Cardiovascular diabetology. Endocrinology reports最新文献

{"title":"The combined predictive value of the triglyceride-glucose index and A Body Shape Index on all-cause mortality: a 26-year prospective cohort analysis from the Rancho Bernardo Study.","authors":"Ziad Gerges, Agalya Ramkumar, Md Imran Hossain, Sui Seng Tee","doi":"10.1186/s40842-026-00284-6","DOIUrl":"10.1186/s40842-026-00284-6","url":null,"abstract":"<p><p>BACKGROUND: Insulin resistance, represented by the triglyceride-glucose (TyG) index, shows interplay with visceral obesity and together promotes cardiovascular diseases and mortality. Recent NHANES data demonstrated that combining TyG with A Body Shape Index (ABSI) outperforms traditional TyG-derived indices in predicting cardiovascular mortality. However, validation in independent cohorts with extended follow-up is needed. METHODS: We analyzed 1,753 participants from Visit 7 of the Rancho Bernardo Study (1988–1992). TyG was calculated as ln[(triglycerides × glucose)/2], ABSI as WC/(BMI2/3 × height1/2), and TyG-ABSI as their product. Cox proportional hazards models assessed associations with all-cause mortality. Harrell’s C-index compared predictive performance, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). RESULTS: During median follow-up of 26.3 years (maximum 31 years), 1,166 deaths occurred (66.5% mortality rate) with zero participants lost to follow-up. The highest TyG-ABSI quartile had significantly increased mortality versus the lowest (fully-adjusted HR = 1.68, 95% CI 1.40–2.02, p < 0.001). TyG-ABSI demonstrated superior C-index (0.710) versus TyG alone (0.623, p < 0.001), with significant IDI (0.032, p < 0.001) and NRI (0.156, p < 0.001). Restricted cubic spline analysis revealed a linear dose-response relationship (p for non-linearity = 0.184). Association was particularly strong in younger adults (< 60 years: HR = 2.74, 95% CI 1.71–4.38, p < 0.001; p-interaction < 0.001). CONCLUSIONS: TyG-ABSI demonstrated superior predictive value for all-cause mortality compared to TyG alone and other modified TyG indices. The particularly strong association in younger adults suggests TyG-ABSI may be especially valuable for early risk stratification. </p>","PeriodicalId":521069,"journal":{"name":"Cardiovascular diabetology. Endocrinology reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular disease risk factors in young people with diabetes mellitus.","authors":"Mumtaz Murat Yardimci","doi":"10.1186/s40842-026-00277-5","DOIUrl":"10.1186/s40842-026-00277-5","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of diabetes in young adults raises concerns regarding its early cardiometabolic consequences. This study aimed to evaluate cardiac function, renal markers, lipid profile, insulin resistance, and vascular risk indicators in young adults with diabetes compared with non-diabetic controls.</p><p><strong>Methods: </strong>This retrospective study included patients aged 18-45 years whose medical records were reviewed between 01/01/2012 and 31/12/2023. Clinical, metabolic, and cardiovascular parameters were analyzed to identify early cardiometabolic alterations associated with diabetes.</p><p><strong>Results: </strong>Young adults with diabetes demonstrated early signs of adverse cardiometabolic remodeling, characterized by mild reductions in ejection fraction, elevated myocardial stress biomarkers, atherogenic dyslipidemia, increased insulin resistance, and subtle renal alterations. Stent use was also more common among diabetic patients, reflecting greater cardiovascular burden. These differences remained consistent across multiple metabolic domains.</p><p><strong>Conclusion: </strong>Diabetes in young adults is associated with an early and unfavorable cardiometabolic phenotype, highlighting the need for proactive cardiovascular risk assessment and targeted preventive strategies. Future longitudinal studies incorporating metabolic, inflammatory, and imaging markers are warranted to clarify progression patterns and guide precision-based interventions.