BMJ Open Diabetes Research & Care最新文献

{"title":"Reduced circulating Mig-6 levels are associated with dysglycemia in metabolic dysfunction associated steatotic liver disease (MASLD).","authors":"Bidisha Mukherjee, Chiranjit Bose, Subhasish Pramanik, Subhadip Kundu, Chinmay Saha, Asif Mondal, Sib Sankar Roy, Satinath Mukhopadhyay","doi":"10.1136/bmjdrc-2026-005947","DOIUrl":"10.1136/bmjdrc-2026-005947","url":null,"abstract":"<p><strong>Introduction: </strong>Type 2 diabetes mellitus (T2D) accelerates the progression of metabolic dysfunction-associated steatotic liver disease (MASLD) to hepatic fibrosis, and a subset of MASLD subjects has T2D. Identification of molecular mediators linking T2D and MASLD progression remains unmet. Studies revealed patients with steatohepatitis have lower hepatic Mitogen inducible gene-6 (Mig-6) expression, and Mig-6 gene silencing causes hyperglycemia in a preclinical study. However, the relationship between Mig-6 and dysglycemia in MASLD, including its association with pancreatic β-cell dysfunction, is unknown. We assessed serum Mig-6 level in MASLD with or without dysglycemia, and its association with Homeostasis Model Assessment of β-cell function (HOMA-β).</p><p><strong>Methods: </strong>Fibrosis 4 Index (FIB-4) score was calculated in 479 MASLD patients; those scoring 1.3-2.67 underwent liver vibration-controlled transient elastography for fibrosis assessment. F2 and F3 fibrosis subjects (119) were classified as normal glucose tolerance (NGT) (35), impaired glucose tolerance (44), and treatment-naïve T2D (40), as per American Diabetes Association criteria. Serum Mig-6 levels were measured by ELISA. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and HOMA-β were computed using serum C peptide.</p><p><strong>Results: </strong>Metabolic syndrome was present in 68% and 27% of participants with FIB-4>1.3 and <1.3, respectively. Reduced serum Mig-6 level was observed in the FIB-4 score >1.3 group. Participants with dysglycemia had lower (p<0.05) serum Mig-6 levels compared with NGT. Mig-6 showed a negative correlation with fasting plasma glucose, hemoglobin A1C and HOMA-IR and a positive correlation with HOMA-β. A cut-off value of serum Mig-6 level <97.49 pg/mL predicted dysglycemia in metabolic dysfunction-associated steatohepatitis (sensitivity 77.50%, specificity 73.08%, receiver operating characteristic analysis curve). 74.2% of the treatment-naïve T2D subjects had a low serum Mig-6, compared with 22% of subjects with NGT. HOMA-β was lower in the group having Mig-6 below the cut-off level (97.49 pg/mL). Positive predictive and negative predictive values of Mig-6 in identifying pancreatic β-cell dysfunction were 79.41% and 85.17%, respectively. For patients having HOMA-IR>1.6, corresponding values were 80% and 86.67%, respectively.</p><p><strong>Conclusion: </strong>Serum Mig-6 levels may identify MASLD patients at an increased risk of dysglycemia and positively correlate with pancreatic β-cell dysfunction.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bringing early detection to life: real-world operationalization of a presymptomatic type 1 diabetes screening and monitoring pilot program.","authors":"Carla Demeterco-Berggren, Emma Ospelt, Trevon Wright, Nicole Rioles, Don Buckingham, Ann Mungmode, Osagie Ebekozien, Christine Byer-Mendoza, Kimberly McNamara, Andrea Huber, Adriana Saldana, Laura Jacobsen","doi":"10.1136/bmjdrc-2026-005980","DOIUrl":"10.1136/bmjdrc-2026-005980","url":null,"abstract":"<p><strong>Objective: </strong>This pilot project served as a proof of concept to assess the operational feasibility of integrating presymptomatic type 1 diabetes screening and monitoring, using islet autoantibody (AAB) testing, into routine clinical care at two pediatric T1D Exchange Quality Improvement Collaborative (T1DX-QI) centers. Additionally, it identified care team perceptions of operational challenges and surveyed healthcare teams' readiness in the T1DX-QI.</p><p><strong>Research design and methods: </strong>Over an 18-month period, this initiative focused on developing and optimizing workflows, provider and patient education, technological integration, and health equity, utilizing quality improvement methodologies. Focus groups were conducted to identify care team perceptions of operational challenges via Zoom. Prior to project start, a cross-sectional survey was administered among T1DX-QI centers to assess screening and monitoring readiness.