Efficient and Effective Diabetes Care in the Era of Digitalization and Hypercompetitive Research Culture: A Focused Review in the Western Pacific Region with Malaysia as a Case Study

There are approximately 220 million (about 12% regional prevalence) adults living with diabetes mellitus (DM) with its related complications, and morbidity knowingly or unconsciously in the Western Pacific Region (WP). The estimated healthcare cost in the WP and Malaysia was 240 billion USD and 1.0 billion USD in 2021 and 2017, respectively, with unmeasurable suffering and loss of health quality and economic productivity. This urgently calls for nothing less than concerted and preventive efforts from all stakeholders to invest in transforming healthcare professionals and reforming the healthcare system that prioritizes primary medical care setting, empowering allied health professionals, improvising health organization for the healthcare providers, improving health facilities and non-medical support for the people with DM. This article alludes to challenges in optimal diabetes care and proposes evidence-based initiatives over a 5-year period in a detailed roadmap to bring about dynamic and efficient healthcare services that are effective in managing people with DM using Malaysia as a case study for reference of other countries with similar backgrounds and issues. This includes a scanning on the landscape of clinical research in DM, dimensions and spectrum of research misconducts, possible common biases along the whole research process, key preventive strategies, implementation and limitations toward high-quality research. Lastly, digital medicine and how artificial intelligence could contribute to diabetes care and open science practices in research are also discussed.

Stress hyperglycemia ratio as a predictor of acute kidney injury and its outcomes in critically ill patients

This study investigated stress hyperglycemia ratio (SHR) for acute kidney injury (AKI) and clinical outcomes in intensive care unit (ICU). Key outcomes were AKI within 48 h after ICU admission, acute kidney disease (AKD), ICU mortality, 28-day mortality, 90-day mortality and 1-year mortality. The associations between SHR and outcomes was estimated via logistic regression, Cox proportional hazards regression, and restricted cubic spline (RCS) analyses. Subgroup analyses assessed the consistency of these associations. Totally 3,714 patients were included from the Medical Information Mart for Intensive Care IV. SHR was associated with an increased risk of AKI (ORadjusted 1.29 95%CI 1.05-1.59). Among AKI patients, SHR was associated with increased risks of AKD (ORadjusted 1.94 95%CI 1.57-2.39), ICU mortality (ORadjusted 2.31 95%CI 1.60-3.32), 28-day mortality (HRadjusted 1.39 95%CI 1.29-1.50), 90-day mortality (HRadjusted 1.37 95%CI 1.26-1.48), and 1-year mortality (HRadjusted 1.37 95%CI 1.27-1.47). RCS analysis revealed a linear relationship with AKI, a J-shaped relationship with AKD, and a U-shaped relationship with mortality. Subgroup analysis confirmed the consistency of relationship between SHR and AKI. SHR demonstrates significant associations with AKI incidence, and correlates with AKD progression/mortality in critically ill adult ICU patients, suggesting its potential as a risk stratification and prognostic tool for AKI management, though further prospective validation is required.

Stress hyperglycemia ratio: a novel predictor of left ventricular dysfunction in peripartum cardiomyopathy

OBJECTIVE

This study aims to assess the predictive value of the stress hyperglycemia ratio (SHR) for left ventricular (LV) systolic dysfunction in patients with peripartum cardiomyopathy (PPCM).

METHODS

We conducted a retrospective analysis of 78 consecutive PPCM patients from January 2007 to March 2023. Their clinical, laboratory, and auxiliary examination data were collected. The estimated average glucose (eAG) was calculated using the formula: eAG = [1.59 × hemoglobin A1c (%) -%2.59]. The SHR was determined by the formula: SHR = (blood glucose at admission)/eAG. The primary outcome measured was the recovery of LV systolic function. A receiver operating characteristic (ROC) curve was used to evaluate the SHR. Logistic regression analysis was performed to identify risk factors for LV systolic dysfunction in PPCM patients.

RESULTS

The mean random blood glucose level in the PPCM patients was 6.38 mmol/L, with an SHR of 1.16. Among these patients, 37 (47.4%) exhibited persistent LV systolic dysfunction during follow-up. The SHR was significantly higher in the non-recovery group than in the recovery group (1.45 vs. 0.91, p < .001). An SHR cutoff of 1.079 predicted persistent LV systolic dysfunction with a sensitivity of 81.1% and a specificity of 90.2%, yielding a Youden index of 0.713. Logistic regression identified an SHR ≥ 1.079, a left ventricular end-diastolic diameter (LVEDD) > 55 mm, and digoxin usage as risk factors for LV systolic dysfunction.

CONCLUSIONS

PPCM patients with an SHR of 1.079 or higher should receive increased scrutiny for persistent LV systolic dysfunction.

Related factors for kidney disease and high chronic kidney disease progression risk in adult-onset type 1 diabetes mellitus patients from China: a multi-center cross-sectional study

BACKGROUND/AIM

Concerning the related factors for kidney disease and high chronic kidney disease (CKD) progression risk, there is still a lack of study in the adult-onset type 1 diabetes mellitus (T1DM) patients from China.

METHODS

Four hundred and eighty-one adult-onset T1DM patients from the Guangdong T1DM translational medicine study were included. Logistic regression analysis (Forward: LR) was utilized to identify glycemic- and nonglycemic-related factors associated with moderate albuminuria, severe albuminuria, mildly reduced estimated glomerular filtration rate (eGFR), decreased eGFR, and high CKD progression risk, and to calculate the odds ratio (OR) and 95% confidence interval (CI).

RESULTS

High CKD progression risk was positively associated with males (OR = 3.13, 95% CI:1.20 - 8.14, p = 0.019), duration of T1DM (OR =1.13, 95% CI:1.05 - 1.21, p < 0.001), triglyceride (OR =1.52, 95% CI:1.11 - 2.08, p = 0.008), and systolic blood pressure (SBP) (OR =1.04, 95% CI:1.02 - 1.07, p = 0.001), and negatively correlated with BMI (OR = 0.80, 95% CI:0.68 - 0.95, p = 0.011). Meanwhile, moderate albuminuria, severe albuminuria, mildly reduced eGFR and decreased eGFR had different each of glycemic- and nonglycemic-related factors.

CONCLUSIONS

Hyperglycemia, hypertension, hyperuricemia, and BMI may be associated with different stages of kidney disease in adult-onset T1DM patients. Early-stage adult-onset T1DM patients with male, low BMI, prolonged diabetes duration, and comorbid hypertension and dyslipidemia should undergo a thorough evaluation of albuminuria and renal function to detect those at high CKD progression risk, who should be timely transferred to the nephrology specialty to receive professional treatment for kidney disease.

Development of a single-dose Q fever vaccine with an injectable nanoparticle-loaded hydrogel: effect of sustained co-delivery of antigen and adjuvant

Q fever is a zoonotic infectious disease caused by Coxiella burnetii, and there is currently no FDA-approved vaccine for human use. The whole-cell inactivated vaccine Q-VAX, which is only licensed in Australia, has a risk of causing severe adverse reactions, making subunit vaccines a good alternative. However, most subunit antigens are weak immunogens and require two or more immunizations to elicit an adequate level of immunity. We hypothesized that by combining a nanoparticle to co-deliver both a protein antigen and an adjuvant, together with a hydrogel depot for sustained-release kinetics, a single-administration of a nanoparticle-loaded hydrogel vaccine could elicit a strong and durable immune response. We synthesized and characterized a protein nanoparticle (CBU-CpG-E2) that co-delivered the immunodominant protein antigen CBU1910 (CBU) from C. burnetii and the adjuvant CpG1826 (CpG). For sustained release, we examined different mixtures of PLGA-PEG-PLGA (PPP) polymers and identified a PPP solution that was injectable at room temperature, formed a hydrogel at physiological temperature, and continuously released protein for 8 weeks in vivo. Single-dose vaccine formulations were administered to mice, and IgG, IgG1, and IgG2c levels were determined over time. The vaccine combining both the CBU-CpG-E2 nanoparticles and the PPP hydrogel elicited a stronger and more durable humoral immune response than the soluble bolus nanoparticle vaccines (without hydrogel) and the free antigen and free adjuvant-loaded hydrogel vaccines (without nanoparticles), and it yielded a balanced IgG2c/IgG1 response. This study demonstrates the potential advantages of using this modular PPP hydrogel/nanoparticle system to elicit improved immune responses against infectious pathogens.

Comparative efficacy and safety of febuxostat and allopurinol in chronic kidney disease stage 3-5 patients with asymptomatic hyperuricemia: a network meta-analysis

OBJECTIVE

This study evaluates and compares the effectiveness and safety of febuxostat and allopurinol in chronic kidney disease (CKD) stages 3-5 patients with asymptomatic hyperuricemia using a network meta-analysis.

METHODS

A systematic review and network meta-analysis were conducted, adhering to PRISMA-NMA guidelines. Searches included PubMed, Embase, Cochrane Library, and Chinese databases up to June 2024. Randomized controlled trials (RCTs) and cohort studies were assessed for methodological rigor using GRADE.

RESULTS

A total of 12 RCTs and 4 cohort studies (n = 2,423 participants) were included. Febuxostat was associated with greater improvements in estimated glomerular filtration rate compared to allopurinol (MD, 4.99 mL/min/1.73 m2; 95%CI -0.65 to 10.78; certainty: low) and placebo (MD, 4.72 mL/min/1.73 m2; 95%CI 0.67 to 8.82; low). Serum uric acid reduction was also more pronounced with febuxostat (MD, -0.61 mg/dL; 95%CI -1.15 to -0.05; moderate). Safety outcomes, including major cardiovascular events and adverse events, showed no significant differences between febuxostat and allopurinol. Subgroup analyses revealed enhanced effectiveness of febuxostat at six months of treatment.

CONCLUSIONS

This analysis provides robust evidence that febuxostat might offers greater improvements in kidney function and uric acid levels compared to allopurinol or placebo in asymptomatic hyperuricemia with CKD stage 3-5 patients, without compromising safety. These findings can guide clinical decision-making and treatment optimization.

