搜索结果：Journal of diabetes investigation

Medical Nutrition Therapy remains the cornerstone of diabetes management. Clinical evidence shows that early intervention with medical nutrition therapy can significantly improve cardiometabolic markers, thereby delaying or preventing diabetes-related complications. As part of medical nutrition therapy, diabetes-specific formula has proven to be an effective tool in clinical practice and a viable support alternative in special circumstances where consuming whole foods is challenging. However, Taiwan currently lacks consensus on diabetes-specific formula products, and many patients with diabetes, as well as some healthcare professionals, still hold misconceptions about these products. To address these needs, the Taiwanese Association of Diabetes Educators and the Diabetes Association of the Republic of China, Taiwan, collaborated to form an expert panel to formulate consensus statements on the appropriate use of diabetes-specific formula. Following a comprehensive review of international guidelines and clinical evidence, the panel formulated five consensus statements covering indications, clinical benefits, nutritional composition, and practical applications of diabetes-specific formula. This consensus provides evidence-based recommendations for integrating diabetes-specific formula into individualized diabetes care, particularly in patients with poor glycemic control, malnutrition, sarcopenia, gestational diabetes, or diabetic kidney disease. These statements are tailored to Taiwan's healthcare system but may serve as a reference for other regions.

We and others have shown that maternal hyperglycemia during pregnancy in women with insulin-dependent diabetes mellitus (IDDM) influences fetal growth. Less is understood regarding how trimester-specific glycemic patterns, particularly glucose variability, shape offspring obesity risk across the life course and whether this is mediated by birthweight. Leveraging data from the Diabetes in Pregnancy Program Grant (PPG; 1978-1995) and the Transgenerational Effects on Adult Morbidity (TEAM Study; 2017-2023) cohort, we aimed to evaluate whether the association between maternal glycemic control and adult offspring obesity status was mediated in part through infant birthweight. Maternal glycohemoglobinA1 levels were collected monthly during pregnancy and harmonized across laboratories using standard deviation units (HbA1SD). Functional principal component analysis characterized patterns in blood glucose level and variability. TEAM Study participants, adult offspring of PPG women, completed in-person or online assessments (via Zoom) of body anthropometrics. Linear mixed-effects models and generalized estimating equations estimated associations between maternal glycemia and adult offspring outcomes. Classical mediation methods tested whether birthweight mediated observed relationships. Consistent with prior findings, third-trimester HbA1SD demonstrated the most consistent positive associations with adult offspring body mass index (BMI) outcomes, after adjustment for maternal BMI at last menstrual period, maternal education, gestational weight gain, and sex of offspring (for offspring weight only). There was no evidence that birthweight mediated the relationship between maternal glycemic patterns and adult offspring overweight and obesity; however, birthweight exhibited an independent direct effect on adult offspring BMI in fully adjusted models. Infant birthweight was not shown to be a mediator in the association of maternal gestational glycemic control and overweight/obesity in adult offspring of women with IDDM. Although birthweight does not appear to mediate these long-term associations, the findings underscore the importance of trimester-specific evaluation of blood glucose level and variability, motivating further investigation into transgenerational metabolic risk pathways. · It is unlikely that birthweight mediates the association between gestational blood glucose levels and offspring adult obesity.. · Higher birthweight is an important risk factor for overweight and obesity in the adult offspring.. · Early gestation hyperglycemia may program obesity in adult offspring of IDDM women..

