Acta Diabetologica最新文献

{"title":"GLP-1 receptor agonist use and contrast-associated acute kidney injury after contrast-enhanced CT and CT angiography in adults with type 2 diabetes and chronic kidney disease: a propensity score-matched cohort study.","authors":"Yu Chang, Kuan-Yu Chi, Hong-Min Lin","doi":"10.1007/s00592-026-02810-5","DOIUrl":"https://doi.org/10.1007/s00592-026-02810-5","url":null,"abstract":"<p><strong>Aims: </strong>To examine whether glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is associated with contrast-associated acute kidney injury (CA-AKI) after contrast-enhanced computed tomography (CE-CT) or computed tomographic angiography (CTA) in adults with type 2 diabetes and chronic kidney disease (CKD).</p><p><strong>Methods: </strong>We conducted a TriNetX retrospective cohort study of adults with type 2 diabetes and CKD who underwent CE-CT or CTA from January 2020 to January 2025. GLP-1 RA use was defined by a prescription within six months before imaging. The primary outcome was a new acute kidney injury diagnosis within three days. Separate 1:1 propensity score-matched analyses were conducted for CE-CT and CTA, with eGFR-stratified and sensitivity analyses.</p><p><strong>Results: </strong>After matching, the CE-CT and CTA cohorts included 6,995 and 3,285 pairs, respectively. CA-AKI occurred in 3.8% of GLP-1 RA users versus 4.5% of non-users after CE-CT (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.71-0.99) and in 4.5% versus 6.1% after CTA (OR 0.74, 95% CI 0.59-0.92). The absolute risk differences were 0.7% points and 1.5% points, respectively. HbA1c remained imbalanced after matching. Negative-control outcomes were null, and eGFR-stratified associations were inconsistent between cohorts.</p><p><strong>Conclusions: </strong>GLP-1 RA use was associated with a lower observed risk of CA-AKI after CE-CT and CTA in adults with type 2 diabetes and CKD. Residual HbA1c imbalance and the observational design limit causal interpretation; prospective studies using creatinine-based outcomes are needed.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gestational diabetes mellitus in Italian diabetes clinics: clinical characteristics, screening practices and management from the amd annals registry.","authors":"Andrea Da Porto, Graziano Di Cianni, Torlone Elisabetta, Manicardi Valeria, Suraci Titti, Rocca Alberto, Pisanu Paola, Rossi Maria Chiara, Candido Riccardo, Russo Giuseppina, Salvatore De Cosmo","doi":"10.1007/s00592-026-02816-z","DOIUrl":"https://doi.org/10.1007/s00592-026-02816-z","url":null,"abstract":"<p><strong>Background: </strong>Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and is associated with adverse maternal and neonatal outcomes. Nationwide real-world data describing characteristics , screening practices, clinical management, and quality of care of women with GDM attending diabetes clinics in Italy are limited.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using data from the AMD Annals Initiative, a well-established large quality-of-care monitoring program. Anonymized clinical data from women with GDM attending participating centers during 2025 were analyzed. Study measures included demographic characteristics, risk factors, oral glucose tolerance test (OGTT) timing and results, therapeutic management, intermediate outcomes, and available maternal and neonatal outcomes.The analysis was descriptive.</p><p><strong>Results: </strong>A total of 13,487 women with GDM were included. The mean age was 33.6±5.4 years, and 41.1% were aged ≥35 years. Pre-pregnancy overweight and obesity were reported in 28.1% and 24.9% of women, respectively. Overall, 20.3% of women met criteria for early OGTT screening based on established risk factors; however, only 15.2% of eligible women underwent testing within the recommended 16-18-week gestational window. Standard OGTT screening between 24 and 28 weeks was performed in 51.5% of cases. Women tested at 16-18 weeks showed higher fasting glucose levels but lower post-load glucose values than those screened at 24-28 weeks. Mean HbA1c at diagnosis was 5.2±0.7%, and only 0.9% of women had HbA1c ≥6.5%. Dietary treatment alone was used in 63.9% of women, while 33.1% required insulin therapy and 5.6% received metformin. Among women with available delivery data (n=2,288), mean gestational age at delivery was 38.8±1.4 weeks, with cesarean section and labor induction rates of 30.0% and 33.6%, respectively. Neonatal outcomes were recorded for 1,384 of these women, whereas postpartum glucose assessment was available for only 3.1% of the entire cohort.