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
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
Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for m...Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for multiple complications. The objective of this study was to characterize clinically and biologically type 2 diabetic patients followed at the National Center for Diabetology and Arterial Hypertension of the Central Hospital of Yaoundé. Method: This prospective, cross-sectional, and analytical study took place from April 5 to July 31, 2023 (4 months) on 100 diabetic patients of both sexes (61 women and 39 men), aged from 31 to 88 years. Body Mass Index, systolic and diastolic blood pressure, and cardiac frequency were measured on each of the patients. Subsequently, blood was collected from the patients for the determination of the complete blood count, HBA1c, lipid profile, serum albumin, TNF-α, and IL-6 levels. The data were analyzed using SPSS 17.0 software. Results: The age average of our population was 56.99 ± 11.51 years, the population was primarily female (61%) and primarily between the ages of 55 and 88. 67% of respondents were married. 59% went to secondary school. 73% of them lived in urban areas. 30% were obese and 40% were overweight, with an average BMI of 28.75 kg/m2. 76% of patients took oral antidiabetic medications. HbA1c level average was 8.65%, with 60% having readings above 6.5%. Low hemoglobin and hypochromia were among the abnormalities of red blood cells observed. Lipid profiles revealed low HDL-cholesterol and high triglycerides and cholesterol. Elevated levels of TNF-α and IL-6 indicated inflammation and cardiovascular risk. Conclusion: These results indicate the necessity of focused diabetic care and management on diabetic patients attending the central hospital of Yaoundé, Cameroon.展开更多
BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset D...BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.METHODS We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021.A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors.Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions.The Cox model was further employed to evaluate the impact of risk factors on DF.The area under the curve(AUC)was measured to evaluate the accuracy of the prediction model.RESULTS Seventy-five diabetic inpatients experienced DF.The incidence density of DF was 4.5/1000 person-years.A long duration of diabetes,lower extremity arterial disease,lower serum albumin,fasting plasma glucose(FPG),and diabetic nephropathy were independently associated with DF.Among these risk factors,the serum albumin concentration was inversely associated with DF,with a hazard ratio(HR)and 95%confidence interval(CI)of 0.91(0.88-0.95)(P<0.001).Additionally,a U-shaped nonlinear relationship was observed between the FPG level and DF.After adjusting for other variables,the HRs and 95%CI for FPG<4.4 mmol/L and≥7.0 mmol/L were 3.99(1.55-10.25)(P=0.004)and 3.12(1.66-5.87)(P<0.001),respectively,which was greater than the mid-range level(4.4-6.9 mmol/L).The AUC for predicting DF over 3 years was 0.797.CONCLUSION FPG demonstrated a U-shaped relationship with DF.Serum albumin levels were negatively associated with DF.The prediction nomogram model of DF showed good discrimination ability using diabetes duration,lower extremity arterial disease,serum albumin,FPG,and diabetic nephropathy(Clinicaltrial.gov NCT05519163).展开更多
BACKGROUND The preservation of isletβ-cell function in elderly patients with type 2 diabetes mellitus(T2DM)is a top priority for diabetic control.AIM To assess the preservation of isletβ-cell function among elderly ...BACKGROUND The preservation of isletβ-cell function in elderly patients with type 2 diabetes mellitus(T2DM)is a top priority for diabetic control.AIM To assess the preservation of isletβ-cell function among elderly Chinese patients with T2DM after different anti-diabetic treatments.METHODS In this longitudinal observational study,elderly patients with T2DM treated with insulin,oral antidiabetic drugs or a combination of both were enrolled to disclose their isletβ-cell function between baseline and follow-up.Isletβ-cell function was determined by the plasma Homeostasis Model forβ-cell function(HOMA-β),Cpeptide and area under the curve(AUC)based on oral glucose tolerance test.Changes inβ-cell function(decrement or increment from baseline)between different therapy groups were the outcomes.RESULTS In total,745 elderly patients(≥60 years)with T2DM[insulin monotherapy,n=105;oral anti-diabetic drugs(OAD)monotherapy,n=321;insulin plus OAD,n=319]had their baseline and follow-upβ-cell function assessed during a median observation period of 4.5 years(range,3.0-7.2 years).Overall,isletβ-cell function(HOMA-β,fasting Cpeptide,fasting insulin,AUCc-pep,AUCins,AUCc-pep/AUCglu,AUCins/AUCglu)consistently deteriorated over time regardless of the three different antidiabetic treatments.No statistical differences in decrement were observed among the three groups regarding the isletβ-cell function indices.All three groups showed an increased ratio of delayed insulin secretion response after 4.5 years of observation.CONCLUSION In Chinese elderly patients with T2DM,isletβ-cell function progressively declines regardless of insulin supplement or insulin plus OAD treatments.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM),driven by insulin resistance and β cell dysfunction,necessitates reliable assessment of β cell function.C-peptide(CP)measurement,a stable marker of endogenous insulin secret...BACKGROUND Type 2 diabetes mellitus(T2DM),driven by insulin resistance and β cell dysfunction,necessitates reliable assessment of β cell function.C-peptide(CP)measurement,a stable marker of endogenous insulin secretion,is useful for this clinically as it avoids interference from exogenous insulin.While fasting CP(FCP)and postprandial CP(PCP),along with glucose-adjusted indices and ratios,such as FCP/fasting plasma glucose(FPG),2 hours postprandial CP(2hCP)/postprandial blood glucose(PBG)and CP ratio,are used,their comparative efficacy in reflectingβcell function remains unclear.Hemoglobin A1c(HbA1c),a key glycemic control indicator,theoretically linksβcell function to complications,but limited studies have explored the associations between diverse CP indices,HbA1c,and diabetic microvascular complications.AIM To investigate the relationships between different CP indices and HbA1c as well as diabetic microvascular complications in T2DM.METHODS T2DM patients admitted to Department of Endocrinology at Beijing Hospital between July 1,2021 and December 31,2021 were included in the study.Clinical and laboratory data were collected,including CP levels,glucose levels,HbA1c levels and diabetic microvascular complications.Statistical analysis was performed using Statistical Package for the Social Sciences 24.0.RESULTS A total of 453 patients were included in the final analysis.Adjusted by confounding factors,CP ratio and CP/blood glucose(BG)ratio were not relevant to HbA1c,but FCP,2hCP,delta CP,FCP/FPG,2hCP/PBG and delta CP/BG were still negatively correlated to HbA1c,of which 2hCP/PBG showed the strongest negative correlation(r=-0.485,P<0.001).Independent of HbA1c and other confounding factors,2hCP,2hCP/PBG,delta CP and delta CP/BG were protective factors of diabetic retinopathy while 2hCP,delta CP and FCP/FPG were protective factors of diabetic peripheral neuropathy.CONCLUSION This study indicates that higher levels of CP indices suggest better glucose control and a lower prevalence of diabetic microvascular complications,and PCP indices,particularly 2hCP/PBG,were more relevant to HbA1c and diabetic microvascular complications than FCP indices.These results suggest CP-related indices could be useful biomarkers for diabetes management,warranting further research.展开更多
BACKGROUND Diabetic retinopathy(DR)is the leading cause of blindness among working-age adults,with an increasing prevalence due to the global burden of diabetes.AIM To develop a polygenic risk score(PRS)to identify hi...BACKGROUND Diabetic retinopathy(DR)is the leading cause of blindness among working-age adults,with an increasing prevalence due to the global burden of diabetes.AIM To develop a polygenic risk score(PRS)to identify high-risk groups for DR and evaluate its severity in patients with type 2 diabetes(T2D).METHODS This population-based study included 13335 patients with T2D,comprising 7295 patients with DR and 6040 without DR.Genetic data,duration of DR diagnosis,body mass index,systolic blood pressure,diastolic blood pressure,and glycated hemoglobin A1c levels were obtained from the study population.The PRS was constructed from a genome-wide association study conducted in a Taiwan region of China Han population.Electronic medical records were used to track patients with T2D and analyze the associations between PRS,timing of DR diagnosis,and therapeutic interventions.The hazard ratio(HR)of PRS for DR development and severity was estimated using multivariate Cox proportional hazards regression.RESULTS The results demonstrated that patients with T2D in the top PRS decile had a 1.21-fold greater risk of developing DR[HR=1.21;95%confidence interval(CI):1.01-1.45;P=0.041]over a 20-year follow-up period.Among patients with DR,those in the highest PRS decile exhibited a 4.81-fold increased risk of requiring more than four laser treatments(HR=4.81;95%CI:1.40-16.5;P=0.012)and a 1.38-fold increased risk of undergoing vitreoretinal surgery(HR=1.38;95%CI:1.01-1.90;P=0.044).CONCLUSION Patients with T2D with a higher PRS are at increased risk of developing DR and may experience more severe forms of the disease.展开更多