Scaffold hopping-based structural modification of tranilast led to the identification of HNW005 as a promising NLRP3 inflammasome and URAT1 dual inhibitor for the treatment of gouty arthritis

Hyperuricemia and monosodium urate induced nod-like receptor family, pyrin domain-containing 3 (NLRP3) inflammasome activation is the major pathogenesis for gouty arthritis, and urate transporter 1 (URAT1) is a proven target for hyperuricemia. In this study, scaffold hopping modification with tranilast led to the identification of HNW005, an NLRP3 inflammasome and URAT1 dual-target inhibitor, which exhibited notable inhibitory potency against NLRP3 inflammasome activation (KD = 204.6 nM, IC50 = 1.7 μM) and uric acid transmembrane transportation (IC50 = 6.4 μM). Importantly, HNW005 displayed significant in vivo efficacy with respect to anti-inflammatory, analgesic, and uric acid-lowering effects (decreasing rate = 64.8 % at 2 mg/kg). In addition, HNW005 also displayed an acceptable pharmacokinetic profile (F = 41.37 %, t1/2 = 3.07 h). Collectively, the results showed that developing dual-target inhibitors of NLRP3 inflammasomes and URAT1 is a feasible strategy for the treatment of gouty arthritis, and HNW005 is worthy of further investigation.

Encouraging the prescribing of SGLT2i and GLP-1RA medications to reduce cardiovascular and renal risk in patients with type 2 diabetes: Rationale and design of a randomized controlled trial

BACKGROUND

Sodium-glucose cotransporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1RA) medications reduce the risk of cardiovascular and renal complications among patients with type 2 diabetes but are underutilized. There are numerous barriers to prescribing including insurance coverage, medication availability, comfort with prescribing, and diffusion of responsibility of prescribing across specialists. Methods are needed to support prescribing in primary care.

METHODS

This was a pragmatic, randomized controlled trial testing interventions to increase appropriate SGLT2i and GLP-1RA prescribing. Primary care providers (PCPs) were randomized to 1 of 3 arms: (1) peer champion support (2) peer champion support and information on insurance coverage, or (3) usual care (no intervention). PCPs in both intervention arms received a welcome email and electronic health record (EHR) messages before visits with patients who had sub-optimally controlled diabetes and an indication for 1 of these medications. In the peer champion support only arm the EHR messages included prescribing tips. In the arm that provided peer champion support and information on insurance coverage, EHR messages contained information on medications in each class that would be most affordable for the patient based on their insurance coverage and offered support for prior authorizations if needed. The primary outcome was prescriptions for an SGLT2i or GLP-1RA medication, beginning 3 days before the targeted visit and continuing through 28 days, in each intervention arm compared to control.

RESULTS

191 primary care providers were included in the study. 1,389 patients had at least 1 visit scheduled with their PCP during the 6-month intervention period; of these 1,079 patients attended at least 1 of these visits and will be included in the primary outcome analysis. 66 providers (484 patients) received the peer champion intervention alone, 63 providers (446 patients) received the peer champion intervention and information on insurance coverage, and 62 providers (459 patients) received usual care. On average, patients were 66 years old, 46% were female, 61% were white, and 16% were Hispanic. There were small differences between groups with regards to patient sex, race, ethnicity, partner status, and percent with Medicare insurance.

CONCLUSIONS

These medication classes have the potential to reduce cardiovascular and kidney disease among patients with type 2 diabetes. This study tests interventions to support prescribing of these medications in primary care.

CLINICAL TRIAL

Clinicaltrials.gov. Unique identifier: (NCT, Registered: NCT05463705).

Extracellular vesicles as biomarkers for metabolic dysfunction-associated steatotic liver disease staging using explainable artificial intelligence

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease globally. Current diagnostic methods, such as liver biopsies, are invasive and have limitations, highlighting the need for non-invasive alternatives.

AIM

To investigate extracellular vesicles (EVs) as potential biomarkers for diagnosing and staging steatosis in patients with MASLD using machine learning (ML) and explainable artificial intelligence (XAI).

METHODS

In this single-center observational study, 798 patients with metabolic dysfunction were enrolled. Of these, 194 met the eligibility criteria, and 76 successfully completed all study procedures. Transient elastography was used for steatosis and fibrosis staging, and circulating plasma EV characteristics were analyzed through nanoparticle tracking. Twenty ML models were developed: Six to differentiate non-steatosis (S0) from steatosis (S1-S3); and fourteen to identify severe steatosis (S3). Models utilized EV features (size and concentration), clinical (advanced fibrosis and presence of type 2 diabetes mellitus), and anthropomorphic (sex, age, height, weight, body mass index) data. Their performance was assessed using receiver operating characteristic (ROC)-area under the curve (AUC), specificity, and sensitivity, while correlation and XAI analysis were also conducted.

RESULTS

The CatBoost C1a model achieved an ROC-AUC of 0.71/0.86 (train/test) on average across ten random five-fold cross-validations, using EV features alone to distinguish S0 from S1-S3. The CatBoost C2h-21 model achieved an ROC-AUC of 0.81/1.00 (train/test) on average across ten random three-fold cross-validations, using engineered features including EVs, clinical features like diabetes and advanced fibrosis, and anthropomorphic data like body mass index and weight for identifying severe steatosis (S3). Key predictors included EV mean size and concentration. Correlation, XAI, and SHapley Additive exPlanations analysis revealed non-linear feature relationships with steatosis stages.

CONCLUSION

The EV-based ML models demonstrated that the mean size and concentration of circulating plasma EVs constituted key predictors for distinguishing the absence of significant steatosis (S0) in patients with metabolic dysfunction, while the combination of EV, clinical, and anthropomorphic features improved the diagnostic accuracy for the identification of severe steatosis. The algorithmic approach using ML and XAI captured non-linear patterns between disease features and provided interpretable MASLD staging insights. However, further large multicenter studies, comparisons, and validation with histopathology and advanced imaging methods are needed.

Bioengineered bacterial extracellular vesicles for targeted delivery of an osteoclastogenesis-inhibitory peptide to alleviate osteoporosis

Osteoporosis (OP) is a systemic skeletal disease commonly found in women after 55 years old and men after 65 years old. With the worldwide aging of population, its prevalence rate is increasing rapidly, bringing huge financial burdens to all countries. As a potential alternative to the conventional OP therapeutics with limited efficacies and side effects, a linear peptide FRATtide capable of binding with phosphorylated GSK3β has been discovered by us to inhibit osteoclastogenesis thus reduce bone loss. While its poor proteolytic stability and osteoclast targetability hinder its effective in vivo treatment. As such, bacterial extracellular vesicles secreted by the rationally recombinant probiotics Escherichia coli Nissle 1917 that express pre-osteoclast fusion protein DC-STAMP (BEV-DCS) are engineered and exploited as delivery vehicles. The BEV-DCS not only protect FRAT from enzymatic degradation but also enable its targeted intracellular delivery into pre-osteoclasts. On the ovariectomy mouse model, the FRAT encapsulated BEV-DCS (FRAT@BEV-DCS) exhibit remarkable bone targeting capacity and osteoporosis ameliorating efficacy without any obvious toxicity. These results reveal the great potential of FRAT@BEV-DCS as a novel therapeutic option for the effective and safe OP treatment.

Effects of exercise with or without a hypocaloric diet on intermuscular and intramuscular fat: a systematic review

BACKGROUND

Intermuscular (InterMAT) and intramuscular (IntraMAT) adipose tissues are key contributors to skeletal muscle function and metabolic health.

OBJECTIVE

In this systematic review, we aimed to investigate the impact of different types of exercise with or without a hypocaloric diet on reducing InterMAT and IntraMAT in various muscle tissues.

METHOD

A literature search was performed via PubMed, Cochrane Library, Scopus, and Web of Science from inception until February 2025. Eligible RCTs examined the effects of exercise compared to control in adults > 18 years. A narrative synthesis was employed with a registered protocol at CRD42024511531.

RESULTS

Nineteen RCTs were included in the systematic review. Resistance and aerobic exercise alongside a hypocaloric diet displayed inconsistent results in reducing thigh InterMAT. Under non-hypocaloric conditions there were consistently no alterations of InterMAT and IntraMAT irrespective of muscle tissue. When concurrent exercise was followed, no statistically significant changes were observed with or without a hypocaloric diet on thigh InterMAT and IntraMAT. Results were overall lacking in regards to resistance or aerobic exercise and IntraMAT due to the low number of studies.

CONCLUSION

There is potential in reducing thigh InterMAT following resistance or aerobic exercise combined with a hypocaloric diet, although inconsistencies among studies were presented. However, irrespective of exercise type, under non-hypocaloric conditions no benefits were conferred on InterMAT and IntraMAT of any muscle tissue. Further research is warranted to determine the effects of different exercise intensities employing an adequate dietary and hypocaloric control on skeletal muscle InterMAT and particularly IntraMAT.

Core GRADE 7: principles for moving from evidence to recommendations and decisions

This seventh article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for moving from evidence to recommendations or policy decisions. Core GRADE users make strong recommendations for an intervention versus a comparator when the desirable consequences clearly outweigh the undesirable consequences, and a conditional (weak) recommendation when the balance is less clear. Primary considerations in deciding on recommendations considering an individual patient perspective include balance of benefits, harms, and burdens; the certainty of evidence; and values and preferences. Secondary considerations, most important from a population perspective, include costs, feasibility, acceptability, and equity. Moving from evidence to recommendations begins with considering evidence regarding patients’ values and preferences and choosing the smallest difference in each outcome that patients perceive as important (the minimal important difference). Core GRADE users construct statements that make clear the values and preferences underlying their recommendations. In general, Core GRADE users make strong recommendations only when certainty of evidence is high or moderate. When evidence certainty is low, recommendations will be conditional under all but special circumstances.