</p><p><strong>Conclusions: </strong>This large real-world analysis provides a first nationwide snapshot of the characteristics and quality of care of GDM in Italy. Although management and perinatal outcomes appear broadly consistent with international standards, substantial gaps remain in adherence to recommended screening pathways, particularly the implementation of early OGTT testing in high-risk women. Improving the completeness and standardization of structured data collection, including maternal and neonatal outcomes, will further strengthen the ability of the AMD Annals to monitor and support continuous improvement in GDM care.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of recurrent acute pancreatitis with GLP-1 receptor agonists after prior pancreatitis: a systematic review.","authors":"Danielle L Voltani, Felipe G Pinto, Soemiwati Holland","doi":"10.1007/s00592-026-02809-y","DOIUrl":"https://doi.org/10.1007/s00592-026-02809-y","url":null,"abstract":"<p><strong>Introduction: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for patients with type 2 diabetes (T2D) and obesity. However, their safety in patients with prior pancreatitis remains uncertain. This systematic review aims to evaluate the risk of recurrent acute pancreatitis (RAP) associated with GLP-1 RA therapy.</p><p><strong>Methods: </strong>We systematically searched for studies evaluating the safety of GLP-1 receptor agonists in adults with type 2 diabetes mellitus (T2DM) or obesity and a history of acute pancreatitis. The primary outcome was recurrent acute pancreatitis. We included studies of adults with prior acute pancreatitis treated with GLP-1 receptor agonists for type 2 diabetes, obesity, or related metabolic conditions. Studies without recurrent acute pancreatitis outcomes, pediatric populations, overlapping cohorts, insufficient data, or non-original publications were excluded.</p><p><strong>Results: </strong>We included four studies comprising 10,624 patients, of whom 5,427 (51.0%) received GLP-1 receptor agonists. Two studies provided comparative data (5,224 GLP-1 RA users; 5,197 controls). GLP-1 receptor agonist use was associated with lower odds of recurrent acute pancreatitis than placebo (OR 0.26, 95% CI 0.05-1.32) and lower risk than SGLT2 inhibitor use (OR 0.57, 95% CI 0.52-0.64). Two additional studies provided recurrence rates among GLP-1 RA users with prior pancreatitis, reporting rates of 9.9% (95% CI 5.8%-16.3%) and 11.9% (95% CI 5.1%-25.8%).</p><p><strong>Conclusion: </strong>Across the four included studies, GLP-1 receptor agonist use was not associated with an increase in RAP among patients with a prior history of acute pancreatitis. However, comparative evidence was limited to two studies, warranting cautious interpretation of these findings.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"miR-142-3p overexpression targets CLTA and impairs clathrin-mediated endocytosis in HLSECs induced by high glucose.","authors":"Weiwen Ding, Yingying Li, Qi Zhang, Rangbao Cheng, Shuyue Wang, Jing Yu, Lirong Wei, Qianqian Tian, Junyi Zhu","doi":"10.1007/s00592-026-02814-1","DOIUrl":"https://doi.org/10.1007/s00592-026-02814-1","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore the effect of miR-142-3p on the endocytosis in human liver sinusoidal endothelial cells (HLSECs) induced by high glucose and to investigate the underlying mechanisms.</p><p><strong>Methods: </strong>Multi-database target prediction was performed to identify potential targets of hsa-miR-142-3p. HLSECs were cultured under 5.5 mmol/L glucose (normal) or 25 mmol/L glucose (high) conditions. qRT-PCR assessed the RNA expression levels of miR-142-3p and CLTA. Western blot assessed the protein expression levels of clathrin-mediated endocytosis(CME)-related genes. Immunofluorescence assay was used to observe the cellular localization of CLTA. A dual-luciferase assay investigated the targeting relationship between miR-142-3p and CLTA. DiI-LDL endocytosis assay was used to study the endocytosis in HLSECs.</p><p><strong>Results: </strong>Bioinformatics analysis predicted CLTA as a potential target of miR-142-3p. The expression level of miR-142-3p was increased and the expression levels of CLTA, α-adaptin, AP2M1 and VPS35 were reduced in high glucose-induced HLSECs (P < 0.05). DiI-LDL endocytosis assay demonstrated that the endocytosis was weakend in HLSECs induced by high glucose. Dual-luciferase reporter assay confirmed that miR-142-3p directly targets CLTA. Compared with the negative control group, inhibition of miR-142-3p significantly increased the expression levels of CLTA, AP2M1, α-adaptin and VPS35, and improved the endocytosis in HLSECs (P < 0.05). In contrast, overexpression of miR-142-3p showed the opposite effects.