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

Maturity-onset diabetes of the young (MODY) accounts for at least 1%-5% of diabetes cases and is usually caused by single gene variants. Accurate diagnosis of MODY is important for effective management, especially in young individuals who are lean and lack islet autoantibodies. Only a few MODY cases associated with multiple gene variants have been reported. We here describe a rare case of MODY with a pathogenic HNF1A variant and a coexisting NEUROD1 variant. We conducted an extensive clinical analysis and explored the complex genetic architecture of the case in order to provide insight into the etiology of MODY. The candidate variants were identified by comprehensive whole-exome and Sanger sequencing, and their functional impact was assessed by analysis of their effects on the surface charge or structural stability of HNF1A and NEUROD1. The proband, a 21-year-old woman with early-onset diabetes, was found to harbor a pathogenic HNF1A p.Arg159Trp variant and a coexisting NEUROD1 p.Arg98Ser variant of uncertain significance. The NEUROD1 variant was also present in her mother and sister, both of whom manifested impaired glucose tolerance, but was absent in her father and brother. Structural analyses suggested that the HNF1A variant alters the surface charge of the protein, whereas the NEUROD1 variant may affect protein structural stability. We have identified an unusual case of MODY with a pathogenic HNF1A variant and a coexisting NEUROD1 variant of uncertain significance, and structural analyses suggested that the NEUROD1 variant may affect protein structure.

Preclinical heart failure (HF) (stages A and B) is common but easily overlooked in asymptomatic patients with type 2 diabetes (T2D). There is a paucity of evidence regarding how coexisting risk factors contribute to the development of HF in asymptomatic Asian patients with T2D, and there is a lack of guidance on the early identification of asymptomatic patients to help cost-effectively allocate preventive therapies. The Diabetes Mellitus Heart Failure Events Analysis and Risk Tracking (DM-HEART) trial, a prospective, multicenter, longitudinal cohort study, recruited asymptomatic patients with T2D and no prior HF between January 2021 and June 2024, with a minimum follow-up period of 12 months. The primary outcome was incident HF, defined as new-onset HF (requiring either hospitalization or an urgent care visit). Secondary outcomes are measured as 3-point major adverse cardiovascular events, comprised of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. DM-HEART will provide epidemiological data on the incidence of HF and assess the prognostic utility of clinical parameters, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), for predicting incident HF events among asymptomatic patients with T2D in preclinical stages of HF. Furthermore, we aim to determine the optimal NT-proBNP cut-off value for predicting incident HF events in East Asian patients with diabetes.

While psychological and emotional changes have been reported in some cases of idiopathic central precocious puberty (CPP), definitive conclusions about these associations are still lacking. This study aimed to investigate the emotional and psychosocial dimensions of girls diagnosed with CPP compared to healthy controls. The study comprised 21 cases with CPP and their parents, as well as 22 healthy controls and their parents. All participants underwent the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (KSADS-PL) during psychiatric evaluation. Additionally, patients completed the Revised Child Anxiety and Depression Scale -Child (RCADS-CV), and Pediatric Quality of Life Inventory (PedsQL) questionnaire. Parents completed the Attention Deficit Hyperactivity Disorder Scale (ADHD), Emotion Regulation Checklist (ERC), Children Empathy-Systemize Scale (EQ-SQ), Strengths and Difficulties Questionnaire (SDQ), Revised Child Anxiety and Depression Scales -Parent Version (RCADS-P), Pediatric Quality of Life Inventory (PedsQL) for their children, and the Beck Depression Inventory for themselves. The median ages in the CPP and control groups were 7.6 years (range: 6-8) and 7.2 years (range: 6.5-8), respectively. KSADS-PL revealed significantly higher rates of anxiety disorder in CPP cases compared to controls. Notable differences were found in the impulsivity subscale of the ADHD scale, physical and school functioning in PedsQL (child and parent forms), peer problems in the SDQ, emotion regulation (ERC), and social phobia and separation anxiety (RCADS-CV). Parental separation anxiety (RCADS-P) also showed significant differences between groups.  Our findings suggest that patients diagnosed with precocious puberty are at an increased risk for psychiatric comorbidities compared to the control group. It is crucial to consider children's psychiatric comorbidities at the time of diagnosis. Additionally, this study provides data for future investigations aimed at assessing stress levels following GnRHa treatment. • Early pubertal onset has been associated with increased vulnerability to anxiety, emotional distress, and  psychosocial difficulties in children. • Previous studies on idiopathic CPP have reported inconsistent findings regarding the extent of psychological and behavioral impairments. • This study demonstrates that girls with idiopathic CPP show significantly higher rates of DSM-based anxiety disorders and broader psychosocial difficulties at the time of diagnosis. • In addition to anxiety, impairments in emotional regulation, peer relationships, impulsivity, and quality of life were identified, highlighting a multidimensional psychosocial impact.