Efficacy and hypoglycaemia outcomes with once-weekly insulin icodec versus once-daily basal insulin in type 2 diabetes according to baseline glucagon-like peptide-1 receptor agonist and sodium-glucose co-transporter-2 inhibitor use: A post hoc analysis of ONWARDS 1-5

AIMS

To assess the treatment effects of once-weekly insulin icodec (icodec) versus once-daily basal insulin comparators in individuals with type 2 diabetes (T2D) according to baseline glucagon-like peptide-1 receptor agonist (GLP-1RA) and sodium-glucose co-transporter-2 inhibitor (SGLT2i) use.

MATERIALS AND METHODS

This post hoc analysis of the randomized ONWARDS 1-5 trials of individuals with T2D assessed treatment outcomes by trial according to baseline GLP-1RA and/or SGLT2i use.

RESULTS

At screening, 21.3% (801/3765) and 36.9% (1388/3765) of participants in ONWARDS 1-5 were treated with a GLP-1RA or an SGLT2i, respectively. Baseline characteristics were broadly similar across treatment arms irrespective of GLP-1RA/SGLT2i use; GLP-1RA users had numerically higher body mass indices than non-users. Across trials, there were no statistically significant treatment interactions by GLP-1RA or SGLT2i subgroups with respect to: change in glycated haemoglobin (HbA1c) and body weight from baseline to end of treatment (except for body weight change by SGLT2i use in ONWARDS 5); weekly basal insulin dose during the last 2 weeks of treatment (except SGLT2i use in ONWARDS 5); and achievement of HbA1c less than 7% without clinically significant or severe hypoglycaemia. Irrespective of GLP-1RA/SGLT2i use, the rates of clinically significant or severe hypoglycaemia were less than one episode per patient-year of exposure across all trials except ONWARDS 4 (basal-bolus trial).

CONCLUSIONS

The efficacy and hypoglycaemia profile of icodec versus once-daily comparators was generally consistent across ONWARDS trials irrespective of background GLP-1RA and/or SGLT2i use.

Exploring the bidirectional association between thyrotropin and thyroid hormones in type 2 diabetes: a systematic review and meta-analysis

Background

Type 2 diabetes mellitus (T2DM) and thyroid dysfunction are some of the most prevalent endocrine disorders globally. Previous studies on the association and effect of thyroid hormones in patients with diabetes have yielded contradictory results. Therefore, this meta-analysis comprehensively examined the latest evidence regarding the bilateral association between thyrotropin and thyroid hormone levels in T2DM.

Methods

A thorough search across multiple databases was conducted to investigate the bidirectional relationship between thyroid hormones and T2DM. Two researchers independently performed data extraction and study quality was assessed using the Newcastle-Ottawa scale, with prevalence, odds ratios, and hazard ratios calculated using a random-effects model.

Results

After screening 4159 studies, 36 were deemed eligible based on the inclusion criteria. A one-unit increase in serum thyroid-stimulating hormone (TSH) level was associated with a 2.49-fold increased odds of T2DM (OR: 2.49, 95%CI: 1.97-3.0). Similarly, a one-unit increase in Triiodothyronine (FT3) levels was associated with a 17% (HR:1.17,95%CI: 1.07-1.26) increased risk of T2DM. The pooled risk estimates of T2DM were 3.63 (95%CI: 1.63-8.09) for hypothyroidism, and 16.33 (95%CI: 7.59-35.12) for overt hypothyroidism. Individuals with thyroid dysfunction exhibited significantly higher HbA1c levels (Hedges'g: - 0.26, 95% CI: - 0.47 to - 0.06) and fasting plasma glucose (FPG) levels (Hedges'g: - 0.33, 95% CI: - 0.61 to - 0.05) compared to those with normal thyroid function.

Conclusions

Thyroid dysfunction, including both overt and subclinical hypo- and hyperthyroidism, significantly increases the risk of T2DM. Elevated TSH and FT3 levels are linked to higher diabetes risk, highlighting the need for regular thyroid screening and integrated clinical management.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01612-w.

Use of adjunctive glycaemic agents with vascular protective properties in individuals with type 1 diabetes: Potential benefits and risks

Glycaemic therapy in type 1 diabetes (T1D) is focused on insulin, with the majority of studies investigating different insulin preparations, delivery devices and dosing accuracy methods. While insulin deficiency is the key mechanism for hyperglycaemia in T1D, individuals with this condition can also develop insulin resistance (IR), making optimisation of glycaemia more challenging. Importantly, IR in T1D increases the risk of both microvascular and macrovascular complications; yet, it is rarely targeted in routine clinical care. In this narrative review, we briefly discuss the mechanistic pathways for diabetes complications in individuals with T1D, emphasising the adverse role of IR. We subsequently cover the use of adjunctive glycaemic therapies for improving the metabolic profile in T1D, focusing on therapies that have possible or definite cardiovascular or renal protective properties in individuals with type 2 diabetes. These include metformin and agents in the thiazolidinedione, Sodium-Glucose Cotransporter-2 inhibitor (SGLT2i) and Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RA) groups. In addition to reviewing the role of these agents in improving metabolic parameters, we address their potential vascular and renal protective effects in individuals with T1D. We suggest a pragmatic approach for using these agents in T1D, based on current knowledge of their benefits and risks, while also highlighting gaps in knowledge and areas that require further research. It is hoped that the review raises awareness of the role of adjunctive therapies in T1D and offers healthcare professionals simple guidance on using such agents for the management of high-risk individuals with T1D.

Cardiovascular outcomes of SGLT-2 inhibitors' subtypes in type 2 diabetes; an updated systematic review and meta-analysis of randomized controlled trials

Introduction

The effects of Sodium-glucose cotransporter-2 (SGLT-2) inhibitors on cardiac outcomes, cardiovascular mortality (CVM), and all-cause mortality (ACM) in type 2 diabetes mellitus (T2DM) patients have been reported heterogeneously in different studies.

Methods

PubMed, Scopus, Embase, Cochrane Library, and Scholar databases were searched with relevant MeSH terms from January 1, 2010, to November 14, 2023. The study used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcomes in all trials included the risk of ACM, CVM, hospitalization for heart failure (HHF), myocardial infarction (MI), and cerebrovascular accidents (CVA) in T2DM patients who were treated with one of the SGLT-2 inhibitors. Heterogeneity between studies was evaluated using Cochran's Q and I2 tests. The Egger's test was used to check for publication bias.

Results

Eighteen studies, including 70,830 participants, were included. A pooled estimate showed that SGLT-2 inhibitor treatment was significantly associated with reduced ACM (OR: 0.82, 95% CI: 0.75-0.90, p-value: 0.001, I2: 35.1%), CVM (OR: 0.88, 95% CI: 0.80-0.96, p-value: 0.001, I2: 0%), MI (OR: 0.88, 95% CI: 0.79-0.98, p-value: 0.001, I2: 0%), and HHF (OR: 0.67, 95% CI: 0.58-0.77, p-value: 0.001). SGL-2 inhibitor treatment had no significant relationship with CVA (stroke) (OR: 0.95, 95% CI: 0.8-1.10, p-value: 0.896). Subgroup analysis showed that the effect of SGLT-2 inhibitor treatment on outcomes varied based on the type of SGLT-2 inhibitor.

Conclusion

SGLT-2 inhibitor treatment significantly reduced CVM, ACM, MI, and HHF. Empagliflozin, Canagliflozin, and Dapagliflozin significantly reduced ACM. Canagliflozin was significantly associated with a reduction in CVM. All SGLT-2 inhibitor treatments were associated with a reduction in HHF.

The burden of type 2 diabetes in China from 1990 to 2021: A comparative analysis with G20 countries using the global burden of disease study 2021

OBJECTIVES

The study aims to evaluate the burden of Type 2 Diabetes (T2D) in China from 1990 to 2021, and compare to it across G20 countries.

METHODS

We utilized data from the Global Burden of Disease Study 2021 to examine the burden of T2D in China from 1990 to 2021. Prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) were calculated. Comparative analyses were conducted with other G20 countries.

RESULTS

T2D prevalence in China increased between 1990 and 2021, with rates rising from 3519.8 (3138.3-3910.1) to 6055.5 (5510.1-6614.3) per 100,000. The death rates slightly decreased from 9.3 (8.2-10.5) per 100,000 to 8.7 (7.3-10.3). The DALYs rate increased from 438.7 (358.5-531.5) to 569.8 (435.4-734.2), with increases observed in YLDs and YLLs. Males had a heavier disease burden in China. Compared to G20 countries, China ranked high in prevalence but had relatively better mortality outcomes in older age groups.

CONCLUSION

This study reveals the enormous burden and remarkable control efforts of T2D in China. Comparative analysis emphasizes the importance of tailored public health interventions to address this growing health crisis.

Efficacy of phentermine/topiramate extended release in weight management and metabolic profiles: A multicentre study in South Korea

AIMS

Clinical trials have demonstrated the effectiveness of the phentermine and topiramate combination in weight management. This research evaluated the efficacy and safety of phentermine/topiramate extended release (ER) for weight management, focusing on alterations in body weight and metabolic parameters in routine clinical practice.

MATERIALS AND METHODS

We retrospectively included people with obesity who initiated phentermine/topiramate ER between January 2020 and April 2023 at 10 tertiary hospitals in South Korea. The study assessed body weight changes at 5-6 months and for those who continued, at 12 months, along with metabolic parameters. Total body weight was measured using calibrated electronic scales with participants in light indoor clothing.

RESULTS

The cohort included 1839 patients (540 men and 1299 women), with a 5-6-month continuation rate of 48%. At 5-6 months, the mean weight reduction was 7.9%, with sex-specific losses of 7.1% in men and 8.2% in women. Over 56% of participants achieved more than 5% weight loss, with 23% exceeding a 10% reduction. Younger participants, women and those with moderate to severe obesity exhibited more pronounced weight loss compared to older men and individuals with mild obesity, respectively. Concurrently, phentermine/topiramate ER treatment improved glucose regulation, lipid profiles and decreased blood pressure: the HbA1c decreased by 0.4 ± 0.9%, low-density lipoprotein (LDL) cholesterol by 10 ± 32 mg/dL and systolic blood pressure by 6 ± 15 mmHg (all p < 0.001). Treatment was well-tolerated, with a 15% incidence of mild adverse events like paresthesia, dry mouth and insomnia. At 12 months, patients who persisted in treatment (21%) experienced an average weight loss of 9.6%, with 65% surpassing a 5% weight loss.