</p>","PeriodicalId":521069,"journal":{"name":"Cardiovascular diabetology. Endocrinology reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of empagliflozin on cardiac function and cardiorespiratory fitness in people with type 2 diabetes: a randomised controlled trial.","authors":"Natalie Nanayakkara, Michael L H Huang, Andre La Gerche, David M Kaye, Mark E Cooper, Murray D Esler, Anne T Reutens, Jonathan E Shaw, Alicia Jenkins, Neale D Cohen","doi":"10.1186/s40842-026-00281-9","DOIUrl":"10.1186/s40842-026-00281-9","url":null,"abstract":"<p><p>BACKGROUND: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in adults with type 2 diabetes mellitus (T2DM). Cardiac dysfunction and decreased exercise capacity are common in people with T2DM, even in those without overt heart failure. Empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, reduces major cardiovascular events and mortality in people with T2DM and established CVD, though the underlying mechanisms are not fully elucidated. This study aimed to assess changes in cardiac function and cardiorespiratory fitness (CRF) at rest and during exercise with empagliflozin treatment in people with T2DM. METHODS: This double-masked, single-centre, randomised, placebo-controlled analysis combined two studies involving adults (≥ 18 years) with T2DM comparing empagliflozin 25 mg daily vs. placebo, each over three months. VO₂ peak was measured using a ramp protocol peak exercise test on a bicycle ergometer, and echocardiography assessed changes in cardiac structure and function. RESULTS: Of 65 recruited participants, 57 completed the study (70.2% male, age 64.9 ± 7.8 year, baseline HbA1c 7.8% (7.5–8.4). Thirty-one participants (67.7% male, age 65.6 ± 6.6 year) were randomised to the placebo group, and 26 participants (73.1% male, age 64.2 ± 9.0 year) were randomised to empagliflozin. No significant between-group difference in the primary outcome of change in VO2 peak was observed. Empagliflozin reduced left ventricular end-diastolic volume (LVEDV) at rest by 9.508 ± 14.54 mL compared with placebo, which increased by 2.13 ± 20.73 mL (p = 0.0232). CONCLUSIONS: In adults with T2D, 12 weeks of empagliflozin significantly reduced LVEDV without changing VO2 peak. Empagliflozin may enhance cardiovascular efficiency without directly improving functional capacity. TRIAL REGISTRATION: ACTRN12617000490370p & ACTRN12619000887178. </p>","PeriodicalId":521069,"journal":{"name":"Cardiovascular diabetology. Endocrinology reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13041438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of cardiovascular disease and diabetes in 2026: expanding prevalence, escalating costs, and the limits of contemporary prevention.","authors":"Gaetano Santulli","doi":"10.1186/s40842-026-00283-7","DOIUrl":"10.1186/s40842-026-00283-7","url":null,"abstract":"<p><p>The recently published 2026 American Heart Association Heart Disease and Stroke Statistics Update extends beyond routine surveillance to provide a systems-level diagnosis of contemporary cardiovascular medicine. When examined collectively, epidemiologic and economic data reveal that cardiovascular disease has evolved from an acute, episodic illness into a chronic, multisystem condition with profound population and fiscal consequences. Nearly half of US adults now meet criteria for cardiovascular disease when hypertension is included, underscoring that cardiovascular pathology has become a defining feature of aging rather than a condition affecting discrete subgroups. Despite declining age-adjusted mortality, prevalence continues to rise, driven by earlier onset of risk factors, improved survival, and prolonged disease duration. This epidemiologic success paradoxically fuels escalating healthcare expenditures, which now exceed $400 billion annually. Disease-specific analyses reinforce this structural challenge. Coronary heart disease has reached epidemiologic stability but remains fiscally unsustainable due to lifelong secondary prevention. Heart failure is the fastest-growing phenotype, reflecting cumulative cardiometabolic injury and exposing the limitations of reactive, hospitalization-centered care models. Stroke incidence has declined, yet prevalence and long-term costs are projected to surge as survival improves. Atrial fibrillation has emerged as a lifetime-risk condition with substantial downstream consequences that are incompletely captured by current cost estimates. Upstream drivers (diabetes, hypertension, and metabolic dysfunction) continue to worsen despite effective therapies, highlighting failures of implementation rather than pharmacology. The introduction of cardiovascular–kidney–metabolic syndrome provides an integrative framework that more accurately reflects contemporary risk and reveals important sex-specific vulnerabilities. Overall, these data demonstrate that knowledge is no longer the limiting factor; durable population health gains will require systemic prevention, integrated care, and policy alignment to translate scientific progress into sustainable outcomes.