Frontiers in clinical diabetes and healthcare最新文献

{"title":"Assessment of the impact of body mass index on right ventricular systolic and diastolic function in patients with type 2 diabetes mellitus using two-dimensional speckle tracking imaging.","authors":"Wenwen Wang, Yuanyuan Peng, Kun Zhao, Ziwei Zheng, Jiangbo Feng, Chengfang Zou, Yongchun Sun, Bo Lin, Liping Wang, Bing Hu, Shaoling Yang","doi":"10.3389/fcdhc.2026.1694955","DOIUrl":"10.3389/fcdhc.2026.1694955","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of different body mass index (BMI) levels on right ventricular (RV) systolic and diastolic function in patients with type 2 diabetes mellitus (T2DM) using two-dimensional speckle tracking imaging (2D-STI), and to provide imaging reference for the early screening of subclinical RV dysfunction in overweight and obese patients with T2DM.</p><p><strong>Method: </strong>A total of 67 newly diagnosed T2DM patients (disease duration ≤6 months, treatment-naïve) and 61 age-matched healthy controls who presented to our hospital from January 2022 to June 2023 were enrolled. All participants with hypertension, cardiovascular diseases, or bronchopulmonary diseases were excluded. According to T2DM status and BMI levels, the subjects were divided into four groups: non-T2DM normal weight group (BMI 18.5-23.9 kg/m², n=30), non-T2DM overweight/obese group (BMI ≥24.0 kg/m², n=31), T2DM normal weight group (n=33), and T2DM overweight/obese group (n=34). The primary endpoint was RV free wall global longitudinal strain (RVFWS), and the secondary endpoint was the early-to-late diastolic strain rate ratio (SRe/SRa). The sample size was calculated based on a pilot study (expected effect size =1.8, α=0.05, statistical power = 80%), with a minimum required sample size of 28 per group, which was met by the actual enrollment. 2D-STI was performed to measure longitudinal strain at the basal, mid, and apical segments of the RV free wall, and the average value was defined as RVFWS. Early diastolic strain rate (SRe) and late diastolic strain rate (SRa) were recorded, and the SRe/SRa ratio was calculated. Two-way analysis of variance (ANOVA) was used to compare differences among groups, and multiple linear regression analysis was performed to identify independent predictors of RV functional parameters and to test for interaction effects. Continuous variables were expressed as mean ± standard deviation, and <i>post-hoc</i> multiple comparisons were conducted using the least significant difference (LSD) method. We integrated interpretations of main and interaction effects to minimize Type I error inflation.</p><p><strong>Results: </strong>Statistically significant differences in RVFWS and SRe/SRa ratio were observed among the four groups (all P < 0.05). Two-way ANOVA revealed significant interactions between BMI and T2DM for both RVFWS and SRe/SRa ratio (all P < 0.001). Compared with Group A, RVFWS and SRe/SRa decreased stepwise in Group B, Group C and Group D, with the greatest decline observed in Group D. Multiple linear regression demonstrated that BMI was significantly negatively associated with RVFWS and the SRe/SRa ratio in the overall cohort (P < 0.001). Full 95% confidence intervals were calculated and reported for all correlation and regression outcomes.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"7 ","pages":"1694955"},"PeriodicalIF":3.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922023","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":"Decoding RAGE in diabetes: a pathogenic signaling hub modulated by decoy receptors in diabetic complications.","authors":"Yupa Srithongchai, Ai Harashima, Seiichi Munesue, Kumi Kimura, Yu Oshima, Mariko Tanaka, Hiroya Takahashi, Pathitta Sakulsak, Chisato Uramoto, Nontaphat Leerach, Yasuhiko Yamamoto","doi":"10.3389/fcdhc.2026.1854214","DOIUrl":"10.3389/fcdhc.2026.1854214","url":null,"abstract":"<p><p>Diabetes is characterized by chronic hyperglycemia and dyslipidemia, which impose sustained metabolic stress and drive the development of diabetic complications. In this review, we position the axis between advanced glycation end-products (AGEs) and the receptor for AGEs (RAGE) as a central hub that couples metabolic stress to persistent cellular stress and inflammatory responses. Ligand engagement of full-length membrane-bound RAGE (mRAGE) enhances reactive oxygen species (ROS) generation and activates nuclear factor kappa B (NF-κB), establishing a self-amplifying feed-forward loop that promotes RAGE expression, inflammation and further AGE accumulation. RAGE exhibits marked structural heterogeneity: in addition to signaling-competent mRAGE, soluble decoy receptors-including soluble RAGE (sRAGE) produced by ectodomain shedding and endogenous secretory RAGE (esRAGE) generated by alternative splicing-sequester ligands and attenuate downstream signaling. Moreover, RAGE recognizes a broad ligand repertoire beyond AGEs, such as S100 proteins and high-mobility group box 1 (HMGB1), reinforcing its role as an integrator of metabolic and sterile inflammatory cues. Notably, RAGE also mediates physiological transport of oxytocin across the blood-brain barrier (BBB), a process implicated in oxytocin-dependent social behaviors, without activating canonical, pro-inflammatory RAGE signaling. Accordingly, therapeutic strategies should selectively suppress pathogenic, ligand-driven RAGE signaling and/or augment decoy RAGE activity while preserving RAGE-dependent oxytocin transport.