Type 2 diabetes mellitus in older adults: clinical considerations and management

Understanding the link between type 2 diabetes mellitus and Parkinson's disease: role of brain insulin resistance

Type 2 diabetes mellitus and Parkinson's disease are chronic diseases linked to a growing pandemic that affects older adults and causes significant socio-economic burden. Epidemiological data supporting a close relationship between these two aging-related diseases have resulted in the investigation of shared pathophysiological molecular mechanisms. Impaired insulin signaling in the brain has gained increasing attention during the last decade and has been suggested to contribute to the development of Parkinson's disease through the dysregulation of several pathological processes. The contribution of type 2 diabetes mellitus and insulin resistance in neurodegeneration in Parkinson's disease, with emphasis on brain insulin resistance, is extensively discussed in this article and new therapeutic strategies targeting this pathological link are presented and reviewed.

Microneedles loaded with l-arginine-modified puerarin-derived carbon nanoparticles improved treatment of diabetic wound via photothermal and nitric oxide-based gas therapy

Due to the high-glucose environment of diabetic wounds, a significant proliferation of bacteria at wound site can occur, resulting in an inflammatory response that extends the inflammatory phase of the wound, thereby complicating the healing process in diabetic wounds. Eliminating the proliferation of bacteria plays a crucial role in promoting the healing of diabetic wounds. Under near-infrared (NIR) laser irradiation, l-arginine (L-Arg) -modified natural product puerarin (Pue)-derived carbon nanoparticles (l-Arg-CNP) not only exhibited excellent photothermal effects but also produced reactive oxygen species (ROS) to react with l-Arg for producing Nitric Oxide (NO), thus contributing to a synergistic antibacterial therapy in diabetic wound. At the same time, l-Arg-CNP retained Pue's original characteristics to promote cell proliferation and angiogenesis. Following the loading of l-Arg-CNP into microneedle patches (l-Arg-CNP@MN), it can deliver them into the deeper wound, effectively killing bacteria, reducing inflammatory infiltration, and promoting neovascularization at the wound site. It offers an effective therapeutic strategy for treating diabetic wound healing.

Phase angle as an independent predictor of sarcopenia and glycemic control in older adults with type 2 diabetes: a cross-sectional observational study

Objectives

The global rise in type 2 diabetes mellitus (T2DM) poses challenges, particularly with the increasing burden of sarcopenia and poor glycemic control. Phase angle (PhA) is a promising biomarker for early detection and management of these conditions. This study aimed to evaluate PhA as an independent predictor of sarcopenia and glycemic control.

Methods

This cross-sectional study included older adults with T2DM hospitalized for diabetes education between April 2021 and March 2023. Measurements included PhA, muscle mass, body fat mass, grip strength, knee extension strength, physical function (Short Physical Performance Battery and 6-min walk distance), and glycemic control (fasting blood glucose and hemoglobin A1c [HbA1c]). Sarcopenia was defined as low muscle mass and physical function. Analyses included Pearson correlations, receiver operating characteristic curve analysis, and multivariate logistic regression.

Results

PhA was moderately correlated with muscle mass (r = 0.42, p < 0.001), grip strength (r = 0.43, p < 0.001), and body mass index (r = 0.27, p = 0.001), and inversely correlated with HbA1c (r = - 0.34, p < 0.001) and age (r = - 0.26, p = 0.003). PhA showed a strong predictive ability for sarcopenia (AUC = 0.83, 95% CI: 0.76-0.90, p < 0.001). Logistic regression indicated PhA as an independent predictor of sarcopenia (OR = 0.105, 95% CI: 0.031-0.353, p < 0.001) and glycemic control (OR = 0.380, 95% CI: 0.201-0.719, p = 0.003).

Conclusions

PhA is a non-invasive, practical tool for predicting sarcopenia and monitoring glycemic control. Routine integration of PhA could identify high-risk patients and guide interventions. Future research should validate its application in diverse settings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01590-z.

Barriers in prescribing antidiabetic medications with cardiovascular benefits: practice, experience, and attitudes of GPs in Croatia

BACKGROUND

The treatment approaches of type 2 diabetes (T2D) are being transformed, due to the availability of novel antidiabetic medications, sodium-glucose co-transporter 2 inhibitors (SGLT2ins), and glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Despite their proven beneficial effects, recent research points to their insufficient prescription. This study aimed to reveal the prescription rates of SGLT2ins and GLP-1 RAs among general practitioners (GPs) in Croatia and to examine factors associated with their low self-confidence in prescribing them.

METHODS

A self-designed survey questionnaire was used and delivered to the GPs' e-mail addresses in digital format. The data on the number of individuals diagnosed with T2D and prescribed new antidiabetic medications were checked by the respondents in their electronic database. Factors associated with lower GPs` self-confidence in prescribing SGLT2ins and GLP-1 RAs were assessed by bivariate and multivariate logistic regression analyses.

RESULTS

The study included 168 GPs (66.1% women; 49.4% specialists in family medicine) and a cohort of 23,036 individuals with T2D. The prescription rates of SGLT2ins and GLP-1 RAs were 21.0% and 14.4%, respectively. Specialists stated a higher level of self-confidence in prescribing these medications, compared to other respondents. In the multivariate models, a factor that was shown to reduce the likelihood of low GPs` self-confidence in prescribing SGLT2ins was "familiarity with the side effects of these medications" (OR = 0.03), while factors that increased this likelihood were: "being familiar with GLP-1 RAs` side effects" (OR = 4.8), "an insufficient knowledge and experience of GPs in adjusting two target outcome measures to the same patient" (OR = 2.2), and "the GPs` assumption that the new guidelines` protocol which separates two target outcome measures is useful only in some cases but not in all" (OR = 5.4). Regarding GLP-1 RAs, only one factor - "familiarity of GPs with GLP-1 RAs side effects", was shown to reduce the probability of GPs` low self-confidence in prescribing this group of medications (OR = 0.27).

CONCLUSION

It is of the utmost importance to identify barriers the GPs face when prescribing these medications, as well as to suggest potential strategies to optimize their prescription.

Accuracy of computer-aided chest x-ray interpretation for tuberculosis screening in people with diabetes mellitus: A systematic review

OBJECTIVES

Diabetes mellitus significantly increases the risk of tuberculosis, and active tuberculosis screening of people with diabetes mellitus has been advocated by WHO and other international bodies. This systematic review aimed to evaluate the accuracy of computer-assisted detection for identifying pulmonary tuberculosis among people living with diabetes mellitus.

METHODS

Medline, Embase, Scopus, Global Health, and Web of Science were searched from January 2010 to May 2024 using MeSH headings and keywords, supplemented with grey literature searches (Conference abstracts, Trial registries, MedRxiv.org, Google Scholar). Studies evaluating computer-assisted detection diagnostic accuracy for identifying tuberculosis in populations living with diabetes mellitus were included. Two researchers independently assessed titles, abstracts, and full texts, extracted data, and assessed the risk of bias using the QUADAS-2 instrument. Forest plots and Summary Receiver Operating Curves were generated using RevMan 5.4, and statistical pooling of studies was carried out in STATA v18 using the bivariate model.

RESULTS

Five eligible studies, all conducted in Asia between 2013 and 2023, were identified, including a total of 1879 individuals with diabetes mellitus, of whom 391 were newly diagnosed with tuberculosis. Four different computer-assisted detection software algorithms were used. The pooled sensitivity was 0.94 (95% CI: 0.85-0.97) and specificity was 0.77 (95% CI: 0.68-0.84). Area Under the receiver operating curve values varied from 0.7 (95% CI: 0.68-0.75) to 0.9 (95% CI: 0.91-0.96). False positive proportions ranged from 0.24% to 30.5%, while false negative proportions were 0%-3.2%. Overall heterogeneity was high (i2 55% for sensitivity and 93% for specificity) but much lower for sensitivity among the three studies using the same computer-assisted detection software (i2 0% for sensitivity; 93% for specificity). The risk of bias of the five studies was generally very low, although detailed information about diabetes management was lacking.

CONCLUSIONS

Computer-assisted detection tools show potential in screening people living with diabetes for active tuberculosis and appear to show good sensitivity at the thresholds indicated, but data are scarce and performance varies across settings.

REVIEW REGISTRATION

The protocol for this review was prespecified and published in PROSPERO (registration number CRD42024523384).

Arecoline Alleviates T2DM via Gut Microbiota Modulation and Liver Gene Regulation in Mice

SCOPE

Arecoline, the main alkaloid in areca nut, has shown potential in modulating metabolism and gut microbiota. This study aimed to evaluate its therapeutic effects on glucose and lipid metabolism, inflammation, liver function, and potential mechanisms in a Type 2 diabetes mellitus (T2DM) mouse model.

METHODS AND RESULTS

T2DM was established in mice with a high-fat, high-sugar diet, and streptozotocin injections. Arecoline significantly reduced fasting blood glucose, enhanced glucose tolerance, and increased insulin sensitivity. Serum lipid profiles showed marked decreases in total cholesterol, triglycerides, and LDL-C levels. Systemic inflammation, as measured by serum levels of IL-1β, IL-6, and MCP-1, decreased significantly. Improvements in liver function were observed, as indicated by reductions in ALT and AST levels. Liver transcriptomic analysis revealed modulation of pathways related to glutathione metabolism, MAPK signaling, and cAMP signaling, which were involved in insulin signaling and oxidative stress response. Additionally, arecoline mitigated gut dysbiosis by restoring microbial diversity, altering gut microbiota composition, and regulating key pathways involved in NAD biosynthesis and fatty acid β-oxidation, which were critical for maintaining energy homeostasis.

CONCLUSION

Arecoline improves glucose metabolism, lipid profiles, and liver function, while modulating gut microbiota and liver metabolic pathways, showing potential as a therapeutic agent for T2DM.

Insulitis and aging: Immune cell dynamics in Langerhans islets

With increasing age, the risk for age-related type-2-diabetes also increases due to impaired glucose tolerance and insulin secretion. This disease process may be influenced by various factors, including immune cell triggered inflammation and fibrosis. Although immune cells are a necessary component of islets, little is known about immune cell accumulation, immune cell subtype shifts and subsequent influence on glucose metabolism in healthy aging. However, this is critical for understanding the mechanisms that influence β-cell health. Therefore, we studied young and old male C57BL/6J mice, focusing on immune cell composition, patterns of accumulation, and the presence of fibrosis within the pancreatic islets. Our findings demonstrate that insulitis occurs in healthy aged mice without immediate development of a diabetic phenotype. Aged islets exhibited an increase in leukocytes and a shift in immune cell composition. While insulitis typically involves excessive immune cell accumulation, we observed a moderate increase in macrophages and T-cells during aging, which may support β-cell proliferation via cytokine secretion. In fact, aged mice in our study showed an increase in β-cell mass as well as a partially higher insulin secretory capacity, which compensated for the loss of β-cell functionality in insulitic islets and led to improved glucose tolerance. Furthermore, fibrosis which is normally triggered by immune cells, increased with age but appears to reach a steady state, emphasizing the importance of counter-regulatory mechanisms and immune system regulation. Our results suggest, that immune cell subtypes change with age and that non-pathological accumulation of immune-cells may regulate glucose metabolism through secretion of cytokines.