</p><p><strong>Results: </strong>Workflows for screening and monitoring were tested over time at the two centers, both developing process maps. A total of 147 individuals were screened during 12 months of active screening. No episodes of diabetes-related ketoacidosis were reported among those screened with confirmed positive results. Key facilitators of implementation identified during focus groups included enhanced interdisciplinary communication, streamlined insurance processes, and improvements to electronic health record systems. Challenges included limited clinical resources, variable patient engagement, and inconsistent insurance coverage. Readiness survey results highlighted that pediatric centers were twice as likely to conduct screening and reported greater access to results from research screening programs.</p><p><strong>Conclusions: </strong>Findings from this pilot offer critical insights into the practical implementation of presymptomatic type 1 diabetes screening and monitoring programs in diverse clinical environments. Despite identified barriers, continuous quality improvement efforts, along with identified facilitators to success, led to an increase in the number of individuals screened and monitored. Future work will focus on expanding these efforts across diverse care settings, with strategies to support sustainability beyond pilot phases.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13223644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping shared genetic determinants of eGFR and albuminuria with a focus on type 2 diabetes: a large-scale European study.","authors":"Cilia Naaman, Frederik Persson, Thomas Kümler, Simone Theilade, Glenn Chertow, Peter Rossing, Tine Hansen, Tarunveer S Ahluwalia","doi":"10.1136/bmjdrc-2025-005863","DOIUrl":"10.1136/bmjdrc-2025-005863","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Chronic kidney disease (CKD) is a global health and economic burden, particularly among individuals with type 2 diabetes (T2D). According to Kidney Disease: Improving Global Outcomes guidelines, key CKD indicators include urine albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). Although independent genetic loci for these traits have been reported, their shared genetic architecture remains insufficiently understood. We hypothesized that there are shared genetic markers of kidney function (eGFR) and albuminuria generally, but also specific to the T2D population.</p><p><strong>Methods: </strong>We conducted a cross-sectional observational study including 432 451 UK Biobank participants of primarily European descent (94%), with a subgroup of 16 265 with T2D after data quality control. We examined whether 423 single-nucleotide polymorphisms previously associated with eGFR in a large genome-wide association study meta-analysis were associated with (a) eGFR estimated using the 2021 race-free CKD-Epidemiology Collaboration creatinine equation (eGFR₂₀₂₁) and (b) UACR. Multiple linear regression models were adjusted for systolic blood pressure, age, sex, and the first 10 genetic principal components to account for population stratification. Analyses were performed using Python and R. Bonferroni correction (BC) was performed. For the T2D subgroup, the models were additionally adjusted for body mass index and glycated hemoglobin.</p><p><strong>Results: </strong>In the overall population, 422 loci were nominally associated with eGFR₂₀₂₁, of which 75 were nominally associated with UACR (p≤0.05); 12 remained significant after BC (<i>P_b</i> ≤ [Formula: see text]). In the T2D subgroup, 76 loci nominally associated with eGFR₂₀₂₁, six also associated nominally with UACR (p≤0.05), and one remained significant after BC (<i>P_b</i> ≤ [Formula: see text]). Two pleiotropic loci (<i>GSTA2, USP2-AS1</i>) suggested diabetes-specific effects.</p><p><strong>Conclusion: </strong>This study identifies several shared genetic loci underlying eGFR and UACR in both general and T2D European populations. These findings highlight common pathobiological pathways between albuminuria and reduced kidney function and provide a genetic map that may inform future CKD risk stratification and towards the development of therapeutic targets.