A review of the last decade: pancreatic cancer and type 2 diabetes

Pancreatic cancer (PC) is a prevalent gastrointestinal tumour known for its high degree of malignancy, resulting in a mere 10% five-year survival rate for most patients. Over the past decade, a growing body of research has shed light on the intricate bidirectional association between PC and Type 2 diabetes (T2DM). The collection of PC- and T2DM-related articles is derived from two comprehensive databases, namely WOS (Web of Science Core Collection) and CNKI (China National Knowledge Infrastructure). This article discusses the last 10 years of research trends in PC and T2DM and explores their potential regulatory relationship as well as related medications.

Estimation of the proportion of cardiovascular disease cases in France attributable to high concentrations of low-density lipoprotein cholesterol

BACKGROUND

Elevated concentrations of low-density lipoprotein cholesterol (LDL-C) are highly prevalent and are associated with the development of cardiovascular diseases.

AIM

To estimate the proportion of cardiovascular disease cases attributable to high concentrations of LDL-C (population attributable fraction [PAF]) in France in 2017, based on the most recent individual data on LDL-C, and the attributable burden on hospitalizations and death.

METHODS

We estimated the PAF of high LDL-C concentrations for ischaemic heart disease (IHD), ischaemic stroke and aortic valve stenosis (AVS). Distributions of LDL-C concentrations were obtained from the most recent French health examination representative survey (ESTEBAN). The relative risks of each disease per 1-mmol/L increase in blood LDL-C were obtained either from the most appropriate meta-analyses or from Mendelian randomization.

RESULTS

The PAF of high LDL-C concentrations varied between 44.2% (95% CI 24.6%-60.5%) for IHD-related death and 49.4% (95% CI 35.6-60.8%) for IHD-related years-of-life lost (YLL), 22.5% (95% CI 0.0-43.3%) and 25.5% (95% CI 11.6-36.8%) for ischaemic stroke indicators, and 29.0% (95% CI 8.6-45.4%) and 29.3% (95% CI 8.4-45.6%) for AVS indicators. Overall, 230,000 hospitalizations, 1,303,000 prevalent cases and 23,000 deaths were estimated to be attributable to high LDL-C concentrations, with most cases related to IHD. PAFs were similar across sex and cardiovascular diseases, whereas PAF strongly varied with age for IHD and ischaemic stroke, with PAF reaching 80.6% (95% CI 55.3-92.7%) and 60.9% (95% CI 33.8-80.8%), respectively, in the group aged 35-44 years.

CONCLUSION

The high estimated PAF of elevated LDL-C concentrations for IHD, ischaemic stroke and AVS support the urgent need to reduce the prevalence of hypercholesterolaemia in this French population.

Prevalence and Cardio-Renal Comorbidities of Masked Hypertension: A Meta-Analysis

AIM

The prognosis of masked hypertension is controversial. The aims of this meta-analysis were to determine the global prevalence of masked hypertension and to better understand its association with the risk of cardiorenal comorbidities and all-cause mortality.

METHODS

We searched the PubMed, Embase (OVID), The Cochrane Library, WanFang Data, and CNKI databases for relevant studies published from inception until January 15, 2024. Cohort studies that reported an association of masked hypertension with the risk of cardiorenal comorbidities and all-cause mortality were eligible for meta-analysis.

RESULTS

Twenty-six studies (with 129,061 participants) were included. The median follow-up duration was 7.38 years. The pooled prevalence of masked hypertension was 18% (95% confidence interval [CI] 15%-21%). Compared with normotensive individuals, those with masked hypertension had an increased risk of all-cause mortality (relative risk [RR] 1.64, 95% CI 1.32-2.04) and incident cardiovascular disease (RR 1.57, 95% CI 1.45-1.69). The results were similar regardless of treatment status and in multiple subgroup analyses. Masked hypertension was also associated with increased risks of cardiovascular mortality (RR 1.69, 95% CI 1.02-2.78) and composite renal outcomes (RR 3.57, 95% CI 2.32-5.50).

CONCLUSION

Masked hypertension is prevalent in adults and associated with increased risks of all-cause mortality, cardiovascular disease, cardiovascular mortality, and composite renal events.

Machine-learning-based prediction of cardiovascular events for hyperlipidemia population with lipid variability and remnant cholesterol as biomarkers

Purpose

Dyslipidemia poses a significant risk for the progression to cardiovascular diseases. Despite the identification of numerous risk factors and the proposal of various risk scales, there is still an urgent need for effective predictive models for the onset of cardiovascular diseases in the hyperlipidemic population, which are essential for the prevention of CVD.

Methods

We carried out a retrospective cohort study with 23,548 hyperlipidemia patients in Shenzhen Health Information Big Data Platform, including 11,723 CVD onset cases in a 3-year follow-up. The population was randomly divided into 70% as an independent training dataset and remaining 30% as test set. Four distinct machine-learning algorithms were implemented on the training dataset with the aim of developing highly accurate predictive models, and their performance was subsequently benchmarked against conventional risk assessment scales. An ablation study was also carried out to analyze the impact of individual risk factors to model performance.

Results

The non-linear algorithm, LightGBM, excelled in forecasting the incidence of cardiovascular disease within 3 years, achieving an area under the 'receiver operating characteristic curve' (AUROC) of 0.883. This performance surpassed that of the conventional logistic regression model, which had an AUROC of 0.725, on identical datasets. Concurrently, in direct comparative analyses, machine-learning approaches have notably outperformed the three traditional risk assessment methods within their respective applicable populations. These include the Framingham cardiovascular disease risk score, 2019 ESC/EAS guidelines for the management of dyslipidemia and the 2016 Chinese recommendations for the management of dyslipidemia in adults. Further analysis of risk factors showed that the variability of blood lipid levels and remnant cholesterol played an important role in indicating an increased risk of CVD.

Conclusions

We have shown that the application of machine-learning techniques significantly enhances the precision of cardiovascular risk forecasting among hyperlipidemic patients, addressing the critical issue of disease prediction's heterogeneity and non-linearity. Furthermore, some recently-suggested biomarkers, including blood lipid variability and remnant cholesterol are also important predictors of cardiovascular events, suggesting the importance of continuous lipid monitoring and healthcare profiling through big data platforms.

Glucagon-like peptide agonists for weight management in antipsychotic-induced weight gain: A systematic review and meta-analysis

INTRODUCTION

Managing body weight in patients with antipsychotic-induced weight gain (AIWG) is challenging. Besides lifestyle interventions, pharmacological interventions may contribute to weight loss. This systematic review and meta-analysis evaluated the effect on weight loss and adverse effects of glucagon-like peptide-1 (GLP-1) agonists in patients with AIWG.

MATERIALS AND METHODS

Following PRISMA guidelines, we performed a meta-analysis of blinded and open-label randomised controlled trials (RCTs), non-randomised controlled trials and cohort studies that evaluated treatment with GLP-1 in patients with AIWG, regardless of psychiatric diagnosis. PubMed, Embase, PsycINFO and Cochrane Library databases were searched. Primary outcome measures were changes in body weight and BMI. Secondary outcomes were changes in adverse effects and severity of psychopathology due to GLP-1 agonists.

RESULTS

Only data for exenatide and liraglutide could be included, that is, five RCTs and one cohort study. For exenatide the mean weight loss was -2.48 kg (95% Confidence Interval (CI) -5.12 to +0.64; p = 0.07), for liraglutide the mean weight loss was -4.70 kg (95% CI -4.85 to -4.56; p < 0.001). The mean change in BMI was -0.82 (95% CI -1.56 to -0.09; p = 0.03) in the exenatide groups and -1.52 (95% CI -1.83 to -1.22; p < 0.001) in the liraglutide groups. Exenatide and liraglutide did not adversely affect psychopathology. The most common adverse events were nausea, vomiting, and diarrhoea.

CONCLUSION

The GLP-1 agonists exenatide and liraglutide are promising drugs for inducing weight loss in patients with AIWG. The adverse effects are acceptable, and the addition of GLP-1 does not increase the severity of psychopathology. However, more research is needed.

Low serum Metrnl levels are associated with increased risk of sarcopenia in the older adults

PURPOSE

Sarcopenia is a geriatric syndrome characterized by progressive loss of muscle mass and function. Meteorin-like (Metrnl) is a secretory protein that has protective effects on skeletal muscle injury. However, the association of Metrnl level with sarcopenia remains unclear.

METHODS

A total of 772 community-dwelling older adults (median age = 76 years), comprising 409 males and 363 females, from both urban and rural areas were enrolled. Serum Metrnl was measured by enzyme-linked immunosorbent assay. Appendicular skeletal muscle mass index (ASMI), grip strength, and gait speed were measured for the assessment of sarcopenia.

RESULTS

We found that serum Metrnl levels were lower in patients with sarcopenia [median (IQR) = 180.1 (151.3-220.3) pg/mL] than older adults without sarcopenia [211.9 (163.2-270.0) pg/mL, P < 0.001]. Receiver-operating characteristic curve analysis showed that the optimal cut-off value of serum Metrnl level that predicted sarcopenia was 197.2 pg/mL with a sensitivity of 59.2% and a specificity of 63.8% (AUC = 0.63, 95% CI = 0.59-0.67, P < 0.001). Multivariate logistic regression analyses showed that lower serum Metrnl level (< 197.2 pg/mL) was significantly associated with increased risk of sarcopenia (adjusted OR = 2.358, 2.36, 95% CI = 1.528-3.685, P < 0.001). Moreover, serum Metrnl concentration was positively correlated with the components of sarcopenia including ASMI (r = 0.135, P < 0.001), grip strength (r = 0.102, P = 0.005), and gait speed (r = 0.106, P = 0.003).

