Journal of Diabetes Investigation最新文献

{"title":"Heat stress alters metabolic pathways and nitric oxide signaling in keratinocytes under hyperglycemia","authors":"Syeda Tayyiba Rahat,&nbsp;Ilkka Miinalainen,&nbsp;Anni I. Nieminen,&nbsp;Seppo Vainio,&nbsp;Nsrein Ali","doi":"10.1111/jdi.70256","DOIUrl":"10.1111/jdi.70256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetic patients are particularly vulnerable to heat exposure due to impaired thermoregulation and reduced sweating ability. The impact of heat on skin cell function, particularly keratinocytes, is poorly understood. Recent studies highlight the critical role of nitric oxide (NO) in thermoregulation and heat stress responses, but its specific involvement in keratinocyte responses and metabolic profiles remains unexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This proof-of-concept study investigates the metabolic profiles of HaCat keratinocytes under normal and high-glucose conditions during varied heat exposures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted experiments using a metabolomics approach, NO levels assessments, western blot analysis, and evaluations of mitochondrial morphology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our findings indicate that acute heat exposure over 90 minutes significantly alters metabolic pathways, particularly amino acid metabolism (including arginine, valine, leucine, and serine), the pyrimidine metabolite uracil, and glycolysis, notably lactate production. Arginine metabolism was uniquely affected by high glucose combined with heat, aligning with previous clinical observations.</p>\u0000 \u0000 <p>Furthermore, we discovered that changes in NO production correlated with heat exposure duration, and that NO levels in extracellular vesicles (EVs) from HaCat cells were inversely related to intracellular NO levels. Additionally, we observed alterations in HSP-70 protein expression and mitochondrial morphology, supporting cellular adaptation to thermal stress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study is the first to demonstrate heat-induced metabolic changes in keratinocytes involving arginine and NO, highlighting their potential as clinical biomarkers for thermal stress adaptation, with implications for both healthy individuals and diabetic patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"17 4","pages":"608-621"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117242","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":"Mechanisms of hesperetin in alleviating diabetic nephropathy: Network pharmacology, molecular docking, and experimental validation","authors":"Yiwen Guo,&nbsp;Fengjiao Zhang,&nbsp;Yu Jin,&nbsp;Menglu Zhu,&nbsp;Zhiqiang Kang","doi":"10.1111/jdi.70243","DOIUrl":"10.1111/jdi.70243","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetic nephropathy (DN) accounts for approximately 50% of chronic kidney disease cases. This study explored the potential regulatory mechanisms of hesperetin in DN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>High glucose (HG)-treated HK-2 cells and streptozotocin (STZ)-induced diabetic mice were used as DN models. Impacts on cells were assessed by detecting viability, apoptosis, inflammatory cytokine release, and malondialdehyde (MDA), ferrous iron (Fe²⁺), and reactive oxygen species (ROS) levels. Network pharmacology and molecular docking were utilized to verify the target of hesperetin in DN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Hesperetin increased cell viability and decreased apoptosis, the release of inflammatory cytokines, and the levels of MDA, Fe²⁺, and ROS in HG-induced HK-2 cells. Hesperetin demonstrated high-affinity binding to insulin-like growth factor 1 receptor (IGF1R). IGF1R was highly expressed in HG-treated HK-2 cells, and its silencing exerted protective effects in HK-2 cells under the HG context. IGF1R overexpression reversed the protective effects of hesperetin in HG-treated HK-2 cells. Hesperetin ameliorated DN progression partly via suppressing IGF1R expression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hesperetin alleviates DN progression by increasing cell viability and decreasing apoptosis, inflammatory cytokine release, and ferroptosis in HK-2 cells partially via modulating IGF1R expression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"17 4","pages":"576-587"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155381","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":"Continuous glucose monitoring reveals bimodal glycemic patterns during and outside Capivasertib administration","authors":"Yuya Suzuki,&nbsp;Takeshi Yamaguchi,&nbsp;Takayasu Uchida,&nbsp;Kimio Matsumura,&nbsp;Nozomi Harai,&nbsp;Kaoru Nagasawa,&nbsp;Yuko Tanabe,&nbsp;Koichi Suyama,&nbsp;Takashi Kadowaki,&nbsp;Yasumichi Mori","doi":"10.1111/jdi.70261","DOIUrl":"10.1111/jdi.70261","url":null,"abstract":"<p>Capivasertib, an AKT inhibitor, interferes with insulin signaling and can induce hyperglycemia. In this case, we monitored blood glucose fluctuations using continuous glucose monitoring (CGM) during capivasertib administration. During the administration period, a post-dose increase in blood glucose was observed, peaking approximately 4 h after oral administration. Additionally, hypoglycemia was detected the following morning, corresponding to approximately 10 h after dinner. These glycemic fluctuations were observed exclusively on dosing days and were completely absent during rest days. The findings highlight the importance of monitoring not only fasting glucose but also post-dose glucose levels for effective glycemic management during capivasertib therapy.