AIMS:To estimate the prevalence and incidence of hypoglycaemia and the variations in Chinese type 2 diabetes (T2D) patients. MATERIALS AND METHODS:A multi-centre, non-interventional study was conducted across 103 hospitals in 20 provinces in China between 18 March 2022 and 5 December 2023. The study adopted an integrated 12-week prospective cohort study design, enrolling 15 437 adults with T2D. Hypoglycaemic events were captured through a structured questionnaire and patient diary, including laboratory-confirmed, symptomatic, any, severe and nocturnal hypoglycaemia. Variations in hypoglycaemia burden were examined by socio-demographic factors, health status, treatment regimens, geographic region and hospital level. The endpoints were the prevalence of patients experiencing at least one hypoglycaemic event and the corresponding incidence during the study period. RESULTS:The 15 437 participants who completed the follow-up at Week 12 were included in this study. During this period, 9.0% [95% CI: 8.6, 9.5] of the participants experienced at least one hypoglycaemic event, corresponding to an incidence rate of 79.8 [76.9, 82.8] events per 100 person-years. Hypoglycaemia burden differed markedly according to treatment background. The 12-week prevalence of any hypoglycaemia was 5.5%, 9.7% and 12.2% among participants receiving neither insulin nor secretagogues, secretagogues without insulin and insulin, respectively, with corresponding incidence rates of 48.6, 105.0 and 104.3 events per 100 person-years. Similar treatment-related patterns were observed for laboratory-confirmed, symptomatic and nocturnal hypoglycaemia. Hypoglycaemia burden also varied substantially across age, diabetes duration, body mass index (BMI), HbA1c, geographic region and hospital level. Greater hypoglycaemia burden was generally observed among participants with longer diabetes duration and lower BMI. The prevalence of any hypoglycaemia was highest in the eastern region and tertiary hospitals, whereas its incidence rate was highest in western regions and primary hospitals. CONCLUSIONS:Although the prevalence and incidence of hypoglycaemia among Chinese T2D patients were lower than previous studies, hypoglycaemia still remains a significant clinical concern. These findings highlight the importance of individualized strategies for glycaemic management to minimize hypoglycaemia risk in routine diabetes care. TRIAL REGISTRATION:Chinese Clinical Trial Registry: ChiCTR2100053847.

BackgroundSystemic glucocorticoids (GCs) remain indispensable in pediatric care, yet their potential long-term cardiovascular sequelae—particularly after exposure during developmental windows—are incompletely defined.ObjectiveTo synthesize representative clinical evidence linking childhood/adolescent systemic GC exposure with cardiac structure remodeling, subclinical functional alterations, and longer-term cardiovascular outcomes, and to contextualize plausibly mediating pathophysiologic pathways.Evidence synthesisAcross pediatric conditions with repeated or prolonged systemic GC use, the most consistent structural signal is a time-locked, reversible myocardial hypertrophy phenotype in neonates/young infants—often observed during or shortly after dexamethasone exposure and regressing after dose reduction or discontinuation. In older children and adolescents, evidence for persistent, overt structural damage is sparse and confounded by underlying disease and treatment context. Conventional systolic indices (e.g., EF) are frequently preserved, while more sensitive metrics (tissue Doppler–derived parameters, myocardial performance index, strain) can reveal mild, subclinical systolic–diastolic impairment in selected populations (e.g., congenital adrenal hyperplasia). For “hard” adult outcomes (heart failure, coronary events, atrial fibrillation), direct longitudinal pediatric-to-adult data remain limited; however, pediatric GC exposure shows clearer dose–time associations with intermediate cardiometabolic risk factors and thromboembolic events, supporting a plausible mediated pathway to later cardiovascular disease.ConclusionsCurrent pediatric evidence more strongly supports transient remodeling and risk-factor clustering than definitive, irreversible cardiomyopathy. Future studies need long-horizon, indication-aware cohorts with harmonized imaging and event endpoints to quantify exposure–response relationships and identify actionable mediators.