CONCLUSIONS

Taken together, our findings demonstrate that low serum Metrnl level is correlated with increased risk of sarcopenia in the older adults.

Analysis of non-targeted serum metabolomics in patients with chronic kidney disease and hyperuricemia

Hyperuricemia (HUA) is a common complication of chronic kidney disease (CKD). Conversely, HUA can promote the disease progression of CKD. However, the molecular mechanism of HUA in CKD development remains unclear. In the present study, we applied ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) to analyze the serum metabolite profiling of 47 HUA patients, 41 non-hyperuricemic CKD (NUA-CKD) patients, and 51 CKD and HUA (HUA-CKD) patients, and then subjected to multivariate statistical analysis, metabolic pathway analysis and diagnostic performance evaluation. Metabolic profiling of serums showed that 40 differential metabolites (fold-change threshold (FC) > 1.5 or<2/3, variable importance in projection (VIP) > 1, and p < 0.05) were screened in HUA-CKD and HUA patients, and 24 differential metabolites (FC > 1.2 or<0.83, VIP>1, and p < 0.05) were screened in HUA-CKD and NUA-CKD patients. According to the analysis of metabolic pathways, significant changes existed in three metabolic pathways (compared with the HUA group) and two metabolic pathways (compared with the HUA-CKD group) in HUA-CKD patients. Glycerophospholipid metabolism was a significant pathway in HUA-CKD. Our findings show that the metabolic disorder in HUA-CKD patients was more serious than that in NUA-CKD or HUA patients. A theoretical basis is provided for HUA to accelerate CKD progress.

Chinese expert consensus on the management of hypertension in adults with type 2 diabetes

Both hypertension and type 2 diabetes are attributable to premature death, cardiovascular and kidney diseases with largely overlapping population. Followed the GRADE approach, this expert consensus aimed to reduce the cardiovascular and kidney death and disability due to hypertension and minimize the treatment burden in adults with type 2 diabetes. Through online survey and discussion, a multidisciplinary team comprehensively prioritized seven key guideline questions. Informed by the evidence synthesis and online discussion, the team developed 12 recommendations under the GRADE Evidence-to-decision (EtD) framework. The recommendations covered the screening of hypertension in adults diagnosed with type 2 diabetes but not hypertension and the monitoring, lifestyle interventions, and medications in those diagnosed with type 2 diabetes and hypertension.

Survodutide for the Treatment of Obesity: Rationale and Design of the SYNCHRONIZE Cardiovascular Outcomes Trial

Dual agonism of glucagon and glucagon-like peptide-1 (GLP-1) receptors may be more effective than GLP-1 receptor agonism alone in reducing body weight, but the cardiovascular (CV) effects are unknown. The authors describe the rationale and design of SYNCHRONIZE-CVOT, a phase 3, randomized, double-blind, parallel-group, event-driven, CV safety study of survodutide, a dual glucagon and GLP-1 receptor agonist, administered subcutaneously once weekly compared with placebo in adults with a body mass index ≥27 kg/m2 and established CV disease or chronic kidney disease, and/or at least 2 weight-related complications or risk factors for CV disease. The primary endpoint of SYNCHRONIZE-CVOT is time to first occurrence of the composite adjudicated endpoint of 5-point major adverse CV events. This global CV outcomes trial is currently enrolling, with a target recruitment of 4,935 participants. SYNCHRONIZE-CVOT is the first trial that will determine the CV safety and efficacy of survodutide in people with obesity and increased CV risk. (A Study to Test the Effect of Survodutide [BI 456906] on Cardiovascular Safety in People With Overweight or Obesity [SYNCHRONIZE-CVOT]; NCT06077864).

SGLT2 inhibitors as a potential therapeutic option for pulmonary hypertension: mechanisms and clinical perspectives

Pulmonary arterial hypertension (PAH), one subtype of pulmonary hypertension (PH), is a life-threatening condition characterized by pulmonary arterial remodeling, elevated pulmonary vascular resistance, and blood pressure in the pulmonary arteries, leading to right heart failure and increased mortality. The disease is marked by endothelial dysfunction, vasoconstriction, and vascular remodeling. The role of Sodium-Glucose Co-Transporter-2 (SGLT2) inhibitors, a class of medications originally developed for diabetes management, is increasingly being explored in the context of cardiovascular diseases, including PAH, due to their potential to modulate these pathophysiological processes. In this review, we systematically examine the burgeoning evidence from both basic and clinical studies that describe the effects of SGLT2 inhibitors on cardiovascular health, with a special emphasis on PAH. By delving into the complex interactions between these drugs and the potential pathobiology that underpins PH, this study seeks to uncover the mechanistic underpinnings that could justify the use of SGLT2 inhibitors as a novel therapeutic approach for PAH. We collate findings that illustrate how SGLT2 inhibitors may influence the normal function of pulmonary arteries, possibly alleviating the pathological hallmarks of PAH such as inflammation, oxidative stress, aberrant cellular proliferation, and so on. Our review thereby outlines a potential paradigm shift in PAH management, suggesting that these inhibitors could play a crucial role in modulating the disease's progression by targeting the potential dysfunctions that drive it. This comprehensive synthesis of existing research underscores the imperative need for further clinical trials to validate the efficacy of SGLT2 inhibitors in PAH and to integrate them into the therapeutic agents used against this challenging disease.

Effects of once-weekly subcutaneous retatrutide on weight and metabolic markers: A systematic review and meta-analysis of randomized controlled trials

Aim

To assess the effects of once-weekly subcutaneous retatrutide on weight and metabolic markers and the occurrence of side effects in patients with overweight, obesity and/or type 2 diabetes (T2D).

Methods

PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were systematically searched for placebo-controlled, randomized clinical trials (RCTs) published up until February 23, 2024. Weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for binary endpoints were computed, with 95 % confidence intervals (CIs).

Results

A total of three studies were included, comprising 640 patients, of whom 510 were prescribed retatrutide. Compared with placebo, retatrutide significantly reduced body weight (WMD -10.66 kg; 95 % CI -17.63, -3.69), body mass index (WMD -4.53 kg/m2; 95 % CI -7.51, -1.55), and waist circumference (WMD -6.61 cm; 95 % CI -13.17, -0.05). In addition, retatrutide significantly increased the proportion of patients who achieved a weight reduction of ≥5 % (RR 2.92; 95 % CI 2.17-3.93), ≥10 % (RR 9.32; 95 % CI 4.56-19.06), ≥15 % (RR 18.40; 95 % CI 6.00-56.42), and ≥20 % (RR 16.61; 95 % CI 4.17-66.12).

Conclusions

In this meta-analysis, the use of once-weekly subcutaneous retatrutide was associated with a significant reduction in body weight and improvement of metabolic markers in patients with overweight, obesity and/or T2D, compared with placebo, with an increase in non-severe gastrointestinal and hypersensitivity adverse events. Phase 3 RCTs are expected to shed further light on the efficacy and safety of once-weekly subcutaneous retatrutide over the long term.

Use of continuous glucose monitoring when initiating glucagon-like peptide-1 receptor agonist therapy in insulin-treated diabetes

Glucagon-like peptide-1 receptor agonist (GLP-1RA) medications have been shown to be effective in achieving optimal glucose control and reducing all-cause death, cardiovascular death, nonfatal myocardial infarction, hospitalization for heart failure, and end-stage kidney disease in individuals with type 1 (T1D) and type 2 diabetes (T2D). However, use of these medications has been associated with increased hypoglycaemia risk in patients treated with concomitant antihyperglycaemic medications. The risk is particularly high in patients with T1D due to their loss of glucagon counter-regulatory response. This article reviews the effect of GLP-1RA formulations on the development of hypoglycaemia in individuals with T1D and T2D treated with insulin therapy, discusses the benefits of continuous glucose monitoring with GLP-1RA treatment, and presents strategies for safely initiating GLP-1RA therapy in these individuals.

Association between sarcopenia and urinary dysfunction in patients with dysphagia

INTRODUCTION

The objective was to determine the relationship between sarcopenia and urinary dysfunction in patients with dysphagia.

MATERIAL AND METHODS

A cross-sectional study was conducted on 460 Japanese Sarcopenic Dysphagia Database participants. Urinary dysfunction was defined as either urinary incontinence or urethral catheter use. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Univariate and multivariate analyses assessed the association between urinary dysfunction and sarcopenia, calf circumference (CC), handgrip strength (HGS), and Barthel Index (BI). Logistic regression analysis was performed for urinary dysfunction adjusted for age, sex, setting, and CCI in addition to BI and HGS or CC or sarcopenia (model 1) or FILS and BI (model 2).

RESULTS

The mean age was 80.8 ± 10.5 years and urinary dysfunction in 137 participants. Urinary dysfunction was not associated with sarcopenia (123 versus 281, p = 0.440) but was associated with CC (27.4 ± 4.2 versus 28.5 ± 3.9, p = 0.009), HGS (9.7 ± 7.9 versus 14.4 ± 9.3, p < 0.001), and BI (19.9 ± 0.3 versus 20.3 ± 0.2, p < 0.001). Logistic regression analysis showed urinary dysfunction was associated with HGS (OR: 0.968, CI: 0.938, 0.998) and BI (OR: 0.955, CI: 0.943, 0.966). The cutoff was 19 kg for men (sensitivity 0.786, specificity 0.56, Area Under Curve (AUC) 0.689) and 6.1 kg for women (sensitivity 0.493, specificity 0.774, AUC 0.639) in HGS and 27.5 points in BI (sensitivity 0.781, specificity 0.604, AUC 0.740).

