Journal of Diabetes Investigation最新文献

{"title":"A 90 g/day low-carbohydrate diet improved glycemic control without decreasing frailty in older patients with type 2 diabetes: A secondary analysis of a randomized controlled trial","authors":"Yu-Ting Wang,&nbsp;Chin-Ying Chen,&nbsp;Wei-Sheng Huang,&nbsp;Hui-Chuen Chen,&nbsp;Long-Teng Lee,&nbsp;Chyi-Feng Jan,&nbsp;Hsien-Liang Huang,&nbsp;Jaw-Shiun Tsai","doi":"10.1111/jdi.70083","DOIUrl":"10.1111/jdi.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study explored the glycemic control and Fried frailty criteria of a 90 g/day low-carbohydrate diet (LCD) in older patients with type 2 diabetes over 18 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-four older patients with type 2 diabetes and HbA1c ≥ 7.5% (58 mmol/mol) at the outpatient clinics were randomly assigned to a 90 g/day LCD or traditional diabetic diet (TDD). The analysis was performed using an intention-to-treat analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 42 (95.5%) patients completed the trial. The 18-month mean change from baseline was statistically significant for 2-h glucose (−100.0 ± 57.7 vs −18.6 ± 86.2 mg/dL) and waist circumference (−6.3 ± 7.9 vs −1.7 ± 4.7 cm) between the LCD and TDD groups (<i>P</i> &lt; 0.05). The 18-month mean change from baseline was not significantly different in HbA1c (−1.55 ± 1.0 vs −0.97 ± 1.2; <i>P</i> = 0.097). After intervention, the proportions of robust, pre-frailty, and frailty in the TDD and LCD groups were 20.0% vs 13.6%, 75.0% vs 86.4%, and 5.0% vs 0.0%, respectively (<i>P</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A 90 g/d LCD reflected improved glycemic control with significantly lower waist circumference without decreasing frailty in older patients with type 2 diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 8","pages":"1398-1408"},"PeriodicalIF":3.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136069","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":"Elevated amputation rates in COVID-19 survivors: Insights from a large-scale Japanese cohort study","authors":"Daisuke Miyamori,&nbsp;Shuhei Yoshida,&nbsp;Masanori Ito","doi":"10.1111/jdi.70078","DOIUrl":"10.1111/jdi.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>COVID-19 has been linked to increased vascular complications, but its long-term impact on amputation rates is unclear. This study evaluated amputation risk post-COVID-19 using a nationwide insurance claims database in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. COVID-19 cases were identified via insurance payment waivers, and amputations were defined by procedure codes. Propensity score matching created balanced cohorts of COVID-19 exposed and unexposed individuals. Matched cohorts were compared for amputation incidence, calculating incidence rate ratios (IRRs), and differences (IRDs). Sensitivity analyses examined outcomes at different time points, and subgroup analyses stratified results by key characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 3,098,948 matched pairs. Over a median follow-up of 7 months, 286 amputations occurred in the COVID-19 group vs 123 in controls (IRR 2.33, 95% CI 1.88–2.90; IRD 5.57 per 1,000,000 person-months, 95% CI 4.22–6.92). The elevated risk persisted beyond 2 years post infection (IRR 2.03, 95% CI 1.31–3.20). Subgroup analyses showed higher risks in individuals with higher comorbidity burden (Charlson Comorbidity Index [CCI] ≥2; IRR 2.45 95% CI 1.92, 2.79) vs lower comorbidity burden (CCI 0–1; IRR 0.71 95%CI 0.29, 1.71) with significant interaction (<i>P</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Amputation rates increased among COVID-19 survivors, persisting for over 2 years post infection. The interaction between COVID-19 and comorbidity burden highlights the need for vigilant long-term monitoring and management of vascular complications in COVID-19 survivors, particularly those with multiple comorbidities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 8","pages":"1551-1560"},"PeriodicalIF":3.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126137","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":"Uhrf1 downregulation promotes β-cell dedifferentiation by decreasing Foxo1 expression in type 2 diabetes","authors":"Lanfang Fu,&nbsp;Juyun Zhang,&nbsp;Zhu Lin,&nbsp;Xubiao Meng","doi":"10.1111/jdi.70082","DOIUrl":"10.1111/jdi.