CONCLUSION

The study suggests phentermine/topiramate ER is an effective option for obesity management in a South Korean population, though long-term adherence remains a challenge.

Elevated uric acid level and metabolic syndrome in Non-Hispanic Black American adults

Objectives

To ascertain the direct and indirect link between elevated uric acid (eUA) and metabolic syndrome (MetSyn) in Non-Hispanic Black (NHB) American adults.

Design

Structural equation modeling (SEM) was used to disentangle the U.S. National Health and Nutritional Examination Survey (2015-2018 NHANES) dataset and investigate the connection between eUA and components of MetSyn as per the criteria from the National Cholesterol Education Program (NCEP) Adult Treatment Panel III. The association between eUA and MetSyn was determined using odds ratios from sex-specific multivariable logistic regression analysis. The analysis was adjusted for age, physical activity, alcohol use, and smoking. SEM coefficients were used to measure the strength of the link between eUA and MetSyn components.

Results

NHB American men with eUA had 1.41-fold greater odds of MetSyn, and NHB American women with eUA had 2.70-fold greater odds of MetSyn after adjusting for confounding factors. Elevated uric acid was more strongly and directly linked to abdominal obesity (β = 0.320, p < 0.01) in NHB American men, and with abdominal obesity (β = 0.423, p < 0.01), dyslipidemia (β = 0.151, p < 0.01) and hypertension (β = 0.121, p < 0.01) in NHB American women than between eUA and other components of MetSyn.

Conclusions

This study's finding linking eUA to MetSyn components in NHB American adults needs reaffirmation through a robust prospective study design. If validated, eUA could help predict and prevent MetSyn in NHB American adults.

Green diabetes project: A comprehensive characterization of sustainable diabetes practices

INTRODUCTION

Technological advancements in diabetes mellitus (DM) management have empowered individuals for self-care. However, the widespread use of disposable devices has contributed to significant waste generation. This study aimed to assess patients' knowledge of sustainability in DM management and identify factors associated with varying levels of environmental concern.

MATERIALS AND METHODS

A cross-sectional observational study was conducted using a six-question survey to patients with DM under insulin therapy. Participants were categorized into three groups based on their level of concern for sustainability: absent, slight and high concern.

RESULTS

Among 285 participants, 11.2 %, 56.9 % and 31.9 % were respectively classified as having absent, slight and high concern. Most (62.1 %) had never discussed environmental sustainability with a healthcare professional, and 183 (64.3 %) reported improper disposal of sharps (general or plastic waste). No significant differences were found between sustainability concern and DM type, glycemic control, or age. Independent predictors of higher level of concern were female gender (p = 0.006) and prior discussion of sustainability during consultations (p < 0.001).

CONCLUSIONS

Waste from DM management poses a significant public health and environmental challenge. Despite widespread concern, awareness and proper disposal practices remain inadequate. Healthcare professionals play a pivotal role raising awareness about the issue.

Icodec: A Novel Once-Weekly Basal Insulin for Diabetes Management

OBJECTIVE

To evaluate the efficacy, safety, and clinical implications of insulin icodec, a novel once-weekly basal insulin for the treatment of type 1 diabetes (T1D) and type 2 diabetes (T2D), with an emphasis on its advantages and challenges in comparison with existing daily basal insulins.

DATA SOURCES

A literature search was performed using PubMed, Google Scholar, Embase, and ClinicalTrials.gov up to August 26, 2024, using the search terms icodec and ONWARDS trial. Studies involving patients living with T1D or T2D on once-weekly insulin icodec compared with once-daily insulins glargine U100, glargine U300, and degludec were considered for this review.

STUDY SELECTION AND DATA EXTRACTION

Relevant English-language studies and those conducted in humans were considered.

DATA SYNTHESIS

Insulin icodec offers reduced dosing frequency and potentially superior glycemic management with a safety profile comparable to existing basal insulins.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

Insulin icodec once-weekly dosing could significantly improve convenience and efficacy over daily basal insulins, representing a significant innovation in insulin therapy.

CONCLUSIONS

Insulin icodec emerges as a promising option for diabetes management, potentially improving treatment adherence and quality of life.

A Revolution in Medicine and Surgery Has Begun

In the last few years, the longevity of Americans has fallen for the first time in our history. Obesity has mushroomed, heart disease still kills approximately 600,000 Americans, and stroke 150,000. This review will cover the 8 most important nongenetic risk factors for heart disease and stroke. Meanwhile, recent research has clarified the root cause of atherosclerosis. The approval of tirzepatide to treat obesity in November 2023 by the FDA turns out to have enormous implications for medicine and surgery and the food industry.

Sodium-Glucose Cotransporter-2 Inhibitors and Diabetic-Ketoacidosis in T2DM Patients: An Updated Meta-Analysis and a Mendelian Randomization Analysis

To evaluate the association of sodium-glucose cotransporter 2 inhibitors (SGLT2i) with diabetic ketoacidosis (DKA) in type 2 diabetes mellitus (T2DM) patients across different subgroups, we searched randomized controlled trials (RCTs) comparing SGLT2i with the control groups among T2DM patients and including DKA as a safety outcome. Pooled risk ratios (RRs) were calculated using random or fixed-effects models, as appropriate. An inverse-variance-weighted Mendelian randomization (MR) analysis was performed to estimate the genetic correlation. Twenty-two trials involving 80,235 patients were included. SGLT2i increased the risk of DKA compared to the control groups (RR 2.32, 95% CI 1.64-3.27). The risk was significantly increased in patients with higher HbA1c levels (> 7.9%) (RR 2.24, 95% CI 1.59-3.14), but not in those with lower HbA1c levels (≤ 7.9%) (RR 1.05, 95% CI 0.49-2.26; interaction P = 0.034). SGLT2i increased DKA risk in chronic kidney disease (CKD) (RR 2.70, 95% CI 1.55-4.71) and high atherosclerotic cardiovascular disease (ASCVD) risk trials (RR 2.46, 95% CI 1.47-4.11) but not significantly in heart failure (HF) trials (RR 1.23, 95% CI 0.51-2.96). Moreover, in the HF trials, SGLT2i consistently did not increase the risk of DKA in any clinical subgroups. Nevertheless, MR analysis still confirmed a genetic association between SGLT2i and the risk of DKA among overall T2DM patients. SGLT2i may increase the risk of DKA in T2DM patients, particularly in patients with higher levels of HbA1c and those with comorbid CKD or at high-risk ASCVD. However, the increased risk was not significant in patients with HF.

Semaglutide ameliorates metabolic disorders in offspring via regulation of oocyte ROS of pre-pregnancy obesity mice

Pre-pregnancy obesity (PPO) seriously threatens the health of both mother and offspring. Pre-pregnancy weight management is particularly important for the prevention of metabolic diseases in offspring. Semaglutide is one of the most effective glucagon-like peptide-1 agonizts for the management of obesity and metabolic diseases, but little is known about its effect on the long-term health of offspring. In this study we investigated the effects of semaglutide administered before pregnancy on the offspring health from PPO mice. PPO mice model was established by feeding with high-fat diet for 16 weeks, and then injected with semaglutide (30 nmol/kg-1·d-1, sc.) for 22 days before pregnancy. After the treatment, the mice were mated with normal males or underwent in vitro fertilization (IVF) for offspring reproduction. We showed that the semaglutide treatment not only improved the lipid and glucose metabolic disorders and fertility of PPO mice, but also significantly reversed the overweight, impaired energy balance, adipose inflammatory state, lipid and glucose metabolic disorders and insulin resistance of their IVF offspring. By conducting RNA-seq analysis, SOD activity and malondialdehyde assays in ovaries, as well as ROS staining in oocytes, we revealed that the semaglutide treatment reduced the elevated oxidative stress in ovaries and high ROS levels in oocytes from PPO mice, possibly through activating the PI3K/AKT pathway and improving the state of SOD. Interestingly, incubation of oocytes from semaglutide-treated dams with H2O2 (100 μM) in vitro during IVF blocked the protective effects of semaglultide against the metabolic disorders in the offspring. In conclusion, semaglutide treatment before pregnancy effectively alleviates obesity-related metabolic disorders in offspring. The regulation of ROS in oocytes plays a crucial role in the protective effects of semaglutide.

Metabolic dysfunction-associated steatotic liver disease (MASLD) in children with obesity: An Obesity Medicine Association (OMA) and expert joint perspective 2025

Introduction

This Obesity Medicine Association (OMA) Expert Joint Perspective examines steatotic liver disease (SLD), which is composed of metabolic dysfunction-associated steatotic liver disease (MASLD), and metabolic dysfunction-associated steatohepatitis (MASH) in children with obesity. The prevalence of obesity is increasing, rates have tripled since 1963 from 5 % to now 19 % of US children affected in 2018. MASLD, is the most common liver disease seen in children, can be a precursor to the development of Type 2 Diabetes (T2DM) and is the primary reason for liver transplant listing in young adults. We must be vigilant in prevention and treatment of MASLD in childhood to prevent further progression.

Methods

This joint clinical perspective is based upon scientific evidence, peer and clinical expertise. The medical literature was reviewed via PubMed search and appropriate articles were included in this review. This work was formulated from the collaboration of eight hepatologists/gastroenterologists with MASLD expertise and two physicians from the OMA.

Results

The authors who are experts in the field, determined sentinel questions often asked by clinicians regarding MASLD in children with obesity. They created a consensus and clinical guideline for clinicians on the screening, diagnosis, and treatment of MASLD associated with obesity in children.

Conclusions

Obesity and the comorbidity of MASLD is increasing in children, and this is a medical problem that needs to be addressed urgently. It is well known that children with metabolic associated chronic disease often continue to have these chronic diseases as adults, which leads to reduced life expectancy, quality of life, and increasing healthcare needs and financial burden. The authors of this paper recommend healthy weight reduction not only through lifestyle modification but through obesity pharmacotherapy and bariatric surgery. Therefore, this guidance reviews available therapies to achieve healthy weight reduction and reverse MASLD to prevent progressive liver fibrosis, and metabolic disease.

