Type 2 diabetes mellitus(T2DM)was identified as the most prevalent form of diabetes.This study employed an integrated strategy combining network pharmacology,metabolomics,and experimental validation to elucidate the t...Type 2 diabetes mellitus(T2DM)was identified as the most prevalent form of diabetes.This study employed an integrated strategy combining network pharmacology,metabolomics,and experimental validation to elucidate the therapeutic mechanisms of red mulberry water extract(RMW)in T2DM.Systematic analysis identified six bioactive constituents,with four key components(cyanidin,quercetin,morin,andβ-carotene)demonstrating significant interactions with diabetes-related targets.Network pharmacology revealed these compounds modulate critical pathways including AMPK(P=2.3×10^(−5)),PI3K-Akt(P=1.8×10^(−4)),and PPAR signaling(P=3.1×10^(−3)).In diabetic mice,treatment significantly improved glycemic control(32.5%reduction in fasting glucose,P<0.01),lipid profiles(36.7%lower TG,P<0.05),antioxidant activity(2.1-fold increased SOD,P<0.05),and inflammation(42%reduced TNF-α,P<0.05).Metabolomic analysis further confirmed alterations in catecholamine and lipid metabolism pathways.These findings collectively demonstrate mulberry's multi-target therapeutic potential through synergistic regulation of glucose metabolism,lipid homeostasis,oxidative stress,and inflammatory responses in diabetes.展开更多
Objectives:The combination of atezolizumab plus bevacizumab(A+B)represents one of the standards first-line treatments for unresectable hepatocellular carcinoma(HCC).Metformin has garnered attention for its potential a...Objectives:The combination of atezolizumab plus bevacizumab(A+B)represents one of the standards first-line treatments for unresectable hepatocellular carcinoma(HCC).Metformin has garnered attention for its potential antitumour and immunomodulatory properties beyond glycaemic control.This study aimed to assess metformin’s impact in patients with type 2 diabetes mellitus(T2DM)receiving A+B therapy.Methods:This retrospective analysis of a prospectively-maintained multicentre database included 523 patients with HCC treated with A+B from the ARTE(Atezolizumab-bevacizumab Real-life Experience for Treatment of Hepatocellular Carcinoma)dataset across 18 Italian centres(May 2020-January 2024).We evaluated objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),overall survival(OS),and time to progression(TTP)using Cox regression analysis and Inverse Probability of Treatment Weighting(IPTW)to address confounding.Results:Among 523 patients,341(65.2%)did not have diabetes and 182(34.8%)had T2DM.In the overall population,metformin showed no significant benefit for PFS(HR=1.15,95%CI[0.88-1.50],p=0.316)or OS(HR=1.28,95%CI[0.94-1.74],p=0.124).In the subgroup with T2DM(N=180),metformin showed no significant benefit for PFS(HR=1.41,95%CI[0.97-2.05],p=0.069),OS(HR=1.23,95%CI[0.81-1.86],p=0.333),or TTP(HR=0.82,95%CI[0.53-1.26],p=0.363).IPTW analysis confirmed these negative findings.Conclusion:This study found no evidence of improved outcomes with metformin use in patients with HCC in particular with T2DM receiving A+B therapy.Routine metformin use should not be expected to enhance A+B efficacy based on current evidence.展开更多
Rheumatoid arthritis(RA)is a chronic systemic autoimmune disease that extends beyond joint inflammation,affecting pulmonary and metabolic pathways.Interstitial lung disease(ILD)is one of its most serious extra-articul...Rheumatoid arthritis(RA)is a chronic systemic autoimmune disease that extends beyond joint inflammation,affecting pulmonary and metabolic pathways.Interstitial lung disease(ILD)is one of its most serious extra-articular complications,while type 2 diabetes mellitus(T2DM)frequently coexists with RA and may exacerbate inflammatory and fibrotic processes.This editorial discusses the study by Sutton et al,the largest population-based analysis to date exploring the link between T2DM and ILD in patients with RA,and reflects on its mechanistic and clinical implications.In a nationwide cohort of more than 120000 hospitalized RA patients,Sutton et al demonstrated that the coexistence of T2DM nearly doubles the odds of developing ILD(odds ratio=2.02;95%confidence interval:1.84-2.22),with additional increases in pulmonary hypertension,pneumothorax,and length of stay.These findings reinforce the concept of a metabolic-pulmonary-autoimmune axis,in which chronic inflammation promotes insulin resistance and metabolic dysfunction,while hyperglycaemia and advanced glycation end-products amplify oxidative stress and fibrogenesis.This reciprocal interaction may induce a self-perpetuating cycle of“metaflammation”,fibrosis,and organ damage.Conclusion:Recognizing diabetes as a silent amplifier of RA-associated ILD redefines the interface between rheumatology,pulmonology,and endocrinology.Early detection and integrated management of metabolic and pulmonary comorbidities should be prioritized,while future studies must determine whether optimizing glycemic control can attenuate pulmonary fibrosis and improve longterm outcomes.展开更多
Objective:To determine whether immunotherapy can bring new hope for patients with limited-stage small-cell lung cancer(LS-SCLC).We conducted this retrospective study to evaluate whether immunotherapy can achieve bette...Objective:To determine whether immunotherapy can bring new hope for patients with limited-stage small-cell lung cancer(LS-SCLC).We conducted this retrospective study to evaluate whether immunotherapy can achieve better efficacy in LS-SCLC patients.Methods:We evaluated 122 LS-SCLC patients who received concurrent chemoradiotherapy(CCRT)or sequential chemoradiotherapy(SCRT)(Group A)and immunotherapy combined with CCRT/SCRT followed by immunotherapy(Group B),to assess the objective response rate(ORR),disease control rate(DCR),and progression-free survival(PFS).Factors affecting prognosis were also explored using Cox analysis.The prognosis of patients with type 2 diabetes and patients with different TNM stages was compared to guide the selection of clinical regimens.Results:The overall ORR was 55.93%.The overall DCR was 98.31%.The DCR was 100%in Group A and 96.61%in Group B.There was no statistical difference in ORR and DCR.The overall median PFS was 9.86 months(95%CI,8.62-11.10),and the difference in median PFS between the two groups was statistically significant(8.94 vs.11.89 months,p=0.03).The Cox regression analysis showed type 2 diabetes was associated with the survival prognosis.Patients with type 2 diabetes tended to choose immunotherapy combined with CCRT/SCRT.Patients in TNM stage IIIB had a significantly worse prognosis than those in stage I+II+IIIA.Conclusion:We suggest that LS-SCLC patients who receive immunotherapy combined with CCRT/SCRT can achieve longer PFS than those with CCRT/SCRT.Type 2 diabetes and TNM stage affect the survival prognosis.Patients with type 2 diabetes may benefit from immunotherapy combination treatments.展开更多
Objective: To investigate the clinical efficacy and safety of auricular acupressure therapy in elderly patients with type 2 diabetic neurogenic bladder, and to provide a feasible external treatment intervention plan b...Objective: To investigate the clinical efficacy and safety of auricular acupressure therapy in elderly patients with type 2 diabetic neurogenic bladder, and to provide a feasible external treatment intervention plan based on traditional Chinese medicine (TCM) for such patients. Methods: A randomized controlled study was conducted, selecting elderly patients with type 2 diabetic neurogenic bladder who met the inclusion criteria and randomly dividing them into a control group and an observation group. The control group received conventional comprehensive diabetes management and bladder function training, while the observation group additionally received auricular acupressure therapy, involving continuous stimulation of relevant auricular points such as Shenmen, Subcortex, Sympathetic, Kidney, Bladder, and Urethra, for a treatment duration of two courses. Changes in maximum urinary flow rate, bladder residual urine volume, TCM syndrome scores, and quality of life index (QOL) were compared between the two groups before and after treatment, and adverse reactions during treatment were recorded and analyzed. Results: After treatment, the observation group demonstrated superior improvement in clinical symptoms such as dysuria and urinary retention compared to the control group, with a significant increase in maximum urinary flow rate, a notable decrease in bladder residual urine volume and TCM syndrome scores, and a concurrent improvement in quality-of-life scores. The differences between the groups were statistically significant (p < 0.05). No serious adverse events occurred during treatment, and minor local discomfort resolved spontaneously after management, indicating overall good safety. Conclusion: As a simple and persistent TCM external treatment method, auricular acupressure therapy can further improve urinary function and quality of life in elderly patients with type 2 diabetic neurogenic bladder when combined with conventional treatment, with high safety and certain clinical promotion value.展开更多