CONCLUSION

Sarcopenia was not associated with urinary dysfunction. However, HGS and BI were related to urinary dysfunction.

Sarcopenia: recent advances for detection, progression, and metabolic alterations along with therapeutic targets

Sarcopenia, a disorder marked by muscle loss and dysfunction, is a global health concern, particularly in aging populations. Sarcopenia is intricately related to various health conditions, including obesity, dysphagia, and frailty, which underscores the complexity. Despite recent advances in metabolomics and other omics data for early detection and treatment, the precise characterization and diagnosis of sarcopenia remains challenging. In the present review we provide an overview of the complex metabolic mechanisms that underlie sarcopenia, with particular emphasis on protein, lipid, carbohydrate, and bone metabolism. The review highlights the importance of leucine and other amino acids in promoting muscle protein synthesis and clarifies the critical role played by amino acid metabolism in preserving muscular health. In addition, the review provides insights regarding lipid metabolism on sarcopenia, with an emphasis on the effects of inflammation and insulin resistance. The development of sarcopenia is largely influenced by insulin resistance, especially with regard to glucose metabolism. Overall, the review emphasizes the complex relationship between bone and muscle health by highlighting the interaction between sarcopenia and bone metabolism. Furthermore, the review outlines various therapeutic approaches and potential biomarkers for diagnosing sarcopenia. These include pharmacological strategies such as hormone replacement therapy and anabolic steroids as well as lifestyle modifications such as exercise, nutrition, and dietary changes.

One arrow two eagles: Multifunctional nano-system for macrophage reprogramming and osteoclastogenesis inhibition against inflammatory osteolysis

Inflammatory osteolysis poses a significant worldwide threat to public health. However, current monotherapies, which target either the prevention of the inflammatory response or the attenuation of osteoclast (OC) formation, have limited efficacy due to the complexity of the bone immune system being overlooked. Herein, by means of modifying salmon calcitonin (sCT), a multifunctional nano-system (AuNDs-sCT) was designed to synergistically inhibit OC differentiation and reverse the inflammatory microenvironment against inflammatory osteolysis. On the one hand, AuNDs-sCT effectively restrained OC differentiation by binding to the calcitonin receptors on the surface of OC precursors, resulting in the down-regulation of OC-specific genes and proteins. The targeted capacity of AuNDs-sCT provided a more durable and precise therapeutic effect. On the other hand, AuNDs-sCT exhibited antioxidant and anti-inflammatory effects, which regulated the polarization "switch" from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype in macrophages by the inhibition of NF-κB p65 phosphorylation, thereby effectively reversed the local inflammatory microenvironment. Additionally, AuNDs-sCT served as a promising fluorescent probe, enabling real-time visualization of the therapeutic process. This capability is expected to optimize drug administration and evaluate therapeutic effects. In summary, by inhibiting OC differentiation and reprogramming macrophages, AuNDs-sCT successfully realized drug repurposing and achieved the "one arrow two eagles" therapeutic strategy, which offers a synergistic and effective treatment option for the clinical management of inflammatory osteolysis.

Changes in alanine aminotransferase and body composition and metabolic factors among individuals receiving medical health checkups

AIM

To examine the relationship between changes in alanine aminotransferase (ALT) and those in body composition and metabolic factors in participants receiving medical health checkups (4350 men [mean age 52.5 years] and 5398 women [mean age 50.5 years]) METHODS: We divided the participants into four types based on their ALT value at baseline and 1 year: A, ALT ≤30 (baseline) and ≤30 (1 year); B, ALT ≥31 (baseline) and ≤30 (1 year); C, ALT ≤30 (baseline) and ≥31 (1 year); and D, ALT ≥31 (baseline) and ≥31 (1 year). The change in each body composition-related parameter (waist circumference, fat mass, fat-free mass, fat mass to fat-free mass ratio, etc.) after 1-year was defined as Δ.

RESULTS

The mean changes in waist circumference (cm) in the four types (A, B, C, and D) were -0.33, -1.54, 0.66, and -0.29 (overall p < 0.0001) in men, and -0.19, -0.90, 0.30, and 0.090 (overall p < 0.0001) in women. The mean changes in fat mass (kg) in the four types were -0.027, -0.86, 0.62, and 0.092 (overall p < 0.0001) in men, and 0.0067, -0.48, 0.39, and 0.063 (overall p < 0.0001) in women. The mean changes in fat-free mass (kg) in the four types were -0.028, -0.55, 0.42, and -0.034 (overall p < 0.0001) in men, and -0.0091, -0.34, 0.12, and -0.045 (overall p = 0.0012) in women. The mean changes in fat mass to fat-free mass ratio in the four types were -0.00042, -0.0120, 0.00837, and 0.00171 (overall p < 0.0001) in men, and -0.00013, -0.00817, 0.00730, and 0.00628 (overall p < 0.0001) in women.

CONCLUSION

A decrease in ALT to ≤30 IU/L may be associated with improved body composition balance, but caution should be exercised for the decrease in muscle mass.

Effect of sex on sodium-glucose co-transporter-2 antagonists and glucagon-like peptide-1 agonists in heart failure

BACKGROUND

Recent evidence suggests that medications not primarily targeting the cardiovascular (CV) system may have cardioprotective effects in patients with heart failure (HF), in particular the anti-diabetic therapies sodium-glucose co-transporter-2 (SGLT-2) antagonists and glucagon-like peptide-1 (GLP-1) agonists. We conducted a systematic review to assess the pooled evidence for the use of SGLT-2 antagonists and GLP-1 agonists in patients with HF and the effect of biological sex on the results.

METHODS

MEDLINE, Embase, Cochrane Library and clinical trial databases were searched until February 2023. Randomized controlled trials (RCTs) published in English that included adult participants with HF who were randomized to an SGLT-2 antagonist or GLP-1 agonist with a primary or secondary outcome of HF hospitalization (HFH) or CV death were eligible for inclusion. Data pooling was undertaken using a random effects model and odds ratios (ORs) to determine the association between drug and outcome. Sub-group analyses to investigate sex differences were conducted.

RESULTS

Six RCTs were included (24 781 patients). Four studies investigated SGLT-2 antagonists, and two studies examined GLP-1 agonists. SGLT-2 antagonists improved HFH {OR [95% confidence interval (CI)]: 0.69 [0.63, 0.77], P < 0.001} and CV death [0.87 (0.78, 0.97), P = 0.01] independent of diabetes status, with excellent homogeneity across all four studies. No beneficial effects were found for GLP-1 agonists. The effects of SGLT-2 antagonists on HFH and CV death were similar in men and women [OR (95% CI): HFH, 0.70 (0.64, 0.76), P < 0.001 and 0.58 (0.46, 0.74), P < 0.001, respectively; CV death, 0.86 (0.78, 0.95), P = 0.003 and 0.84 (0.73, 0.96), P = 0.01, respectively], and the neutral effect of GLP-1 agonists on HFH and CV death was similar in men and women (all P > 0.05).

CONCLUSIONS

SGLT-2 antagonists but not GLP-1 agonists beneficially affect HFH and CV death in patients with HF with or without diabetes. We show for the first time that GLP-1 agonists have a neutral effect on HFH and CV death in both male and female HF patients and a reduction in HFH and CV death in male and female HF patients taking SGLT-2 antagonists.

Area deprivation index impact on type 2 diabetes outcomes in a regional health plan

BACKGROUND

Rates of attainment of high-quality diabetes care have been shown to be lower for those living in more disadvantaged and rural areas. Diabetes management relies on access to care and is impacted by physical, social, and economic factors. Area deprivation index (ADI) is one way to quantify geographic disparities in aggregate. We aimed to investigate how ADI impacts outcomes in members with type 2 diabetes enrolled in a large, regional health plan.

OBJECTIVE

To evalute clinical and economic objectives. Clinical objectives included the percentage of members who achieved hemoglobin A1c (A1c) goal level of 7% or less, the percentage of members who received comorbidity-focused therapies, noninsulin diabetes medication adherence, and the frequency and type of health care services used. Economic outcomes included per member per month differences in total cost of care, pharmacy cost, medical cost, and diabetes-associated cost.

METHODS

This retrospective review of pharmacy and medical claims included 8,814 adult members with newly diagnosed type 2 diabetes enrolled in an integrated health plan during calendar year 2021. To be included, members were required to be at least 18 years of age, reside in Pennsylvania, and have continuous enrollment for 2 years prior to type 2 diabetes diagnosis. State-level ADI data were derived for each member and applied to the Census block group on file in the administrative claims data. The study population deciles were grouped into ADI quintiles for analysis. Multivariable regression models and descriptive statistics were used to evaluate the association between ADI and outcomes while controlling for confounding variables.

RESULTS

There were no statistically significant differences between any ADI quintile for achievement of A1c goal or receipt of comorbidity-focused therapy. Significant differences were identified between ADI quintiles 1 (least deprived) and 5 (most deprived) for obtainment of at least 1 A1c test during calendar year 2021 (72% vs 56%, P < 0.01) and adherence to noninsulin diabetes medications (70% vs 62%, P < 0.01). Significant differences were also identified for all-cause inpatient, outpatient, and unplanned health care service utilization. The difference in per member per month all-cause total cost of care was on average $363.50 less for those living in ADI quintile 1 vs those in quintile 5 (P < 0.01).