</p>","PeriodicalId":521069,"journal":{"name":"Cardiovascular diabetology. Endocrinology reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13041046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A one-week reduced-carbohydrate diet lowers insulin requirements and shifts the IGF axis with no detectable short-term change in endothelial function in a randomized, crossover trial of adults with type 1 diabetes.","authors":"M Naweed Akbar, T Jordan Smith, Sivaprakasam Chinnarasu, Wendi Welch, Wang Zuofei, Bridget Litts, Lauren M LeStourgeon, Mohammad Saleem, Mohd Mabood Khan, Annet Kirabo, Justin M Gregory","doi":"10.1186/s40842-026-00276-6","DOIUrl":"10.1186/s40842-026-00276-6","url":null,"abstract":"<p><strong>Background: </strong>Individuals with type 1 diabetes mellitus (T1DM) must deliver insulin into the peripheral circulation rather than more physiologically into the hepatic portal circulation, leading to a chronic state of underinsulinization in the liver. Previous research suggests that decreased hepatic insulin perturbs the growth hormone-IGF-1 system in these patients. We tested whether short-term carbohydrate restriction, by lowering exogenous insulin requirements and exacerbating hepatic underinsulinization, modifies IGF axis hormones, binding proteins, and vascular function.</p><p><strong>Methods: </strong>We performed a secondary analysis of plasma samples collected during a single-blind crossover study of twelve adults with T1DM using automated insulin delivery. In random order, the participants consumed a one-week reduced carbohydrate diet (RCD) and an isocaloric standard carbohydrate diet (SCD), each followed by a study visit. We measured total and free IGF-1 and IGF-binding proteins (IGFBP-1, IGFBP-2, and IGFBP-3) after overnight fasting and during the final 30 min of a hyperinsulinemic-euglycemic clamp. We also measured endothelial function using brachial artery flow-mediated dilation (FMD).</p><p><strong>Results: </strong>The RCD lowered the total daily insulin dose versus SCD (16% during the week and 24% in the 24 h before testing), with similar glucose levels across diets. Compared with SCD, RCD reduced total IGF-1 and IGFBP-3 and increased IGFBP-1 and IGFBP-2 at baseline. These patterns also persisted during insulin-stimulated conditions. Free IGF-1 was more variable and did not differ significantly between diets. Despite clear shifts in the IGF axis, FMD did not differ between diets and did not correlate with IGF axis markers after either intervention.</p><p><strong>Conclusions: </strong>In adults with T1DM studied under nearly matched glycemia, one week of carbohydrate reduction lowered insulin requirements and shifted the IGF axis in a pattern akin to reduced portal insulin exposure, without detectable changes in conduit artery endothelial function. These findings identify the IGF axis as a sensitive physiologic readout of insulin exposure. Longer-term studies are needed to determine whether sustained changes in the IGF axis impact vascular biology or cardiometabolic risk.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04118374.