Background:Diabetes mellitus(DM)is a chronic illness with potentially fatal and debilitating consequences.Problems with glycemic management are a major issue that adds an added strain to public health services.Objecti...Background:Diabetes mellitus(DM)is a chronic illness with potentially fatal and debilitating consequences.Problems with glycemic management are a major issue that adds an added strain to public health services.Objectives:The purpose of this study is to evaluate the prevalence of poor glycemic control and its related variables among type 2 diabetes mellitus(T2DM)patients in southern Jordan.Methods:A cross-sectional study was carried out in the Prince Hashem bin Abdullah II Hospital in Jordan's southernmost province.For the period April–July 2024,516 individuals with T2D were enrolled.A structured questionnaire that had been pre-prepared was used to collect data.As an index of glycemic control,a glycated hemoglobin(Hb A1c)7%cut-off point was adopted.Results:Poor glycemic control was prevalent in 81.0%of T2DM individuals.Inadequate glycemic control was significantly worse in non-married patients and those with 10 or more years of diabetes duration,insulin treatment,dyslipidemia,neuropathy,cardiovascular illness,and glomerular filtration rate(GFR=60 m L/min;[P<0.05]).Moreover,dyslipidemia and insulin administration increased the likelihood of poor glycemic control(odds ratio[OR]:2 and 5,respectively)(P<0.05).Conclusions:Inadequate glycemic control was common among the current study par ticipants.To prevent disease consequences and enhance the health of patients with diabetes,health care professionals should pay special attention to related risk factors such as dyslipidemia,neuropathy,cardiovascular disease(CVD),extended illness duration,and insulin usage.展开更多
Diabetic kidney disease (DKD)is one of the most common and severe microvascular complications of type 2 diabetes mellitus (T2DM). It is also a major cause of end-stage renal disease (ESRD), making early identification...Diabetic kidney disease (DKD)is one of the most common and severe microvascular complications of type 2 diabetes mellitus (T2DM). It is also a major cause of end-stage renal disease (ESRD), making early identification and intervention crucial. Insulin resistance (IR)is a key pathophysiological mechanism of T2DM and plays a central role in the progression of DKD. In recent years, a series of novel surrogate indicators of IR, such as the triglyceride-glucose (TyG) index, TyG-body mass index (TyG-BMI), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), and metabolic score for insulin resistance (METS-IR), have attracted widespread attention due to their simplicity and cost-effectiveness. This article reviews the research progress of novel surrogate indicators of insulin resistance (IR) in type 2 diabetic kidney disease (DKD), aiming to provide references for the early prevention and improved prognosis of DKD.展开更多
Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and wheth...Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and whether this association differs by baseline body-mass index(BMI).Methods:This retrospective cohort study used electronic health records from the TriNetX U.S.research network.Adults aged 20 years or older diagnosed with T2DM between 2016 and 2024 were included if they received any hypoglycemic agents within 3 months before and after diagnosis.Following 1:1 propensity score matching,both the GLP-1 RA user and non-user groups included 183,264 patients.The study outcome was defined as a diagnosis of malignant neoplasms.Hazard ratios(HRs)for overall and site-specific cancer risk were estimated using Cox proportional hazards models.Kaplan–Meier analysis and stratified analysis by BMI were performed.Results:Early GLP-1 RA use demonstrated a modest but significant association with reduced overall cancer risk(HR 0.93;95%CI:0.90–0.96).Reduced risks were noted for cancers of the digestive(HR 0.81),respiratory(HR 0.66),and female genital(HR 0.87)systems.In stratified analysis,benefits were more pronounced in patients with BMI≥30,particularly for pancreatic and colorectal cancers.Conclusion:Early initiation of GLP-1 receptor agonists in patients with diagnosed T2DM was associated with a modest reduction in overall cancer risk,particularly among individuals with obesity.These findings highlight the dual metabolic and oncologic value of prompt GLP-1 RA therapy.展开更多
Objective:To investigate the effects of switching to either Prandilin 25R monotherapy or Prandilin 25R combined with ganagliflozin proline tablets after short-term intensive continuous subcutaneous insulin infusion du...Objective:To investigate the effects of switching to either Prandilin 25R monotherapy or Prandilin 25R combined with ganagliflozin proline tablets after short-term intensive continuous subcutaneous insulin infusion during hospitalization in elderly patients with type 2 diabetes mellitus on glycemic control,glycometabolic indicators,and cardiovascular risk factors,and to evaluate the safety of the two regimens.Methods:A total of 78 elderly patients with type 2 diabetes mellitus admitted to our hospital from January 2025 to September 2025 were selected and randomly divided into a control group and an observation group,with 39 cases in each group.The control group received monotherapy with insulin lispro protamine recombinant injection(Prandilin 25R)after intensive continuous subcutaneous insulin infusion,while the observation group received Prandilin 25R combined with ganagliflozin proline tablets.Continuous glucose monitoring(CGM)was performed for 14 days during the intensive continuous subcutaneous insulin infusion therapy phase in the hospital,followed by routine fingertip blood glucose monitoring after 14 days.Glycemic control indicators,glycometabolic indicators,and the incidence of adverse reactions were compared between the two groups.Results:After treatment,the mean amplitude of glycemic excursions and the 24-hour blood glucose standard deviation were significantly lower in the observation group than in the control group,while the time spent within the target blood glucose range was significantly higher(p<0.05).The levels of glycated hemoglobin,fasting blood glucose,and 2-hour postprandial blood glucose were better in the observation group than in the control group;moreover,the body mass index,systolic blood pressure,and blood lipid levels improved more significantly in the observation group than in the control group(p<0.05).There was no statistically significant difference in the incidence of hypoglycemia between the two groups.Conclusion:Combination therapy with ganagliflozin proline tablets after short-term intensive continuous subcutaneous insulin infusion therapy can effectively improve glycemic variability in elderly patients with type 2 diabetes mellitus,with good safety.This suggests that ganagliflozin proline tablets have a hypoglycemic advantage in the combination regimen and possess high clinical promotional value.展开更多
Objective:To analyze the application value of phased nursing care in patients undergoing laser treatment for melasma.Methods:A total of 68 patients with melasma who received laser treatment at the Dermatology Departme...Objective:To analyze the application value of phased nursing care in patients undergoing laser treatment for melasma.Methods:A total of 68 patients with melasma who received laser treatment at the Dermatology Department of Yichang Central People’s Hospital from June 2023 to June 2025 were selected as the study subjects.According to differences in nursing plans,patients were randomly divided into two groups,with 34 patients in each group:the control group received routine nursing care,while the observation group received phased nursing care.The wound healing,negative emotions,and self-efficacy of the two groups before and after nursing were compared.Results:The duration of erythema in the observation group was shorter than that in the control group,and the area of pigmentation was smaller than that in the control group(p<0.05).After nursing,the SAS and SDS scores of the observation group were lower than those of the control group(p<0.05),and the GSES scores of the observation group were higher than those of the control group(p<0.05).Conclusion:Phased nursing care can significantly improve wound healing in patients undergoing laser treatment for melasma,reduce negative emotions,and enhance self-efficacy.展开更多
