Acta Diabetologica最新文献

{"title":"Needle characteristics and the insulin injection experience in patients with diabetes.","authors":"Edoardo Mannucci, Basilio Pintaudi, Maria Elena Lunati, Paolo Fiorina","doi":"10.1007/s00592-025-02538-8","DOIUrl":"https://doi.org/10.1007/s00592-025-02538-8","url":null,"abstract":"<p><strong>Background: </strong>Fear of pain during insulin injection, using pen injectors, still represents a barrier to diabetes treatment. The development of smaller and thinner needles has improved comfort during the injection, but the influence of other needle geometry features, has been less thoroughly assessed. The aim of this review, is to evaluate the role that pen needle geometry plays in determining patient experience during insulin injection.</p><p><strong>Methods: </strong>A literature search was conducted in PubMed and Scopus to identify the publications assessing the effect of needle geometry and quality on insertion force and pain, experienced by the patient during injection. 22 studies were included in this review. All studies included, at minimum, an evaluation of the perceived injection pain, using a Visual Analogue Scale (VAS).</p><p><strong>Results: </strong>The clinical evidence demonstrated that in addition to the pain reduction experienced with increasing needle gauge, other geometrical features such as shorter needle length, thinner wall design, improved tip geometry and coating with lubricant, are associated with reduced injection pain and improved patient experience. Furthermore, it was indicated that the needle features shown to help reduce the experienced pain, would not negatively affect the frequency and intensity of injection related site reactions or needle-related failures, such as breakage and bending.</p><p><strong>Conclusions: </strong>Pen needle geometry affects the insulin injection experience of diabetic patients. Increased needle gauge, shorter length, improved tip design and mechanical characteristics of the needle are all associated with a perceived reduction of the pain during insulin injection and an overall improved patient experience.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245667","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":"Continuous interstitial glucose monitoring in diabetic and non-diabetic critically ill patients is simple and accurate: comparison with venous, arterial and capillary glucose measurements.","authors":"Davide Chiumello, Mattia Passeri, Silvia Coppola, Elena Chiodaroli, Simone Carnier, Marialaura Montante, Tommaso Pozzi, Ilaria Goggi, Francesco Bifari, Umberto Mortola, Lucia Centofanti, Franco Folli","doi":"10.1007/s00592-025-02531-1","DOIUrl":"https://doi.org/10.1007/s00592-025-02531-1","url":null,"abstract":"<p><strong>Introduction: </strong>To reduce mortality, thigh glycemic control is recommended in critically ill patients due to their extreme glycemic variability. Continuous glucose monitoring (CGM) devices allows frequent determination of blood glucose levels; however, conflicting results have been reported from studies assessing their accuracy in critically ill patients. Aim of this study was to assess the repeatability and the analytical and clinical accuracy of FreeStyle Libre 2 (FSL-)CGM.</p><p><strong>Materials and methods: </strong>Prospective single-center observational study enrolling 40 critically ill patients. For four consecutive days, we measured three consecutive interstitial FSL-CGM-derived glucose levels, along with one arterial and venous blood gas analysis and a capillary-derived blood glucose level, obtaining a total of 480 FSL-CGM-derived glucose measurements and 160 measurements from arterial and venous blood gas analysis and from capillary glucose.</p><p><strong>Results: </strong>The mean blood glucose levels in the three daily timepoints from FSL-CGM were 130 ± 35, 131 ± 35 and 131 ± 35 mg/dL (p = 0.660). The Bland-Altman analysis comparing arterial BGA- and FSL-CGM-derived blood glucose levels had a bias of 10.3 mg/dL with limits of agreement from - 27.2 to 47.7. The mean absolute relative difference (MARD) between FSL-CGM and arterial blood gas analysis was 12 ± 10%. The Clarke, Parkes and Surveillance error grid analyses comparing arterial BGA- and FSL-CGM-derived blood glucose levels showed a good clinical accuracy. The presence of diabetes did not influence analytical accuracy, while the use of vasopressors was associated with a higher MARD.</p><p><strong>Conclusions: </strong>FSL-CGM demonstrated reproducibility and reliable analytical and clinical accuracy in critically ill patients, without difference between diabetic and non-diabetic patients, over a period of up to 96 h (4 days).