</p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"17 4","pages":"698-701"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177070","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":"Effects of short-term tofogliflozin treatment on the insulin secretory capacity of people with type 2 diabetes: A randomized controlled trial, the TOP-ELM study","authors":"Maiko Miyamoto,&nbsp;Aika Miya,&nbsp;Akinobu Nakamura,&nbsp;Yuka Takahashi,&nbsp;Yuki Yamauchi,&nbsp;Shingo Yanagiya,&nbsp;Takahiro Takase,&nbsp;Mayuko Ono,&nbsp;Kiyohiko Takahashi,&nbsp;Kazufumi Okada,&nbsp;Hiraku Kameda,&nbsp;Kyu Yong Cho,&nbsp;Tatsuya Atsumi,&nbsp;TOP-ELM study group","doi":"10.1111/jdi.70245","DOIUrl":"10.1111/jdi.70245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims/Introduction</h3>\u0000 \u0000 <p>We aimed to explore the short-term effects of tofogliflozin on the insulin secretory capacity of people with type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We performed a multicenter, prospective, randomized, active-controlled, open-label, parallel-group comparison study of people with type 2 diabetes aged 20–89 years, with hemoglobin A1c (HbA1c) 6.5%–9.0%, not previously treated with antihyperglycemic agents. The participants were randomly assigned to a group that received 20 mg tofogliflozin per day or a group that received 500 mg metformin per day for 4 weeks. Fasting blood samples were obtained and oral glucose tolerance testing was performed before and after treatment. The changes from baseline to week 4 in glucose tolerance and insulin secretory capacity were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty participants in the metformin group and 35 in the tofogliflozin group completed the study. After 4 weeks, the HbA1c, glycated albumin, and fasting plasma glucose concentrations had significantly decreased in both groups, with no significant differences between the two groups. The fatty liver index improved significantly more in the tofogliflozin group. The disposition index (DI) did not significantly increase in either group, and there was no difference between the groups. However, in the tofogliflozin group, the DI improved in participants with poorer glucose tolerance at baseline or larger improvements after treatment, but not in the metformin group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Short-term tofogliflozin therapy did not improve the insulin secretory capacity of treatment-naïve people with type 2 diabetes. However, tofogliflozin may facilitate the early recovery of insulin secretory capacity in individuals with poor glucose tolerance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"17 4","pages":"627-635"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146091713","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":"A machine learning approach to predicting severe diabetes distress in adults with type 1 diabetes mellitus","authors":"Naoki Sakane,&nbsp;Yushi Hirota,&nbsp;Akane Yamamoto,&nbsp;Junnosuke Miura,&nbsp;Hiroko Takaike,&nbsp;Sari Hoshina,&nbsp;Masao Toyoda,&nbsp;Nobumichi Saito,&nbsp;Kiminori Hosoda,&nbsp;Masaki Matsubara,&nbsp;Atsuhito Tone,&nbsp;Satoshi Kawashima,&nbsp;Hideaki Sawaki,&nbsp;Tomokazu Matsuda,&nbsp;Masayuki Domichi,&nbsp;Akiko Suganuma,&nbsp;Seiko Sakane,&nbsp;Takashi Murata","doi":"10.1111/jdi.70229","DOIUrl":"10.1111/jdi.70229","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetes distress is common in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to construct and validate prediction models for diabetes distress in adults with T1DM using continuous glucose monitoring (CGM) metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The CGM metrics were collected from 259 adults with T1DM. Severe diabetes distress was defined as 40 points on the Problem Areas in Diabetes scale. Prediction models were developed based on ten machine learning algorithms: random forest (RF), support vector machine (SVM), Naive Bayes (NB), Neural Network (NN), k-nearest neighbor (k-NN), XGBoost (XGB), SGDClassifier (SGDC), XGB_limitet_depth (CGB_ld), L1LogisticRegression (L1), and LightGBM. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, and F1 score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the ten models, accuracy in the NN model was the highest (NN: 0.744, L1: 0.731, NB: 0.718, SVM: 0.692, SGDC: 0.654, RF: 0.628, k-NN: 0.628, LightGBM: 0.615, XGBoost: 0.564, and XGB_ld: 0.564). The NN model achieved the highest AUC of 0.728 (95% confidence interval: 0.608–0.845).