CONCLUSIONS

Significant differences were identified between ADI quintiles 1 and 5 for noninsulin diabetes medication adherence, frequency of A1c test claims, all-cause health care service utilization, and total cost of care. There were no statistically significant differences between ADI quintiles for achievement of A1c goal or receipt of comorbidity-focused therapies.

A retrospective cohort study of coagulation function in patients with liver cirrhosis receiving cefoperazone/sulbactam with and without vitamin K1 supplementation

BACKGROUND

Cefoperazone/sulbactam is commonly prescribed for the treatment of infected patients with cirrhosis.

AIM

To investigate the effect of cefoperazone/sulbactam on coagulation in cirrhotic patients and assess the effectiveness of vitamin K1 supplementation in preventing cefoperazone/sulbactam-induced coagulation disorders.

METHOD

This retrospective cohort study compared coagulation function in 217 cirrhotic patients who received cefoperazone/sulbactam with and without vitamin K1 supplementation (vitamin K1 group, n = 108; non-vitamin K1 group, n = 109). Propensity score matching (PSM) was used to to reduce confounders' influence, the SHapley additive exPlanations (SHAP) model to explore the importance of each variable in coagulation disorders.

RESULTS

In the non-vitamin K1 group, the post-treatment prothrombin time (PT) was 16.5 ± 6.5 s and the activated partial thromboplastin time (aPTT) was 34.8 ± 9.4 s. These were significantly higher than pre-treatment values (PT: 14.6 ± 2.4 s, p = 0.005; aPTT: 30.4 ± 5.9 s, p < 0.001). In the vitamin K1 group, no differences were observed in PT, thrombin time, or platelet count, except for a slightly elevated post-treatment aPTT (37.0 ± 10.4 s) compared to that of pre-treatment (34.4 ± 7.2 s, p = 0.033). The vitamin K1 group exhibited a lower risk of PT prolongation (OR: 0.211, 95% CI: 0.047-0.678) and coagulation disorders (OR: 0.257, 95% CI: 0.126-0.499) compared to that of the non-vitamin K1 group. Propensity score matching analysis confirmed a reduced risk in the vitamin K1 group for prolonged PT (OR: 0.128, 95% CI: 0.007-0.754) and coagulation disorders (OR: 0.222, 95% CI: 0.076-0.575). Additionally, the vitamin K1 group exhibited lower incidences of PT prolongation, aPTT prolongation, bleeding, and coagulation dysfunction compared to the non-vitamin K1 group.

CONCLUSION

Cefoperazone/sulbactam use may be linked to a higher risk of PT prolongation and coagulation disorders in cirrhotic patients. Prophylactic use of vitamin K1 can effectively reduce the risk.

Muscle Strength Comparison in Immune-Mediated Rheumatic Disease vs Healthy Adults: A Meta-Analysis

OBJECTIVES

Patients with immune-mediated rheumatic diseases (IMRDs) often exhibit reduced muscle strength. Therefore, this review aimed to evaluate muscle strength in patients with IMRDs compared with healthy control and to summarize the relationship between low muscle strength and clinical features in patients with IMRDs.

DESIGN

Systematic review with meta-analysis of case-control studies.

SETTING AND PARTICIPANTS

Patients with IMRDs.

METHODS

A comprehensive search was conducted in the Embase, MEDLINE, Web of Science, and Cochrane databases to identify relevant studies published up to November 2023 on rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and spondyloarthritis. Meta-analysis was performed using a random-effects model to determine the mean difference (MD) in muscle strength between patients with IMRDs and an age- and sex-matched healthy control group.

RESULTS

We identified 11,692 studies, and 760 studies were selected for screening. Ultimately, 26 studies met the inclusion criteria, composed of 2661 individuals, mostly women. The IMRDs women group had lower handgrip muscle strength (MD, -9.53; 95% CI, -11.78 to -7.28 kg) than the healthy control group, whereas the handgrip strength men groups did not differ significantly from that of the healthy control group. Similar trend was observed in lower limb muscle strength for the IMRDs women group than the healthy control group (MD, -63.10; 95% CI, -94.18 to -32.01 Nm). Four studies examined muscle strength and clinical features in rheumatoid arthritis: one associated it with age and disease activity, 2 associated it with disease duration, and 3 associated it with physical function. In systemic lupus erythematosus, only 2 studies associated low muscle strength with age, disease activity, and fatigue. No associations were found in spondyloarthritis, and none were found in systemic sclerosis.

CONCLUSIONS AND IMPLICATIONS

Patients with IMRD exhibit lower muscle strength than healthy counterparts, with low strength moderately associated with longer disease duration, worsening disease activity, and decline in physical function. Targeted interventions are crucial for preventing and managing muscle weakness in IMRDs.

Efficacy of antiobesity medications among breast cancer survivors taking aromatase inhibitors

PURPOSE

Aromatase inhibitors (AI) block estrogen synthesis and are used as long-term adjuvant treatment for breast cancer in postmenopausal women. AI use can be associated with weight gain that can lead to increased cardiometabolic risk. The response to anti-obesity medications (AOM) in patients using AI has yet to be studied. We sought to investigate weight loss outcomes of AOM in patients taking AI for breast cancer treatment.

METHODS

This is a matched retrospective cohort study of breast cancer survivors on AI using AOM (AOM/AI group). We compared their weight loss outcomes with a group of female patients with obesity, without a history of breast cancer or AI use, on AOM (AOM group). The primary endpoint was total body weight loss percentage (TBWL %) at the last follow-up. We performed mixed linear regression models, including diabetes status at baseline, to assess associations between use of AOM with/without AI with total body weight loss percentage (TBWL%).

RESULTS

We included 124 patients: 62 in the AOM/AI group (63.6 ± 10 years, body mass index [BMI] 34.3 ± 7.1 kg/m2) and 62 in the AOM group (62.8 ± 9.9 years, BMI 34.6 ± 6.5 kg/m2). The mean time of follow up was 9.3 ± 3.5 months, with no differences among the two groups. The AOM/AI group had a lower TBWL% compared to the AOM group at the last follow-up -5.3 ± 5.0 vs. -8.2 ± 6.3 (p = 0.005). The results remained significant after adjusting for diabetes status (p = 0.0002). At 12 months, the AOM/AI group had a lower TBWL% compared to the AOM group 6.4 ± 0.8% vs. 9.8 ± 0.9% (p = 0.04). The percentage of patients achieving ≥ 5%, ≥ 10%, and ≥ 15% of weight loss at 12 months was greater in the AOM compared to the AOM/AI group. Although the weight loss response was suboptimal, patients in the AOM/AI group had improvement in fasting glucose, glycated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol.

CONCLUSIONS

The use of AI in breast cancer survivors is associated with less weight loss response to AOM compared to patients without breast cancer history and who do not take AI. Studies are needed to assess the mechanisms behind the differential weight loss response to AOM in women taking AI.

Assessment and Management of Patients with Obesity and Hypertension in European Society of Hypertension Excellence Centres. A survey from the ESH Working Group on Diabetes and Metabolic Risk Factors

BACKGROUND

Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs).

METHODS

We conducted a cross-sectional, international 30-item survey through e-mails.

RESULTS

In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors.

CONCLUSION

Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.

Glucagon-Like Peptide-1 Receptor Agonist Mediated Weight Loss and Diabetes Mellitus Benefits: A Narrative Review

Obesity and type 2 diabetes mellitus (T2DM) are chronic diseases with increasing prevalence, underscoring the urgent need for effective treatment and management strategies. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as an essential class of drugs for managing both obesity and T2DM, offering additional benefits for cardiovascular and kidney health. GLP-1 RAs work by targeting GLP-1 receptors, mimicking the effects of the natural hormone GLP-1 to regulate blood glucose levels, promote weight loss, and provide potential benefits for cardiovascular health. This narrative review evaluates the mechanisms of action, clinical efficacy, and broader roles of GLP-1 RAs in promoting weight loss and glycemic control. In addition, the present investigation explores recent clinical studies demonstrating the effectiveness of GLP-1 RAs in diabetic and nondiabetic populations, highlighting their potential in addressing obesity even in those without T2DM and describing probable benefits to cardiovascular health. Finally, our investigation outlines the importance of future research to further define the potential benefits of GLP-1 RAs.

The recent development, application, and future prospects of muscle atrophy animal models

Muscle atrophy, characterized by the loss of muscle mass and function, is a hallmark of sarcopenia and cachexia, frequently associated with aging, malignant tumors, chronic heart failure, and malnutrition. Moreover, it poses significant challenges to human health, leading to increased frailty, reduced quality of life, and heightened mortality risks. Despite extensive research on sarcopenia and cachexia, consensus in their assessment remains elusive, with inconsistent conclusions regarding their molecular mechanisms. Muscle atrophy models are crucial tools for advancing research in this field. Currently, animal models of muscle atrophy used for clinical and basic scientific studies are induced through various methods, including aging, genetic editing, nutritional modification, exercise, chronic wasting diseases, and drug administration. Muscle atrophy models also include in vitro and small organism models. Despite their value, each of these models has certain limitations. This review focuses on the limitations and diverse applications of muscle atrophy models to understand sarcopenia and cachexia, and encourage their rational use in future research, therefore deepening the understanding of underlying pathophysiological mechanisms, and ultimately advancing the exploration of therapeutic strategies for sarcopenia and cachexia.