</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245666","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":"Beyond GLP-1: efficacy and safety of dual and triple incretin agonists in personalized type 2 diabetes care-a systematic review and network meta-analysis.","authors":"Kangling Yan, Haichuan Yu, Benoît Blaise","doi":"10.1007/s00592-025-02534-y","DOIUrl":"https://doi.org/10.1007/s00592-025-02534-y","url":null,"abstract":"<p><strong>Background: </strong>Dual and triple incretin-based agonists, targeting combinations of GLP-1, GIP, and glucagon receptors, represent an innovative approach in T2DM care. However, comparative efficacy and safety analyses tailored to receptor-specific strategies are limited.</p><p><strong>Purpose: </strong>This systematic review and network meta-analysis uniquely evaluates the efficacy and safety of dual and triple incretin agonists compared to standard therapies, offering insights into personalized, receptor-specific T2DM therapies.</p><p><strong>Data sources: </strong>Systematic searches in PubMed, Web of Science, Cochrane Library, and Embase (up to July 2024) identified RCTs.</p><p><strong>Study selection: </strong>Trials assessing dual or triple incretin therapies in T2DM with outcomes on weight, HbA1c, FBG, AEs, and SAEs were included.</p><p><strong>Data extraction: </strong>Data on efficacy and safety were extracted by independent reviewers and assessed for quality using the NIH Quality Assessment Tool.</p><p><strong>Data synthesis: </strong>Retatrutide achieved the greatest weight reduction (MD: - 8.601; 95% CrI: - 11.20 to - 5.95) while Tirzepatide was most effective in lowering FBG (MD: - 57.30) and HbA1c ( - 1.88), with 95% CrIs of - 65.41 to - 48.9 and - 2.15 to - 1.64 respectively. Tirzepatide (RR 1.15) and Cotadutide (1.38) increased AEs, while Semaglutide reduced SAEs (0.35); 95% Crls: 1.04-1.33, 1.16-1.68, and 0.13-0.78, respectively.</p><p><strong>Limitations: </strong>Small sample sizes, short study durations, and reliance on indirect comparisons in some cases may limit the certainty of these findings. Direct head-to-head trials are needed to confirm these results.</p><p><strong>Conclusion: </strong>Receptor-specific targeting optimizes T2DM treatment, with Semaglutide supporting glycemic control, Tirzepatide enhancing weight loss and glucose regulation, and Retatrutide potentially offering broader metabolic benefits, advancing receptor-targeted, personalized therapy.</p><p><strong>Prospero registration number: </strong>CRD42024532368.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223983","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":"Polypharmacy in older patients with diabetes mellitus: a population based-study of northern Italy.","authors":"Elena Succurro, Luisa Ojeda-Fernández, Carlotta Franchi, Anna Zanovello, Laura Pierini, Alessandro Nobili, Ida Fortino, Giorgio Sesti, Marta Baviera","doi":"10.1007/s00592-025-02523-1","DOIUrl":"https://doi.org/10.1007/s00592-025-02523-1","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the trends in chronic polypharmacy and identify predictors of polypharmacy exposure in a population residing in Lombardy region of Italy.</p><p><strong>Methods: </strong>Using an administrative health database, we identified individuals aged 65-90 years with diabetes mellitus (DM) treated with antihyperglycemic drugs from 2010 to 2022. The trend of chronic polypharmacy was assessed using the Cochran-Armitage trend test. An adjusted logistic regression model was employed to analyze predictors of polypharmacy exposure.</p><p><strong>Results: </strong>The number of older patients with DM increased from 243,160 in 2010 to 314,238 in 2022. The prevalence of polypharmacy exposure rose from 13.8% in 2010 to 15.8% in 2013, followed by a decline starting in 2014. Notably, in 2020, the prevalence dropped to 11.8%, further decreasing to 9.1% in 2021, before rising again to 11.7% in 2022. We also observed an increased use of recommended antihyperglycemic drugs over time. Significant predictors of polypharmacy exposure included advanced age, female sex, comorbidities, and use of DPP-4i, GLP-1-RA, insulin, and SGLT2-i.</p><p><strong>Conclusions: </strong>The observed decrease in polypharmacy in the latter years of the study period may reflect improvements in the management of older patients with DM, aligning with recommended therapies, particularly for those at higher risk of polypharmacy.