Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods W...Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.展开更多
BACKGROUND Epidemiological surveys indicate an increasing incidence of type 2 diabetes mellitus(T2DM)among children and adolescents worldwide.Due to rapid disease progression,severe long-term cardiorenal complications...BACKGROUND Epidemiological surveys indicate an increasing incidence of type 2 diabetes mellitus(T2DM)among children and adolescents worldwide.Due to rapid disease progression,severe long-term cardiorenal complications,a lack of effective treatment strategies,and substantial socioeconomic burdens,it has become an urgent public health issue that requires management and resolution.Adolescent T2DM differs from adult T2DM.Despite a significant increase in our understanding of youth-onset T2DM over the past two decades,the related review and evidence-based content remain limited.AIM To visualize the hotspots and trends in pediatric and adolescent T2DM research and to forecast their future research themes.METHODS This study utilized the terms“children”,“adolescents”,and“type 2 diabetes”,retrieving relevant articles published between 1983 and 2023 from three citation databases within the Web of Science Core Collection(SCI,SSCI,ESCI).Utilizing CiteSpace and VoSviewer software,we analyze and visually represent the annual output of literature,countries involved,and participating institutions.This allows us to predict trends in this research field.Our analysis encompasses co-cited authors,journal overlays,citation overlays,time-zone views,keyword analysis,and reference analysis,etc.RESULTS A total of 9210 articles were included,and the annual publication volume in this field showed a steady growth trend.The United States had the highest number of publications and the highest H-index.The United States also had the most research institutions and the strongest research capacity.The global hot journals were primarily diabetes professional journals but also included journals related to nutrition,endocrinology,and metabolism.Keyword analysis showed that research related to endothelial dysfunction,exposure risk,cardiac metabolic risk,changes in gut microbiota,the impact on comorbidities and outcomes,etc.,were emerging keywords.They have maintained their popularity in this field,suggesting that these areas have garnered significant research interest in recent years.CONCLUSION Pediatric and adolescent T2DM is increasingly drawing global attention,with genes,behaviors,environmental factors,and multisystemic interventions potentially emerging as future research hot spots.展开更多
The onset and progression of type 2 diabetes mellitus(T2DM)are strongly associated with imbalances in gut bacteria,making the gut microbiome a new potential therapeutic focus.This commentary examines the recent public...The onset and progression of type 2 diabetes mellitus(T2DM)are strongly associated with imbalances in gut bacteria,making the gut microbiome a new potential therapeutic focus.This commentary examines the recent publication in World Journal of Diabetes.The article explores the association between T2DM and gut microbiota,with a focus on the pathophysiological changes related to dysbiosis.It proposes innovative microbiome-targeted therapeutic strategies and evaluates the challenges and future directions of such approaches.This editorial summarizes the key points of their discussion of the role of the gut microbiome in T2DM and elaborates on the influence of specific gut microbial species on the disease through the host–microbiota metabolic axis.It provides new insights for future research on gut-microbiota-based interventions for T2DM.展开更多
BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female pat...BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.展开更多
BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of ...BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin(HbA1c)≥10%and varying backgrounds of glycemic control.METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months.Participants were categorized into four groups based on prior glycemic history:Newly diagnosed,previously well controlled with recent worsening,previously off-target but now worsening,and HbA1c consistently above 10%.HbA1c levels were monitored quarterly,and patients received medical,educational,and dietary support as needed.The analysis focused on the success rates of good glycemic control and the associated factors within each group.RESULTS The study showed significant improvements in HbA1c levels in all participants.The most significant improvement was observed in individuals newly diagnosed with diabetes:65%achieved an HbA1c target of≤7%.The results varied between participants with different glycemic control histories,followed by decreasing success rates:39%in participants with previously good glycemic control,21%in participants whose glycemic control had deteriorated compared to before,and only 10%in participants with persistently poor control,with mean HbA1c levels of 6.3%,7.7%,8.2%,and 9.7%,respectively.After one year,65.2%of the“newly diagnosed patients”,39.3%in the“previously controlled group”,21.9%in the“previously off-target but now worsened'”group and 10%in the“poorly controlled from the start”group had achieved HbA1c levels of 7 and below.CONCLUSION In poorly controlled diabetes,the rate at which treatment goals are achieved is associated with the glycemic background characteristics,emphasizing the need for tailored strategies.Therefore,different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.展开更多
BACKGROUND At present,the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent,to explore the efficacy of laparoscopic jejunoileal side to side anastomosis ...BACKGROUND At present,the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent,to explore the efficacy of laparoscopic jejunoileal side to side anastomosis in the treatment of type 2 diabetes,the report is as follows.AIM To investigate the effect of jejunoileal side-to-side anastomosis on metabolic parameters in patients with type 2 diabetes mellitus(T2DM).METHODS We retrospectively analyzed the clinical data of 78 patients with T2DM who were treated via jejunoileal lateral anastomosis.Metabolic indicators were collected preoperatively,as well as at 3 and 6 months postoperative.The metabolic indicators analyzed included body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),2-hour blood glucose(PBG),glycated hemoglobin(HbA1c),fasting C-peptide,2-hour C-peptide(PCP),fasting insulin(Fins),2-hour insulin(Pins),insulin resistance index(HOMA-IR),βCellular function index(HOMA-β),alanine aminotransferase,aspartate aminotransferase,serum total cholesterol(TC),low-density lipoprotein cholesterol(L DL-C),triglycerides(TG),high-density lipoprotein,and uric acid(UA)levels.RESULTS SBP,DBP,PBG,HbA1c,LDL-C,and TG were all significantly lower 3 months postoperative vs preoperative values;body weight,BMI,SBP,DBP,FBG,PBG,HbA1c,TC,TG,UA,and HOMA-IR values were all significantly lower 6 months postoperative vs at 3 months;and PCP,Fins,Pins,and HOMA-βwere all significantly higher 6 months postoperative vs at 3 months(all P<0.05).CONCLUSION Side-to-side anastomosis of the jejunum and ileum can effectively treat T2DM and improve the metabolic index levels associated with it.展开更多
The recent study of Ding et al provides valuable insights into the functional implications of novel mitochondrial tRNATrp and tRNASer(AGY)variants in type 2 diabetes mellitus(T2DM).This editorial explores their findin...The recent study of Ding et al provides valuable insights into the functional implications of novel mitochondrial tRNATrp and tRNASer(AGY)variants in type 2 diabetes mellitus(T2DM).This editorial explores their findings,highlighting the role of mitochondrial dysfunction in the pathogenesis of T2DM.By examining the molecular mechanisms through which these tRNA variants contribute to disease progression,the study introduces new targets for therapeutic strategies.We discuss the broader implications of these results,emphasizing the importance of understanding mitochondrial genetics in addressing T2DM.展开更多
BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T...BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T2DM).Based on conven-tional nursing methods,community home care has important clinical significance in controlling blood sugar and disease progression.AIM To explore the impact of community public health nursing on treatment effect,health cognition,and self-management in patients with T2DM.METHODS One hundred patients with T2DM were selected as the research subjects.The patients were divided into either a conventional nursing group or community nursing(CN)group using the random number table method.The conventional nursing group(50 cases)received routine care,while the CN group(50 cases)received community public health care in addition to routine care as that for the conventional nursing group.The rate of excellent and good blood glucose control,fasting blood glucose before and after care,2-h postprandial blood glucose,health cognition,and self-management ability,and patient satisfaction were compared between the two groups.RESULTS The CN group had a higher rate of excellent blood sugar control than the conventional nursing group(88%vs 70%,P<0.05).Before care,there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients(P>0.05).After nursing,fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups,and both blood glucose levels in the CN group were lower than those of the conventional nursing group(P<0.05).Compared with the scores before care,the cognitive level score for diabetes and self-management ability score improved after care in both groups.The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group(P<0.05).The overall satisfaction of the CN group was better than that of the conventional nursing group(98%vs 86%,P<0.05).CONCLUSION Community public health care based on conventional care of T2DM can achieve better blood sugar control,and improve patients’health cognitive level and self-management ability.展开更多
Type 2 diabetes mellitus(T2DM)is a metabolic disorder marked by chronic hyperglycemia and low-grade inflammation,contributing to various complications.Natural agents with immunomodulatory and antioxidant properties ha...Type 2 diabetes mellitus(T2DM)is a metabolic disorder marked by chronic hyperglycemia and low-grade inflammation,contributing to various complications.Natural agents with immunomodulatory and antioxidant properties have gained attention as adjunct therapies.To review the effects of Allium sativum on inflammatory pathways and metabolic alterations associated with T2DM.A narrative review was performed using PubMed/MEDLINE,EMBASE,and Scielo databases.The search included terms such as“allium sativum”,“inflammation",“oxidative stress”,and“diabetes mellitus”.Studies in English and Spanish-ranging from clinical trials to meta-analyses-were selected based on relevance.Bioactive compounds such as allicin,S-allyl cysteine,and diallyl disulfide exhibit anti-inflammatory,antioxidant,hypoglycemic,and lipid-lowering actions.Preclinical studies show improved glucose metabolism,insulin sensitivity,and organ function.Moreover,clinical evidence supports reductions in fasting glucose,hemoglobin A1c,blood pressure,and oxidative stress,with good safety profiles.Allium sativum appears to be a promising adjuvant in T2DM management,offering metabolic and anti-inflammatory benefits.Nonetheless,further high-quality clinical trials are needed to confirm its long-term efficacy and standardize its therapeutic use.展开更多
A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mel...A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM)based on data from randomized controlled trials(RCTs).We searched electronic databases including PubMed,Cochrane Library,Embase,and Web of Science to identify clinical trials published up to 31 March 2023.Data was pooled using a random-effects model if significant heterogeneity(I2>50%),otherwise use a fixed-effects model.Fifty-six trials that included 3317 patients were enrolled for analysis.Meta-analysis reported that probiotic/prebiotic/synbiotic supplementation significantly reduced systolic blood pressure(SBP)(weighted mean difference(WMD):-3.57 mmHg,95% confidence interval(CI):-5.36,-1.78;P=0.000),diastolic blood pressure(DBP)(WMD:-2.05 mmHg,95%CI:-3.07,-1.04;P=0.000),triglycerides(TG)(WMD:-16.10 mg/dL,95%CI:-20.16,-12.05;P=0.000),total cholesterol(TC)(WMD:-14.00 mg/dL,95%CI:-20.46,-7.55;P=0.000),low-density lipoprotein cholesterol(LDL-C)(WMD:-7.03 mg/dL,95%CI:-9.25,-4.81;P=0.000),fasting plasma glucose(FPG)(WMD:-16.57 mg/dL,95%CI:-20.39,-12.74;P=0.000),hemoglobin A1c(HbA1c)(WMD:-0.44%,95%CI:-0.68,-0.20;P=0.000),insulin(standardized mean difference(SMD):-0.37,95%CI:-0.53,-0.21;P=0.000),homeostatic model assessment of insulin resistance(HOMA-IR)(WMD:-1.05,95%CI:-1.56,-0.54;P=0.000),C-reactive protein(CRP)(SMD:-0.35,95%CI:-0.57,-0.13;P=0.002),tumor necrosis factor-α(TNF-α)(SMD:-1.07,95%CI:-1.57,-0.56;P=0.000),interleukin-6(IL-6)(SMD:-0.37,95%CI:-0.61,-0.13;P=0.003)levels,they also increased the high-density lipoprotein cholesterol(HDL-C)(WMD:3.70 mg/dL,95%CI:1.80,5.60;P=0.000)levels in T2DM patients,as compared to the placebo groups.This meta-analysis supports the use of probiotic/prebiotic/synbiotic supplementation as an adjunctive therapy to improve blood pressure,glycemic control parameters,lipid profile and inflammatory markers in patients with T2DM,which are well-known cardiovascular risk factors.展开更多
BACKGROUND Gut microbiota play a crucial role in metabolic diseases,including type 2 diabetes(T2DM)and hyperuricemia(HUA).One-third of uric acid is excreted into the intestinal tract and further metabolized by gut mic...BACKGROUND Gut microbiota play a crucial role in metabolic diseases,including type 2 diabetes(T2DM)and hyperuricemia(HUA).One-third of uric acid is excreted into the intestinal tract and further metabolized by gut microbiota.Thus,the gut microbiota might be a new therapeutic target for HUA.Empagliflozin significantly lowers serum uric acid levels and contributes to cardiovascular benefits which are partly attributed to altered gut microbiota.We hypothesize that gut dysbiosis in patients with diabetes and HUA,and the reduction of uric acid by empagliflozin,may be mediated by gut microbiota.AIM To investigate dysbiosis in patients with T2DM and HUA,and the effect of empagliflozin on gut microbiota associated with purine metabolism.METHODS In this age and sex-matched,case-control study,we recruited 30 patients with T2DM and HUA;30 with T2DM;and 30 healthy controls at the Henan Provincial People’s Hospital between February 2019 and August 2023.Nine patients with T2DM and HUA were treated with empagliflozin for three months.Gut microbiota profiles were assessed using the 16S rRNA gene.RESULTS Patients with T2DM and HUA had the highest total triglycerides(1.09 mmol/L in heathy control vs 1.56 mmol/L in T2DM vs 2.82 mmol/L in T2DM+HUA)and uric acid levels(302.50μmol/L in heathy control vs 288.50μmol/L in T2DM vs 466.50μmol/L in T2DM+HUA)among the three groups.The composition of the gut microbiota differed significantly between patients with T2DM and HUA,and those with T2DM/healthy controls(P<0.05).Notably,patients with T2DM and HUA demonstrated a deficiency of uric acid-degrading bacteria such as Romboutsia,Blautia,Clostridium sensu stricto 1(P<0.05).Empagliflozin treatment was associated with significantly reduced serum uric acid levels and purine metabolism-related pathways and genes in patients with T2DM and HUA(P<0.05).CONCLUSION Gut dysbiosis may contribute to the pathogenesis of HUA in T2DM,and empagliflozin may partly restore the gut microbiota related to uric acid metabolism.