Objective:To investigate the effects and potential mechanisms of action of Panax notoginseng(Burk)F.H.Chen(P.notoginseng,San Qi)flowers in type 2 diabetes mellitus(T2DM)using network pharmacology,in vivo experiments,a...Objective:To investigate the effects and potential mechanisms of action of Panax notoginseng(Burk)F.H.Chen(P.notoginseng,San Qi)flowers in type 2 diabetes mellitus(T2DM)using network pharmacology,in vivo experiments,and RNA sequencing(RNA-seq).Methods:Network pharmacology analysis was performed to identify and correlate the drug targets of flower buds of P.notoginseng(PNF)with T2DM disease targets and to predict the key targets and pathways involved in the therapeutic effects of PNF in T2DM.In vivo experiments were conducted to assess the effects of PNF on glucose and lipid metabolism in mice with T2DM.RNA-seq was performed,and the results were integrated with network pharmacology data to assess the therapeutic mechanisms of PNF in T2DM.The results from transcriptomics and network pharmacology were validated using real-time polymerase chain reaction.Results:A total of 27 intersecting targets were identified by overlapping 35 drug targets with T2DM targets.Further topological analysis using the Centiscape 2.2 tool revealed five core targets,including signal transducer and activator of transcription 3(STAT3).Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis indicated that the JAK/STAT signaling pathway is a key mechanism underlying the therapeutic effects of PNF in T2DM.In vivo experiments confirmed that PNF effectively regulates glycolipid metabolism in a mouse model of diabetes.KEGG pathway enrichment analysis of RNA-seq data highlighted the JAK2/STAT3 and PI3K/AKT pathway as a potential mechanism.PNF high-dose(PNFH)increased the gene expression levels of PIK3R1 and AKT2,decreased the expression of PCK1,JAK2,and STAT3,and showed a trend toward increasing INSR expression without reaching statistical significance.Conclusion:PNF improves glycolipid metabolism disorders in T2DM,potentially by modulating the JAK2/STAT3 and PI3K/AKT signaling pathway.展开更多
OBJECTIVE:To investigate the mechanism of action of Qinlian Jiangxia decoction(芩连姜夏汤,QLJXD)in the treatment of type 2 diabetes mellitus(T2DM)complicated by hyperlipidemia using network pharmacology,molecular dock...OBJECTIVE:To investigate the mechanism of action of Qinlian Jiangxia decoction(芩连姜夏汤,QLJXD)in the treatment of type 2 diabetes mellitus(T2DM)complicated by hyperlipidemia using network pharmacology,molecular docking,molecular dynamics simulation and in vivo experiments.METHODS:Drug components,targets and disease targets were identified using databases such as TCM systems pharmacology database and analysis platform and Gene Cards.The intersecting targets were subjected to protein-protein interaction analysis using the search tool for the retrieval of interacting genes/proteins database.Subsequently,Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis of the intersecting targets were conducted using the Metascape platform to identify core components and targets.The results were validated using molecular docking,molecular dynamics simulations and in vivo experiments.RESULTS:QLJXD contains 76 active ingredients and 136 disease targets.The core ingredients are quercetin,β-sitosterol,wogonin and baicalein,while the core targets are fatty acid binding protein 4(FABP4)and peroxisome proliferative activated receptor gamma(PPARG).Molecular docking and molecular dynamics simulations revealed that the core ingredients bound well to the core targets.Animal experiments demonstrated that QLJXD effectively inhibited the expression of FABP4 and increased the expression of PPARG,thereby enhancing disorders of glycolipid metabolism.CONCLUSION:The putative therapeutic efficacy of QLJXD in the management of T2DM complicated with hyperlipidemia may be ascribed to the synergistic actions of multiple components,such as quercetin,β-sitosterol,wogonin,and baicalein,which collectively modulate FABP4 and PPARG molecular targets.展开更多
BACKGROUND There is a lack of clinical evidence on the efficacy and safety of transitioning from a thrice-daily pre-mixed insulin or basal-prandial regimen to insulin degludec/aspart(IDegAsp)therapy,with insufficient ...BACKGROUND There is a lack of clinical evidence on the efficacy and safety of transitioning from a thrice-daily pre-mixed insulin or basal-prandial regimen to insulin degludec/aspart(IDegAsp)therapy,with insufficient data from the Chinese population.AIM To demonstrate the efficacy,safety,and treatment satisfaction associated with the transition to IDegAsp in type 2 diabetes mellitus(T2DM).METHODS In this 12-week open-label,non-randomized,single-center,pilot study,patients with T2DM receiving thrice-daily insulin or intensive insulin treatment were transitioned to twice-daily injections of insulin IDegAsp.Insulin doses,hemoglobin A1c(HbA1c)levels,fasting blood glucose(FBG),hypoglycemic events,a Diabetes Treatment Satisfaction Questionnaire,and other parameters were assessed at baseline and 12-weeks.RESULTS This study included 21 participants.A marked enhancement was observed in the FBG level(P=0.02),daily total insulin dose(P=0.03),and overall diabetes treatment satisfaction(P<0.01)in the participants who switched to IDegAsp.There was a decrease in HbA1c levels(7.6±1.1 vs 7.4±0.9,P=0.31)and the frequency of hypoglycemic events of those who switched to IDegAsp decreased,however,there was no statistically significant difference.CONCLUSION The present findings suggest that treatment with IDegAsp enhances clinical outcomes,particularly FBG levels,daily cumulative insulin dose,and overall satisfaction with diabetes treatment.展开更多
Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods W...Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.展开更多
This article explores the bidirectional relationship between type 2 diabetes mellitus(T2DM)and depression,focusing on their shared pathophysiological mechanisms,including immune-inflammatory responses,gut-brain axis d...This article explores the bidirectional relationship between type 2 diabetes mellitus(T2DM)and depression,focusing on their shared pathophysiological mechanisms,including immune-inflammatory responses,gut-brain axis dysregu-lation,metabolic abnormalities,and neuroendocrine modulation.Research indicates that T2DM contributes to anxiety and depression through chronic low-grade inflammation,insulin resistance,gut microbiota imbalance,and hy-peractivation of the hypothalamic-pituitary-adrenal axis.Conversely,depression may increase the risk of T2DM via lifestyle disruption,immune activation,and neurotransmitter imbalance.Additionally,metabolic pathway disturbances-such as reduced adiponectin,impaired insulin signaling,and altered amino acid me-tabolism-may influence mood regulation and cognition.The article further examines emerging therapeutic strategies targeting these shared mechanisms,including anti-inflammatory treatments,gut microbiota modulation,hypothalamic-pituitary-adrenal axis interventions,metabolic therapies(e.g.,glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors),and multidisciplinary integrative management.Emphasizing the multisystem nature of diabetes-depression comorbidity,this work highlights the importance of incorporating mental health strategies into diabetes care to optimize outcomes and enhance patient quality of life.展开更多
BACKGROUND Metabolic dysfunction-associated fatty liver disease(MAFLD)and type 2 diabetes mellitus(T2DM)are independent risk factors for the development of cardiovascular disease(CVD)and an exaggerated CVD risk is exp...BACKGROUND Metabolic dysfunction-associated fatty liver disease(MAFLD)and type 2 diabetes mellitus(T2DM)are independent risk factors for the development of cardiovascular disease(CVD)and an exaggerated CVD risk is expected when both diseases co-exist.Therefore,thorough risk stratification is important to inform better clinical practice decisions based on good quality evidence for patient with MAFLD and T2DM.AIM To identify the CVD and cardiovascular event(CVE)risk in a systematic review when MAFLD and T2DM co-exist to inform better clinical practice decisions.METHODS A systematic review was performed by compiling data by searching PubMed,EMBASE and Cochrane Library databases.Quality appraisal of retrieved studies and the meta-analysis were performed using Joanna Briggs Institute(JBI)tool and RevMan 5.4 software respectively.The effect indicators for CVE and CVD risk were expressed as odds ratios(OR)and 95%CI with P-values<0.05 as significant.RESULTS Fourteen(5 cohort and 9 cross-sectional)studies with 370013 participants were included in this review.The metaanalysis of CVE showed that the risk of CVE in T2DM was higher in the MAFLD group when compared to the non-MAFLD group[OR 1.28(95%CI,1.04-1.56)P=0.02]with follow up duration ranging between 5-6 years.The prevalence of CVD in the metanalysis of cross-sectional studies was found to be higher[OR 1.47(95%CI,1.21-1.78)P=0.0001]in T2DM with MAFLD when compared to T2DM without MAFLD.Significant heterogeneity exists due to variations in study design,methodologies,and MAFLD diagnostic criteria,which may have influenced the study's findings.CONCLUSION The presence of MAFLD in T2DM increased the risk of CVE.The prevalence of CVD is higher in T2DM with MAFLD as compared to T2DM without MAFLD.Large well-designed multicentric long-term prospective studies are necessary to appropriately risk stratify the cardiovascular effect of the MAFLD in T2DM patients.展开更多