Elevated Serum SERPINE2 Levels are Linked to Impaired Renal Function in Patients with Type 2 Diabetes Mellitus

INTRODUCTION

Diabetic nephropathy (DN) is the primary complication associated with diabetes mellitus and is increasingly acknowledged as the leading cause of end-stage renal disease worldwide, placing a significant economic burden on society. This study determined how blood serpin peptidase inhibitor clade E member 2 (SERPINE2) levels affect DN in individuals with type 2 diabetes mellitus (T2DM).

METHODS

We recruited 292 individuals diagnosed with T2DM and 120 healthy controls for this study. We employed comprehensive and systematic data collection methodologies to gather relevant biomarkers and information on biochemical parameters. We measured serum levels of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), transforming growth factor-β1 (TGFβ1), connective tissue growth factor (CTGF), and SERPINE2 by the enzyme-linked immunosorbent assay in control subjects and patients with T2DM. We calculated generalized odds ratios (OR) to estimate the risk of developing DN.

RESULTS

Patients with diabetes had significantly higher levels of SERPINE2 (285.64 ± 56.58 pg/mL) than healthy controls (184.84 ± 23.54 pg/mL). Additionally, the multivariate logistic regression analysis indicated that patients with diabetes with DN possessed higher levels of serum SERPINE2 (OR 1.033, 95% confidence interval [CI] 1.013-1.053; P = 0.001), along with an increased body mass index (BMI), duration of diabetes, serum creatinine (Scr), NGAL, KIM-1, TGFβ1, and CTGF. Receiver operating characteristic (ROC) curve analysis indicated that patients with T2DM and serum SERPINE2 levels exceeding 278.94 pg/mL had a significantly higher risk of developing DN.

CONCLUSION

The results showed that patients with diabetes with DN have higher levels of serum SERPINE2. A more extensive population-based prospective study is needed to validate our findings.

Cardiometabolic multimorbidity and frailty in middle-aged and older adults: a cross-nationally harmonized study

Background

Cardiometabolic diseases are prevalent among ageing populations and have a close association with frailty. However, the cumulative impact multiple cardiometabolic diseases have on frailty remains underexplored.

Methods

This study used data from four international cohorts - HRS, CHARLS, ELSA and SHARE - to examine the correlation between frailty and cardiometabolic diseases (CMD). The frailty index was used for assessing frailty and statistical analyses were performed as a means of analysing the correlation between the number of cardiometabolic conditions and frailty severity. Linear regression models were employed to evaluate the associations between CMD and frailty severity.

Results

The study found that as the number of cardiometabolic diseases increased, the frailty index rose significantly [one disease, β = 7.80 (95% CI: 7.70 to 7.90) p < 0.05; two diseases, β = 17.92 (95% CI: 17.76 to 18.08) p < 0.05; three diseases, β = 28.79 (95% CI: 28.41 to 29.17) p < 0.05]. Stroke was found to have the most pronounced impact on frailty (β = 12.34 [95%CI 12.20 to 12.48] p < 0.05) and the coexistence of multiple conditions served to amplify the symptoms of frailty.

Conclusion

This study highlights the compounded impact multiple cardiometabolic diseases have on frailty and also emphasizes the necessity for early intervention.

Technology use and health behavior among patients with diabetes: do underlying motives for technology adoption matter?

Introduction

A growing number of health technology solutions are designed for people with diabetes to ease disease self-management. However, according to some studies, technology can also bring dissatisfaction. According to the Motivation, Engagement, and Thriving in User Experience model, the use of technology is only beneficial if it is linked to the experience of autonomy. The study aimed to investigate the associations between health technology use and technology adoption motivation and associated health behavior of people with type 1 and type 2 diabetes.

Methods

A cross-sectional questionnaire study was conducted on a sample of 315 patients with diabetes. The Technology Adoption Propensity Questionnaire was applied to assess general attitudes toward technology, the Autonomy and Competence in Technology Adoption Questionnaire for underlying motives of technology use, and the Summary of Diabetes Self-Care Activities tool for health behavior.

Results

The results showed that technology use was predicted by proficiency (but not optimism) and lower levels of vulnerability and dependence. In addition, technology use predicted health behavior (diet and physical exercise) frequency. After refining the results further, among technology users, only autonomous motivation of technology use predicted health behavior, while controlled motivation had a slightly negative predictive effect on following the diet.

Discussion

Particular attention should be paid to person-based health-related technology interventions for enhancing proficiency and reducing feelings of vulnerability and dependence on technologies. Ultimately, it is not the adoption of a technology per se, but the autonomous motivation for adoption that is associated with more favorable health behavior.

Digital health technologies/interventions in smart ward development for elderly patients with diabetes: A perspective from China and beyond

Diabetes is highly prevalent among the elderly worldwide, with the highest number of diabetes cases in China. Yet, the management of diabetes remains unsatisfactory. Recent advances in digital health technologies have facilitated the establishment of smart wards for diabetes patients. There is a lack of smart wards tailored specifically for older diabetes patients who encounter unique challenges in glycemic control and diabetes management, including an increased vulnerability to hypoglycemia, the presence of multiple chronic diseases, and cognitive decline. In this review, studies on digital health technologies for diabetes in China and beyond were summarized to elucidate how the adoption of digital health technologies, such as real-time continuous glucose monitoring, sensor-augmented pump technology, and their integration with 5th generation networks, big data cloud storage, and hospital information systems, can address issues specifically related to elderly diabetes patients in hospital wards. Furthermore, the challenges and future directions for establishing and implementing smart wards for elderly diabetes patients are discussed, and these challenges may also be applicable to other countries worldwide, not just in China. Taken together, the smart wards may enhance clinical outcomes, address specific issues, and eventually improve patient-centered hospital care for elderly patients with diabetes.

The potential of novel gut microbiota supplement in mitigating gut inflammation, alleviating oxidative stress linked to aging, and improving cognitive function in aged mice

BACKGROUND

Aging is a physiological process that impacts multiple systems of organs. Alzheimer's disease (AD) is the most common form of dementia in the elderly, and it is a major problem in aging societies. The development of AD is linked to an accumulation of amyloid beta and Tau proteins, which impair cognition and cause memory loss.

PURPOSE

We studied whether probiotics strains could protect and how effectively probiotics might delay age-related changes.

METHODS

Two probiotics, Lactobacillus paracasei MSMC39-1 and Bifidobacterium animalis MSMC83 strain, were administered orally to mice beginning in middle age and continuing into aged mice. The mice were subsequently monitored and assessed for inflammation and oxidative stress in the colon, brain, and liver tissues, as well as for overall health, over a period of 16 weeks.

RESULTS

We found aged mice received the combination of these probiotics showed a lower level of inflammatory markers and improved overall health compared to the control group. MSMC39-1 and MSMC83 enhance gut integrity and general well-being in aged mice and result in improved cognitive memory.

CONCLUSION

Our findings suggest that these probiotics supplements may be particularly useful in strategies for the prevention of age-related pathologies by reducing inflammation and oxidative stress, which in turn would slow disease progression.

CLINICAL TRIAL NUMBER

Not applicable.

Frailty in randomized controlled trials of glucose-lowering therapies for type 2 diabetes: An individual participant data meta-analysis of frailty prevalence, treatment efficacy, and adverse events

BACKGROUND

The representation of frailty in type 2 diabetes trials is unclear. This study used individual participant data from trials of newer glucose-lowering therapies to quantify frailty and assess the association between frailty and efficacy and adverse events.

METHODS AND FINDINGS

We analysed IPD from 34 trials of sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP1) receptor agonists, and dipeptidyl peptidase 4 (DDP4) inhibitors. Frailty was quantified using a cumulative deficit frailty index (FI). For each trial, we quantified the distribution of frailty; assessed interactions between frailty and treatment efficacy (HbA1c and major adverse cardiovascular events [MACE], pooled using random-effects network meta-analysis); and associations between frailty and withdrawal, adverse events, and hypoglycaemic episodes. Trial participants numbered 25,208. Mean age across the included trials ranged from 53.8 to 74.2 years. Using a cut-off of FI > 0.2 to indicate frailty, median prevalence was 9.5% (IQR 2.4%-15.4%). Applying a higher threshold of FI > 0.3, median prevalence was 0.5% (IQR 0.1%-1.5%). Prevalence was higher in trials of older people and people with renal impairment however, even in these higher risk populations, people with FI > 0.4 were generally absent. For SGLT2 inhibitors and GLP1 receptor agonists, there was a small attenuation in efficacy on HbA1c with increasing frailty (0.08%-point and 0.14%-point smaller reduction, respectively, per 0.1-point increase in FI), below the level of clinical significance. Findings for the effect of treatment on MACE (and whether this varied by frailty) had high uncertainty, with few events occurring in trial follow-up. A 0.1-point increase in the FI was associated with more all-cause adverse events regardless of treatment allocation (incidence rate ratio, IRR 1.44, 95% CI 1.35-1.54, p < 0.0001), adverse events judged to the possibly or probably related to treatment (1.36, 1.23, to 1.49, p < 0.0001), serious adverse events (2.09, 1.85, to 2.36, p < 0.0001), hypoglycaemia (1.21, 1.06, to 1.38, p = 0.012), baseline risk of MACE (hazard ratio 3.01, 2.48, to 3.67, p < 0.0001) and with withdrawal from the trial (odds ratio 1.41, 1.27, to 1.57, p < 0.0001). The main limitation was that the large cardiovascular outcome trials did not include data on functional status and so we were unable to assess frailty in these larger trials.

CONCLUSIONS

Frailty was uncommon in these trials, and participants with a high degree of frailty were rarely included. Frailty is associated very modest attenuation of treatment efficacy for glycaemic outcomes and with greater incidence of both adverse events and MACE independent of treatment allocation. While these findings are compatible with calls to relax HbA1c-based targets in people living with frailty, they also highlight the need for inclusion of people living with frailty in trials. This would require changes to trial processes to facilitate the explicit assessment of frailty and support the participation of people living with frailty. Such changes are important as the absolute balance of risks and benefits remains uncertain among those with higher degrees of frailty, who are largely excluded from trials.