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM)is a prevalent metabolic disorder increasingly linked with hypertension,posing significant health risks.The need for a predictive model tailored for T2DM patients is evident,as...BACKGROUND Type 2 diabetes mellitus(T2DM)is a prevalent metabolic disorder increasingly linked with hypertension,posing significant health risks.The need for a predictive model tailored for T2DM patients is evident,as current tools may not fully capture the unique risks in this population.This study hypothesizes that a nomogram incorporating specific risk factors will improve hypertension risk prediction in T2DM patients.AIM To develop and validate a nomogram prediction model for hypertension in T2DM patients.METHODS A retrospective observational study was conducted using data from 26850 T2DM patients from the Anhui Provincial Primary Medical and Health Information Management System(2022 to 2024).The study included patients aged 18 and above with available data on key variables.Exclusion criteria were type 1 diabetes,gestational diabetes,insufficient data,secondary hypertension,and abnormal liver and kidney function.The Least Absolute Shrinkage and Selection Operator regression and multivariate logistic regression were used to construct the nomogram,which was validated on separate datasets.RESULTS The developed nomogram for T2DM patients incorporated age,low-density lipoprotein,body mass index,diabetes duration,and urine protein levels as key predictive factors.In the training dataset,the model demonstrated a high discriminative power with an area under the receiver operating characteristic curve(AUC)of 0.823,indicating strong predictive accuracy.The validation dataset confirmed these findings with an AUC of 0.812.The calibration curve analysis showed excellent agreement between predicted and observed outcomes,with absolute errors of 0.017 for the training set and 0.031 for the validation set.The Hosmer-Lemeshow test yielded non-significant results for both sets(χ^(2)=7.066,P=0.562 for training;χ^(2)=6.122,P=0.709 for validation),suggesting good model fit.CONCLUSION The nomogram effectively predicts hypertension risk in T2DM patients,offering a valuable tool for personalized risk assessment and guiding targeted interventions.This model provides a significant advancement in the management of T2DM and hypertension comorbidity.展开更多
Diabetes mellitus(DM)is a metabolic disorder characterized by persistent hyperglycemia and other symptoms,which pose significant challenges to individual health,life expectancy,and public healthcare systems.The escala...Diabetes mellitus(DM)is a metabolic disorder characterized by persistent hyperglycemia and other symptoms,which pose significant challenges to individual health,life expectancy,and public healthcare systems.The escalating global prevalence of diabetes underscores the need for innovative therapeutic interventions.In this article,we critically comment on the study by Wang et al,published in the World Journal of Diabetes,which elucidates the therapeutic potential of Plantamajoside(PMS)in type 2 DM(T2DM)management.The authors provide evidence for the mechanism of action of PMS in T2DM models,demonstrating prevention of endoplasmic reticulum stress and apoptosis of pancreaticβ-cells via activation of DNAJC1.This manuscript provides a brief review of the pathogenesis of T2DM,explores the various roles of PMS in disease therapy in addition to the DNAJC-related apoptotic and autophagic functions,critically evaluates the experimental approaches employed by Wang et al,and provides recommendations for advancing future research.展开更多
BACKGROUND Coronary heart disease(CHD)is a prevalent type 2 diabetes mellitus(T2DM)complication.Further,the risk stratification before angiography may help diagnose T2DM with CHD early.However,few studies have investi...BACKGROUND Coronary heart disease(CHD)is a prevalent type 2 diabetes mellitus(T2DM)complication.Further,the risk stratification before angiography may help diagnose T2DM with CHD early.However,few studies have investigated the coronary imaging characteristics and risk factors of patients with T2DM complicated with CHD.AIM To compare the differences in coronary imaging between patients with T2DM with and without CHD,determine the risk factors of T2DM complicated with CHD,and establish a predictive tool for diagnosing CHD in T2DM.METHODS This study retrospectively analyzed 103 patients with T2DM from January 2022 to May 2024.They are categorized based on CHD occurrence into:(1)The control group,consisting of patients with T2DM without CHD;and(2)The observation group,which includes patients with T2MD with CHD.Age,sex,smoking and drinking history,CHD family history,metformin(MET)treatment pre-admission,body mass index,fasting blood glucose(FBG),triglyceride(TG),total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol(LDL-C),serum creatinine,blood urea nitrogen(BUN),alanine aminotransferase,aspartate aminotransferase,glycosylated hemoglobin(HbA1c),and coronary imaging data of both groups were collected from the medical record system.Logistic risk analysis was conducted to screen risk factors.The prediction model’s prediction efficiency was evaluated with receiver operating characteristic curves.RESULTS The control and observation groups consisted of 48 and 55 cases,respectively.The two groups were statistically different in terms of age(t=2.006,P=0.048),FBG(t=6.038,P=0.000),TG(t=2.015,P=0.047),LDL-C(t=2.017,P=0.046),and BUN(t=2.035,P=0.044).The observation group demonstrated lower proportions of patients receiving MET(χ^(2)=5.073,P=0.024)and higher proportions of patients with HbA1c of>7.0%(χ^(2)=6.980,P=0.008)than the control group.The observation group consisted of 15,17,and 23 cases of moderate stenosis,severe stenosis,and occlusion,respectively,with a greater number of coronary artery occlusion cases than the control group(χ^(2)=6.399,P=0.041).The observation group consisted significantly higher number of diffuse lesion cases at 35 compared with the control group(χ^(2)=15.420,P=0.000).The observation group demonstrated a higher right coronary artery(RCA)stenosis index(t=6.730,P=0.000),circumflex coronary artery(LCX)stenosis index(t=5.738,P=0.000),and total stenosis index(t=7.049,P=0.000)than the control group.FBG[odds ratio(OR)=1.472;95%confidence interval(CI):1.234-1.755;P=0.000]and HbA1c(OR=3.197;95%CI:1.149-8.896;P=0.026)were independent risk factors for T2DM complicated with CHD,whereas MET(OR=0.350;95%CI:0.129-0.952;P=0.040)was considered a protective factor for CHD in T2DM.CONCLUSION Coronary artery occlusion is a prevalent complication in patients with T2DM.Patients with T2MD with CHD demonstrated a higher degree of RCA and LCX stenosis than those with T2DM without CHD.FBG,HbA1c,and MET treatment history are risk factors for T2DM complicated with CHD.展开更多
BACKGROUND Hepatitis B and C and alcoholic liver disease are the principal causes of hepaticrelated morbidity and mortality.However,evidence of the associations between diabetes without the above risk factors and hepa...BACKGROUND Hepatitis B and C and alcoholic liver disease are the principal causes of hepaticrelated morbidity and mortality.However,evidence of the associations between diabetes without the above risk factors and hepatic-related study endpoints is not well understood.In addition,the effects of associated metabolic dysfunction and exercise on hepatic outcomes are still not clear.AIM To investigate the incidence and relative hazards of cirrhosis of the liver,hepato cellular carcinoma(HCC),hepatic-related complications and mortality in patients with type 2 diabetes(T2D)who were nonalcoholic and serologically negative for hepatitis B and C in Taiwan.METHODS A total of 33184 T2D patients and 648746 nondiabetic subjects selected from Taiwan’s adult preventive health care service were linked to various National Health Insurance databases,cancer registry,and death registry to identify cirrhosis of the liver,HCC,hepatic-related complications,and mortality.The Poisson assumption and Cox proportional hazard regression model were used to estimate the incidences and relative hazards of all hepatic-related study endpoints,respectively.We also compared the risk of hepatic outcomes stratified by age,sex,associated metabolic dysfunctions,and regular exercise between T2D patients and nondiabetic subjects.RESULTS Compared with nondiabetic subjects,T2D patients had a significantly greater incidence(6.32 vs 17.20 per 10000 person-years)and greater risk of cirrhosis of the liver[adjusted hazard ratio(aHR)1.45;95%CI:1.30-1.62].The aHRs for HCC,hepatic complications,and mortality were 1.81,1.87,and 2.08,respectively.An older age,male sex,obesity,hypertension,and dyslipidemia further increased the risks of all hepatic-related study endpoints,and regular exercise decreased the risk,irrespective of diabetes status.CONCLUSION Patients with T2D are at increased risk of cirrhosis of the liver,HCC,hepatic-related complications,and mortality,and associated metabolic dysfunctions provide additional hazard.Coordinated interprofessional care for high-risk T2D patients and diabetes education,with an emphasis on the importance of physical activity,are crucial for minimizing hepatic outcomes.