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148027096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated multicompartment urinary long non-coding RNAs profiling (cellular, cell-free, and extracellular vesicle) for better differential diagnosis of biopsy-proven diabetic and non-diabetic kidney disease beyond conventional markers.","authors":"Madhurima Basu, Subhasis Neogi, Ranu Pal, Pradip Mukhopadhyay, Arpita Ray Chaudhury, Nitai P Bhattacharyya, Sujoy Ghosh","doi":"10.1136/bmjdrc-2026-006123","DOIUrl":"10.1136/bmjdrc-2026-006123","url":null,"abstract":"<p><strong>Introduction: </strong>Renal involvement in type 2 diabetes (T2DM) can be due to diabetes (diabetic kidney disease, DKD) or other causes (non-DKD, NDKD) or both (mixed kidney disease). Available clinical and laboratory parameters have limitations in predicting a diagnosis (gold standard renal biopsy). Long non-coding RNAs (lncRNAs) evaluated in preclinical models but unexplored in biopsy-proven kidney disease in T2DM. We aimed to determine whether there is differential expression of lncRNAs in DKD (compared with NDKD).</p><p><strong>Research design and methods: </strong>lncRNAs preselected through database search for evaluation in humans.Discovery cohort: Preselected lncRNAs () evaluated in three components of urine (urinary cell, urinary exosome, and cell-free urine) from biopsy-proven DKD, NDKD, T2DM without kidney disease and healthy subjects (n=40/group). lncRNAs found consistently significant in all components were checked in kidney tissue. Receiver operating characteristic curves were performed to evaluate diagnostic performance.Validation cohort: Best performing lncRNA (in discovery cohort) evaluated in independent cohort.</p><p><strong>Clinical utility: </strong>The utility of identified lncRNAs was further assessed for clinical decision-making.</p><p><strong>Results: </strong>Discovery cohort: Level of MALAT1 and PVT1 differed in all urinary components of DKD and elevated in kidney biopsy tissue. MALAT1 showed the most consistent results. Urinary cell-derived MALAT1 showed the most consistent results (ΔCt <8.3, sensitivity 90%, specificity 89.6% OR 53.9, p<0.0001) to differentiate DKD from NDKDValidation cohort: Urinary cell-derived MALAT1 showed sensitivity (90%) and specificity (88.5%).</p><p><strong>Clinical utility: </strong>Addition of MALAT1 to currently existing clinical/biochemical discriminators of DKD from NDKD helps improve clinical decision making, with a net reclassification improvement (NRI) of 0.53, 64% of DKD cases were correctly reclassified to a higher probability of disease (NRI+ = 0.280), and 62.5% of NDKD controls were correctly reclassified to a lower probability of disease (NRI- = 0.250).</p><p><strong>Conclusions: </strong>Urinary cell-derived MALAT1 improves the ability to differentiate DKD from NDKD over and above currently used clinical and biochemical parameters.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in immune cell profiles around the time of islet autoimmunity seroconversion in children with and without type 1 diabetes.","authors":"Kirk R Hohsfield, Patrick Carry, Sarah Slack, Charles T Repaci, Lauren A Vanderlinden, Katerina Kechris, Marian Rewers, Jill M Norris, Randi K Johnson","doi":"10.1136/bmjdrc-2026-006015","DOIUrl":"10.1136/bmjdrc-2026-006015","url":null,"abstract":"<p><strong>Introduction: </strong>Seroconversion (SV) marks islet autoimmunity (IA) onset and preclinical type 1 diabetes (T1D), yet the contributions beyond T and B lymphocytes remain unclear. We evaluated DNA methylation (DNAm)-derived immune cell ratios between T1D cases and controls around SV.</p><p><strong>Research design and methods: </strong>High-resolution immune cell-type deconvolution of peripheral blood DNAm from nested case-control samples in the Diabetes Autoimmunity Study in the Young (DAISY; n=151) and the Environmental Determinants of Diabetes in the Young (TEDDY; n=166) estimated immune cell proportions at pre-SV (the latest visit before SV) and at SV (the first visit with persistent detected autoantibodies) to construct immune cell ratios, such as the neutrophil-to-lymphocyte ratio (NLR). Linear models compared T1D cases to matched T1D controls (IA negative) at pre-SV, SV, and the change across time points.</p><p><strong>Results: </strong>From pre-SV to SV, controls showed expected developmental increases in B-memory/naive, B-CD4T-CD8T memory/naive, and NLR, while cases failed to follow these patterns, with attenuated trajectories of 35%, 38%, and 21%, respectively. Pre-SV, cases had 15% higher NLR and 9% lower CD4T/CD8T. At SV, the combined B-CD4T-CD8T memory/naive ratio was 26% reduced in cases.