BackgroundDiabetic retinopathy (DR) remains one of the leading causes of visual impairment worldwide. Recent studies have suggested that hemoglobin (Hb) levels may be associated with the risk of DR; however, the evidence has been inconsistent. This study aimed to evaluate the relationship between Hb concentration and the presence of DR among Chinese individuals with type 2 diabetes mellitus (T2DM).MethodsWe performed a cross-sectional analysis including 9, 215 patients with T2DM. Hemoglobin levels were categorized into sex-specific tertiles to examine their association with DR. Multivariable logistic regression models were constructed with adjustment for demographic, behavioral, and clinical covariates. Potential nonlinear relationships were explored using restricted cubic spline (RCS) models. Subgroup and sensitivity analyzes were also conducted to assess the robustness of the findings.ResultsAmong all participants, 1, 757 (19.1%) were diagnosed with DR. The prevalence of DR was significantly higher in the lowest Hb tertile compared with the middle and highest tertiles (24.5% vs. 16.4% vs. 16.6%, P < 0.001). After adjusting for potential confounders, each 1 g/L increase in Hb was associated with a 1% reduction in DR risk (adjusted OR 0.99, 95% CI 0.98-0.99). Compared with the lowest tertile, participants in higher Hb tertiles had a lower likelihood of DR (T2: OR 0.68, 95% CI 0.59-0.78, P < 0.001; T3: OR 0.67, 95% CI 0.58-0.77, P < 0.001). These associations were consistent across predefined subgroups (all P for interaction > 0.05) and remained stable in sensitivity analyzes restricted to complete cases. RCS analysis demonstrated a nonlinear, inverted L-shaped association between Hb and DR in men (P for nonlinearity = 0.041), whereas a linear inverse relationship was observed in women (P for nonlinearity = 0.977).ConclusionsHb levels are negatively associated with the presence of DR in Chinese patients with T2DM, suggesting that Hb may serve as a useful clinical indicator for DR risk stratification.

BackgroundPrevious studies have demonstrated that the triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio is closely related to chronic kidney disease and albuminuria. However, the evidence linking TG/HDL-C ratios to albuminuria among individuals with type 2 diabetes (T2D) remains limited. Given the heightened susceptibility of this high-risk population to kidney and cardiovascular ailments, this study concentrated on individuals with T2D to investigate the association between TG/HDL-C and albuminuria.MethodsA total of 2,323 people diagnosed with T2D participated in this cross-sectional research. The relationship between TG/HDL-C and albuminuria prevalence was evaluated using logistic regression analysis. Restricted cubic spline (RCS) models were applied to identify nonlinear relationships. The ability of TG/HDL-C versus other markers to distinguish albuminuria was examined using receiver operating characteristic (ROC) curves. Further subgroup analyses were conducted to explore heterogeneity across different populations. In addition, we explored whether serum uric acid (SUA) and fasting blood glucose (FBG) accounted for part of the association between TG/HDL-C and albuminuria.ResultsThe albuminuria group and the non-albuminuria group showed a significant difference in TG/HDL-C. Additionally, the prevalence of albuminuria increased progressively across ascending quartiles of TG/HDL-C. RCS curve analysis revealed that albuminuria and TG/HDL-C do not follow a linear relationship (P-overall < 0.001; P-nonlinear < 0.001), with a threshold observed at a TG/HDL-C ratio of 2.08. Furthermore, TG/HDL-C demonstrated relatively higher discrimination, particularly in women. Subgroup analysis indicated that among female T2D patients, TG/HDL-C was more strongly linked to UACR. Exploratory mediation analysis suggested that blood glucose and oxidative stress may contribute to the indirect pathway linking TG/HDL-C and albuminuria.ConclusionIn conclusion, the TG/HDL-C ratio was positively associated with the prevalence of albuminuria in patients with T2D. However, causal inference is limited by the cross-sectional design. Further prospective studies are needed to confirm our findings.

BackgroundThe Dietary Index for Gut Microbiota (DI-GM) is a novel index reflecting diet quality relative to gut microbiota health.ObjectiveThe study aims to investigate the relationship between DI-GM and cognitive function in older adults.MethodsData were obtained from 2629 participants aged ≥60 years in the National Health and Nutrition Examination Surveys (NHANES) (2011-2014). Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), the Animal Fluency Test (AFT), the Digit Symbol Substitution Test (DSST), and a global z score. Multivariable linear regression, restricted cubic splines (RCS), and subgroup analysis were performed. Predictive utility of DI-GM was assessed via the receiver operating characteristic (ROC) analysis against a baseline model. Mediation analysis examined relationships among DI-GM, the Dietary Inflammatory Index (DII), and cognitive outcomes.ResultsHigher DI-GM was associated with higher AFT, DSST, and the global z scores (p < 0.001). After full adjustment, participants with DI-GM (≥ 6) showed higher AFT score (β = 1.11, 95% CI 0.46∼1.75), DSST score (β = 4.95, 95% CI 3.05∼6.86) and z score (β = 0.19, 95% CI 0.10∼0.28), compared to those with DI-GM (0-3). No significant direct association was observed with CERAD (β = 0.45, 95% CI -0.29∼1.18, p = 0.233). RCS indicated linear relationships between DI-GM and cognitive function scores. DI-GM had excellent predictive performances based on the ROC. No significant interactions were detected by subgroup analysis. Furthermore, DII partly mediated the relationship between DI-GM and cognitive function.ConclusionsThe DI-GM showed a linear positive correlation with cognitive function in older adults.