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 Type 2 diabetes mellitus(T2DM)is a severe global health problem that causes prolonged disease exposure and an elevated risk for chronic complications,posing a substantial health burden.Although therapies,su...BACKGROUND Type 2 diabetes mellitus(T2DM)is a severe global health problem that causes prolonged disease exposure and an elevated risk for chronic complications,posing a substantial health burden.Although therapies,such as GLP-1 receptor agonists and SGLT2 inhibitors,have been successfully developed,new therapeutic options are still expected to offer better blood glucose control and decrease complications.AIM To elucidate the mechanism by which TERT/FOXO1 affects high glucose(HG)-induced dysfunction in isletβ-cells via the regulation of ATG9A-mediated autophagy.METHODS High-fat diet(HFD)-fed/streptozotocin(STZ)-treated mice or HG-treated MIN6 cells were used to establish T2DM models.Fasting blood glucose(FBG)and insulin levels in mice,as well as morphological changes in islet tissues,were assessed.Cell proliferation and the apoptosis rate were measured via EdU assays and flow cytometry,respectively.The expression levels of TERT,FOXO1,ATG9A and autophagy-related proteins(LC3B,p62)were analyzed via western blotting.The relationship between FOXO1 and ATG9A was assessed using dual-luciferase reporter gene assays and ChIP assays.RESULTS T2DM modeling in HFD-fed/STZ-treated mice and HG-treated MIN6 cells led to elevated TERT and FOXO1 expression and reduced ATG9A expression.Mice with T2DM were found to have decreased body weight,worsened morphology,elevated FBG and suppressed insulin levels.HG-treated MIN6 cells presented decreased viability and LC3B expression,in addition to increased p62 expression and apoptosis rates.FOXO1 knockdown both in vitro and in vivo protected mice and cells against isletβ-cell dysfunction via the activation of autophagy.The molecular mechanism involved the suppression of ATG9A expression by TERT through FOXO1 transcription activation.CONCLUSION Our results suggested that TERT/FOXO1 inhibits ATG9A expression to decrease isletβ-cell function in T2DM.展开更多
BACKGROUND Early diagnosis of left ventricular diastolic dysfunction(LVDD)is essential for preventing heart failure.B-type natriuretic peptide(BNP)is a viable marker for predicting LVDD,as elevated BNP levels have bee...BACKGROUND Early diagnosis of left ventricular diastolic dysfunction(LVDD)is essential for preventing heart failure.B-type natriuretic peptide(BNP)is a viable marker for predicting LVDD,as elevated BNP levels have been associated with worsening LVDD in patients with diabetes over time.However,the utility of BNP as a diagnostic marker in diabetes is controversial,as BNP levels are often low in overweight individuals.AIM To examine the effectiveness of BNP levels and fragmented QRS(fQRS)on electrocardiography for diagnosing LVDD in patients with type 2 diabetes.METHODS This retrospective cohort study included 303 patients with type 2 diabetes(67.4±12.3 years old)with preserved ejection fraction(EF)≥50%admitted to Toyama University Hospital for glycemic management and comorbidity evaluation between November 2017 and April 2021.All participants underwent plasma BNP measurement,electrocardiography,and echocardiography.Cardiologists who were blinded to the BNP results assessed the electrocardiograms and echocardiograms.Subgroup analyses were conducted for overweight individuals.RESULTS Receiver operating characteristic(ROC)curve analysis determined optimal BNP cut-off values of 34.8 pg/mL and 7.2 pg/mL for diagnosing LVDD in non-overweight[area under the ROC curve(AUC):0.70]and overweight(AUC:0.55)groups,respectively(P=0.040).In the overweight subgroup,fQRS showed greater diagnostic accuracy for LVDD(AUC:0.67),indicating moderate diagnostic utility compared with the low performance of the BNP cutoff of 35 pg/mL(AUC:0.52)(P=0.010).Multivariate analyses confirmed that fQRS was superior to BNP for LVDD diagnosis regardless of the patient’s weight.CONCLUSION A BNP level≥35 pg/mL in non-overweight individuals may be a reliable LVDD marker.Additionally,fQRS was more effective than BNP in diagnosing LVDD irrespective of the patient’s weight.fQRS can complement BNP in the early detection of LVDD,especially in overweight patients,potentially improving early detection and mitigating progression to heart failure with preserved EF in patients with type 2 diabetes.展开更多
In this editorial,I discuss the article by Wang et al,published in the World Journal of Diabetes,which explores jejunoileal side-to-side anastomosis as a novel surgical intervention for type 2 diabetes mellitus(T2DM)....In this editorial,I discuss the article by Wang et al,published in the World Journal of Diabetes,which explores jejunoileal side-to-side anastomosis as a novel surgical intervention for type 2 diabetes mellitus(T2DM).T2DM,often associated with obesity,remains a global health challenge,as sustained remission is difficult to achieve with conventional pharmacological therapy.Jejunoileal anastomosis offers a promising alternative,particularly for patients with normal or relatively high body mass index,and addresses the unique challenges posed by diverse patient populations.This procedure preserves gastric anatomy while simultaneously improving metabolic parameters,such as glycemic control,lipid profiles,and pancreaticβ-cell function.Unlike traditional metabolic surgeries that involve permanent anatomical alterations,this approach provides advantages such as reversibility,shorter operative times,and minimal nutritional complications,making it appealing to patients for whom conventional bariatric surgery is unsuitable.Advances in gut hormone physiology and incretin modulation support these findings.This innovative approach represents a potential paradigm shift in T2DM treatment,offering insights into the evolving role of surgical interventions in metabolic regulation.While early findings show promising diabetes remission rates and metabolic improvements at six months post-surgery,further studies with longer follow-up periods and broader patient cohorts are required.展开更多
Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced...Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced secretion of glucagon-like peptide-1.This surgical procedure alters the direction of nutrient flow,activates distal ileal L cells,and increases endogenous glucagon-like peptide-1 levels,supporting glucose homeostasis,enhancing insulin sensitivity,regulating body weight,and improving cardiovascular health.This structural adjustment transforms the gastrointestinal tract into an active endocrine regulatory organ,providing a pathway for metabolic improvement in patients with T2DM and other complex metabolic disorders.Although this procedure demonstrates significant metabolic improvements within 3-6 months after surgery,integrating hormone level measurements,metabolic marker analysis,and long-term follow-up has become crucial for exploring the complex mechanisms of T2DM in the field of metabolic surgery and T2DM management.Multidisciplinary collaboration involving support from endocrinology,nutrition,and rehabilitation teams before and after surgery is becoming increasingly vital in the long-term management of patients with T2DM.This collaboration optimizes surgical outcomes and enhances metabolic management.Side-to-side anastomosis shows potential in the multitarget metabolic management of T2DM,providing an additional intervention option for patients with T2DM and metabolic disorders.展开更多
基金supported by the R&D project of Pazhou Lab(Huangpu)under Grant 2023K0610the National Natural Science Foundation of China(Grants 12126602)+4 种基金the National Natural Science Foundation of China(Grants 82030102)the Shenzhen Medical Research Fund(Grants C2302001)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Chinese Postdoctoral Science Foundation(No.2022M721463)the Ministry of Science and Technology of China(Grants 2022YFC3702703).