Although several studies have reported elevated serum galectin-3 levels in type 2 diabetes mellitus, its association with type 2 diabetes mellitus, in Japan, where obesity is relatively uncommon, remains unclear. We investigated whether serum galectin-3 levels can be a predictive marker for type 2 diabetes mellitus in a Japanese general population. A total of 433 participants who underwent a health check-up in Nagasaki between 2013 and 2014 were enrolled; of these, 307 participants completed follow-up by 2023. Participants were classified into quartiles based on serum galectin-3 levels measured by a sandwich enzyme immunoassay, and multivariate logistic regression analysis was performed. The serum galectin-3 levels were associated with type 2 diabetes mellitus prevalence (P = 0.002) in the regression analysis. Over the 10-year follow-up, the highest galectin-3 quartile had a higher type 2 diabetes mellitus incidence than the lowest galectin-3 quartile (adjusted odds ratio: 5.75; 95% confidence interval: 1.08-30.65). Subgroup analysis stratified by body mass index revealed that each 1-standard deviation increase in serum galectin-3 level was associated with a significantly increased risk of incident type 2 diabetes mellitus in the low body mass index group, but not in the high body mass index group. The serum galectin-3 levels were significantly associated with type 2 diabetes mellitus prevalence and incidence in a general Japanese population, particularly among individuals without obesity. Galectin-3 may be a useful biomarker for identifying individuals at risk of type 2 diabetes mellitus.

Diabetes poses a growing global health burden. This study investigated the causal effects of lifestyle and socioeconomic factors on diabetes risk and related complications and comorbidities. We applied two-sample univariable and multivariable Mendelian randomization to assess the causal impact of 26 lifestyle and socioeconomic factors on diabetes, 7 complications, and 13 comorbidities. Genetically predicted protective factors included vigorous physical activity (odds ratio [OR], 0.98 [0.98-0.99]), computer use time (OR, 0.13 [0.05, 0.30]), carbohydrate intake (OR, 0.22 [0.15, 0.34]), short (OR, 0.04 [0.01, 0.16]) and long sleep duration (OR, 0.62 [0.47, 0.82]), moderate alcohol (OR, 0.13 [0.04, 0.50]) and caffeine (OR, 0.72 [0.64, 0.81]) consumption, education (OR, 0.25-0.67), and household income (OR, 0.52-0.65), which were associated with reduced risks of type 2 and gestational diabetes, stroke, coronary heart disease, heart failure, myocardial infarction, sleep apnea, and anxiety disorder (adjusted P-values <0.05). Conversely, genetically predicted factors, such as television watching (OR, 1.39 [1.23, 1.57]) and driving time (OR, 3.28 [1.27, 8.48]), insomnia (OR, 1.21-1.82), smoking behaviors (OR, 1.17-1.77), alcohol dependence (OR, 1.17-1.28), coffee consumption (OR, 1.01 [1.00, 1.02]), and the Townsend deprivation index (OR, 1.51-1.57), are associated with increased risks of diabetes-related outcomes (i.e., all diabetic types, neovascular glaucoma, heart failure, nonalcoholic fatty liver disease, sleep apnea, and eating disorder) (adjusted P-values <0.05). Our findings support causal roles of lifestyle and socioeconomic factors and diabetes-related outcomes, emphasizing the need for targeted public health strategies to promote healthier living and socioeconomic equity.