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"7 ","pages":"1854214"},"PeriodicalIF":3.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922018","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":"Real-world outcomes of sitagliptin and sitagliptin/metformin single-pill combination treatment in diverse type 2 diabetes populations (DIVERSITY study).","authors":"Andrej Janez, Mirjana Bojic, Tomislav Bozek, Zdravko Kamenov, Tatjana Milenkovic, Gabriela Radulian, Tamás Várkonyi","doi":"10.3389/fcdhc.2026.1905393","DOIUrl":"10.3389/fcdhc.2026.1905393","url":null,"abstract":"<p><strong>Introduction: </strong>Real-world evidence on dipeptidyl peptidase-4 (DPP-4) inhibitors is limited by selective populations in randomized trials. The international, prospective DIVERSITY study evaluated the effectiveness, safety, and treatment acceptability of sitagliptin and sitagliptin/metformin single-pill combination (SPC) in routine clinical practice across diverse type 2 diabetes (T2D) populations.</p><p><strong>Methods: </strong>This non-interventional, multicenter study enrolled adults with T2D eligible for sitagliptin or sitagliptin/metformin SPC and followed them for 6 months with three data captures (baseline, ~3 months, ~6 months). The analysis set comprised 2,603 patients (mean age 64.6y ± 10.6; 53.1% women) meeting all criteria and with ≥152 days between first and third captures. Primary outcomes were absolute changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and post-prandial glucose (PPG) from baseline to 6 months. Secondary outcomes included the proportion achieving HbA1c <7% at 3 and 6 months, changes in body mass index (BMI), and hypoglycemia incidence. Safety was assessed in all treated patients (safety analysis set [SAS], n=2,697).</p><p><strong>Results: </strong>Glycemic control improved over the 6-month observation period. Among patients with paired data, mean HbA1c fell from 7.98% to 6.99% (Δ -0.99%, 95% CI -1.05 to -0.93). Reductions were observed with both regimens: sitagliptin monotherapy (Δ -0.93%, 95% CI -1.01 to -0.85) and sitagliptin/metformin SPC (Δ -1.03%, 95% CI -1.11 to -0.96). FPG decreased by -1.91 mmol/L (95% CI -2.03 to -1.79) and PPG by -2.39 mmol/L (95% CI -2.56 to -2.21). The share of patients with HbA1c <7% rose from 16.9% at baseline to 53.7% at 6 months. BMI changes were small and consistent with weight neutrality (mean -0.61 ± 1.33 kg/m²). Treatment-related symptoms of hypoglycemia were rare (3 cases [0.1%] of all treated patients) and treatment acceptability was high: ≥90% patients and investigators reported satisfaction at 6 months.</p><p><strong>Conclusions: </strong>In routine practice across heterogeneous T2D populations, sitagliptin and sitagliptin/metformin SPC were associated with clinically meaningful improvements in HbA1c, FPG, and PPG over 6 months, with effects consistent with a weight-neutral profile, a low reported incidence of hypoglycemia, and high treatment satisfaction. These findings are consistent with the use of sitagliptin-based regimens, whether used as monotherapy or as add-on therapy, as treatment options in routine real-world care, including in older and multimorbid patients.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"7 ","pages":"1905393"},"PeriodicalIF":3.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922010","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":"Outcomes of the Sustainable Culturally Adapted Nutrition Program (SCAN) and food supplement program to improve engagement with the National Diabetes Prevention Program (NDPP).","authors":"William B Perkison, Pierre Fwelo, Natalia I Heredia, Ella Garza, James J Yang, Fernanda Velasco-Huerta, Serena A Rodriguez, Sidra S Beg, Catherine Pulicken, Patenne D Mathews, Belinda M Reininger, Roshanda S Chenier, Maria E Fernandez","doi":"10.3389/fcdhc.2026.1838175","DOIUrl":"10.3389/fcdhc.2026.1838175","url":null,"abstract":"<p><strong>Purpose: </strong>The National Diabetes Prevention Program (National DPP) is an evidence-based lifestyle program for patients with prediabetes, but low attendance and retention hinder its effectiveness. To improve adherence, we developed the Sustainable Culturally Adapted Nutrition (SCAN) program. SCAN includes 4 group cooking technique lessons and group motivational interviewing counseling to reinforce participants' ability to adapt and sustain the dietary recommendations discussed in the National DPP. The study aims were to assess 1) the feasibility of incorporating SCAN into the National DPP and 2) health related outcomes for SCAN + National DPP compared to National DPP only.