文摘Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.
基金Supported by the National Natural Science Foundation of China,No.82105018 and No.81903950.
文摘BACKGROUND Epidemiological surveys indicate an increasing incidence of type 2 diabetes mellitus(T2DM)among children and adolescents worldwide.Due to rapid disease progression,severe long-term cardiorenal complications,a lack of effective treatment strategies,and substantial socioeconomic burdens,it has become an urgent public health issue that requires management and resolution.Adolescent T2DM differs from adult T2DM.Despite a significant increase in our understanding of youth-onset T2DM over the past two decades,the related review and evidence-based content remain limited.AIM To visualize the hotspots and trends in pediatric and adolescent T2DM research and to forecast their future research themes.METHODS This study utilized the terms“children”,“adolescents”,and“type 2 diabetes”,retrieving relevant articles published between 1983 and 2023 from three citation databases within the Web of Science Core Collection(SCI,SSCI,ESCI).Utilizing CiteSpace and VoSviewer software,we analyze and visually represent the annual output of literature,countries involved,and participating institutions.This allows us to predict trends in this research field.Our analysis encompasses co-cited authors,journal overlays,citation overlays,time-zone views,keyword analysis,and reference analysis,etc.RESULTS A total of 9210 articles were included,and the annual publication volume in this field showed a steady growth trend.The United States had the highest number of publications and the highest H-index.The United States also had the most research institutions and the strongest research capacity.The global hot journals were primarily diabetes professional journals but also included journals related to nutrition,endocrinology,and metabolism.Keyword analysis showed that research related to endothelial dysfunction,exposure risk,cardiac metabolic risk,changes in gut microbiota,the impact on comorbidities and outcomes,etc.,were emerging keywords.They have maintained their popularity in this field,suggesting that these areas have garnered significant research interest in recent years.CONCLUSION Pediatric and adolescent T2DM is increasingly drawing global attention,with genes,behaviors,environmental factors,and multisystemic interventions potentially emerging as future research hot spots.
文摘The onset and progression of type 2 diabetes mellitus(T2DM)are strongly associated with imbalances in gut bacteria,making the gut microbiome a new potential therapeutic focus.This commentary examines the recent publication in World Journal of Diabetes.The article explores the association between T2DM and gut microbiota,with a focus on the pathophysiological changes related to dysbiosis.It proposes innovative microbiome-targeted therapeutic strategies and evaluates the challenges and future directions of such approaches.This editorial summarizes the key points of their discussion of the role of the gut microbiome in T2DM and elaborates on the influence of specific gut microbial species on the disease through the host–microbiota metabolic axis.It provides new insights for future research on gut-microbiota-based interventions for T2DM.
文摘BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.
文摘BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin(HbA1c)≥10%and varying backgrounds of glycemic control.METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months.Participants were categorized into four groups based on prior glycemic history:Newly diagnosed,previously well controlled with recent worsening,previously off-target but now worsening,and HbA1c consistently above 10%.HbA1c levels were monitored quarterly,and patients received medical,educational,and dietary support as needed.The analysis focused on the success rates of good glycemic control and the associated factors within each group.RESULTS The study showed significant improvements in HbA1c levels in all participants.The most significant improvement was observed in individuals newly diagnosed with diabetes:65%achieved an HbA1c target of≤7%.The results varied between participants with different glycemic control histories,followed by decreasing success rates:39%in participants with previously good glycemic control,21%in participants whose glycemic control had deteriorated compared to before,and only 10%in participants with persistently poor control,with mean HbA1c levels of 6.3%,7.7%,8.2%,and 9.7%,respectively.After one year,65.2%of the“newly diagnosed patients”,39.3%in the“previously controlled group”,21.9%in the“previously off-target but now worsened'”group and 10%in the“poorly controlled from the start”group had achieved HbA1c levels of 7 and below.CONCLUSION In poorly controlled diabetes,the rate at which treatment goals are achieved is associated with the glycemic background characteristics,emphasizing the need for tailored strategies.Therefore,different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.
文摘BACKGROUND At present,the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent,to explore the efficacy of laparoscopic jejunoileal side to side anastomosis in the treatment of type 2 diabetes,the report is as follows.AIM To investigate the effect of jejunoileal side-to-side anastomosis on metabolic parameters in patients with type 2 diabetes mellitus(T2DM).METHODS We retrospectively analyzed the clinical data of 78 patients with T2DM who were treated via jejunoileal lateral anastomosis.Metabolic indicators were collected preoperatively,as well as at 3 and 6 months postoperative.The metabolic indicators analyzed included body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),2-hour blood glucose(PBG),glycated hemoglobin(HbA1c),fasting C-peptide,2-hour C-peptide(PCP),fasting insulin(Fins),2-hour insulin(Pins),insulin resistance index(HOMA-IR),βCellular function index(HOMA-β),alanine aminotransferase,aspartate aminotransferase,serum total cholesterol(TC),low-density lipoprotein cholesterol(L DL-C),triglycerides(TG),high-density lipoprotein,and uric acid(UA)levels.RESULTS SBP,DBP,PBG,HbA1c,LDL-C,and TG were all significantly lower 3 months postoperative vs preoperative values;body weight,BMI,SBP,DBP,FBG,PBG,HbA1c,TC,TG,UA,and HOMA-IR values were all significantly lower 6 months postoperative vs at 3 months;and PCP,Fins,Pins,and HOMA-βwere all significantly higher 6 months postoperative vs at 3 months(all P<0.05).CONCLUSION Side-to-side anastomosis of the jejunum and ileum can effectively treat T2DM and improve the metabolic index levels associated with it.
文摘The recent study of Ding et al provides valuable insights into the functional implications of novel mitochondrial tRNATrp and tRNASer(AGY)variants in type 2 diabetes mellitus(T2DM).This editorial explores their findings,highlighting the role of mitochondrial dysfunction in the pathogenesis of T2DM.By examining the molecular mechanisms through which these tRNA variants contribute to disease progression,the study introduces new targets for therapeutic strategies.We discuss the broader implications of these results,emphasizing the importance of understanding mitochondrial genetics in addressing T2DM.