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Islet β-cell dedifferentiation is a major pathological mechanism of type 2 diabetes (T2D). Forkhead box o1 (Foxo1) is a master regulator of β-cell dedifferentiation. The mechanisms by which Foxo1 expression is regulated remain unexplored. Epigenetic modification is involved in the occurrence and development of T2D. Ubiquitin-like with PDH and ring finger domains 1 (Uhrf1), as an important epigenetic regulator, is associated with the maintenance of DNA methylation and histone modification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to discover whether Uhrf1 regulates Foxo1 expression and β-cell dedifferentiation of rat insulinoma (INS-1) cells.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>RT-qPCR and Western blot were performed to detect the levels of Uhrf1, Foxo1, β-cell dedifferentiation, and proliferation and apoptosis related indicators. ChIP-qPCR was used to analyze the relative lysine trimethylation at positions 4, 9, and 27 on histone H3 (H3K4/9/27me3) enrichment on the Foxo1 promoter. Dual-luciferase reporter assay was performed to assess the interaction between Uhrf1 and Foxo1. Finally, a diabetic rat model was established and the rat islet β-cells were isolated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Glucolipotoxicity-induced β-cell dedifferentiation of INS-1 cells, which was restored after Uhrf1 overexpression. Mechanistically, Uhrf1 regulated the H3K4/9/27me3 of the Foxo1 promoter region. Besides, Foxo1 overexpression suppressed β-cell dedifferentiation of INS-1 cells. Moreover, islet β-cells isolated from diabetic model rats showed increased dedifferentiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Uhrf1 knockdown promoted H3K27me3 and H3K9me3 and reduced H3K4me3 level in INS-1 cells, resulting in the downregulation of Foxo1 expression, thus promoting β-cell dedifferentiation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 8","pages":"1371-1381"},"PeriodicalIF":3.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of HbA1c variability and time-in-range fluctuations on large and small nerve fiber dysfunction in well-controlled type 2 diabetes: A prospective cohort observational study","authors":"Yun-Ru Lai,&nbsp;Wen-Chan Chiu,&nbsp;Ben-Chung Cheng,&nbsp;I-Hsun Yu,&nbsp;Ting-Yin Lin,&nbsp;Hui-Ching Chiang,&nbsp;Chun-En Aurea Kuo,&nbsp;Cheng-Hsien Lu","doi":"10.1111/jdi.70079","DOIUrl":"10.1111/jdi.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims/Introduction</h3>\u0000 \u0000 <p>Glycemic variability (GV) is a critical factor in the development of diabetic sensorimotor polyneuropathy (DSPN). This study aimed to evaluate the association of long-term GV, measured by glycated hemoglobin (HbA1c) average real variability (ARV), and short-term GV, assessed by time-in-range (TIR) ARV, with large and small nerve fiber dysfunction in individuals with well-controlled Type 2 Diabetes (T2D).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A prospective study conducted at a tertiary hospital in Taiwan included 82 T2D participants. Long-term GV was assessed using HbA1c ARV from visit-to-visit measurements at three-month intervals over 1 year. Short-term GV was evaluated as TIR ARV from seven-day fingerstick data collected quarterly. Large and small nerve functions were assessed using the Toronto Clinical Neuropathy Score (TCNS), nerve conduction studies, quantitative thermal testing, and Sudoscan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Linear regression analysis adjusted for age, diabetes duration, and renal function revealed strong correlations between HbA1c ARV, TIR ARV, and diabetes duration. At baseline, high HbA1c ARV and TIR ARV groups exhibited higher TCNS and composite nerve conduction amplitude scores but lower cold detection thresholds compared to the low median groups. At one-year follow-up, TCNS significantly increased in the high HbA1c ARV (<i>P</i> = 0.001) and TIR ARV (<i>P</i> = 0.003) groups compared to the low median groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both long-term and short-term GV significantly contribute to small and large nerve fiber dysfunction in T2D, yielding similar neurological outcomes despite stable mean glucose levels. Combining GV minimization strategies with standard glycemic control may be essential in reducing DSPN risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 8","pages":"1507-1517"},"PeriodicalIF":3.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109321","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":"Accelerating innovation and ensuring the thoughtful withdrawal of lifeline medicines for people living with diabetes in Asia","authors":"Yutaka Seino,&nbsp;Daisuke Yabe,&nbsp;Sung Hee Choi,&nbsp;Chih-Cheng Hsu,&nbsp;Chien-Ning Huang,&nbsp;Altaisaikhan Khasag,&nbsp;Kathryn Tan,&nbsp;Kohjiro Ueki,&nbsp;Yuichiro Yamada,&nbsp;Zhanay A Akanov,&nbsp;Takashi Kadowaki","doi":"10.1111/jdi.70063","DOIUrl":"10.1111/jdi.70063","url":null,"abstract":"<p>Coordinated regional action is urgently needed to safeguard insulin access in Asia amid global product realignment. This editorial emphasizes the ethical imperative and policy frameworks required to balance innovation with equitable, uninterrupted diabetes care.