Impact of bodyweight loss on type 2 diabetes remission: a systematic review and meta-regression analysis of randomised controlled trials

BACKGROUND

Bodyweight loss is associated with type 2 diabetes remission; however, the quantitative relationship between the degree of bodyweight loss and the likelihood of remission, after controlling for confounding factors, remains unknown. We aimed to analyse the relationship between the degree of bodyweight loss and diabetes remission after controlling for various confounding factors, and to provide estimates for the effect sizes of these factors on diabetes remission.

METHODS

This systematic review and meta-regression analysis followed Cochrane and PRISMA guidelines to systematically review, synthesise, and report global evidence from randomised controlled trials done in individuals with type 2 diabetes and overweight or obesity. The outcome was the proportion of participants with complete diabetes remission (HbA1c <6·0% [42 mmol/mol] or fasting plasma glucose [FPG] <100 mg/dL [5·6 mmol/L], or both, with no use of glucose-lowering drugs) or partial diabetes remission (HbA1c <6·5% [48 mmol/mol] or FPG <126 mg/dL [7·0 mmol/L], or both, with no use of glucose-lowering drugs) at least 1 year after a bodyweight loss intervention. We searched PubMed, Embase, and trial registries from database inception up to July 30, 2024. Data were extracted from published reports. Meta-analyses and meta-regressions were performed to analyse the data. The study protocol is registered with PROSPERO (CRD42024497878).

FINDINGS

We identified 22 relevant publications, encompassing 29 outcome measures of complete diabetes remission and 33 outcome measures of partial remission. The pooled mean proportion of participants with complete remission 1 year after the intervention was 0·7% (95% CI 0·1-4·6) in those with bodyweight loss less than 10%, 49·6% (40·4-58·9) in those with bodyweight loss of 20-29%, and 79·1% (68·6-88·1) in those with bodyweight loss of 30% or greater; no studies reported on complete remission with 10-19% bodyweight loss. The pooled mean proportion of participants with partial remission 1 year after the intervention was 5·4% (95% CI 2·9-8·4) in those with bodyweight loss less than 10%, 48·4% (36·1-60·8) in those with 10-19% bodyweight loss, 69·3% (55·8-81·3) in those with bodyweight loss of 20-29%, and 89·5% (80·0-96·6) in those with bodyweight loss of 30% or greater. There was a strong positive association between bodyweight loss and remission. For every 1 percentage point decrease in bodyweight, the probability of reaching complete remission increased by 2·17 percentage points (95% CI 1·94-2·40) and the probability of reaching partial remission increased by 2·74 percentage points (2·48-3·00). No significant or appreciable associations were observed between age, sex, race, diabetes duration, baseline BMI, HbA1c, insulin use, or type of bodyweight loss intervention and remission. Overall, data were derived from randomised controlled trials with a low risk of bias in all quality domains.

INTERPRETATION

A robust dose-response relationship between bodyweight loss and diabetes remission was observed, independent of age, diabetes duration, HbA1c, BMI, and type of intervention. These findings highlight the crucial role of bodyweight loss in managing type 2 diabetes and reducing the risk of diabetes-related complications.

FUNDING

Biomedical Research Program at Weill Cornell Medicine-Qatar and the Qatar National Research Fund (a member of Qatar Foundation).

Urinary titin as a biomarker of sarcopenia in diabetes: a propensity score matching analysis

PURPOSE

Measuring urinary titin levels is expected to be useful in screening for muscle damage or injury in various diseases. We evaluated whether urinary titin levels were elevated in individuals with type 2 diabetes mellitus (T2DM) and how urinary titin levels were associated with the diagnosis of sarcopenia in T2DM.

METHODS

We performed a cross-sectional analysis of 114 controls and 515 patients with T2DM. Multivariate-adjusted models were used to determine the odds ratios (OR) of urinary titin cutoff values for diagnosing sarcopenia.

RESULTS

Urinary titin levels were higher in the T2DM group than in the non-diabetes group after propensity score matching (median [IQR] 3.2 [2.3, 4.6] vs. 4.4 [2.7, 6.9] pmol/mg·creatinine). T2DM was associated with high titin levels after correction for comorbidities (odds ratio 2.46, 95% confidence interval (CI) 1.29-4.70, P = 0.006) but not after correction for sarcopenia-associated factors. Urinary titin levels above the cutoff value showed an odd ratio of 6.61 (age- and body mass index-adjusted, 1.26-34.6, P = 0.021) for the diagnosis of sarcopenia in men with T2DM aged ≥ 75 years.

CONCLUSION

Results indicated that T2DM was associated with a high-titin state and that the urinary titin cutoff value could be useful for identifying candidates at high risk for sarcopenia, such as elderly men.

Pathophysiological hallmarks in type 2 diabetes heterogeneity (review)

The mechanistic complexity in type 2 diabetes (T2DM) is primarily responsible for the degrees of heterogeneity and development of complications. A complex mode of interactions between different pathophysiological events and diabetogenic environmental factors support for the genesis of diabetes heterogeneity both in phenotypic and clinical contexts. The currently used diabetes classification strategies suffer from several inconsistencies that cannot fully capture the inherent heterogeneity among the diabetes patients. To effectively address this pathobiological and heterogeneity-related issue in diabetes research, the current review proposes nine pathophysiological hallmarks of T2DM that aims to mechanistically explain complexities of diabetes associated pathophysiological events and their underlying features. These pathophysiological hallmarks are pancreatic beta cell dysfunction, insulin sensitivity, insulin resistance, obesity, aging, subclinical inflammation, metabolic dysregulation, prothrombotic state induction and hypertension. Detail knowledge of these pathophysiological hallmarks with their key molecular mediators, influencing factors, clinical biomarkers and clinical assessment methodologies will greatly support precision medicine approaches in diabetes including patient stratification, subtype diagnosis and treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-024-00783-w.

Long-Term Administration of Antioxidant N-Acetyl-L-Cysteine Impacts Beta Cell Oxidative Stress, Insulin Secretion, and Intracellular Signaling Pathways in Aging Mice

Research into the effects of long-term antioxidant supplementation on the islet microenvironment is limited. This study examined whether long-term N-acetyl-L-cysteine (NAC) supplementation can prevent changes in metabolic outcomes, beta cell function, and pancreatic stellate cell (PaSC) activation in aging mice. Male C57BL/6N mice at 18 weeks were administered 50 mM NAC through their daily drinking water and treated for up to 60 weeks. Aging NAC mice displayed lower body weights and improved glucose tolerance but reduced insulin secretion and insulin signaling compared to control (ND) mice. When some 40-week-old ND and NAC mice were subjected to 8 weeks of a high-fat diet (HFD)-stress challenge, results showed that NAC reduced HFD-induced beta cell oxidative stress and preserved nuclear PDX-1 expression. The findings from this study suggest that while NAC can be beneficial for diet-induced stress during aging, the effects of long-term NAC on the islets of physiologically aging mice are more ambiguous. Further exploration is required to determine the effects of NAC-mediated lowering of beta cell oxidative stress on insulin secretion and signaling pathways. This study highlights the importance of investigating oxidative stress balance in aging islets under normal diet conditions to determine if antioxidative therapies can be utilized without interfering with essential physiological processes.

Anti-sarcopenic effects of active vitamin D through modulation of anabolic and catabolic signaling pathways in human skeletal muscle: A randomized controlled trial

BACKGROUND

The muscle-building and strengthening effects of the active form of vitamin D in humans remain unclear.

METHODS

In this ancillary study of the Diabetes Prevention with active Vitamin D trial, we examined clinical and experimental aspects to investigate the effects and mechanisms of eldecalcitol, an active form of vitamin D, in preventing sarcopenia. We examined changes in molecules involved in muscle synthesis and degradation pathways in muscle samples from 32 participants before and after 1 year of eldecalcitol or placebo treatment. The protein levels of molecules involved in muscle synthesis and degradation pathways were examined using western blotting. Additionally, the skeletal muscle and body fat volumes were measured using bioelectrical impedance analysis with a body composition analyzer.

RESULTS

We found that eldecalcitol treatment for 1 year resulted in higher phosphorylation levels of mTOR and FOXO1 signaling pathways, which are associated with increased muscle mass and strength than those with placebo treatment. Body composition measurements at 1 year showed that the eldecalcitol group had significantly higher skeletal muscle mass (1.9 % vs. -3.4 %, p = 3.26E-9) and muscle strength (4.1 % vs. -0.7 %, p = 2.57E-17), and lower fat mass (-3.2 % vs. 1.8 %, p = 1.73E-12) than those in the placebo group.

CONCLUSION

This study suggested that the active form of vitamin D regulates the protein synthesis and degradation pathways in human skeletal muscle and may help prevent sarcopenia. This study was registered at UMIN clinical trials registry, UMIN 000005394.

Age and Sex Differences in Efficacy of Treatments for Type 2 Diabetes: A Network Meta-Analysis

Importance

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors improve hyperglycemia, and SGLT2 inhibitors and GLP-1 receptor agonists reduce the risk of major adverse cardiovascular events (MACEs) among individuals with type 2 diabetes. It is not clear whether efficacy varies by age or sex.

Objective

To assess whether age or sex are associated with differences in the efficacy of SGLT2 inhibitors, GLP-1 receptor agonists, and DPP4 inhibitors.

Data Sources and Study Selection

The MEDLINE and Embase databases and US and Chinese clinical trial registries were searched for articles published from inception to November 2022; in August 2024, the search was updated to capture the trial results. Two reviewers screened for randomized clinical trials of SGLT2 inhibitors, GLP-1 receptor agonists, or DPP4 inhibitors vs a placebo or active comparator in adults with type 2 diabetes.

Data Extraction and Synthesis

Individual participant data and aggregate data were used to estimate age × treatment interactions and sex × treatment interactions in multilevel network meta-regression models.

Main Outcome and Measures

Hemoglobin A1c (HbA1c) and MACEs.