BACKGROUND The incidence of type 2 diabetes mellitus(T2DM)in children and adolescents is increasing,yet there is limited information on the available pharmacological interventions to combat T2DM and prevent associated...BACKGROUND The incidence of type 2 diabetes mellitus(T2DM)in children and adolescents is increasing,yet there is limited information on the available pharmacological interventions to combat T2DM and prevent associated comorbidities.AIM To assess the effectiveness of current pharmacological treatments in managing T2DM in children and adolescents.The protocol of the study was registered in PROSPERO(CRD42022382165).METHODS Searches were performed in PubMed,EMBASE,Scopus,and ClinicalTrials.gov for publications between 1990 to September 2024 without language restrictions.Randomized control trials(RCTs)of pharmacotherapy in children and adolescents with T2DM(aged<19 years)were included.The primary outcome was a change in glycated hemoglobin(HbA1c)from baseline to follow-up.Secondary outcomes were changes in body weight,body mass index(BMI),total cholesterol,triglycerides,high density lipoprotein,and low-density lipoprotein from baseline,and incidence of adverse events during study periods.Screening,full-text review,data extraction,and assessments of risk of bias were done by two reviewers.Conflicts on each step were resolved by a third reviewer.Data analysis was performed using Review Manager Version 6.5(RevMan 6.5)and‘R’software via RStudio,‘meta’and‘netmeta’.RESULTS A total of 12 studies having low to moderate risk of bias with 1658 participants,and follow-up duration 12-52 weeks were included.In our network meta-analysis,compared to control(s),the reduction of HbA1c was sig-nificantly larger for dulaglutide[mean difference(MD),95%confidence interval:-1.20,-2.12 to-0.28],followed by dapagliflozin(-0.94,-1.44 to-0.44),liraglutide(-0.91,-1.37 to-0.45),empagliflozin(-0.87,-1.40 to-0.34),exenatide(-0.59,-1.07 to-0.11)and linagliptin(-0.45,-0.87 to-0.02)while other drugs had little or no effect.While liraglutide was associated with a change in body weight[MD-2.41(-4.68,-0.14)kg],no other drug treatment was associated with significant changes in body weight,BMI,and lipids.Apart from level 1 hypoglycemia with liraglutide[risk difference(RD):0.20,0.04-0.37]and minor adverse events with dulaglutide(RD:0.24,0.08-0.40),no other treatment was associated with excess risk of hypoglycemia or minor or major adverse events.CONCLUSION Pharmacotherapy of T2DM with dulaglutide,dapagliflozin,liraglutide,empagliflozin,exenatide,and linagliptin in children is associated with modest reduction of HbA1c.Larger RCTs with longer follow-up durations are needed to guide better therapeutic decision making.展开更多
Type 2 diabetes mellitus(T2DM)significantly elevates the risk of colorectal cancer(CRC)and complicates its treatment by promoting chemoresistance.Poor glycemic control has been linked to exacerbated CRC progression an...Type 2 diabetes mellitus(T2DM)significantly elevates the risk of colorectal cancer(CRC)and complicates its treatment by promoting chemoresistance.Poor glycemic control has been linked to exacerbated CRC progression and diminished chemotherapy efficacy,impacting patient outcomes through various mechanisms such as oxidative stress,activation of metabolic pathways,and altered protein modifications that hinder apoptosis and enhance tumor survival.Clinical evidence shows that T2DM patients experience higher rates of chemoresistance and reduced disease-free survival and overall survival compared to non-diabetic patients.Specifically,those with poor glycemic control exhibit increased chemo-resistance and poorer survival metrics.Antidiabetic treatments,including metformin,acarbose,and gliclazide,show promise in improving chemotherapy response and glycemic management,potentially enhancing patient outcomes.Addressing this challenge requires a comprehensive,multidisciplinary approach involving oncologists,endocrino-logists,and surgeons to optimize patient care.Integrated strategies that prioritize glycemic control are essential for reducing chemoresistance and improving survival in CRC patients with T2DM.展开更多
Objective:This study aimed to determine the effect of a culture-specificbehavior modificationprogram on glycated hemoglobin(HbA1c)and blood pressure among adults with diabetes and hypertension.Methods:This study was a...Objective:This study aimed to determine the effect of a culture-specificbehavior modificationprogram on glycated hemoglobin(HbA1c)and blood pressure among adults with diabetes and hypertension.Methods:This study was a single-blind randomized controlled trial design.From January to May 2024,a total of 60 patients with uncontrolled type 2 diabetes and hypertension from the primary care unit of a hospital in northeastern(Isan)Thailand were recruited.The intervention group received the usual care supplemented by a culture-specificbehavior modificationprogramm implemented through interactive classes and online web application consisting of information,motivation,and behavioral skills(diet,exercise,and medication use),the control group received the usual care.HbA1c and blood pressure measurements were collected at both baseline and at 12 weeks.Results:A total of 51 patients completed the study,the intervention group(n=26)and control group(n=25),respectively.After 12 weeks,23.1%of patients in the intervention group could maintain their HbA1c<7.0%;those with poorly controlled HbA1c decreased from 7.7%at baseline to 3.8%at 12 weeks.After 12 weeks,69.2%of intervention group participants could maintain systolic blood pressure<130 mmHg and 53.8%could keep diastolic blood pressure<80 mmHg.Analysis revealed that HbA1c,systolic and diastolic blood pressure levels in the intervention group were lower than the control group after the intervention(P<0.05).There was a statistically significantdifference a linear combination of HbA1c and blood pressure(systolic and diastolic BP levels)between time and group(P<0.05).Conclusion:These results suggest that healthcare providers can incorporate elements of this program to manage blood glucose and blood pressure effectively.Future studies should consider a longitudinal design with a larger sample size and include outcomes of lipid levels to confirmlong-term motivation.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a signif...BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a significant economic burden on the healthcare system.T2DM is closely associated with insulin resistance,impaired pancreatic B cell function,and disordered glucose and lipid metabolism,which can lead to various complications,reducing patients'quality of life and increasing the risk of disability and death.Thus,finding effective preventive and intervention measures is crucial.Exercise therapy,a key part of diabetes management,has gained attention in recent years,with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.AIM To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.METHODS Systematic searches were conducted using PubMed,EMBASE,Cochrane Library,and Chinese databases for relevant randomized controlled trials(RCTs).The inclusion criteria were participants aged≥18 years with T2DM and the intervention involved combined resistance and aerobic exercise for≥8 weeks.The primary outcome indicators were fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),glycated hemoglobin A1c(HbA1c),and total cholesterol(TC)levels.Data analysis was performed using RevMan software,and the interventional effects were assessed using weighted mean differences or standardized mean differences(SMD).RESULTS Six RCTs meeting the inclusion criteria were included,with a total sample size of 366 participants.The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM.Specific results were as follows:(1)For fasting blood glucose,combined exercise was more effective than aerobic exercise alone[SMD=1.22;95%confidence interval(95%CI):0.70,1.74;P<0.00001];(2)LDL-C levels were significantly reduced by the combined intervention(SMD=1.45;95%CI:1.18-1.72;P<0.00001);(3)The combined intervention significantly increased HDL-C levels(SMD=1.42;95%CI:0.98-1.87;P<0.00001);(4)The combined intervention significantly reduced TG levels(SMD=1.12;95%CI:0.85-1.39;P<0.00001;(5)No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group(SMD=-0.03;95%CI:-1.09 to 1.04;P<0.00001);and(6)The combined exercise intervention group significantly reduced TC levels(SMD=2.66;95%CI:1.93-3.38;P<0.00001).The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors,including the patient's age,baseline blood glucose levels,and exercise intensity.CONCLUSION Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose,LDL-C,HDL-C,TG,and TC levels in patients with T2DM,especially in terms of blood glucose control and cardiovascular risk,demonstrating better outcomes than aerobic exercise alone.展开更多
文摘Type 2 diabetes mellitus(T2DM)was identified as the most prevalent form of diabetes.This study employed an integrated strategy combining network pharmacology,metabolomics,and experimental validation to elucidate the therapeutic mechanisms of red mulberry water extract(RMW)in T2DM.Systematic analysis identified six bioactive constituents,with four key components(cyanidin,quercetin,morin,andβ-carotene)demonstrating significant interactions with diabetes-related targets.Network pharmacology revealed these compounds modulate critical pathways including AMPK(P=2.3×10^(−5)),PI3K-Akt(P=1.8×10^(−4)),and PPAR signaling(P=3.1×10^(−3)).In diabetic mice,treatment significantly improved glycemic control(32.5%reduction in fasting glucose,P<0.01),lipid profiles(36.7%lower TG,P<0.05),antioxidant activity(2.1-fold increased SOD,P<0.05),and inflammation(42%reduced TNF-α,P<0.05).Metabolomic analysis further confirmed alterations in catecholamine and lipid metabolism pathways.These findings collectively demonstrate mulberry's multi-target therapeutic potential through synergistic regulation of glucose metabolism,lipid homeostasis,oxidative stress,and inflammatory responses in diabetes.
