Acta Diabetologica最新文献

{"title":"Time above range and no coefficient of variation is associated with diabetic retinopathy in individuals with type 1 diabetes and glycated hemoglobin within target.","authors":"Fernando Sebastian-Valles, Julia Martínez-Alfonso, Jose Alfonso Arranz Martin, Jessica Jiménez-Díaz, Iñigo Hernando Alday, Victor Navas-Moreno, Teresa Armenta-Joya, Maria Del Mar Fandiño García, Gisela Liz Román Gómez, Jon Garai Hierro, Luis Eduardo Lander Lobariñas, Carmen González-Ávila, Purificación Martinez de Icaya, Vicente Martínez-Vizcaíno, Mónica Marazuela, Miguel Antonio Sampedro-Nuñez","doi":"10.1007/s00592-024-02347-5","DOIUrl":"https://doi.org/10.1007/s00592-024-02347-5","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to investigate the association between glucose metrics and diabetic retinopathy in type 1 diabetes (T1D) patients using flash continuous glucose monitoring (FGM) systems, including those maintaining glycated hemoglobin (HbA1c) within the target range.</p><p><strong>Methods: </strong>We conducted a cross-sectional study involving 1070 T1D patients utilizing FGM systems. Data on clinical, anthropometric, and socioeconomic characteristics were collected and retinopathy was classified based on international standards.</p><p><strong>Results: </strong>Patients' mean age was 47.6 ± 15.0 years, with 49.4% of them being females. Within the cohort, 24.8% of patients presented some form of retinopathy. In the analysis involving the entire sample of subjects, male gender (OR = 1.51, p = 0.027), Time Above Range (TAR) > 250 mg/dL (OR = 1.07, p = 0.025), duration of diabetes (OR = 1.09, p < 0.001), smoking (OR = 2.30, p < 0.001), and history of ischemic stroke (OR = 5.59, p = 0.025) were associated with diabetic retinopathy. No association was observed between the coefficient of variation and diabetic retinopathy (p = 0.934). In patients with HbA1c < 7%, the highest quartile of TAR > 250 was independently linked to diabetic retinopathy (OR = 8.32, p = 0.040), in addition to smoking (OR = 2.90, p = 0.031), duration of diabetes (OR = 1.09, p < 0.001), and hypertension (OR = 2.35, p = 0.040).</p><p><strong>Conclusion: </strong>TAR > 250 mg/dL significantly emerges as a modifiable factor associated with diabetic retinopathy, even among those patients maintaining recommended HbA1c levels. Understanding glucose metrics is crucial for tailoring treatment strategies for T1D patients.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892607","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":"The impact of homocysteine on patients with diabetic nephropathy: a mendelian randomization study.","authors":"Baiju Wang, Han Li, Na Wang, Yuan Li, Zihua Song, Yajuan Chen, Xiaobing Li, Lei Liu, Hanwen Chen","doi":"10.1007/s00592-024-02343-9","DOIUrl":"https://doi.org/10.1007/s00592-024-02343-9","url":null,"abstract":"<p><strong>Background/aims: </strong>Homocysteine (Hcy) has been associated with an increased risk of diabetic nephropathy (DN) in patients, but there is still controversy. This study aims to investigate the causal relationship between plasma Hcy and DN.</p><p><strong>Methods: </strong>A Mendelian randomization (MR) study using data from 2 samples was employed to infer causal relationships. The aggregated genetic data associated with Hcy was derived from the largest genome-wide association study (GWAS) to date, involving 44,147 individuals of European ancestry.Data on SNP-diabetic nephropathy, creatinine, and urea nitrogen were obtained from the IEU GWAS database. The analysis method employed a fixed-effect or random-effect inverse variance-weighted approach to estimate effects.Additional analysis methods were used to assess stability and sensitivity. The potential for pleiotropy was evaluated using the MR-Egger intercept test.</p><p><strong>Results: </strong>Using 12 SNPs as instrumental variables, two-sample MR analysis revealed no evidence of a causal relationship between genetically predicted plasma Hcy levels and diabetic nephropathy, as well as creatinine and blood urea nitrogen levels. This finding is consistent with the results obtained from other testing methods.