American Society for Metabolic and Bariatric Surgery Review of Body Composition

Although the body mass index (BMI) has been used as a measure of obesity for decades, it is now possible to measure adiposity more directly with technologies that can quantitate body fat and other tissues. The purpose of this review is to understand body composition, describe the different ways to measure it, review changes in body composition after metabolic and bariatric surgery (MBS), and provide guidance on how providers can introduce measurements of body composition into their everyday practice.

Use of semaglutide and risk of non-arteritic anterior ischemic optic neuropathy: A Danish-Norwegian cohort study

AIMS

To investigate the putative association between semaglutide and non-arteritic anterior ischaemic optic neuropathy (NAION).

MATERIALS AND METHODS

Data from national health registries in Denmark (2018-2024) and Norway (2018-2022) were used to compare NAION risk in individuals with type 2 diabetes initiating semaglutide versus sodium-glucose co-transporter 2 inhibitors (SGLT-2is). A supplementary self-controlled analysis examined NAION risk among all semaglutide users. National estimates were pooled using a fixed-effects model.

RESULTS

We identified 44 517 users of semaglutide for the management of type 2 diabetes in Denmark and 16 860 in Norway, with a total of 32 NAION events observed. The unadjusted incidence rate of NAION was 2.19/10 000 person-years among Danish semaglutide initiators, compared to 1.18 among SGLT-2i initiators. In Norway, the corresponding rates were 2.90 and 0.92, respectively. After adjustment, the pooled hazard ratio (HR) was 2.81 (95% confidence interval [CI] 1.67-4.75), and the incidence rate difference (IRD) was +1.41 (95% CI +0.53 to +2.29) per 10 000 person-years. Estimates were consistent across both countries but higher and less precise in Norway (HR 7.25; 95% CI 2.34-22.4) compared to Denmark (HR 2.17; 95% CI 1.20-3.92). Results remained consistent across sensitivity and supplementary analyses, with a stronger association observed in a post hoc per-protocol analysis (HR 6.35; 95% CI 2.88-14.0). In the supplementary self-controlled study, symmetry ratios (SRs) for NAION were 1.14 (95% CI 0.55-2.36) in Denmark and 2.67 (95% CI 0.91-8.99) in Norway.

CONCLUSIONS

The use of semaglutide for managing type 2 diabetes is associated with an increased risk of NAION compared with the use of SGLT-2is. However, the absolute risk remains low.

Features, functions, and associated diseases of visceral and ectopic fat: a comprehensive review

Obesity is a complex, chronic, and recurrent disease marked by abnormal or excessive fat accumulation that poses significant health risks. The distribution of body fat, especially ectopic fat deposition, plays a crucial role in the development of chronic metabolic diseases. Under normal conditions, fatty acids are primarily stored in subcutaneous adipose tissue; however, excessive intake can lead to fat accumulation in visceral adipose tissue and ectopic sites, including the pancreas, heart, and muscle. This redistribution is associated with disruptions in energy metabolism, inflammation, and insulin resistance, impairing organ function and raising the risk of cardiovascular disease, diabetes, and fatty liver. This review explores the roles of visceral and ectopic fat in the development of insulin resistance and related diseases such as type 2 diabetes and metabolic dysfunction-associated steatotic liver disease. Specifically, we examine the structure and characteristics of different fat types, their associations with disease, and the underlying pathogenic mechanisms. Future strategies for managing obesity-related diseases may include lifestyle modifications, surgical interventions, and emerging medications that target lipid metabolism and energy regulation, aiming to improve patient outcomes.

Post-COVID microvascular dysfunction in hospitalized COVID-19 survivors is associated with acute disease severity and persistent cognitive complaints

OBJECTIVE

Coronavirus disease 2019 (COVID-19) is known to have adverse effects on the brain's vasculature in some patients. After recovery of the infection, vascular abnormalities may persist, but it remains unclear which pathological pathways play a role in post-COVID vascular and cognitive dysfunction and may contribute to post-COVID cognitive complaints.

METHODS

In this observational cohort study, 108 previously hospitalized COVID-19 survivors (general ward: n = 53; intensive care unit (ICU): n = 55) were compared. Cerebral microvascular properties in the cortical gray matter (cGM), normal-appearing white matter (NAWM), and white matter hyperintensities (WMH) were assessed using multi-b-value diffusion MRI around 9 months post-infection and related to acute systemic blood markers and post-COVID cognitive performance and complaints.

RESULTS

A lower microvascular perfusion volume fraction (fmv) and blood flow-related measure (fmv·Dmv) were found in ICU compared to general ward patients in the cGM (p = .032; p = .021), NAWM (p = .008; p = .006), and WMH (p = .014; p = .035). No associations were found between diffusion/perfusion metrics and cognitive performance, but a lower fmv in the NAWM was found in those with more cognitive complaints (p = .047). In ICU survivors, higher median blood lactate levels during ICU admission were associated with lower fmv (p = .031) and fmv·Dmv (p = .044) in the NAWM.

INTERPRETATION

Significantly more widespread post-COVID cerebral microvascular dysfunction was found in COVID-19 ICU compared to general ward survivors. Post-COVID microvascular dysfunction in the NAWM may be due to more severe cerebral tissue hypoxia at time of the infection and is associated with persisting subjective cognitive complaints, even in absence of objective cognitive problems.

Choroidal thickness as predictor of subclinical carotid atherosclerosis in adults with type 1 diabetes

Patients with Type 1 Diabetes (T1DM) have a higher risk of cardiovascular disease. This study used carotid ultrasound to identify subclinical carotid plaques and Optical Coherence Tomography (OCT) to evaluate ophthalmological markers as predictors of carotid plaque presence in 242 adults with T1DM, employing machine learning models for early risk assessment. Individuals with carotid plaques (N = 67) did not show significant differences in retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) and inner plexiform layer (IPL) complex compared to those without (N = 175). However, subfoveal and temporal choroidal area thickness significantly decreased in individuals with plaques (P ≤ 0.01). Machine learning identified age, hypertension, dyslipidemia, smoking, and diabetic retinopathy as key predictors for plaque presence, while ophthalmological measures made a modest contribution. Choroidal thickness exhibited an inverse relationship with plaque risk. Despite robust accuracy and high specificity (82-85% and 92-98%, respectively), the models were overly conservative in predicting positive instances (balanced accuracy of 0.60 for the left eye and 0.71 for the right eye). If further validated, choroidal thickness could complement traditional risk factors as an early marker of CV risk in T1DM patients. Integrating this measure in specialized clinical settings could help identify individuals who may need additional cardiovascular assessments.

Association between relative fat mass and sterility in women of reproductive age in the United States: results from the 2013-2018 NHANES

Background

A major problem that affects women of reproductive age globally is sterility. A new statistic called Relative Fat Mass (RFM) provides an accurate representation of the percentage of total body fat in people. This study aims to investigate the relationship between RFM and sterility in fertility-age American women.

Methods

This study employed a cross-sectional design using data collected from NHANES between 2013 and 2018. The association between RFM and sterility was investigated using logistic regression analysis, controlling for a number of variables. The results were more resilient when RFM was transformed into a four-category variable in order to further examine the patterns of the association between different RFM levels and sterility. The dose-response association between RFM and sterility was illustrated using restricted cubic spline (RCS) analysis. Sensitivity and subgroup analyses were also conducted to assess the robustness and consistency of the results.

Results

This study included 3,197 women aged 18-45, consisting of 2,854 non-sterile participants and 343 sterile participants. First, in the fully adjusted model, RFM and the prevalence of sterility had a positive correlation (OR = 1.05, 95% CI = 1.01-1.09). When converting RFM from a continuous to a categorical variable, the prevalence of sterility was significantly greater in the highest quartile than in the lowest quartile (OR = 2.59, 95% CI = 1.40-4.82). Furthermore, RFM and sterility prevalence were found to be positively linearly correlated by RCS analysis, with sterility rates sharply increasing as RFM levels rose. The positive correlation between RFM and the frequency of sterility was shown to be constant throughout various populations, according to subgroup analysis across stratified parameters. Finally, sensitivity analysis further confirmed the reliability and consistency of the study's findings.

Conclusion

A representative sample of American women of reproductive age showed a positively correlation between RFM and the prevalence of sterility. RFM may help identify women at risk for sterility, and waist circumference management could potentially help lower the risk of sterility.

Effects of changes in body composition on cardiometabolic diseases by sex and presence of sarcopenia

BACKGROUND

Muscle mass loss and fat mass increase are risk factors for cardiometabolic disease. We evaluated the effect of changes in body composition on the incidence of cardiometabolic diseases in older adults with or without sarcopenia, over two-year follow-up.

MATERIALS AND METHODS

Changes in body composition and the development of cardiometabolic diseases over 2 years were measured in community-dwelling older adults recruited from the Korean Frailty Aging Cohort Study. Individuals with sarcopenia were 1:1 matched to those without sarcopenia via propensity score matching.

RESULTS

Among a total of 1634 eligible subjects, 353 were identified with sarcopenia. In men without sarcopenia, an increase in waist circumference by 1 cm was associated with a 32 % higher risk of the development of hypertension. Conversely, an increase in appendicular lean mass by 1 kg was associated with lower risks of the development of cardiovascular disease (41 % lower) and hyperlipidemia (28 % lower). However, there were no significant associations between changes in body composition and any incident cardiometabolic diseases in men with sarcopenia. Women without sarcopenia who experienced an increase in weight of 1 kg were 21 % less likely to develop hyperlipidemia. In women with sarcopenia, the risk of diabetes mellitus was reduced by 30 % with an incremental increase in weight by 1 kg, while the risk of hyperlipidemia increased almost threefold with an increase in appendicular lean mass by 1 kg.

CONCLUSIONS

In older adults without sarcopenia, a decrease in obesity-related indices and a gain in muscle gain are beneficial for men, but inverse relationships between weight and cardiometabolic diseases were reported in women. We found no cardiometabolic benefit of increasing lean mass in older adults with sarcopenia regardless of sex.