Early prescription of SGLT2i for acute patient care: from current evidence to future directions

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as transformative therapies in the management of chronic heart failure (HF), offering substantial reductions in mortality and hospitalizations. Beyond their initial classification as diuretics, SGLT2i exert a spectrum of cardioprotective effects that extend far beyond renal modulation. By activating autophagic pathways and mimicking a starvation-like state, SGLT2i enhance cellular bioenergetics and mitigate acute injury, potentially underpinning both their immediate and sustained cardiometabolic benefits when administered early in acute care settings. In acute decompensated HF, early initiation of SGLT2i enhances clinical decongestion by increasing diuresis, improving diuretic efficiency, and mitigating diuretic resistance, translating to shorter hospitalizations and reduced readmissions and mortality. In acute myocardial infarction, SGLT2i reduce the incidence of first and total HF hospitalizations, arrhythmic events, adverse cardiac remodelling, and contrast-induced acute kidney injury, while mitigating stent failure and atherosclerotic progression. Furthermore, they demonstrated efficacy in preventing new-onset and recurrent supraventricular and ventricular arrhythmias. However, the evidence remains inconclusive regarding their impact on sudden cardiac death or outcomes following cardiac arrest. In critically ill patients, SGLT2i use is associated with reduced rates of acute kidney injury and the need for renal replacement therapy, with promising implications for the management of sepsis and multi-organ dysfunction. Importantly, adverse effects such as renal impairment, electrolyte disturbances, acid-base imbalances, urinary tract infections, and dysglycemia appear infrequently in this population. This narrative review synthesizes the underlying pathophysiological mechanisms, current clinical evidence, and potential future applications of early SGLT2i therapy in acute care settings, providing insights into their expanding role in contemporary cardiovascular medicine.

Unraveling the mechanisms of Shaoyang Shenggu decoction in treating knee osteoarthritis through mass spectrometry and bioinformatics

ETHNOPHARMACOLOGICAL RELEVANCE

KOA is a common chronic joint disease in orthopedics that leads to pain, stiffness, and functional limitations. Traditional Chinese medicine categorizes it under "bi syndrome," "wei syndrome," and "bone bi.".The theory that "Shaoyang governs the bones"is first recorded in the "Huangdi Neijing."Shaoyang Shenggu Fang has demonstrated favorable efficacy in repairing cartilage injury.

OBJECTIVE

To identify the active components of Shaoyang Shenggu Fang (SYSGF) and elucidate their mechanisms in the treatment of knee osteoarthritis (KOA) through mass spectrometry data combined with network pharmacology, bioinformatics, and single-cell analysis, and to perform preliminary validation of the results using clinical samples and animal experiments.

METHODS

The primary compounds in SYSGF were detected using UPLC-Q-TOF. Network pharmacology and bioinformatics analyses were employed to explore the mechanisms of SYSGF in KOA, identifying core targets and key pathways. Clinical samples were utilized to validate the expression levels of core genes during the KOA process. Micro-CT and pathological staining were conducted to assess the effects of SYSGF on cartilage degeneration in KOA animal models. WB and PCR were performed to confirm the expression levels of core genes and key pathways before and after treatment. Finally, single-cell analysis was conducted to further investigate the relationship between core genes and chondrocyte subpopulations.

RESULTS

A total of 46 active compounds from SYSGF were identified, and bioinformatics analyses determined five core targets (CYP1B1, VEGFA, NR4A1, BMP1, and FAP) and three key pathways (MAPK signaling pathway, HIF-1 signaling pathway, and PI3K-Akt signaling pathway). Validation with clinical samples revealed a significant increase in the expression levels of CYP1B1, NR4A1, and FAP in degenerated cartilage, while the expression levels of VEGFA and BMP1 were found to be decreased. Micro-CT and pathological staining revealed that SYSGF effectively alleviated cartilage damage caused by monosodium iodoacetate (MIA). Furthermore, SYSGF was found to inhibit the expression of CYP1B1, NR4A1, and FAP, while upregulating the expression of VEGFA and BMP1, thereby alleviating the progression of KOA and correlating with the MAPK signaling pathway, HIF-1 signaling pathway, and PI3K-Akt signaling pathway. Finally, we observed that the occurrence of KOA is closely related to the infiltration of various chondrocyte subtypes and immune regulation, with FCs, PreHTCs, and ProCs being the primary chondrocyte subtypes involved. CYP1B1, VEGFA, NR4A1, BMP1, and FAP play significant roles in chondrocyte phenotype transformation and inflammation.

CONCLUSION

SYSGF may inhibit chondrocyte phenotype transformation and inflammation to improve KOA by regulating these key proteins, and is associated with the MAPK signaling pathway, HIF-1 signaling pathway, and PI3K-Akt signaling pathway.

Core GRADE 6: presenting the evidence in summary of findings tables

This sixth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to summary of findings tables. These tables provide essential information about the effects of interventions on patient important outcomes, including relative and absolute effects, certainty of evidence, and a plain language summary. For binary outcomes calculating absolute effects requires applying relative risk estimates to baseline risks from studies representative of the target population. For groups of patients with very different baseline risks, summary of findings tables include separate rows with different estimates of absolute effects. For continuous outcomes, challenges arise when individual studies use different instruments to measure patient reported outcomes. Facilitating interpretation then requires providing details about units of measurement and minimally important differences.

Asymmetric Dimethylarginine: A Never-Aging Story

Human aging is intrinsically associated with the onset and the progression of several disease states causing significant disability and poor quality of life. Although such association was traditionally considered immutable, recent advances have led to a better understanding of several critical biochemical pathways involved in the aging process. This, in turn, has stimulated a significant body of research to investigate whether reprogramming these pathways could delay the progression of human ageing and/or prevent relevant disease states, ultimately favoring healthier aging process. Cellular senescence is regarded as the principal causative factor implicated in biological and pathophysiological processes involved in aging. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and an independent risk factor for several age-associated diseases. The selective extracorporeal removal of ADMA is emerging as a promising strategy to reduce the burden of age-associated disease states. This article discusses the current knowledge regarding the critical pathways involved in human aging and associated diseases and the possible role of ADMA as a target for therapies leading to healthier aging processes.

Integrating bioinformatics and machine learning to identify biomarkers of branched chain amino acid related genes in osteoarthritis

BACKGROUND

Branched-chain amino acids (BCAA) metabolism is significantly associated with osteoarthritis (OA), but the specific mechanism of BCAA related genes (BCAA-RGs) in OA is still unclear. Therefore, this research intended to identify potential biomarkers and mechanisms of action of BCAA-RGs in OA tissues.

METHODS

Differential genes were obtained from the Gene Expression Omnibus (GEO) database and intersections were taken with BCAA-RGs to identify candidate genes. The underlying mechanisms were revealed using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Subsequently, by combining three machine learning algorithms to identify genes with highly correlated OA features. In addition, created diagnostic maps and subject Receiver operating characteristic curves (ROCs) to assess the ability of the signature genes to diagnose OA and to predict their possible roles in molecular regulatory network axes and molecular signaling pathways.

RESULTS

Eight candidate genes were acquired by intersecting 4,178 DEGs and 14 BCAA-RGs. Subsequently, five candidate biomarkers were obtained, namely SLC3A2, SLC7A5, SLC43A2, SLC43A1, and SLC7A7. Importantly, SLC3A2 and SLC7A5 were validated by validation set and qRT-PCR. Furthermore, the nomogram constructed by SLC3A2 and SLC7A5 exhibited excellent accuracy in predicting the incidence of OA. The enrichment results demonstrated that SLC3A2 and SLC7A5 were significantly enriched in ribosome, insulin signaling pathway, olfactory transduction, etc. Meanwhile, we also found XIST regulated SLC7A5 through hsa-miR-30e-5p, and regulated SLC3A2 through hsa-miR-7-5p.OIP5-AS1 regulated SLC7A5 and SLC3A2 through hsa-miR-7-5p. By the way, 150 drugs were identified, including Acetaminophen and Acrylamide, which exhibited simultaneous targeting of these two biomarkers.

CONCLUSION

Based on bioinformatics, SLC3A2 and SLC7A5 were identified as biomarkers related to BCAA in OA, which may provide a new reference for the treatment and diagnosis of OA patients.

Pharmacology; ii. Cardiovascular Disease and iii. Systematic Review and Meta-analysis. Effectiveness and safety of chronic diuretic use in older adults: an umbrella review of recently published systematic reviews and meta-analyses of randomized-controlled trials

BACKGROUND

Healthcare providers should balance the potential risks and benefits of chronic diuretic use, particularly in older adults, as with age, diuretic benefits may decline and risks increase. A comprehensive synthesis and critical evaluation of the available evidence on chronic diuretic treatment effects is currently lacking.

METHODS

We conducted an umbrella review of systematic reviews and meta-analyses published since 2018 on health outcomes associated with diuretic use in randomized-controlled trials (RCTs). We conducted random-effects meta-analysis for pooled effect estimates and narratively summarized data that could not be pooled.

RESULTS

We included 741 effect estimations from 117 systematic reviews (SRs) on 1566 RCTs in individuals aged 62 ± 6 years. Of our 33 meta-analyses, 11 provided convincing, high-quality evidence: finerenone reduced the risk of cardiovascular (CV) mortality and end-stage kidney disease in individuals with chronic kidney disease (CKD) and/or type 2 diabetes (T2D). Torasemide reduced the risk of heart failure-related hospitalization (HFH) more than furosemide in individuals with HF. Thiazides reduced CV events in individuals with hypertension. Mineralocorticoid receptor antagonists (MRAs) reduced HFH, but also increased hyperkalemia risk in individuals with HF. MRAs also reduced the risk of atrial fibrillation in those with HF or CVD, and reduced HFH, major adverse cardiovascular events (MACEs), > 40% eGFR decrease, and composite kidney outcomes in individuals with CKD and/or T2D. Lower quality evidence suggests that in older (≥ 65 years), but not in younger adults, diuretics may reduce CV mortality, but also increase adverse event (AE) risk.