To evaluate whether sodium-glucose cotransporter 2 inhibitor (SGLT2i) initiation is associated with the risk of urinary tract infection (UTI), with upper UTI and genital infection assessed as secondary outcomes, compared with metformin in patients with immune-mediated inflammatory diseases (IMIDs) and type 2 diabetes. We conducted a target trial emulation using an active-comparator, new-user design with a Japanese hospital-based claims database from 2014 to 2024. Adults with IMIDs and type 2 diabetes who newly initiated an SGLT2i or metformin were included. The primary outcome was UTI; secondary outcomes were upper UTI and genital infection. Hazard ratios (HRs) were estimated using inverse probability of treatment weighting and weighted Cox proportional hazards models. Prespecified subgroup and interaction analyses further evaluated heterogeneity in UTI risk according to concomitant immunosuppressive therapies. We analyzed 1,845 SGLT2i initiators and 1,499 metformin initiators (mean age 71.8&#x2009;years; 55.4% female). Compared with metformin initiation, SGLT2i initiation was not associated with increased risks of UTI (HR 1.14, 95% confidence interval [CI] 0.84-1.55) or upper UTI (HR 1.28, 95% CI 0.71-2.31). Results for UTI were broadly similar across categories of concomitant immunosuppressive therapies, and interaction analyses showed no evidence of effect modification across these strata, including glucocorticoid dose. The risk of genital infection was higher with SGLT2i initiation (HR 2.31, 95% CI 1.16-4.63). Among patients with IMIDs and type 2 diabetes, SGLT2i initiation was not associated with increased risks of UTI or upper UTI compared with metformin, although the risk of genital infection was higher.

The Steno Type 1 Risk Engine (ST1RE) was developed to improve cardiovascular risk prediction in people with type 1 diabetes (T1D), but its applicability in Asian populations remains uncertain. Data from the Hong Kong Diabetes Register were analyzed. Cardiovascular risk was assessed using four models: ST1RE, the Joint Asia Diabetes Evaluation (JADE) coronary heart disease equation, Risk Equations for Complications of Type 2 Diabetes (RECODe), and the United Kingdom Prospective Diabetes Study Outcomes Model version 2 (UKPDS-OM2). Associations between risk scores and incident cardiovascular disease (CVD) were examined using Cox regression, and predictive performance was evaluated using the concordance index (C-index). The analysis included 172 Chinese T1D patients (50% male), with a mean age of 31.0&#x2009;&#xb1;&#x2009;15.8 and 9.3&#x2009;&#xb1;&#x2009;6.7&#x2009;years of T1D at baseline. Over 21.8&#x2009;&#xb1;&#x2009;5.78&#x2009;years of follow-up, 16 (9.30%) patients developed CVD. All risk scores were significantly associated with incident CVD (P&#x2009;<&#x2009;0.05) and achieved C-indices >0.8, indicating good discrimination. The limited sample size reduced statistical power. ST1RE and other risk models developed for people with type 2 diabetes may be suitable for cardiovascular risk prediction in Chinese with T1D. Further investigation with a larger cohort is advised.

Diabetic peripheral neuropathy (DPN) is a severe complication of diabetes mellitus (DM). Measurement of plantar fascia thickness (PFT) by ultrasound has been proposed as an alternative index of tissue glycation and a marker for diabetes complications such as DPN. A cross-sectional study was conducted in 290 patients with type 1 DM (age 54 [20-87] years and diabetes duration 28 [1-79] years) and 41 healthy volunteers (age 49 [26-73] years). PFT was measured during outpatient clinical evaluation by means of ultrasound. Values were compared with sex, age, anthropometric parameters, advanced glycation end products (AGEs) measured by skin autofluorescence, and parameters derived from clinical evaluation of DPN. Patients with type 1 DM had significantly thicker plantar fascia than controls (2.9&#x2009;&#xb1;&#x2009;0.6&#x2009;mm vs. 2.4&#x2009;&#xb1;&#x2009;0.2&#x2009;mm; P&#x2009;<&#x2009;0.001); 199/290 (68.6%) patients with type 1 DM had altered PFT. In this population, male patients and those with worse glycemic control and longer duration of disease had a higher risk of having altered PFT. Higher PFT was significantly associated with reduced vibration sensitivity, higher levels of HbA1c and AGEs, presence of retinopathy and reduced renal function, and a worse diabetic foot risk classification. The use of AHCL integrated systems appeared to be associated with better plantar fascia outcomes. Our findings indicate that PFT showed a relationship with diabetes microvascular complications, glucometabolic compensation, and with the use of automated insulin delivery systems. PFT might be a useful tool in the assessment of patients with T1DM.