</p><p><strong>Conclusions: </strong>miR-142-3p overexpression targets CLTA and impairs CME in HLSECs induced by high glucose. The concurrent changes in other CME-related genes further suggest a broader regulatory role of miR-142-3p on the endocytosis.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aldosterone-mineralocorticoid receptor signaling and residual cardiorenal risk in type 2 diabetes.","authors":"Shan Zhao, Chuxian Wang, Yang Ou","doi":"10.1007/s00592-026-02811-4","DOIUrl":"https://doi.org/10.1007/s00592-026-02811-4","url":null,"abstract":"<p><p>Clinically important cardiorenal risk persists in type 2 diabetes mellitus (T2DM) despite major advances in metabolic and organ-protective therapy. This narrative review evaluates aldosterone-mineralocorticoid receptor (MR) signaling as one potential contributor and separates mechanistic plausibility from clinical-outcome evidence. PubMed, Embase, Web of Science Core Collection, and ClinicalTrials.gov searches, together with supplementary searches using the Foreign Medical Literature Retrieval Service (FMRS; Metstr), were updated through 22 September 2026; titles/abstracts and relevant full texts were independently screened by two authors. Experimental and observational evidence links MR signaling with inflammation, oxidative stress, fibrosis, endothelial dysfunction, and cardiorenal remodeling, but circulating aldosterone, renin, and the aldosterone-to-renin ratio have no validated thresholds for identifying clinically relevant tissue MR activation or predicting treatment response in unselected T2DM. In T2DM with chronic kidney disease (CKD) receiving maximum tolerated renin-angiotensin system blockade, finerenone reduces prespecified kidney and cardiovascular composite outcomes. By contrast, CONFIDENCE and phase 2 BI 690,517 mainly provide urinary albumin-to-creatinine ratio-based surrogate evidence, and FINEARTS-HF extends clinical-outcome evidence to heart failure with mildly reduced or preserved ejection fraction but was not restricted to diabetes. We therefore present four candidate domains for future MR-oriented phenotyping as a hypothesis-generating framework, not a diagnostic or treatment-selection algorithm. Overall, MR signaling is best regarded as a biologically plausible contributor within a multifactorial residual-risk model; prospective validation is required before biomarker-guided MR-targeted therapy can be recommended.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 receptor agonists and hair loss: adverse effect, epiphenomenon, or therapeutic paradox?","authors":"Ademir Carvalho Leite Júnior, Howard Lopes Ribeiro Junior","doi":"10.1007/s00592-026-02812-3","DOIUrl":"https://doi.org/10.1007/s00592-026-02812-3","url":null,"abstract":"<p><strong>Objective: </strong>Incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual/triple agonists, have revolutionized the management of obesity and type 2 diabetes. However, hair loss has emerged as an adverse event in clinical practice. This review synthesizes the evidence on the prevalence, mechanistic pathways, and clinical course of hair loss associated with semaglutide, tirzepatide, and retatrutide.</p><p><strong>Methods: </strong>A narrative review was conducted using the PubMed/MEDLINE database. Data were integrated from clinical trials, real-world observational studies, and pharmacovigilance databases to evaluate the oncological and dermatological implications of these therapies.</p><p><strong>Results: </strong>There is a discrepancy in hair loss prevalence, ranging from 3 to 7% in controlled trials to over 70% in real-world cohorts. Telogen effluvium (TE) is the predominant phenotype, driven primarily by the magnitude and velocity of weight loss rather than drug toxicity. Newer agents like tirzepatide demonstrate stronger associations with hair shedding compared to older GLP-1 RAs. Pharmacovigilance data show inconsistent but significant signals for semaglutide and tirzepatide, with reporting odds ratios indicating a drug-associated risk. Conversely, paradoxical improvements in androgenetic alopecia and inflammatory scarring alopecias have been reported, likely mediated by metabolic normalization and anti-inflammatory effects. Female sex and significant weight reduction (> 10%) were the most robust predictors of hair loss.</p><p><strong>Conclusion: </strong>Hair loss associated with incretin-based therapies is a biologically complex, threshold-dependent phenomenon reflecting systemic metabolic reprogramming. While predominantly transient and reversible, its psychological impact can compromise treatment adherence. Clinicians should provide proactive counseling, emphasizing the self-limiting nature of TE in this context while monitoring for diverse follicular responses.