CONCLUSIONS

Our umbrella review offers a comprehensive and up-to-date evaluation of the benefits and harms of diuretics. However, further research is needed to establish their efficacy and safety in populations commonly seen in clinical practice, especially older adults living with multimorbidity and frailty.

Effect of SGLT2 inhibitors on inflammatory markers and oxygen consumption in non-diabetic patients with STEMI undergoing primary PCI: A parallel design single blind controlled trial

BACKGROUND

The sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated potential benefits, including anti-inflammatory effects, reverse left ventricular remodeling, improved myocardial fibrosis, and enhanced microcirculation. However, the potential of these drugs to improve cardiac remodeling and function in non-diabetic patients without heart failure remains unclear.

OBJECTIVE

This study aims to evaluate the impact of the SGLT2 inhibitor (empagliflozin) on inflammatory markers and maximum oxygen consumption (VO2 max) in non-diabetic patients experiencing acute ST-segment elevation myocardial infarction (STEMI) and undergoing percutaneous coronary intervention (PCI).

METHODS

The expression levels of tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), high-sensitivity C-reactive protein (hs-CRP), and VO2 max were measured and compared before and after surgery in both groups.

RESULTS

Baseline levels of TNF-α, IL-10, and hs-CRP did not differ significantly between the two groups prior to treatment. One month post-treatment, both groups demonstrated reductions in TNF-α and hs-CRP levels relative to preoperative values, with the experimental group showing significantly lower levels of TNF-α and hs-CRP compared to the control group (P < 0.05). Additionally, the VO2 max values measured one week post-surgery revealed a statistically significant difference between the two groups (t = 2.4, P = 0.03).

CONCLUSION

Empagliflozin administration in non-diabetic patients with STEMI undergoing emergency PCI may effectively reduce inflammatory markers and improve oxygen consumption capacity. These findings suggest a potential cardioprotective role for empagliflozin in this patient population.

An evaluation of recaticimab for the treatment of hypercholesterolemia

INTRODUCTION

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, by preventing the degradation of LDL receptors, either through interference in the binding of PCSK9 to LDL receptors or through silencing of PCSK9 at a molecular level, have revolutionized lipid-lowering treatment and offer the opportunity to further improve clinical outcomes for patients with hypercholesterolemia.

AREAS COVERED

We discuss the role of PCSK9 as a therapeutic target for hypercholesterolemia, describe the pharmacodynamics, pharmacokinetics, and metabolism of recaticimab, and report the recent clinical trials with this 'humanized' IgG1 monoclonal antibody (mAb) against PCSK9.

EXPERT OPINION

Recaticimab has a high affinity for PCSK9 that confers a prolonged duration of action. Recaticimab durably decreases LDL-cholesterol, non-HDL-cholesterol and apoB, but can also lower Lp(a). Recaticimab may offer advantages over current mAbs in clinical use in terms of its long half-life, dosing interval of up to 12 weeks, and potentially a lower cost; however, long-term concerns regarding immunogenicity remain. Longer-term studies in a variety of more diverse patient cohorts will be needed to further evaluate the efficacy, safety, and durability of recaticimab and to ascertain the optimal dosing schedule for cardiovascular outcome studies.

Knowledge, Attitude, and Practice Toward Hyperuricemia Among Patients Diagnosed with Hyperuricemia

Objective

To investigate the knowledge, attitude, and practice (KAP) of patients diagnosed with hyperuricemia toward hyperuricemia.

Methods

This cross-sectional study enrolled patients with hyperuricemia who sought medical care at Taikang Xianlin Drum Tower Hospital between September 15, 2023, and January 11, 2024. A self-administered questionnaire was developed to collect participants' socio-demographic information and KAP scores regarding hyperuricemia. The threshold for sufficient knowledge, positive attitude, and proactive practice was ≥ 70.0% of the total score.

Results

This study included 483 non-problematic valid questionnaires, with a mean age of 41.83±14.13 years. The mean knowledge, attitude, and practice scores were 14.65±3.23 (66.59% of the possible maximum of 22), 40.89±4.32 (74.35% of the possible maximum of 55), and 25.66±4.54 (73.31% of the possible maximum of 35). A master's degree or above education (OR=2.555, 95%CU: 1.059-6.164, P=0.037), an income of 10,000-20,000 CNY (OR=2.216, 95% CI: 1.157-4.244, P=0.016), an income of >20,000 CNY (OR=2.237, 95% CI: 1.091-4.586, P=0.028), last uric acid test within the past year (OR=0.583, 95% CI: 0.341-0.997, P=0.049), and not taking uric acid-lowering medication (OR=0.326, 95% CI: 0.204-0.520, P<0.001) were independently associated with knowledge. The knowledge scores (OR=1.181, 95% CI: 1.100-1.269, P<0.001), attitude scores (OR=1.122, 95% CI: 1.063-1.184, P<0.001), age (OR=1.023, 95% CI: 1.005-1.041, P=0.011), current drinker (OR=0.489, 95% CI: 0.301-0.792, P=0.004), last uric acid test within 1 year (OR=0.488, 95% CI: 0.266-0.894, P=0.020), last uric acid test over 1 year ago (OR=0.297, 95% CI: 0.151-0.585, P<0.001), and high uric acid levels at the last test (OR=0.542, 95% CI: 0.299-0.980, P=0.043) were independently associated with practice. The structured equation model showed that knowledge positively influenced attitude (β=0.676, P<0.001) and practice (β=0.494, P=0.002). Attitude positively influenced practice (β=0.624, P<0.001).

Conclusion

Patients with hyperuricemia have insufficient knowledge but a positive attitude and proactive practice toward hyperuricemia. Educational and motivational interventions should be designed to improve practice.

Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram

The medical needs of obesity have been underrecognized, though it has posed long-term and enormous challenges to global health. Correspondingly, clinical services for obesity are still uncommon and in their infancy across health systems. It is meaningful to sort out the implementation of such clinical services involving a multiplicity of factors to identify measures for service development, scaling-up and optimization. This study aims to generate a comprehensive understanding of key variables and factors in the utilization and delivery of clinical services for adult patients with obesity and their dynamic patterns and to explore viable options for improved implementation of such services in health systems. We conducted a scoping review of published articles in the database from the lens of system dynamics through causal loop diagramming. Based on the data obtained from the review, we employed the causal loop diagramming as a tool to capture the variables in the implementation of clinical obesity services and their causal relationships. Twenty-one studies were finally included in the review. Based on the evidence consolidated through the review, we developed a causal loop diagram containing 19 causal variables and 38 causal arrows in single directions centered around the service utilization and delivery in the clinical obesity service. The feedback loops revealed potential activation points to intervene to facilitate the service implementation, such as, promotion of obesity as a disease with medical needs and available clinical services, provision of obesity-specific medical education and training opportunities, and prioritization of obesity-specific procedures in clinical protocols. The possible intervention points identified through the causal loop analysis can facilitate the development, implementation, and optimization of clinical obesity services in health systems.

Metformin for covid-19: systematic review and meta-analysis of randomised controlled trials

Objective

To summarise the effects of metformin on covid-19 to inform a World Health Organization (WHO) clinical practice guideline.

Design

Systematic review and meta-analysis.

Data sources

As part of a living systematic review and network meta-analysis of drug treatments for covid-19 (covid-19 LNMA), a search was performed of the WHO covid-19 database, six Chinese databases, and the Epistemonikos Foundation's Living Overview of the Evidence covid-19 Repository (covid-19 L-OVE).

Eligibility criteria for selecting studies

Randomised controlled trials that compared metformin with placebo in patients with acute covid-19 infection.

Data synthesis

Frequentist pairwise meta-analyses were performed using the restricted maximum likelihood random effects model. The effects of interventions on selected outcomes were summarised using risk ratios, risk difference, and mean difference when appropriate, along with their corresponding 95% confidence intervals (CIs). To estimate absolute effects, the control arm event rate was used as the baseline risk. The risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool and the certainty of evidence using the GRADE (grading of recommendations assessment, development and evaluation) approach, with the minimally important difference in effect as the threshold.

Results

Three randomised controlled trials of 1869 patients were included; one study provided long term follow-up on long covid. Metformin might have little or no impact on mortality (risk ratio 0.76, 95% CI 0.30 to 1.90; risk difference 3 fewer per 1000, 95% CI 8 fewer to 11 more; low certainty). The effects of metformin on admission to hospital because of covid-19 remain uncertain (risk ratio 0.74, 95% CI 0.28 to 1.95; risk difference 15 fewer per 1000, 95% CI 42 fewer to 55 more; very low certainty). Metformin results in little or no difference in adverse effects leading to discontinuation (risk difference 0.2 more per 1000, 95% CI 2.7 fewer to 3.1 more; high certainty). Metformin might decrease the development of long covid (risk ratio 0.6, 95% CI 0.4 to 0.9; risk difference 41 fewer per 1000, 95% CI 62 fewer to 10 fewer; low certainty). However, the effect is based on a single trial of 1126 patients, which has a high risk of bias owing to missing data, and nearly half of the participants were unvaccinated.

Conclusions

Current evidence based on randomised trials suggests no significant effect of metformin on acute clinical outcomes in patients with non-severe covid-19. Metformin might reduce the incidence of long covid when used to treat patients with non-severe acute covid-19 infection, but this was suggested by low certainty evidence from a single trial.

Long-term outcomes following alternative second-line oral glucose-lowering treatments: Results from the real-world progression in type 2 diabetes mellitus United Kingdom (RAPIDS-UK) model

AIMS

To compare long-term complications for people with type 2 diabetes mellitus (T2DM) following second-line treatment in routine practice with sulphonylureas (SU), dipeptidyl peptidase-4 inhibitors (DPP4i), or sodium-glucose co-transporter-2 inhibitors (SGLT2i) added to metformin.