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study developed a predictive model for severe diabetes distress using machine learning, incorporating both demographic and CGM metrics in adults with type 1 diabetes mellitus. The NN model demonstrated potential as a practical tool to assist clinicians in identifying individuals at risk of severe diabetes distress.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"17 4","pages":"689-697"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218018","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":"MiR-210-3p is upregulated in diabetic peripheral neuropathy and may be involved in the progression of the disease by targeting brain-derived neurotrophic factor","authors":"Yafei Zhao,&nbsp;Liu Wang,&nbsp;Dongcai Feng","doi":"10.1111/jdi.70199","DOIUrl":"10.1111/jdi.70199","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetic peripheral neuropathy (DPN), a complication of diabetes, is characterized by complex pathophysiology, high global morbidity, and limited early diagnostic tools. MicroRNAs (miRNAs) have emerged as potential regulators in DPN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to investigate miR-210-3p as a diagnostic biomarker for DPN and elucidate its molecular mechanisms in disease progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 72 type 2 diabetes patients, 75 DPN patients, and 70 healthy controls were enrolled. Serum miR-210-3p expression was measured by RT-qPCR, and its diagnostic value was evaluated using ROC curve analysis. Multivariate logistic regression identified risk factors for DPN in type 2 diabetes patients. <i>In vitro</i>, a high-glucose (HG) induced RSC96 Schwann cell model was established to explore miR-210-3p function. Dual-luciferase reporter experiments demonstrated that miR-210-3p directly targets BDNF. Additionally, CCK-8 assays measured proliferation, flow cytometry analyzed apoptosis, and transwell chambers quantified cell migration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Serum levels of miR-210-3p were markedly elevated in DPN patients compared with both type 2 diabetes subjects and healthy controls (<i>P</i> &lt; 0.001). The diagnostic performance was robust, achieving an AUC of 0.830 (sensitivity 72.0%; specificity 80.6%). Multivariate analysis confirmed miR-210-3p, fasting blood glucose, and glycated hemoglobin A1c as independent DPN risk factors. MiR-210-3p negatively regulated BDNF, and the miR-210-3p inhibitor reversed HG-induced Schwann cell dysfunction, while BDNF knockdown abrogated this protective effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MiR-210-3p serves as a potential diagnostic biomarker for DPN and regulates Schwann cell function via targeting BDNF, providing novel insights into DPN pathogenesis and therapeutic targets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"17 4","pages":"672-680"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103277","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":"Tracking three decades of type 1 diabetes-related chronic kidney disease in East Asia: Burden, age–sex patterns, and quality of care index","authors":"Qiongfang Zhang,&nbsp;Huan Wang,&nbsp;Mei Sun,&nbsp;Yi Wu,&nbsp;Pan Xie","doi":"10.1111/jdi.70259","DOIUrl":"10.1111/jdi.70259","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The escalating burden of type 1 diabetes-related chronic kidney disease (CKD-T1DM) presents a critical public health challenge worldwide. This study aims to comprehensively evaluate the longitudinal trends in disease burden and healthcare quality for CKD-T1DM in East Asia compared with global patterns from 1990 to 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Utilizing data from the Global Burden of Disease (GBD) Study 2023, we analyzed the age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life years (ASDR) rates of CKD-T1DM. The Estimated Annual Percentage Change (EAPC) was calculated to quantify temporal trends. Additionally, a multidimensional quality of care index (QCI) was constructed using principal component analysis (PCA) based on four proxy indicators to assess and benchmark healthcare performance across East Asian countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Contrary to the global trend of rising mortality and disability burdens, East Asia exhibited a significant concurrent decline in ASIR, ASMR, and ASDR from 1990 to 2023. However, substantial regional heterogeneity was observed: Japan and South Korea maintained consistently high QCI scores (63.8–75.0), while China, Mongolia, and North Korea lagged significantly behind. The study also confirmed a bimodal age-specific incidence pattern peaking in adolescence (10–14 years) and older adulthood (55–69 years), alongside notable gender disparities in older populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>East Asia has achieved remarkable progress in mitigating the CKD-T1DM burden, diverging significantly from the global trajectory; however, deep structural inequities in care quality persist between high-income and middle-to-low-income nations. Integrating QCI into national monitoring systems and prioritizing comprehensive, lifespan-oriented management strategies are essential to addressing these disparities and sustaining regional improvements.