</p><p><strong>Conclusions: </strong>Two-sample Mendelian Randomization analysis found no evidence of a causal relationship between plasma homocysteine levels and diabetic nephropathy, creatinine, or urea.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892606","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":"The differences of metabolic profiles, socioeconomic status and diabetic retinopathy in U.S. working-age and elderly adults with diabetes: results from NHANES 1999-2018.","authors":"Bo Li, Xiaoyun Cheng, Yikeng Huang, Chuandi Zhou, Chufeng Gu, Xinyu Zhu, Chenxin Li, Mingming Ma, Ying Fan, Xun Xu, Zhi Zheng, Haibing Chen, Shuzhi Zhao","doi":"10.1007/s00592-024-02328-8","DOIUrl":"https://doi.org/10.1007/s00592-024-02328-8","url":null,"abstract":"<p><strong>Aims: </strong>Controlled metabolic factors and socioeconomic status (SES) was crucial for prevention of diabetic retinopathy (DR). The study aims to assess the metabolic factors control and SES among working-age adults (18-64 years) with diabetes compared to older adults (65 years and older).</p><p><strong>Methods: </strong>Totals of 6738 participants with self-reported diagnosed diabetes from National Health and Nutrition Examination Survey were included, of whom 3482 were working-age and 3256 were elderly. The prevalence of DR, metabolic factors control, and the impact of SES and diabetic duration on DR was estimated. Subgroup analysis among working-age adults was employed across different diabetic duration and SES level.</p><p><strong>Results: </strong>The prevalence of DR was 20.8% among working-age adults and 20.6% in elderly adults. Further, working-age adults possessed suboptimal control on glycemia (median HbA1c: 7.0% vs. 6.8%, p < 0.001) and lipids (Low-density lipoprotein < 100 mg/dL: 46.4% vs. 63.5%, p < 0.001), but better blood pressure control (< 130/80 mmHg: 53.5% vs. 37.5%, p < 0.001) compared to the elderly, judging based on age-specific control targets. Prolonged diabetic duration didn't improve glycemic and composite factors control. SES like education and income impacted metabolic factors control and adults with higher SES were more likely to control well. Diabetic duration was a significant risk factor (OR = 4.006, 95%CI= (2.752,5.832), p < 0.001) while higher income (OR = 0.590, 95%CI= (0.421,0.826), p = 0.002) and educational level (OR = 0.637, 95%CI= (0.457,0.889), p = 0.008) were protective against DR.</p><p><strong>Conclusions: </strong>Working-age adults with diabetes demonstrate suboptimal metabolic profile control, especially glycemia and lipids. Additional efforts are needed to improve metabolic factor control and reduce DR risk, particularly for those with longer diabetes duration, less education, and lower incomes.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888110","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 between all-cause mortality and vascular complications in U.S. adults with newly diagnosed type 2 diabetes (NHANES 1999–2018)","authors":"Tian-Yu Zhang, Xue-Ning Wang, Hong-Yu Kuang, Zi-Meng Zhang, Cheng-Ye Xu, Kang-Qi Zhao, Wu-Ying Ha-Si, Cong Zhang, Ming Hao","doi":"10.1007/s00592-024-02342-w","DOIUrl":"https://doi.org/10.1007/s00592-024-02342-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Aims</h3><p>The impact of macrovascular and microvascular complications, the common vascular complications of type 2 diabetes, on long-term mortality has been well evaluated, but the impact of different complications of newly diagnosed type 2 diabetes (diagnosed within the past 2 years) on long-term mortality has not been reported. We aimed to investigate the relationship between all-cause mortality and vascular complications in U.S. adults (aged ≥ 20 years) with newly diagnosed type 2 diabetes.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We used data from the 1999–2018 National Health and Nutritional Examination Surveys (NHANES). Cox proportional hazard models was used to assess hazard ratios (HR) and 95% confidence intervals for all-cause mortality.