Atherogenic Effect of Homocysteine, a Biomarker of Inflammation and Its Treatment

Hyperhomocysteinemia (HHcy) is an independent risk factor for atherosclerosis. Ischemic stroke and heart disease, coronary heart disease, and cardiovascular disease are events resulting from long-lasting and silent atherosclerosis. This paper deals with the synthesis of homocysteine (Hcy), causes of HHcy, mechanism of HHcy-induced atherosclerosis, and treatment of HHcy. Synthesis and metabolism of Hcy involves demethylation, transmethylation, and transsulfuration, and these processes require vitamin B 6 and vitamin B 12 folic acid (vitamin B 9 ). Causes of HHcy include deficiency of vitamins B 6 , B 9 , and B 12 , genetic defects, use of smokeless tobacco, cigarette smoking, alcohol consumption, diabetes, rheumatoid arthritis, low thyroid hormone, consumption of caffeine, folic acid antagonist, cholesterol-lowering drugs (niacin), folic acid antagonist (phenytoin), prolonged use of proton pump inhibitors, metformin, and hypertension. HHcy-induced atherosclerosis may be mediated through oxidative stress, decreased availability of nitric oxide (NO), increased expression of monocyte chemoattractant protein-1, smooth muscle cell proliferation, increased thrombogenicity, and induction of arterial connective tissue. HHcy increases the generation of atherogenic biomolecules such as nuclear factor-kappa B, proinflammatory cytokines (IL-1β, IL-6, and IL-8), cell adhesion molecules (intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and E-selection), growth factors (IGF-1 and TGF-β), and monocyte colony-stimulating factor which lead to the development of atherosclerosis. NO which is protective against the development of atherosclerosis is reduced by HHcy. Therapy with folic acid, vitamin B 6 , and vitamin B 12 lowers the levels of Hcy, with folic acid being the most effective. Dietary sources of folic acid, vitamin B 6 , vitamin B 12 , omega-3 fatty acid, and green coffee extract reduce Hcy. Abstaining from drinking coffee and alcohol, and smoking also reduces blood levels of Hcy. In conclusion, HHcy induces atherosclerosis by generating atherogenic biomolecules, and treatment of atherosclerosis-induced diseases may be by reducing the levels of Hcy.

The association of glycaemic risk factors and diabetes duration with risk of heart failure in people with type 2 diabetes: A systematic review and meta-analysis

AIMS

To conduct a systematic review in order to better understand the association of glycaemic risk factors and diabetes duration with risk of heart failure (HF) in individuals with type 2 diabetes (T2D).

METHODS

We identified longitudinal studies investigating the association of glycaemic factors (glycated haemoglobin [HbA1c], HbA1c variability, and hypoglycaemia) and diabetes duration with HF in individuals with T2D. Hazard ratios and odds ratios were extracted and meta-analysed using a random-effects model where appropriate. Risk of bias assessment was carried out using a modified Newcastle-Ottawa Scale. Egger's test along with the trim-and-fill method were used to assess and account for publication bias.

RESULTS

Forty studies representing 4 102 589 people met the inclusion criteria. The risk of developing HF significantly increased by 15% for each percentage point increase in HbA1c, by 2% for each additional year of diabetes duration, and by 43% for having a history of severe hypoglycaemia. Additionally, variability in HbA1c levels was associated with a 20%-26% increased risk of HF for each unit increase in the metrics of variability (HbA1c standard deviation, coefficient of variation, and average successive variability). All included studies scored high in the risk of bias assessment. Egger's test suggested publication bias, with trim-and-fill analyses revealing a significant 14% increased risk of HF per percentage point increase in HbA1c.

CONCLUSIONS

Glycaemic risk factors and diabetes duration significantly contribute to the heightened risk of HF among individuals with T2D. A reduction in risk of HF is anticipated with better management of glycaemic risk factors.

Tight Versus Liberal Blood Glucose Control in Patients With Diabetes in the ICU: A Meta-Analysis of Randomized Controlled Trials

Introduction: Glycemia is an important factor among critically ill patients in the intensive care unit (ICU). There is conflicting evidence on the preferred strategy of blood glucose control among patients with diabetes in the ICU. We aimed to conduct a meta-analysis comparing tight with liberal blood glucose in critically ill patients with diabetes in the ICU. Methods: We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing tight versus liberal blood glucose control in critically ill patients with diabetes from inception to December 2023. We pooled odds-ratios (OR) and 95% confidence intervals (CI) with a random-effects model for binary endpoints. We used the Review Manager 5.17 and R version 4.3.2 for statistical analyses. Risk of bias assessment was performed with the Cochrane tool for randomized trials (RoB2). Results: Eight RCTs with 4474 patients were included. There was no statistically significant difference in all-cause mortality (OR 1.11; 95% CI 0.95-1.28; P = .18; I² = 0%) between a tight and liberal blood glucose control. RoB2 identified all studies at low risk of bias and funnel plot suggested no evidence of publication bias. Conclusion: In patients with diabetes in the ICU, there was no statistically significant difference in all-cause mortality between a tight and liberal blood glucose control. PROSPERO registration: CRD42023485032.

Role of HbA1c in Mortality Among Patients With a Medical History of Ischemic Stroke and Paroxysmal Atrial Fibrillation: A Systematic Review

Elevated HbA1c, a marker of poor glycemic control, is associated with adverse cardiovascular outcomes and mortality. HbA1c influences outcomes through distinct mechanisms of vascular dysfunction and atherosclerosis in ischemic stroke, during atrial remodeling and thrombus formation in paroxysmal atrial fibrillation (PAF). Optimal HbA1c thresholds are generally below optimal levels, with levels above this being linked to higher mortality in both populations. At extremes of glycemic control in ischemic stroke, patients face recurrence and poor recovery, while PAF patients experience amplified thromboembolic risks. In patients with both conditions, poor HbA1c control synergistically raises mortality. This systematic review explores how HbA1c levels directly contribute to mortality in patients with ischemic stroke and PAF, aiming to establish a causal link between elevated HbA1c and increased mortality risk. This review includes a comprehensive analysis of four cross-sectional studies, five randomized controlled trials (RCTs), and 17 cohort studies, providing a diverse range of evidence on the topic. The inclusion of these study designs offers a well-rounded understanding of the impact and outcomes observed in the research. Mortality metrics include short-term mortality, such as 30-day or 90-day, and long-term mortality over one, three, or five years. Specific metrics, like cardiovascular mortality, focus on deaths from stroke; some studies link mortality to functional decline post-stroke, where complications from immobility or recurrent vascular events contribute to outcomes. Secondary outcomes include survival metrics, functional recovery metrics, and complications. Studies use narrative synthesis due to its ability to accommodate heterogeneity in study designs, populations, and outcome measures, enabling a nuanced interpretation of complex, context-dependent data. HbA1c levels' impact on stroke outcomes, considering age, gender, and severity, is also examined. Confounding factors, functional recovery, and complications are also considered. A narrative synthesis was chosen. The study emphasizes the importance of strict glycemic control in patients with ischemic stroke or PAF, especially those with elevated HbA1c levels. It supports clinical guidelines for individualized HbA1c targets, with most stroke patients having a target of <7%. Clinicians should prioritize close monitoring and tailor treatment plans to avoid extreme HbA1c levels, which could inform more personalized and effective treatment strategies. Tight control of HbA1c levels entails individualized targets based on patient characteristics, with an emphasis on personalized treatment strategies that may include lifestyle modifications, oral hypoglycemics, or insulin therapy to optimize glycemic control.

Sleep risk factors modify the association between c-reactive protein and type 2 diabetes: A prospective cohort study

OBJECTIVE

To investigate the prospective association between serum CRP levels and T2D incidence and explore whether such association was modified by sleep risk factors.

METHODS

The study included 366 746 participants without diabetes and exhibited CRP measures at baseline from the UK Biobank. Sleep risk factors included sleep duration, insomnia, snoring, chronotype, and daytime sleepiness. Cox proportional hazards model was used to estimate the hazard ratio (HR), and 95 % confidence interval (CI) of T2D associated with CRP levels. Interactions between CRP and sleep risk factors were also tested.

RESULTS

During a median follow-up of 10.4 years, 14 200 T2D cases were identified. The HRs (95 % CIs) of T2D were 1.31 (1.21-1.43), 1.62 (1.50-1.75), 1.98 (1.83-2.13), and 2.38 (2.21-2.57), respectively, in higher quintile groups of CRP levels compared with the lowest group (p-value for trend <0.001). There were interactions of CRP levels with self-reported sleep duration, snoring, and daytime sleepiness (p-value for interaction = 0.002, 0.0002, and 0.0001). The associated risks between T2D and the elevation in CRP were more evident among participants with high-risk sleep factors.

CONCLUSIONS

Our study indicates that the elevation in serum CRP levels is associated with a higher T2D incidence; and such relation is modified by sleep risk factors including sleep duration, snoring, and daytime sleepiness.

A Comprehensive Review of the Role of GLP-1 Agonists in Weight Management and Their Effect on Metabolic Parameters Such as Blood Glucose, Cholesterol, and Blood Pressure

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been developed to manage type 2 diabetes mellitus. Although, in the last 10 years, the use of GLP-1 RAs, especially semaglutide and liraglutide, has increased, its clinical implications and how it affects metabolic parameters have yet to be fully consolidated. This narrative review explores the metabolic effects of GLP-1 RAs in weight management, blood glucose, cardiovascular health, lipid profiles, and blood pressure. Data were collected by comparing GLP-1 RAs, such as semaglutide, liraglutide, tripeptide, and exenatide, as well as comparing them to a baseline treatment group. GLP-1 RAs have shown consistent results in managing blood glucose levels by lowering HbA1c with minimal hypoglycemic risk and increasing insulin production and synthesis. GLP-1 RAs have been found to improve overall cardiovascular health and reduce major adverse cardiovascular events (MACE) by improving the endothelial function of the vasculature and lowering ANP (atrial natriuretic peptide) production, leading to reduced blood pressure. In addition to the cardiovascular benefits, GLP-1 RAs have a varying effect on lipid profiles, finding statistically significant results for low-density lipoprotein cholesterol levels. In conjunction with all the effects, GLP-1 RAs have been found to lower weight and aid in weight management.