Patients with diabetes are at an increased risk of heart failure. The triglyceride-glucose index increases the risk of diabetes-related heart failure (dHF). We aimed to validate a practical clinical risk score for dHF in a large diabetic cohort and assess whether this score can identify dHF patients with an elevated triglyceride-glucose (TyG) index who have poor outcomes. Participants were drawn from multiple NHANES cycles (1999-2018). A simplified TRS-HFDM score (0-6 points) and TyG-related parameters were calculated in 3,455 participants with dHF. Candidate variables were evaluated using multivariable Cox proportional hazards models, Kaplan-Meier curves, and restricted cubic splines (RCS); independent predictors with statistical significance were included. Sensitivity analyses tested robustness. Kaplan-Meier analysis revealed that higher levels of TRS-HFDM were significantly associated with poor dHF participants survival. Multivariate-adjusted Cox regression analysis revealed that high quartile levels of TyG-related indices were significantly associated with mortality in participants with dHF [TyG-Age: HR&#x2009;=&#x2009;6.94, 95% CI: 4.34-11.08, P&#x2009;<&#x2009;0.001; TyG-eGFR: HR&#x2009;=&#x2009;3.78, 95% CI: 2.66-5.37, P&#x2009;<&#x2009;0.001]. The participants in the highest quartile of TyG-Age had a six-fold increased risk of mortality compared to those in the lowest quartile (95% CI: 3.93-10.24). Nonlinear trends were observed between TyG-Age indices and mortality of dHF participants (P for overall&#x2009;<&#x2009;0.0001; P for nonlinear&#x2009;<&#x2009;0.0001). The sensitivity analyses supported the positive correlations between TyG-related indices and mortality of the TRS-HFDM-determined dHF population. TyG-related indices, especially TyG-Age, have strong prognostic value for mortality in adults with dHF. TyG-Age and TRS-HFDM may serve as surrogate biomarkers for clinical management of dHF.

To evaluate the effect of sodium-glucose cotransporter 2 inhibitor (SGLT2i) administration at hospital discharge on heart failure (HF) readmission among older patients (&#x2265;75&#x2009;years) with HF and diabetes and to compare the effectiveness of four SGLT2is, namely, ipragliflozin, empagliflozin, canagliflozin, and dapagliflozin, with a focus on direct head-to-head comparisons among individual SGLT2is. We conducted a retrospective cohort study using the Medical Data Vision claims database. We included 66,895 patients aged &#x2265;75&#x2009;years who were emergently hospitalized for HF with comorbid diabetes between 2018 and 2022. Patients were categorized according to SGLT2i administration at discharge. Propensity score matching (PSM) was applied to adjust for baseline characteristics. The primary outcome was HF readmission, assessed using Kaplan-Meier analysis and Cox proportional hazards models. Inverse probability of treatment weighting (IPTW) was used to compare the four SGLT2is. After PSM, SGLT2i users showed a significantly lower risk of HF readmission than nonusers (hazard ratio [HR] 0.91, 95% confidence interval [CI]: 0.85-0.97, P&#x2009;=&#x2009;0.003). Sensitivity analysis censoring death and treatment discontinuation or initiation produced consistent results (HR 0.79, 95% CI: 0.74-0.85, P&#x2009;<&#x2009;0.001). An IPTW-based comparison of the four agents revealed no significant differences, suggesting similar class-wide effectiveness. Among older patients with HF and diabetes, SGLT2i administration was associated with reduced HF readmission risk, with no meaningful differences among the four agents. These findings support a class-wide effect of SGLT2i and highlight the importance of their appropriate initiation and continuation in older adults.