BACKGROUND Type 2 diabetic nephropathy(T2DN)is a severe complication of diabetes mellitus,and identifying biomarkers for its prognosis remains a critical challenge.Previous studies have suggested potential roles of mi...BACKGROUND Type 2 diabetic nephropathy(T2DN)is a severe complication of diabetes mellitus,and identifying biomarkers for its prognosis remains a critical challenge.Previous studies have suggested potential roles of microRNAs(e.g.,miR-495-3p),adiponectin(ADPN),and cardiometabolic index(CMI)in metabolic and renal pathologies.However,their combined predictive value for T2DN prognosis is not well understood.AIM To explore serum miR-495-3p,ADPN,and CMI levels in T2DN and their value in predicting prognosis.METHODS A total of 98 T2DN patients(study group)and 49 type 2 diabetic patients with normal renal function(control group)were enrolled from February 2020 to February 2022.Serum levels of miR-495-3p,ADPN,and CMI were measured in both groups.Patients were followed up for 6 months to assess prognosis.Dif-ferences between groups were analyzed,and multivariate logistic regression and receiver operating characteristic(ROC)curve analyses were performed to eva-luate the predictive value of these biomarkers.RESULTS The study group exhibited significantly lower miR-495-3p levels and higher ADPN and CMI levels compared to the control group(P<0.05).Poor prognosis patients had even lower miR-495-3p and higher ADPN and CMI levels than those with good prognosis(P<0.05).Multivariate analysis identified alanine amino-transferase,aspartate aminotransferase,urea nitrogen,serum creatinine,miR-495-3p,ADPN,and CMI as independent predictors of prognosis(P<0.05).ROC analysis revealed area under the curve values of 0.762(miR-495-3p),0.902(ADPN),0.757(CMI),0.899(alanine aminotransferase),0.852(aspartate ami-notransferase),0.916(urea nitrogen),and 0.910(serum creatinine)for predicting poor prognosis(P<0.05).CONCLUSION Low miR-495-3p and high ADPN and CMI levels are linked to T2DN and poor prognosis,highlighting their potential for risk prediction and clinical management.展开更多
BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of type 2 diabetes mellitus(T2DM),significantly affecting patients’quality of life and imposing a substantial economic burden.Recent studies have...BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of type 2 diabetes mellitus(T2DM),significantly affecting patients’quality of life and imposing a substantial economic burden.Recent studies have highlighted the role of thyroid hormones in diabetes complications,particularly in elderly patients with T2DM.However,the relationship between thyroid hormone sensitivity and DPN remains unclear.AIM To investigate the correlation between thyroid hormone sensitivity and DPN in elderly patients with T2DM.METHODS In a cohort of 256 elderly patients with T2DM,propensity score matching was used to balance age,sex,and diabetes duration.Clinical data were collected to calculate thyroid hormone sensitivity and analyze its correlation with DPN.A random forest model was used to evaluate the diagnostic value of free triiodothyronine/free thyroxine(FT_(3)/FT_(4))for DPN.RESULTS Patients with DPN had a lower FT_(3)/FT_(4) ratio[(0.302±0.053)vs(0.316±0.049),P=0.040].Quartile stratification showed decreasing DPN prevalence with higher FT_(3)/FT_(4) ratios.Spearman’s correlation analysis showed that a lower FT_(3)/FT_(4) ratio was associated with higher glycated hemoglobin,fasting blood glucose,reduced nerve conduction velocity,and electrical skin conductance.Logistic regression indicated a positive relationship between the median FT_(3)/FT_(4) ratio and bilateral foot electrochemical skin conductance[odds ratio(OR):1.019;95%CI:1.005-1.034;P=0.007]and sural nerve sensory amplitude(OR:1.310;95%CI:1.008-1.703;P=0.043).Receiver operating characteristic analysis using a random forest model showed that incorporating FT_(3)/FT_(4) improved predictive performance for DPN,with an area under the curve of 0.74,sensitivity of 0.79,specificity of 0.64,and accuracy of 0.77.CONCLUSION In elderly patients with T2DM with euthyroidism,a lower FT_(3)/FT_(4) ratio is correlated with increased DPN incidence,affecting both large and small nerve fibers.FT_(3)/FT_(4) is an effective predictor of DPN.展开更多
BACKGROUND Current evidence suggests that commonly used antidiabetic drugs have varying effects on cancer risk.Some antidiabetics offer protective effects against cancer,whereas others may increase risk in specific po...BACKGROUND Current evidence suggests that commonly used antidiabetic drugs have varying effects on cancer risk.Some antidiabetics offer protective effects against cancer,whereas others may increase risk in specific populations.AIM To comprehensively compare the effects of different antidiabetic drugs on the risk of various cancers in patients with type 2 diabetes mellitus(T2DM)through a systematic review and network meta-analysis.METHODS Four databases(PubMed,EMBASE,Cochrane Library,and Web of Science)were searched from their inception until April 11,2025.Published randomized controlled trials that enrolled at least 100 participants and had an intervention duration of at least 1 year were included.The inclusion criteria were studies involving adult patients with T2DM and interventions that compared different classes of antidiabetic drugs with a placebo or another antidiabetic drug.Network meta-analysis was conducted using Stata 17.0 software.Confidence in network meta-analysis was used to assess the quality of evidence regarding the risk of cancer associated with different antidiabetic drugs.RESULTS A total of 13535 articles were identified.After applying the inclusion and exclusion criteria,87 high-quality studies involving 216106 patients and 26 different drugs across seven classes were included in this study.Indirect evidence from network meta-analysis revealed some heterogeneity;however,this did not affect the reliability of the results.The results indicated that antidiabetic drugs did not increase the overall risk of cancer compared with placebo.In contrast,some antidiabetic medications demonstrated a more pronounced advantage in reducing cancer risk,such as dipeptidyl peptidase-4 inhibitors for thyroid and rectal cancers;sodium-glucose co-transporter type 2 inhibitors for lung and bronchial cancers;sulfonylureas for gastric and colon cancers;biguanides for pancreatic cancer;insulin for bladder cancer;glucagon-like peptide-1 receptor agonists for prostate,uterine,hepatocellular,renal,and hematologic cancers;and thiazolidinediones for breast cancer.CONCLUSION Antidiabetic drugs reduce cancer risk in patients with T2DM.However,given the limitations in the number and quality of the included studies,our conclusions should be interpreted with caution.More large-scale,high-quality clinical trials are required to validate our findings towards the optimization of comprehensive cancer management strategies for patients with T2DM.展开更多
This letter comments on a study linking metabolic dysfunction-associated steatotic liver disease(MASLD),vitamin D3,and severe gastric autonomic neuropathy(diabetic gastric motility disorders)in type 2 diabetes mellitu...This letter comments on a study linking metabolic dysfunction-associated steatotic liver disease(MASLD),vitamin D3,and severe gastric autonomic neuropathy(diabetic gastric motility disorders)in type 2 diabetes mellitus(T2DM).We question the necessity of excluding patients with severe cataract(unable to complete fundus exams),as the focus on T2DM-MASLD correlation may render other T2DM complications less relevant.We emphasize vitamin D3’s multifaceted relevance:It associates with T2DM(high-dose supplementation reduces onset risk),MASLD(serum levels predict risk),smooth muscle function,immunity,and T2DM-related fractures via advanced glycation end products.We propose correlating MASLD severity with vitamin D3 levels and diabetic gastric motility disorders in validation analyses(e.g.,correlation,area under the curve)to refine factor analysis.Additionally,based on the authors’note of vitamin D3-tryptophan metabolism links,we call for deeper integration of metabolic pathways to clarify vitamin D3’s role in smooth muscle electrophysiology,leveraging the team’s prior research insights.展开更多