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223989","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":"Trajectories of physical activity and influencing factors in patients with type 2 diabetes mellitus: a mixed-methods study.","authors":"YinShi Kan, Lin Liu, ShiHong Yuan, XiangNing Li, XiaoJuan Wan, Yan Zou, Yue Su, Yuying He, Yueqi Zhao, BeiXi Shi, Mark Hayter, Jing Chen, JinPing Wang, Li Fang, Yu Zhang","doi":"10.1007/s00592-025-02540-0","DOIUrl":"https://doi.org/10.1007/s00592-025-02540-0","url":null,"abstract":"<p><strong>Aim: </strong>To explore the different trajectories of physical activtity (PA) change in Type 2 diabetes mellitus (T2DM) patients and the factors affecting them, and to delve deeper into the PA experiences and needs of the different trajectory groups.</p><p><strong>Design: </strong>An observational longitudinal study and a descriptive qualitative study.</p><p><strong>Methods: </strong>276 patients with T2DM were recruited from two tertiary hospitals and followed them up in this longitudinal study. Over nine months, Latent Class Growth Modeling (LCGM) was used to identify distinct PA trajectories among patients with T2DM. The Attitude-Social Influence-Self-Efficacy (ASE) model provided the theoretical framework. Data were collected through General Information Questionnaires, Exercise Self-Efficacy Scales, Exercise Behavioral Attitude and Social Influence Scale, and Behavioural Planning Intention Scale. The analysis sought to identify factors affecting changes in PA trajectories. Subsequently, the PA experiences supportive/hindering factors and PA needs of T2DM patients with different trajectories were explored through qualitative interviews. The GRAMMS (Good Reporting of a Mixed Methods Study) checklist was used to guide the reporting of this study.</p><p><strong>Results: </strong>Patients with T2DM were categorized into 3 distinct trajectories of total PA change: a low-level stabilization group (N = 181, 65.7%), a medium-level fluctuation group (N = 79, 28.7%), and a high-level decline group (N = 16, 5.6%). Logistic regression analysis identified self-efficacy, comorbidities, family environment, and intentions as significant predictors of these trajectories. Additionally, qualitative interviews with 17 participants revealed 7 experiential themes and 3 categories of need.</p><p><strong>Conclusion: </strong>Three distinct PA trajectories were identified in T2DM patients, each with notable differences in PA experiences and needs. It is suggested that healthcare providers should therefore develop targeted, systematic health education and intervention programs tailored to individual patient characteristics to sustain PA behavior and achieve long-term PA benefits.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223991","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":"Use of the temporary glycemic target feature in the medtronic MiniMed™ 780G advanced hybrid closed loop system: a real-world evidence study.","authors":"Jeremy Basset-Sagarminaga, Tim van den Heuvel, Javier Castañeda, Ohad Cohen","doi":"10.1007/s00592-025-02526-y","DOIUrl":"https://doi.org/10.1007/s00592-025-02526-y","url":null,"abstract":"<p><strong>Aim: </strong>The MiniMed™ 780G system utilizes an Advanced Hybrid Closed-Loop algorithm, which is optimized to perform best at a glucose target of 100 mg/dL. The system also includes a temporary target feature (TT) of 150 mg/dL that can be set when higher glucose utilization is anticipated (e.g., exercise/strenuous work).</p><p><strong>Methods: </strong>Real-world data from 1002 randomly selected users of the MiniMed™ 780G and MiniMed™ 670G systems were used to investigate the TT functionality (n = 501 MiniMed™ 780G users, n = 501 MiniMed™ 670G users). Continuous glucose monitoring (CGM) metrics were calculated for 4-h intervals (4 h prior to commencing TT use and 0-4, 4-8, 8-12, 12-16, 16-20 and 20-24 h after TT initiation).</p><p><strong>Results: </strong>CGM results showed that, with both systems, the time-in-range (TIR) during TT periods mostly equalled or exceeded TIR in corresponding non-TT periods. In the first 4 h after TT initiation, the MiniMed™ 780G system demonstrated a TIR and time in tight range (TITR) of 71.6% and 46.4%, respectively, [a 1.6 (p = 0.11) and 2.6 (p = 0.009) percentage point benefit in TIR and TITR, respectively, versus the 670G system]. Mean time-below-range remained below target in both periods.</p><p><strong>Conclusions: </strong>These findings confirm that the TT setting performs as intended, allowing users to maintain TIR during strenuous activity without compromising safety.