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 928 participants were enrolled in this study. At a mean follow-up of 10.8 years, 181 individuals died. In the fully adjusted model, the hazard ratio (HR) (95% confidence interval [CI]) of all-cause mortality for individuals with any single complication compared with those with newly diagnosed type 2 diabetes without complications was 2.24 (1.37, 3.69), and for individuals with two or more complications was 5.34 (3.01, 9.46).Co-existing Chronic kidney disease (CKD) and diabetic retinopathy (DR) at baseline were associated with the highest risk of death (HR 6.07[2.92–12.62]), followed by CKD and cardiovascular disease (CVD) (HR 4.98[2.79–8.89]) and CVD and DR (HR 4.58 [1.98–10.57]).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The presence of single and combined diabetes complications exerts a long-term synergistic adverse impact on overall mortality in newly diagnosed U.S. adults with type 2 diabetes, underscoring the importance of comprehensive complication screening to enhance risk stratification and treatment.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"17 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141884871","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 glycemic monitoring in managing diabetes in adult patients with wolfram syndrome","authors":"Agnieszka Zmysłowska,&nbsp;Julia Grzybowska-Adamowicz,&nbsp;Arkadiusz Michalak,&nbsp;Julia Wykrota,&nbsp;Agnieszka Szadkowska,&nbsp;Wojciech Młynarski,&nbsp;Wojciech Fendler","doi":"10.1007/s00592-024-02350-w","DOIUrl":"10.1007/s00592-024-02350-w","url":null,"abstract":"<div><h3>Aims</h3><p>In this study we evaluated the use of Continuous Glucose Monitoring system in adults with insulin-dependent diabetes in the course of Wolfram syndrome (WFS) in comparison to patients with type 1 diabetes (T1D).</p><h3>Methods</h3><p>Individuals with WFS (N = 10) used continuous glucose monitoring for 14 days and were compared with 30 patients with T1D matched using propensity score for age and diabetes duration. Glycemic variability was calculated with Glyculator 3.0.</p><h3>Results</h3><p>We revealed significant differences in glycemic indices between adults with Wolfram syndrome-related diabetes and matched comparison group. Patients with Wolfram syndrome presented lower mean glucose in 24-h and nighttime records [24h: 141.1 ± 30.4mg/dl (N = 10) vs 164.9 ± 31.3mg/dl (N = 30), p = 0.0427; nighttime: 136.7 ± 39.6mg/dl vs 166.2 ± 32.1mg/dl (N = 30), p = 0.0442]. Moreover, they showed lower standard deviation of sensor glucose over all periods [24h: 50.3 ± 9.2mg/dl (N = 10) vs 67.7 ± 18.7 mg/dl (N = 30), p = 0.0075; daytime: 50.8 ± 8.7mg/dl (N = 10) vs 67.4 ± 18.0mg/dl (N = 30), p = 0.0082; nighttime: 45.1 ± 14.9mg/dl (N = 10) vs 65.8 ± 23.2mg/dl (n = 30), p = 0.0119] and coefficient of variation at night [33.3 ± 5.8% (N = 10) vs 40.5 ± 8.8% (N = 30), p = 0.0210]. Additionally, WFS patients displayed lower time in high-range hyperglycemia (&gt; 250mg/dl) across all parts of day [24h: 4.6 ± 3.8% (N = 10) vs 13.4 ± 10.5% (N = 30), p = 0.0004; daytime: 4.7 ± 3.9% (N = 10) vs 13.8 ± 11.2% (N = 30), p = 0.0005; nighttime: 4.2 ± 5.5% (N = 10) vs 12.1 ± 10.3% (N = 30), p = 0.0272].</p><h3>Conclusions</h3><p>Adult patients with Wolfram syndrome show lower mean blood glucose, less extreme hyperglycemia, and lower glycemic variability in comparison to patients with type 1 diabetes.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"61 10","pages":"1333 - 1338"},"PeriodicalIF":3.1,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-024-02350-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141884872","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":"Association of frailty index with all-cause and cardiovascular mortality with different diabetic status: NHANES 1999–2018","authors":"Yu-Jun Xiong, Xiang-Da Meng, Hua-Zhao Xu, Xing-Yun Zhu","doi":"10.1007/s00592-024-02348-4","DOIUrl":"https://doi.org/10.1007/s00592-024-02348-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Aims</h3><p>The relationship between frailty and mortality among individuals with varying diabetic statuses represents a burgeoning area of concern and scholarly interest within the medical community. However, there are limited studies that explore the relationship between frailty and mortality, as well as cause-specific mortality among individuals with non-diabetes, prediabetes, and diabetes patients. Hence, this study aims to investigate the relationship between the frailty statues and all-cause mortality, as well as cause-specific mortality in individuals with varying diabetic statuses using the data in the NHANES database.