BACKGROUND Diabetic kidney disease(DKD)has become the leading cause of end-stage renal disease.The disease characteristics,morbidity,and renal function progression rate of patients with DKD are all related to sex.This...BACKGROUND Diabetic kidney disease(DKD)has become the leading cause of end-stage renal disease.The disease characteristics,morbidity,and renal function progression rate of patients with DKD are all related to sex.This suggests that sex hormones may play an important role in changing renal function in patients with diabetes.There have been only a few studies on the correlation between sex hormones and DKD,which have contradictory conclusions.AIM To investigate the relationship between circulating sex hormone levels and DKD in men and postmenopausal women with type 2 diabetes mellitus(T2DM).METHODS This retrospective cross-sectional study included 356 patients with T2DM.Pearson or Spearman rank correlation analyses assessed the relationships between sex hormone levels and renal function indices.By adjusting for age,body mass index,systolic blood pressure,diastolic blood pressure,duration of diabetes,use of sodium-glucose cotrasporter-2 inhibitor,use of glucagon-like peptide-1 receptor agonist,hypertension,use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor,diabetic retinopathy,diabetic peripheral vascular disease,triglyceride,uric acid,and hemoglobin A1c,multiple linear regression and logistic regression analyses were conducted to identify factors influencing the urinary albumin/creatinine ratio(UACR)and DKD.RESULTS In men,dehydroepiandrosterone sulfate levels were inversely associated with log-transformed UACR after adjustment for covariate factors[regression coefficient(β)=-0.691,95%confidence interval(CI):-1.241 to-0.141 for quartile 4 vs quartile 1;P=0.006 for trend].Elevated levels of estradiol were positively associated with DKD[odds ratio(OR)=3.097,95%CI:1.083-8.856 for quartile 4 vs quartile 1;P=0.041 for trend],and higher luteinizing hormone(LH)levels were similarly associated with DKD(OR=4.164,95%CI:1.30-13.330 for quartile 4 vs quartile 1;P=0.048 for trend).In postmenopausal women,LH levels were positively correlated with log-transformed UACR and DKD(β=1.039,95%CI:0.284-1.794 for quartile 4 vs quartile 1;P=0.006 for trend and OR=15.117,95%CI:2.191-104.326 for quartile 4 vs quartile 1;P=0.004 for trend).Follicle-stimulating hormone(FSH)levels were also positively associated with DKD(OR=9.588,95%CI:1.680-54.709 for quartile 4 vs quartile 1;P=0.014 for trend).CONCLUSION In men with T2DM,elevated levels of estradiol and LH levels were positively associated with increased risk of DKD.In postmenopausal women with T2DM,high FSH and LH levels were positively associated with increased risk of DKD.展开更多
Background:Type 2 diabetes(T2D)accounts for the majority of diabetes incidences and remains a widespread global chronic disorder.Apart from early lifestyle changes,intervention options for T2D are mainly pharmaceutica...Background:Type 2 diabetes(T2D)accounts for the majority of diabetes incidences and remains a widespread global chronic disorder.Apart from early lifestyle changes,intervention options for T2D are mainly pharmaceutical.Methods:Repetitive transcranial magnetic stimulation(rTMS)has been approved by the FDA as a therapeutic intervention option for major depressive disorders,with further studies also indicating its role in energy metabolism and appetite.Considering its safe and non-invasive properties,we evaluated the effects of rTMS on systemic metabolism using T2D rats.Results:We observed that rTMS improved glucose tolerance and insulin sensitivity in T2D rats after a 10-day exposure.Improved systemic insulin sensitivity was main-tained after a 21-day treatment period,accompanied by modest yet significant weight loss.Circulating serum lipid levels,including those of cholesteryl ester,tryglyceride and ceramides,were also reduced following rTMS application.RNA-seq analyses fur-ther revealed a changed expression profile of hepatic genes that are related to sterol production and fatty acid metabolism.Altered expression of hypothalamic genes that are related to appetite regulation,neural activity and ether lipid metabolism were also implicated.Conclusion:In summary,our data report a positive impact of rTMS on systemic insu-lin sensitivity and weight management of T2D rats.The underlying mechanisms via which rTMS regulates systemic metabolic parameters partially involve lipid utilization in the periphery as well as central regulation of energy intake and lipid metabolism.展开更多
OBJECTIVE To explore hypoglycemic effect of 95%ethanol fraction of Nitraria roborowskii Kom(NRK-C)and its possible mechanism evaluated in the type 2 diabetes mellitus(T2DM)mice.METHODS The body weight,organ indices,bl...OBJECTIVE To explore hypoglycemic effect of 95%ethanol fraction of Nitraria roborowskii Kom(NRK-C)and its possible mechanism evaluated in the type 2 diabetes mellitus(T2DM)mice.METHODS The body weight,organ indices,blood glucose levels,serum biochemical indexes,as well as HE/PAS histopathological section were all analyzed to assess the hypoglycemic effect of NRK-C in T2DM mice induced by a high-fat diet(HFD)combined with six intraperitoneal injections of 35 mg·kg^(-1)of streptozotocin(STZ).The Western blotting and immunofluorescence were further applied to determine the regulatory effect of NRK-C on key signaling proteins.RESULTS The fasting blood glucose levels were significantly reduced after 7 weeks of administration of NRK-C.In addition,NRK-C could also significantly improve glucose tolerance,hepatic glycogen levels,and lipid levels(total cholesterol,triglyceride,low density lipoprotein and high density lipoprotein),and significantly reduced insulin resistance of diabetic mice,which played an important role in the antidiabetic effects.Further mechanism research demonstrated that phosphorylated PI3K expression was up-regulated and p-GSK3βexpression was up-regulated after NRK-C intervention,indicating that NRK-C might exert a potential antidiabetic effect by modulating the PI3K/AKT signaling pathway.CONCLUSION All these results suggested that NRK-C might improve T2DM and had the potential to be used as an adjunctive therapy.展开更多
Objective:To investigate the relationship between Jiaotai pill(JTP),its main component berberine(BBR),and the serotonin(5-HT)system in regulating islet hormone secretion and alleviating pancreatic b-cell dysfunction d...Objective:To investigate the relationship between Jiaotai pill(JTP),its main component berberine(BBR),and the serotonin(5-HT)system in regulating islet hormone secretion and alleviating pancreatic b-cell dysfunction during type 2 diabetes mellitus(T2DM)progression.Methods:T2DM rat model was established using a high-fat diet and streptozotocin injection.JTP,BBR,and Metformin were intragastrically administered for 35 days.The analyzed indices included blood glucose,blood lipids,islet hormones,and proteins related to 5-HT synthesis,secretion,and transport.Additionally,an in vitro model of glucose injury in islet cells was established to study the effects of JTP and BBR on islet hormone secretion following tryptophan hydroxylase 1(TPH1)inhibition.Results:JTP and BBR significantly improved blood glucose and lipid levels and islet morphology in T2DM rats.Both models exhibited reduced islet 5-HT levels and impaired islet hormone secretion.However,the administration of JTP and BBR reversed these effects.Furthermore,JTP and BBR upregulated the expression of TPH1(P=.0194,P=.0413)transglutaminase 2(TGase2;P=.0492,P=.0349),serotonin transporter(SERT,P=.0090),and 5-hydroxytryptamine 1F receptor(5-HT1FR)in the islet 5-HT pathway(P=.0194).In the cell model,the regulatory effects of JTP and BBR on islet hormone levels were significantly weakened after TPH1 inhibition(P=.001),suggesting that JTP and BBR influence islet hormone secretion through the pancreatic 5-HT system.Conclusion:The islet 5-HT system is correlated with islet hormone secretion dysfunction in T2DM.JTP and BBR can improve islet hormone secretion by activating the TPH1/TGase2/SERT/5-HT1FR pathway in the islet 5-HT system in T2DM rats.展开更多
BACKGROUND Cardiac autonomic neuropathy correlates intimately with cardiovascular complications and unexpected death.It is a typical clinical abnormality seen in coronary artery disease-affected individuals with concu...BACKGROUND Cardiac autonomic neuropathy correlates intimately with cardiovascular complications and unexpected death.It is a typical clinical abnormality seen in coronary artery disease-affected individuals with concurrent type 2 diabetes mellitus(T2DM).Moreover,blood glucose(BG)variability has been clinically shown to induce cardiovascular events and sudden death.AIM To investigate how BG variability impacts heart rate(HR)dynamics in older adults with T2DM+coronary heart disease(CHD)and to evaluate the ability of functional myocardial ischemia to predict outcomes in this cohort.METHODS We enrolled 143 older T2DM+CHD patients admitted to the First Affiliated Hospital,Hengyang Medical School,University of South China over a 3.5-year period(January 2018 to July 2021).Using a standard deviation of BG cutoff of 1.4 mmol/L,subjects were stratified into abnormal(n=75)and normal(n=68)fluctuation groups.All patients underwent 72-hour dynamic BG monitoring to detect BG fluctuation parameters.The time domain index of HR variability was measured by dynamic electrocardiogram.To determine how well glucose fluctuation measures predicted functional myocardial ischemia,the area under the receiver operating characteristic curve(AUC)was calculated.RESULTS The abnormal fluctuation group showed greater levels of mean amplitude of glycemic excursions(MAGE),mean of daily differences(MODD),largest amplitude of glycemic excursions(LAGE),and mean postprandial glucose excursions(MPPGE)relative to the normal group(P<0.05),along with lower levels of standard deviation of normal-to-normal(NN)interval(SDNN),standard deviation of the average NN interval(SDANN),standard deviation of NN intervals over every 5-minute period(SDNNindex),root mean square of successive differences(rMSSD),and percentage of NN intervals differing by>50 ms(pNN50;P<0.05).Pearson correlation analysis showed that MAGE,MODD,LAGE,and MPPGE were negatively correlated with SDNN,SDANN,SDNNindex,rMSSD,and pNN50 in older patients with T2DM complicated by CHD(P<0.05).The AUC of MAGE combined with MPPGE in predicting the occurrence of functional myocardial ischemia was 0.912,which was significantly higher than 0.694 of SDNN(P<0.05).CONCLUSION A negative correlation was found between BG variability and HR dynamics in older CHD+T2DM patients,and MAGE combined with MPPGE demonstrated better efficacy in predicting functional myocardial ischemia,which deserves clinical attention.展开更多