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223923","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":"Association of baseline and changes in estimated glucose disposal rate and risk of chronic kidney disease: evidence from a national longitudinal study.","authors":"Fan Zhang, Jiao Li, Xueling Li, Liuyang Huang, Yifei Zhong","doi":"10.1007/s00592-025-02528-w","DOIUrl":"https://doi.org/10.1007/s00592-025-02528-w","url":null,"abstract":"<p><strong>Objective: </strong>This study explored the relationship between baseline estimated glucose disposal rate (eGDR), its trajectories, and the risk of chronic kidney disease (CKD).</p><p><strong>Methods: </strong>Participants from the China Health and Retirement Longitudinal Study were included. eGDR was calculated using a validated formula, and CKD was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73m2 or self-reported. Group-based trajectory modeling identified distinct eGDR patterns, and Cox proportional hazards models assessed associations between eGDR and CKD risk.</p><p><strong>Results: </strong>A total of 5,238 participants were analyzed, with 436 incident CKD cases during the 5-year follow-up. Higher baseline eGDR (≥ 8 mg/kg/min) was associated with a reduced CKD risk (Hazard Ratio [HR] = 0.40; 95% Confidence Interval [CI]: 0.19-0.88; P = 0.022). An L-shaped relationship was observed between eGDR and CKD risk. Three eGDR trajectories were identified: low-stability (41.8%), decreasing (14.5%), and high-stability (43.7%). Only the high-stability trajectory significantly reduced CKD risk (HR = 0.77; 95% CI: 0.62-0.96; P = 0.019) compared to the low-stability group.</p><p><strong>Conclusion: </strong>Higher baseline eGDR and consistently high eGDR trajectories were linked to a lower CKD risk, highlighting the significance of maintaining insulin sensitivity for CKD prevention.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223981","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":"Crosstalk of immunity and metabolism: interaction of toll-like receptors (TLRs) and gut microbiota.","authors":"Shabana, Saleem Ullah Shahid, Uzma Irfan, Sumreen Hayat, Sumbal Sarwar","doi":"10.1007/s00592-025-02532-0","DOIUrl":"https://doi.org/10.1007/s00592-025-02532-0","url":null,"abstract":"<p><p>The human gut is the largest interface between the external environment and the human body. The gut immune system should, therefore, be able to differentiate between the normal nonpathogenic residents of the gut and any pathogenic invaders. This differentiation is based on the tiny molecular differences on the cell surfaces of the microorganisms. The first interaction between the pathogen and the immune system is thus crucial. This sensing by the immune system is done by a family of pattern recognition receptors (PRRs), among which the most important are the toll-like receptors (TLRs). The distribution of TLRs in the different areas of gastrointestinal tract (GIT)c depends on the type of commensal residents of that area. The interaction between gut microbiota and TLRs on one hand restricts the colonization of particular microbes to a particular area and on the other hand, dictates the type of TLRs distributed in a particular gut location. This interaction promotes tolerance to the normal residents, but the same time enables the gut associated lymphoid tissue to be able to detect any foreign and potentially pathogenic invaders. The numbers and polarization of the underlying populations of macrophages and dendritic cells beneath the Paneth and M-cells depends upon the trophic factors released by the intestinal epithelial cells as a result of signaling through TLRs. The interaction between these two players is not only immune related, but also has many metabolic consequences. The link between inflammation and many metabolic diseases has been consistently reported. The role of TLRs in the metabolic reprogramming of immune cells is crucial which facilitates the conservation of metabolic energy to be harnessed for immune functions. The knowledge on the TLR-microbiota interaction, its role in immune and metabolic functions, and the results of manipulations with this interaction are the subject of this review.