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 7","pages":"1147-1150"},"PeriodicalIF":3.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109320","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":"Gastric filling ultrasound in assessing gastrointestinal motility in type 2 diabetic patients with neuropathy: A clinical study","authors":"Juan Yan,&nbsp;Xiaoying Sun,&nbsp;Xiaoyan Liu,&nbsp;Xiaoming Li","doi":"10.1111/jdi.70059","DOIUrl":"10.1111/jdi.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study evaluates gastrointestinal motility dysfunction in type 2 diabetes patients with and without neuropathy compared to healthy individuals using gastric filling ultrasound.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We enrolled 210 participants: 50 healthy controls, 106 diabetic controls (without neuropathy), and 54 observation patients (with neuropathy). Gastric emptying times and fullness scores were measured at 30 and 60 min post-meal. Small intestinal transit rates were assessed at baseline and 60 min. Gastric capacity and wall thickness were evaluated by ultrasound, while motilin and glucagon levels were measured by ELISA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The observation group showed significantly prolonged gastric emptying vs both control groups (30 min: 75.38 ± 13.49 vs 52.46 ± 11.37 vs 45.96 ± 12.85 min; 60 min: 122.53 ± 16.38 vs 84.27 ± 11.44 vs 75.12 ± 10.20 min; all <i>P</i> &lt; 0.001). Gastric fullness scores exhibited similar progressive increases (30 min: 7.45 ± 0.66 vs 5.37 ± 0.75 vs 4.53 ± 0.69; 60 min: 6.84 ± 0.51 vs 4.56 ± 0.68 vs 3.72 ± 0.51; <i>P</i> &lt; 0.001). Small intestinal transit was slowest in the observation group (baseline: 3.62 ± 0.21 vs 4.53 ± 0.36 vs 5.36 ± 0.25 cm/min; 60 min: 3.05 ± 0.15 vs 4.15 ± 0.50 vs 5.25 ± 0.31 cm/min; <i>P</i> &lt; 0.05). The observation group had significantly reduced gastric capacity (714.68 ± 35.49 vs 875.25 ± 53.66 vs 923.63 ± 39.72 mL) and increased wall thickness (4.16 ± 0.55 vs 3.33 ± 0.42 vs 2.98 ± 0.26 cm) vs other groups (<i>P</i> &lt; 0.001). Hormonal changes included lower motilin (28.44 ± 5.16 vs 45.67 ± 7.33 vs 53.71 ± 8.65 pg/mL) and higher glucagon (382.56 ± 23.62 vs 295.14 ± 11.55 vs 256.86 ± 27.90 pg/mL) in the observation group (<i>P</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Gastric filling ultrasound demonstrates progressive gastrointestinal impairment from healthy individuals to diabetic patients, with the most severe dysfunction in neuropathic cases. These objective measures support regular gastrointestinal assessment in diabetes management, particularly for patients developing neuropathy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 8","pages":"1518-1525"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092428","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":"Canagliflozin protects cardiovascular function in type 2 diabetic coronary artery disease by regulating natriuretic peptide B","authors":"Jiarui Zhang,&nbsp;Lichenlu Huang,&nbsp;Yongqin Zheng,&nbsp;Ji Yang,&nbsp;Xiaopei Wu,&nbsp;Jundong He","doi":"10.1111/jdi.70056","DOIUrl":"10.1111/jdi.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Canagliflozin (Cana) has protected against diabetes-related cardiovascular disease. This study was intended to explore the effect and molecular mechanism of Cana on cardiovascular protection in type 2 diabetic coronary atherosclerotic heart disease (CAD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We constructed a rat model of type 2 diabetic CAD and examined its physiological and biochemical indices before and after Cana treatment. Next-generation transcriptome sequencing was performed on rat cardiac tissue. Various functional and molecular experiments involving Cana treatment and the natriuretic peptide B (<i>NPPB</i>) gene were performed on human cardiomyocytes (AC16 cells).