"Metabolic surgery in Asian patients with type 2 diabetes mellitus and body mass index less than 30kg/m2: A systematic review"

Background

The effect of metabolic surgery on long-term diabetes remission in Asian patients with a body mass index (BMI) < 30 kg/m2 has not been widely reported.

Methods

We conducted a systematic review of the PubMed and Cochrane Library databases from inception to June 2024. All clinical trials and observational studies involving the effect of metabolic surgery in Asian patients with type 2 diabetes mellitus and BMI <30 kg/m2 were considered. The quality of the studies was assessed using the Newcastle-Ottawa scale.

Results

Of the 1175 studies screened, 21 studies (11 prospective and 10 retrospective), including 1005 patients, were selected. Only one study had a control group. The longest follow-up was 60 months. The results showed significant improvement in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), 2-h plasma glucose (2hPG), homeostasis model assessment for insulin resistance index (HOMA-IR), fasting C-peptide, triglycerides, total cholesterol, and a reduction in the use of oral hypoglycemic agents/insulin at 12, 24, 36, and 60 months after metabolic surgery. The most common surgical complications observed were anemia (2.1 %-33 %), marginal ulcer (4.2 %-17.3 %), gastrointestinal bleeding (1.9 %-12 %), anastomotic leak (2.1 %-3.5 %), anastomotic stenosis (2.1 %-3.5 %), reoperation (1.18 %), and a mortality rate of zero.

Conclusions

Long-term diabetes remission, along with improvements in HbA1c, 2hPG, FBG, and HOMA-IR, with an acceptable rate of complications, was observed in Asian patients with BMI <30 kg/m2 after metabolic surgery. Future research with controlled studies should focus on preoperative patient selection criteria beyond just the BMI cutoff.

A sugary solution: Harnessing polysaccharide-based materials for osteoporosis treatment

Osteoporosis, a prevalent skeletal disorder characterized by diminished bone density, compromised microstructure, and heightened fracture susceptibility, poses a growing public health concern exacerbated by aging demographics. Polysaccharides-based materials, derived from a diverse range of sources, exhibit exceptional biocompatibility. They possess a structure similar to the extracellular matrix, which can enhance cell adhesion in vivo, and demonstrate superior biological activity compared to artificial materials. This study delved into an in-depth examination of the various biomaterials and polysaccharide families associated with the treatment of osteoporosis. This article elucidates the benefits and attributes of polysaccharide-based materials in contrast to current clinical treatment modalities, delineating how these materials address prevalent challenges in the clinical management of osteoporosis. An overview of the prospective applications of polysaccharide-based materials in the future is also provided, as well as outlines the challenges that should be addressed prior to the clinical implementation of such materials.

Low LDL-C: Is It all Good News?

PURPOSE OF REVIEW

This review presents the risks and benefits of very low LDL cholesterol and the safety of using lipid-lowering therapy to achieve these levels.

RECENT FINDINGS

A growing body of literature suggests that lower LDL cholesterol levels are associated with a reduced risk of cardiovascular disease. Further, achieving these levels with pharmaceuticals is remarkably safe. Although statins may slightly increase the risk of diabetes mellitus and hemorrhagic stroke, the benefits outweigh the risks. While recommendations from professional societies are increasingly aggressive, additional risk reduction could be achieved by setting more even ambitious LDL cholesterol goals.

Uncover visit-to-visit blood pressure variability as the hidden risk factor/predictor for coronary artery disease, stroke and malignant tumor in patients with type 2 diabetes

Visit-to-visit blood pressure variability is a factor for a series of cardiovascular diseases in hypertensive patients. Hypertension is a common complication of patients with type 2 diabetes mellitus. Our research demonstrated that blood pressure variability is more important than systolic blood pressure to be associated with the occurrence of coronary artery disease and stroke. However, the importance of visit-to-visit blood pressure variability was easily overlooked. The results aimed to inform the health professionals the significance of stability blood pressure variability in the blood pressure management for patients with type 2 diabetes.

Causal association of serum vitamin D levels with urolithiasis: a bidirectional two-sample Mendelian randomization study

BACKGROUND

In light of inconsistent evidence from previous observational studies regarding the correlation between serum vitamin D levels and urolithiasis, this study aimed to investigate the genome-wide causal association between genetically predicted serum 25(OH)D levels and urolithiasis using the Mendelian randomization (MR) approach.

METHODS

In this study, we utilized genome-wide association studies (GWAS) summary statistics from the UK Biobank and SUNLIGHT consortium for serum vitamin D levels, as well as urolithiasis data from FinnGen. We employed bidirectional two-sample MR analysis to evaluate potential causal relationships. The primary MR analysis relied on the inverse variance weighted (IVW) method, supplemented by MR-Egger, weighted median, and weighted mode approaches. Sensitivity analyses were conducted to ensure result robustness, including Cochran's Q test, MR-Egger intercept test, leave-one-out tests, and MR pleiotropy residual sum and outlier (MR-PRESSO) test.

RESULTS

The MR analysis indicated no significant causal effects of serum 25(OH)D levels on urolithiasis [IVW method: (kidney and ureteral stones: OR = 1.134;95% CI, 0.953 to 1.350, p = 0.155; lower urinary tract stones: OR = 1.158; 95% CI, 0.806 to 1.666, p = 0.428)]. However, according to the IVW results, genetically predicted kidney and ureteral stones were associated with decreased serum 25(OH)D levels (beta = -0.025; 95% CI, -0.048 to -0.003; p = 0.028), while they did not indicate a causal effect of lower urinary tract stones on serum 25(OH)D levels (beta = -0.002; 95% CI, -0.013 to -0.008; p = 0.662). A sensitivity analysis suggested the robustness of these causal associations.

CONCLUSIONS

Our MR study did not provide evidence supporting a causal association between serum 25(OH)D levels and urolithiasis among individuals of European descent. However, there might exist a negative causal association between kidney and ureteral stones and serum 25(OH)D levels.

Identification of metabolic reprogramming-related genes as potential diagnostic biomarkers for diabetic nephropathy based on bioinformatics

BACKGROUND

Diabetic nephropathy (DN) is a serious complication of diabetes mellitus, marked by progressive renal damage. Recent evidence indicates that metabolic reprogramming is crucial to DN pathogenesis, yet its underlying mechanisms are not well understood. This study aimed to examine how metabolic reprogramming-related genes (MRRGs) are differentially expressed and to explore their potential mechanisms in the development of DN.

METHODS

We analyzed the datasets GSE30528 and GSE96804 from the Gene Expression Omnibus (GEO), comprising 50 DN samples and 33 controls. MRRGs were sourced from GeneCards and PubMed. Data preprocessing included batch effect correction using the R package sva, followed by normalization and differential expression analysis with limma (|logFC|> 0.5, adj.p < 0.05). Functional enrichment analyses (GO, KEGG, GSEA) were performed using clusterProfiler. Protein-protein interaction (PPI) networks were constructed via STRING, identifying hub genes through CytoHubba. Regulatory networks (mRNA-TF, mRNA-miRNA) were derived from ChIPBase and StarBase. Validation of hub genes and ROC analysis assessed diagnostic performance. ssGSEA quantified immune cell infiltration.

RESULTS

Our analysis identified 708 differentially expressed genes (DEGs), including 119 metabolic reprogramming-related DEGs (MRRDEGs). Enrichment analyses revealed significant roles for MRRDEGs in processes such as wound healing and pathways like MAPK signaling. The PPI network identified nine hub genes: FN1, CD44, KDR, EGF, HSPG2, HGF, FGF9, IGF1, and ALB, which exhibited high diagnostic accuracy (AUC 0.7 to 0.9). Notably, FN1 and CD44 showed significant association with renal fibrosis and could serve as potential biomarkers for early diagnosis and therapeutic targets in DN. Immune infiltration analysis showed notable differences in immune cell composition between DN and control samples.

CONCLUSION

This study identifies hub genes such as FN1 and CD44, with potential diagnostic value in DN. It also reveals immune cell infiltration differences between DN patients and controls, offering insights into disease progression and potential therapeutic targets.