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The study utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999–2018, incorporating a final sample size of 57, 098 participants. Both univariable and multivariable-adjusted logistic regression analyses, as well as Cox regression analysis were employed to examine the relationship between frailty index (FI) and mortality.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>This study, found a significant positive correlation between the frailty and the increased risk of all-cause mortality non-diabetic [OR 4.277, 95%CI (3.982, 4.594), <i>P</i> &lt; 0.001], prediabetic [OR 2.312, 95%CI (2.133, 2.506), <i>P</i> &lt; 0.001], and diabetic patients [OR 3.947, 95%CI (3.378, 4.611), <i>P</i> &lt; 0.001]. This correlation still existed even after adjusting for confounding factors including age, sex, BMI, poverty, fasting insulin, education, smoke, alcohol drink, waist, hypertension, hyperlipidemia, fasting glucose, HbA1c, eGFR, creatinine and total bilirubin. Our result also suggested a significant positive correlation between the frailty index and the increased risk of CVD mortality among non-diabetic [OR 3.095, 95%CI (2.858, 3.352), <i>P</i> &lt; 0.001] and prediabetic [OR 5.985, 95%CI (5.188, 6.904), <i>P</i> &lt; 0.001] individuals. However, in patients with diabetes, the correlation between frailty and CVD mortality lost significance after adjusting for possible confounding factors [OR 1.139, 95%CI (0.794, 1.634), <i>P</i> &gt; 0.05].</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>A nonlinear relationship has been identified between the FI and all-cause mortality, as well as CVD mortality in non-diabetic and pre-diabetic population. In diabetic patients, there was a significant positive correlation between the frailty and the increased risk of all-cause mortality, but not with CVD mortality. Renal function and liver function might potentially acted as an intermediary factor that elevated the risk of CVD mortality in frail patients with diabetes.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"75 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141884870","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":"Elucidating the role of genetically determined metabolites in Diabetic Retinopathy: insights from a mendelian randomization analysis.","authors":"Yao Tan, Zuyun Yan, Jiayang Yin, Jiamin Cao, Bingyu Xie, Feng Zhang, Wenhua Zhang, Wei Xiong","doi":"10.1007/s00592-024-02345-7","DOIUrl":"https://doi.org/10.1007/s00592-024-02345-7","url":null,"abstract":"<p><strong>Aims: </strong>Diabetic retinopathy (DR) results from complex genetic and metabolic interactions. Unraveling the links between blood metabolites and DR can advance risk prediction and therapy.</p><p><strong>Methods: </strong>Leveraging Mendelian Randomization (MR) and Linkage Disequilibrium Score Regression (LDSC), we analyzed 10,413 DR cases and 308,633 controls. Data was sourced from the Metabolomics GWAS server and the FinnGen project.</p><p><strong>Results: </strong>Our research conducted a comprehensive MR analysis across 486 serum metabolites to investigate their causal role in DR. After stringent selection and validation of instrumental variables, we focused on 480 metabolites for analysis. Our findings revealed 38 metabolites potentially causally associated with DR. Specifically, 4-androsten-3beta,17beta-diol disulfate 2 was identified as significantly associated with a reduced risk of DR (OR = 0.471, 95% CI = 0.324-0.684, p = 7.87 × 10^- 5), even after rigorous adjustments for multiple testing. Sensitivity analyses further validated the robustness of this association, and linkage disequilibrium score regression analyses showed no significant genetic correlation between this metabolite and DR, suggesting a specific protective effect against DR.