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The physiological, biochemical, and imaging parameters of the model rats were abnormal. Cana treatment reversed these injuries. In all, 369 differentially expressed genes were discovered by next-generation transcriptome sequencing; <i>NPPB</i> was identified as the target gene. Cana treatment significantly improved the function of AC16 cells treated with high glucose and significantly upregulated the expression level of the <i>NPPB</i> gene. The <i>NPPB</i> gene significantly increased the viability of AC16 cells and significantly decreased the apoptosis rate and reactive oxygen species (ROS) level. In addition, <i>NPPB</i> significantly upregulated the expression of B-cell lymphoma 2 (Bcl-2) and downregulated the expression of Bcl-2 associated X protein (Bax). Cana treatment further improved these cellular functions and protein expression levels. Furthermore, the <i>NPPB</i> gene significantly upregulated protein kinase 1-α (PKG1α) expression level and Cana treatment enhanced the regulatory effect of <i>NPPB</i> on PKG1α.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The cardiovascular protective effect of Cana in diabetes mellitus was mediated by upregulating the expression of <i>NPPB</i> and upregulating the level of PKG1α, which in turn regulated the viability, apoptosis rate, and ROS level of AC16 cells.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 8","pages":"1430-1444"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101280","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":"Commentary on “Prevalence, incidence, and risk factors of diabetic retinopathy and macular edema in patients with early and late-onset type 2 diabetes mellitus”","authors":"Fatemeh Rasulpur,&nbsp;Mohammad Ranaee,&nbsp;Mohammad Barary,&nbsp;Sahar Sadr Moharerpour,&nbsp;Soheil Ebrahimpour","doi":"10.1111/jdi.70076","DOIUrl":"10.1111/jdi.70076","url":null,"abstract":"<p>Dear Editor,</p><p>Epidemiological comparisons of diabetic retinopathy (DR) and diabetic macular edema (DME) between early-onset (EOD) and late-onset (LOD) type 2 diabetes mellitus constitute a growing research priority because global trends toward earlier type 2 diabetes mellitus diagnosis increase lifetime risk of micro-vascular sequelae. Tsui <i>et al</i>.<span>¹</span> recently reported higher DR prevalence and incidence in urban southern Chinese adults with EOD relative to LOD and identified glycemic control and diabetes duration as dominant risk factors. Although the study provides valuable population-based data, several methodological issues limit the strength and generalizability of the conclusions.</p><p>First, the analytic model omitted widely available laboratory indicators of systemic inflammation and oxidative stress that are mechanistically linked to DR progression. Composite indices derived from full blood counts (neutrophil-to-lymphocyte, platelet-to-lymphocyte, monocyte-to-lymphocyte ratios; systemic immune-inflammation, inflammatory response, and aggregate systemic inflammation indices) as well as cytokines (interleukin-1β, -6, -8; tumor necrosis factor-α), micronutrients (vitamins C, E, D, B12; zinc), mean platelet volume, and erythrocyte sedimentation rate have each shown predictive value across DR stages<span>²</span>. Their inclusion would have enabled adjustment for subclinical inflammatory burden and reinforced causal inference.</p><p>Second, key diabetes-related comorbidities, such as neuropathy, peripheral arterial disease, psychological disorders, and diabetic foot disease, were not systematically documented. These conditions share pathogenic pathways with DR and can alter retinal micro-circulation, potentially confounding associations between age at diagnosis and ocular outcomes.</p><p>Third, medication exposure was insufficiently characterized. Interferons, corticosteroids, and other immuno-modulators influence retinal vascular permeability and may precipitate or ameliorate DR<span>^{3, 4}</span>. Detailed pharmacotherapy histories, including cumulative dose and treatment duration, are therefore essential covariates.</p><p>Fourth, sociodemographic variables such as ethnicity, educational attainment, and socioeconomic status were reported only in aggregate, precluding stratified analyses. Social determinants shape health-care access, metabolic control, and diet quality; their exclusion hampers external validity, particularly beyond Han Chinese urban populations.</p><p>Finally, operational definitions for insulin resistance, nutritional status, and body composition were not provided, despite their recognized roles in DR pathogenesis. Incorporating standardized metrics such as the homeostasis model assessment of insulin resistance, body-mass index, or dual-energy X-ray absorptiometry would strengthen etiologic insights.