MATERIALS AND METHODS

We used the RAPIDS microsimulation model to predict diabetes complications over 5 years after second-line treatment initiation. We combined information on 'real-world' treatment duration in England from the Clinical Practice Research Datalink with evidence on treatment effectiveness from Randomised Controlled Trials (RCTs). We estimated between-treatment differences in the probabilities of end-stage kidney disease (ESKD), heart failure hospitalisation (HF), diabetic eye disease, myocardial infarction (MI), and lower-extremity amputation (LEA).

RESULTS

The predicted probabilities of complications within 5 years were lower following second-line treatment with SGLT2i compared to SU and DPP4i. The mean (95% CI) difference (reduction) in the predicted probability of ESKD following SGLT2i versus SU was -0.81% (-0.89, -0.73), and for SGLT2i versus DPP4i the corresponding difference was -0.87% (-0.95, -0.79). The reduction in the probability of HF following SGLT2i versus SU was -0.90% (-1.01, -0.80), and for SGLT2i versus DPP4i it was -0.95% (-1.06, -0.84). The corresponding differences in the probabilities of diabetic eye disease following SGLT2i versus SU were -1.41% (-1.57, -1.26), and for SGLT2i versus DPP4i was -0.44% (-0.59, -0.29). The predicted probabilities of LEA were similar across treatments. Pre-existing CVD did not modify the predicted probabilities of complications.

CONCLUSIONS

For a general T2DM population, second-line treatment with SGLT2i rather than SU or DPP4i can reduce the probability of complications within 5 years.

Impact of HbA1c variability and time-in-range fluctuations on large and small nerve fiber dysfunction in well-controlled type 2 diabetes: A prospective cohort observational study

AIMS/INTRODUCTION

Glycemic variability (GV) is a critical factor in the development of diabetic sensorimotor polyneuropathy (DSPN). This study aimed to evaluate the association of long-term GV, measured by glycated hemoglobin (HbA1c) average real variability (ARV), and short-term GV, assessed by time-in-range (TIR) ARV, with large and small nerve fiber dysfunction in individuals with well-controlled Type 2 Diabetes (T2D).

MATERIALS AND METHODS

A prospective study conducted at a tertiary hospital in Taiwan included 82 T2D participants. Long-term GV was assessed using HbA1c ARV from visit-to-visit measurements at three-month intervals over 1 year. Short-term GV was evaluated as TIR ARV from seven-day fingerstick data collected quarterly. Large and small nerve functions were assessed using the Toronto Clinical Neuropathy Score (TCNS), nerve conduction studies, quantitative thermal testing, and Sudoscan.

RESULTS

Linear regression analysis adjusted for age, diabetes duration, and renal function revealed strong correlations between HbA1c ARV, TIR ARV, and diabetes duration. At baseline, high HbA1c ARV and TIR ARV groups exhibited higher TCNS and composite nerve conduction amplitude scores but lower cold detection thresholds compared to the low median groups. At one-year follow-up, TCNS significantly increased in the high HbA1c ARV (P = 0.001) and TIR ARV (P = 0.003) groups compared to the low median groups.

CONCLUSIONS

Both long-term and short-term GV significantly contribute to small and large nerve fiber dysfunction in T2D, yielding similar neurological outcomes despite stable mean glucose levels. Combining GV minimization strategies with standard glycemic control may be essential in reducing DSPN risk.

Phospholipids and their metabolites as diagnostic biomarkers of human diseases

Phospholipids that occur predominantly in the plasma membrane of mammalian cells are phosphatidylcholine (PC), phosphatidylserine (PS), phosphatidylethanolamine (PE), sphingomyelin (SM), and phosphatidylinositol (or phosphoinositide; PI). These membrane phospholipids are a promising source of disease-related biomarkers. Phospholipids and their metabolites are altered by the type of disease or disease progression. Metabolomics has shown that increased or decreased levels of altered phospholipids and their metabolites can be useful indicators for the diagnosis of various human diseases. In this review, we discuss the utility of the five major membrane phospholipids (PC, PS, PE, and SM, and PI) and their metabolites as diagnostic biomarkers of human diseases.

Sarcopenia: an Aging Perspective and Management Options

There is no doubt that sarcopenia is one of the most defining characteristics of aging that negatively impacts the people's health and quality of life. The condition is characterized by the progressive and generalized loss of muscle mass and strength, affecting physical performance. It is part of aging but can be exacerbated by pathophysiological conditions like cancer and several factors such as a sedentary lifestyle, poor nutrition, chronic diseases, falls and immobilization. Numerous cellular mechanisms have been implicated in its pathogenesis, including hormonal changes, mitochondrial dysfunctions, altered apoptotic and autophagic signaling, muscle fiber composition, and inflammatory pathways. To prevent sarcopenia, exercise is one of the most effective strategies as it has a strong influence on both anabolic and catabolic muscle pathways and helps improve skeletal muscle function. A well-rounded, multicomponent exercise program that targets muscle strength, aerobic capacity, and balance is recommended for optimal results. While nutrition is essential for muscle maintenance, relying solely on dietary interventions is unlikely to fully address sarcopenia. Therefore, a combination of adequate nutrition and regular exercise is recommended to promote muscle health and function. The purpose of this study is to review sarcopenia from an aging viewpoint and discuss the role of exercise and nutrition as prevention and management options.

Therapeutic Management of LDL-C: Efficacy and Economic Impact Assessment

Cardiovascular disease (CVD) is one of the largest global disease burdens. Despite guidelines and recommendations and the proven advantages of lipid-lowering therapies (LLTs) in preventing CVD, achieving treatment targets remains disappointing. A key barrier to optimal LLT is therapy discontinuation. To be widely adopted in clinical practice, new lipid-lowering therapies must both prevent major adverse cardiovascular events (MACEs) and exhibit cost effectiveness to ensure widespread utilization by patients, physicians, and insurers. While non-statin LLTs have shown cardiovascular value, their cost effectiveness is controversial. This review highlights the LLTs that are currently widely adopted and summarizes the available evidence on their cost effectiveness.

Global Trends in Childhood Acute Lymphoblastic Leukemia Burden and Quality of Care Inequalities Across Regions, 1990 to 2021: A Systematic Analysis Using Global Burden of Disease Study 2021 Data

OBJECTIVE

To reveal the global trends in the burden and quality of care for childhood ALL from 1990 to 2021, along with inequalities in quality of care across regions, thus identifying regions requiring targeted interventions for optimizing health care resource allocation.

METHODS

Utilizing Global Burden of Disease Study 2021 data, this research analyzed the temporal trends in the global burden of childhood ALL from 1990 to 2021. The quality of care index (QCI) was used to quantify care quality, and the gender disparity ratio (GDR) was used to assess gender disparities. Trend analyses were conducted using the estimated annual percentage change (EAPC), and the associations between QCI, GDR, and the sociodemographic index (SDI) were explored. Inequalities in QCI and GDR across regions were evaluated using the slope index of inequality (SII) and health inequality concentration index.

RESULTS

From 1990 to 2021, the incidence and death rates, as well as disability-adjusted life years (DALYs) and years of life lost (YLLs) due to childhood ALL, significantly decreased. However, the number of prevalence and prevalence crude rate increased by 66.818% and 37.923%, respectively. Global care quality continued to improve, with an EAPC of 2.566 (95% CI: 2.488-2.645). In 2021, regions with high QCI were concentrated in high-income areas like Western Europe, while low QCI regions were primarily in low-income areas like sub-Saharan Africa and Oceania. Although the health inequality concentration index of global quality of care decreased from 0.550 in 1990 to 0.395 in 2021, the SII increased from 35.396 to 87.141. Care quality was consistently higher in females than in males, particularly in low and low-middle SDI regions, while the disparities in high and middle SDI regions were gradually narrowing.

CONCLUSION

Despite the gradual decrease in the burden of childhood ALL globally and the steady improvement in quality of care, absolute inequalities remain a significant challenge. Future efforts should focus on increasing health care resource allocation in low SDI regions, enhancing international cooperation, improving the quality and accessibility of care in priority regions, and promoting global health equity.

Stress hyperglycemia ratio linked to all-cause mortality in critically ill patients with ischemic heart disease

BACKGROUND

The stress hyperglycaemia ratio (SHR), a quantitative indicator of hyperglycaemia in stress, has been shown to correlate with poor disease prognosis. However, the relationship between SHR and short-term prognosis in critically ill patients with ischemic heart disease (IHD) remains unclear.

METHODS

This retrospective study analyzed data of 2559 critically ill patients with IHD from the Medical Information Mart for Intensive Care III database. Endpoints were in-hospital mortality and intensive care unit (ICU) mortality. Kaplan-Meier survival curves, Cox proportional hazards models, restricted cubic spline, subgroup analysis, and receiver operating characteristic curves were used to explore the association between SHR and mortality in critically ill patients with IHD.

RESULTS

A total of 99 (3.87%) in-hospital deaths and 62 (2.42%) ICU deaths were recorded. In multivariate Cox proportional hazards models, higher SHR was independently associated with in-hospital mortality (hazard ratio (HR): 1.93 [95% confidence interval (CI): 1.42-2.61], P-value < 0.0001) and ICU mortality (HR, 1.70; 95% CI, 1.17-2.47; P-value = 0.01). Restricted cubic splines showed that SHR was linearly positive correlated with both in-hospital mortality and ICU mortality. Subgroup analysis revealed the robustness of the results. The area under the curve of SHR for predicting in-hospital mortality and ICU mortality was 0.715 and 0.711, respectively.

CONCLUSION

SHR was significantly positively correlated with in-hospital mortality and ICU mortality in patients with critical IHD. It might enhance the predictive accuracy of existing clinical disease scores and guide personalized blood glucose control.

