-Buenosvinos, María Antequera-González, Laura Álvarez-Álvarez, María Rubín-García, María Romeo-Santos, Ana Segura-Grau, María D Ballesteros-Pomar, Antonio José Molina, Vicente Martín-Sánchez","doi":"10.1002/dmrr.70204","DOIUrl":"10.1002/dmrr.70204","url":null,"abstract":"<p><strong>Background and aims: </strong>People with type 1 diabetes mellitus (T1D) are at increased risk of disordered eating behaviours (DEBs), partly due to aspects of diabetes management. The aim of this study was to estimate the prevalence of DEBs in a group of adults with T1D in Spain and to examine their association with sociodemographic, clinical, and lifestyle-related factors.</p><p><strong>Methods: </strong>A nationwide cross-sectional study was conducted as part of the D1ANAS project, involving 451 people aged ≥ 16 years with T1D living in Spain. DEBs were assessed using the validated Spanish version of the Diabetes Eating Problems Survey-Revised (DEPS-R), with scores ≥ 20 indicating a positive screening. Sociodemographic, clinical, and lifestyle variables were collected using a self-administered online questionnaire. Multivariate linear regression analyses were performed to identify factors independently associated with the total DEPS-R score.</p><p><strong>Results: </strong>The mean DEPS-R score was 16.8 (SD 12.1), and 31.7% of participants screened positive for DEBs, with higher prevalence in women than men (35.4% vs. 14.8%, p < 0.001) 36.6% of participants reported insulin restriction behaviours, with no significant differences between sexes. In the adjusted models, female sex (β = 3.23, 95% CI = 0.65-5.82), higher HbA1c percentage (β = 2.12, 95% CI = 1.32-2.93), and higher zBMI (β = 3.44, 95% CI = 2.44-4.44) were independently associated with higher DEPS-R scores, as were poorer perceived health (β = 5.11, 95% CI = 2.25-7.96), poorer diet quality (β = 13.42, 95% CI = 7.23-19.61) and poor sleep perception (β = 3.43, 95% CI = 1.46-5.39). The model explained 29.6% of the variance in DEPS-R scores.</p><p><strong>Conclusion: </strong>DEBs affect about one-third of the participants with T1D and are associated with poorer metabolic control, higher BMI, and adverse lifestyle and psychosocial factors, highlighting the need for diabetes-specific screening and multidisciplinary management.</p>","PeriodicalId":48934,"journal":{"name":"Diabetes-Metabolism Research and Reviews","volume":"42 5","pages":"e70204"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality and Characteristics of Short Spanish-Language Videos on Social Media About Type 2 Diabetes Mellitus.","authors":"Anderson N Soriano-Moreno, Carlos Quispe-Vicuña, Milagros L Garcia-Cordova, Ruth Mery Valera-Palli, Sandy Ester Saldaña-Cabanillas","doi":"10.1002/dmrr.70178","DOIUrl":"10.1002/dmrr.70178","url":null,"abstract":"<p><strong>Background: </strong>Social media has become a common source of educational information on type 2 diabetes. However, evidence regarding the quality of this content remains limited. This study evaluated the quality of short Spanish-language videos about type 2 diabetes published on Facebook, Instagram, TikTok, and YouTube.</p><p><strong>Methods: </strong>A cross-sectional study analysed 400 short videos, including the top-ranked videos identified per platform (n = 100 each), collected between March 4 and 25, 2026. Spanish-language short-form videos (≤ 10 min) on type 2 diabetes intended for a general audience were included, while promotional or humourous content was excluded. Informational quality was assessed using the Journal of the American Medical Association (JAMA) benchmark criteria and the Global Quality Score (GQS).</p><p><strong>Results: </strong>Overall, quality was low, with a mean GQS score of 2.5 ± 0.82 (on a 5-point scale) and low adherence to JAMA criteria, including authorship (35.5%), attribution (5.8%), and disclosure (1.0%). In multivariable analysis, videos on YouTube (β: 0.6; 95% CI: 0.3-0.8) and Instagram (β: 0.3; 95% CI: 0.1-0.5) had higher GQS scores compared with TikTok. Videos featuring a health professional were also associated with higher GQS scores (β: 0.4; 95% CI: 0.2-0.6). Compared with videos shorter than 30 s, videos lasting 31-60 s (β: 0.3; 95% CI: 0.0-0.6), 61-120 s (β: 0.5; 95% CI: 0.2-0.8), and more than 120 s (β: 0.7; 95% CI: 0.4-1.0) had higher GQS scores.</p><p><strong>Conclusion: </strong>Spanish-language type 2 diabetes-related videos on social media generally showed low quality. Higher quality was associated with content featuring healthcare professionals, longer video duration, and platforms such as YouTube and Instagram.</p>","PeriodicalId":48934,"journal":{"name":"Diabetes-Metabolism Research and Reviews","volume":"42 4","pages":"e70178"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disentangling the Multifactorial Influences on Diabetes Risk Among Rural Communities: Food Environment, Diet Quality, and Dietary Chemical Exposures.","authors":"David C Lee, Haley L Motola, Jessie Moore, Tammy Flores, Crystal So, Haeseung Yi, Vittorio Albergamo, Leonardo Trasande, Brian Elbel, Lorna E Thorpe","doi":"10.1002/dmrr.70177","DOIUrl":"10.1002/dmrr.70177","url":null,"abstract":"<p><strong>Aims: </strong>Rural communities experience a higher prevalence of type 2 diabetes and diabetes-related mortality than urban populations. This study sought to disaggregate the influences of demographic and socioeconomic factors, food environment, diet quality, and dietary chemical exposures on diabetes risk in rural areas.