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of diabetes-related clinical indices in patients with non-small cell lung cancer and comorbid type 2 diabetes receiving immune checkpoint inhibitor therapy.","authors":"Qiang Ren, Hengwei Zhang, Delong Huang, Haoshu Zhong, Junhao Wu, Yiren Wang, Yangkai Zhao, Shaojie Luo, Yuying Li","doi":"10.1007/s00592-026-02806-1","DOIUrl":"https://doi.org/10.1007/s00592-026-02806-1","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1) or programmed death-ligand 1 (PD-L1) have transformed the treatment of non-small cell lung cancer (NSCLC). However, diabetes-induced immune dysfunction may attenuate ICI efficacy. Clinical evidence further suggests poorer outcomes in patients with NSCLC and comorbid type 2 diabetes mellitus (T2DM). Reliable prognostic tools for this subgroup remain lacking.</p><p><strong>Methods: </strong>We conducted a three-part study. First, a two-sample Mendelian randomization (MR) analysis was performed to assess the causal relationship between T2DM and PD-L1. Second, Cox regression was applied to evaluate associations between diabetes-related clinical indices and progression-free survival (PFS) and overall survival (OS). Third, machine learning models were developed to predict prognosis using diabetes-related features.</p><p><strong>Results: </strong>MR analysis supported a causal association between T2DM and PD-L1. Cox regression identified HbA1c as significantly associated with PFS. Among the machine learning models, the support vector machine (SVM) achieved the best performance for predicting PFS (AUC = 0.935, 95% CI: 0.872-0.997; C-index: 0.763). For OS prediction, the best-performing model was a random forest model based on HbA1c (AUC = 0.863, 95% CI: 0.736-0.990; C-index: 0.618).</p><p><strong>Conclusion: </strong>Diabetes-related indices-particularly HbA1c-are meaningful prognostic markers in patients with NSCLC and comorbid T2DM receiving ICI therapy. The proposed machine learning models may support individualized outcome prediction and clinical decision-making.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for cardiovascular disease, chronic kidney disease, and type 2 diabetes in populations with overweight and obesity: an umbrella review and cohort analysis.","authors":"Yingkai Liu, Jing Wang, Yan Yu, Xiaoli Chen, Xueyin Chen, Yu Chen, Genghang Chen, Shaonan Liu","doi":"10.1007/s00592-026-02801-6","DOIUrl":"https://doi.org/10.1007/s00592-026-02801-6","url":null,"abstract":"<p><strong>Aims: </strong>Individuals with overweight and obesity are at high risk of cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM). We aimed to identify the risk factors for CVD, CKD, and T2DM among individuals with overweight and obesity, and to validate the associations of these risk factors with the three outcomes.</p><p><strong>Methods: </strong>We conducted an umbrella review and a cohort analysis. Seven databases were searched from inception to December 31, 2025. Systematic reviews reporting the risk factors in populations with overweight and obesity, and CVD, CKD, or T2DM were included. The ROBIS and GRADE tools were used to assess the methodological quality and certainty of evidence. A cohort study dataset from the China Health and Retirement Longitudinal Study (CHARLS) was used for validation. Associations with the composite outcome and its individual components (CVD, CKD, and T2DM) were examined.</p><p><strong>Results: </strong>Nine systematic reviews were included in the umbrella review, and three key factors were identified. Anthropometric measures were associated with CVD (HRs 1.10-1.29) and T2DM (RRs 1.31-1.88). Compared with metabolically healthy individuals, those with metabolically unhealthy phenotypes had HRs ranging from 1.46 to 2.68. Metabolically unhealthy individuals had higher risks (RRs 2.42-5.90). Unhealthy dietary patterns increased CVD, CKD and T2DM risk (HRs 1.11-2.05), whereas healthy dietary patterns reduced risk. In this cohort study, 1,305 participants were included, and 538 developed CVD, CKD or T2DM. Transitioning from a metabolically healthy to a metabolically unhealthy phenotype (OR 1.66 [1.19, 2.30]), transitioning from a metabolically unhealthy to a metabolically healthy phenotype (OR 1.56 [1.08, 2.24]), and maintaining a stable metabolically unhealthy status (OR 1.88 [1.39, 2.54]) were significantly associated with an increased risk of incident CVD, CKD and T2DM composite; disease-specific analyses indicated that this association was driven primarily by T2DM.