文摘BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T2DM).Based on conven-tional nursing methods,community home care has important clinical significance in controlling blood sugar and disease progression.AIM To explore the impact of community public health nursing on treatment effect,health cognition,and self-management in patients with T2DM.METHODS One hundred patients with T2DM were selected as the research subjects.The patients were divided into either a conventional nursing group or community nursing(CN)group using the random number table method.The conventional nursing group(50 cases)received routine care,while the CN group(50 cases)received community public health care in addition to routine care as that for the conventional nursing group.The rate of excellent and good blood glucose control,fasting blood glucose before and after care,2-h postprandial blood glucose,health cognition,and self-management ability,and patient satisfaction were compared between the two groups.RESULTS The CN group had a higher rate of excellent blood sugar control than the conventional nursing group(88%vs 70%,P<0.05).Before care,there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients(P>0.05).After nursing,fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups,and both blood glucose levels in the CN group were lower than those of the conventional nursing group(P<0.05).Compared with the scores before care,the cognitive level score for diabetes and self-management ability score improved after care in both groups.The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group(P<0.05).The overall satisfaction of the CN group was better than that of the conventional nursing group(98%vs 86%,P<0.05).CONCLUSION Community public health care based on conventional care of T2DM can achieve better blood sugar control,and improve patients’health cognitive level and self-management ability.
文摘Type 2 diabetes mellitus(T2DM)is a metabolic disorder marked by chronic hyperglycemia and low-grade inflammation,contributing to various complications.Natural agents with immunomodulatory and antioxidant properties have gained attention as adjunct therapies.To review the effects of Allium sativum on inflammatory pathways and metabolic alterations associated with T2DM.A narrative review was performed using PubMed/MEDLINE,EMBASE,and Scielo databases.The search included terms such as“allium sativum”,“inflammation",“oxidative stress”,and“diabetes mellitus”.Studies in English and Spanish-ranging from clinical trials to meta-analyses-were selected based on relevance.Bioactive compounds such as allicin,S-allyl cysteine,and diallyl disulfide exhibit anti-inflammatory,antioxidant,hypoglycemic,and lipid-lowering actions.Preclinical studies show improved glucose metabolism,insulin sensitivity,and organ function.Moreover,clinical evidence supports reductions in fasting glucose,hemoglobin A1c,blood pressure,and oxidative stress,with good safety profiles.Allium sativum appears to be a promising adjuvant in T2DM management,offering metabolic and anti-inflammatory benefits.Nonetheless,further high-quality clinical trials are needed to confirm its long-term efficacy and standardize its therapeutic use.
基金Jiangsu College of Nursing 2023 Special Fund for Research and Development of Medical-Educational Integration。
文摘A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM)based on data from randomized controlled trials(RCTs).We searched electronic databases including PubMed,Cochrane Library,Embase,and Web of Science to identify clinical trials published up to 31 March 2023.Data was pooled using a random-effects model if significant heterogeneity(I2>50%),otherwise use a fixed-effects model.Fifty-six trials that included 3317 patients were enrolled for analysis.Meta-analysis reported that probiotic/prebiotic/synbiotic supplementation significantly reduced systolic blood pressure(SBP)(weighted mean difference(WMD):-3.57 mmHg,95% confidence interval(CI):-5.36,-1.78;P=0.000),diastolic blood pressure(DBP)(WMD:-2.05 mmHg,95%CI:-3.07,-1.04;P=0.000),triglycerides(TG)(WMD:-16.10 mg/dL,95%CI:-20.16,-12.05;P=0.000),total cholesterol(TC)(WMD:-14.00 mg/dL,95%CI:-20.46,-7.55;P=0.000),low-density lipoprotein cholesterol(LDL-C)(WMD:-7.03 mg/dL,95%CI:-9.25,-4.81;P=0.000),fasting plasma glucose(FPG)(WMD:-16.57 mg/dL,95%CI:-20.39,-12.74;P=0.000),hemoglobin A1c(HbA1c)(WMD:-0.44%,95%CI:-0.68,-0.20;P=0.000),insulin(standardized mean difference(SMD):-0.37,95%CI:-0.53,-0.21;P=0.000),homeostatic model assessment of insulin resistance(HOMA-IR)(WMD:-1.05,95%CI:-1.56,-0.54;P=0.000),C-reactive protein(CRP)(SMD:-0.35,95%CI:-0.57,-0.13;P=0.002),tumor necrosis factor-α(TNF-α)(SMD:-1.07,95%CI:-1.57,-0.56;P=0.000),interleukin-6(IL-6)(SMD:-0.37,95%CI:-0.61,-0.13;P=0.003)levels,they also increased the high-density lipoprotein cholesterol(HDL-C)(WMD:3.70 mg/dL,95%CI:1.80,5.60;P=0.000)levels in T2DM patients,as compared to the placebo groups.This meta-analysis supports the use of probiotic/prebiotic/synbiotic supplementation as an adjunctive therapy to improve blood pressure,glycemic control parameters,lipid profile and inflammatory markers in patients with T2DM,which are well-known cardiovascular risk factors.
基金Supported by the National Natural Science Foundation of China,No.82270865the Henan Provincial Key Research and Development Projects,No.231111313200+1 种基金the Henan Provincial Medical Science and Technology Research Program-the Provincial and Ministerial Major Projects,No.SBGJ202301002the Scientific and Technological Project in Henan Province,No.LHGJ20190614.
文摘BACKGROUND Gut microbiota play a crucial role in metabolic diseases,including type 2 diabetes(T2DM)and hyperuricemia(HUA).One-third of uric acid is excreted into the intestinal tract and further metabolized by gut microbiota.Thus,the gut microbiota might be a new therapeutic target for HUA.Empagliflozin significantly lowers serum uric acid levels and contributes to cardiovascular benefits which are partly attributed to altered gut microbiota.We hypothesize that gut dysbiosis in patients with diabetes and HUA,and the reduction of uric acid by empagliflozin,may be mediated by gut microbiota.AIM To investigate dysbiosis in patients with T2DM and HUA,and the effect of empagliflozin on gut microbiota associated with purine metabolism.METHODS In this age and sex-matched,case-control study,we recruited 30 patients with T2DM and HUA;30 with T2DM;and 30 healthy controls at the Henan Provincial People’s Hospital between February 2019 and August 2023.Nine patients with T2DM and HUA were treated with empagliflozin for three months.Gut microbiota profiles were assessed using the 16S rRNA gene.RESULTS Patients with T2DM and HUA had the highest total triglycerides(1.09 mmol/L in heathy control vs 1.56 mmol/L in T2DM vs 2.82 mmol/L in T2DM+HUA)and uric acid levels(302.50μmol/L in heathy control vs 288.50μmol/L in T2DM vs 466.50μmol/L in T2DM+HUA)among the three groups.The composition of the gut microbiota differed significantly between patients with T2DM and HUA,and those with T2DM/healthy controls(P<0.05).Notably,patients with T2DM and HUA demonstrated a deficiency of uric acid-degrading bacteria such as Romboutsia,Blautia,Clostridium sensu stricto 1(P<0.05).Empagliflozin treatment was associated with significantly reduced serum uric acid levels and purine metabolism-related pathways and genes in patients with T2DM and HUA(P<0.05).CONCLUSION Gut dysbiosis may contribute to the pathogenesis of HUA in T2DM,and empagliflozin may partly restore the gut microbiota related to uric acid metabolism.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM)is a prevalent metabolic disorder increasingly linked with hypertension,posing significant health risks.The need for a predictive model tailored for T2DM patients is evident,as current tools may not fully capture the unique risks in this population.This study hypothesizes that a nomogram incorporating specific risk factors will improve hypertension risk prediction in T2DM patients.AIM To develop and validate a nomogram prediction model for hypertension in T2DM patients.METHODS A retrospective observational study was conducted using data from 26850 T2DM patients from the Anhui Provincial Primary Medical and Health Information Management System(2022 to 2024).The study included patients aged 18 and above with available data on key variables.Exclusion criteria were type 1 diabetes,gestational diabetes,insufficient data,secondary hypertension,and abnormal liver and kidney function.The Least Absolute Shrinkage and Selection Operator regression and multivariate logistic regression were used to construct the nomogram,which was validated on separate datasets.RESULTS The developed nomogram for T2DM patients incorporated age,low-density lipoprotein,body mass index,diabetes duration,and urine protein levels as key predictive factors.In the training dataset,the model demonstrated a high discriminative power with an area under the receiver operating characteristic curve(AUC)of 0.823,indicating strong predictive accuracy.The validation dataset confirmed these findings with an AUC of 0.812.The calibration curve analysis showed excellent agreement between predicted and observed outcomes,with absolute errors of 0.017 for the training set and 0.031 for the validation set.The Hosmer-Lemeshow test yielded non-significant results for both sets(χ^(2)=7.066,P=0.562 for training;χ^(2)=6.122,P=0.709 for validation),suggesting good model fit.CONCLUSION The nomogram effectively predicts hypertension risk in T2DM patients,offering a valuable tool for personalized risk assessment and guiding targeted interventions.This model provides a significant advancement in the management of T2DM and hypertension comorbidity.