Relative fat mass as a predictor of gallstones: insights from national health and nutrition examination survey data

BACKGROUND

Gallstones have been linked to obesity. Relative fat mass (RFM) has emerged as a novel obesity index that more precisely represents the body fat distribution. The correlation between RFM and the risk of developing gallstones remains unclear. This study aims to explore the correlation between RFM and the prevalence of gallstones.

METHODS

A cross-sectional analysis was conducted on the data from the NHANES 2017-2020. The correlation between RFM and the formation of gallstones was examined through multivariate logistic regression, receiver operating characteristic (ROC) curve, sensitivity analysis, subgroup analysis, and restricted cubic spline regression.

RESULTS

Among the 12,947 subjects, 1362 were categorized as having gallstones. It was observed that as the quartile range of RFM increased, with a notable rise in the prevalence of gallstones (3.7% vs. 7.5% vs. 9.8% vs. 21.1%, P < 0.001). Logistic and RCS regression analyses indicated a significantly positive linear correlation between RFM and the prevalence of gallstones, even after accounting for confounders potential (adjusted OR = 1.075, 95% CI: 1.050, 1.101). There is still a significant correlation between RFM and the prevalence of gallstones across both subgroup and sensitivity analyses. ROC analysis indicated that RFM (AUC = 0.696, 95%CI: 0.682, 0.711) can serve as a more robust identify for developing gallstones compared to traditional anthropometric indices.

CONCLUSION

This study is the first to provide the evidence of a significantly positive correlation between RFM and the formation of gallstones. However, further prospective studies are needed to validate these findings.

Investigating the presence and detectability of structural peripheral arterial changes in children with well-regulated type 1 diabetes versus healthy controls using ultra-high frequency ultrasound: a single-centre cross-sectional and case-control study

Background

Children with type 1 diabetes have an increased risk of macrovascular complications. This study used ultra-high frequency ultrasound (UHFUS), enabling differentiation of intima thickness (IT), and media thickness (MT) in peripheral arteries, to examine early peripheral arterial changes in children with type 1 diabetes (CWD).

Methods

This cross-sectional and case-control study performed at the Queen Silvia Children's Hospital, Gothenburg, Sweden included CWD, aged 6-15.99 y/o, diabetes duration ≥5 years, compared to age and sex matched healthy controls. Exclusion criteria included other medical conditions or treatments besides insulin, abnormal examination findings or inability to handle extensive examinations. UHFUS measurements from the radial, dorsal pedal (DP), and carotid arteries as well as blood samples, blood pressure (BP)- and BMI z-score were collected from all study participants, and glucometrics from CWD.

Findings

Study inclusion was performed during 02/25/2019-06/28/2022, and a total of 50 CWD, and 41 healthy controls were included in the study. Of these, five CWD and four healthy controls were excluded, resulting in 45 (22 girls (49%), 23 boys (51%)) CWD (12.0 (2.3) y/o) and 37 (19 girls (51%), 18 boys (49%)) healthy controls (11.3 (2.5) y/o) included in data analysis. CWD had a mean HbA1c of 6.6% (48.1 mmol/mol), higher DBP z-scores (p = 0.019), DP IT, DP intima-media thickness (IMT), and radial IT compared with controls (p = 0.003, p = 0.008, and p = 0.002, respectively). Carotid IT was correlated with time in range (r = -0.47, p = 0.014), time in tight range (r = -0.64, p < 0.001), and glucose variability (r = 0.40, p = 0.004) in CWD. Time in tight range and longitudinal HbA1c were the strongest determinants for carotid IT in CWD, and type 1 diabetes diagnosis was the strongest determinant for IT across all arteries.

Interpretation

Children with well-regulated type 1 diabetes show early vascular changes in radial and DP arteries. Regression analyses indicate significant links between IT and hyperglycaemia and type 1 diabetes diagnosis respectively, indicating that structural arterial changes start in the intima. Our findings further emphasise increased time in normoglycemia as the most crucial action to prevent cardiovascular complications in type 1 diabetes. Additional larger studies are needed to confirm and further interpret the meaning of these results.

Funding

ALF-agreement, Child Diabetes Foundation, Swedish Diabetes Foundation, and the Sahlgrenska University Hospital Foundations.

Protective role of the longevity-associated BPIFB4 gene on cardiac microvascular cells and cardiac aging

In recent years, the role of the cardiac microvasculature in modulating the symptoms and disease progression of patients affected by cardiac pathology has been reconsidered. The term cardiac microvascular disease (CMD) describes the set of functional and/or structural alterations of the cardiac microvasculature that reduce the ability of the heart to adequately increase its coronary blood flow to keep up with increased metabolic demand. CMD is involved in the evolution of heart disease of both ischemic and non-ischemic origin as well as in cardiac aging. The primary actors involved in this process are the cells of the stromal compartment, whose nature and biology are now investigated to a new level of detail thanks to single-cell omics studies. Recent studies on the genetics of extreme longevity have identified a polymorphic haplotype variant of the BPIFB4 gene that confers prolonged life span and health span, atheroprotective advantages, and an improved immune response. The aim of this review was to focus on the beneficial effects of the longevity-associated variant (LAV) of BPIFB4 on cardiac microvascular cell biology, providing novel and exciting mechanisms of its action directed against the development or progression of many age-related cardiovascular diseases, thus emphasizing its translational therapeutic potential.

Associations of multiple plasma metals with the risk of type 2 diabetes in Chinese adults: A cross-sectional study

Evidence regarding the associations between co-exposure to multiple metals and diabetes risk was scarce. This study aimed to evaluate the associations of multiple metals with diabetes risk using multiple statistical methods. This cross-sectional study included 192 diabetic patients and 189 healthy subjects. We employed inductively coupled plasma mass spectrometry (ICP-MS) to determine the plasma concentrations of 18 metals. Least absolute shrinkage and selection operator (LASSO) regression, logistic regression, and Bayesian kernel machine regression (BKMR) were applied to evaluate associations of multiple metals with diabetes risk comprehensively. These models consistently suggested that aluminium and selenium were positively associated with diabetes risk, while manganese, rubidium, and lead were negatively associated with diabetes risk. Age-specific differences of selenium and sex-specific differences of manganese in diabetes risk were also observed based on stratified analyses. According to RCS analyses, we obtained dose-response relationships between metals and diabetes risk:(1) there were inverted U-shaped associations of plasma aluminium and selenium with diabetes risk, with the threshold close to 20.5µg/L and 75.9µg/L, respectively (both P for overall < 0.05; both P for non-linearity < 0.05). (2) There were L-shaped associations of rubidium and lead with diabetes risk, with the turning point close to 144.5µg/L and 2.5µg/L, respectively (both P for overall < 0.05; both P for non-linearity < 0.05). (3) Manganese was linearly and negatively correlated with diabetes risk when concentrations of manganese were less than approximately 4.2 μg/L (P for overall < 0.05; P for non-linearity = 0.268). The BKMR model also revealed a negative combined effect of metal mixtures on diabetes risk and potential interactions between six pairs of metals (aluminium-manganese, aluminium-selenium, aluminium-rubidium, aluminium-lead, manganese-selenium, and manganese-rubidium). In summary, we need to pay attention to the role of low plasma levels of aluminium, selenium, manganese, rubidium, and lead in diabetes, especially regarding their safety windows.

MSTNet: Multi-scale spatial-aware transformer with multi-instance learning for diabetic retinopathy classification

Diabetic retinopathy (DR), the leading cause of vision loss among diabetic adults worldwide, underscores the importance of early detection and timely treatment using fundus images to prevent vision loss. However, existing deep learning methods struggle to capture the correlation and contextual information of subtle lesion features with the current scale of dataset. To this end, we propose a novel Multi-scale Spatial-aware Transformer Network (MSTNet) for DR classification. MSTNet encodes information from image patches at varying scales as input features, constructing a dual-pathway backbone network comprised of two Transformer encoders of different sizes to extract both local details and global context from images. To fully leverage structural prior knowledge, we introduce a Spatial-aware Module (SAM) to capture spatial local information within the images. Furthermore, considering the differences between medical and natural images, specifically that regions of interest in medical images often lack distinct subjectivity and continuity, we employ a Multiple Instance Learning (MIL) strategy to aggregate features from diverse regions, thereby enhancing correlation to subtle lesion areas. Ultimately, a cross-fusion classifier integrates dual-pathway features to produce the final classification result. We evaluate MSTNet on four public DR datasets, including APTOS2019, RFMiD2020, Messidor, and IDRiD. Extensive experiments demonstrate that MSTNet exhibits superior diagnostic and grading accuracy, achieving improvements of up to 2.0% in terms of ACC and 1.2% in terms of F1 score, highlighting its effectiveness in accurately assessing fundus images.

Association between current relative fat mass and history of female infertility based on the NHANES survey

Infertility is a significant global issue affecting millions of couples, and increased body fat is considered a major contributing factor. Traditional assessment methods, such as body mass index (BMI) and waist circumference (WC), are limited in accurately reflecting body fat composition. The relative fat mass (RFM) index, a newer tool, provides a more precise assessment of fat content, but its relationship with infertility remains unclear. This study aimed to investigate the correlation between relative fat mass and a history of infertility by analyzing data from the National Health and Nutrition Examination Survey (NHANES). The study included 3915 women aged 18 to 45 years. Infertility status was self-reported, and RFM was calculated using a specific formula. Logistic regression models were employed, adjusting for multiple covariates, to investigate the relationship between RFM and infertility. Women with a history of infertility had a significantly higher RFM when compared to those who were not infertile. Specifically, women in the highest RFM quartile had almost three-fold higher odds of history of infertility than those in the lowest quartile (odds ratio [OR]: 2.87; 95% confidence interval [CI]: 1.85-4.44). Subgroup analyses indicated a stronger association between RFM and a history of infertility; this relationship was predominantly observed in women under 35 years-of-age. Sensitivity analyses confirmed the robustness of these findings. Higher RFM is more likely to be associated with a history of infertility. While RFM provides a more accurate assessment of body fat distribution compared to BMI and WC, making it a valuable tool for evaluating infertility, further research is now needed to determine the impact of interventions based on RFM measurements.