Pleiotropic Effects of PCSK9 Inhibitors on Cardio-Cerebrovascular Diseases

Cardiovascular disease (CVD) and ischemic stroke (IS) are the primary causes of mortality worldwide. Hypercholesterolemia has been recognized as an independent risk factor for CVD and IS. Numerous clinical trials have unequivocally demonstrated that reducing levels of low-density lipoprotein cholesterol (LDL-C) significantly mitigates the risk of both cardiac and cerebral vascular events, thereby enhancing patient prognosis. Consequently, LDL-C reduction remains a pivotal therapeutic strategy for CVD and IS. However, despite intensive statin therapy, a significant proportion of high-risk hypercholesterolemic patients fail to achieve sufficient reductions in LDL-C levels. In response to this challenge, an inhibitor targeting proprotein convertase subtilisin-kexin type 9 (PCSK9) has been developed as a therapeutic intervention for hyperlipidemia. Numerous randomized controlled trials (RCTs) have conclusively demonstrated that the combination of PCSK9 inhibitors and statins significantly enhances prognosis not only in patients with CVD, but also in those afflicted with symptomatic intracranial artery stenosis (sICAS). PCSK9 inhibitors significantly reduce LDL-C levels by binding to the PCSK9 molecule and preventing its interaction with LDLRs. This prevents degradation of the receptor and increases uptake of LDL-C, thereby decreasing its concentration in blood. Besides significantly reducing LDL-C levels, PCSK9 inhibitors also demonstrate anti-inflammatory and anti-atherosclerotic properties while promoting plaque stabilization and inhibiting platelet aggregation and thrombosis. This article aims to provide a comprehensive review based on the relevant literature regarding the evolving understanding of pleiotropic effects associated with PCSK9 inhibitors, particularly focusing on their impact on the cardiovascular system and central nervous system.

Representation of racialised and ethnically diverse populations in multicentre randomised controlled trials of GLP-1 medicines for obesity: a systematic review and meta-analysis of gaps

INTRODUCTION

Trials of GLP-1 (glucagon-like peptide-1) medicines have changed the paradigm of obesity treatment. Diversity in trial participation is imperative considering that obesity disproportionately impacts marginalised populations worldwide. We performed a systematic review and meta-analyses to evaluate the representation of racialised and ethnically diverse populations in randomised controlled trials (RCTs) of GLP-1 medicines for obesity.

METHODS

We searched PubMed/Embase/ClinicalTrials.gov. Prevalence of each racial/ethnic group was compared in relation to the USA, Canada, the UK, Brazil and South Africa. The geographical locations of the trial sites were extracted.

RESULTS

27 RCTs were identified (n=21 547 participants). Meta-analyses of prevalence demonstrated the vast predominance of white/Caucasians (79%) with smaller proportion of blacks (9%), Asians (13%), Indigenous (2%) and Hispanics (22%). The gaps in representation were evidenced by the significantly under-represented proportion of non-white individuals in these RCTs as compared with the prevalence of non-white individuals in the general population of the USA (-23%, p=0.002) and Canada (-34%, p<0.0001), reaching an alarming gap of -58% in relation to Brazil and striking under-representation of -68% as compared with South Africa. Similar discrepancies in proportions of blacks, Asians and Indigenous peoples as compared with reference nations were found. Moreover, the trial sites (n=1859) were predominately located in high-income countries (84.2%), in sharp contrast to the global prevalence of obesity that is predominantly in low-income and middle-income countries.

CONCLUSION

There are discrepancies in representation of racialised and ethnically diverse populations in obesity trials as compared with multiethnic populations worldwide. These data highlight the need for broader reform in the research process in order to ultimately address health inequities.

Adipokines and Cardiometabolic Heart Failure with Preserved Ejection Fraction: A State-of-the-Art Review

BACKGROUND

Cardiometabolic heart failure with preserved ejection fraction (HFpEF) is largely driven by obesity-related factors, including adipokines and bioactive peptides primarily secreted by the adipose tissue, such as leptin, adiponectin, and resistin. These molecules link metabolic dysregulation to cardiovascular dysfunction, influencing HFpEF progression and patient outcomes Methods: A comprehensive literature search was conducted in PubMed up to 20 November 2024, using keywords and MeSH terms, such as "HFpEF", "adipokines", "leptin", "adiponectin", and "resistin", yielding 723 results. Boolean operators refined the search, and reference lists of key studies were reviewed. After screening for duplicates and irrelevant studies, 103 articles were included, providing data on adipokines' roles in HFpEF pathophysiology, biomarkers, and therapeutic implications.

RESULTS

Both preclinical and clinical studies have demonstrated that adipokines play a role in modulating cardiovascular function, thereby contributing to the development of cardiometabolic HFpEF. Leptin promotes myocardial hypertrophy, fibrosis, endothelial dysfunction, and inflammation, though contradictory evidence suggests potential cardioprotective roles in subgroups like obese African American women. Adiponectin generally offers protective effects but presents a paradox, where elevated levels may correlate with worse outcomes, which may reflect either a compensatory response to cardiac dysfunction or a maladaptive state characterized by adiponectin resistance. Resistin is associated with increased cardiovascular risk through pro-inflammatory and pro-fibrotic effects, though its role in HFpEF requires further clarification. Other adipokines, like retinol-binding protein 4 and omentin-1, have emerged as potential contributors. Despite growing insights, clinical translation remains limited, underscoring a significant gap between experimental evidence and therapeutic application.

CONCLUSIONS

Future research should focus on targeted interventions that modulate adipokine pathways to potentially improve HFpEF outcomes. Innovative treatment strategies addressing underlying metabolic disturbances and adipokine dysregulation are essential for advancing the management of this challenging condition.

Machine learning models for coagulation dysfunction risk in inpatients administered β-lactam antibiotics

The β-Lactam antibiotics represent a widely used class of antibiotics, yet the latent and often overlooked risk of coagulation dysfunction associated with their use underscores the need for proactive assessment. Machine learning methodologies can offer valuable insights into evaluating the risk of coagulation dysfunction associated with β-lactam antibiotics. This study aims to identify the risk factors associated with coagulation dysfunction related to β-lactam antibiotics and to develop machine learning models for estimating the risk of coagulation dysfunction with real-world data. A retrospective study was performed using machine learning modeling analysis on electronic health record data, employing five distinct machine learning methods. The study focused on adult inpatients discharged from 1 January 2018, to 31 December 2021, at the First Affiliated Hospital of Shandong First Medical University. The models were developed for estimating the risk of coagulation dysfunction associated with various β-lactam antibiotics based on electronic health record feasibility. The dataset was divided into training and test sets to assess model performance using metrics such as total accuracy and area under the curve. The study encompassed risk-factor analysis and machine learning model development for coagulation dysfunction in inpatients administered different β-lactam antibiotics. A total of 45,179 participants were included in the study. The incidence of coagulation disorders related to cefazolin sodium, cefoperazone/sulbactam sodium, cefminol sodium, amoxicillin/sulbactam sodium, and piperacillin/tazobactam sodium was 2.4%, 5.4%, 1.5%, 5.5%, and 4.8%, respectively. Machine learning models for estimating coagulation dysfunction associated with each β-lactam antibiotic underwent validation with 5-fold cross-validation and test sets. On the test set, the optimal models for cefazolin sodium, cefoperazone/sulbactam sodium, cefminol sodium, amoxicillin/sulbactam sodium, and piperacillin/tazobactam sodium yielded AUC values of 0.798, 0.768, 0.919, 0.783, and 0.867, respectively. The study findings suggest that machine learning classifiers can serve as valuable tools for identifying patients at risk of coagulation dysfunction associated with β-lactam antibiotics and intervening based on high-risk predictions. Enhanced access to administrative and clinical data could further enhance the predictive performance of machine learning models, thereby expanding pharmacovigilance efforts.

Effects of sodium-dependent glucose transporter 2 inhibitors in patients with type 2 diabetes mellitus and asymptomatic heart failure

Sodium-dependent glucose transporter 2 inhibitors (SGLT2i) have been increasingly used with proven efficacy in patients with heart failure (HF), regardless of diabetes status. Grubić Rotkvić et al recently published an observational study on SGLT2i therapy in patients with type 2 diabetes mellitus and asymptomatic HF. They found that the use of SGLT2i led to reduced cardiac load and improved cardiovascular performance, reinforcing the evolving paradigm that SGLT2i are not merely glucose-lowering agents but are integral to the broader management of cardiovascular risk in patients with type 2 diabetes mellitus. The study by Grubić Rotkvić et al contributes to the growing body of literature supporting the early use of SGLT2i in patients with diabetic cardiomyopathy, offering a potential strategy to mitigate the progression of HF. Future larger studies should be conducted to confirm these findings, and explore the long-term cardiovascular benefits of SGLT2i, particularly in asymptomatic patients at risk of developing HF.

Risk factors associated with SGLT2 inhibitor discontinuation in diabetic patients with heart failure

Sodium-glucose cotransporter 2 inhibitors (SGLT2i), have shown benefits in patient with heart failure (HF), however, adherence remains a significant issue: with only 60% of patients continuing usage beyond a year. This study aims to identify patients at risk of discontinuing SGLT2i and promote its judicious use to reduce hospitalizations and improve cardiovascular outcomes. Using the Korean National Health Insurance Service database, patients diagnosed with HF and diabetes mellitus (n = 1,665,565) between 2013 and 2018 were identified. Among them, 55,694 participants prescribed SGLT2i were enrolled. The primary endpoint included 1) all-cause mortality and 2) SGLT2i-related hospitalization, encompassing incidents such as ketoacidosis, acute kidney injury, urinary tract infections, fall-related fractures, and other unplanned hospitalizations. During the follow-up period (median: 2.3 years; range: 1.2-3.6 years), 8,463 participants reached the primary endpoint (25.5 for all-cause death and 39.4 for SGLT2i-related hospitalizations per 1,000 person-years). Independent risk factors for the primary endpoint in multivariate Cox regression and propensity-score matching analyses included age of ≥ 70 years, body mass index (BMI) <18.5 kg/m2, body weight <60 kg, anemia, chronic kidney disease, and the use of diuretics. Age (hazard ratio [HR] 1.45, 95% confidence interval [CI]: 1.36-1.54), BMI (HR 1.78, 95% CI: 1.29-2.45), body weight (HR 1.17, 95% CI: 1.09-1.26) and the use of furosemide (HR 1.45, 95% CI: 1.22-1.74) (all p<0.001) were consistent independent risk factors in the propensity score-matched cohort. Having three or more risk factors was associated with an adjusted HR that was 3.04 times higher than cases with no risk factor (95% CI: 2.83-3.28, p<0.001). Old age, low weight or BMI, and the use of diuretics are risk factors that hinder the continuous use of SGLT2i in diabetic patients with HF. Close monitoring for side effects is essential when prescribing SGLT2i, particularly for those with multiple risk factors.