文摘Diabetes mellitus(DM)is a metabolic disorder characterized by persistent hyperglycemia and other symptoms,which pose significant challenges to individual health,life expectancy,and public healthcare systems.The escalating global prevalence of diabetes underscores the need for innovative therapeutic interventions.In this article,we critically comment on the study by Wang et al,published in the World Journal of Diabetes,which elucidates the therapeutic potential of Plantamajoside(PMS)in type 2 DM(T2DM)management.The authors provide evidence for the mechanism of action of PMS in T2DM models,demonstrating prevention of endoplasmic reticulum stress and apoptosis of pancreaticβ-cells via activation of DNAJC1.This manuscript provides a brief review of the pathogenesis of T2DM,explores the various roles of PMS in disease therapy in addition to the DNAJC-related apoptotic and autophagic functions,critically evaluates the experimental approaches employed by Wang et al,and provides recommendations for advancing future research.
基金Supported by the Science and Technology Major Project of Changzhou Science and Technology Bureau,No.CE20205047Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2022D01F52Changzhou A Major Scientific Research Project of the Municipal Health Commission,No.ZD202220.
文摘BACKGROUND Coronary heart disease(CHD)is a prevalent type 2 diabetes mellitus(T2DM)complication.Further,the risk stratification before angiography may help diagnose T2DM with CHD early.However,few studies have investigated the coronary imaging characteristics and risk factors of patients with T2DM complicated with CHD.AIM To compare the differences in coronary imaging between patients with T2DM with and without CHD,determine the risk factors of T2DM complicated with CHD,and establish a predictive tool for diagnosing CHD in T2DM.METHODS This study retrospectively analyzed 103 patients with T2DM from January 2022 to May 2024.They are categorized based on CHD occurrence into:(1)The control group,consisting of patients with T2DM without CHD;and(2)The observation group,which includes patients with T2MD with CHD.Age,sex,smoking and drinking history,CHD family history,metformin(MET)treatment pre-admission,body mass index,fasting blood glucose(FBG),triglyceride(TG),total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol(LDL-C),serum creatinine,blood urea nitrogen(BUN),alanine aminotransferase,aspartate aminotransferase,glycosylated hemoglobin(HbA1c),and coronary imaging data of both groups were collected from the medical record system.Logistic risk analysis was conducted to screen risk factors.The prediction model’s prediction efficiency was evaluated with receiver operating characteristic curves.RESULTS The control and observation groups consisted of 48 and 55 cases,respectively.The two groups were statistically different in terms of age(t=2.006,P=0.048),FBG(t=6.038,P=0.000),TG(t=2.015,P=0.047),LDL-C(t=2.017,P=0.046),and BUN(t=2.035,P=0.044).The observation group demonstrated lower proportions of patients receiving MET(χ^(2)=5.073,P=0.024)and higher proportions of patients with HbA1c of>7.0%(χ^(2)=6.980,P=0.008)than the control group.The observation group consisted of 15,17,and 23 cases of moderate stenosis,severe stenosis,and occlusion,respectively,with a greater number of coronary artery occlusion cases than the control group(χ^(2)=6.399,P=0.041).The observation group consisted significantly higher number of diffuse lesion cases at 35 compared with the control group(χ^(2)=15.420,P=0.000).The observation group demonstrated a higher right coronary artery(RCA)stenosis index(t=6.730,P=0.000),circumflex coronary artery(LCX)stenosis index(t=5.738,P=0.000),and total stenosis index(t=7.049,P=0.000)than the control group.FBG[odds ratio(OR)=1.472;95%confidence interval(CI):1.234-1.755;P=0.000]and HbA1c(OR=3.197;95%CI:1.149-8.896;P=0.026)were independent risk factors for T2DM complicated with CHD,whereas MET(OR=0.350;95%CI:0.129-0.952;P=0.040)was considered a protective factor for CHD in T2DM.CONCLUSION Coronary artery occlusion is a prevalent complication in patients with T2DM.Patients with T2MD with CHD demonstrated a higher degree of RCA and LCX stenosis than those with T2DM without CHD.FBG,HbA1c,and MET treatment history are risk factors for T2DM complicated with CHD.
基金Supported by The Far Eastern Memorial Hospital,No.FEMH-2022-C-015,No.FEMH-2022-C-017 and No.FEMH-2023-C-082.
文摘BACKGROUND Hepatitis B and C and alcoholic liver disease are the principal causes of hepaticrelated morbidity and mortality.However,evidence of the associations between diabetes without the above risk factors and hepatic-related study endpoints is not well understood.In addition,the effects of associated metabolic dysfunction and exercise on hepatic outcomes are still not clear.AIM To investigate the incidence and relative hazards of cirrhosis of the liver,hepato cellular carcinoma(HCC),hepatic-related complications and mortality in patients with type 2 diabetes(T2D)who were nonalcoholic and serologically negative for hepatitis B and C in Taiwan.METHODS A total of 33184 T2D patients and 648746 nondiabetic subjects selected from Taiwan’s adult preventive health care service were linked to various National Health Insurance databases,cancer registry,and death registry to identify cirrhosis of the liver,HCC,hepatic-related complications,and mortality.The Poisson assumption and Cox proportional hazard regression model were used to estimate the incidences and relative hazards of all hepatic-related study endpoints,respectively.We also compared the risk of hepatic outcomes stratified by age,sex,associated metabolic dysfunctions,and regular exercise between T2D patients and nondiabetic subjects.RESULTS Compared with nondiabetic subjects,T2D patients had a significantly greater incidence(6.32 vs 17.20 per 10000 person-years)and greater risk of cirrhosis of the liver[adjusted hazard ratio(aHR)1.45;95%CI:1.30-1.62].The aHRs for HCC,hepatic complications,and mortality were 1.81,1.87,and 2.08,respectively.An older age,male sex,obesity,hypertension,and dyslipidemia further increased the risks of all hepatic-related study endpoints,and regular exercise decreased the risk,irrespective of diabetes status.CONCLUSION Patients with T2D are at increased risk of cirrhosis of the liver,HCC,hepatic-related complications,and mortality,and associated metabolic dysfunctions provide additional hazard.Coordinated interprofessional care for high-risk T2D patients and diabetes education,with an emphasis on the importance of physical activity,are crucial for minimizing hepatic outcomes.