</p><p><strong>Conclusions: </strong>These patterns may reflect increased neutrophil activation or pancreatic infiltration, altered CD4 and CD8 T cell balance, and delayed or disrupted immune maturation with the persistence or expansion of naive B and T cells or impaired transition to memory B and T subsets following antigen exposure. Our findings highlight early shifts in innate and adaptive immune cell dynamics during T1D pathogenesis and support methylation-derived immune cell ratios as potential biomarkers for risk stratification and mechanistic insight.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of sulfonylureas on kidney outcomes in adults with type 2 diabetes and moderate cardiovascular risk: a target trial emulation.","authors":"Stacey Sklepinski, Alexandria A Ratzki-Leewing, Jeph Herrin, Kavya Sindhu Swarna, Yihong Deng, Eric C Polley, Joshua J Neumiller, Rodolfo J Galindo, Guillermo E Umpierrez, Joseph S Ross, Juan P Brito, Victor M Montori, Mindy M Mickelson, Rozalina Grubina McCoy","doi":"10.1136/bmjdrc-2025-005775","DOIUrl":"10.1136/bmjdrc-2025-005775","url":null,"abstract":"<p><strong>Introduction: </strong>To assess the within-class variation in kidney outcomes following initiation of sulfonylurea therapy.</p><p><strong>Research design and methods: </strong>We used claims data of enrollees in commercial, Medicare Advantage, and traditional Medicare health plans between 2014 and 2021 to emulate a target trial including adults ≥21 years with type 2 diabetes at moderate cardiovascular risk to compare initiation of glimepiride, glipizide, or glyburide on the incidence of chronic kidney disease (CKD) stage 3 or worse, including initiation of kidney replacement therapy (primary outcome); secondary outcomes examined incident CKD stages 3-4, kidney failure (including kidney replacement therapy), all-cause mortality, and hypoglycemia requiring emergency department or hospital care. Random treatment assignment was emulated using propensity scores, estimated using the super learner ensemble method, and incorporated as inverse probability of treatment weights into proportional hazards models.</p><p><strong>Results: </strong>The weighted study cohort included 295 092 individuals starting glimepiride (n=134 926), glipizide (n=145 984), and glyburide (n=14 182). One year after treatment initiation, stage 3 or worse CKD developed in 2.1% of patients in the glimepiride group, 2.2% in the glipizide group, and 1.8% in the glyburide group. Glyburide was associated with a lower risk of kidney complications compared with both glimepiride (HR 0.84, 95% CI 0.76 to 0.92) and glipizide (HR 0.81, 95% CI 0.73 to 0.89), despite a higher risk of severe hypoglycemia (HR 1.47, 95% CI 1.27 to 1.71 vs glipizide and HR 1.22, 95% CI 1.05 to 1.42 vs glimepiride). In contrast, the risk of kidney complications was modestly increased with glipizide compared with glimepiride use (HR 1.04, 95% CI 1.00 to 1.07).</p><p><strong>Conclusions: </strong>Glyburide was associated with a modestly lower risk of kidney complications, despite a higher risk of hypoglycemia, while glipizide was associated with a higher risk of kidney complications. These hypothesis-generating findings suggest important within-class differences that warrant consideration in clinical decision-making and future research. Despite rigorous prespecified causal inference analytic methods, the risk of unmeasured confounding and bias by indication with the use of observational data remains.</p><p><strong>Trial registration number: </strong>NCT05214573.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical therapies for diabetic foot ulcers: a systematic review and network meta-analysis.","authors":"Lihong Chen, Jui-Ching Chen, Ting Lin, Feiyan Shi, Dawei Chen, Chun Wang, Yun Gao, Harikrishna K Ragavan Nair, Xingwu Ran","doi":"10.1136/bmjdrc-2026-006026","DOIUrl":"10.1136/bmjdrc-2026-006026","url":null,"abstract":"<p><strong>Objective: </strong>Diabetic foot ulcer (DFU) is a life-threatening complication associated with high amputation and mortality rates. While numerous topical therapies exist, their comparative efficacy and safety remain unclear. We aimed to compare the efficacy and safety of topical therapies for DFUs to identify optimal treatment strategies.</p><p><strong>Research design and methods: </strong>We searched PubMed, Embase, and CENTRAL from inception to February 1, 2025, for randomized clinical trials (RCTs) evaluating topical therapies for DFUs. We excluded non-topical interventions to ensure clinically relevant comparisons. A Bayesian network meta-analysis was performed. The primary outcome was wound healing rate.