Results

Of the 601 eligible trials identified (592 trials with 309 503 participants reported HbA1c; mean age, 58.9 [SD, 10.8] years; 42.3% were female and 23 trials with 168 489 participants reported MACEs; mean age, 64.0 [SD, 8.6] years; 35.3% were female), individual participant data were obtained for 103 trials (103 reported HbA1c and 6 reported MACEs). The use of SGLT2 inhibitors (vs placebo) was associated with less HbA1c lowering with increasing age for monotherapy (absolute reduction [AR], 0.24% [95% credible interval {CrI}, 0.10% to 0.38%] per 30-year increment in age), for dual therapy (AR, 0.17% [95% CrI, 0.10% to 0.24%]), and for triple therapy (AR, 0.25% [95% CrI, 0.20% to 0.30%]). The use of GLP-1 receptor agonists was associated with greater HbA1c lowering with increasing age for monotherapy (AR, -0.18% [95% CrI, -0.31% to -0.05%] per 30-year increment in age) and for dual therapy (AR, -0.24% [95% CrI, -0.40% to -0.07%]), but not for triple therapy (AR, 0.04% [95% CrI, -0.02% to 0.11%]). The use of DPP4 inhibitors was associated with slightly better HbA1c lowering in older people for dual therapy (AR, -0.09% [95% CrI, -0.15% to -0.03%] per 30-year increment in age), but not for monotherapy (AR, -0.08% [95% CrI, -0.18% to 0.01%]) or triple therapy (AR, -0.01% [95% CrI, -0.06% to 0.05%]). The relative reduction in MACEs with use of SGLT2 inhibitors was greater in older vs younger participants per 30-year increment in age (hazard ratio, 0.76 [95% CrI, 0.62 to 0.93]), and the relative reduction in MACEs with use of GLP-1 receptor agonists was less in older vs younger participants (hazard ratio, 1.47 [95% CrI, 1.07 to 2.02]). There was no consistent evidence for sex × treatment interactions with use of SGLT2 inhibitors and GLP-1 receptor agonists.

Conclusions and Relevance

The SGLT2 inhibitors and GLP-1 receptor agonists were associated with lower risk of MACEs. Analysis of age × treatment interactions suggested that SGLT2 inhibitors were more cardioprotective in older than in younger people despite smaller reductions in HbA1c; GLP-1 receptor agonists were more cardioprotective in younger people.

Sodium-glucose Cotransporter 2 Inhibitors and Inverse Risk of New-onset Atopic Dermatitis in Diabetic Population: a Nationwide, Active-comparator Study

BACKGROUND

Sodium-glucose cotransporter-2 inhibitors (SGLT2i), a novel class of antidiabetic medications, have emerged as a key treatment option for diabetes management. Notably, SGLT2i promote glucose and sodium excretion through urine, a mechanism that may be implicated in the potential association between SGLT2i use and atopic dermatitis (AD) risk.

OBJECTIVES

This study investigated the relationship between SGLT2i use and new-onset AD in diabetic patients.

METHODS

This nationwide active-comparator cohort study utilized data from the Taiwan National Health Insurance Database to investigate the association between SGLT2i use and AD risk. The study included adult patients with type 2 diabetes who initiated SGLT2i or DPP4i between May 2016 and December 2018, with no prescriptions for other SGLT2i or DPP4i in the 12 months prior to cohort entry. A total of 148,354 SGLT2i users were identified as the study group, while 322,703 DPP4i users were designated as the active comparator group. The primary outcome was the incidence of AD. To minimize potential confounding, inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics, medical history, and ever having medication use between the two groups. Additionally, sensitivity analyses, subgroup analyses, and gender-specific assessments were conducted to further validate the findings. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of developing AD.

RESULTS

In the full cohort, SGLT2i users had a lower AD incidence (9.742 vs. 12.070 per 1,000 person-years) than DPP4i users. SGLT2i users had a significantly lower risk of AD compared to DPP4i users (HR = 0.847) after IPTW adjustment. Different SGLT2i types also showed a consistent protective effect for AD. Notably, the highest SGLT2i dosage was associated with the lowest AD risk (IPTW-adjusted HR = 0.647), consistent across sensitivity analyses. Additionally, male SGLT2i users exhibit a much lower risk of AD (IPTW-adjusted HR=0.750) than female SGLT2i users.

CONCLUSIONS

SGLT2i show a significant protective effect against AD in diabetic patients compared to DPP4i. This robust finding, consistent across weighting and sensitivity analyses, supports SGLT2i use, with a strong protective effect also observed in the dose-response analysis.

Interpretable time-series neural turing machine for prognostic prediction of patients with type 2 diabetes in physician-pharmacist collaborative clinics

BACKGROUND

Type 2 diabetes (T2D) has become a serious health threat globally. However, the existing approaches for diabetes prediction mainly had difficulty in addressing multiple time-series features. This study aims to provide an adjunctive tool for the clinical identification of patients in physician-pharmacist collaborative clinics at high risk of poor prognosis.

METHODS

This study proposes a novel interpretable time-series Neural Turing Machine (ITS-NTM) to form patient characteristics into feature matrixes to simulate one's disease and treatment process, predicting the prognosis of patients with T2D and alerting early interventions. Model robustness was verified by 10-fold cross-validation, external validation and multi-model comparisons. We also conducted dynamic prediction and feature importance analysis to explore its interpretability.

RESULTS

The study population included patients with T2D attending physician-pharmacist collaborative clinics over 12 months in primary healthcare centers, while clinical features and behavioral indicators at baseline, 3rd, 6th, 9th and 12th months were used to reflect the fluctuation of disease control over time. Compared with five state-of-the-art prediction models, the ITS-NTM obtains 92.0 % in accuracy and 91.8 % F1-score, demonstrating the superiority performance. Feature importance demonstrated that the top 5 features were glycosylated hemoglobin, fasting blood glucose, medication adherence scores, 2-hour postprandial blood glucose and waist-to-hip ratio, which had the greatest impact on the performance of the predictive model.

CONCLUSIONS

Proposed ITS-NTM could be used to promote the implementation of physician-pharmacist collaborative clinics, and further prompt the application of artificial intelligence to optimize the allocation of medical resources and improve the quality of care in under-resourced areas.

Effect of glucagon-like peptide-1 receptor agonists and co-agonists on body composition: Systematic review and network meta-analysis

BACKGROUND AND AIMS

While glucagon-like peptide-1 receptor agonists (GLP-1RAs) effectively reduce body weight, their impact on lean mass remains uncertain. This meta-analysis evaluated the effects of GLP-1RAs and GLP-1/GIP receptor dual agonists (GLP-1/GIP-RAs) on body composition, focusing on total weight, fat mass, and lean mass in adults with diabetes and/or overweight/obesity.

METHODS

A systematic search of Medline, Embase, and the Cochrane Library was conducted through November 12, 2024. Data were analyzed using random-effects pairwise and network meta-analyses to compare interventions with placebo or active comparators.

RESULTS

Twenty-two randomized controlled trials (2258 participants) were included. GLP-1RAs significantly reduced total body weight (MD -3.55 kg, 95 %-CI [-4.81, -2.29]), fat mass (MD -2.95 kg, 95 %-CI [-4.11, -1.79]), and lean mass (MD -0.86 kg, 95 %-CI [-1.30, -0.42]), with lean mass loss comprising approximately 25 % of the total weight loss. However, the relative lean mass, defined as percentage change from baseline, was unaffected. Liraglutide, at 3.0 mg weekly or 1.8 mg daily, was the only GLP-1RA to achieve significant weight reduction without significantly reducing lean mass. Tirzepatide (15 mg weekly) and semaglutide (2.4 mg weekly) were the most effective for weight and fat mass reduction but were among the least effective in preserving lean mass.

CONCLUSIONS

Potent GLP-1 RAs, such as tirzepatide and semaglutide, demonstrate greater overall weight loss but are associated with a significant reduction in lean mass.

Systemic immune-inflammation index to albumin (SII/ALB) ratio as a novel dual-dimensional powerful predictor for hip fractures in elderly females with diabetes: a postmenopausal longitudinal cohort study

PURPOSE

Hip fracture is the most dangerous and potentially lethal fracture, described as "the last fracture of life" in older adults. Previous studies have shown that excessive immunoinflammatory response and nutrient deficiency may be involved. Nevertheless, a predictor for hip fracture risk that combines a thorough evaluation of immunoinflammatory with malnutritional conditions in postmenopausal women with type 2 diabetes mellitus (T2DM) remains scarce. This study explored the relationship between the SII/ALB ratio (SAR) and fragility fracture risk in postmenopausal older adults with T2DM.

METHODS

Between January 2014 and January 2021, a total of 509 postmenopausal female participants with T2DM were recruited from the Medical Record Database of the People's Hospital of Guangxi Zhuang Autonomous Region. Finally, 363 participants with an age median of 69.00 (64.00-75.00), were eligible for inclusion in this analysis. According to the statistical tertiles of the SAR, all participants were split into three groups: low-level (≤ 98.24, n = 121), moderate-level (98.24-157.25, n = 121), and high-level (≥ 157.25, n = 121). The participants were followed up for seven years, with a median follow-up time of 45.9 months (1389 person-years). The relationships between the SAR and a real-world fragility fracture event and an individualized future 10-year probability of major osteoporotic fracture (MOF) and hip fracture (HF) calculated by the fracture risk assessment tool (FRAX) were evaluated through Spearman's partial correlation analysis, restricted cubic spline (RCS) model, Cox proportional hazards regression model, and Kaplan-Meier survival analysis. Furthermore, some indicators such as geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and SII were also calculated and compared to their diagnostic efficacy and the clinical application value through the receiver operating characteristic (ROC) curve analysis and the decision curve analysis (DCA), respectively.

RESULTS

Of the 363 participants, 69 suffered a real-world fragility fracture event (19%). Spearman's partial correlation analysis indicated that SAR was negatively related to femoral neck (FN) bone mineral density (BMD) (r = -0.108, P = 0.041) and total hip (TH) BMD (r = -0.118, P = 0.025), but not lumbar spine (LS) BMD (all Models P > 0.05); positively correlated with an individualized future 10-year probability of MOF (r = 0.136, P = 0.010) and HF (r = 0.139, P = 0.008) calculated by FRAX, especially in hip fracture risk. The RCS model demonstrated the relationship between the SAR and a fragility fracture endpoint event in a J-shaped dose-dependent manner (P for overall < 0.001, P for nonlinear = 0.866). Multivariate Cox regression analysis indicated that the SAR was positively associated with fragility fracture risk (P < 0.001). Kaplan-Meier survival analysis showed that patients with higher levels of SAR had a greater probability of fragility fracture risk (log-rank, P < 0.0001). The ROC curve demonstrated an optimal SAR cut-off value of 146.209 with an area under the curve (AUC) of 0.740, a sensitivity of 0.681, and a specificity of 0.701 (P < 0.001). According to the AUC values, the ROC curve analysis combined with the DCA illustrated that the diagnostic efficacy and the clinical application benefit ranked as follows: SAR > SII > PNI > GNRI, respectively.

CONCLUSION

Our findings show the SAR is a novel dual-dimensional powerful predictor for fragility fracture risk, especially hip fracture, and as an effective tool for developing fragility fracture prevention strategies in postmenopausal females with T2DM. Consequently, monitoring SAR levels in usual clinical practice to focus on immunoinflammatory and nutritional status to identify individuals at high risk of hip fracture and implement timely fracture interventions is particularly essential.