文摘Objectives:The combination of atezolizumab plus bevacizumab(A+B)represents one of the standards first-line treatments for unresectable hepatocellular carcinoma(HCC).Metformin has garnered attention for its potential antitumour and immunomodulatory properties beyond glycaemic control.This study aimed to assess metformin’s impact in patients with type 2 diabetes mellitus(T2DM)receiving A+B therapy.Methods:This retrospective analysis of a prospectively-maintained multicentre database included 523 patients with HCC treated with A+B from the ARTE(Atezolizumab-bevacizumab Real-life Experience for Treatment of Hepatocellular Carcinoma)dataset across 18 Italian centres(May 2020-January 2024).We evaluated objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),overall survival(OS),and time to progression(TTP)using Cox regression analysis and Inverse Probability of Treatment Weighting(IPTW)to address confounding.Results:Among 523 patients,341(65.2%)did not have diabetes and 182(34.8%)had T2DM.In the overall population,metformin showed no significant benefit for PFS(HR=1.15,95%CI[0.88-1.50],p=0.316)or OS(HR=1.28,95%CI[0.94-1.74],p=0.124).In the subgroup with T2DM(N=180),metformin showed no significant benefit for PFS(HR=1.41,95%CI[0.97-2.05],p=0.069),OS(HR=1.23,95%CI[0.81-1.86],p=0.333),or TTP(HR=0.82,95%CI[0.53-1.26],p=0.363).IPTW analysis confirmed these negative findings.Conclusion:This study found no evidence of improved outcomes with metformin use in patients with HCC in particular with T2DM receiving A+B therapy.Routine metformin use should not be expected to enhance A+B efficacy based on current evidence.
文摘Rheumatoid arthritis(RA)is a chronic systemic autoimmune disease that extends beyond joint inflammation,affecting pulmonary and metabolic pathways.Interstitial lung disease(ILD)is one of its most serious extra-articular complications,while type 2 diabetes mellitus(T2DM)frequently coexists with RA and may exacerbate inflammatory and fibrotic processes.This editorial discusses the study by Sutton et al,the largest population-based analysis to date exploring the link between T2DM and ILD in patients with RA,and reflects on its mechanistic and clinical implications.In a nationwide cohort of more than 120000 hospitalized RA patients,Sutton et al demonstrated that the coexistence of T2DM nearly doubles the odds of developing ILD(odds ratio=2.02;95%confidence interval:1.84-2.22),with additional increases in pulmonary hypertension,pneumothorax,and length of stay.These findings reinforce the concept of a metabolic-pulmonary-autoimmune axis,in which chronic inflammation promotes insulin resistance and metabolic dysfunction,while hyperglycaemia and advanced glycation end-products amplify oxidative stress and fibrogenesis.This reciprocal interaction may induce a self-perpetuating cycle of“metaflammation”,fibrosis,and organ damage.Conclusion:Recognizing diabetes as a silent amplifier of RA-associated ILD redefines the interface between rheumatology,pulmonology,and endocrinology.Early detection and integrated management of metabolic and pulmonary comorbidities should be prioritized,while future studies must determine whether optimizing glycemic control can attenuate pulmonary fibrosis and improve longterm outcomes.
基金funded by the National Natural Science Foundation of China(grant no.82273162)the National Natural Science Foundation of China(grant no.82203272)the Science and Technology Development Foundation of Nanjing Medical University(grant NMUB20240119)。
文摘Objective:To determine whether immunotherapy can bring new hope for patients with limited-stage small-cell lung cancer(LS-SCLC).We conducted this retrospective study to evaluate whether immunotherapy can achieve better efficacy in LS-SCLC patients.Methods:We evaluated 122 LS-SCLC patients who received concurrent chemoradiotherapy(CCRT)or sequential chemoradiotherapy(SCRT)(Group A)and immunotherapy combined with CCRT/SCRT followed by immunotherapy(Group B),to assess the objective response rate(ORR),disease control rate(DCR),and progression-free survival(PFS).Factors affecting prognosis were also explored using Cox analysis.The prognosis of patients with type 2 diabetes and patients with different TNM stages was compared to guide the selection of clinical regimens.Results:The overall ORR was 55.93%.The overall DCR was 98.31%.The DCR was 100%in Group A and 96.61%in Group B.There was no statistical difference in ORR and DCR.The overall median PFS was 9.86 months(95%CI,8.62-11.10),and the difference in median PFS between the two groups was statistically significant(8.94 vs.11.89 months,p=0.03).The Cox regression analysis showed type 2 diabetes was associated with the survival prognosis.Patients with type 2 diabetes tended to choose immunotherapy combined with CCRT/SCRT.Patients in TNM stage IIIB had a significantly worse prognosis than those in stage I+II+IIIA.Conclusion:We suggest that LS-SCLC patients who receive immunotherapy combined with CCRT/SCRT can achieve longer PFS than those with CCRT/SCRT.Type 2 diabetes and TNM stage affect the survival prognosis.Patients with type 2 diabetes may benefit from immunotherapy combination treatments.
基金Clinical Study on the Treatment of Neurogenic Bladder in Elderly Patients with Type 2 Diabetes Mellitus by Auricular Point Pressing Needle TherapyZhejiang Provincial Traditional Chinese Medicine Science and Technology Project,Zhejiang Provincial People’s Hospital(Project No.:2024ZL252)。
文摘Objective: To investigate the clinical efficacy and safety of auricular acupressure therapy in elderly patients with type 2 diabetic neurogenic bladder, and to provide a feasible external treatment intervention plan based on traditional Chinese medicine (TCM) for such patients. Methods: A randomized controlled study was conducted, selecting elderly patients with type 2 diabetic neurogenic bladder who met the inclusion criteria and randomly dividing them into a control group and an observation group. The control group received conventional comprehensive diabetes management and bladder function training, while the observation group additionally received auricular acupressure therapy, involving continuous stimulation of relevant auricular points such as Shenmen, Subcortex, Sympathetic, Kidney, Bladder, and Urethra, for a treatment duration of two courses. Changes in maximum urinary flow rate, bladder residual urine volume, TCM syndrome scores, and quality of life index (QOL) were compared between the two groups before and after treatment, and adverse reactions during treatment were recorded and analyzed. Results: After treatment, the observation group demonstrated superior improvement in clinical symptoms such as dysuria and urinary retention compared to the control group, with a significant increase in maximum urinary flow rate, a notable decrease in bladder residual urine volume and TCM syndrome scores, and a concurrent improvement in quality-of-life scores. The differences between the groups were statistically significant (p < 0.05). No serious adverse events occurred during treatment, and minor local discomfort resolved spontaneously after management, indicating overall good safety. Conclusion: As a simple and persistent TCM external treatment method, auricular acupressure therapy can further improve urinary function and quality of life in elderly patients with type 2 diabetic neurogenic bladder when combined with conventional treatment, with high safety and certain clinical promotion value.