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"17 4","pages":"649-662"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177085","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":"Letter to the Editor in response to the article “Dysregulation of miR-21-5p in diabetic nephropathy and its role in inflammatory response”","authors":"Ciyu Zhao","doi":"10.1111/jdi.70262","DOIUrl":"10.1111/jdi.70262","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;We read with interest the article by Zhang &lt;i&gt;et al&lt;/i&gt;. entitled “Dysregulation of miR-21-5p in diabetic nephropathy and its role in inflammatory response” published in &lt;i&gt;Journal of Diabetes Investigation&lt;/i&gt;&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;. The study presents important clinical and cellular evidence that serum miR-21-5p is upregulated in diabetic nephropathy (DN) and may serve as a diagnostic marker. While the findings are valuable, several aspects could be further explored to strengthen their translational relevance.&lt;/p&gt;&lt;p&gt;First, elucidating the direct molecular targets of miR-21-5p in renal cells is essential for mechanistic understanding. Although the authors show that miR-21-5p knockdown reduces inflammation and proliferation, the specific downstream targets in kidney cells remain unidentified. While PDCD4 and PFKFB2 are mentioned in other contexts, direct validation in renal cells—for example, via luciferase reporter assays and Western blot—would clarify its pathogenic role. Such an approach is well established in miRNA research; for instance, studies have demonstrated that miRNAs such as miR-192-5p can directly target specific genes (e.g., GLP-1R) to regulate fibrosis in DN&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;. Similar direct target validation for miR-21-5p would transform correlation into causation and support therapeutic development.&lt;/p&gt;&lt;p&gt;Second, the robustness of clinical associations could be enhanced by multivariate analysis. The correlations between miR-21-5p and eGFR or inflammatory markers are compelling but derived from univariate tests. Renal function is influenced by factors such as age, hypertension, and diabetes duration. Multivariable regression would help determine whether miR-21-5p is an independent predictor of DN severity, as emphasized in contemporary biomarker guidelines&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;.&lt;/p&gt;&lt;p&gt;Third, diagnostic specificity should be tested against nondiabetic kidney diseases. The study successfully distinguishes DN from T2DM without nephropathy and healthy controls. To establish specificity for diabetic kidney disease, however, comparison with other chronic kidney diseases—such as hypertensive nephropathy or IgA nephropathy—is needed, as emphasized in recent biomarker discovery studies&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;. Notably, miR-21-5p has been reported to be elevated in conditions like IgA nephropathy, underscoring the necessity of such comparative validation&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;. Including such controls would clarify whether miR-21-5p is a general marker of renal injury or specific to the diabetic milieu.&lt;/p&gt;&lt;p&gt;In summary, Zhang &lt;i&gt;et al&lt;/i&gt;. have highlighted miR-21-5p as a promising candidate in DN. Further work to identify its renal targets, perform adjusted clinical analyses, and include disease-specific controls will be key to translating these observations into clinically useful tools.&lt;/p&gt;&lt;p&gt;The author declares no conflict of interest.&lt;/p&gt;&lt;p&gt;Approval of the research protocol: None.&lt;/p&gt;&lt;p&gt;Informed con","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"17 4","pages":"705-706"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146193834","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":"Advances in continuous glucose monitoring and their impact on glycemic control in diabetes","authors":"Yi-Hsuan Lai,&nbsp;Bo-Jen Chen,&nbsp;Wei-Hsiang Chuang,&nbsp;Yi-Der Jiang","doi":"10.1111/jdi.70273","DOIUrl":"10.1111/jdi.70273","url":null,"abstract":"&lt;p&gt;Achieving optimal glycemic control remains a central challenge in diabetes care. Despite pharmacologic advances, substantial proportions of patients fail to reach recommended targets, contributing to the ongoing complications. The need for more precise, dynamic glucose data has accelerated continuous glucose monitoring (CGM) adoption. Recent technological advances have dramatically improved sensor accuracy and clinical utility, making CGM central to modern diabetes management. Current guidelines recommend CGM soon after diagnosis for most insulin-treated individuals and broader consideration regardless of diabetes type or A1c level&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;. CGM-derived metrics—particularly time in range (TIR), glycemic variability (GV), and time below range (TBR)—correlate with clinical outcomes&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt;, with TIR demonstrating strong correlation with HbA1c&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;. This review summarizes recent progress in CGM technology, highlights clinical evidence, and discusses future directions for precision diabetes care.