Td2Ast project: A pragmatic intervention on diet and physical activity for patients with type 2 diabetes mellitus

AIM

The purpose of this study was to assess the efficacy of an educational intervention based on the Behavior Change Wheel (BCW) framework for individuals with type 2 diabetes mellitus (T2DM) on dietary and physical activity recommendations in a Spanish region.

METHODS

A two-arm pragmatic randomized pilot trial was developed. The intervention consisted of a 6-month period with three components: face-to-face counseling, a phone call, and specially designed written guidelines focusing on dietary and physical activity recommendations The primary outcome was changes in dietary and physical activity recommendations. The secondary outcome, the impact of the intervention on HbA1c levels, body mass index, and the frequency of consultations to primary care.

RESULTS

n=208 patients were recruited. Individuals in the intervention experienced a significative improvement in adherence to dietary recommendations (+0.52; p-value<0.001), physical activity (+0.79; p-value<0.001), and a decrease in HbA1c levels (0.11 %; p-value=0.04).

CONCLUSION

The 6-month intervention, designed for T2DM patients and based on the BCW model, has demonstrated effectiveness in improving adherence to healthy dietary and physical activity recommendations, as well as reducing HbA1c levels.

Effects of different hypoglycaemic drugs on beta-cell function in type 2 diabetes mellitus: a systematic review and network meta-analysis

AIM

This study compared the effects of hypoglycaemic drugs on beta-cell function among type 2 diabetes mellitus (T2DM) patients through a network meta-analysis of randomized controlled trials (RCTs).

METHODS

We searched the PubMed, EMBASE, and Cochrane Library databases for RCTs of different hypoglycaemic drugs as T2DM treatment from database inception to December 1, 2024. The primary outcome was homeostasis model assessment-β (HOMA-β), and the secondary outcome was glycated haemoglobin (HbA1c). Direct and indirect evidence types were combined to calculate weighted mean difference (WMD) and 95% confidence interval (CI) values for the change in (△) HOMA-β and △HbA1c, and to determine surface under the cumulative ranking curve (SUCRA) values.

RESULTS

A total of 58 RCTs involving 16,345 T2DM patients were incorporated into this network meta-analysis. The mean patient age was 66.70 years, and 54.14% were male. For improving HOMA-β, the top treatments were glimepiride + rosiglitazone (WMD = 81.83, 95% CI 45.85-117.82) and glibenclamide + rosiglitazone (WMD = 79.51, 95% CI 40.66-118.36). Acarbose (WMD = 60.90, 95% CI 27.56-94.25) ranked third as monotherapy. For reducing HbA1c, glibenclamide + rosiglitazone was the most efficacious treatment (WMD = - 2.48, 95% CI - 3.67 to - 1.29), followed by metformin + exenatide (WMD = - 1.77, 95% CI - 2.25 to - 1.29) and liraglutide (WMD = - 1.77, 95% CI - 2.33 to - 1.21). The treatment with the highest SUCRA value for HOMA-β improvement was glimepiride + rosiglitazone (95.1%), followed by glibenclamide + rosiglitazone (94.9%). For HbA1c improvement, glibenclamide + rosiglitazone had the highest SUCRA value (97.6%).

CONCLUSIONS

The combination of glimepiride/glibenclamide and rosiglitazone was the most effective hypoglycaemic regimen for protecting beta-cell function and improving glycaemic control in T2DM treatment, possibly due to control of HbA1c and glycotoxicity.

Efficacy of Colchicine in Stroke Prevention in Patients With Cardiovascular Diseases: A Meta-Analysis of Randomized Controlled Trials

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. Low-dose colchicine is a novel and nonstandard management approach for patients with CVDs who are at an increased risk of adverse events. However, few studies have reported the risk of stroke with colchicine, with controversial results. This meta-analysis aimed to compare the efficacy of colchicine and placebo for stroke prevention in patients with CVD. Major electronic databases were screened for randomized controlled trials (RCTs) comparing colchicine and placebo in patients with CVDs from inception to June 2024. Pooled estimates were calculated as risk ratios (RRs) with 95% confidence intervals (CIs) using an inverse-variance random-effects model. Statistical significance was set at P < 0.05. A total of 15 RCTs encompassing 25,116 patients with CVDs were included (12,568: colchicine and 12,548: placebo). The pooled analysis demonstrated a significant reduction in stroke [RR, 0.80 (95% CI, 0.64-0.99); P = 0.04] with colchicine compared with placebo. The risk of all-cause mortality [RR, 1.00 (95% CI, 0.77-1.28)] was comparable between the 2 groups. On subgroup analysis, low-dose colchicine (0.5 mg/day) demonstrated a significantly lower risk of stroke compared with high-dose (>0.5 mg/day) colchicine, which failed to achieve statistical significance. Based on this meta-analysis, colchicine significantly reduced stroke in patients with CVDs compared with placebo. This effect was most significant with low-dose colchicine at 0.5 mg/day. However, no differences were observed in all-cause mortality. Further long-term RCTs are warranted to investigate stroke prevention using colchicine in this population.

Association between hyperuricemia and all-cause mortality in people taken Statins: a retrospective cohort study

Background

Statins are one of the most widely prescribed medicines in clinical practice. Their benefits have extended beyond cardiovascular applications to reduce serum uric acid levels. This study aims to investigate the relationship of hyperuricemia with the risk of all-cause mortality among individuals taking statins.

Method

A retrospective cohort study was performed using data from the National Health and Nutrition Examination Survey (NHANES) database between 2005 and 2018. The weighted Cox proportional hazards models were used to investigate the relationship between hyperuricemia and all cause-mortality.

Results

A total of 1,958 participants were enrolled for analysis. Of them 1,429 participants were with normal uric acid levels and 529 people were with hyperuricemia. After 12 years of follow-up, there were 267 participants who died from all-cause mortality in the non-hyperuricemia group and 136 died in the hyperuricemia group. Additionally, 32.49% of participants took more than five kinds of medicines in the non-hyperuricemia group compared to 42.05% participants in the hyperuricemia group. Even after adjusting for confounding factors, we found that the serum uric acid (SUA) level was significantly correlated with all-cause mortality among statin users (HR = 1.13, 95% CI:1.02-1.24, p = 0.0161). Additionally, hyperuricemia resulted in significant increases in all-cause mortality relative to non-hyperuricemia participants in three models (HR = 1.51, 95% CI:1.16-1.96, P = 0.0023).

Conclusion

Although statins have been shown to reduce uric acid levels, hyperuricemia is still significantly associated with the all-cause mortality in people taking statins. Those taking statins and having hyperuricemia should pay special attention to their SUA level.

Association between diabetes self-management education attendance, hospital admissions and mortality in type 2 diabetes: A cohort analysis protocol

INTRODUCTION

Type 2 diabetes is associated with excess hospital admissions and increased mortality. Structured diabetes self-management education (DSME) is recommended internationally and is associated with improved self-management skills, well-being and minor improvements in glycated haemoglobin (HBA1c), but does it reduce hospital admissions or prevent premature mortality? Our aim is to examine the relationship between DSME attendance, hospitalisations, mortality and 3-point major adverse cardiovascular events (MACE) in people with type 2 diabetes to inform future healthcare policy and diabetes care.

METHODS AND ANALYSIS

This protocol details a 10-year retrospective open cohort study of patients aged over 18 years old who have a clinical diagnosis of type 2 diabetes and were registered to an English GP practice from 29 March 2011 to 29 March 2021 and have attended DSME. Patients in the 'ever' cohort will be matched at baseline for age, sex, age at diagnosis and diabetes duration, to those who have 'never' attended DSME. Data will be identified via the UK Clinical Practice Research Datalink and linked to Hospital Episode Statistics Admitted Patient Care data, Office for National Statistics death registrations and patient Index of Multiple Deprivation deciles. Patients will be followed-up through serial cross-sections. Multiple imputation will be considered to manage covariates where data are >12-months from baseline or are not expected to be missing at random. Cox proportional hazard regression and time to event modelling adjusted a priori for cofounding during multivariate analysis will be used.

ETHICS AND DISSEMINATION

This study was approved by CPRD (24_003744). Study findings will be disseminated through peer-reviewed publications and international conferences.

Roadmap for alleviating the manifestations of ageing in the cardiovascular system

Ageing of the cardiovascular system is associated with frailty and various life-threatening diseases. As global populations grow older, age-related conditions increasingly determine healthspan and lifespan. The circulatory system not only supplies nutrients and oxygen to all tissues of the human body and removes by-products but also builds the largest interorgan communication network, thereby serving as a gatekeeper for healthy ageing. Therefore, elucidating organ-specific and cell-specific ageing mechanisms that compromise circulatory system functions could have the potential to prevent or ameliorate age-related cardiovascular diseases. In support of this concept, emerging evidence suggests that targeting the circulatory system might restore organ function. In this Roadmap, we delve into the organ-specific and cell-specific mechanisms that underlie ageing-related changes in the cardiovascular system. We raise unanswered questions regarding the optimal design of clinical trials, in which markers of biological ageing in humans could be assessed. We provide guidance for the development of gerotherapeutics, which will rely on the technological progress of the diagnostic toolbox to measure residual risk in elderly individuals. A major challenge in the quest to discover interventions that delay age-related conditions in humans is to identify molecular switches that can delay the onset of ageing changes. To overcome this roadblock, future clinical trials need to provide evidence that gerotherapeutics directly affect one or several hallmarks of ageing in such a manner as to delay, prevent, alleviate or treat age-associated dysfunction and diseases.

Investigating Drug-Induced Thyroid Dysfunction Adverse Events Associated With Non-Selective RET Multi-Kinase Inhibitors: A Pharmacovigilance Analysis Utilizing FDA Adverse Event Reporting System Data

Purpose

This study aims to investigate the potential association between non-selective RET kinase inhibitors and thyroid dysfunction (TD) by conducting a pharmacovigilance analysis using data from the US FDA Adverse Event Reporting System (FAERS).