</p><p><strong>Methods: </strong>We employed a pragmatic quasi-experimental approach for this pilot. 37 National DPP participants were recruited from a Federally Qualified Health Center in Houston, Texas, and were randomized to participate in the intervention or control arms. The primary outcome was National DPP attendance, and the secondary outcomes were weight and body mass index (BMI). Chi-square and Fisher's exact tests compared baseline characteristics. Linear regression assessed the association between weight and National DPP attendance.</p><p><strong>Results: </strong>At 12 months, the intention-to-treat and per-protocol analyses found no significant difference in attendance. There was a greater dose-response association between National DPP attendance and average weight loss in the intervention group. Among the SCAN cohort, there were improvements in confidence in assessing personal risk for diabetes and ability to reach healthcare providers.</p><p><strong>Conclusion: </strong>SCAN's integration into the National DPP has shown potential in improving attendance and was well received. Larger scale implementation is necessary to understand the long-term impact of SCAN.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"7 ","pages":"1838175"},"PeriodicalIF":3.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908192","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":"Bone morphogenetic protein 4-associated mitochondrial dysfunction in diabetic nephropathy involves Parkin downregulation.","authors":"Masanori Tamaki, Tatsuya Tominaga, Kazuhiro Hasegawa, Takahiro Kida, Shinji Miyakami, Ikuko Shimizu, Sumiyo Yamaguchi, Masanori Minato, Kojiro Nagai, Shu Wakino","doi":"10.3389/fcdhc.2026.1860424","DOIUrl":"10.3389/fcdhc.2026.1860424","url":null,"abstract":"<p><strong>Background: </strong>Diabetic nephropathy (DN) is characterized by mesangial expansion and mitochondrial dysfunction. Although bone morphogenetic protein 4 (BMP4) is a pro-fibrotic factor in DN, its role in mesangial mitochondrial homeostasis remains unclear. This study investigated whether a decrease in Parkin is involved in mitochondria-related abnormalities following BMP4 stimulation.</p><p><strong>Methods: </strong>Renal tissues from streptozotocin (STZ)-induced diabetic mice were subjected to biochemical, histological, and molecular analyses. <i>In vitro</i>, cultured mouse mesangial cells were exposed to recombinant BMP4 in the presence or absence of the activin receptor-like kinase (ALK) inhibitor LDN-193189. A mesangial cell line overexpressing Parkin was used to assess the role of Parkin under BMP4 stimulation. Mitochondrial function and the expression of Parkin and related genes were analyzed.</p><p><strong>Results: </strong>In STZ-induced diabetic mice, mesangial expansion was accompanied by mitochondrial abnormalities, increased BMP4 expression, diminished mtDNA copy number, and decreased expression of Parkin and related genes. In cultured mesangial cells, BMP4 stimulation was accompanied by a decrease in Parkin expression and reduced mitochondria-related indices, including decreased expression of mitochondrial function-related genes, reduced ATP production, and loss of membrane potential. The BMP4-induced changes in gene expression and mitochondrial functional indices were ameliorated by ALK inhibition. Furthermore, Parkin overexpression ameliorated BMP4-induced decreases in gene expression and mitochondrial functional indices.</p><p><strong>Conclusion: </strong>These findings suggest that decreased Parkin expression associated with BMP4 stimulation may be one of the molecular alterations contributing to mitochondria-related abnormalities in mesangial cells. Disrupted mitochondrial homeostasis accompanied by decreased Parkin expression may represent a candidate therapeutic pathway in DN.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"7 ","pages":"1860424"},"PeriodicalIF":3.5,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820415","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":"Economic evaluation of liraglutide versus sitagliptin in the treatment of type 2 diabetes mellitus inadequately controlled with metformin.","authors":"Fengkun Yang, Xiaohui Zheng, Wenqi Li, Zhenying Zhao","doi":"10.3389/fcdhc.2026.1906364","DOIUrl":"https://doi.org/10.3389/fcdhc.2026.1906364","url":null,"abstract":"<p><strong>Objective: </strong>To assess the long-term economic value of liraglutide compared with sitagliptin among patients with type 2 diabetes mellitus (T2DM) who fail to achieve adequate glycemic control with metformin monotherapy.