CLINICAL TRIAL NUMBER

Not applicable.

Independent influence of type 2 diabetes on reduced cardiopulmonary fitness in patients after percutaneous coronary intervention: a cross-sectional study

Previous studies have found a significant association between type 2 diabetes (T2DM) and impaired cardiopulmonary fitness (CRF); however, little evidence was shown in patients after percutaneous coronary intervention (PCI). This study aimed to evaluate the independent effects of T2DM on CRF in patients who have undergone successful percutaneous coronary intervention (PCI) and received guideline-directed medical therapy. Additionally, we explored whether this association is influenced by factors such as demographic features, physical activity level, duration of diabetes, time from index PCI, and history of occlusion myocardial infarction. We retrospectively analyzed data from post-PCI patients who consecutively visited the Cardiac Rehabilitation Center at Beijing Anzhen Hospital between September 2023 and July 2024. To isolate the impact of T2DM on cardiovascular fitness, we implemented strict exclusion criteria for confounding comorbidities, particularly heart failure. Cardiorespiratory fitness was quantified through gold-standard measures: peak oxygen uptake (VO2max) and metabolic equivalents (METs). Baseline characteristics were compared between patients with T2DM and non-diabetic patients (DM group vs. non-DM group). A multivariable regression model was used to evaluate the independent effect of T2DM on CRF, adjusting for confounding factors such as demographic features, physical activity level, duration of diabetes, time since index PCI, and residual comorbidities. Subgroup analyses and interaction tests were performed to assess the impact of T2DM across different subgroups. 201 patients (150 non-DM and 51 DM patients) were included in the final analysis. Hypertension was significantly more prevalent in DM patients (68.6 vs. 42.7%, p = 0.001), while other comorbidities, anthropometric measurements, lifestyle factors, and time from index PCI showed no significant differences between groups (all p > 0.05). Multivariate logistic regression analyses demonstrated significant negative associations between T2DM and both VO2max and METs. After adjusting for basic demographic and lifestyle factors (Model 1), T2DM was inversely associated with VO2max (β=-98.3, 95% CI -193.4 to -3.3, p = 0.044) and METs (β=-0.4, 95% CI -0.8 to -0.0, p = 0.05). These negative associations remained robust and became stronger in Model 2, which further adjusted for physical activity status, hypertension, hyperlipidemia, history of occlusion myocardial infarction, time from index PCI, DM duration, and using beta-blockers, showing more pronounced inverse relationships with both VO2max (β=-212.3, 95% CI -389.4 to -35.3, p = 0.02) and METs (β=-0.9, 95% CI -1.6 to -0.2, p = 0.014). Subgroup analyses indicated consistent inverse associations, with no significant effect modification based on sex, age, body mass index (BMI), time since the index PCI, physical activity status, or a history of occlusion myocardial infarction. Our study demonstrates that T2DM is an independent negative predictor of CRF in post-PCI patients, with consistent findings across various subgroups and robust results after adjusting for confounding factors. These findings underscore the importance of CRF assessment in post-PCI patients and highlight the need for targeted interventions to improve CRF in individuals with T2DM.

Protective effects of Colla Corii Asini Collagen Peptides on D-galactose injection combined with UVB irradiation-induced aging in mice

Skin aging, autonomic mobility, memory function and physical deterioration are important features of aging, and effective anti-aging treatments are important in slowing down these processes. The objective of this research was to evaluate the protective effect of Colla Corii Asini (Ejiao) Collagen Peptides (CCACPs) on D-galactose (D-gal) injection combined with UV irradiation-induced senescence in mice. BY-HEALTH collagen oral solution (Bcos) was used as a positive control. Behavioural experiments showed that CCACPs significantly improved voluntary activity, learning memory and exercise endurance in aging mice. Elisa results showed that CCACPs reduced the levels of matrix metalloproteinase-1 (MMP-1) and MMP-3 in the skin, acetylcholinesterase (AChE) in the brain, and alanine aminotransferase (ALT) and azelaic aminotransferase (AST) in the liver of mice, while increasing the levels of collagen I in the skin and SOD in the brain. RT-qPCR revealed that CCACPs reduced the expression of p16, p19 and p21 genes in the liver and hippocampus, as well as the expression of IL-6 in the skin. Histological analysis of brain hippocampus, liver and skin confirmed the protective effects of CCACPs. The findings indicated that CCACPs may potentially slow the aging effects caused by D-galactose and UVB exposure in mice by reducing cellular senescence and oxidative stress levels. The results of this research provide the scientific basis for continuing to advance the extraction of collagen peptides from Colla Corii Asini as a potential anti-aging therapy.

Overcoming dietary complexity in type 2 diabetes: influencing factors and coping strategies

BACKGROUND

Adherence to dietary guidelines is a fundamental aspect of diabetes management; however, it poses a significant challenge for patients with diabetes. Our research aims to assess the level of dietary compliance among individuals with type 2 diabetes (T2DM) and to identify the factors that influence their adherence to dietary advice.

METHODS

This study was a cross-sectional survey. The patients with T2DM undergoing treatment at our hospital from March, 2023, to June, 2024 were included. Compliance with dietary recommendations was assessed using the validated dietary compliance scale for type 2 diabetes mellitus patients (DCS-T2DM). Spearman correlation and logistic regression analyses were conducted to evaluate the factors influencing dietary compliance in patients with T2DM.

RESULTS

A total of 308 T2DM patients were included in our study. The results revealed that 46.10% of the participants had suboptimal dietary compliance. There were significant correlations between dietary compliance and several demographic and clinical factors, including age (r = 0.501), gender (r = 0.447), education level (r = 0.610), average monthly household per capita income (r = 0.627), and the duration, since T2DM diagnosis (r = 0.552), all of which were statistically significant (p < 0.05). Logistic regression identified age (OR = 1.705, 95%CI 1.262 ~ 1.987), gender (OR = 2.401, 95%CI 1.909 ~ 3.134), education level (OR = 3.083, 95%CI 2.434 ~ 3.957), average monthly household per capita income (OR = 3.721, 95%CI 2.553 ~ 4.405), and the time since T2DM diagnosis (OR = 2.470, 95%CI 1.755 ~ 3.262) as significant predictors of dietary compliance.

CONCLUSIONS

46.10% of patients with T2DM exhibited suboptimal dietary adherence, with age, gender, education, income, and diabetes duration significantly predicting compliance. It is imperative for healthcare providers to devise individualized intervention strategies that incorporate these pivotal factors to enhance dietary adherence in patients with T2DM.

Serine metabolism in aging and age-related diseases

Non-essential amino acids are often overlooked in biomedical research; however, they are crucial components of organismal metabolism. One such metabolite that is integral to physiological function is serine. Serine acts as a pivotal link connecting glycolysis with one-carbon and lipid metabolism, as well as with pyruvate and glutathione syntheses. Interestingly, increasing evidence suggests that serine metabolism may impact the aging process, and supplementation with serine may confer benefits in safeguarding against aging and age-related disorders. This review synthesizes recent insights into the regulation of serine metabolism during aging and its potential to promote healthy lifespan and mitigate a spectrum of age-related diseases.

Treatment persistence, adherence and healthcare resource utilisation for iGlarLixi versus basal-bolus insulin or premixed insulin in older adult ethnic minorities with type 2 diabetes: SoliEthnicity study

AIMS

Most type 2 diabetes (T2D) studies have predominantly enrolled White people aged <65 years. This retrospective study evaluated outcomes for iGlarLixi (fixed-ratio combination [FRC] of insulin glargine 100 U/mL and lixisenatide) versus basal-bolus or premixed insulin in African American, Asian and Hispanic adults with T2D aged ≥65 years.

METHODS

Medicare claims data were assessed from beneficiaries receiving basal insulin who newly initiated iGlarLixi, basal-bolus insulin, or premixed insulin between 7/1/2019 and 12/30/2021. Groups were propensity score matched at baseline and followed for up to 12 months. Endpoints (primary: treatment persistence; secondary: treatment adherence, hypoglycaemia event rates, healthcare resource utilisation) were assessed using multivariable regression.

RESULTS

Treatment persistence was higher for iGlarLixi versus basal-bolus or premixed insulin in the overall population (26.9%, 7.6%, 18.9%; adjusted p < 0.0001) and numerically higher in all ethnic subgroups. Treatment adherence was numerically higher for iGlarLixi versus basal-bolus or premixed insulin in the overall population (28.0%, 8.0%, 19.0%) and in all subgroups. Hypoglycaemia event rates were numerically lower for iGlarLixi versus basal-bolus insulin or premixed insulin in the overall population (2.5, 3.8, 7.5/100 person-years' follow-up) and in all subgroups except Asians receiving basal-bolus insulin. All-cause and diabetes-related hospitalisation and emergency department visit event rates were lower with iGlarLixi versus basal-bolus insulin or premixed insulin in the overall population, and in all subgroups except for hospitalisations in Hispanics.

CONCLUSION

FRC therapies such as iGlarLixi represent an appropriate treatment option when intensifying basal insulin therapy in ethnic minority older adults with T2D.

Exploring synergistic inhibitory mechanisms of flavonoid mixtures on α-glucosidase by experimental analysis and molecular dynamics simulation

The study was the first to evaluate the synergistic interaction of luteolin + quercetin, luteolin + 3-O-methylquercetin, and quercetin + 3-O-methylquercetin mixtures on α-glucosidase and the binding mechanisms were explored using both experimental and theoretical approaches. The results showed that three flavonoid mixtures exhibited a mixed type of inhibition and demonstrated the most potent synergistic effects on α-glucosidase inhibition at 6:4 ratio, with interaction index (γ) of 0.85, 0.78 and 0.73, respectively. The three mixtures had a great influence on α-glucosidase secondary structures. Molecular simulation further demonstrated that three flavonoid mixtures formed hydrophobic interactions and hydrogen bonds with amino acid residues at different sites of α-glucosidase. Collectively, luteolin + quercetin, luteolin + 3-O-methylquercetin and quercetin + 3-O-methylquercetin were found to inhibit α-glucosidase in a synergistic manner and can be potentially used for the development of hypoglycemic food products.

Can 12-Week Resistance Training Improve Muscle Strength, Dynamic Balance and the Metabolic Profile in Older Adults with Type 2 Diabetes Mellitus?

The present study aimed to evaluate the effects of 12-week resistance training (RT) on muscle strength, dynamic balance, glycemic control and the lipid profile.