People with diabetes exhibit early-stage cardiovascular disease (CVD). In this study, we developed a new diagnostic algorithm to predict all-cause mortality and CVD using both the ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in individuals with diabetes. This study utilized data from the Kyushu Prevention Study for Atherosclerosis, a prospective, multicenter survey. A total of 3,933 participants with diabetes were followed. The primary outcomes were all-cause mortality and CVD. Risk was categorized based on ABI and baPWV, and the prognostic differences were evaluated. Additionally, the independence of this classification from the Framingham Risk Score (FRS) was tested. ABI was the strongest predictor of all-cause mortality. Individuals with a low ABI (<0.70) had the highest risk, while those with an intermediate ABI (0.70-1.0) exhibited a risk similar to individuals with the extremely high baPWV (&#x2265;24&#x2009;m/s), forming the second highest-risk group. For coronary heart disease, ABI and baPWV had complementary predictive value. Individuals with a low ABI (<1.0) or high baPWV (&#x2265;19&#x2009;m/s) were at the highest risk, whereas those with a low baPWV (<14&#x2009;m/s) had the lowest risk. For cerebrovascular disease, only baPWV was a significant predictor, with risk cutoffs above 23&#x2009;m/s and below 14&#x2009;m/s. We developed a new diagnostic algorithm incorporating both ABI and baPWV to predict all-cause mortality and CVD in individuals with diabetes. This algorithm improved the accuracy of mortality and CVD risk assessment and was independent from the FRS.

Thiazolidinediones (TZDs) are antidiabetic agents recognized for their effectiveness in secondary cardiovascular prevention; however, their role in primary prevention remains uncertain. This study evaluated the primary cardiovascular preventive effect of TZDs in patients with type 2 diabetes mellitus (T2DM). Using the nationwide health claims database, we conducted a cohort study including 1,958,643 adults with T2DM and no prior history of cardiovascular disease. TZD users were compared with dipeptidyl peptidase-4 inhibitor (DPP-4i) users as active comparators. After 1:1 propensity score matching (PSM), major cardiovascular events-composite of myocardial infarction (MI), stroke, hospitalization for heart failure (HF), and all-cause mortality-were compared using Cox proportional hazards models. In the PSM cohort consisting of 47,536 TZD users and 47,536 DPP-4i users, TZD users were associated with a lower risk of major cardiovascular events (HR 0.85, 95% CI 0.82-0.88). TZD users had lower risks of MI (HR 0.72, 95% CI 0.64-0.82), stroke (HR 0.84, 95% CI 0.78-0.90), and all-cause mortality (HR 0.86, 95% CI 0.82-0.90), with no difference in HF hospitalizations. TZD use was associated with a reduced risk of major cardiovascular events in T2DM patients, suggesting a potential role of TZDs in primary cardiovascular prevention.

Monocyte dysfunction is central to the pathogenesis of diabetes. This study investigated the association between cholesterol accumulation in monocytes and diabetic complications as well as post-discharge glycemic control. We conducted a retrospective two-part study. Study 1, a cross-sectional study, included 40 patients with type 2 diabetes mellitus to assess the associations between monocyte cholesterol levels and diabetic complication indices. Study 2, a longitudinal study, included 19 patients with type 2 diabetes mellitus hospitalized for an approximately 2-week educational program. Changes in monocyte cholesterol levels from admission to discharge were compared between two groups: those whose hemoglobin A1c (HbA1c) increased 3 months after discharge (HbA1c elevated group; n&#x2009;=&#x2009;10) and those whose HbA1c decreased or remained stable (HbA1c non-elevated group; n&#x2009;=&#x2009;9). In Study 1, monocyte cholesterol levels correlated with the severity of diabetic complications, including carotid intima-media thickness, the fibrosis-4 index, and retinopathy stage. In Study 2, during hospitalization, no significant change in monocyte cholesterol levels was observed in all patients, while a significant decrease was demonstrated in the HbA1c non-elevated group. Monocytic cholesterol accumulation is associated with the severity of diverse diabetic complications and predicts the risk of glycemic deterioration after discharge. These findings suggest that monocytic cholesterol could serve as a novel translational biomarker for 'metabolic memory' and therapeutic resistance in type 2 diabetes mellitus.