Objective:To investigate the influence and underlying mechanisms of imrecoxib on liver damage in rats with type 2 diabetes mellitus(T2DM).Methods:A rat model of T2DM was established by a high-fat diet and streptozotoc...Objective:To investigate the influence and underlying mechanisms of imrecoxib on liver damage in rats with type 2 diabetes mellitus(T2DM).Methods:A rat model of T2DM was established by a high-fat diet and streptozotocin administration.Rats were then treated with imrecoxib 10,20,or 40 mg/kg for 5 weeks.Body weight and fasting blood glucose levels were measured.The analysis included serum liver function,blood lipid profiles,and the levels of inflammatory factors in the rats.Liver tissue histology was evaluated using hematoxylin and eosin staining.Western blotting was conducted to measure the liver expression of proteins such as AKT,PI3K,NF-κB,p-AKT,p-PI3K,and p-NF-κB.Results:Rats treated with imrecoxib showed a greater weight gain compared to untreated diabetic rats.Compared to untreated diabetic rats,imrecoxib at all three doses reduced alanine aminotransferase,aspartate aminotransferase,triglycerides,cholesterol,tumor necrosis factor-α,interleukin(IL)-6,and IL-1β,and significantly increased the levels of IL-10 and IL-4.In imrecoxib-treated rats,the expression levels of AKT,PI3K,p-AKT,and p-PI3K were higher in comparison to the diabetes group,whereas the expression of p-NF-κB was lower.Conclusions:Imrecoxib could alleviate hepatic damage in T2DM rats by modulating PI3K/AKT/NF-κB signaling.展开更多
Anemia is a common yet often overlooked complication in patients with type 2 diabetes mellitus(T2DM),particularly those with chronic kidney disease.It significantly impacts patients'quality of life,cardiovascular ...Anemia is a common yet often overlooked complication in patients with type 2 diabetes mellitus(T2DM),particularly those with chronic kidney disease.It significantly impacts patients'quality of life,cardiovascular health,and treatment outcomes.Despite its high prevalence,current clinical guidelines lack specific recommendations for anemia prevention and management in T2DM,especially in the context of newer antidiabetic therapies.This review explores the potential of emerging antidiabetic medications,such as sodium-glucose cotransporter-2 inhibitors,glucagon-like peptide-1 receptor agonists(GLP-1 RAs),and combined GLP-1-RA/GIP to mitigate anemia risk.Early detection and management of anemia in T2DM patients are crucial for improving glycemic control,reducing cardiovascular morbidity,and enhancing overall treatment outcomes.This review underscores the need for further research to better understand the mechanisms by which these novel therapies influence anemia risk and to integrate these findings into clinical practice.展开更多
BACKGROUND Acute-on-chronic liver failure(ACLF)patients have a high short-term mortality rate,and the severity evaluation of ACLF is necessary for prognostication.Therefore,it was meaningful to evaluate the associatio...BACKGROUND Acute-on-chronic liver failure(ACLF)patients have a high short-term mortality rate,and the severity evaluation of ACLF is necessary for prognostication.Therefore,it was meaningful to evaluate the association between type 2 diabetic mellitus(DM)and ACLF and further explore the feasibility of using DM as a prognostic indicator in ACLF patients.The association between type 2 DM and the prognosis of patients with severe liver disease remains unclear.AIM To examine the effect of type 2 DM on the prognosis of patients with ACLF.METHODS Clinical data from 222 ACLF patients were collected and analyzed.The patients were categorized into two groups depending on whether they had DM or not,and the clinical data of ACLF patients were measured within 48 h after admission.Complications of ACLF were documented during treatment,such as hepatic encephalopathy,hepatorenal syndrome,acute upper gastrointestinal hemorrhage,and spontaneous peritonitis(SBP).Values of laboratory parameters,complication rates,and hospital mortality rates were compared between two groups.RESULTS Among 222 ACLF patients,38 cases were categorized into DM groups,the mean age was 56.32 years and 73.68%were male.The prognosis of ACLF patients was significantly correlated with DM in univariate[hazard ratio(HR)=2.4,95%confidence interval(CI)=1.5-3.7,P<0.001]and multivariable analysis(HR=3.17,95%CI=1.82-5.523,P<0.001).The incident of SBP(34.21%vs 13.59%,P=0.038)and other infections like lung,urinary,blood,and cholecyst(44.74%vs 28.26%,P=0.046)were higher in DM patients than non-DM counterparts.In addition,the ACLF patients with DM tended to have a high mortality rate(P<0.001).Cumulative survival time was also significantly shorter in the ACLF patients with DM than non-DM.CONCLUSION A significant association between DM and the prognosis of ACLF patients was found in China.The ACLF patients with DM had higher incidence of hospital mortality and infection than those without DM.展开更多
BACKGROUND Diabetic peripheral neuropathy(DPN)is a chronic and serious microvascular complication of diabetes linked to redox imbalance.Sestrin2,a novel inducible stress protein,participates in glucose metabolic regul...BACKGROUND Diabetic peripheral neuropathy(DPN)is a chronic and serious microvascular complication of diabetes linked to redox imbalance.Sestrin2,a novel inducible stress protein,participates in glucose metabolic regulation and redox homeostasis.However,the association between serum Sestrin2 and DPN is unknown.AIM To explore the association between serum Sestrin2 and DPN in patients with type 2 diabetes mellitus(T2DM).METHODS A total of 96 T2DM patients and 39 healthy volunteers,matched by age and sex,participated in this cross-sectional study.Clinical features and metabolic indices were identified.Serum Sestrin2 was measured by ELISA.The association between Sestrin2 and DPN was studied.Correlation and logistic regression analyses were used to evaluate the associations of different metabolic indices with Sestrin2 and DPN.RESULTS The 96 patients with T2DM were divided into DPN(n=47)and patients without DPN(n=49).Serum Sestrin2 was significantly lower in healthy volunteers than in all T2DM patients combined[9.10(5.41-13.53)ng/mL vs 12.75(7.44-23.80)ng/mL,P<0.01].T2DM patients without DPN also had significantly higher levels of Sestrin2 than healthy volunteers[14.58(7.93-26.62)ng/mL vs 9.10(5.41-13.53)ng/mL,P<0.01].However,T2DM patients with DPN had lower circulating Sestrin2 levels compared to T2DM patients without DPN[9.86(6.72-21.71)ng/mL vs 14.58(7.93-26.62)ng/mL,respectively,P<0.01].Bivariate correlation analysis revealed that serum Sestrin2 was positively correlated with body mass index(r=0.672,P=0.000),hemoglobin A1c(HbA1c)(r=0.292,P=0.000),serum creatinine(r=0.206,P=0.016),triglycerides(r=0.731,P=0.000),and fasting glucose(r=0.202,P=0.040),and negatively associated with estimated glomerular filtration rate(r=-0.230,P=0.007).After adjustment for sex,age,HbA1c,and diabetes duration,multiple regression analysis revealed that Sestrin2 was independently correlated with body mass index and triglyceride levels(P=0.000).Logistic regression analyses indicated that Sestrin2,diabetes duration,and high-density lipoprotein were strongly associated with DPN(odds ratio=0.855,1.411,and 0.041,respectively).CONCLUSION Our results show Sestrin2 is decreased in T2DM patients with DNP.As lower Sestrin2 is independently associated with DPN,Sestrin2 may contribute to progression of DPN in T2DM patients.展开更多
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Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for multiple complications. The objective of this study was to characterize clinically and biologically type 2 diabetic patients followed at the National Center for Diabetology and Arterial Hypertension of the Central Hospital of Yaoundé. Method: This prospective, cross-sectional, and analytical study took place from April 5 to July 31, 2023 (4 months) on 100 diabetic patients of both sexes (61 women and 39 men), aged from 31 to 88 years. Body Mass Index, systolic and diastolic blood pressure, and cardiac frequency were measured on each of the patients. Subsequently, blood was collected from the patients for the determination of the complete blood count, HBA1c, lipid profile, serum albumin, TNF-α, and IL-6 levels. The data were analyzed using SPSS 17.0 software. Results: The age average of our population was 56.99 ± 11.51 years, the population was primarily female (61%) and primarily between the ages of 55 and 88. 67% of respondents were married. 59% went to secondary school. 73% of them lived in urban areas. 30% were obese and 40% were overweight, with an average BMI of 28.75 kg/m2. 76% of patients took oral antidiabetic medications. HbA1c level average was 8.65%, with 60% having readings above 6.5%. Low hemoglobin and hypochromia were among the abnormalities of red blood cells observed. Lipid profiles revealed low HDL-cholesterol and high triglycerides and cholesterol. Elevated levels of TNF-α and IL-6 indicated inflammation and cardiovascular risk. Conclusion: These results indicate the necessity of focused diabetic care and management on diabetic patients attending the central hospital of Yaoundé, Cameroon.