</p><p><strong>Results: </strong>We included 51 RCTs involving 6161 patients and 23 interventions. 12 topical therapies, including placenta-derived products, platelet-related products, ON101, epidermal growth factor, and tissue-engineered skin substitutes, significantly improved wound healing rates vs standard of care (SOC). Placenta-derived products showed the greatest efficacy (OR 7.85 (95% credible interval (CrI) 4.62 to 14.15)) and were the only intervention to significantly reduce adverse events vs SOC (0.25 (95% CrI 0.10 to 0.60)). No interventions differed significantly from SOC in time to wound healing, serious adverse events, or infections.</p><p><strong>Conclusions: </strong>Placenta-derived products and other biological or advanced topical therapies may demonstrate greater efficacy than the SOC in facilitating the healing of DFUs. Nevertheless, the certainty of evidence for most comparisons remains in the low-to-moderate range. These findings suggest potential benefits in integrating these therapies into the management of DFUs. However, high-quality RCTs are necessary to verify long-term outcomes.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health literacy profiles of people living with type 2 diabetes: a cluster-based approach to inform tailored interventions-the Entred 3 study.","authors":"Roxane Agius, Laurent Rigal, Henri Panjo, Richard H Osborne, Sandrine Fosse-Edorh, Xavier Debussche","doi":"10.1136/bmjdrc-2026-005977","DOIUrl":"10.1136/bmjdrc-2026-005977","url":null,"abstract":"<p><strong>Introduction: </strong>Health literacy is a multidimensional determinant of health that influences diabetes outcomes and social inequities in health (SIH). Studies often measure it unidimensionally, failing to capture people's diverse health literacy skills. We identified multidimensional health literacy profiles among adults living with type 2 diabetes (T2D) in France and described their clinical, behavioral and social characteristics with a view to informing future tailored interventions.</p><p><strong>Research design and methods: </strong>This study used a cross-sectional design based on a subsample of the Entred 3 national survey, combining self-reported questionnaire data with linked administrative health data covering the previous 10 years. Health literacy was assessed using the Health Literacy Questionnaire (HLQ) among 510 individuals with T2D who completed the cross-sectional survey online. Hierarchical clustering based on standardized HLQ scores identified distinct health literacy clusters.</p><p><strong>Results: </strong>We identified 13 health literacy clusters among the online survey participants, labelled from A to M, five requiring tailored public health and clinical responses. Substantial heterogeneity concerning health literacy skills and associations with SIH and health outcomes was observed. For example, cluster A demonstrated strong self-management skills counteracted by severe barriers to care navigation and information comprehension in a highly vulnerable setting. Furthermore, cluster D reflected globally low health literacy scores, poor health outcomes and high exposure to risk factors despite recent diabetes diagnosis. A third example is cluster K, which highlighted strong relational and cognitive skills but limited engagement in self-care and significant exposure to risk factors despite favorable socioeconomic conditions.</p><p><strong>Conclusions: </strong>Health literacy profiles reflect complex combinations of skills, risks and social determinants, which can potentially inform how to tailor public health interventions, so that no group is left behind.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147926367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between type 2 diabetes mellitus and psychosocial burdens in older adults in Germany: findings from the longitudinal Gesundheit 65+ study.","authors":"Lottie Friederici, Christin Heidemann, Vera Birgel, Beate Gaertner, Jens Baumert","doi":"10.1136/bmjdrc-2026-006056","DOIUrl":"10.1136/bmjdrc-2026-006056","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigates the association between type 2 diabetes mellitus and six psychosocial burdens (depressive symptoms, loneliness, and low levels of energy, life satisfaction, satisfaction with one's activity level, and perceived social support) among older adults, using data from the population-based longitudinal study Gesundheit 65+ in Germany.