METHODS

The Laboratory of Movement Studies in the University of São Paulo, Brazil, developed this longitudinal study between 2021 and 2023. It assessed 62 males with type 2 diabetes mellitus pre and post an RT protocol. The participants, who were 69.8 (±3.9) years old, took part in a 12-week twice-weekly RT program. Three sets of eight to twelve repetitions each were executed for eight exercises targeting the large muscle groups. The intensity was set between 7 and 8 out of 10 for perceived effort, according to the Omni Resistance Exercise Scale. All participants were evaluated pre and post in knee extensor and flexor strength by isokinetic dynamometry, handgrip strength by manual dynamometry and dynamic postural balance by a force platform, as well as blood tests to determine the lipid and glycemic profiles. For comparison, paired t or Wilcoxon tests were used at an alpha of 5%.

RESULTS

There was an improvement in muscular strength by handgrip restricted to the non-dominant side (p = 0.033) and for the bilateral knee flexors (p < 0.001) and extensors (p < 0.001), as determined by isokinetic dynamometry. There was no improvement in dynamic postural balance, glycemic control or lipid control.

CONCLUSIONS

The 12-week RT promoted improved muscle strength in knee extension and flexion and non-dominant grip pressure but did not affect dynamic balance, glycemic control or the lipid profile.

Achieving prediabetes reversal in China: a nationwide longitudinal study on the role of blood glucose and lipid management in middle-aged and elderly adults

Background

Prediabetes, impacting a third of the adult Chinese population, is linked to a variety of detrimental health outcomes. However, scant research has delved into the factors that affect a regression from prediabetes to normal glucose regulation (NGR) in middle-aged and elderly Chinese adults.

Methods

We conducted a longitudinal analysis of 2,655 adults, aged 45 years and above, drawing data from wave 1 and wave 3 of the China Health and Retirement Longitudinal Study (CHARLS). We employed a stepwise logistic regression model to identify factors associated with the regression to NGR. Restricted Cubic Spline (RCS) analysis was used to evaluate the dose-response relationships between baseline fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) levels and the likelihood of regression to NGR. Attribution fraction (AF) analysis was conducted to measure the impact of modifiable factors on the regression of prediabetes. We further examined how changes in these factors were associated with regression to NGR.

Results

During the 4-year follow-up, 570 of 2,655 prediabetes participants regressed to NGR. The stepwise logistic regression model identified older age, female sex, abdominal obesity (OR 0.70, 95% CI 0.57-0.86), elevated LDL-C (OR 0.69, 95% CI 0.48-0.97), higher FPG (OR 0.68, 95% CI 0.52-0.90), and higher HbA1c (OR 0.23, 95% CI 0.18-0.30) as factors associated with regression to NGR. AF analysis showed that a lower initial HbA1c was the most influential factor for regression to NGR. Additionally, evaluated blood lipid profiles reduced the odds of regression to NGR.

Conclusion

This study underscores the influence of age, gender, abdominal obesity, LDL-C levels, FPG, HbA1c, and blood lipid profiles on the likelihood of regressing from prediabetes to NGR. It suggests that adopting a healthy lifestyle and preemptively mitigating these risks may be more beneficial than addressing them after they have been identified in clinical settings.

Relation of Insulin Resistance to Brain Glucose Metabolism in Fasting and Hyperinsulinemic States: A Systematic Review and Meta-analysis

CONTEXT

Abnormal brain glucose metabolism may cause cognitive disease in type 2 diabetes, yet the relation between insulin resistance and brain glucose metabolism has not been systematically described.

OBJECTIVE

We evaluated the impact of metabolic condition (fasting vs insulin stimulation, eg, from hyperinsulinemic clamp) on the association between insulin resistance of different etiologies and brain glucose metabolism.

DATA SOURCES

PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from inception until February 2022.

STUDY SELECTION

Of 656 unique records, we deemed 31 eligible. Criteria were studies assessing brain glucose metabolism (uptake or metabolic rate) by 18F-2-fluoro-2-deoxy-D-glucose-positron emission tomography in individuals characterized by measures of or clinical proxies for insulin resistance (eg, type 2 diabetes and obesity).

DATA EXTRACTION

Two independent investigators extracted data and assessed study quality.

DATA SYNTHESIS

We applied random-effects models to pool Hedge's g standardized mean differences. Insulin resistance was associated with decreased brain glucose metabolism during fasting [-0.47 SD, 95% confidence interval (CI): -0.73 to -0.22, P < .001, I2 = 71%] and increased metabolism during insulin stimulation (1.44 SD, 95% CI 0.79 to 2.09, P = .002, I2 = 43%). Contrary to type 2 diabetes and other insulin resistance-related conditions, obesity was not associated with brain hypometabolism in fasting states (0.29 SD, 95% CI -.81 to 1.39).

CONCLUSION

Metabolic conditions modify associations between insulin resistance and brain glucose metabolism; ie, most individuals with insulin resistance display hypometabolism during fasting and hypermetabolism during insulin stimulation.

Relationship Between Body Mass Index and Low Skeletal Muscle Mass in Adults Based on NHANES 2011-2018

Sarcopenia, a syndrome characterized by declining muscle mass and function, is associated with various adverse health outcomes. While body mass index (BMI) is a fundamental health indicator, its relationship with sarcopenia is complex and remains inadequately explored. Low BMI has been linked to muscle loss, but the role of other demographic and clinical factors in this relationship is unclear. This cross-sectional study analyzed data from the NHANES 2011-2018 cohort, including 7,455 adults aged ≥ 20 years. Low muscle mass was diagnosed based on appendicular skeletal muscle mass using DXA criteria. BMI was categorized into quartiles for analysis. Weighted multivariable logistic regression assessed associations between BMI and low muscle mass, adjusting for confounders such as age, gender, ethnicity, income-to-poverty ratio, and chronic diseases (e.g., diabetes and hypertension). Variance inflation factors (VIF) confirmed the absence of multicollinearity. Lower BMI was significantly associated with higher odds of low muscle mass (adjusted OR: 0.508, 95% CI: 0.483-0.533, p < 0.001), while higher BMI exhibited a protective effect. Age (OR: 1.035, 95% CI: 1.025-1.045, p < 0.001) and female gender (OR: 1.570, 95% CI: 1.267-1.949, p < 0.001) were independent risk factors. Racial disparities were noted, with non-Hispanic Black individuals at lower risk compared to non-Hispanic Whites (OR: 0.242, 95% CI: 0.152-0.384, p < 0.001). Other significant factors included diabetes and alcohol consumption, while education and smoking status were not significantly associated. BMI is inversely associated with low muscle mass prevalence, with lower BMI posing a higher odds. The findings underscore the clinical importance of monitoring BMI and addressing multifactorial risk profiles for low muscle mass management and prevention.

Dietary carotenoid intakes and biological aging among US adults, NHANES 1999-2018

BACKGROUND

Carotenoids have been shown to have multiple health benefits, including antioxidant and anti-inflammatory. The data for the effect of dietary specific carotenoids on biological aging is limited. Our study aims to examine the association between dietary carotenoid intake levels and biological aging.

METHODS

This cross-sectional study was performed among 27,338 adults from NHANES 1999-2018. Dietary intake was assessed through two 24-hour dietary recall interviews. Biological aging indices included allostatic load (AL), homeostatic dysregulation (HD), Klemera-Doubal method (KDM), and phenoAge (PA). Multiple linear regression, weighted quantile sum (WQS) regression and quantile g-computation (QG-comp) were used to explore the associations of single carotenoid and mixed carotenoids with biological aging.

RESULTS

Associations between dietary carotenoid intake levels and biological aging indices were significant among adults across the United States. Multiple linear regression showed that most carotenoids were significantly negatively correlated with AL (β = -0.017 - -0.011), HD (β = -0.045 - -0.032), KDM (β = -0.984 - -0.471), and PA (β = -0.975 - -0.539). Subgroup analysis indicated that male, older individuals, smokers, alcohol drinkers, and less physically active individuals are particularly sensitive populations. Meanwhile, WQS regression and QG-comp analyses consistently indicated a negative association between mixed carotenoids exposure and four biological aging indices, highlighting that lutein/zeaxanthin and β-carotene were responsible for the outcomes.

CONCLUSIONS

Increased dietary intakes of various carotenoids were associated with lower biological aging indices, which was possibly and mainly driven by lutein/zeaxanthin and β-carotene.

Aptamer proximal enzyme cascade reactions for ultrafast detection of glucose in human blood serum

An innovative colorimetric sensing strategy was developed for the detection of glucose by the integration of glucose aptamer, glucose oxidase (GOx), and horseradish peroxidase (HRP), termed aptamer proximal enzyme cascade reactions (APECR). In the presence of glucose, aptamer binding enables GOx to catalyze glucose oxidation into H2O2 efficiently. Subsequently, the adjacent HRP catalyzes the oxidation of the peroxidase substrate, 2,2'-biazobis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS2-), utilizing the generated H2O2, resulting in a distinct color change. In comparison to the free enzymes and the HRP-GOx system, APECR exhibited higher colorimetric signal. This approach achieved glucose detection within three minutes, which was significantly faster than previous methods. This method showed good sensitivity and selectivity with a limit of detection of 0.013 mM. Moreover, the practical utility of this strategy was verified by achieving rapid detection of glucose in clinical serum samples. Hence, the developed strategy has the advantages of simple operation and rapid analysis time for the detection of glucose in human serum.

Moderate-to-vigorous physical activity does not improve mortality in type 2 diabetes patients with severe abdominal aortic calcification

BACKGROUND

The impact of moderate-to-vigorous physical activity (MVPA) on all-cause mortality in type 2 diabetes (T2D) patients with severe abdominal aortic calcification (SAAC) remains unclear.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014, including T2D patients aged 40 years and older. AAC was assessed using the Kauppila scoring system, with SAAC defined as a score >6. Self-reported MVPA was categorized based on weekly minutes of activity. The weighted Cox regression model was used to investigate risk associations.

RESULTS

Among the weighted sample of 20,328,606 T2D participants, 16.39% had SAAC. SAAC was significantly associated with increased all-cause mortality (HR 2.57, 95% CI 1.52-4.35) after adjusting for confounders. MVPA did not significantly reduce mortality risk in patients with SAAC (HR 1.00, 95% CI 0.40-2.49).

CONCLUSION

SAAC is a robust predictor of mortality in T2D patients, and MVPA does not improve mortality outcomes in this high-risk group. Future studies should conduct more detailed subgroup analyses to identify the specific indications for MVPA.