</p><p><strong>Materials and methods: </strong>We enrolled participants from rural Sullivan County in an observational cohort study involving surveys and biospecimen collection measuring bisphenols and phthalates. We measured these endocrine disrupting chemicals found in food packaging, as rural residents generally consume canned foods and other shelf-stable foods more frequently than their urban counterparts. We used LASSO regression to compare the relative influence of these factors had on rural diabetes risk.</p><p><strong>Results: </strong>Based on values for LASSO regression coefficients among 276 participants, the strongest risk factors for diagnosed diabetes included: older age (+0.486), lower household income (+0.172), Hispanic ethnicity (+0.124), red meat intake (+0.093), proportion of fast food restaurants among nearby restaurants (+0.071), and two phthalates (+0.149 and + 0.107). Among study participants without a history of diabetes, high HbA1c levels were associated with older age (+0.106), being non-Hispanic Black (+0.064), more trans-fat and red meat intake (+0.044 and +0.028), higher BMI (+0.014), higher levels of total bisphenols (+0.005), and higher levels of high-molecular weight phthalates (+0.002).</p><p><strong>Conclusions: </strong>Demographic and socioeconomic factors were the strongest predictors of rural diabetes risk; however, diet quality, food environment, and dietary chemical exposures also each played a key role. Our study identified modifiable risk factors, which could help reduce the burden of rural diabetes.</p>","PeriodicalId":48934,"journal":{"name":"Diabetes-Metabolism Research and Reviews","volume":"42 4","pages":"e70177"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MicroRNAs in Obesity-Associated Metabolic Inflammation: From Molecular Mechanisms to Clinical Translation.","authors":"Jiaxin Mao, Ying Yang, Yuxin Xiong, Xiayan Wang, Qiurong Wu, Wenjie Lin, Xiaogang Li, Yiping Li","doi":"10.1002/dmrr.70175","DOIUrl":"10.1002/dmrr.70175","url":null,"abstract":"<p><p>Metabolic inflammation, triggered by obesity is a core pathological link in complications such as type 2 diabetes, cardiovascular diseases, and non-alcoholic fatty liver disease. This review explains the central hub role of microRNAs in obesity-related chronic low-grade inflammation, achieved through their precise regulation of macrophage polarisation, inflammatory signalling pathways, and adipokine secretion. Importantly, this relationship is bidirectional-while miRNAs regulate inflammatory cascades, the inflammatory environment itself can alter miRNA expression, forming complex feedback loops. Circulating miRNAs, due to their stability (conferred by encapsulation in exosomes or binding to proteins), tissue specificity, and strong correlation with pathological processes, show great potential as promising non-invasive biomarkers for metabolic inflammation, useful for assessing its activity and complication risk. Furthermore, miRNA-based intervention strategies have demonstrated significant metabolic improvements in animal models. However, their clinical translation still faces challenges such as insufficient delivery targeting, off-target effects, and pharmacokinetic defects. This article aims to summarise the regulatory network of miRNAs in metabolic inflammation and discuss in depth their potential and the bottlenecks to be solved for moving from basic research to clinical application, providing new theoretical basis and strategic directions for the diagnosis and targeted therapy of obesity-related metabolic diseases.</p>","PeriodicalId":48934,"journal":{"name":"Diabetes-Metabolism Research and Reviews","volume":"42 4","pages":"e70175"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compensated But Failing: Early β-Cell Dysfunction Under Normoglycemia in Children and Adolescents With Overweight and Obesity.","authors":"Paulina Correa-Burrows, Estela Blanco, Raquel Burrows","doi":"10.1002/dmrr.70172","DOIUrl":"10.1002/dmrr.70172","url":null,"abstract":"<p><strong>Background: </strong>The global rise of obesity has accelerated the onset of type-2 diabetes mellitus (T2DM) also among youth. Early detection of impaired β-cell function in at-risk populations is crucial for prevention; however, reference standards for children and adolescents remain scarce. We aimed to establish population-based percentile distributions specific to developmental stage and weight status for multiple markers of β-cell function in Chilean youth, thereby addressing this critical gap.</p><p><strong>Methods: </strong>Cross-sectional study in 988 children and adolescents aged 6-17 years. Anthropometric measurements included weight, height, and waist circumference; weight status was classified using WHO 2007 standards. Participants were stratified into three developmental groups: Tanner 1-2 (G1), Tanner 3-5 (G2), and adolescents ≥ 16 years (G3). Fasting glucose and insulin were measured; insulin sensitivity and β-cell function were estimated using HOMA. Disposition index (DI) was calculated.