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Supported by National Natural Science Foundation of China,No.82000792General Project of Chongqing Natural Science Foundation,No.CSTB2023NSCQ-MSX0246 and No.CSTB2022NSCQ-MSX1271+1 种基金Research Project of the State Administration of Traditional Chinese Medicine on Collaborative Chronic Disease Management of Traditional Chinese Medicine and Western Medicine,No.CXZH2024087Science and Health Joint Project of Dazu District Science and Technology Bureau,No.DZKJ2024JSYJ-KWXM1002.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM)is a severe global health problem that causes prolonged disease exposure and an elevated risk for chronic complications,posing a substantial health burden.Although therapies,such as GLP-1 receptor agonists and SGLT2 inhibitors,have been successfully developed,new therapeutic options are still expected to offer better blood glucose control and decrease complications.AIM To elucidate the mechanism by which TERT/FOXO1 affects high glucose(HG)-induced dysfunction in isletβ-cells via the regulation of ATG9A-mediated autophagy.METHODS High-fat diet(HFD)-fed/streptozotocin(STZ)-treated mice or HG-treated MIN6 cells were used to establish T2DM models.Fasting blood glucose(FBG)and insulin levels in mice,as well as morphological changes in islet tissues,were assessed.Cell proliferation and the apoptosis rate were measured via EdU assays and flow cytometry,respectively.The expression levels of TERT,FOXO1,ATG9A and autophagy-related proteins(LC3B,p62)were analyzed via western blotting.The relationship between FOXO1 and ATG9A was assessed using dual-luciferase reporter gene assays and ChIP assays.RESULTS T2DM modeling in HFD-fed/STZ-treated mice and HG-treated MIN6 cells led to elevated TERT and FOXO1 expression and reduced ATG9A expression.Mice with T2DM were found to have decreased body weight,worsened morphology,elevated FBG and suppressed insulin levels.HG-treated MIN6 cells presented decreased viability and LC3B expression,in addition to increased p62 expression and apoptosis rates.FOXO1 knockdown both in vitro and in vivo protected mice and cells against isletβ-cell dysfunction via the activation of autophagy.The molecular mechanism involved the suppression of ATG9A expression by TERT through FOXO1 transcription activation.CONCLUSION Our results suggested that TERT/FOXO1 inhibits ATG9A expression to decrease isletβ-cell function in T2DM.
基金Supported by the JSPS KAKENHI,No.JP21K10300 and No.JP24K02714.
文摘BACKGROUND Early diagnosis of left ventricular diastolic dysfunction(LVDD)is essential for preventing heart failure.B-type natriuretic peptide(BNP)is a viable marker for predicting LVDD,as elevated BNP levels have been associated with worsening LVDD in patients with diabetes over time.However,the utility of BNP as a diagnostic marker in diabetes is controversial,as BNP levels are often low in overweight individuals.AIM To examine the effectiveness of BNP levels and fragmented QRS(fQRS)on electrocardiography for diagnosing LVDD in patients with type 2 diabetes.METHODS This retrospective cohort study included 303 patients with type 2 diabetes(67.4±12.3 years old)with preserved ejection fraction(EF)≥50%admitted to Toyama University Hospital for glycemic management and comorbidity evaluation between November 2017 and April 2021.All participants underwent plasma BNP measurement,electrocardiography,and echocardiography.Cardiologists who were blinded to the BNP results assessed the electrocardiograms and echocardiograms.Subgroup analyses were conducted for overweight individuals.RESULTS Receiver operating characteristic(ROC)curve analysis determined optimal BNP cut-off values of 34.8 pg/mL and 7.2 pg/mL for diagnosing LVDD in non-overweight[area under the ROC curve(AUC):0.70]and overweight(AUC:0.55)groups,respectively(P=0.040).In the overweight subgroup,fQRS showed greater diagnostic accuracy for LVDD(AUC:0.67),indicating moderate diagnostic utility compared with the low performance of the BNP cutoff of 35 pg/mL(AUC:0.52)(P=0.010).Multivariate analyses confirmed that fQRS was superior to BNP for LVDD diagnosis regardless of the patient’s weight.CONCLUSION A BNP level≥35 pg/mL in non-overweight individuals may be a reliable LVDD marker.Additionally,fQRS was more effective than BNP in diagnosing LVDD irrespective of the patient’s weight.fQRS can complement BNP in the early detection of LVDD,especially in overweight patients,potentially improving early detection and mitigating progression to heart failure with preserved EF in patients with type 2 diabetes.
文摘In this editorial,I discuss the article by Wang et al,published in the World Journal of Diabetes,which explores jejunoileal side-to-side anastomosis as a novel surgical intervention for type 2 diabetes mellitus(T2DM).T2DM,often associated with obesity,remains a global health challenge,as sustained remission is difficult to achieve with conventional pharmacological therapy.Jejunoileal anastomosis offers a promising alternative,particularly for patients with normal or relatively high body mass index,and addresses the unique challenges posed by diverse patient populations.This procedure preserves gastric anatomy while simultaneously improving metabolic parameters,such as glycemic control,lipid profiles,and pancreaticβ-cell function.Unlike traditional metabolic surgeries that involve permanent anatomical alterations,this approach provides advantages such as reversibility,shorter operative times,and minimal nutritional complications,making it appealing to patients for whom conventional bariatric surgery is unsuitable.Advances in gut hormone physiology and incretin modulation support these findings.This innovative approach represents a potential paradigm shift in T2DM treatment,offering insights into the evolving role of surgical interventions in metabolic regulation.While early findings show promising diabetes remission rates and metabolic improvements at six months post-surgery,further studies with longer follow-up periods and broader patient cohorts are required.
基金Supported by the National Natural Science Foundation of China,No.82471616,No.82170418 and No.82271618Natural Science Foundation of Hubei Province,No.2022CFA015+2 种基金Central Guiding Local Science and Technology Development Project,No.2022BGE237Key Research and Development Program of Hubei Province,No.2022BCE001 and No.2023BCB139Hubei Provincial Health Commission Project,No.WJ2023M151。
文摘Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced secretion of glucagon-like peptide-1.This surgical procedure alters the direction of nutrient flow,activates distal ileal L cells,and increases endogenous glucagon-like peptide-1 levels,supporting glucose homeostasis,enhancing insulin sensitivity,regulating body weight,and improving cardiovascular health.This structural adjustment transforms the gastrointestinal tract into an active endocrine regulatory organ,providing a pathway for metabolic improvement in patients with T2DM and other complex metabolic disorders.Although this procedure demonstrates significant metabolic improvements within 3-6 months after surgery,integrating hormone level measurements,metabolic marker analysis,and long-term follow-up has become crucial for exploring the complex mechanisms of T2DM in the field of metabolic surgery and T2DM management.Multidisciplinary collaboration involving support from endocrinology,nutrition,and rehabilitation teams before and after surgery is becoming increasingly vital in the long-term management of patients with T2DM.This collaboration optimizes surgical outcomes and enhances metabolic management.Side-to-side anastomosis shows potential in the multitarget metabolic management of T2DM,providing an additional intervention option for patients with T2DM and metabolic disorders.