Methods

Data for non-selective RET MKIs were obtained from the FAERS database, spanning the first quarter of 2015 to the fourth quarter of 2023. Disproportionality analysis was used to quantify the AE signals associated with non-selective RET MKIs and to identify TD AEs. Subgroup analyses and multivariate logistic regressions were used to assess the factors influencing the occurrence of TD AEs. Time-to-onset (TTO) analysis and the Weibull Shape Parameter (WSP) test were also performed.

Results

Descriptive analysis revealed an increasing trend in TD adverse events linked to non-selective RET MKIs, with a notable proportion of serious reactions reported. Disproportionality analysis using ROR, PRR, BCPNN, and EBGM algorithms consistently demonstrated a positive association between Sunitinib, Cabozantinib, and Lenvatinib with TD adverse events. Subgroup analyses highlighted differential susceptibility to TD based on age, gender, and weight, with varying patterns observed for each inhibitor. Logistic regression analyses identified factors independently influencing the occurrence of TD adverse events, emphasizing the importance of age, gender, and weight in patient stratification. Time-to-onset analysis indicated early manifestation of TD adverse events following treatment with non-selective RET MKIs, with a decreasing risk over time.

Conclusion

The results of our study indicate a correlation between the use of non-selective RET MKIs and the occurrence of TD AEs. This may provide support for the clinical monitoring and risk identification of non-selective RET MKIs. Nevertheless, further clinical studies are required to substantiate the findings of this study.

Early increase in carotid intima-media thickness in women with childhood-onset type 1 diabetes compared with healthy peers: the Norwegian Atherosclerosis and Childhood Diabetes study

INTRODUCTION

The risk of cardiovascular disease is increased in individuals with type 1 diabetes, despite good glycemic control. This study aims to evaluate early signs of atherosclerosis and predisposing factors in individuals with childhood-onset type 1 diabetes compared with healthy controls.

RESEARCH DESIGN AND METHODS

The Atherosclerosis and Childhood Diabetes study is a prospective population-based cohort study with follow-up every fifth year. The cohort consists of 329 subjects with type 1 diabetes and 173 controls. Carotid intima-media thickness (cIMT) was measured at baseline and 5 and 10 years of follow-up. Data from the Norwegian Childhood Diabetes Registry were used in assessment of traditional risk factors.

RESULTS

Mean cIMT in young women with type 1 diabetes increased significantly over a 10-year period compared with healthy controls (∆0.019 mm (0.001-0.035), p=0.035). At the 10-year follow-up the group with type 1 diabetes had a mean age of 24.2±2.9 years (13.7±2.8 years at baseline), diabetes duration of 15.6±3.4 years (5.4±3.3 years at baseline) and HbA1c of 8.2±3.6% (66±16 mmol/mol) (8.4±3.4% (68±13 mmol/mol) at baseline). Women with type 1 diabetes had significantly higher mean weight, body mass index, waist circumference, diastolic blood pressure (DBP), serum low-density lipoprotein (LDL)-cholesterol and apolipoprotein B, while men with type 1 diabetes had significantly higher mean DBP and urinary albumin-creatinine ratio compared with the control group. Mean cIMT change over time was not associated with long-term HbA1c or LDL-cholesterol burden in childhood and adolescence.

CONCLUSION

Young women with childhood-onset type 1 diabetes of relatively short diabetes duration had a higher mean cIMT over a 10-year period compared with their healthy female controls, with values similar to males.

Natural remedies proposed for the management of diabetic retinopathy (DR): diabetic complications

Diabetic retinopathy (DR) represents a significant and serious complication associated with diabetes mellitus (DM), often resulting in considerable visual impairment or even blindness. The intricate pathological processes underlying DR complicate the effectiveness of current treatment modalities. Studies have highlighted the potential of natural products in the treatment of DR via several beneficial effects including anti-inflammatory, antioxidant, anti-neovascular, and anti-apoptotic properties. Flavonoids, saponins, saccharides, and alkaloids exhibited various beneficial effects in DR in in vivo and in vitro studies. However, the clinical utilization of these natural compounds is hindered by issues such as inadequate specificity, low bioavailability, and potential toxicity. Therefore, there is a pressing need for rigorous clinical studies to confirm the efficacy of natural products in preventing or mitigating the progression of DR.

Safety of sodium-glucose cotransporter 2 inhibitors in kidney transplant recipients with diabetes mellitus

AIM

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are important anti-hyperglycemic medications with reno-protective benefits for patients with diabetic kidney disease. Their utilization in kidney transplant recipients (KTRs) remains underexplored due to safety concerns, particularly regarding urinary tract infections. This study investigates the safety profile of SGLT2i therapy in KTRs.

METHODS

We conducted a retrospective analysis of KTRs with diabetes mellitus, comparing those treated with SGLT2i to those on standard diabetes therapy, monitored over three years at a tertiary center. The primary outcome was a renal composite of dialysis, re-transplantation, acute kidney failure, or acute rejection. Secondary outcomes included urinary tract infections, diabetic ulcers, fractures, amputations, diabetic ketoacidosis, all-cause mortality, and glycemic control.

RESULTS

Two hundred forty individuals using SGLT2i (median age 63, 20 % female) were matched with non-users. SGLT2i users had a lower incidence of the composite renal outcome (8.9 vs. 13.3 events per 100 patient-years), but after adjustment for independent predictors, the risk was similar (HR 0.99, 95 % CI 0.65-1.52, P = 0.970). Other outcomes showed comparable or lower risks in SGLT2i users. Glycemic control improved more significantly in SGLT2i users.

CONCLUSION

In KTRs with diabetes, SGLT2i therapy improved glycemic control without increased safety concerns compared to standard treatments. Both groups exhibited similar risks of significant kidney-related events and all-cause mortality. These findings provide crucial insights into the existing limited data concerning this vulnerable population, which faces elevated risks of renal complications and medication-related adverse effects. Ongoing randomized controlled trials will provide additional safety data for SGLT2i in KTRs.

Diabesity and cardiovascular mortality in a prospective population cohort followed for more than 20 years

INTRODUCTION

Control of the main cardiovascular risk factors had succeeded in reducing cardiovascular diseases (CVD). However, the general increase in the prevalence of type 2 diabetes mellitus (DM2) and obesity has slowed this decline. Both CVRFs are strongly associated, and the term diabesity has been coined to refer to this relationship. The main objective of this study was to assess the influence of diabesity on cardiovascular mortality.

METHODS

Prospective cohort study involving 1246 individuals (54.3% women) followed for 20.9 years (SD=7.31) and selected by random two-stage sampling in a province in southeastern Spain. Diabesity was defined as the combination of DM2 with overweight and obesity. Survival curves (Kaplan-Meier) were calculated and two Cox regression models were used, one unadjusted and the other adjusted by the main explanatory variables in which the diabesity variable consisted of 6 categories (normal weight, overweight, obesity, normal weight+DM2, overweight+DM2 and obesity+DM2).

RESULTS

There were 95 deaths due to CV causes (7.6% of the total; 6.2% women and 9.3% men; p=0.01). After adjustment, the combination of DM2 and overweight increased the incidence of cardiovascular mortality by 133% (HR=2.33; 95% CI: 1.18-4.58; p=0.014) and the combination of DM2 and obesity by 49% (HR=1.49; 95% CI: 0.64-3.45; p=0.351), not reaching statistical significance in the latter case.

CONCLUSIONS

In the general population, the results of our study show that the combination of overweight and DM2 is associated with higher CV mortality. It seems a priority to intervene intensively in the control of both overweight and DM2.

Changes in pre-diabetes and diabetes prevalence and diabetes self-management behaviors across socioeconomic spectra in rural southwest China: 2013-2022

BACKGROUND

This study aimed to uncover the changing prevalence of pre-diabetes and diabetes as well as diabetes self-management behaviors across socioeconomic gradients in rural southwest China.

METHODS

A two-wave, community-based, cross-sectional survey was conducted. A total of 7,747 and 7,536 individuals aged ≥ 35 years, residing in rural southwest China, were selected using a three-stage stratified random sampling method. Demographic characteristics and self-management behaviors were collected through face-to-face interviews, and physical indicators were measured through on-site examinations. An individual socioeconomic position (SEP) index was constructed using principal component analysis based on three variables: education, annual household income, and access to medical services.

RESULTS

In 2022, the overall prevalence of pre-diabetes and diabetes (15.7% and 7.6%) were lower than in 2013 (18.3% and 8.2%) (P < 0.05). This decline was also observed in subgroups including women, those aged 45-54 years, those of Han ethnicity, those with a high educational level, those with a high annual household income, and those with good access to medical services and high SEP (P < 0.05). In contrast, higher rates were found among ethnic minorities, those with low annual household income, and those with low SEP. The overall rate of compliance with anti-diabetic medications or insulin injection was higher in 2022 (95.9%) compared to 2013 (76.5%), with the largest relative increase occurring among participants with a low level of education and income, poor access to medical services, and low SEP (P < 0.01). The proportion of individuals having taken measures to control diabetes was lower in 2022 (39.7%) compared to 2013 (53.3%) (P < 0.01). This lower rate was also observed among the subgroups categorized by sex, education, and income level, in the Han majority, and among participants with good access to medical services and high SEP (P < 0.05). Furthermore, while the overall rate of regular self-monitoring of blood glucose did not differ between the two survey years (41.8% and 44.7%, P > 0.05), a higher rate was uncovered among patients with low education level, low annual household income, poor access to medical services, and low SEP in 2022 compared to 2013 (P < 0.05).

CONCLUSIONS

The prevalence of pre-diabetes and diabetes, as well as the rate of taking measures to control diabetes, were lower among the rural Chinese adult population in 2022 compared with 2013. However, compliance with anti-diabetes medications or insulin injections was higher. Additionally, socioeconomic disparities are associated with these Changes.