文摘Background:Diabetes mellitus(DM)is a chronic illness with potentially fatal and debilitating consequences.Problems with glycemic management are a major issue that adds an added strain to public health services.Objectives:The purpose of this study is to evaluate the prevalence of poor glycemic control and its related variables among type 2 diabetes mellitus(T2DM)patients in southern Jordan.Methods:A cross-sectional study was carried out in the Prince Hashem bin Abdullah II Hospital in Jordan's southernmost province.For the period April–July 2024,516 individuals with T2D were enrolled.A structured questionnaire that had been pre-prepared was used to collect data.As an index of glycemic control,a glycated hemoglobin(Hb A1c)7%cut-off point was adopted.Results:Poor glycemic control was prevalent in 81.0%of T2DM individuals.Inadequate glycemic control was significantly worse in non-married patients and those with 10 or more years of diabetes duration,insulin treatment,dyslipidemia,neuropathy,cardiovascular illness,and glomerular filtration rate(GFR=60 m L/min;[P<0.05]).Moreover,dyslipidemia and insulin administration increased the likelihood of poor glycemic control(odds ratio[OR]:2 and 5,respectively)(P<0.05).Conclusions:Inadequate glycemic control was common among the current study par ticipants.To prevent disease consequences and enhance the health of patients with diabetes,health care professionals should pay special attention to related risk factors such as dyslipidemia,neuropathy,cardiovascular disease(CVD),extended illness duration,and insulin usage.
文摘Diabetic kidney disease (DKD)is one of the most common and severe microvascular complications of type 2 diabetes mellitus (T2DM). It is also a major cause of end-stage renal disease (ESRD), making early identification and intervention crucial. Insulin resistance (IR)is a key pathophysiological mechanism of T2DM and plays a central role in the progression of DKD. In recent years, a series of novel surrogate indicators of IR, such as the triglyceride-glucose (TyG) index, TyG-body mass index (TyG-BMI), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), and metabolic score for insulin resistance (METS-IR), have attracted widespread attention due to their simplicity and cost-effectiveness. This article reviews the research progress of novel surrogate indicators of insulin resistance (IR) in type 2 diabetic kidney disease (DKD), aiming to provide references for the early prevention and improved prognosis of DKD.
基金financial support fromthe Chung Shan Medical University Hospital,Taiwan(CSH-2022-A-009).
文摘Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and whether this association differs by baseline body-mass index(BMI).Methods:This retrospective cohort study used electronic health records from the TriNetX U.S.research network.Adults aged 20 years or older diagnosed with T2DM between 2016 and 2024 were included if they received any hypoglycemic agents within 3 months before and after diagnosis.Following 1:1 propensity score matching,both the GLP-1 RA user and non-user groups included 183,264 patients.The study outcome was defined as a diagnosis of malignant neoplasms.Hazard ratios(HRs)for overall and site-specific cancer risk were estimated using Cox proportional hazards models.Kaplan–Meier analysis and stratified analysis by BMI were performed.Results:Early GLP-1 RA use demonstrated a modest but significant association with reduced overall cancer risk(HR 0.93;95%CI:0.90–0.96).Reduced risks were noted for cancers of the digestive(HR 0.81),respiratory(HR 0.66),and female genital(HR 0.87)systems.In stratified analysis,benefits were more pronounced in patients with BMI≥30,particularly for pancreatic and colorectal cancers.Conclusion:Early initiation of GLP-1 receptor agonists in patients with diagnosed T2DM was associated with a modest reduction in overall cancer risk,particularly among individuals with obesity.These findings highlight the dual metabolic and oncologic value of prompt GLP-1 RA therapy.
文摘Objective:To investigate the effects of switching to either Prandilin 25R monotherapy or Prandilin 25R combined with ganagliflozin proline tablets after short-term intensive continuous subcutaneous insulin infusion during hospitalization in elderly patients with type 2 diabetes mellitus on glycemic control,glycometabolic indicators,and cardiovascular risk factors,and to evaluate the safety of the two regimens.Methods:A total of 78 elderly patients with type 2 diabetes mellitus admitted to our hospital from January 2025 to September 2025 were selected and randomly divided into a control group and an observation group,with 39 cases in each group.The control group received monotherapy with insulin lispro protamine recombinant injection(Prandilin 25R)after intensive continuous subcutaneous insulin infusion,while the observation group received Prandilin 25R combined with ganagliflozin proline tablets.Continuous glucose monitoring(CGM)was performed for 14 days during the intensive continuous subcutaneous insulin infusion therapy phase in the hospital,followed by routine fingertip blood glucose monitoring after 14 days.Glycemic control indicators,glycometabolic indicators,and the incidence of adverse reactions were compared between the two groups.Results:After treatment,the mean amplitude of glycemic excursions and the 24-hour blood glucose standard deviation were significantly lower in the observation group than in the control group,while the time spent within the target blood glucose range was significantly higher(p<0.05).The levels of glycated hemoglobin,fasting blood glucose,and 2-hour postprandial blood glucose were better in the observation group than in the control group;moreover,the body mass index,systolic blood pressure,and blood lipid levels improved more significantly in the observation group than in the control group(p<0.05).There was no statistically significant difference in the incidence of hypoglycemia between the two groups.Conclusion:Combination therapy with ganagliflozin proline tablets after short-term intensive continuous subcutaneous insulin infusion therapy can effectively improve glycemic variability in elderly patients with type 2 diabetes mellitus,with good safety.This suggests that ganagliflozin proline tablets have a hypoglycemic advantage in the combination regimen and possess high clinical promotional value.
文摘Objective:To analyze the application value of phased nursing care in patients undergoing laser treatment for melasma.Methods:A total of 68 patients with melasma who received laser treatment at the Dermatology Department of Yichang Central People’s Hospital from June 2023 to June 2025 were selected as the study subjects.According to differences in nursing plans,patients were randomly divided into two groups,with 34 patients in each group:the control group received routine nursing care,while the observation group received phased nursing care.The wound healing,negative emotions,and self-efficacy of the two groups before and after nursing were compared.Results:The duration of erythema in the observation group was shorter than that in the control group,and the area of pigmentation was smaller than that in the control group(p<0.05).After nursing,the SAS and SDS scores of the observation group were lower than those of the control group(p<0.05),and the GSES scores of the observation group were higher than those of the control group(p<0.05).Conclusion:Phased nursing care can significantly improve wound healing in patients undergoing laser treatment for melasma,reduce negative emotions,and enhance self-efficacy.
基金supported by the Creation and Talent Introduction Base of Prevention and Treatment of Diabetes and Its Complications withTraditional Chinese Medicine(B20055).