Aerobic exercise and metformin attenuate the cognitive impairment in an experimental model of type 2 diabetes mellitus: focus on neuroinflammation and adult hippocampal neurogenesis

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that increases the prevalence of cognitive impairment in the geriatric population. Aerobic exercise is an excellent non-pharmacological therapeutic strategy to prevent Alzheimer's disease, the most common form of dementia. The exact molecular mechanism of aerobic exercise (Exe) as an intervention to counter cognitive decline is far from clear. Metformin is a first-line agent against T2DM with neuroprotective properties. The present study assessed the role of treadmill exercise in combination with a low dose of metformin (Met; 70 mg/kg) in cognitive impairment and its associated molecular mechanism in T2DM rats. The experimental model of T2DM-associated cognitive decline was created by administration of a high-fat diet (HFD) with a low dose of streptozotocin (STZ; 35 mg/kg). Neurobehavioral assessments were performed to evaluate spatial recognition and fear-conditioned memory across the groups: control, HFD + STZ, HFD + STZ + Exe, and HFD + STZ + Exe + Met. In addition, we performed immunohistochemistry and western blotting on the rat hippocampal tissue from the above groups for protein expression studies. T2DM rats showed a significant cognitive decline compared to the control group, which improved in the long-term exercise and metformin co-administered animals. The level of neuroinflammation was significantly elevated in the hippocampal tissue of T2DM rats compared to the control and lowered after exercise and metformin treatment. T2DM reduced mature neurons and neurogenesis while increasing astrogliosis and microgliosis, ameliorated by exercise and metformin treatment. Moreover, T2DM impaired hippocampal neurogenesis by reducing the canonical Wnt/β-catenin pathway, which got upregulated in exercise and metformin-co-administered rats. Long-term aerobic exercise with metformin treatment ameliorated neuroinflammation and promoted adult hippocampal neurogenesis via upregulating the canonical Wnt/β-catenin pathway in T2DM rats.

Intermittent Use of Flash Glucose Monitoring Improves Glycemic Control in Chinese Older Patients with Type 2 Diabetes Mellitus

OBJECTIVE

To explore the efficacy and safety of intermittent use of flash glucose monitoring (FGM) for improving glycemic control in Chinese elderly patients with type 2 diabetes mellitus (T2DM).

METHODS

This is a prospective observational study involving patients with T2DM aged ≥60 years. The study period spans 12 weeks, with participants wearing FGM at weeks 0, 5, and 10. Participants were divided into two subgroups based on HbA1c at enrollment: < 7.0% and ≥7.0%. The primary outcome of the study was HbA1c level. Secondary outcomes included time in range (3.9-10mmol/L) (TIR), time below range (<3.9mmol/L) (TBR), time above range (>10.0mmol/L) (TAR), and glycemic variability (GV).

RESULTS

A total of 68 patients completed the 12-week FGM follow-up (age 67.9 ± 5.2 years; BMI 25.4 ± 3.3kg/m²). Overall findings revealed that compared to baseline, HbA1c decreased from 7.81 ± 1.25% to 7.44±1.10% after 12 weeks of intermittent wearing of FGM (p <0.001). In the subgroup analysis with HbA1c ≥7.0%, the results showed a significant reduction in HbA1c of 0.51mmol/L after 12 weeks (8.36 ± 0.95% vs 7.75 ± 0.97%, p < 0.001). And there was a significant reduction in TBR in the subgroup with HbA1c < 7% (p = 0.028). Multiple linear regression analysis showed that the baseline HbA1c (β = -0.529, P<0.001), duration of T2DM (β = 0.341, P = 0.001), and the frequency of sensor use (β = -0.269, P = 0.043) were associated with the reduction in HbA1c level.

CONCLUSION

Intermittent use of FGM is associated with an improvement in glycemic outcomes and reduces the risk of hypoglycemia in Chinese elderly patients with T2DM.

Rspo3-mediated metabolic liver zonation regulates systemic glucose metabolism and body mass in mice

The unique architecture of the liver consists of hepatic lobules, dividing the hepatic features of metabolism into 2 distinct zones, namely the pericentral and periportal zones, the spatial characteristics of which are broadly defined as metabolic zonation. R-spondin3 (Rspo3), a bioactive protein promoting the Wnt signaling pathway, regulates metabolic features especially around hepatic central veins. However, the functional impact of hepatic metabolic zonation, regulated by the Rspo3/Wnt signaling pathway, on whole-body metabolism homeostasis remains poorly understood. In this study, we analyze the local functions of Rspo3 in the liver and the remote actions of hepatic Rspo3 on other organs of the body by using murine models. Rspo3 expression analysis shows that Rspo3 expression patterns are spatiotemporally controlled in the murine liver such that it locates in the pericentral zones and converges after feeding, and the dynamics of these processes are disturbed in obesity. We find that viral-mediated induction of Rspo3 in hepatic tissue of obesity improves insulin resistance and prevents body weight gain by restoring attenuated organ insulin sensitivities, reducing adipose tissue enlargement and reversing overstimulated adaptive thermogenesis. Denervation of the hepatic vagus suppresses these remote effects, derived from hepatic Rspo3 induction, toward adipose tissues and skeletal muscle, suggesting that signals are transduced via the neuronal communication consisting of afferent vagal and efferent sympathetic nerves. Furthermore, the non-neuronal inter-organ communication up-regulating muscle lipid utilization is partially responsible for the ameliorations of both fatty liver development and reduced skeletal muscle quality in obesity. In contrast, hepatic Rspo3 suppression through Cre-LoxP-mediated recombination system exacerbates diabetes due to glucose intolerance and insulin resistance, promotes fatty liver development and decreases skeletal muscle quality, resulting in obesity. Taken together, our study results reveal that modulation of hepatic Rspo3 contributes to maintaining systemic glucose metabolism and body composition via a newly identified inter-organ communication mechanism.

Association of hypertension and long-term blood pressure changes with new-onset diabetes in the elderly: A 10-year cohort study

AIM

To explore the correlation between new-onset diabetes (NOD), hypertension and blood pressure management among elderly individuals in China.

MATERIALS AND METHODS

A cohort analysis involved 1380 participants aged 60 years or older, initially free of diabetes in 2008, from the Chinese Longitudinal Healthy Longevity Survey. Follow-up assessments occurred every 2-3 years. The relationship between hypertension, blood pressure changes and NOD was analysed using multivariable-adjusted Cox regression.

RESULTS

By 2018, 102 participants developed diabetes, while 1278 remained without diabetes. The cumulative diabetes prevalence increased from 3.1% at 3 years to 7.4% at 10 years. Hypertension prevalence increased from 20.9% at baseline to 41.0% at 10 years, with higher rates in those diagnosed with diabetes during follow-up. Multivariate analysis identified age, gender, baseline hypertension and systolic blood pressure (SBP) as independent predictors of NOD. Hypertension combined with overweight/obesity significantly increased the risk of NOD (hazard ratio [HR] 2.837; 95% confidence interval [CI], 1.680-4.792). We evaluated participants' blood pressure management levels in 2008 and 2011, then tracked the onset of diabetes from 2011 to 2018. Compared with participants with an average SBP below 120 mmHg in 2008 and 2011, those with SBP of 140 mmHg or higher had an 8-fold higher risk of developing NOD (adjusted HR8.492, 95% CI 2.048-35.217, P = .003), the highest risk group. Participants with SBP of 130-139.9 mmHg also had a significantly increased risk (adjusted HR 5.065, 95% CI 1.186-21.633, P = .029), while those with SBP of 120-129.9 mmHg showed no significant difference (HR 2.730, 95% CI 0.597-12.481, P = .195). Consistently high SBP (≥ 130 mmHg) further increased NOD risk (adjusted HR 3.464, 95% CI 1.464-8.196, P = .005).

CONCLUSIONS

Significant predictors of NOD included age, gender, baseline hypertension and blood pressure management. Maintaining SBP consistently below 130 mmHg may be an effective strategy to reduce the incidence of NOD in the general elderly population.

Grip-Strength-Lean-Mass Index (GSLMI) as a valuable tool for sarcopenia diagnosis and survival prognosis in cancer patients: a nationwide multicenter cohort study

OBJECTIVES

To identify whether the Grip-Strength-Lean-Mass Index (GSLMI) can precisely diagnose sarcopenia and predict prognosis for cancer patients in clinical settings.

DESIGN

A nationwide multicenter cohort study.

SETTING AND PARTICIPANTS

8,831 inpatients aged 18 years and older, histologically diagnosed with cancer and receiving anti-cancer therapy.

MEASUREMENTS

The GSLMI is the ratio of hand grip strength (HGS) divided by lean mass (LM), calculated by the formula: GSLMI = HGS (kg) / LM (kg). Kaplan-Meier curves and Cox models were used to estimate the association between the GSLMI and survival.

RESULTS

A total of 3,071 (48.40%) male and 3,274 (51.60%) female patients were enrolled in the study. The prevalence of GLIS-defined sarcopenia was 2,646 (41.70%). The optimal sex-specific thresholds with the best diagnostic performance to identify a low GSLMI were determined to be <0.61 for males and <0.47 for females based on the ROC curves. According to Kaplan-Meier curves, patients with a high GSLMI exhibited better overall survival than those with a low GSLMI (HR = 0.664, 95%CI = 0.604-0.729, log-rank P < 0.001). Multivariable survival analysis revealed that the GSLMI showed an independent association with a lower hazard of death as a continuous variable (HR = 0.70, 95% CI = 0.51-0.96).

CONCLUSIONS

The GSLMI may serve as a novel diagnostic tool for identifying sarcopenia and may have prognostic value for cancer patients. Using the GSLMI represents a feasible and promising option for better managing the health of patients with cancer.

Association of oxidative balance score with cardiovascular disease and all-cause and cardiovascular mortality in American adults with type 2 diabetes: data from the National Health and Nutrition examination survey 1999-2018

Background

Oxidative stress has an important role in type 2 diabetes (T2D). Oxidative balance score (OBS) is an emerging assessment of dietary and lifestyle oxidative balance. We aimed to explore the association of OBS with cardiovascular disease (CVD) and all-cause and CVD mortality in the T2D population through NHANES 1999-2018.

Methods

OBS integrated 16 dietary components and 4 lifestyle components. T2D was diagnosed according to the American Diabetes Association criteria. Multivariate logistic regression and multivariate Cox proportional hazards regression analyses were used to explore the association of OBS with CVD and mortality in T2D, respectively.