Glucagon-like peptide-1: a new potential regulator for mesenchymal stem cells in the treatment of type 2 diabetes mellitus and its complication

Glucagon-like peptide-1 is an enteric proinsulin hormone secreted by intestinal L-cells that orchestrates insulin secretion in a glucose-dependent manner. Renowned for preserving pancreatic β-cell mass, glucagon-like peptide-1 facilitates β-cell proliferation and inhibits apoptosis, while concurrently suppressing glucagon secretion from pancreatic α-cells, thereby exerting hypoglycemic effects.Recent in vitro and in vivo studies have clarified the benefits of combination therapy with glucagon-like peptide-1 and stem cells in Type 2 diabetes mellitus. Glucagon-like peptide-1 enhances the repair of type 2 diabetes mellitus-afflicted tissues and organs by modulating sourced mesenchymal stem cell differentiation, proliferation, apoptosis, and migration. Importantly, glucagon-like peptide-1 overcomes the detrimental effects of the diabetic microenvironment on transplanted mesenchymal stem cells by increasing the number of localized cells in stem cell therapy and the unstable efficacy of stem cell therapy.This review elucidates the molecular and cellular mechanisms through which glucagon-like peptide-1 regulates mesenchymal stem cells in the type 2 diabetes mellitus context and discuss its therapeutic prospects for type 2 diabetes mellitus and its associated complications, proposing a novel and comprehensive treatment paradigm.

Obesity medications in patients with recurrent weight gain or suboptimal clinical response following bariatric surgery: a meta-analysis

BACKGROUND

Postoperative recurrent weight gain or suboptimal clinical response are important concerns; however, there is no consensus regarding the use of pharmacotherapy to manage weight after bariatric surgery. Hence, it is reasonable to combine the available data to provide a practical guideline for clinicians about the administration of obesity medications for patients with recurrent weight gain or suboptimal clinical response after bariatric surgery.

METHODS

We conducted a search of electronic databases, including Scopus, PubMed/Medline, and the Web of Science, up to December 2024. The eligible studies included randomized controlled trials or retrospective studies that assessed the effects of obesity medications on weight, body mass index (BMI), or percentage total weight loss (%TWL) in patients experiencing recurrent weight gain or a suboptimal clinical response following bariatric surgery.

RESULTS

This meta-analysis reviewed 26 relevant studies and demonstrated that glucagon-like peptide-1 (GLP-1) receptor agonists reduced weight by 8.38 kg (95% CI: -9.68 to -7.08) and BMI by 3.76 kg/m² (95% CI: -4.50 to -3.01). The overall %TWL was 9.94% (95% CI: 8.34 to 11.53). After subgroup analysis, we found that the effect of semaglutide on %TWL was significantly greater than that of liraglutide. In terms of non-GLP-1 receptor agonists, patients achieved a weight loss of 2.97 kg (95% CI: -4.00 to -1.95), a BMI loss of 1.41 kg/m² (95% CI: -2.28 to -0.53), and a % TWL of 4.50% (95% CI: 2.86 to 6.15). The subgroup analysis suggested that combination therapy had more pronounced effects on outcomes than monotherapy.

CONCLUSION

Our results indicated that obesity medications may be an effective adjunctive therapy to maintain weight loss post-bariatric surgery.

Prevalence of and risk factors for important comorbidities of systemic lupus erythematosus using data from a multicenter Chinese cohort registry: A cross-sectional study

OBJECTIVES

Patients with systemic lupus erythematosus (SLE) are at high risk of cardiovascular disease (CVD), fragility fractures, and malignancies. However, data regarding these comorbidities among Chinese SLE patients are limited. We aimed to determine the prevalence of and risk factors for these three major comorbidities in a large cohort of Chinese SLE patients.

METHODS

In this cross-sectional study, demographic, clinical, and common comorbidity profiles were obtained from the medical records of SLE patients enrolled in the Chinese SLE Treatment and Research group (CSTAR) registry. Univariate and multivariate logistic regression analyses were performed to identify possible risk factors related to these comorbidities.

RESULTS

A total of 38,105 SLE patients were included (92.2% women). The median age at registration was 34.0 years (interquartile range, 27.0-46.0 years). The prevalence rates of the three important comorbidities at baseline were as follows: CVD, 1.9% (95% confidence interval [CI]: 1.8-2.0%); fragility fractures, 0.7% (95% CI: 0.6-0.8%); and malignancies, 0.7% (95% CI: 0.6-0.8%). In the multivariable-adjusted model, lupus anticoagulant, anticardiolipin antibody, anti-β2GP1 antibody, neuropsychiatric involvement, and hematological involvement were positively associated with CVD in SLE patients. Mucocutaneous manifestations, hyperimmunoglobulinemia, hypocomplementemia, anti-dsDNA, anti-Sm, and anti-nRNP/U1RNP antibody, and hydroxychloroquine therapy were negatively associated with CVD. The multivariate analysis revealed that age older than 50 years and hypocomplementemia were associated with fragility fractures and malignancies.

CONCLUSION

CVD, fragility fractures, and malignancies commonly occur in SLE patients. Patients with traditional and SLE-related factors should be more carefully monitored for these important comorbidities. Key Points • SLE patients have an increased risk of cardiovascular disease, fragility fractures, and malignancy. However, data regarding these comorbidities among Chinese SLE patients are limited. • Several associated risk factors for these three comorbidities of SLE were identified.Characteristics, symptom severity, and QOL differ in different age groups. • Lupus patients with traditional and SLE-related factors should be more carefully monitored for the presence of these comorbidities.

Diagnostic and prognostic roles of endothelial- and platelet-derived extracellular vesicles in cardiovascular diseases

Extracellular vesicles (EVs) are membrane-bound structures released by all cell types. They play a critical role in intercellular communication by transferring their cargo, comprising proteins, lipids, metabolites, RNAs, miRNAs, and DNA fragments, to recipient cells. This transfer influences gene expression, signaling pathways, and cellular behavior. Due to their ability to alter the physiology of recipient cells, EVs hold significant therapeutic potential. Additionally, EVs are implicated in various physiological and pathological processes, including immune regulation, cancer progression, and cardiovascular diseases. EVs have been detected in many biological fluids, such as peripheral blood, saliva, urine, cerebrospinal fluid, and breast milk. The cargo of EVs dynamically reflects the physiological and pathological state of their parent cells, making them promising candidates for liquid biopsies in various clinical conditions. Specifically, different EV subtypes in cardiovascular diseases have been studied, with both endothelial and platelet-derived EVs playing significant roles in cardiovascular pathologies. This review focuses on the diagnostic and prognostic potential of endothelial and platelet-derived EVs in cardiovascular diseases, highlighting the role of EV subpopulations.

Sodium-Glucose Cotransporter-2 Inhibitors in Liver Cirrhosis: A Systematic Review of Their Role in Ascites Management, Slowing Disease Progression, and Safety

Sodium-glucose cotransporter-2 inhibitors (SGLT2Is) are widely used for type 2 diabetes mellitus (T2DM), conferring cardiovascular and renal benefits with evidence supporting their role in metabolic-associated steatotic liver disease (MASLD), the fastest rising etiology for liver cirrhosis. Our study collects and synthesizes all available data on SGLT2I use in liver cirrhosis to summarize their potential benefits and risks. We systematically reviewed the literature on SGLT2I use in adults with cirrhosis, focusing on 6 outcome domains, including ascites reduction, disease progression, hemodynamics, acute kidney injury (AKI), electrolyte abnormalities, and infection risk. We identified 16 studies: compensated (n = 5), decompensated (n = 3), and refractory ascites (n = 8). All studies of decompensated cirrhosis (n = 11) reported ascites reduction. Most studies (7 of 9) indicated SGLT2Is slowed disease progression by reducing clinical decompensation (n = 4) or improving laboratory markers (n = 3). A minority of studies revealed safety concerns with 2 of 9 studies showing evidence of hemodynamic instability and acute kidney injury (AKI), 2 out of 13 for electrolyte abnormalities, and 2 out of 5 for infection risk. Current evidence strongly supports SGLT2Is for refractory ascites management and suggests potential benefits in slowing progression across cirrhosis severities. Longer-term prospective trials in patients with non-refractory decompensated cirrhosis and real-world safety data are essential to clarify and potentially expand the role of SGLT2Is in cirrhosis management.

Incidence, prevalence, and burden of type 2 diabetes in China: Trend and projection from 1990 to 2050

BACKGROUND

Type 2 diabetes is common in China without comprehensive summary and future anticipation of its incidence, prevalence, associated death, and disability. This analysis described the epidemiological transition of type 2 diabetes in the past three decades and projected the trend in the future three decades in China.

METHODS

Age-, sex-, and year-specific incidence, prevalence, death, and disability-adjusted life years (DALYs) for people with 15 years or older and diabetes or high fasting glucose in China and related countries from 1990 to 2021 were obtained from the Global Burden of Disease. We obtained the trends of age-, sex-, and year-specific rates and absolute numbers of incidence, prevalence, deaths, and DALYs attributable to type 2 diabetes in China from 1990 to 2021. Using the Lee-Carter model, we projected the incidence, prevalence, deaths, and DALYs attributable to type 2 diabetes to 2050 stratified by age and sex.

RESULTS

The age-standardized incidence of type 2 diabetes was 341.5 per 100,000 persons (1.6 times in 1990) and the age-standardized prevalence was 9960.0 per 100,000 persons (2.5 times in 1990) in China 2021. In 2021, there were 0.9 million deaths and 26.8 million DALYs due to type 2 diabetes or hyperglycemia, as 2.9 and 2.7 times the data in 1990, respectively. In the projection, the age-standardized incidence (449.5 per 100,000 persons in 2050) will continue to increase but the growing rate will slow down in the future decades. With the population aging, there will be estimated 211.2 million Chinese people with type 2 diabetes with an anticipated age-standardized prevalence of 18,171.2 per 100,000 persons, 244.6 per 100,000 deaths, and 4720.2 per 100,000 DALYs in 2050. The incidence of type 2 diabetes kept growing among adolescents and young adults in the past three decades (128.7, 439.9, and estimated 1870.8 per 100,000 persons in 1990, 2021, and 2050, respectively).

CONCLUSIONS

The incidence, prevalence, and disease burden of type 2 diabetes grew rapidly in China in the past three decades. The greatest challenges in the future three decades will be the prevention of type 2 diabetes in young people and the care for elder adults.