</p>","PeriodicalId":521069,"journal":{"name":"Cardiovascular diabetology. Endocrinology reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13020340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fuel toxicity-associated spectrum (FTAS): a unifying nomenclature for metabolic disorders.","authors":"Pichakacheri Sureshkumar","doi":"10.1186/s40842-026-00282-8","DOIUrl":"10.1186/s40842-026-00282-8","url":null,"abstract":"<p><p>BACKGROUND: The global obesity surge has precipitated a parallel rise in diabetes, cardiovascular, kidney, and reproductive-metabolic diseases like polycystic ovarian syndrome (PCOS), creating an unsustainable healthcare burden fragmented by organ-specific nomenclature. Legacy terms like type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) focus on end-stage manifestations, obscuring shared pathogenic roots. This review aimed to propose and define the Fuel Toxicity-Associated Spectrum (FTAS) as a unifying nomenclature and staging framework for adiposity-related metabolic disorders. This represents a novel conceptual synthesis building upon established pathophysiological principles. METHOD: We conducted a narrative review, synthesizing literature on the pathophysiology and nomenclature of adiposopathy associated metabolic conditions to build a logical argument for this new mechanistic classification. REVIEW FINDINGS: We propose that the FTAS framework reconceptualizes disorders from metabolic syndrome to overt organ damage as manifestations of a single pathophysiological process: chronic nutrient excess driving adipose tissue dysfunction and systemic fuel toxicity (lipotoxicity, glucotoxicity, organelle dysfunction). We provide a unifying nosology, mapping legacy diagnoses to FTAS equivalents (e.g. type 2 diabetes to FTAS-Hyperglycemia) and integrates related constructs into a hierarchical model. A novel four-stage system (Stages 0–3) was formulated, representing a hypothesis that transcending organ silos facilitates a complication-centric approach to care. The review also outlines a proposed prospective validation roadmap and a phased implementation strategy for the framework. CONCLUSION: The FTAS provides a proposed holistic, pathophysiologically grounded, and destigmatizing lexicon that unifies metabolic conditions. It aligns with modern, metabolism-targeting pharmacotherapies and is hypothesized to transform clinical practice and research by promoting early, integrated intervention, though this requires prospective validation. </p>","PeriodicalId":521069,"journal":{"name":"Cardiovascular diabetology. Endocrinology reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147477910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists among ischemic stroke patients.","authors":"Qinglan Ding, Jason J Sico, Anthony J Perkins, Laura J Myers, Joanne K Daggy, Ali Sexson, Stanley E Taylor, Laura Burrone, Kimberly Waddell, Dawn M Bravata","doi":"10.1186/s40842-026-00280-w","DOIUrl":"10.1186/s40842-026-00280-w","url":null,"abstract":"<p><p>BACKGROUND: Stroke is a leading cause of death and disability. Trials suggest that sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and glucagon-like peptide-receptor-1 receptor agonists (GLP-1 RAs) reduce cardiovascular risk in selected populations. OBJECTIVES: To describe facility-level use of SGLT-2i/GLP-1 RAs among patients hospitalized with ischemic stroke in the US Department of Veterans Affairs (VA) hospitals and to examine facility determinants of prescribing. METHODS: We performed a retrospective trend analysis across 88 VA facilities (fiscal years 2020–2023). Prescribing was ascertained from VA pharmacy data; the outcome was the proportion of ischemic-stroke admissions receiving an SGLT-2i or GLP-1 RA. Facility-level binomial logistic models evaluated associations with VA hospital complexity (1, high; 2, low complexity), rural-serving, and volume. RESULTS: Among 17,093 admissions, facility-level prescribing ranged from 13.2% to 38.3%. Overall use increased from 21.8% (2020) to 30.1% (2023; P < 0.001), driven largely by patients with diabetes (38.9% to 51.5%); rates also increased in overweight patients (27.1% to 34.3%) but remained low in those without diabetes or overweight (3.4% to 7.0%, P = 0.010). Across years, 45.7% of patients with diabetes received therapy versus 7.8% without diabetes. In adjusted analyses, prescribing rates were lower at complexity 1b (OR 0.8, 95% CI 0.66–0.96) and 1c (OR 0.69, 95%CI 0.58–0.83) versus 2; rural-serving and volume were not associated with prescribing. CONCLUSIONS: Use of SGLT-2i/GLP-1 RAs among patients with ischemic stroke increased modestly but remained low in those without diabetes. Substantial between-facility variation—particularly low prescribing rates at complexity class 1b/1c