</p><p><strong>Research design and methods: </strong>Data were collected from June 2021 to April 2023 via a baseline survey and three follow-up waves, primarily using paper questionnaires. The present study included 12,514 observations across 3,547 participants aged 65 and older. The presence of type 2 diabetes in the last 12 months was self-reported. Psychosocial burdens were assessed using validated scales. Binomial and multinomial logistic regressions were conducted, adjusting for sex, age, education, physical activity, obesity, cardiovascular comorbidities and cancer.</p><p><strong>Results: </strong>Type 2 diabetes was significantly associated with all examined psychosocial burdens in the unadjusted analysis. In the fully adjusted model, having type 2 diabetes increased the odds of experiencing depressive symptoms (OR 1.60, 95% CI 1.18 to 2.17), low energy (1.37, 95% CI 1.06 to 1.77), low/middle life satisfaction (1.41, 95% CI 1.15 to 1.73), loneliness (1.31, 95% CI 1.03 to 1.66) and neither satisfaction nor dissatisfaction with one's activity level (1.38, 95% CI 1.11 to 1.72), whereas the association with perceived social support lost statistical significance. Sensitivity analysis confirmed the results. No significant interactions were found for sex, age group, or study wave.</p><p><strong>Conclusions: </strong>Type 2 diabetes is associated with higher odds of different psychosocial challenges in older adults. These findings emphasize the need for integrated care models that routinely screen for and manage these conditions in persons with diabetes.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acylcarnitines and prediction of renal function decline in type 2 diabetes.","authors":"Vincenzo Trischitta, Andrea Fontana, Hetal Shah, Mario Mastroianno, Cornelia Prehn, Salvatore De Cosmo, Jerzy Adamski, Massimiliano Copetti, Alessandro Doria, Claudia Menzaghi","doi":"10.1136/bmjdrc-2025-005748","DOIUrl":"10.1136/bmjdrc-2025-005748","url":null,"abstract":"<p><strong>Introduction: </strong>We comprehensively investigated whether serum acylcarnitine levels are associated with and predict the decline of glomerular filtration rate (GFR) in type 2 diabetes.</p><p><strong>Research design and methods: </strong>Two cohorts of patients with type 2 diabetes were investigated: a subset of the aggregate Gargano Mortality Study (aGMS, n=575; 9 years of median follow-up; mean age=60.9±9.8; mean diabetes duration=11.6±9.3) as a discovery set from Italy. A sample from the Joslin Kidney Study (JKS, n=252; 10 years of median follow-up; mean age=57.8±5.6; mean diabetes duration=14.2±7.6) was used as an independent validation set with different environmental and ethnic background for some associated metabolites in the aGMS.</p><p><strong>Main outcome: </strong>estimated GFR (eGFR) change over time (mL/min/1.73 m²/year).</p><p><strong>Results: </strong>Eleven out of the 40 acylcarnitines (by the AbsoluteIDQTM p180 Kit, BIOCRATES) were significantly associated with the rate of eGFR decline after Bonferroni correction. All 11 molecules were internally validated (p<0.05). Most of these associations survived the adjustment for several confounders, including age, sex, smoking habit, body mass index, glycated hemoglobin, disease duration, albumin excretion rate, triglycerides, low-density lipoprotein and statins treatment (p<0.05). Tiglylcarnitine and methylglutarylcarnitine, but not tetradecenoylcarnitine and hexadecenoylcarnitine, were also associated with eGFR decline in the JKS (p<0.05). Using multivariable least absolute shrinkage and selection operator regression analysis, methylglutarylcarnitine, hydroxyvalerylcarnitine, hexenoylcarnitine, decadienylcarnitine, dodecanedioylcarnitine, tetradecadienylcarnitine were independently associated with kidney function decline. The pairwise correlation among these ranged from -0.02 to 0.55. An acylcarnitine score comprising these six molecules improved discrimination (p<0.01) and reclassification (p<0.001) of two clinical prediction models of GFR decline in diabetes.</p><p><strong>Conclusions: </strong>In patients with type 2 diabetes, four short, three medium and four long-chain acylcarnitines are associated with the rate of kidney function decline. Adding the acylcarnitine score to clinical prediction models improves the identification of individuals who are at greater risk of progression to kidney failure.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}