</p><p><strong>Methods: </strong>A Markov model based on China's health system was constructed. Using data from the 1860-LIRA-DPP-4 study, long-term costs, and utilities over a 30-year horizon were simulated for Chinese T2DM patients receiving liraglutide or sitagliptin in combination with metformin. The incremental cost-effectiveness ratio (ICER) was estimated against a willingness-to-pay (WTP) threshold of three times the 2025 per capita gross domestic product (GDP) in China. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analysis were performed to validate the robustness of the base-case results.</p><p><strong>Results: </strong>Thirty-year disease simulation showed that, compared with sitagliptin plus metformin, liraglutide plus metformin yielded an ICER of 267,985.96 RMB/QALY, which was below the predefined WTP threshold, indicating that it is cost-effective. One-way sensitivity analysis revealed that costs in the complication-free state for the intervention group, utility values for uncomplicated diabetes, and utility values for complicated diabetes had the greatest impacts on the ICER. Probabilistic sensitivity analysis showed that liraglutide plus metformin was cost effective for 63.6% of the iterations. Scenario analysis indicated that the economic advantage of liraglutide plus metformin became more pronounced as the price of liraglutide decreased.</p><p><strong>Conclusion: </strong>Within the Chinese healthcare setting, for patients with T2DM inadequately controlled on metformin monotherapy, liraglutide plus metformin has a 63.6% probability of being cost-effective at the pre-specified WTP threshold, suggesting that the combination regimen is likely to be cost-effective.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"7 ","pages":"1906364"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802375","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":"Metabolic and clinical markers of T2D in obese Indians: an age-sex matched case-control study.","authors":"Anagha Vyawahare, Pramod Tripathi, Nidhi Kadam, Diptika Tiwari, Baby Sharma, Thejas Kathrikolly, Malhar Ganla, Banshi Saboo","doi":"10.3389/fcdhc.2026.1809646","DOIUrl":"https://doi.org/10.3389/fcdhc.2026.1809646","url":null,"abstract":"<p><strong>Introduction: </strong>Type 2 diabetes (T2D) is a significant metabolic disorder with disproportionately high burden in obese South Asian populations, yet not all obese individuals develop the disease. This study identified the metabolic, inflammatory, and pharmacological markers associated with prevalent T2D in obese Indians using age- and sex-matched case-control analysis.</p><p><strong>Methods: </strong>A matched-pair analysis was performed on 514 age- and sex-matched pairs with and without T2D. Patients had obesity [body mass index (BMI) 25-45 kg/m², aged 20-75 years] and participated in a one-year lifestyle intervention program in India. Anthropometric, biochemical markers and medical history were analyzed. Homeostatic model assessment for insulin resistance (HOMA2IR) and beta-cell function (HOMA2%B) was calculated. Significant markers were incorporated into a logistic regression model and temporally validated in an independent time-cohort (n=966). Performance was evaluated through discrimination [receiver operating characteristics area under the curve (ROC-AUC)], calibration, and decision curve analysis. A nomogram was constructed based on the logistic regression model.</p><p><strong>Results: </strong>Median age and BMI were 46 (IQR 12) years and 29.7 (IQR 5.5) kg/m². Key markers associated with prevalent T2D were poor beta-cell function (HOMA2%B ≤50; OR = 40.9, 95% CI: 24.5-68.2), insulin resistance (HOMA2IR ≥2; OR = 4.5, 95% CI: 3.0-6.7), low HDL-C (OR = 2.1, 95% CI: 1.5-3.0), elevated hsCRP ≥3 mg/L (OR = 1.9, 95% CI: 1.4-2.7), Obesity Class I (BMI 25.0-29.9 kg/m²; OR = 2.1, 95% CI: 1.5-2.9), and antihypertensive medication use (OR = 1.7, 95% CI: 1.2-2.4). Model discrimination was good (AUC 0.860 development, 0.865 validation, both p<0.001). The Hosmer-Lemeshow test showed good model fit (p=0.562). Isotonic-calibrated Models 1 and 2 had Brier scores 0.14 and 0.162, indicating acceptable calibration. Decision curve analysis confirmed net clinical benefit across threshold probabilities 0.10-0.85.