Results

3801 adult T2D participants were included. In fully adjusted models, OBS, dietary OBS, and lifestyle OBS were all negatively associated with the prevalence of CVD (odds ratios of 0.98, 0.98, and 0.85, respectively). Higher OBS and lifestyle OBS (p for trend 0.016 and <0.001, respectively) rather than dietary OBS (p for trend = 0.06) were associated with significantly lower odds of CVD. Higher OBS, dietary OBS, and lifestyle OBS were all negatively associated with all-cause mortality (hazard ratios [HR] of 0.98, 0.98, and 0.92, respectively; p for trend of 0.002, 0.009, and 0.035, respectively). Higher OBS and dietary OBS were negatively associated with CVD mortality (HR 0.96 and 0.95, respectively; p for trend both <0.001), whereas lifestyle OBS was not. Restricted cubic spline analysis suggested that most associations were linear. Stratified analyses showed that these associations were influenced by some demographic variables and disease status.

Conclusions

Adherence to higher OBS was associated with reduced CVD prevalence and mortality risk in T2D. Antioxidant diet and lifestyle had more significant associations with mortality and CVD prevalence, respectively. However, as these findings are merely associations and do not allow causal inferences to be drawn, future validation in high-quality randomized controlled trials is needed.

FAPs orchestrate homeostasis of muscle physiology and pathophysiology

As a common clinical manifestation, muscle weakness is prevalent in people with mobility disorders. Further studies of muscle weakness have found that patients with muscle weakness present with persistent muscle inflammation, loss of muscle fibers, fat infiltration, and interstitial fibrosis. Therefore, we propose the concept of muscle microenvironment homeostasis, which explains the abnormal pathological changes in muscles through the imbalance of muscle microenvironment homeostasis. And we identified an interstitial progenitor cell FAP during the transition from normal muscle microenvironment homeostasis to muscle microenvironment imbalance caused by muscle damage diseases. As a kind of pluripotent stem cell, FAPs do not participate in myogenic differentiation, but can differentiate into fibroblasts, adipocytes, osteoblasts, and chondrocytes. As a kind of mesenchymal progenitor cell, it is involved in the generation of extracellular matrix, regulate muscle regeneration, and maintain neuromuscular junction. However, the muscle microenvironment is disrupted by the causative factors, and the abnormal activities of FAPs eventually contribute to the complex pathological changes in muscles. Targeting the mechanisms of these muscle pathological changes, we have identified appropriate signaling targets for FAPs to improve and even treat muscle damage diseases. In this review, we propose the construction of muscle microenvironmental homeostasis and find the key cells that cause pathological changes in muscle after homeostasis is broken. By studying the mechanism of abnormal differentiation and apoptosis of FAPs, we found a strategy to inhibit the abnormal pathological changes in muscle damage diseases and improve muscle regeneration.

Cardiologists vs Endocrinologists in Glycemic Control for Coronary Artery Disease Patients with Type 2 Diabetes: A Cross-Sectional Study

Background

The comorbidity of coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) presents significant challenges in clinical management, particularly regarding glycemic control. The clinical management of CAD complicated by T2DM requires coordinated glycemic control, as poor management can exacerbate cardiovascular risks and increase morbidity and mortality. While endocrinologists traditionally manage diabetes, cardiologists are increasingly involved due to the cardiovascular risks associated with poor glycemic control. This study explores the current practices of glycemic management by cardiologists and endocrinologists in patients with CAD and T2DM, focusing on treatment intensification in a Chinese hospital setting.

Methods

This cross-sectional study included 1,074 hospitalized patients with both CAD and T2DM, admitted to the Cardiology Department of Ruijin Hospital between January 2021 and December 2023. Data were retrospectively collected from electronic medical records, including demographic information, clinical characteristics, and treatment interventions. Patients were stratified by year, and differences in treatment strategies between cardiologists and endocrinologists were analyzed. Glycemic control was assessed using HbA1c levels, with treatment intensification defined by any adjustment in antidiabetic therapy and consideration for comprehensive cardiovascular risk factors.

Results

Endocrinologists were significantly more likely to initiate treatment intensification, especially in cases of severe hyperglycemia (HbA1c ≥9.0%), while cardiologists' role in glycemic management was limited, with a preference for outpatient endocrinology referrals over in-hospital adjustments. Despite improvements in glycemic control, the percentage of patients achieving comprehensive cardiovascular risk management targets remained low.

Conclusion

This study underscored the distinct yet complementary roles of cardiologists and endocrinologists in managing glycemic control among patients with CAD and T2DM, noting endocrinologists' more active involvement in treatment intensification. Future integrated care models should harness the unique expertise of both specialties to optimize patient outcomes, better address glycemic control needs, and enhance overall cardiovascular risk management in this high-risk patient population.

Volatile organic compounds exposure in relation to glucose homeostasis and type 2 diabetes in older adults from the NHANES

The impact of volatile organic compounds (VOCs) on type 2 diabetes (T2D) among older adults is unknown. The multiple linear regression model and the multiple binary logistic regression were used to evaluate the relationships between mVOCs and glucose homeostasis/T2D, respectively. Among the 19 mVOCs, the higher levels of urinary N-acetyl-S-(2-hydroxypropyl)-L-cysteine (2HPMA, compound CID:44146439) and N-acetyl-S-(2-hydroxypropyl)-L-cysteine (HPMMA, compound CID:107774684) were significantly associated with higher odds of T2D (OR = 1.16, 95% confidence interval [CI]:1.01-1.34 for 2HPMA; and OR = 1.27, 95% CI:1.04-1.54 for HPMMA). In addition, higher concentrations of multiple mVOCs in urine were significantly correlated with glucose homeostasis biomarkers, including 2HPMA and 2-thioxothiazolidine-4-carboxylic acid (TTCA, compound CID:3034757) with fasting glucose, HPMMA and mandelic acid (MA, compound CID:1292) with HbA1c, phenylglyoxylic acid (PGA, compound CID:11915) with serum insulin, HbA1c and HOMA-IR. Our findings suggested that exposure to VOCs were associated with increased odds of T2D in older adults, which might be mediated by impaired glucose homeostasis. Mitigating VOCs should be a necessary component of public health strategies aimed at reducing the burden of type 2 diabetes.

Physicians and hospital pharmacists' knowledge, attitudes, and practices towards polypharmacy in older patients with chronic diseases

This web-based cross-sectional study aimed to evaluate the knowledge, attitudes, and practices of physicians and hospital pharmacists towards polypharmacy in older adult patients with chronic diseases in China. This study enrolled 374 physicians and pharmacists (270 females, 92 physicians) in 20 Chinese provinces between December 2022 and March 2023. The knowledge, attitude, and practice scores were 12.65 ± 2.05 (possible range, 0-18), 29.07 ± 2.68 (possible range, 7-35), and 26.16 ± 5.56 (possible range, 7-35), respectively. Working as a hospital pharmacist (vs. physician) was independently associated with adequate knowledge (OR = 2.190; 95% CI = 1.291-2.713; P = 0.004). Working in a tertiary hospital (OR = 4.296; 95% CI = 1.390-13.272; P = 0.011) was independently associated with a positive attitude. Knowledge score (OR = 1.176; 95%CI = 1.038-1.333; P = 0.011), hospital pharmacist (OR = 0.276; 95% CI = 0.137-0.557; P < 0.001), master's degree or higher (OR = 1.754; 95% CI  = 1.011-3.045; P = 0.046) and senior professional title (OR = 2.020; 95% CI = 1.032-3.952; P = 0.040) were independently associated with proactive practice toward polypharmacy in older adults. Physicians and hospital pharmacists had favorable knowledge, positive attitudes, and proactive practice toward polypharmacy. In conclusion, enhancing knowledge through continuous education, promoting interprofessional collaboration, educating patients, and conducting regular evaluations for quality improvement are necessary to improve the KAP of healthcare professionals toward polypharmacy in older adults.

Association between triglyceride-glucose index and the risk of heart failure hospitalization in older diabetic patients received right ventricular pacing: a retrospective cohort study

BACKGROUND

The prognostic value of triglyceride-glucose (TyG) index is not yet known for older diabetic patients received right ventricular pacing (RVP). We aimed to investigate the association between TyG index and the risk of heart failure hospitalization (HFH) in older diabetic patients received RVP.

METHODS

This study was conducted between January 2017 and January 2018 at Fuwai Hospital, Beijing, China, and included older (age ≥ 65 years) diabetic patients that received RVP for the first time. TyG index were obtained before implantation. The primary endpoint was HFH.

RESULTS

A total of 231 patients were divided into three groups according to the tertiles of TyG index: < 8.5 (T1, N = 77), 8.5-9.1 (T2, N = 77), and > 9.1 (T3, N = 77). T3 group had higher rate of HFH (Log-rank = 11.7, P = 0.003). Multivariate analyses showed that, TyG index served as an independent predictor for HFH, both as numerical variable (HR = 1.94, 95% CI 1.21-3.11, P = 0.006), and as categorical variable (HR = 2.31, 95% CI 1.09-4.89, P = 0.03). RCS demonstrated that the risk of HFH was relatively low until TyG index exceeded 8.8, beyond which the risk began to increase rapidly (P-non-linear = 0.006).

CONCLUSION

Preimplantation TyG index emerges as a robust, independent predictor for HFH in older diabetic patients received RVP, and TyG index > 8.8 might be the optimal cut-off value.

Development and Validation of a Risk Prediction Model for Sarcopenia in Chinese Older Patients with Type 2 Diabetes Mellitus

Purpose

Sarcopenia is a common prevalent age-related disorder among older patients with type 2 diabetes mellitus (T2DM). This study aimed to develop and validate a nomogram model to assess the risk of incident sarcopenia among older patients with T2DM.

Patients and methods

A total of 1434 older patients (≥ 60 years) diagnosed with T2DM between May 2020 and November 2023 were recruited. The study cohort was randomly divided into a training set (n = 1006) and a validation set (n = 428) at the ratio of 7:3. The best-matching predictors of sarcopenia were incorporated into the nomogram model. The accuracy and applicability of the nomogram model were measured by using the area under the receiver operating characteristic curve (AUC), calibration curve, Hosmer-Lemeshow test, and decision curve analysis (DCA).

Results

571 out of 1434 participants (39.8%) had sarcopenia. Nine best-matching factors, including age, body mass index (BMI), diabetic duration, glycated hemoglobin A1c (HbA1c), 25 (OH)Vitamin D, nephropathy, neuropathy, nutrition status, and osteoporosis were selected to construct the nomogram prediction model. The AUC values for training and validation sets were 0.800 (95% CI = 0.773-0.828) and 0.796 (95% CI = 0.755-0.838), respectively. Furthermore, the agreement between predicted and actual clinical probability of sarcopenia was demonstrated by calibration curves, the Hosmer-Lemeshow test (P > 0.05), and DCA.

Conclusion

Sarcopenia was prevalent among older patients with T2DM. A visual nomogram prediction model was verified effectively to evaluate incident sarcopenia in older patients with T2DM, allowing targeted interventions to be implemented timely to combat sarcopenia in geriatric population with T2DM.