Molecular recognition of peptides and proteins by cucurbit[n]urils: systems and applications

The development of methodology for attaching ligand binding sites to proteins of interest has accelerated biomedical science. Such protein tags have widespread applications as well as properties that significantly limit their utility. This review describes the mechanisms and applications of supramolecular systems comprising the synthetic receptors cucurbit[7]uril (Q7) or cucurbit[8]uril (Q8) and their polypeptide ligands. Molecular recognition of peptides and proteins occurs at sites of 1-3 amino acids with high selectivity and affinity via several distinct mechanisms, which are supported by extensive thermodynamic and structural studies in aqueous media. The commercial availability, low cost, high stability, and biocompatibility of these synthetic receptors has led to the development of myriad applications. This comprehensive review compiles the molecular recognition studies and the resulting applications with the goals of providing a valuable resource to the community and inspiring the next generation of innovation.

Ezetimibe: Integrating Established Use with New Evidence - A Comprehensive Review

PURPOSE OF REVIEW

To consolidate key information on the efficacy and safety of ezetimibe, with a focus on the latest evidence.

RECENT FINDINGS

While ezetimibe has long been used alongside statins to help achieve lipid goals when statins are insufficient or in statin-intolerant patients, recent studies confirm and extend its benefits. Ezetimibe, when added to statins, is now recognized as an effective option for high-risk cardiovascular patients. Additionally, for those intolerant to statins, it can be combined with bempedoic acid, offering significant LDL cholesterol reduction. Ezetimibe's favourable tolerability, with fewer side effects than statins, along with the availability of fixed-dose combinations, enhances both treatment efficacy and patient adherence. Overall, this review underscores ezetimibe's evolving role in lipid management, providing valuable guidance for optimizing cardiovascular risk reduction strategies.

Stress hyperglycemia ratio association with all-cause mortality in critically ill patients with coronary heart disease: an analysis of the MIMIC-IV database

Background The stress hyperglycemia ratio (SHR) indicates relative hyperglycemia levels. Research on the impact of SHR on mortality in coronary heart disease (CHD) patients in intensive care is limited. This study explores the predictive accuracy of SHR for the prognosis of CHD patients in the ICU. Methods This study included 2,059 CHD patients from the American Medical Information Mart for Intensive Care (MIMIC-IV) database. SHR was determined using the formula: SHR = (admission glucose) (mmol/L) / (1.59 * HbA1c [%] - 2.59). Subjects were stratified into quartiles based on SHR levels to examine the correlation between SHR and in-hospital mortality. The restricted cubic splines and Cox proportional hazards models were employed to assess this association, while Kaplan-Meier survival analysis was executed to ascertain the mortality rates across the SHR quartiles. Results Among the 2059 participants (1358 men), the rates of in-hospital and ICU mortality were 8.5% and 5.25%, respectively. Analysis showed SHR as a significant predictor of increased risk for both in-hospital (HR,1.16, 95% CI: 1.02-1.32, P = 0.022) and ICU mortality (HR, 1.16, 95% CI: 1.01-1.35, P = 0.040) after adjustments. A J-shaped relationship was noted between SHR and mortality risks (p for non-linearity = 0.002, respectively). Kaplan-Meier analysis confirmed substantial differences in in-hospital and ICU mortality across SHR quartiles. Conclusions SHR significantly predicts in-hospital and ICU mortality in critically ill CHD patients, indicating that higher SHR levels correlate with longer ICU stays and increased mortality. This underscores the potential of SHR as a prognostic marker for ICU CHD patients.

The Interaction and Implication of Stress-Induced Hyperglycemia and Cytokine Release Following Traumatic Injury: A Structured Scoping Review

INTRODUCTION

This is a structured scoping review to assess whether there is a relationship between stress-induced hyperglycemia (SIH), cytokine interactions, and mortality in trauma patients in comparison to non-diabetic normoglycemia [NDN], diabetic normoglycemia [DN], and diabetic hyperglycemia [DH].

METHODS

We conducted a literature search of MEDLINE (PubMed) databases from 2000 to 2022 using a search strategy to identify observational studies. Initially, 2879 articles were retrieved. Of these, 2869 were excluded due to insufficient variables, and non-trauma focuses.

RESULTS

Nine studies on the interaction between SIH and proinflammatory cytokines were analyzed. SIH was associated with the highest mortality rate (21.3%), followed by DH (5.4%), DN (2.8%), and NDN (2.3%) (p < 0.001). Furthermore, SIH patients exhibited an 11.28-fold higher likelihood of mortality compared to NDN patients (95% CI [9.13-13.93]; p < 0.001) and a 4.72-fold higher likelihood compared to DH patients (OR 4.72; 95% CI [3.55-6.27]; p < 0.001).

CONCLUSIONS

SIH patients had elevated IL-6 concentrations relative to NDN, DN, and DH patients. SIH is linked to higher mortality in trauma, with greater odds than NDN. However, the robustness of this association is still being determined due to statistical and clinical variability. Uncertainties about injury severity and IL-6 level similarities between SIH and DH patients require further investigation.

Prognostic effectiveness of interactive vs. non-interactive mobile app interventions in type 2 diabetes: a systematic review and meta-analysis

BACKGROUND

Mobile app interventions are emerging as significant tools in managing the prognosis of type 2 diabetes, demonstrating progressively greater impacts. The effectiveness of these interventions needs further evidence-based support.

OBJECTIVE

This study conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the effectiveness of mobile app interventions in improving prognosis for patients with type 2 diabetes.

METHODS

We searched PubMed, Cochrane, Embase, and Web of Science for relevant studies published from inception to 18 April 2024, adhering to the Cochrane Handbook guidelines. The quality of the included studies was assessed using the Cochrane risk of bias tool. Primary outcomes measured were changes in glycated hemoglobin (HbA1c) and diabetes self-management (DSM). Secondary outcomes included changes in diastolic blood pressure (DBP), systolic blood pressure (SBP), triglycerides(TG), total cholesterol(TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), lipid profiles, fasting plasma glucose (FPG), body mass index (BMI), and Steps outcomes. Subgroup analyses were performed for the primary outcomes and for high-density lipoprotein (HDL), low-density lipoprotein (LDL), diastolic blood pressure (DBP), and systolic blood pressure (SBP). Interventions with or without interactions were also used as a basis for subgrouping.

RESULTS

A total of 15 eligible articles involving 17 studies with 2,028 subjects (1,123 in the intervention group and 1,020 in the control group) were included in the synthesis. Interactive mobile app interventions significantly reduced HbA1c levels (SMD - 0.24; 95% CI, -0.33 to -0.15; P < 0.00001) and significantly improved diabetes self-care (SMD 0.71; 95% CI, 0.21 to 1.21; P = 0.005). Secondary outcomes, including FPG, LDL, DBP, and SBP, showed varying degrees of improvement. Subgroup analyses indicated that the intervention effect was more pronounced and less heterogeneous in the short-term (≤ 3 months) for younger Asian individuals (< 55 years) who used an interactive mobile app.

CONCLUSION

Interactive mobile app interventions effectively improve HbA1c levels and diabetes self-care competencies in patients with type 2 diabetes. These interventions offer supportive evidence for their clinical use in managing and prognosticating type 2 diabetes.

SYSTEMATIC REVIEW REGISTRATION

CRD42024550643.

Exploring research trends and hotspots on PCSK9 inhibitor studies: a bibliometric and visual analysis spanning 2007 to 2023

Background

Following the identification of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, research in this area has experienced significant growth. However, a thorough bibliometric analysis of this burgeoning field remains conspicuously absent. The current study aims to delineate research hotspots and anticipate future trends on PCSK9 inhibitors employing bibliometric analysis.

Methods

A systematic search was conducted in the Web of Science Core Collection (WoSCC) to identify scholarly articles and reviews pertaining to PCSK9 inhibitors, yielding 1,812 documents. Data extraction was followed by analysis and visualization using Excel, VOSviewer, and CiteSpace software.

Results

A total of 1,812 publications were included in the final analysis. Ray, KK from the UK was the most prolific author, followed by Pordy, R from the USA. The USA led in publication output [number of publications (Np):776] and number of citations without self-citations (Nc) at 34,289, as well as an H-index of 93. "Cardiovascular System Cardiology" emerged as the predominant subject area. Amgen and the Journal of Clinical Lipidology were identified as the most active institution and journal, respectively. Keywords such as "lipoprotein(a)," "bempedoic acid," "percutaneous coronary intervention," "inclisiran," "peripheral artery disease," "mortality," and "endothelial dysfunction" are gaining prominence in the field.

Conclusion

The research on PCSK9 inhibitors is experiencing a sustained growth trajectory. The USA exerts considerable influence in this area, with the Journal of Clinical Lipidology expected to feature more groundbreaking studies. Research on "lipoprotein(a)", "bempedoic acid", "percutaneous coronary intervention", "peripheral artery disease", and "endothelial dysfunction" are poised to become focal points of future investigation.