sites—highlights the need for future studies to evaluate barriers in prescribing. TRIAL REGISTRATION: ClinicalTrials.gov NCT04322162. Registration Date of 04/02/2020. </p>","PeriodicalId":521069,"journal":{"name":"Cardiovascular diabetology. Endocrinology reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147392239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A bibliometric analysis of systematic reviews and meta-analyses on diabetes mellitus: global research trends from scopus database (1988-2024).","authors":"Alaleh Dalvand, Hossein Aazami, Hassan Akbarniakhaky, Sajad Parvar, Reza Habibi, Ghazal Mohammadi, Ali Faryabi, Hojat Dehghanbanadaki","doi":"10.1186/s40842-026-00272-w","DOIUrl":"10.1186/s40842-026-00272-w","url":null,"abstract":"<p><p>BACKGROUND: Diabetes mellitus, a global epidemic, necessitates robust evidence synthesis to guide clinical practice. This study analyzes systematic reviews and meta-analyses in diabetes research to identify trends, gaps, and key insights for advancing diabetes management. METHODS: We analyzed 10,714 systematic reviews and meta-analyses on diabetes mellitus, published between 1988 and 2024, sourced from Scopus. Publication trends, collaboration networks, and research clusters were examined using VOSviewer and Scimago Graphica. RESULTS: Research output surged post-2011, with China leading overall (3,241 publications, 30.25%), followed by the United States (1,915, 17.87%) and the United Kingdom (1,560, 14.56%). Twelve clinical clusters emerged, including therapeutics (e.g., metformin, dual-agonist therapies), cardiovascular outcomes, lifestyle factors, mental health, maternal health, and bone health. High-impact studies underscored vascular complications, mental health links, and gestational diabetes risks, shaping practice. Recent trends emphasize dual-agonist therapies like Tirzepatide, digital health, and weight management, while gastric bypass surgery, bone mineral density, and maternal health reflect enduring influence. Research shifted from early methodological approaches to later comorbidity-driven studies, yet low- and middle-income country (LMIC) contributions remain limited. CONCLUSION: This study illuminates a dynamic evidence base for diabetes mellitus, spanning decades of impactful clinical research and emerging innovations. However, disparities in LMIC representation and insufficient long-term evaluations of novel therapies limit its global applicability. Future research must prioritize LMIC populations and sustained efficacy studies to strengthen diabetes management strategies worldwide. </p>","PeriodicalId":521069,"journal":{"name":"Cardiovascular diabetology. Endocrinology reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12964769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metformin and beyond: glucose-lowering therapy as a potential modulator of abdominal aortic aneurysm growth and stability- systematic review with narrative synthesis.","authors":"Margaret Plamenova Dimova, Bistra Petrova Boneva, Boris Nikolaev Ilchev, Yanislava Ivo Karusheva","doi":"10.1186/s40842-026-00275-7","DOIUrl":"10.1186/s40842-026-00275-7","url":null,"abstract":"<p><p>BACKGROUND: Abdominal aortic aneurysm (AAA) is a life-threatening vascular disease with rupture mortality exceeding 80%. Although diabetes mellitus (DM) is a major risk factor for atherosclerotic cardiovascular disease, a growing body of epidemiological and experimental evidence suggests an inverse association between DM and AAA development, progression, and rupture. Increasing attention has focused on glucose-lowering therapies—particularly metformin—as potential modulators of aortic wall remodeling. METHODS: We conducted a systematic literature search followed by a narrative synthesis of evidence from observational studies, randomised controlled trials (RCTs), and experimental research evaluating the association between diabetes mellitus, antidiabetic therapies, and abdominal aortic aneurysm. PubMed, Scopus, and the Cochrane Library were searched through February 2025 to identify relevant primary human studies assessing the impact of DM and glucose-lowering therapies on AAA incidence, growth, rupture, and related outcomes. Experimental animal models and mechanistic