</p><p>In summary, Tsui <i>et al</i>. furnish important evidence that ","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 8","pages":"1566-1567"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144074964","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":"Conundrum and chances of diabetes management in the Western Pacific Region: A narrative review","authors":"Yerin Hwang,&nbsp;Hyunmin Lee,&nbsp;Moon-Kyu Lee","doi":"10.1111/jdi.70053","DOIUrl":"10.1111/jdi.70053","url":null,"abstract":"<p>The prevalence of diabetes is increasing globally, and glucose management is essential for the treatment of diabetes. Most guidelines recommend early intensive therapy and individualized approaches. Although many countries have implemented various guidelines and educational programs to enhance glucose management, the target achievement rate still remains very low. Studies from several countries and regions have identified various factors that influence blood glucose management, either positively or negatively. These factors have been comprehensively incorporated into guidelines to assist people with diabetes and healthcare professionals in following them and/or developing additional guidelines through further research. We and others have suggested that diverse factors should be considered—including comorbidities, age, complications, life expectancy, and pathophysiologic characteristics, such as ethnic differences in insulin sensitivity and secretion. The Western Pacific (WP) region, comprising countries with significant cultural and racial diversity, necessitates customized programs and community-based management strategies. In this review, we present specific challenges and opportunities for diabetes management identified through a systematic review of the literature from the WP region, along with those common to other regions. To improve healthcare policy and management in the WP region, it is essential to address regional characteristics and the factors that act as either barriers or facilitators to develop strategies for early intensive and individualized therapeutic approaches. Moreover, additional studies on diabetes pathophysiology and management—including pharmacotherapy—are urgently needed.</p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 8","pages":"1357-1366"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144074992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of lifestyle on diabetic nephropathy in aged 18–64 years: A population-based cross-sectional analysis from NHANES 2007–2018","authors":"Zhijun Zhang,&nbsp;Zhaoyinling Wei,&nbsp;Ling Gao","doi":"10.1111/jdi.70069","DOIUrl":"10.1111/jdi.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The relationship between lifestyle and overall health has garnered significant attention. This study aimed to evaluate the association between lifestyle factors and diabetic nephropathy (DN) in adults aged 18–64 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study involving 2,389 participants from the 2007–2018 National Health and Nutrition Examination Survey (NHANES). The use of the Healthy Eating Index (HEI), Metabolic Equivalent of Task (MET), sleeping duration, smoking, and drinking status as indicators to assess lifestyle. Logistic regression analyses and restricted cubic splines were used to analyze the results. A subgroup analysis was performed to identify any variations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Logistic regression analysis indicates that poor HEI and sleep duration but not physical activity are associated with an increased risk of DN. Subgroup analyses revealed significant interactions between HEI and age, blood pressure, HbA1c, and lipid control; MET interacted with blood pressure and HbA1c control; Sleeping duration interacted with age, smoking, blood pressure, HbA1c, and lipid control; Smoking interacted with age, blood pressure control, and lipid control; Drinking interacted with blood pressure control. Moreover, restricted cubic splines indicated that with increasing HEI, the prevalence of DN tended to decrease. However, the associations between the other two lifestyle factors (MET level and sleeping duration) and DN were all U-shaped.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lifestyle factors are closely associated with diabetic nephropathy. Both unhealthy eating habits and inadequate or excessive sleeping duration and physical activity contribute to an increased risk of diabetic nephropathy, whereas no statistically significant association is observed in smoking and drinking.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 8","pages":"1452-1462"},"PeriodicalIF":3.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956595","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}