文摘Objective:To investigate the effects and potential mechanisms of action of Panax notoginseng(Burk)F.H.Chen(P.notoginseng,San Qi)flowers in type 2 diabetes mellitus(T2DM)using network pharmacology,in vivo experiments,and RNA sequencing(RNA-seq).Methods:Network pharmacology analysis was performed to identify and correlate the drug targets of flower buds of P.notoginseng(PNF)with T2DM disease targets and to predict the key targets and pathways involved in the therapeutic effects of PNF in T2DM.In vivo experiments were conducted to assess the effects of PNF on glucose and lipid metabolism in mice with T2DM.RNA-seq was performed,and the results were integrated with network pharmacology data to assess the therapeutic mechanisms of PNF in T2DM.The results from transcriptomics and network pharmacology were validated using real-time polymerase chain reaction.Results:A total of 27 intersecting targets were identified by overlapping 35 drug targets with T2DM targets.Further topological analysis using the Centiscape 2.2 tool revealed five core targets,including signal transducer and activator of transcription 3(STAT3).Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis indicated that the JAK/STAT signaling pathway is a key mechanism underlying the therapeutic effects of PNF in T2DM.In vivo experiments confirmed that PNF effectively regulates glycolipid metabolism in a mouse model of diabetes.KEGG pathway enrichment analysis of RNA-seq data highlighted the JAK2/STAT3 and PI3K/AKT pathway as a potential mechanism.PNF high-dose(PNFH)increased the gene expression levels of PIK3R1 and AKT2,decreased the expression of PCK1,JAK2,and STAT3,and showed a trend toward increasing INSR expression without reaching statistical significance.Conclusion:PNF improves glycolipid metabolism disorders in T2DM,potentially by modulating the JAK2/STAT3 and PI3K/AKT signaling pathway.
文摘OBJECTIVE:To investigate the mechanism of action of Qinlian Jiangxia decoction(芩连姜夏汤,QLJXD)in the treatment of type 2 diabetes mellitus(T2DM)complicated by hyperlipidemia using network pharmacology,molecular docking,molecular dynamics simulation and in vivo experiments.METHODS:Drug components,targets and disease targets were identified using databases such as TCM systems pharmacology database and analysis platform and Gene Cards.The intersecting targets were subjected to protein-protein interaction analysis using the search tool for the retrieval of interacting genes/proteins database.Subsequently,Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis of the intersecting targets were conducted using the Metascape platform to identify core components and targets.The results were validated using molecular docking,molecular dynamics simulations and in vivo experiments.RESULTS:QLJXD contains 76 active ingredients and 136 disease targets.The core ingredients are quercetin,β-sitosterol,wogonin and baicalein,while the core targets are fatty acid binding protein 4(FABP4)and peroxisome proliferative activated receptor gamma(PPARG).Molecular docking and molecular dynamics simulations revealed that the core ingredients bound well to the core targets.Animal experiments demonstrated that QLJXD effectively inhibited the expression of FABP4 and increased the expression of PPARG,thereby enhancing disorders of glycolipid metabolism.CONCLUSION:The putative therapeutic efficacy of QLJXD in the management of T2DM complicated with hyperlipidemia may be ascribed to the synergistic actions of multiple components,such as quercetin,β-sitosterol,wogonin,and baicalein,which collectively modulate FABP4 and PPARG molecular targets.
基金Supported by CAMS Innovation Fund for Medical Sciences,No.2023-I2M-C&T-B-043National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-015+1 种基金CAMS Innovation Fund for Medical Sciences,No.2021-1-12M-002Beijing Municipal Natural Science Foundation,No.M22014.
文摘BACKGROUND There is a lack of clinical evidence on the efficacy and safety of transitioning from a thrice-daily pre-mixed insulin or basal-prandial regimen to insulin degludec/aspart(IDegAsp)therapy,with insufficient data from the Chinese population.AIM To demonstrate the efficacy,safety,and treatment satisfaction associated with the transition to IDegAsp in type 2 diabetes mellitus(T2DM).METHODS In this 12-week open-label,non-randomized,single-center,pilot study,patients with T2DM receiving thrice-daily insulin or intensive insulin treatment were transitioned to twice-daily injections of insulin IDegAsp.Insulin doses,hemoglobin A1c(HbA1c)levels,fasting blood glucose(FBG),hypoglycemic events,a Diabetes Treatment Satisfaction Questionnaire,and other parameters were assessed at baseline and 12-weeks.RESULTS This study included 21 participants.A marked enhancement was observed in the FBG level(P=0.02),daily total insulin dose(P=0.03),and overall diabetes treatment satisfaction(P<0.01)in the participants who switched to IDegAsp.There was a decrease in HbA1c levels(7.6±1.1 vs 7.4±0.9,P=0.31)and the frequency of hypoglycemic events of those who switched to IDegAsp decreased,however,there was no statistically significant difference.CONCLUSION The present findings suggest that treatment with IDegAsp enhances clinical outcomes,particularly FBG levels,daily cumulative insulin dose,and overall satisfaction with diabetes treatment.
基金supported by the R&D project of Pazhou Lab(Huangpu)under Grant 2023K0610the National Natural Science Foundation of China(Grants 12126602)+4 种基金the National Natural Science Foundation of China(Grants 82030102)the Shenzhen Medical Research Fund(Grants C2302001)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Chinese Postdoctoral Science Foundation(No.2022M721463)the Ministry of Science and Technology of China(Grants 2022YFC3702703).
文摘Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.
基金Supported by the Quzhou Science and Technology Plan Project funded by the Quzhou Municipal Science and Technology Bureau,No.2022K67,No.2022K69,and No.2024K076.
文摘This article explores the bidirectional relationship between type 2 diabetes mellitus(T2DM)and depression,focusing on their shared pathophysiological mechanisms,including immune-inflammatory responses,gut-brain axis dysregu-lation,metabolic abnormalities,and neuroendocrine modulation.Research indicates that T2DM contributes to anxiety and depression through chronic low-grade inflammation,insulin resistance,gut microbiota imbalance,and hy-peractivation of the hypothalamic-pituitary-adrenal axis.Conversely,depression may increase the risk of T2DM via lifestyle disruption,immune activation,and neurotransmitter imbalance.Additionally,metabolic pathway disturbances-such as reduced adiponectin,impaired insulin signaling,and altered amino acid me-tabolism-may influence mood regulation and cognition.The article further examines emerging therapeutic strategies targeting these shared mechanisms,including anti-inflammatory treatments,gut microbiota modulation,hypothalamic-pituitary-adrenal axis interventions,metabolic therapies(e.g.,glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors),and multidisciplinary integrative management.Emphasizing the multisystem nature of diabetes-depression comorbidity,this work highlights the importance of incorporating mental health strategies into diabetes care to optimize outcomes and enhance patient quality of life.
文摘BACKGROUND Metabolic dysfunction-associated fatty liver disease(MAFLD)and type 2 diabetes mellitus(T2DM)are independent risk factors for the development of cardiovascular disease(CVD)and an exaggerated CVD risk is expected when both diseases co-exist.Therefore,thorough risk stratification is important to inform better clinical practice decisions based on good quality evidence for patient with MAFLD and T2DM.AIM To identify the CVD and cardiovascular event(CVE)risk in a systematic review when MAFLD and T2DM co-exist to inform better clinical practice decisions.METHODS A systematic review was performed by compiling data by searching PubMed,EMBASE and Cochrane Library databases.Quality appraisal of retrieved studies and the meta-analysis were performed using Joanna Briggs Institute(JBI)tool and RevMan 5.4 software respectively.The effect indicators for CVE and CVD risk were expressed as odds ratios(OR)and 95%CI with P-values<0.05 as significant.RESULTS Fourteen(5 cohort and 9 cross-sectional)studies with 370013 participants were included in this review.The metaanalysis of CVE showed that the risk of CVE in T2DM was higher in the MAFLD group when compared to the non-MAFLD group[OR 1.28(95%CI,1.04-1.56)P=0.02]with follow up duration ranging between 5-6 years.The prevalence of CVD in the metanalysis of cross-sectional studies was found to be higher[OR 1.47(95%CI,1.21-1.78)P=0.0001]in T2DM with MAFLD when compared to T2DM without MAFLD.Significant heterogeneity exists due to variations in study design,methodologies,and MAFLD diagnostic criteria,which may have influenced the study's findings.CONCLUSION The presence of MAFLD in T2DM increased the risk of CVE.The prevalence of CVD is higher in T2DM with MAFLD as compared to T2DM without MAFLD.Large well-designed multicentric long-term prospective studies are necessary to appropriately risk stratify the cardiovascular effect of the MAFLD in T2DM patients.