studies were reviewed separately to explore biological plausibility and underlying pathways. RESULTS: Across more than 30 population-based cohorts and registry studies, DM was consistently associated with a lower likelihood of AAA development, slower aneurysm growth, and reduced rupture risk. Longitudinal studies reported attenuated aneurysm expansion among diabetic individuals, with reductions in growth rates ranging approximately from 0.3 to 0.8 mm/year. Experimental and mechanistic studies were broadly consistent with these associations and are summarized separately. Among glucose-lowering therapies, metformin emerged as the most extensively studied agent, with observational data suggesting slower AAA progression independent of glycaemic control. Early RCTs confirm feasibility and safety but remain underpowered for definitive clinical outcomes. Evidence for newer drug classes, including SGLT2 inhibitors and GLP-1 receptor agonists, is currently limited to preclinical models. CONCLUSIONS: Current evidence supports a biologically plausible and epidemiologically consistent inverse association between diabetes mellitus and AAA development and progression. Metformin appears to exert stabilising effects on aneurysm biology through pleiotropic vascular mechanisms beyond glucose lowering. Definitive confirmation from adequately powered, event-driven randomised trials is still required. Glucose-lowering therapy—particularly metformin—may represent a promising future pharmacologic adjunct for delaying AAA progression and improving long-term outcomes. </p>","PeriodicalId":521069,"journal":{"name":"Cardiovascular diabetology. Endocrinology reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12950239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the heterogeneity of T2DM: a narrative review of clustering algorithms in stratifying comorbidity and complication risk.","authors":"Namra Aziz, Neha Kamran, Aysha Almas, Gerald S Bloomfield, Asma Ahmed, Zainab Samad, Tariq Mahmood","doi":"10.1186/s40842-026-00273-9","DOIUrl":"10.1186/s40842-026-00273-9","url":null,"abstract":"<p><p>Diabetes is a growing global health concern, affecting 537 million adults worldwide, significantly contributing to mortality and disability. Cluster analysis, a branch of Unsupervised machine learning (ML), has been increasingly used to identify distinct subgroups of patients with diabetes, enabling better disease stratification and personalized treatment strategies. Despite the growing burden of diabetes, clinical management often relies on generalized treatment approaches that may not account for patient heterogeneity. There is a need to better understand the underlying subtypes of diabetes to enable more personalized care. This narrative review evaluates the application of clustering in stratifying diabetes patients across diverse populations based on clinical, biomarker, and molecular characteristics and more. A literature search was conducted using PubMed, and Google Scholar following the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines. A total of 22 articles were finalized to be included in the analysis where different clustering approaches on diabetes patients have been used. This review further classifies the studies into diabetes subgroups focusing specifically on type 2 diabetes patients where Severe Autoimmune Diabetes (SAID), Severe Insulin Deficient Diabetes (SIDD), Mild Obesity-Related Diabetes (MOD), and Mild Age-Related Diabetes (MARD) clusters were most commonly found, and biomarker-based classification such as inflammatory and molecular including only type 2 diabetes patients, where additional two clusters: Severe Insulin Resistant Diabetes with Relative Insulin Insufficiency (SIRD-RII), and Mild Age-Related Diabetes with Relative Insulin Insufficiency (MARD-RII), were found. This review underscores the potential of clustering in diabetes research and identifies gaps in standardization across studies. Future research should focus on refining clustering approaches, mainly introducing soft clustering to identify if patients fall in more than 1 cluster.</p>","PeriodicalId":521069,"journal":{"name":"Cardiovascular diabetology. Endocrinology reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}