</p><p><strong>Conclusion: </strong>This study identified and temporally validated key metabolic and clinical markers associated with prevalent T2D, demonstrating good discrimination (AUC 0.860) in obese Indian individuals. External validation and prospective evaluation are needed before clinical application.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"7 ","pages":"1809646"},"PeriodicalIF":3.5,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802362","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":"Construction of a dynamic prediction model for diabetic retinopathy risk in adults with adult-onset type 1 diabetes: a real-world longitudinal cohort study.","authors":"Di Bao, Yingying Li, Chun Mu, Qiuling Xing","doi":"10.3389/fcdhc.2026.1873754","DOIUrl":"10.3389/fcdhc.2026.1873754","url":null,"abstract":"<p><strong>Objective: </strong>To construct and validate a dynamic prediction model for diabetic retinopathy (DR) risk in adults with adult-onset type 1 diabetes mellitus (T1DM).</p><p><strong>Methods: </strong>A longitudinal cohort of 572 adult-onset T1DM patients from a tertiary hospital in Tianjin, China (2014-2023) was analyzed. LASSO regression and multivariable Cox regression with time-varying covariates (duration and HbA1c) were used to identify independent predictors of DR and to construct a nomogram. Model performance was assessed using the concordance index (C-index), area under the receiver operating characteristic curve (AUC), Brier score, calibration curves, Hosmer-Lemeshow test, and decision curve analysis (DCA). Internal validation was performed by bootstrap resampling (1000 replicates).</p><p><strong>Results: </strong>Multivariable Cox regression identified diabetic peripheral vascular disease, diabetic kidney disease, metabolic bone disease, dynamic disease duration, time-varying HbA1c, body mass index (BMI), and gender as independent predictors of DR. The dynamic model had a C-index of 0.704 (corrected: 0.681), with 1-, 2-, and 3-year AUCs of 0.704, 0.713, and 0.732, respectively. Brier scores were all <0.1. Calibration was acceptable at 2 and 3 years; the 1-year calibration slope was elevated (1.895). Hosmer-Lemeshow test P-values were >0.05 at all time points. The dynamic model outperformed a traditional static model in both discrimination and calibration. DCA showed favorable net clinical benefit for 2- and 3-year predictions.</p><p><strong>Conclusion: </strong>This study demonstrates the feasibility of dynamic DR risk assessment in adult-onset T1DM. The proposed nomogram may serve as an auxiliary tool for predicting 2- to 3-year DR risk, supporting nurses in risk stratification and individualized screening guidance.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"7 ","pages":"1873754"},"PeriodicalIF":3.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714828","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":"Dapagliflozin & pioglitazone combination therapy in T2DM with or without MASLD - a systematic review and meta-analysis: PRO-2 study.","authors":"Shashank Joshi, Shambo Samrat Samajdar, Arvind Gupta, Mithun Bhartia, Sailesh Lodha, Supratik Bhattacharyya, Krishna Seshadri, Lakshmi Nagendra, A G Unnikrishnan, Dakshata Padhye, Lakshmi Nalini Kopalle, Ashok Kumar Das, Om Lakhani, Jothydev Kesavadev, Ameya Joshi, Sambit Das, Smriti Gadia, Thamburaj Anthuvan","doi":"10.3389/fcdhc.2026.1733995","DOIUrl":"10.3389/fcdhc.2026.1733995","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the efficacy and safety of dapagliflozin plus pioglitazone versus comparators on metabolic control and hepatic steatosis in adults with type 2 diabetes mellitus (T2DM), with or without metabolic dysfunction-associated steatotic liver disease (MASLD).</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized and observational studies in PubMed, Embase, Cochrane Central, Scopus, Web of Science with a search updated through January 2026, following peer review. Eligible studies enrolled adults with T2DM with or without MASLD, receiving dapagliflozin plus pioglitazone in comparison with standard care or monotherapy, or as pooled-arm exploratory estimates. The primary outcome was glycemic control (HbA1c and fasting and postprandial glucose levels). Secondary outcomes included body weight, insulin resistance indices, related liver outcomes (liver fat content, NAFLD activity score [NAS], and steatohepatitis resolution), liver enzymes, non-invasive fibrosis indices, lipid parameters, and safety outcomes.</p><p><strong>Results: </strong>Thirteen studies (n = 1411) met the inclusion criteria. Dapagliflozin-pioglitazone significantly improved glycemic control, with a reduction in HbA1c (mean difference -0.49%; 95% CI -0.64 to -0.34), and Fasting Blood Glucose (-11.96 mg/dL; 95% CI -16.30 to -7.62) and Post-Prandial Glucose (-21.54 mg/dL; 95% CI -30.84 to -12.24). Hepatic outcomes also improved, with reductions in liver fat content (standardized mean difference -0.42; 95% CI -0.61 to -0.22) and NAS (standardized mean difference -0.39; 95% CI -0.56 to -0.22), and higher rates of steatohepatitis resolution (risk ratio 1.48; 95% CI 1.13-1.92). Certainty of evidence was moderate for glycemic and steatosis outcomes and low for histological endpoints.