</p><p><strong>Conclusions: </strong>Our study identifies 4-androsten-3beta,17beta-diol disulfate 2, a metabolite of androgens, as a significant protective factor against diabetic retinopathy, suggesting androgens as potential therapeutic targets.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141873895","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":"Knockout of M-LP/Mpv17L, a newly identified atypical PDE, alleviates diabetic conditions in mice","authors":"Reiko Iida,&nbsp;Misuzu Ueki,&nbsp;Toshihiro Yasuda","doi":"10.1007/s00592-024-02337-7","DOIUrl":"10.1007/s00592-024-02337-7","url":null,"abstract":"","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"61 10","pages":"1327 - 1331"},"PeriodicalIF":3.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-024-02337-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858726","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":"Correction to: Personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery: a systematic synthesis of mixed methods research.","authors":"Yaxin Bi, Lijun He, Fang Yan, Yi Liu, Yu Zhang, Ronghua Gong","doi":"10.1007/s00592-024-02326-w","DOIUrl":"10.1007/s00592-024-02326-w","url":null,"abstract":"","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791627","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":"Improved diabetic retinopathy severity classification using squeeze-and-excitation and sparse light weight multi-level attention u-net with transfer learning from xception.","authors":"Sachin Bhandari, Sunil Pathak, Sonal Amit Jain, Basant Agarwal","doi":"10.1007/s00592-024-02341-x","DOIUrl":"https://doi.org/10.1007/s00592-024-02341-x","url":null,"abstract":"<p><strong>Aims: </strong>Diabetic Retinopathy (DR) is a significant cause of vision loss in diabetic patients, making early detection and accurate severity classification essential for effective management and prevention. This study aims to develop an enhanced DR severity classification approach using advanced model architectures and transfer learning to improve diagnostic accuracy and support better patient care.</p><p><strong>Methods: </strong>We propose a novel model, Xception Squeeze-and-Excitation Sparse Lightweight Multi-Level Attention U-Net (XceSE_SparseLwMLA-UNet), designed to classify DR severity using fundus images from the Messidor 1 and Messidor 2 datasets. The XceSE_SparseLwMLA-UNet integrates several advanced mechanisms: the Squeeze-and-Excitation (SE) mechanism for adaptive feature recalibration, the Sparse Lightweight Multi-Level Attention (SparseLwMLA) mechanism for effective contextual information integration, and transfer learning from the Xception architecture to enhance feature extraction capabilities. The SE mechanism refines channel-wise feature responses, while SparseLwMLA enhances the model's ability to identify complex DR patterns. Transfer learning utilizes pre-trained weights from Xception to improve generalization across DR severity levels.</p><p><strong>Results: </strong>The proposed XceSE_SparseLwMLA-UNet model demonstrates superior performance in DR severity classification, achieving higher accuracy and improved multi-class F1 scores compared to existing models. The model's color-coded segmentation outputs offer interpretable visual representations, aiding medical professionals in assessing DR severity levels.</p><p><strong>Conclusions: </strong>The XceSE_SparseLwMLA-UNet model shows promise for advancing early DR diagnosis and management by enhancing classification accuracy and providing valuable visual insights. Its integration of advanced architectural features and transfer learning contributes to better patient care and improved visual health outcomes.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141764805","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}