Understanding the relative contributions of basal and postprandial hyperglycaemia (BH and PPH) to hyperglycaemia is pivotal to optimising the therapeutic strategies for type 2 diabetes (T2D). We used continuous glucose monitoring (CGM) to quantify longitudinal changes in the relative contributions of BH and PPH to overall hyperglycaemia in 22 treatment-na&#xef;ve Han Chinese adults with T2D before and after 3&#x2009;months of intensive glucose-lowering therapy. At baseline (HbA1c 10.0&#x2009;&#xb1;&#x2009;0.3%), BH predominated, contributing ~73-77% of overall hyperglycaemia. Following treatment (HbA1c 7.1&#x2009;&#xb1;&#x2009;0.2%), the contribution of BH decreased markedly (~35-38%), while PPH became the dominant contributor of hyperglycaemia (~62-66%). The improvement in glycaemic control was also accompanied by enhanced insulin secretion and sensitivity, without changes in gastric emptying. These findings provide longitudinal, CGM-based evidence of a dynamic shift in glycaemic determinants with therapy. Therapeutic strategies should be adapted accordingly, with initial focus on BH followed by increasing emphasis on PPH as glycaemic control improves.

Although clinical guideline of gestational diabetes mellitus (GDM) is well-defined, still influence of the household environment and caregiver support on patient's adherence to self-management remains under-explored. This study aimed to identify the patient, household, and caregiver-level determinants of GDM self-management in Dhaka, Bangladesh. This cross-sectional study was conducted among 251 dyads of GDM patients including their caregivers across four tertiary hospitals in Dhaka. Diabetes self-management (DSM) was evaluated using the validated Diabetes Self-Management Questionnaire (DSMQ) (Cronbach's alpha&#x2009;=&#x2009;0.74), supplemented by a pretested, semi-structured instrument assessing caregiver knowledge and support. Predictors of suboptimal DSM were identified using multivariable logistic regression with backward elimination in STATA. Model discrimination was validated using the area under the receiver operating characteristic curve (AUC-ROC). Suboptimal DSM was observed in 68.5% of participants. Domain-specific analysis revealed critical gaps in glycemic monitoring (82.5%), dietary control (75.7%), and physical activity (73.3%), while healthcare utilization (56.2%) showed higher adherence. Multivariable modeling demonstrated that household architecture was a dominant predictor; living in nuclear or extended families significantly increased the odds of suboptimal DSM compared to living alone. Further determinants included clinical complexity (comorbidities, family history) and reproductive history (parity &#x2265;2). Notably, caregiver-level factors, specifically poor knowledge and inadequate support (prevalent in >50% of caregivers), were robustly associated with deficient glycemic monitoring and healthcare utilization (AUC&#x2009;=&#x2009;0.78). The findings suggest that the household unit, rather than the individual patient, is the functional unit of GDM care. Transitioning toward family-centered therapeutic models is essential to improve maternal and neonatal outcomes in GDM cases.

Gestational diabetes mellitus (GDM) poses major health risks for mothers and infants. Evidence on the association between dietary protein intake and GDM risk remains inconsistent. This study investigated dietary protein quantity and quality in relation to GDM. A hospital-based case-control study was conducted in Isfahan, Iran, involving 200 cases and 263 controls. Dietary intake was assessed using three 24-h dietary records, and protein intake was categorized into plant- and animal-based sources. Multivariate logistic regression models were applied to evaluate associations. Higher plant protein intake was associated with a significantly lower risk of GDM (OR&#x2009;=&#x2009;0.34; 95% CI: 0.20-0.59). Similarly, higher seafood (OR&#x2009;=&#x2009;0.40; 95% CI: 0.24-0.68) and egg intake (OR&#x2009;=&#x2009;0.59; 95% CI: 0.35-0.98) were inversely associated with GDM risk. In contrast, total protein, animal protein, poultry, dairy protein, aromatic amino acids, and branched-chain amino acids showed no significant or meaningful trend with GDM risk. Our study did not identify significant associations between total or animal protein intake during pregnancy and GDM risk. However, higher consumption of plant protein, seafood, and eggs was associated with lower odds of GDM in multivariable-adjusted models that accounted for BMI, total energy intake, socioeconomic status, and other relevant confounders. Given the observational case-control design, these findings cannot establish causality, and the possibility of residual confounding remains. Nevertheless, the results suggest that protein-intake quality may play a role in GDM risk, warranting confirmation in prospective cohorts and randomized trials.