基金Supported by National Natural Science Foundation of China,No.81972947Academic Promotion Programme of Shandong First Medical University,No.2019LJ005.
文摘BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.METHODS We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021.A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors.Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions.The Cox model was further employed to evaluate the impact of risk factors on DF.The area under the curve(AUC)was measured to evaluate the accuracy of the prediction model.RESULTS Seventy-five diabetic inpatients experienced DF.The incidence density of DF was 4.5/1000 person-years.A long duration of diabetes,lower extremity arterial disease,lower serum albumin,fasting plasma glucose(FPG),and diabetic nephropathy were independently associated with DF.Among these risk factors,the serum albumin concentration was inversely associated with DF,with a hazard ratio(HR)and 95%confidence interval(CI)of 0.91(0.88-0.95)(P<0.001).Additionally,a U-shaped nonlinear relationship was observed between the FPG level and DF.After adjusting for other variables,the HRs and 95%CI for FPG<4.4 mmol/L and≥7.0 mmol/L were 3.99(1.55-10.25)(P=0.004)and 3.12(1.66-5.87)(P<0.001),respectively,which was greater than the mid-range level(4.4-6.9 mmol/L).The AUC for predicting DF over 3 years was 0.797.CONCLUSION FPG demonstrated a U-shaped relationship with DF.Serum albumin levels were negatively associated with DF.The prediction nomogram model of DF showed good discrimination ability using diabetes duration,lower extremity arterial disease,serum albumin,FPG,and diabetic nephropathy(Clinicaltrial.gov NCT05519163).
基金Medical Ethics Committee of the Nanxishan Hospital of Guangxi Zhuang Autonomous Region(Approval No.NXSYY-2024-209).
文摘BACKGROUND The preservation of isletβ-cell function in elderly patients with type 2 diabetes mellitus(T2DM)is a top priority for diabetic control.AIM To assess the preservation of isletβ-cell function among elderly Chinese patients with T2DM after different anti-diabetic treatments.METHODS In this longitudinal observational study,elderly patients with T2DM treated with insulin,oral antidiabetic drugs or a combination of both were enrolled to disclose their isletβ-cell function between baseline and follow-up.Isletβ-cell function was determined by the plasma Homeostasis Model forβ-cell function(HOMA-β),Cpeptide and area under the curve(AUC)based on oral glucose tolerance test.Changes inβ-cell function(decrement or increment from baseline)between different therapy groups were the outcomes.RESULTS In total,745 elderly patients(≥60 years)with T2DM[insulin monotherapy,n=105;oral anti-diabetic drugs(OAD)monotherapy,n=321;insulin plus OAD,n=319]had their baseline and follow-upβ-cell function assessed during a median observation period of 4.5 years(range,3.0-7.2 years).Overall,isletβ-cell function(HOMA-β,fasting Cpeptide,fasting insulin,AUCc-pep,AUCins,AUCc-pep/AUCglu,AUCins/AUCglu)consistently deteriorated over time regardless of the three different antidiabetic treatments.No statistical differences in decrement were observed among the three groups regarding the isletβ-cell function indices.All three groups showed an increased ratio of delayed insulin secretion response after 4.5 years of observation.CONCLUSION In Chinese elderly patients with T2DM,isletβ-cell function progressively declines regardless of insulin supplement or insulin plus OAD treatments.
基金Supported by National High Level Hospital Clinical Research Funding,No.BJ-2022-145China Endocrinology and Metabolism Young Scientific Talent Research Project,No.2021-N-03.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM),driven by insulin resistance and β cell dysfunction,necessitates reliable assessment of β cell function.C-peptide(CP)measurement,a stable marker of endogenous insulin secretion,is useful for this clinically as it avoids interference from exogenous insulin.While fasting CP(FCP)and postprandial CP(PCP),along with glucose-adjusted indices and ratios,such as FCP/fasting plasma glucose(FPG),2 hours postprandial CP(2hCP)/postprandial blood glucose(PBG)and CP ratio,are used,their comparative efficacy in reflectingβcell function remains unclear.Hemoglobin A1c(HbA1c),a key glycemic control indicator,theoretically linksβcell function to complications,but limited studies have explored the associations between diverse CP indices,HbA1c,and diabetic microvascular complications.AIM To investigate the relationships between different CP indices and HbA1c as well as diabetic microvascular complications in T2DM.METHODS T2DM patients admitted to Department of Endocrinology at Beijing Hospital between July 1,2021 and December 31,2021 were included in the study.Clinical and laboratory data were collected,including CP levels,glucose levels,HbA1c levels and diabetic microvascular complications.Statistical analysis was performed using Statistical Package for the Social Sciences 24.0.RESULTS A total of 453 patients were included in the final analysis.Adjusted by confounding factors,CP ratio and CP/blood glucose(BG)ratio were not relevant to HbA1c,but FCP,2hCP,delta CP,FCP/FPG,2hCP/PBG and delta CP/BG were still negatively correlated to HbA1c,of which 2hCP/PBG showed the strongest negative correlation(r=-0.485,P<0.001).Independent of HbA1c and other confounding factors,2hCP,2hCP/PBG,delta CP and delta CP/BG were protective factors of diabetic retinopathy while 2hCP,delta CP and FCP/FPG were protective factors of diabetic peripheral neuropathy.CONCLUSION This study indicates that higher levels of CP indices suggest better glucose control and a lower prevalence of diabetic microvascular complications,and PCP indices,particularly 2hCP/PBG,were more relevant to HbA1c and diabetic microvascular complications than FCP indices.These results suggest CP-related indices could be useful biomarkers for diabetes management,warranting further research.
基金Supported by China Medical University Hospital,No.DMR-113-105.
文摘BACKGROUND Diabetic retinopathy(DR)is the leading cause of blindness among working-age adults,with an increasing prevalence due to the global burden of diabetes.AIM To develop a polygenic risk score(PRS)to identify high-risk groups for DR and evaluate its severity in patients with type 2 diabetes(T2D).METHODS This population-based study included 13335 patients with T2D,comprising 7295 patients with DR and 6040 without DR.Genetic data,duration of DR diagnosis,body mass index,systolic blood pressure,diastolic blood pressure,and glycated hemoglobin A1c levels were obtained from the study population.The PRS was constructed from a genome-wide association study conducted in a Taiwan region of China Han population.Electronic medical records were used to track patients with T2D and analyze the associations between PRS,timing of DR diagnosis,and therapeutic interventions.The hazard ratio(HR)of PRS for DR development and severity was estimated using multivariate Cox proportional hazards regression.RESULTS The results demonstrated that patients with T2D in the top PRS decile had a 1.21-fold greater risk of developing DR[HR=1.21;95%confidence interval(CI):1.01-1.45;P=0.041]over a 20-year follow-up period.Among patients with DR,those in the highest PRS decile exhibited a 4.81-fold increased risk of requiring more than four laser treatments(HR=4.81;95%CI:1.40-16.5;P=0.012)and a 1.38-fold increased risk of undergoing vitreoretinal surgery(HR=1.38;95%CI:1.01-1.90;P=0.044).CONCLUSION Patients with T2D with a higher PRS are at increased risk of developing DR and may experience more severe forms of the disease.