Efficacy and safety of nicorandil for prevention of contrast-induced nephropathy in patients undergoing coronary procedures: a systematic review and meta-analysis

BACKGROUND

Contrast-induced nephropathy (CIN) is a potentially serious complication of intravenous or intra-arterial contrast administration during angiographic procedures that results in renal dysfunction. CIN can increase the risk of mortality by three-fold. This meta-analysis assesses the efficacy and safety of nicorandil for the prevention of CIN in patients undergoing percutaneous coronary intervention (PCI) or coronary angiography (CAG).

METHODS

Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov were used to perform a thorough literature search from their inception to July 2024. Twelve randomized controlled trials (RCTs) were included. A random-effects meta-analysis was performed on RevMan and pooled estimates were presented as forest plots. The Mantel-Haenszel method was used for dichotomous outcomes and risk ratios (RRs) were calculated along with 95% confidence intervals (95% CI).

RESULTS

This meta-analysis included 2787 participants (nicorandil: 1418, control: 1394). The use of nicorandil was protective against CIN (RR 0.38, 95% CI 0.29-0.50). There was no significant difference in major adverse events between the groups (RR 0.77, 95% CI 0.52-1.13, p = 0.18). Similarly, the use of nicorandil did not affect the risk of developing stroke (RR 1.05, 95% CI: 0.38-2.95), myocardial infarction (RR 0.90, 95% CI: 0.56-1.43), heart failure (RR 0.81, 95% CI: 0.39-1.68), cardiac death (RR 0.90, 95% CI: 0.28-2.88) and dialysis (RR 0.70, 95% CI: 0.11-4.44).

CONCLUSION

This meta-analysis concludes that nicorandil reduces CIN incidence after PCI or CAG without significantly increasing major adverse events. However, further well-designed, large-scale RCTs are needed to strengthen the practical relevance before routine clinical use.

Ranibizumab with luseogliflozin in type 2 diabetes with diabetic macular oedema: A randomised clinical trial

AIMS

Anti-vascular endothelial growth factor (VEGF) therapy is the standard treatment for diabetic macular oedema (DMO); however, unmet needs remain. This study aimed to assess the effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in treating DMO.

MATERIALS AND METHODS

This multicentre randomised open-label trial included 60 patients with DMO who were eligible for anti-VEGF therapy. Patients were randomised to receive luseogliflozin or glimepiride. Ranibizumab was administered initially to the target eye, with additional doses per protocol. The number of ranibizumab doses up to week 48, and re-admission rates were evaluated. Fellow eye injections were also assessed.

RESULTS

Sixty participants, mostly with diabetic retinopathy and half previously treated with anti-VEGF therapy, were included. SGLT2i and sulfonylurea (SU) groups achieved equivalent glycated haemoglobin, central retinal thickness (CRT), and best-corrected visual acuity improvements. Injection frequency for the target eye was similar between groups (SGLT2i vs. SU: 3.9 ± 0.7 vs. 4.7 ± 0.7 times, p = 0.36). Re-administration rates were decreased significantly after the fourth injection in the SGLT2i group (p = 0.030, hazard ratio: 0.45, 95% confidence interval: 0.22-0.92). Fellow eyes in the SGLT2i group showed significant CRT reduction and fewer injections compared with those in the SU group (1.3 ± 0.6 vs. 3.4 ± 0.8, p = 0.016).

CONCLUSIONS

Although the overall number of anti-VEGF injections in the target eye showed no significant difference, some patients responded favourably to SGLT2i and required fewer injections. The reduction in fellow eye injections suggests SGLT2i's efficacy in treating early-stage DMO.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trial Registry (UMIN000033961); Japan Registry of Clinical Trials (jRCTs031180210).

Unraveling the therapeutic potential of Astilbe rivularis Buch.-Ham. ex D. Don in attenuation of diabetic neuropathy in laboratory rats

ETHNOPHARMACOLOGICAL RELEVANCE

Astilbe rivularis Buch.-Ham. ex D. Don is a rare medicinal plant, traditionally employed for treating several disorders. The juice, decoction or powder of the roots, rhizomes, leaves and even the entire plant, are used for managing peptic ulcer, diarrhoea, jaundice, sprains and muscular swellings, bone fracture and dislocation of joints, postpartum bleeding and other menstrual disorders. These conventional medicinal uses make Astilbe rivularis a promising candidate for further research.

AIM OF THE STUDY

This study was designed to explore the neuroprotective potential of hydroethanolic extract of Astilbe rivularis (ARHE) in diabetic neuropathy (DN) in rats.

MATERIALS AND METHODS

GC-MS analysis was used to identify the phytoconstituents present in the plant extract. DN was induced by administration of STZ (55 mg/kg, i.p.), 15 min after NAD (230 mg/kg, i.p.) injection. The rats with fasting blood glucose (FBG) level >250 mg/dl were included in the study. DN was assessed by estimating the level of FBG, lipid profile, and invitro and invivo oxidative stress parameters. Additionally, behavioural parameters like, mechanical hyperalgesia, hot and cold allodynia were estimated to assess diabetic neuropathy. Furthermore, the level of antioxidant enzymes like SOD, GSH, and TBARS in sciatic nerve and inflammatory markers like, TGF-β and IL-6 were measured.

RESULTS

Altogether, 30 phytoconstituents were identified including heptafluorobutyric acid, hexadecanoic acid, and beta-sitosterol depicting antioxidant, antidiabetic, and anticancer properties, respectively. Administration of different doses (100, 200, and 400 mg/kg) of ARHE to diabetic rats attenuated elevated blood glucose level and restored lipid profile, body weight, food and water intake, and antioxidant level. Moreover, elevated level of inflammatory markers like, TGF-β and IL-6 was also found to be attenuated in sciatic nerve. Furthermore, ARHE attenuated the pain response assessed by mechanical hyperalgesia and hot and cold allodynia in diabetic neuropathy rats. ARHE also showed inhibitory activity on ALR enzyme and erythrocyte sorbitol accumulation, and ameliorated oxidative stress. Histopathological study indicated improvement in the architecture of sciatic nerve tissue in diabetic neuropathy rats with the treatment of ARHE.

CONCLUSIONS

Conclusively, hydroethanolic extract of Astilbe rivularis exhibited neuroprotective potential and ameliorated diabetic neuropathy in rats.

Changes in Urinary NGAL, FN, and LN Excretion in Type 2 Diabetic Patients Following Anti-Diabetic Therapy with Metformin

Background: Excessive accumulation of glomerular extracellular matrix (ECM) is a key factor in the development and progression of diabetic nephropathy (DN). As kidney dysfunction has been reported in normoalbuminuric patients, identifying novel diagnostic and prognostic markers is essential for the prevention and treatment of DN. Methods: Urinary excretion of neutrophil gelatinase-associated lipocalin (NGAL) and ECM-related glycoproteins, i.e., fibronectin (FN) and laminin (LN), was measured in obese patients with newly diagnosed type 2 diabetes mellitus (T2DM) before and after 6 months of metformin therapy. Results: Baseline NGAL (1.27 (0.80-2.36) ng/mg Cr), FN (11.19 (5.31-21.56) ng/mg Cr) and LN (123.17 (54.56-419.28) pg/mg Cr) levels did not significantly differ between T2DM patients and controls (1.95 (1.09-2.97) ng/mg Cr, 11.94 (7.78-18.01) ng/mg Cr and 157.85 (83.75-326.40) pg/mg Cr, respectively). In multivariate regression analysis, the body mass index was identified as the only significant predictor influencing urinary NGAL and FN levels at baseline, with β = 0.249, p = 0.005 and β = 1.068, p = 0.010, respectively. Metformin treatment significantly increased urinary levels of both ECM proteins, i.e., FN (18.48 (11.64-32.46) ng/mg Cr) and LN (179.51 (106.22-414.68) pg/mg Cr), without any effect on NGAL levels (1.44 (0.81-2.72) ng/mg Cr). FN and LN were positively associated with NGAL both before (r = 0.709 and r = 0.646, both p < 0.001, respectively) and after (r = 0.594 and r = 0.479, both p < 0.001, respectively) therapy. No correlations were found between NGAL, FN, LN, and albuminuria. However, NGAL was positively correlated with the albumin/creatinine ratio (ACR) both before (r = 0.323, p < 0.05) and after (r = 0.287, p < 0.05) therapy, and negatively with estimated glomerular filtration rate (eGFR) in pre-treatment diabetics (r = -0.290, p < 0.05). FN and LN were also correlated with ACR (r = 0.384, p < 0.01 and r = 0.470, p < 0.001), although the association for LN was limited to untreated patients (r = 0.422, p < 0.01). Conclusions: Our results suggest that metformin has a beneficial effect on ECM turnover with a significant increase in urinary excretion of non-collagenous markers of glomerular injury, i.e., FN and LN. Additionally, ECM-related markers may serve as useful tools for monitoring early renal injury in obese diabetic patients.

Cutaneous wound healing in type 2 diabetes db/db mice was impaired with specific changes in proinflammatory cytokine expression

In db/db mice, cutaneous wound healing was delayed, and excessive wound exudates enlarged the wound. However, the relationship between enlarged wounds and proinflammatory cytokine expression remains unknown. Therefore, we investigated the expression of proinflammatory cytokines Tnf-α and Il-6 in cutaneous wound healing with diabetes. In this study, 12 C57BL/6J mice (wild-type: WT) and 14 db/db mice were subjected to full-thickness wound injuries. Wound healing was assessed until day 14, and wound tissues were harvested on days 7, 9, 11, and 14. The wound areas increased for 4 days, gradually increased until day 9, and stabilized until day 14 in the db/db group, but increased for 3 days, rapidly decreased until day 12, and gradually decreased until day 14 in the WT group. On day 14, the wound area in the db/db group was significantly larger than that in the WT group (p < 0.01). The relative expressions of the Tnf-α and Il-6 in the db/db group were significantly higher than those in the WT group on days 7-14, and on days 11 and 14, respectively (p < 0.05). Our study showed that cutaneous wound healing was delayed with wound expansion and the expression of Tnf-α and Il-6 was high throughout the measurement time points in db/db mice. These abnormal expressions could influence impaired cutaneous wound healing in diabetic mellitus.