&lt;/p&gt;&lt;p&gt;Compared with self-monitoring of blood glucose (SMBG), CGM offers superior detection of glycemic variability, nocturnal hypoglycemia, and postprandial excursions. CGM technology has evolved dramatically over the past two decades (Table 1), transitioning from early devices requiring frequent fingerstick calibration (2–4 times daily) with mean absolute relative difference (MARD) of 15–20% to contemporary factory-calibrated sensors achieving MARD below 9%. Modern real-time CGM systems now offer 10–14 days wear time, Bluetooth connectivity, and seamless integration with smartphones, while automated insulin delivery (AID) systems have further advanced with closed-network architecture enabling real-time algorithmic insulin adjustments. Recent studies demonstrate AID systems achieved an 11% TIR increase, a 0.95% TBR reduction, and a 12% decrease in time above range versus multiple daily injections or traditional pumps&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;, with meta-analyses confirming mean HbA1c reductions of 0.36%&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;.&lt;/p&gt;&lt;p&gt;Current guidelines recommend AID systems as preferred therapy over multiple daily injections in type 1 diabetes, and consideration for type 2 diabetes patients on basal insulin not achieving glycemic targets. The 2026 ADA Standards delineate the CGM technologies—including real-time CGM (rtCGM), intermittently scanned CGM (isCGM), over-the-counter CGM systems, and clinic-owned professional CGM—emphasizing individualized device selection according to patients' clinical needs, personal preferences, and digital literacy&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;. While both rtCGM and isCGM demonstrate superiority over SMBG, rtCGM may provide greater HbA1c reductions in insulin-treated populations through real-time alerts facilitating timely treatment adjustments and hypoglycemia intervention&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt;.&lt;/p&gt;&lt;p&gt;Barriers include cost, reimbursement variability, digital literacy, an","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"17 4","pages":"557-560"},"PeriodicalIF":3.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281581","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":"Retrospective comparison of the clinical effects of oral semaglutide and SGLT2 inhibitors treatment in patients with type 2 diabetes","authors":"Yasuhiro Omori,&nbsp;Ryota Usui,&nbsp;Yuji Yamazaki,&nbsp;Hitoshi Kuwata,&nbsp;Yoshiyuki Hamamoto,&nbsp;Yuichiro Yamada,&nbsp;Yutaka Seino","doi":"10.1111/jdi.70240","DOIUrl":"10.1111/jdi.70240","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Recent studies have demonstrated that both oral semaglutide and sodium–glucose cotransporter 2 inhibitors (SGLT2is) have beneficial effects on glycemic and weight management as well as providing renal and cardiovascular protection. However, direct comparisons of the effects of these two drugs in clinical practice remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This study is a single-center, retrospective, observational study. Patients with type 2 diabetes who were initiated on oral semaglutide or SGLT2is and continued treatment for 6 months or more were retrospectively analyzed and compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The semaglutide group (84 patients) and the SGLT2is group (231 patients) showed similar, significant reductions in glycated hemoglobin (HbA1c) (semaglutide: −0.88 ± 0.14%; <i>P</i> &lt; 0.01, and SGLT2is: −0.86 ± 0.06%; <i>P</i> &lt; 0.01, at 6 months), body weight (semaglutide: −2.58 ± 0.37 kg; <i>P</i> &lt; 0.01, and SGLT2is: −2.30 ± 0.18 kg; <i>P</i> &lt; 0.01, at 6 months), and fat mass (semaglutide: −2.20 ± 0.50 kg; <i>P</i> &lt; 0.01, and SGLT2is: −1.93 ± 0.44 kg; <i>P</i> &lt; 0.01, at 6 months), being decreased similarly and significantly in both groups. On the other hand, there was a significant reduction in skeletal muscle mass only in the SGLT2is group (semaglutide: −0.10 ± 0.30 kg; <i>P</i> = 0.74, and SGLT2is: −0.40 ± 0.14 kg; <i>P</i> &lt; 0.01 at 6 months).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While both drugs elicited comparable effects on glycemic management and body weight reduction in patients with type 2 diabetes, caution is needed when using SGLT2is in patients at potential risk for sarcopenia, as they may lead to less favorable changes in skeletal muscle mass compared to oral semaglutide.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"17 3","pages":"432-438"},"PeriodicalIF":3.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12950920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002722","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}