</p><p><strong>Conclusions: </strong>Dapagliflozin-pioglitazone combination therapy was associated with improvements in glycemic control and non-invasive markers of hepatic steatosis in adults with T2DM, with or without MASLD, while maintaining a favorable safety profile. Certainty of evidence was moderate for metabolic and steatosis outcomes and low for histological endpoints. Given the predominance of surrogate hepatic endpoints and limited biopsy-confirmed data, these findings should be interpreted with appropriate caution.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1117019, identifier CRD420251117019.</p>","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"7 ","pages":"1733995"},"PeriodicalIF":3.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13429781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671523","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":"Malnutrition and type 2 diabetes mellitus across diverse global populations: a systematic review of observational evidence.","authors":"Olalekan Chris Akinsulie, Oluwagbemisola Oyin Olukogbe, Babatunde Ibrahim Olowu, Victor Ayodele Aliyu, Ibrahim Idris, Charles Egede Ugwu, Damilola A Ibirogba, Adesina Abiodun Ridwan, Oluwole Fasakin, Fakorede Bushroh Adeola","doi":"10.3389/fcdhc.2026.1749421","DOIUrl":"10.3389/fcdhc.2026.1749421","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Malnutrition, encompassing undernutrition, overnutrition, and micronutrient deficiency represents a global public health challenge with substantial implications for the development and clinical progression of type 2 diabetes mellitus (T2DM). The bidirectional relationship between nutritional status and glycemic regulation remains incompletely characterized across diverse geographic and socioeconomic settings worldwide, warranting a systematic synthesis of the available observational evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted across PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL register from inception through December 2024. Twenty primary studies were included from multiple high-, middle-, and low-income countries across Asia, Europe, Africa, the Americas, and the Middle East, encompassing a total of more than 25,000 participants. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) checklist; 45% of studies were assessed as high confidence and 55% as moderate confidence, following structured qualitative domain-level appraisal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Malnutrition prevalence, assessed by multiple validated instruments, ranged substantially across study populations and settings. Nutritional risk, defined by Geriatric Nutritional Risk Index criteria, was identified in 30.3% of participants in one Chinese cross-sectional study (n=551). Malnutrition prevalence, assessed using heterogeneous validated instruments across clinically and geographically diverse populations, ranged from 18.5% to 83.8% across included studies; this wide range reflects substantial variation in assessment instrument, patient acuity, clinical setting, and population demographics rather than a uniform epidemiological estimate. Indicators of undernutrition - including hypoalbuminemia, low BMI, and micronutrient deficiency - were associated with impaired glycemic regulation, greater complication burden, and elevated mortality risk. Adjusted odds ratios for diabetic retinopathy associated with malnutrition ranged from 1.67 (95% CI: 1.04-2.70) to 2.24 (95% CI: 1.07-4.69) depending on nutritional index used. Severe malnutrition was associated with 8.91-fold higher adjusted mortality odds (95% CI: 1.04-76.18) compared with moderate malnutrition among hospitalized T2DM patients. Conversely, indicators of overnutrition including elevated BMI and increasing waist circumference - were consistently associated with incident T2DM and adverse cardiometabolic profiles across multiple prospective and cross-sectional studies. Early-life famine exposure was associated with elevated adjusted odds of hyperglycemia in adulthood (aOR range: 1.34-1.57), emphasizing the relevance of developmental nutritional programming to adult T2DM risk. A dual burden of maln","PeriodicalId":73075,"journal":{"name":"Frontiers in clinical diabetes and healthcare","volume":"7 ","pages":"1749421"},"PeriodicalIF":3.5,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681319","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}