Ferroptosis: mechanism and role in diabetes-related cardiovascular diseases

Cardiovascular diseases represent the principal cause of death and comorbidity among people with diabetes. Ferroptosis, an iron-dependent non-apoptotic regulated cellular death characterized by lipid peroxidation, is involved in the pathogenesis of diabetic cardiovascular diseases. The susceptibility to ferroptosis in diabetic hearts is possibly related to myocardial iron accumulation, abnormal lipid metabolism and excess oxidative stress under hyperglycemia conditions. Accumulating evidence suggests ferroptosis can be the therapeutic target for diabetic cardiovascular diseases. This review summarizes ferroptosis-related mechanisms in the pathogenesis of diabetic cardiovascular diseases and novel therapeutic choices targeting ferroptosis-related pathways. Further study on ferroptosis-mediated cardiac injury can enhance our understanding of the pathophysiology of diabetic cardiovascular diseases and provide more potential therapeutic choices.

A sex-disaggregated analysis of the prognostic value of lean type 2 diabetes mellitus in the adult population with acute myocardial infarction

BACKGROUND

Emerging evidence has demonstrated the unfavourable cardiovascular risk of individuals with lean type 2 diabetes mellitus (T2DM). Our study aims to investigate the prognostic value of lean T2DM in patients with acute myocardial infarction (AMI), stratified by sex.

METHODS

The study cohort examines the clinical characteristics and long-term outcomes of individuals with AMI, stratified by four phenotypes based on T2DM and lean body category-lean T2DM, non-lean T2DM, lean non-T2DM and non-lean non-T2DM. The primary outcome was long-term all-cause mortality. Cox regression model was constructed to investigate the associations of lean and non-lean T2DM phenotypes with mortality, adjusted for age, ethnicity, previous AMI, AMI type, chronic kidney disease, angiotensin converting enzyme inhibitor or angiotensin receptor blockers, beta-blockers, and smoking status.

RESULTS

A cohort of 9545 AMI patients was examined, with a mean follow-up duration of 3.4 ± 2.4 years. Majority had the non-lean T2DM phenotype (40.4%), followed by non-lean non-T2DM (29.8%), lean non-T2DM (15.9%), and lean T2DM (13.9%). In the T2DM group, one-quarter was lean (N = 1324), while the vast majority (74.5%) was non-lean. Individuals with lean T2DM tended to be female and older. Patients with lean T2DM had the highest rates of heart failure (23.3%, p < 0.001), cardiogenic shock (9.1%, p = 0.036), and long-term all-cause mortality (32.6%, p < 0.001). Cox regression demonstrated that lean T2DM was an independent predictor of mortality (adjusted hazard ratio [aHR] 1.171, 95% CI 1.040-1.319, p = 0.009) after adjustment. The presence of higher mortality risk following AMI was present in males (aHR 1.201, 95% CI 1.037-1.391, p = 0.015), but not in females (aHR 1.066, 95% CI 0.869-1.308, p = 0.538).

CONCLUSIONS

The lean T2DM phenotype was present in one-quarter of the AMI cohort with T2DM. The lean T2DM phenotype was an independent predictor of long-term mortality following AMI, although this association was stronger in males than in females.

Clinical Outcomes in Diabetic Patients with Zinc Deficiency: A Multi-Institutional Population-Based Study

OBJECTIVE

This study aimed to investigate the association between zinc deficiency (ZD) and the risks of all-cause mortality, major adverse cardiovascular events (MACEs), major adverse kidney events (MAKEs), and all-cause hospitalization in diabetic patients.

METHODS

This retrospective cohort study utilized the TriNetX research network to identify adult patients with diabetes mellitus (DM) between January 1, 2010, and August 31, 2024. Propensity score matching was used to match patients with serum zinc levels below 70 µg/dL (ZD group) to those with serum zinc levels between 70 and 120 µg/dL (control group).

RESULTS

Each group comprised 11,698 matched patients with balanced baseline characteristics. During the 1-year follow-up period, the ZD group exhibited significantly higher risks of all-cause mortality (hazard ratio [HR]: 1.788, 95% confidence interval [CI]: 1.591-2.009), MACEs (HR: 1.641, 95% CI: 1.278-2.105), and MAKEs (HR: 1.534, 95% CI: 1.293-1.821), as well as a higher risk of hospitalization (HR: 1.272, 95% CI: 1.216-1.330).

CONCLUSION

Zinc deficiency in diabetic patients is associated with increased risks of all-cause mortality, MACEs, MAKEs, and all-cause hospitalization. These findings underscore the importance of assessing zinc status in the clinical management of patients with DM.

Impact of High-Intensity Interval Exercise With Elastic Bands Versus Continuous Moderate-Intensity Aerobic Exercise on Glycemic Control in People With Type 1 Diabetes

BACKGROUND

Engaging in physical exercise is recommended to enhance cardiovascular health and manage blood sugar levels in people with type 1 diabetes (T1D).

HYPOTHESIS

The impact of high-intensity interval exercise with elastic bands (EB-HIIE) versus continuous moderate-intensity aerobic exercise (CONT) on glycemic control is different in men with T1D.

STUDY DESIGN

Crossover study design.

LEVEL OF EVIDENCE

Level 3.

METHODS

Participants (39 men with T1D) underwent either an EB-HIIE or a CONT session in randomized order, with a separation of ≥72 hours to avoid carry-over effects. Changes in glucose values during exercise were measured simultaneously from venous blood (YSI) and interstitial fluid (Dexcom G6 glucose sensor). Subsequent 24-hour glucose was monitored using the glucose sensor.

RESULTS

Blood glucose was lower in CONT vs EB-HIIE (P < .01). Post hoc analysis revealed clinically relevant differences during exercise (-35.1 mg/dl; P = .02), at its end (-49.5 mg/dl; P < .01), and at 10 and 20 minutes after completion (-51.2 mg/dl; P < .01 and -45.9 mg/dl; P < .01, respectively). Time-in-range 24 hours after exercise completion was significantly higher with EB-HIIE than with CONT (66.5% vs 59.3%), although both were significantly better than the previous 24 hours before exercise (50%).

CONCLUSION

Results suggest that EB-HIIE is a safe training method for male adults with diabetes, resulting in euglycemia during and immediately after exercise and improving glucose outcomes in the subsequent 24 hours.

CLINICAL RELEVANCE

This study provides new evidence and practical information on how to implement safe physical activity in daily life of patients with diabetes. EB-HIIT exhibited lower hypoglycemia risk during exercise and better glycemic control in the subsequent 24 hours. In contrast, practicing CONT exercise is associated with higher risk of hypoglycemia. Healthcare providers should take this information into account when prescribing exercise.

Insights into the Sources, Structure, and Action Mechanisms of Quinones on Diabetes: A Review

Quinones, one of the oldest organic compounds, are of increasing interest due to their abundant presence in a wide range of natural sources and their remarkable biological activity. These compounds occur naturally in green leafy vegetables, fruits, herbs, animal and marine sources, and fermented products, and have demonstrated promising potential for use in health interventions, particularly in the prevention and management of type 2 diabetes (T2DM). This review aims to investigate the potential of quinones as a health intervention for T2DM from the multidimensional perspective of their sources, types, structure-activity relationship, glucose-lowering mechanism, toxicity reduction, and bioavailability enhancement. Emerging research highlights the hypoglycemic activities of quinones, mainly driven by their redox properties, which lead to covalent binding, and their structural substituent specificity, which leads to their non-covalent binding to biocomplexes. Quinones can improve insulin resistance and regulate glucose homeostasis by modulating mitochondrial function, inflammation, lipid profile, gastrointestinal absorption, and by acting as insulin mimetics. Meanwhile, increasing attention is being given to research focused on mitigating the toxicity of quinones during administration and enhancing their bioavailability. This review offers a critical foundation for the development of quinone-based health therapies and functional foods aimed at diabetes management.

Costs and Healthcare Utilization of Heart Disease by COVID-19 Diagnosis and Race and Ethnicity

Introduction

Heart disease poses a significant health and economic burden in the U.S., with considerable variations in outcomes across different racial and ethnic groups. The COVID-19 pandemic has further highlighted the disparities in healthcare utilization and costs associated with heart disease.

Methods

The authors used the 2021 Merative MarketScan Medicaid claims database to estimate the medical costs and healthcare utilization associated with heart disease by racial and ethnic groups and COVID-19 diagnosis status. This study focused on individuals aged ≥18 years continuously enrolled in a noncapitated insurance plan in 2021. The outcome measures included total medical expenditures and healthcare utilization, including the numbers of emergency department visits and inpatient admissions and length of inpatient stay. The authors employed a generalized linear model with a family of gamma and log links for medical costs, and a negative binomial regression was used for healthcare utilization. Three-way interactions of heart disease, COVID-19 diagnosis, and race and ethnicity categories were implemented after adjusting for age, sex, and comorbidities. The authors reported average marginal effects with 95% CIs.

Results

Among 1,008,166 Medicaid beneficiaries, 8% had heart disease in 2021. The cost associated with heart disease was $10,819 per beneficiary in 2021 (95% CI=10,292; 11,347; p<0.001). The cost was $15,840 (95% CI=14,389; 17,291; p<0.001) for non-Hispanic Black individuals; $9,945 (95% CI=9,172; 10,718; p<0.001) for non-Hispanic White; and $8,511 (95% CI=7,490; 9,531; p<0.001) for Hispanic individuals. Individuals with a COVID-19 diagnosis ($19,638) had $9,541 (95% CI=7,049; 12,032; p<0.001) higher costs associated with heart disease than those without COVID-19 ($10,098) (p<0.001). Individuals with heart disease had higher numbers of emergency department visits (0.937 per beneficiary, 95% CI=0.913; 0.960), inpatient admissions (0.463 per beneficiary, 95% CI=0.455; 0.471), and average length of stay (2.541 days per admission, 95% CI=2.405; 2.677) than those without heart disease.