文摘BACKGROUND Type 2 diabetic nephropathy(T2DN)is a severe complication of diabetes mellitus,and identifying biomarkers for its prognosis remains a critical challenge.Previous studies have suggested potential roles of microRNAs(e.g.,miR-495-3p),adiponectin(ADPN),and cardiometabolic index(CMI)in metabolic and renal pathologies.However,their combined predictive value for T2DN prognosis is not well understood.AIM To explore serum miR-495-3p,ADPN,and CMI levels in T2DN and their value in predicting prognosis.METHODS A total of 98 T2DN patients(study group)and 49 type 2 diabetic patients with normal renal function(control group)were enrolled from February 2020 to February 2022.Serum levels of miR-495-3p,ADPN,and CMI were measured in both groups.Patients were followed up for 6 months to assess prognosis.Dif-ferences between groups were analyzed,and multivariate logistic regression and receiver operating characteristic(ROC)curve analyses were performed to eva-luate the predictive value of these biomarkers.RESULTS The study group exhibited significantly lower miR-495-3p levels and higher ADPN and CMI levels compared to the control group(P<0.05).Poor prognosis patients had even lower miR-495-3p and higher ADPN and CMI levels than those with good prognosis(P<0.05).Multivariate analysis identified alanine amino-transferase,aspartate aminotransferase,urea nitrogen,serum creatinine,miR-495-3p,ADPN,and CMI as independent predictors of prognosis(P<0.05).ROC analysis revealed area under the curve values of 0.762(miR-495-3p),0.902(ADPN),0.757(CMI),0.899(alanine aminotransferase),0.852(aspartate ami-notransferase),0.916(urea nitrogen),and 0.910(serum creatinine)for predicting poor prognosis(P<0.05).CONCLUSION Low miR-495-3p and high ADPN and CMI levels are linked to T2DN and poor prognosis,highlighting their potential for risk prediction and clinical management.
基金National Natural Science Foundation of China,No.82270881 and No.82200928National High-Level Hospital Clinical Research Funding,No.BJ-2023-124 and No.BJ-2023-130.
文摘BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of type 2 diabetes mellitus(T2DM),significantly affecting patients’quality of life and imposing a substantial economic burden.Recent studies have highlighted the role of thyroid hormones in diabetes complications,particularly in elderly patients with T2DM.However,the relationship between thyroid hormone sensitivity and DPN remains unclear.AIM To investigate the correlation between thyroid hormone sensitivity and DPN in elderly patients with T2DM.METHODS In a cohort of 256 elderly patients with T2DM,propensity score matching was used to balance age,sex,and diabetes duration.Clinical data were collected to calculate thyroid hormone sensitivity and analyze its correlation with DPN.A random forest model was used to evaluate the diagnostic value of free triiodothyronine/free thyroxine(FT_(3)/FT_(4))for DPN.RESULTS Patients with DPN had a lower FT_(3)/FT_(4) ratio[(0.302±0.053)vs(0.316±0.049),P=0.040].Quartile stratification showed decreasing DPN prevalence with higher FT_(3)/FT_(4) ratios.Spearman’s correlation analysis showed that a lower FT_(3)/FT_(4) ratio was associated with higher glycated hemoglobin,fasting blood glucose,reduced nerve conduction velocity,and electrical skin conductance.Logistic regression indicated a positive relationship between the median FT_(3)/FT_(4) ratio and bilateral foot electrochemical skin conductance[odds ratio(OR):1.019;95%CI:1.005-1.034;P=0.007]and sural nerve sensory amplitude(OR:1.310;95%CI:1.008-1.703;P=0.043).Receiver operating characteristic analysis using a random forest model showed that incorporating FT_(3)/FT_(4) improved predictive performance for DPN,with an area under the curve of 0.74,sensitivity of 0.79,specificity of 0.64,and accuracy of 0.77.CONCLUSION In elderly patients with T2DM with euthyroidism,a lower FT_(3)/FT_(4) ratio is correlated with increased DPN incidence,affecting both large and small nerve fibers.FT_(3)/FT_(4) is an effective predictor of DPN.
基金Supported by National Natural Science Foundation of China,No.82305205Young Elite Scientists Sponsorship Program by China Association of Chinese Medicine,No.2023-QNRC2-A05+1 种基金Safeguard Project of Guang’anmen Hospital,China Academy of Chinese Medical Sciences,No.GAMHH9324001Special Program for the Training of Outstanding Young Scientific and Technological Talents Under the Basic Scientific Research Operating Expenses of the China Academy of Chinese Medical Sciences,No.ZZ18-YQ-011.
文摘BACKGROUND Current evidence suggests that commonly used antidiabetic drugs have varying effects on cancer risk.Some antidiabetics offer protective effects against cancer,whereas others may increase risk in specific populations.AIM To comprehensively compare the effects of different antidiabetic drugs on the risk of various cancers in patients with type 2 diabetes mellitus(T2DM)through a systematic review and network meta-analysis.METHODS Four databases(PubMed,EMBASE,Cochrane Library,and Web of Science)were searched from their inception until April 11,2025.Published randomized controlled trials that enrolled at least 100 participants and had an intervention duration of at least 1 year were included.The inclusion criteria were studies involving adult patients with T2DM and interventions that compared different classes of antidiabetic drugs with a placebo or another antidiabetic drug.Network meta-analysis was conducted using Stata 17.0 software.Confidence in network meta-analysis was used to assess the quality of evidence regarding the risk of cancer associated with different antidiabetic drugs.RESULTS A total of 13535 articles were identified.After applying the inclusion and exclusion criteria,87 high-quality studies involving 216106 patients and 26 different drugs across seven classes were included in this study.Indirect evidence from network meta-analysis revealed some heterogeneity;however,this did not affect the reliability of the results.The results indicated that antidiabetic drugs did not increase the overall risk of cancer compared with placebo.In contrast,some antidiabetic medications demonstrated a more pronounced advantage in reducing cancer risk,such as dipeptidyl peptidase-4 inhibitors for thyroid and rectal cancers;sodium-glucose co-transporter type 2 inhibitors for lung and bronchial cancers;sulfonylureas for gastric and colon cancers;biguanides for pancreatic cancer;insulin for bladder cancer;glucagon-like peptide-1 receptor agonists for prostate,uterine,hepatocellular,renal,and hematologic cancers;and thiazolidinediones for breast cancer.CONCLUSION Antidiabetic drugs reduce cancer risk in patients with T2DM.However,given the limitations in the number and quality of the included studies,our conclusions should be interpreted with caution.More large-scale,high-quality clinical trials are required to validate our findings towards the optimization of comprehensive cancer management strategies for patients with T2DM.
基金Supported by Fujian Provincial Science and Technology Innovation Joint Fund Project,No.2024Y9555Youth Research Project of the Science and Technology Plan of Fujian Provincial Health Commission,No.2024QNB005+1 种基金Fujian Provincial Natural Science Foundation Project,No.2024J011124Fujian Provincial Medical Project for Creating Dual High-Quality Development(High Level and High Standard),No.ETK2025004.
文摘This letter comments on a study linking metabolic dysfunction-associated steatotic liver disease(MASLD),vitamin D3,and severe gastric autonomic neuropathy(diabetic gastric motility disorders)in type 2 diabetes mellitus(T2DM).We question the necessity of excluding patients with severe cataract(unable to complete fundus exams),as the focus on T2DM-MASLD correlation may render other T2DM complications less relevant.We emphasize vitamin D3’s multifaceted relevance:It associates with T2DM(high-dose supplementation reduces onset risk),MASLD(serum levels predict risk),smooth muscle function,immunity,and T2DM-related fractures via advanced glycation end products.We propose correlating MASLD severity with vitamin D3 levels and diabetic gastric motility disorders in validation analyses(e.g.,correlation,area under the curve)to refine factor analysis.Additionally,based on the authors’note of vitamin D3-tryptophan metabolism links,we call for deeper integration of metabolic pathways to clarify vitamin D3’s role in smooth muscle electrophysiology,leveraging the team’s prior research insights.
基金Supported by the National Natural Science Foundation of China,No.82270942.