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223985","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":"Proximity extension assay inflammatory profiling cannot distinguish the presence of residual C-peptide in patients with long-standing type 1 diabetes.","authors":"Ebrahim Anvari, Per Lundkvist, Kailash Singh, Daniel Espes","doi":"10.1007/s00592-025-02537-9","DOIUrl":"https://doi.org/10.1007/s00592-025-02537-9","url":null,"abstract":"<p><strong>Objective: </strong>Many patients with long-standing type 1 diabetes (T1D) have remaining low levels of C-peptide, i.e. and indirect sign of remaining functional beta-cells. This study focused on identifying differences in immunological and inflammatory biomarkers in patients with longstanding T1D and remaining C-peptide.</p><p><strong>Research design and methods: </strong>Adult patients (n = 120) with long-standing T1D (≥ 10 years) and healthy controls (HC) (n = 50) were recruited at Uppsala University Hospital. Residual beta-cell function was determined with an ultrasensitive C-peptide ELISA under fasting conditions. T1D patients were divided into two groups (C-peptide positive vs. C-peptide negative). Using the OLINK Explore Inflammation proximity extension assay (PEA), 368 circulating immunological and inflammatory biomarkers were analyzed in plasma.</p><p><strong>Results: </strong>The three groups could not be distinguished by principal component analysis and when correcting for multiple testing we found no differences in circulating biomarkers. However, based on uncorrected p-values there were six biomarkers that were different when comparing all T1D patients with HC and eight markers that were different when comparing C-peptide positive vs. negative T1D patients.</p><p><strong>Conclusion: </strong>A wide inflammatory assay analysis cannot distinguish patients with longstanding T1D and remaining C-peptide from patients with a complete loss of C-peptide nor from HC.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223990","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":"Obesity paradox: association between lipid metabolism indices and skeletal muscle mass in older adults: the mediating role of uric acid.","authors":"Chaofan Sun, Xiaohui Yang, Xingzhong Feng","doi":"10.1007/s00592-025-02527-x","DOIUrl":"https://doi.org/10.1007/s00592-025-02527-x","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to explore the relationships between lipid metabolism indices-the Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI), Cardiac Metabolic Index (CMI), and Atherogenic Index of Plasma (AIP)-and sarcopenia in individuals aged ≥ 60 years, and to investigate the mediating role of uric acid (UA) in these relationships. The goal was to provide scientific evidence and practical guidance for preventing and treating sarcopenia in older adults.</p><p><strong>Methods: </strong>Data from 2001 participants aged ≥ 60 years in the 2003-2006 National Health and Nutrition Examination Survey (NHANES) were analyzed. Statistical analyses, including logistic regression, restricted cubic splines (RCS), subgroup analysis, and mediation analysis, were conducted to examine the associations among various lipid metabolism indices, UA levels, and sarcopenia.</p><p><strong>Results: </strong>Multivariable-adjusted models revealed significant inverse associations between lipid metabolism indices and sarcopenia (all P < 0.05). In the fully adjusted model (model III), the adjusted odds ratios (OR) for LAP, VAI, CMI, and AIP were 0.97 (95% CI: 0.97-0.98), 0.78 (0.68-0.89), 0.32 (0.21-0.49), and 0.27 (0.15-0.52), respectively (all P < 0.05). RCS analyses revealed inverse dose-response relationships between lipid metabolism indices and sarcopenia. The ROC analysis revealed that LAP showed the highest diagnostic value among the four indices. Subgroup analyses showed no significant differences in this relationship across different subgroups. Notably, UA partially mediated these associations (mediation proportions: 8.91-20.66%). These findings suggest that maintaining lipid homeostasis and UA levels may offer protective benefits against age-related sarcopenia.</p><p><strong>Conclusions: </strong>Our findings advance the understanding of the obesity paradox by revealing that higher lipid metabolism indices (LAP, VAI, CMI, AIP) and UA levels are inversely associated with sarcopenia in the elderly, with UA partially mediating these protective effects. These results highlight the importance of maintaining lipid and UA levels within normal ranges as a potential novel strategy for preventing and managing sarcopenia. These findings suggest that reconsidering these biomarkers in the management of geriatric muscle health is necessary, highlighting their importance in understanding and addressing the pathogenesis of sarcopenia in aging populations.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223988","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}