</p><p><strong>Results: </strong>G2 participants exhibited higher insulin, HOMA-IR, and HOMA-β levels, alongside lower HOMA-S levels compared to G1 and G3. Across all developmental groups, β-cell function varied by weight status: normal-weight individuals displayed more favourable insulin profiles than those with overweight or obesity. DI declined significantly with excess weight in G3, although values remained below 1.0 across groups. Fasting glucose was consistently within the normal range, independent of weight status.</p><p><strong>Conclusion: </strong>Our findings suggest that differences in β-cell function may be present even in the context of normal fasting glucose, indicating that glycaemia alone may not fully capture early variations in glucose-insulin dynamics. Since pubertal stage and adiposity significantly influenced these results, incorporating development- and weight-specific considerations may improve the interpretation of metabolic markers during growth. These findings support the need for more nuanced approaches to characterise metabolic variability in youth.</p>","PeriodicalId":48934,"journal":{"name":"Diabetes-Metabolism Research and Reviews","volume":"42 4","pages":"e70172"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statistical Misinterpretation of Nonsignificant Results in Diabetes Randomised Clinical Trials.","authors":"Amin Sharifan, Gregg C Fonarow","doi":"10.1002/dmrr.70179","DOIUrl":"10.1002/dmrr.70179","url":null,"abstract":"","PeriodicalId":48934,"journal":{"name":"Diabetes-Metabolism Research and Reviews","volume":"42 4","pages":"e70179"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metformin: Historical Origins, Mechanisms of Action, and Emerging Clinical Applications.","authors":"Ye Hu, Xinmiao Zhang, Changwei Yang, Xiaohong Wu, Xiao Ye, Jicheng Yu, Yunbei Yang","doi":"10.1002/dmrr.70171","DOIUrl":"10.1002/dmrr.70171","url":null,"abstract":"<p><p>Metformin is derived from the plant Galega officinalis with the blood-glucose-lowering properties. Although its early development was hindered by the toxicity issues associated with other guanidine derivatives and the rise of insulin therapies, it ultimately established its position as a first-line oral hypoglycemic agent for addressing insulin resistance and managing hyperglycemia through extensive clinical validation. With a nearly 70-year history in diabetes treatment, the mechanisms by which metformin modulates blood glucose have been widely studied and refined. Recent investigations into combination therapies, fixed-dose formulations, and novel applications underscores a broader therapeutic potential beyond glycemic control. This paper aims to review the development trajectory of metformin, consolidate the latest evidence for its clinical benefits, and critically appraise its future directions and constraints.</p>","PeriodicalId":48934,"journal":{"name":"Diabetes-Metabolism Research and Reviews","volume":"42 4","pages":"e70171"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endogenous Recovery of Fasting C-Peptide Decreases Progression of Sudomotor Small-Fibre Dysfunction in Adults With Diabetes: A Real-World Cohort Study.","authors":"Qingyun Cai, Ting Xie, Hongjian Gong, Wenjie Zhang, Lixin Guo, Qi Pan","doi":"10.1002/dmrr.70173","DOIUrl":"10.1002/dmrr.70173","url":null,"abstract":"<p><strong>Aims: </strong>To determine whether recovery of fasting C-peptide (ΔFCP) reduces deterioration in sudomotor small-fibre function, whether a threshold exists, and whether associations are complication-specific.</p><p><strong>Methods: </strong>Retrospective real-world cohort of 288 hospitalised adults with diabetes with repeated fasting C-peptide and Sudoscan electrochemical skin conductance (ESC). Deterioration in sudomotor small-fibre function was defined as worsening foot ESC. Large-fibre neuropathy (LFN) and diabetic kidney disease (DKD) progression were assessed by nerve conduction and kidney outcomes. Cox models, restricted cubic splines, maximally selected rank statistics, and subgroup/landmark/sensitivity analyses were performed.</p><p><strong>Results: </strong>Over a median 2.2 years, higher ΔFCP was independently associated with lower risk of deterioration in sudomotor small-fibre function, but not with LFN or DKD progression. Highest versus lowest ΔFCP tertile: adjusted HR 0.31 (95% CI 0.14-0.69; p < 0.001). An optimal ΔFCP cutoff of 126.8 pmol/L was identified; ΔFCP ≥ 126.8 pmol/L was associated with a 66% lower risk of sudomotor deterioration (HR 0.34, 95% CI 0.17-0.69; p < 0.001), remaining robust in landmark and sensitivity analyses. Baseline C-peptide mediated little of the association.</p><p><strong>Conclusions: </strong>Endogenous fasting C-peptide recovery is linked to a clinically meaningful, threshold-dependent reduction in the progression of sudomotor small-fibre dysfunction, supporting β-cell preservation/recovery as targets in early diabetic neuropathy.</p>","PeriodicalId":48934,"journal":{"name":"Diabetes-Metabolism Research and Reviews","volume":"42 4","pages":"e70173"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}