文摘BACKGROUND Diabetic kidney disease(DKD)has become the leading cause of end-stage renal disease.The disease characteristics,morbidity,and renal function progression rate of patients with DKD are all related to sex.This suggests that sex hormones may play an important role in changing renal function in patients with diabetes.There have been only a few studies on the correlation between sex hormones and DKD,which have contradictory conclusions.AIM To investigate the relationship between circulating sex hormone levels and DKD in men and postmenopausal women with type 2 diabetes mellitus(T2DM).METHODS This retrospective cross-sectional study included 356 patients with T2DM.Pearson or Spearman rank correlation analyses assessed the relationships between sex hormone levels and renal function indices.By adjusting for age,body mass index,systolic blood pressure,diastolic blood pressure,duration of diabetes,use of sodium-glucose cotrasporter-2 inhibitor,use of glucagon-like peptide-1 receptor agonist,hypertension,use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor,diabetic retinopathy,diabetic peripheral vascular disease,triglyceride,uric acid,and hemoglobin A1c,multiple linear regression and logistic regression analyses were conducted to identify factors influencing the urinary albumin/creatinine ratio(UACR)and DKD.RESULTS In men,dehydroepiandrosterone sulfate levels were inversely associated with log-transformed UACR after adjustment for covariate factors[regression coefficient(β)=-0.691,95%confidence interval(CI):-1.241 to-0.141 for quartile 4 vs quartile 1;P=0.006 for trend].Elevated levels of estradiol were positively associated with DKD[odds ratio(OR)=3.097,95%CI:1.083-8.856 for quartile 4 vs quartile 1;P=0.041 for trend],and higher luteinizing hormone(LH)levels were similarly associated with DKD(OR=4.164,95%CI:1.30-13.330 for quartile 4 vs quartile 1;P=0.048 for trend).In postmenopausal women,LH levels were positively correlated with log-transformed UACR and DKD(β=1.039,95%CI:0.284-1.794 for quartile 4 vs quartile 1;P=0.006 for trend and OR=15.117,95%CI:2.191-104.326 for quartile 4 vs quartile 1;P=0.004 for trend).Follicle-stimulating hormone(FSH)levels were also positively associated with DKD(OR=9.588,95%CI:1.680-54.709 for quartile 4 vs quartile 1;P=0.014 for trend).CONCLUSION In men with T2DM,elevated levels of estradiol and LH levels were positively associated with increased risk of DKD.In postmenopausal women with T2DM,high FSH and LH levels were positively associated with increased risk of DKD.
基金National Key Technologies Research and Development Program of China,Grant/Award Number:2020YFA0803701National Natural Science Foundation of China,Grant/Award Number:52107241,81973699 and 82274361CAMS Innovation Fund for Medical Sciences,Grant/Award Number:2021-12M-1-052。
文摘Background:Type 2 diabetes(T2D)accounts for the majority of diabetes incidences and remains a widespread global chronic disorder.Apart from early lifestyle changes,intervention options for T2D are mainly pharmaceutical.Methods:Repetitive transcranial magnetic stimulation(rTMS)has been approved by the FDA as a therapeutic intervention option for major depressive disorders,with further studies also indicating its role in energy metabolism and appetite.Considering its safe and non-invasive properties,we evaluated the effects of rTMS on systemic metabolism using T2D rats.Results:We observed that rTMS improved glucose tolerance and insulin sensitivity in T2D rats after a 10-day exposure.Improved systemic insulin sensitivity was main-tained after a 21-day treatment period,accompanied by modest yet significant weight loss.Circulating serum lipid levels,including those of cholesteryl ester,tryglyceride and ceramides,were also reduced following rTMS application.RNA-seq analyses fur-ther revealed a changed expression profile of hepatic genes that are related to sterol production and fatty acid metabolism.Altered expression of hypothalamic genes that are related to appetite regulation,neural activity and ether lipid metabolism were also implicated.Conclusion:In summary,our data report a positive impact of rTMS on systemic insu-lin sensitivity and weight management of T2D rats.The underlying mechanisms via which rTMS regulates systemic metabolic parameters partially involve lipid utilization in the periphery as well as central regulation of energy intake and lipid metabolism.
文摘OBJECTIVE To explore hypoglycemic effect of 95%ethanol fraction of Nitraria roborowskii Kom(NRK-C)and its possible mechanism evaluated in the type 2 diabetes mellitus(T2DM)mice.METHODS The body weight,organ indices,blood glucose levels,serum biochemical indexes,as well as HE/PAS histopathological section were all analyzed to assess the hypoglycemic effect of NRK-C in T2DM mice induced by a high-fat diet(HFD)combined with six intraperitoneal injections of 35 mg·kg^(-1)of streptozotocin(STZ).The Western blotting and immunofluorescence were further applied to determine the regulatory effect of NRK-C on key signaling proteins.RESULTS The fasting blood glucose levels were significantly reduced after 7 weeks of administration of NRK-C.In addition,NRK-C could also significantly improve glucose tolerance,hepatic glycogen levels,and lipid levels(total cholesterol,triglyceride,low density lipoprotein and high density lipoprotein),and significantly reduced insulin resistance of diabetic mice,which played an important role in the antidiabetic effects.Further mechanism research demonstrated that phosphorylated PI3K expression was up-regulated and p-GSK3βexpression was up-regulated after NRK-C intervention,indicating that NRK-C might exert a potential antidiabetic effect by modulating the PI3K/AKT signaling pathway.CONCLUSION All these results suggested that NRK-C might improve T2DM and had the potential to be used as an adjunctive therapy.
基金supported by the National Natural Science Foundation of China(81673680)the Fundamental Research Funds for the Central Public Welfare Research Institutes(YZX-202306).
文摘Objective:To investigate the relationship between Jiaotai pill(JTP),its main component berberine(BBR),and the serotonin(5-HT)system in regulating islet hormone secretion and alleviating pancreatic b-cell dysfunction during type 2 diabetes mellitus(T2DM)progression.Methods:T2DM rat model was established using a high-fat diet and streptozotocin injection.JTP,BBR,and Metformin were intragastrically administered for 35 days.The analyzed indices included blood glucose,blood lipids,islet hormones,and proteins related to 5-HT synthesis,secretion,and transport.Additionally,an in vitro model of glucose injury in islet cells was established to study the effects of JTP and BBR on islet hormone secretion following tryptophan hydroxylase 1(TPH1)inhibition.Results:JTP and BBR significantly improved blood glucose and lipid levels and islet morphology in T2DM rats.Both models exhibited reduced islet 5-HT levels and impaired islet hormone secretion.However,the administration of JTP and BBR reversed these effects.Furthermore,JTP and BBR upregulated the expression of TPH1(P=.0194,P=.0413)transglutaminase 2(TGase2;P=.0492,P=.0349),serotonin transporter(SERT,P=.0090),and 5-hydroxytryptamine 1F receptor(5-HT1FR)in the islet 5-HT pathway(P=.0194).In the cell model,the regulatory effects of JTP and BBR on islet hormone levels were significantly weakened after TPH1 inhibition(P=.001),suggesting that JTP and BBR influence islet hormone secretion through the pancreatic 5-HT system.Conclusion:The islet 5-HT system is correlated with islet hormone secretion dysfunction in T2DM.JTP and BBR can improve islet hormone secretion by activating the TPH1/TGase2/SERT/5-HT1FR pathway in the islet 5-HT system in T2DM rats.
基金Supported by National Natural Science Foundation of China,No.82270939The Clinical Research 4310 Program of the First Affiliated Hospital of the University of South China,No.20214310NHYCG02。
文摘BACKGROUND Cardiac autonomic neuropathy correlates intimately with cardiovascular complications and unexpected death.It is a typical clinical abnormality seen in coronary artery disease-affected individuals with concurrent type 2 diabetes mellitus(T2DM).Moreover,blood glucose(BG)variability has been clinically shown to induce cardiovascular events and sudden death.AIM To investigate how BG variability impacts heart rate(HR)dynamics in older adults with T2DM+coronary heart disease(CHD)and to evaluate the ability of functional myocardial ischemia to predict outcomes in this cohort.METHODS We enrolled 143 older T2DM+CHD patients admitted to the First Affiliated Hospital,Hengyang Medical School,University of South China over a 3.5-year period(January 2018 to July 2021).Using a standard deviation of BG cutoff of 1.4 mmol/L,subjects were stratified into abnormal(n=75)and normal(n=68)fluctuation groups.All patients underwent 72-hour dynamic BG monitoring to detect BG fluctuation parameters.The time domain index of HR variability was measured by dynamic electrocardiogram.To determine how well glucose fluctuation measures predicted functional myocardial ischemia,the area under the receiver operating characteristic curve(AUC)was calculated.RESULTS The abnormal fluctuation group showed greater levels of mean amplitude of glycemic excursions(MAGE),mean of daily differences(MODD),largest amplitude of glycemic excursions(LAGE),and mean postprandial glucose excursions(MPPGE)relative to the normal group(P<0.05),along with lower levels of standard deviation of normal-to-normal(NN)interval(SDNN),standard deviation of the average NN interval(SDANN),standard deviation of NN intervals over every 5-minute period(SDNNindex),root mean square of successive differences(rMSSD),and percentage of NN intervals differing by>50 ms(pNN50;P<0.05).Pearson correlation analysis showed that MAGE,MODD,LAGE,and MPPGE were negatively correlated with SDNN,SDANN,SDNNindex,rMSSD,and pNN50 in older patients with T2DM complicated by CHD(P<0.05).The AUC of MAGE combined with MPPGE in predicting the occurrence of functional myocardial ischemia was 0.912,which was significantly higher than 0.694 of SDNN(P<0.05).CONCLUSION A negative correlation was found between BG variability and HR dynamics in older CHD+T2DM patients,and MAGE combined with MPPGE demonstrated better efficacy in predicting functional myocardial ischemia,which deserves clinical attention.