Conclusions

The study's findings showed that costs and healthcare utilization associated with heart disease are substantial in all racial and ethnic groups and the highest among non-Hispanic Black individuals. Furthermore, individuals with a COVID-19 diagnosis had approximately 2 times higher costs associated with heart disease than individuals without a COVID-19 diagnosis.

Cerebromicrovascular mechanisms contributing to long COVID: implications for neurocognitive health

Long COVID (also known as post-acute sequelae of SARS-CoV-2 infection [PASC] or post-COVID syndrome) is characterized by persistent symptoms that extend beyond the acute phase of SARS-CoV-2 infection, affecting approximately 10% to over 30% of those infected. It presents a significant clinical challenge, notably due to pronounced neurocognitive symptoms such as brain fog. The mechanisms underlying these effects are multifactorial, with mounting evidence pointing to a central role of cerebromicrovascular dysfunction. This review investigates key pathophysiological mechanisms contributing to cerebrovascular dysfunction in long COVID and their impacts on brain health. We discuss how endothelial tropism of SARS-CoV-2 and direct vascular infection trigger endothelial dysfunction, impaired neurovascular coupling, and blood-brain barrier disruption, resulting in compromised cerebral perfusion. Furthermore, the infection appears to induce mitochondrial dysfunction, enhancing oxidative stress and inflammation within cerebral endothelial cells. Autoantibody formation following infection also potentially exacerbates neurovascular injury, contributing to chronic vascular inflammation and ongoing blood-brain barrier compromise. These factors collectively contribute to the emergence of white matter hyperintensities, promote amyloid pathology, and may accelerate neurodegenerative processes, including Alzheimer's disease. This review also emphasizes the critical role of advanced imaging techniques in assessing cerebromicrovascular health and the need for targeted interventions to address these cerebrovascular complications. A deeper understanding of the cerebrovascular mechanisms of long COVID is essential to advance targeted treatments and mitigate its long-term neurocognitive consequences.

An Overview of Real-World Data Infrastructure for Cancer Research

AIMS

There is increasing interest in the opportunities offered by Real World Data (RWD) to provide evidence where clinical trial data does not exist, but access to appropriate data sources is frequently cited as a barrier to RWD research. This paper discusses current RWD resources and how they can be accessed for cancer research.

MATERIALS AND METHODS

There has been significant progress on facilitating RWD access in the last few years across a range of scales, from local hospital research databases, through regional care records and national repositories, to the impact of federated learning approaches on internationally collaborative studies. We use a series of case studies, principally from the UK, to illustrate how RWD can be accessed for research and healthcare improvement at each of these scales.

RESULTS

For each example we discuss infrastructure and governance requirements with the aim of encouraging further work in this space that will help to fill evidence gaps in oncology.

CONCLUSION

There are challenges, but real-world data research across a range of scales is already a reality. Taking advantage of the current generation of data sources requires researchers to carefully define their research question and the scale at which it would be best addressed.

Exploring diabetes through the lens of AI and computer vision: Methods and future prospects

Early diagnosis and timely initiation of treatment plans for diabetes are crucial for ensuring individuals' well-being. Emerging technologies like artificial intelligence (AI) and computer vision are highly regarded for their ability to enhance the accessibility of large datasets for dynamic training and deliver efficient real-time intelligent technologies and predictable models. The application of AI and computer vision techniques to enhance the analysis of clinical data is referred to as eHealth solutions that employ advanced approaches to aid medical applications. This study examines several advancements and applications of machine learning, deep learning, and machine vision in global perception, with a focus on sustainability. This article discusses the significance of utilizing artificial intelligence and computer vision to detect diabetes, as it has the potential to significantly mitigate harm to human life. This paper provides several comments addressing challenges and recommendations for the use of this technology in the field of diabetes. This study explores the potential of employing Industry 4.0 technologies, including machine learning, deep learning, and computer vision robotics, as effective tools for effectively dealing with diabetes related aspects.

Innovations in quantitative rapid testing: Early prediction of health risks

As health monitoring becomes increasingly intricate, the demand for innovative solutions to predict and assess health status is more pressing than ever. This review focuses on the transformative potential of multi-sensor technologies in health monitoring, emphasizing their role in early health status prediction. By integrating diverse sensor types ranging from wearable fitness trackers to implantable devices and environmental monitors healthcare professionals can gain a richer, more nuanced understanding of an individual's physiological state. We analyze various configurations of multi-sensor networks and their efficacy in identifying early indicators of health issues, such as cardiovascular diseases, diabetes, and respiratory ailments. For example, the combination of biometric sensors that track vital signs with environmental data on pollutants can yield invaluable insights into a patient's overall health. This integrated approach not only improves the accuracy of health assessments but also facilitates timely interventions. Furthermore, we address the challenges inherent in multi-sensor systems, including data integration, device interoperability, and the need for advanced algorithms capable of processing complex datasets. Recent advancements in machine learning and artificial intelligence are underscored as pivotal in enhancing the capabilities of these technologies for predictive health analytics. Ultimately, this review highlights how multi-sensor systems can redefine early health status prediction, paving the way for proactive healthcare strategies that significantly improve patient outcomes and optimize healthcare delivery.

Network pharmacology-based study on the mechanism of Tangfukang formula against type 2 diabetes mellitus

OBJECTIVE

To explore the mechanism of Tangfukang formula (, TFK) in treating type 2 diabetes mellitus (T2DM).

METHODS

We employed network pharmacology combined with experimental validation to explore the potential mechanism of TFK against T2DM. Initially, we filtered bioactive compounds with the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and Symptom Mapping (SymMap), and gathered targets of TFK and T2DM. Subsequently, we constructed a protein-protein interaction (PPI) network, enriched core targets through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), and adopted molecular docking to study the binding mode of compounds and the signaling pathway. Finally, we employed a KKAy mice model to investigate the effect and mechanism of TFK against T2DM. Biochemical assay, histology assay, and Western blot (WB) were used to assess the mechanism.

RESULTS

There were 492 bioactive compounds of TFK screened, and 1226 overlapping targets of TFK against T2DM identified. A compound-T2DM-related target network with 997 nodes and 4439 edges was constructed. KEGG enrichment analysis identified some core pathways related to T2DM, including adenosine 5-monophosphate-activated protein kinase (AMPK) signaling pathway. Molecular docking study revealed that compounds of TFK, including citric acid, could bind to the active pocket of AMPK crystal structure with free binding energy of －4.8, －8 and －7.9, respectively. Animal experiments indicated that TFK decreased body weight, fasting blood glucose, fasting serum insulin, homeostasis model of insulin resistance, glycosylated serum protein, total cholesterol, triglyceride, and low-density lipoprotein cholesterol, and improve oral glucose tolerance test results. TFK reduced steatosis in liver tissue, and infiltration of inflammatory cells, and protected liver cells to a certain extent. WB analysis revealed that, TFK upregulated the phosphorylation of AMPK and branched-chain α-ketoacid dehydrogenase proteins.

CONCLUSION

TFK has the potential to effectively manage T2DM, possibly by regulating the AMPK signaling pathway. The present study lays a new foundation for the therapeutic application of TFK in the treatment of T2DM.

Perceptions of healthcare professionals and patients with cardiovascular diseases on mHealth lifestyle apps: A qualitative study

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death globally and is predominantly associated with a cluster of lifestyle risk factors. Mobile health (mHealth) apps offer the potential to overcome traditional barriers by supporting healthy lifestyle behaviours. However, knowledge about perceptions of mHealth lifestyle apps among healthcare professionals and people with CVD is sparse. This study examined barriers and facilitators of using the mHealth apps for healthy lifestyle support among healthcare professionals and CVD patients.

METHODS

We conducted an in-depth qualitative study employing individual semi-structured interviews with 8 CVD healthcare professionals and 4 patients with CVD in Australia. Participants were asked open-ended questions about their perceptions and experiences with mHealth lifestyle apps. A thematic analysis approach was used to establish perceived barriers and facilitators for mHealth lifestyle apps.

RESULTS

Most participants perceived mHealth lifestyle apps as useful. The key perceptions of facilitators included features for tailoring to personal needs, low costs and wide availability of the apps and addressing barriers to use like reminders. Both healthcare professionals and patients identified the strengths and weaknesses regarding the usefulness of mHealth lifestyle apps. Healthcare professionals and patients perceived several barriers to mHealth app use including trustworthiness, scientific validity, language barriers, the capability of using an app or digital literacy, costs for some commercial apps, and accessibility of an app for low-income groups.

CONCLUSION

Lifestyle apps provide an opportunity for better patient and healthcare professional communications, however, several barriers including improving digital health literacy and scientific validations of the apps are required before being recommended in clinical practice. Findings from this study can inform potential mHealth lifestyle app design to meet the demands of users. Addressing these barriers effectively can enhance the adoption and efficacy of mHealth apps, ultimately contributing to improved CVD management and healthier lifestyle behaviours.

Mechanism of mTOR/RILP-regulated autophagic flux in increased susceptibility to myocardial ischemia-reperfusion in diabetic mice

Background

The increased myocardial vulnerability that occurs in diabetic patients following an ischemia-reperfusion injury (I/RI) represents a significant perioperative safety risk. A comprehensive understanding of the intrinsic mechanisms underlying this phenomenon is therefore of paramount importance.

Purposes

The objective of this study is to investigate the potential mechanism of action between impaired autophagic flux and increased vulnerability in diabetic myocardium. This will provide a foundation for the clinical search for effective preventive and curative measures.

Methods

The transcriptomic alterations in autophagy-related genes following myocardial exposure to I/RI were analyzed by single-cell sequencing. This was followed by the validation of potential mechanisms of action between impaired autophagic flux and increased susceptibility at the cellular and animal levels, respectively.

Results

After I/RI in diabetic myocardium, there was a significant increase in the number of CM1 subgroups and a specific downregulation of 239 autophagy-related genes led by RILP. HE staining revealed that myocardial injury was exacerbated in diabetic mice subjected to I/RI. Transmission electron microscopy revealed that the accumulation of autophagic vesicles in cardiomyocytes of diabetic mice resulted in impaired autophagic flux. qRT-PCR revealed that the expression of RILP was significantly reduced in diabetic mice subjected to I/RI. WB showed that P62 was significantly increased and RILP was significantly decreased in diabetic mice subjected to I/RI compared to healthy mice. Inhibition of mTOR during hypoxia/reoxygenation (H/R) injury restored RILP expression and attenuated cellular injury in cardiomyocytes cultured with high glucose.