</p><p><strong>Conclusions: </strong>Our analyses revealed that anthropometric measures, metabolic phenotypes, and dietary patterns are associated with CVD, CKD, and T2DM among individuals with overweight and obesity, especially T2DM. Integrated prevention strategies targeting these modifiable risk factors should be prioritized to optimize clinical management.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD420261350841.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmasking covert metabolic syndrome in normal-weight women: regional adiposity and muscle quality outperform BMI in a temporally validated machine learning triage framework.","authors":"Olga S Palamarchuk, Oleh O Moroz, Volodymyr P Feketa","doi":"10.1007/s00592-026-02815-0","DOIUrl":"https://doi.org/10.1007/s00592-026-02815-0","url":null,"abstract":"<p><strong>Aims: </strong>Traditional screening based on body mass index (BMI) fails to identify the metabolically obese normal-weight (MONW) phenotype. We aimed to develop and temporally validate an interpretable machine learning framework utilizing non-invasive surrogate markers of central adiposity (waist-to-height ratio, WHtR) and relative functional muscle capacity (relative handgrip strength, RHGS) for cross-sectional triage of prevalent metabolic syndrome (MetS) in women.</p><p><strong>Methods: </strong>In 2,418 women (NHANES 2011-2014), we excluded pregnant women and applied independent K-nearest neighbors imputation (k = 5) without data leakage. Using XGBoost, we evaluated baseline M1 (Age + BMI), intermediate M2 (Age + BMI + RHGS), and proposed M3 (Age + WHtR + RHGS). Following TRIPOD Type 3 temporal validation, we trained models on Cycle 2011-2012 (N = 1,167) and tested them on Cycle 2013-2014 (N = 1,251). SHapley Additive exPlanations (SHAP) extracted exploratory, model-dependent decision reference points.</p><p><strong>Results: </strong>In the unstratified cohort, M3 achieved comparable discrimination to M2 (AUC 0.782 vs. 0.769, DeLong p = 0.117). However, in normal-weight women (n = 371), M3 demonstrated marked superiority over M1 (AUC 0.855 [95% CI 0.800-0.910] vs. 0.757 [95% CI 0.678-0.835], p < 0.001) and M2 (AUC 0.801, p = 0.015), with near-perfect calibration (Brier score = 0.068), high rule-out reliability (NPV = 98.9%), and a negative likelihood ratio (LR-) of 0.12 (95% CI 0.06-0.22). SHAP dependence analysis illustrated non-additive muscle-fat interactions, where lower strength (< 0.891 kg/kg) amplified risk primarily when WHtR exceeded 0.529.</p><p><strong>Conclusions: </strong>Replacing BMI with indices of visceral adiposity and relative strength markedly improves MetS triage in normal-weight women. This temporally validated framework provides a non-invasive pre-laboratory triage tool to prioritize high-risk MONW individuals for comprehensive clinical evaluation.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary modulation of the gut microbiota in type 2 diabetes and obesity: mechanisms, interventions, and clinical perspectives.","authors":"Alicja Kubica, Weronika Maszczyk","doi":"10.1007/s00592-026-02805-2","DOIUrl":"https://doi.org/10.1007/s00592-026-02805-2","url":null,"abstract":"<p><p>Obesity and type 2 diabetes mellitus (T2DM) are associated with heterogeneous changes in gut microbial composition and function, while mechanistic studies support plausible links among diet, microbial metabolism, intestinal barrier function, immune signaling, and host metabolism. This narrative review integrates diet-microbiome mechanisms, dietary-assessment and multi-omics methodology, major dietary patterns, quantitative clinical intervention evidence, treatment-related microbiome modulation, and implications for precision nutrition. High-fiber, Mediterranean, plant-based, and Western-style dietary patterns can modify microbial functions and metabolites, but responses vary across populations, substrates, baseline microbiota, medications, and study methods. Randomized trials and meta-analyses show selected metabolic effects of dietary and microbiome-targeted interventions; effects are generally modest and heterogeneous, and prebiotics, probiotics, synbiotics, and postbiotics are not interchangeable across products or populations. Medication and procedural exposures can also alter microbiome and metabolome readouts and confound interpretation. Current evidence does not provide a validated basis for routine microbiome-guided pharmacological or surgical treatment selection. Integration of dietary, microbiome, metabolome, and clinical data may identify metabotypes and candidate response patterns, but individualized microbiome-based nutrition remains an emerging, validation-dependent research domain rather than routine clinical practice.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}