基金funded by the“Hengrui-Tianqing Medical Education Fund”of the Second Affiliated Hospital of Wannan Medical College(grant no.HXKT2022026)Natural Science Research Program for Universities in Anhui Province(grant no.2023AH051739).
文摘Objective:To investigate the influence and underlying mechanisms of imrecoxib on liver damage in rats with type 2 diabetes mellitus(T2DM).Methods:A rat model of T2DM was established by a high-fat diet and streptozotocin administration.Rats were then treated with imrecoxib 10,20,or 40 mg/kg for 5 weeks.Body weight and fasting blood glucose levels were measured.The analysis included serum liver function,blood lipid profiles,and the levels of inflammatory factors in the rats.Liver tissue histology was evaluated using hematoxylin and eosin staining.Western blotting was conducted to measure the liver expression of proteins such as AKT,PI3K,NF-κB,p-AKT,p-PI3K,and p-NF-κB.Results:Rats treated with imrecoxib showed a greater weight gain compared to untreated diabetic rats.Compared to untreated diabetic rats,imrecoxib at all three doses reduced alanine aminotransferase,aspartate aminotransferase,triglycerides,cholesterol,tumor necrosis factor-α,interleukin(IL)-6,and IL-1β,and significantly increased the levels of IL-10 and IL-4.In imrecoxib-treated rats,the expression levels of AKT,PI3K,p-AKT,and p-PI3K were higher in comparison to the diabetes group,whereas the expression of p-NF-κB was lower.Conclusions:Imrecoxib could alleviate hepatic damage in T2DM rats by modulating PI3K/AKT/NF-κB signaling.
文摘Anemia is a common yet often overlooked complication in patients with type 2 diabetes mellitus(T2DM),particularly those with chronic kidney disease.It significantly impacts patients'quality of life,cardiovascular health,and treatment outcomes.Despite its high prevalence,current clinical guidelines lack specific recommendations for anemia prevention and management in T2DM,especially in the context of newer antidiabetic therapies.This review explores the potential of emerging antidiabetic medications,such as sodium-glucose cotransporter-2 inhibitors,glucagon-like peptide-1 receptor agonists(GLP-1 RAs),and combined GLP-1-RA/GIP to mitigate anemia risk.Early detection and management of anemia in T2DM patients are crucial for improving glycemic control,reducing cardiovascular morbidity,and enhancing overall treatment outcomes.This review underscores the need for further research to better understand the mechanisms by which these novel therapies influence anemia risk and to integrate these findings into clinical practice.
基金Fujian Health Research Talents Training Program,No.2019-1-42National Natural Science Foundation of China,No.81702073and Fujian Provincial Natural Science Foundation General Project,No.2020J01955.
文摘BACKGROUND Acute-on-chronic liver failure(ACLF)patients have a high short-term mortality rate,and the severity evaluation of ACLF is necessary for prognostication.Therefore,it was meaningful to evaluate the association between type 2 diabetic mellitus(DM)and ACLF and further explore the feasibility of using DM as a prognostic indicator in ACLF patients.The association between type 2 DM and the prognosis of patients with severe liver disease remains unclear.AIM To examine the effect of type 2 DM on the prognosis of patients with ACLF.METHODS Clinical data from 222 ACLF patients were collected and analyzed.The patients were categorized into two groups depending on whether they had DM or not,and the clinical data of ACLF patients were measured within 48 h after admission.Complications of ACLF were documented during treatment,such as hepatic encephalopathy,hepatorenal syndrome,acute upper gastrointestinal hemorrhage,and spontaneous peritonitis(SBP).Values of laboratory parameters,complication rates,and hospital mortality rates were compared between two groups.RESULTS Among 222 ACLF patients,38 cases were categorized into DM groups,the mean age was 56.32 years and 73.68%were male.The prognosis of ACLF patients was significantly correlated with DM in univariate[hazard ratio(HR)=2.4,95%confidence interval(CI)=1.5-3.7,P<0.001]and multivariable analysis(HR=3.17,95%CI=1.82-5.523,P<0.001).The incident of SBP(34.21%vs 13.59%,P=0.038)and other infections like lung,urinary,blood,and cholecyst(44.74%vs 28.26%,P=0.046)were higher in DM patients than non-DM counterparts.In addition,the ACLF patients with DM tended to have a high mortality rate(P<0.001).Cumulative survival time was also significantly shorter in the ACLF patients with DM than non-DM.CONCLUSION A significant association between DM and the prognosis of ACLF patients was found in China.The ACLF patients with DM had higher incidence of hospital mortality and infection than those without DM.
基金National Natural Science Foundation of China,No.81870593Natural Science Foundation of Shandong Province of China,No.ZR2020MH106+1 种基金Medical Health Science and Technology Project of Shandong Province,No.202003060396 and No.202003060400Quality Improvement of Postgraduate Education in Shandong Province,No.SDYAL19156.
文摘BACKGROUND Diabetic peripheral neuropathy(DPN)is a chronic and serious microvascular complication of diabetes linked to redox imbalance.Sestrin2,a novel inducible stress protein,participates in glucose metabolic regulation and redox homeostasis.However,the association between serum Sestrin2 and DPN is unknown.AIM To explore the association between serum Sestrin2 and DPN in patients with type 2 diabetes mellitus(T2DM).METHODS A total of 96 T2DM patients and 39 healthy volunteers,matched by age and sex,participated in this cross-sectional study.Clinical features and metabolic indices were identified.Serum Sestrin2 was measured by ELISA.The association between Sestrin2 and DPN was studied.Correlation and logistic regression analyses were used to evaluate the associations of different metabolic indices with Sestrin2 and DPN.RESULTS The 96 patients with T2DM were divided into DPN(n=47)and patients without DPN(n=49).Serum Sestrin2 was significantly lower in healthy volunteers than in all T2DM patients combined[9.10(5.41-13.53)ng/mL vs 12.75(7.44-23.80)ng/mL,P<0.01].T2DM patients without DPN also had significantly higher levels of Sestrin2 than healthy volunteers[14.58(7.93-26.62)ng/mL vs 9.10(5.41-13.53)ng/mL,P<0.01].However,T2DM patients with DPN had lower circulating Sestrin2 levels compared to T2DM patients without DPN[9.86(6.72-21.71)ng/mL vs 14.58(7.93-26.62)ng/mL,respectively,P<0.01].Bivariate correlation analysis revealed that serum Sestrin2 was positively correlated with body mass index(r=0.672,P=0.000),hemoglobin A1c(HbA1c)(r=0.292,P=0.000),serum creatinine(r=0.206,P=0.016),triglycerides(r=0.731,P=0.000),and fasting glucose(r=0.202,P=0.040),and negatively associated with estimated glomerular filtration rate(r=-0.230,P=0.007).After adjustment for sex,age,HbA1c,and diabetes duration,multiple regression analysis revealed that Sestrin2 was independently correlated with body mass index and triglyceride levels(P=0.000).Logistic regression analyses indicated that Sestrin2,diabetes duration,and high-density lipoprotein were strongly associated with DPN(odds ratio=0.855,1.411,and 0.041,respectively).CONCLUSION Our results show Sestrin2 is decreased in T2DM patients with DNP.As lower Sestrin2 is independently associated with DPN,Sestrin2 may contribute to progression of DPN in T2DM patients.