Conclusion

Following I/RI in diabetic myocardium, an increase in the CM1 subpopulation and a reduction in RILP expression result in impaired autophagic flux. Regulation of the mTOR/RILP pathway can restore impaired autophagic flux and improve myocardial vulnerability, thereby exerting cardioprotective effects.

Intestinal neutrophil extracellular traps promote gut barrier damage exacerbating endotoxaemia, systemic inflammation and progression of diabetic retinopathy in type 2 diabetes

AIMS/HYPOTHESIS

Within the small intestine, neutrophils play an integral role in preventing bacterial infection. Upon interaction with bacteria or bacteria-derived antigens, neutrophils initiate a multi-staged response of which the terminal stage is NETosis, formation of protease-decorated nuclear DNA into extracellular traps. NETosis has a great propensity to elicit ocular damage and has been associated with diabetic retinopathy and diabetic macular oedema (DME) progression. Here, we interrogate the relationship between gut barrier dysfunction, endotoxaemia and systemic and intestinal neutrophilia in diabetic retinopathy.

METHODS

In a cohort of individuals with type 2 diabetes (n=58) with varying severity of diabetic retinopathy and DME, we characterised the abundance of circulating neutrophils by flow cytometry and markers of gut permeability and endotoxaemia by plasma ELISA. In a mouse model of type 2 diabetes, we examined the effects of diabetes on abundance and function of intestinal, blood and bone marrow neutrophils, gut barrier integrity, endotoxaemia and diabetic retinopathy severity. Pharmacological inhibition of NETosis was achieved by i.p. injection of the peptidyl arginine deiminase 4 inhibitor (PAD4i) GSK484 daily for 4 weeks between 6 and 7 months of type 2 diabetes.

RESULTS

In human participants, neutrophilia was unique to individuals with type 2 diabetes with diabetic retinopathy and DME and was accompanied by heightened circulating markers of gut permeability. At late-stage diabetes, neutrophilia and gut barrier dysfunction were seen in db/db mice. The db/db mice exhibited an increase in stem-like pre-neutrophils in the intestine and bone marrow and a decrease in haematopoietic vascular reparative cells. In the db/db mouse intestine, enhanced loss of gut barrier integrity was associated with elevated intestinal NETosis. Inhibition of NETosis by the PAD4i GSK484 resulted in decreased abundance of premature neutrophils in the intestine and blood and resulted in neutrophil retention in the bone marrow compared with vehicle-treated db/db mice. Additionally, the PAD4i decreased senescence within the gut epithelium and yielded a slowing of diabetic retinopathy progression.

CONCLUSIONS/INTERPRETATION

Severity of diabetic retinopathy and DME were associated with peripheral neutrophilia, gut barrier dysfunction and endotoxaemia in the human participants. db/db mice exhibited intestinal neutrophilia, specifically stem-like pre-neutrophils, which was associated with elevated NETosis and decreased levels of vascular reparative cells. Chronic inhibition of NETosis in db/db mice reduced intestinal senescence and NETs in the retina. These changes were associated with reduced endotoxaemia and an anti-inflammatory bone marrow milieu with retention of pre-neutrophils in the bone marrow and increased gut infiltration of myeloid angiogenic cells. Collectively, PAD-4i treatment decreased gut barrier dysfunction, restoring physiological haematopoiesis and levels of haematopoietic vascular reparative cells.

Impact of Exercise Manual Program on Biochemical Markers in Sedentary Prediabetic Patients: A Randomized Controlled Trial

Background and Objectives: Prediabetes is a medical disease characterized by elevated blood sugar levels that exceed normal levels but do not meet the criteria for a diagnosis of diabetes mellitus. This study aimed to assess the impact of structured exercise manual interventions on the biochemical markers of sedentary prediabetic patients over sixteen weeks. Materials and Methods: A sixteen-weeks randomized controlled trial was conducted to assess the impact of an exercise-based manual program on biochemical markers, such as HbA1c, insulin sensitivity measures, and lipid profiles, in sedentary individuals with prediabetes. The Riphah Rehabilitation Center in Lahore, Pakistan, was the site of the trial. In this investigation, 126 individuals with prediabetes were randomly assigned to three groups: control, unsupervised, and supervised. The RCT was completed by 36 participants in each group after a 16-weeks intervention in the supervised and unsupervised groups, as well as a follow-up in the control group. An activity-based exercise manual that included dietary guidelines, educational materials, and an exercise routine was followed by both the supervised and unsupervised groups. The exercise interventions included both aerobic and resistance components. Results: The results indicated that the supervised group exhibited a substantial increase in insulin sensitivity, lipid profiles, and glycemic control when contrasted with the unsupervised and control groups. Significant improvements were observed in key biochemical parameters, including fasting blood levels (supervised as compared to unsupervised and control, respectively, the mean difference was 12.82 mg/dL vs. 11.36 mg/dL vs. 0.09 mg/dL p > 0.001), HbA1c (supervised as compared to unsupervised and control groups, respectively, the mean difference was 0.67% vs. 0.69% vs. 0.13% p < 0.001), and lipid profile (triglycerides (mean difference 0.25 mmol/L, 0.08 mmol/L, 0.11 mmol/L p < 0.001); LDL (mean difference 19.31 mg/dL, 10.51 mg/dL, 2.49 mg/dL p < 0.001); HDL (mean difference -12.68 mg/dL, -8.03 mg/dL, -1.48 mg/dL p < 0.001)). In comparison to the unsupervised and control groups, the insulin sensitivity parameters also demonstrated a modest improvement in the supervised group. The supervised group exhibited the greatest benefits from exercise among the groups that received exercise interventions. Conclusions: The present investigation demonstrated the significance of including structured physical activity into the regular routine of individuals with prediabetes, to decelerate the advancement of prediabetes to type 2 diabetes mellitus (T2DM). The current study emphasizes the essential role of structured exercise routines in the control of prediabetes and suggests that monitoring enhances the adherence and effectiveness of lifestyle interventions.

Association between novel anthropometric indices and overactive bladder: a population-based study

Background

Abdominal obesity is recognized as a key risk factor for developing OAB. However, traditional measures of obesity, such as the waist-to-height ratio (WHtR), waist circumference, and body mass index (BMI), may not sufficiently capture fat distribution in the body. This study aims to evaluate the relationship between novel anthropometric indices and OAB, providing a more accurate assessment of obesity-related risk factors.

Methods

The National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2018 were utilized, comprising 27,560 participants. To assess the association and discriminative ability of novel anthropometric indices, including the Body Roundness Index (BRI), A Body Shape Index (ABSI), Waist-to-Weight Index (WWI), and Relative Fat Mass (RFM), with OAB, we employed multivariable logistic regression, restricted cubic spline (RCS) analysis, subgroup analysis, and receiver operating characteristic (ROC) curve methods.

Results

Multivariable logistic regression analysis indicated that higher levels of novel anthropometric indices were positively associated with OAB prevalence. One z-score increase in WWI, BRI, RFM, and ABSI was associated with a 16, 31, 57, and 5% higher likelihood of OAB, respectively. RCS analysis revealed a non-linear relationship between RFM and OAB. ROC analysis indicated that WWI (AUC = 0.680) and RFM (AUC = 0.661) provided better diagnostic accuracy than traditional measures such as BMI (AUC = 0.599). Subgroup analyses supported the robustness of these findings.

Conclusion

Novel anthropometric indices were positively associated with OAB prevalence. WWI and RFM demonstrated significantly better diagnostic value for OAB than BMI and WHtR. Future studies should investigate the potential of combining multiple anthropometric indices to improve predictive accuracy and conduct prospective studies to determine causality.

Understanding the Prevalence of Medial Arterial Calcification Among Complex Reconstructive Patients: Insights from a Decade of Experience at a Tertiary Limb Salvage Center

Background: Medial arterial calcification (MAC), a distinct form of vascular pathology frequently coexisting with peripheral arterial disease (PAD), poses unique challenges in limb salvage among patients with diabetes, chronic kidney disease, and end-stage renal disease. This study examines the incidence of MAC and its impact on limb salvage outcomes over a decade of experience at a tertiary limb salvage center. Methods: A retrospective review of all complex lower extremity (LE) reconstructions using local flap (LF) or free tissue transfer (FTT), performed from July 2011 to September 2022, was conducted. Patients were classified into MAC and No MAC groups based on pedal radiography evaluations using the Ferraresi MAC scoring system. The primary outcomes were major lower extremity amputation (MLEA), the need for postoperative vascular intervention, major adverse limb events (MALE; defined as the composite of any unplanned reoperation, MLEA, or postoperative revascularization attempt), and mortality. Results: During the study period, a total of 430 LE reconstructions were performed with LF or FTT. A total of 323 cases (75.1%) demonstrated no MAC while the remaining 107 (24.9%) demonstrated MAC. The MAC group exhibited significantly higher rates of diabetes, PAD, and renal disease. With a follow-up duration of 17.0 (IQR: 33.9) months, the MAC group demonstrated a significantly higher rate of MLEA (24.3% vs. 13.0%, p = 0.006), postoperative vascular intervention (23.4% vs. 8.7%, p < 0.001), MALE (57.0% vs. 25.7%, p < 0.001), and mortality (28.0% vs. 9.9%, p < 0.001). Multivariate analysis identified MAC as independently predictive of MALE (OR: 1.8, CI: 1.1-3.0, p = 0.033). Conclusion: MAC is prevalent among surgical candidates for limb salvage. Patients with MAC represent a significant medical and reconstructive challenge. Radiographic screening for MAC should be considered in all limb salvage candidates with LE wounds, especially in those with diabetes and kidney disease. Assessing MAC is important for better evaluating risk factors and surgical options so as to optimize outcomes in this challenging population.