文摘BACKGROUND The incidence of type 2 diabetes mellitus(T2DM)in children and adolescents is increasing,yet there is limited information on the available pharmacological interventions to combat T2DM and prevent associated comorbidities.AIM To assess the effectiveness of current pharmacological treatments in managing T2DM in children and adolescents.The protocol of the study was registered in PROSPERO(CRD42022382165).METHODS Searches were performed in PubMed,EMBASE,Scopus,and ClinicalTrials.gov for publications between 1990 to September 2024 without language restrictions.Randomized control trials(RCTs)of pharmacotherapy in children and adolescents with T2DM(aged<19 years)were included.The primary outcome was a change in glycated hemoglobin(HbA1c)from baseline to follow-up.Secondary outcomes were changes in body weight,body mass index(BMI),total cholesterol,triglycerides,high density lipoprotein,and low-density lipoprotein from baseline,and incidence of adverse events during study periods.Screening,full-text review,data extraction,and assessments of risk of bias were done by two reviewers.Conflicts on each step were resolved by a third reviewer.Data analysis was performed using Review Manager Version 6.5(RevMan 6.5)and‘R’software via RStudio,‘meta’and‘netmeta’.RESULTS A total of 12 studies having low to moderate risk of bias with 1658 participants,and follow-up duration 12-52 weeks were included.In our network meta-analysis,compared to control(s),the reduction of HbA1c was sig-nificantly larger for dulaglutide[mean difference(MD),95%confidence interval:-1.20,-2.12 to-0.28],followed by dapagliflozin(-0.94,-1.44 to-0.44),liraglutide(-0.91,-1.37 to-0.45),empagliflozin(-0.87,-1.40 to-0.34),exenatide(-0.59,-1.07 to-0.11)and linagliptin(-0.45,-0.87 to-0.02)while other drugs had little or no effect.While liraglutide was associated with a change in body weight[MD-2.41(-4.68,-0.14)kg],no other drug treatment was associated with significant changes in body weight,BMI,and lipids.Apart from level 1 hypoglycemia with liraglutide[risk difference(RD):0.20,0.04-0.37]and minor adverse events with dulaglutide(RD:0.24,0.08-0.40),no other treatment was associated with excess risk of hypoglycemia or minor or major adverse events.CONCLUSION Pharmacotherapy of T2DM with dulaglutide,dapagliflozin,liraglutide,empagliflozin,exenatide,and linagliptin in children is associated with modest reduction of HbA1c.Larger RCTs with longer follow-up durations are needed to guide better therapeutic decision making.
文摘Type 2 diabetes mellitus(T2DM)significantly elevates the risk of colorectal cancer(CRC)and complicates its treatment by promoting chemoresistance.Poor glycemic control has been linked to exacerbated CRC progression and diminished chemotherapy efficacy,impacting patient outcomes through various mechanisms such as oxidative stress,activation of metabolic pathways,and altered protein modifications that hinder apoptosis and enhance tumor survival.Clinical evidence shows that T2DM patients experience higher rates of chemoresistance and reduced disease-free survival and overall survival compared to non-diabetic patients.Specifically,those with poor glycemic control exhibit increased chemo-resistance and poorer survival metrics.Antidiabetic treatments,including metformin,acarbose,and gliclazide,show promise in improving chemotherapy response and glycemic management,potentially enhancing patient outcomes.Addressing this challenge requires a comprehensive,multidisciplinary approach involving oncologists,endocrino-logists,and surgeons to optimize patient care.Integrated strategies that prioritize glycemic control are essential for reducing chemoresistance and improving survival in CRC patients with T2DM.
基金supported by the 90th Anniversary of Chulalong-korn University Scholarship(Ratchadaphiseksomphot Endowment Fund)。
文摘Objective:This study aimed to determine the effect of a culture-specificbehavior modificationprogram on glycated hemoglobin(HbA1c)and blood pressure among adults with diabetes and hypertension.Methods:This study was a single-blind randomized controlled trial design.From January to May 2024,a total of 60 patients with uncontrolled type 2 diabetes and hypertension from the primary care unit of a hospital in northeastern(Isan)Thailand were recruited.The intervention group received the usual care supplemented by a culture-specificbehavior modificationprogramm implemented through interactive classes and online web application consisting of information,motivation,and behavioral skills(diet,exercise,and medication use),the control group received the usual care.HbA1c and blood pressure measurements were collected at both baseline and at 12 weeks.Results:A total of 51 patients completed the study,the intervention group(n=26)and control group(n=25),respectively.After 12 weeks,23.1%of patients in the intervention group could maintain their HbA1c<7.0%;those with poorly controlled HbA1c decreased from 7.7%at baseline to 3.8%at 12 weeks.After 12 weeks,69.2%of intervention group participants could maintain systolic blood pressure<130 mmHg and 53.8%could keep diastolic blood pressure<80 mmHg.Analysis revealed that HbA1c,systolic and diastolic blood pressure levels in the intervention group were lower than the control group after the intervention(P<0.05).There was a statistically significantdifference a linear combination of HbA1c and blood pressure(systolic and diastolic BP levels)between time and group(P<0.05).Conclusion:These results suggest that healthcare providers can incorporate elements of this program to manage blood glucose and blood pressure effectively.Future studies should consider a longitudinal design with a larger sample size and include outcomes of lipid levels to confirmlong-term motivation.
基金Supported by Research Project of Zhejiang Provincial Science and Technology Plan for Traditional Chinese Medicine,No.2024ZL753and Research Project of Zhejiang Provincial Medical and Health Science and Technology Plan,No.2024KY1406.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a significant economic burden on the healthcare system.T2DM is closely associated with insulin resistance,impaired pancreatic B cell function,and disordered glucose and lipid metabolism,which can lead to various complications,reducing patients'quality of life and increasing the risk of disability and death.Thus,finding effective preventive and intervention measures is crucial.Exercise therapy,a key part of diabetes management,has gained attention in recent years,with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.AIM To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.METHODS Systematic searches were conducted using PubMed,EMBASE,Cochrane Library,and Chinese databases for relevant randomized controlled trials(RCTs).The inclusion criteria were participants aged≥18 years with T2DM and the intervention involved combined resistance and aerobic exercise for≥8 weeks.The primary outcome indicators were fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),glycated hemoglobin A1c(HbA1c),and total cholesterol(TC)levels.Data analysis was performed using RevMan software,and the interventional effects were assessed using weighted mean differences or standardized mean differences(SMD).RESULTS Six RCTs meeting the inclusion criteria were included,with a total sample size of 366 participants.The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM.Specific results were as follows:(1)For fasting blood glucose,combined exercise was more effective than aerobic exercise alone[SMD=1.22;95%confidence interval(95%CI):0.70,1.74;P<0.00001];(2)LDL-C levels were significantly reduced by the combined intervention(SMD=1.45;95%CI:1.18-1.72;P<0.00001);(3)The combined intervention significantly increased HDL-C levels(SMD=1.42;95%CI:0.98-1.87;P<0.00001);(4)The combined intervention significantly reduced TG levels(SMD=1.12;95%CI:0.85-1.39;P<0.00001;(5)No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group(SMD=-0.03;95%CI:-1.09 to 1.04;P<0.00001);and(6)The combined exercise intervention group significantly reduced TC levels(SMD=2.66;95%CI:1.93-3.38;P<0.00001).The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors,including the patient's age,baseline blood glucose levels,and exercise intensity.CONCLUSION Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose,LDL-C,HDL-C,TG,and TC levels in patients with T2DM,especially in terms of blood glucose control and cardiovascular risk,demonstrating better outcomes than aerobic exercise alone.