ObjectiveTo investigate the association between serum cystatin C (CysC) levels and tophus presence, and to assess its diagnostic value for structural joint damage in gout.MethodsIn this cross-sectional study of 598 gout patients, we examined the association between serum CysC and both the presence and burden of tophi. The predictive value of CysC for tophus and bone erosion was further evaluated using logistic regression and ROC curve analyses.ResultsElevated serum CysC levels were significantly associated with older age, longer disease duration, and an increased prevalence of tophus, bone erosion, and the patients in the highest quartile (Q4, >1.28 mg/L) had a 3.87-fold higher adjusted odds of tophus (P < 0.05), showing a significant dose–response trend (P for trend = 0.003). Serum CysC alone demonstrated a moderate predictive value for tophus (AUC = 0.627), which improved in multivariable models (AUC = 0.777). A similar enhancement in predictive performance was noted for bone erosion (fully adjusted AUC, 0.756). There was a significant interaction between serum CysC and magnesium regarding tophus risk (P < 0.001). Furthermore, multivariate ordinal regression analysis identified higher CysC, longer gout duration, bone erosion, and the double contour sign as independent predictors of tophus burden.ConclusionSerum CysC independently predicts tophus in gout and shows interaction with serum magnesium. Its integration into risk assessment may improve clinical stratification and support timely, individualized treatment strategies.

Gout and hyperuricemia, linked to purine metabolism abnormalities or impaired uric acid excretion, are rising with lifestyle changes. Effective self-management and health literacy are crucial for gout management. While large language models (LLMs) show promise in enhancing health management, their potential on gout patient education remains underexplored. This study aimed to evaluate the accuracy and readability of responses generated by three LLMs, including DeepSeek-V3, DeepSeek-R1, and GPT-5, to questions based on the gout and hyperuricemia guidelines published by the American College of Rheumatology (ACR). Based on the ACR gout guidelines, a set of 42 questions was curated and submitted to three LLMs. Their responses were independently rated on a 5-point Likert scale by three expert gout and hyperuricemia specialists against the guidelines. Accuracy was rated as either an average score of ≥ 4 (low threshold) or 5 (high threshold). The readability of the responses was assessed by Microsoft Word, which provided metrics including the word count, character count, Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level (FKGL), and Automated Readability Index (ARI) were calculated. Our findings reveal that response accuracy was significantly higher for GPT-5 compared to DeepSeek-V3 (P < 0.001), with no significant difference between GPT-5 and DeepSeek-R1 (P > 0.05). In terms of readability, GPT-5 produced the most complex responses (FKGL: 12.89 ± 2.22, ARI: 14.87 ± 2.40), while DeepSeek-R1 generated the longest outputs. LLMs show potential in generating responses that are consistent with clinical guidelines for gout management. The deployment of LLMs in gout patient education and clinical decision support necessitates the simultaneous optimization of both accuracy and readability.

BackgroundDiabetic kidney disease (DKD) is a prevalent microvascular complication of type 2 diabetes mellitus (T2DM) and contributes substantially to end-stage renal disease. The atherogenic index of plasma (AIP) has exhibited biomarker utility. However, its relationship with DKD remains uncertain.MethodsThis cross-sectional investigation included 10,112 T2DM subjects from the National Metabolic Management Center of Yuhuan Second People’s Hospital between September 2017 and February 2025 and 5,573 individuals in NHANES cohort (1999–2020). AIP values were calculated and categorized into quartiles. Multivariable logistic regression, restricted cubic spline, and stratified subgroup analyses were applied for assessing the link between AIP and DKD. The area under the curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI) was used to assess the discriminative ability of AIP.ResultsAfter adjustment for confounding factors, each one-unit AIP rise resulted in a 72% higher likelihood of DKD (OR: 1.72, 95% CI: 1.51–1.96, p < 0.001). Relative to the lowest AIP quartile, the highest quartile showed a 54% higher odds DKD (OR: 1.54, 95% CI: 1.36–1.75, p < 0.001), with a clear dose–response effect (P for trend <0.001). Spline modeling indicated a positive linear link between AIP and DKD, which was apparent in all examined subgroups (all P for interaction >0.05) and externally validated in NHANES. Incorporating AIP into the baseline model modestly improved discrimination, increasing the area under the curve from 68.42 to 68.76%, with a continuous NRI of 0.118 (95% CI: 0.079–0.157, p < 0.001) and an IDI of 0.006 (95% CI: 0.004–0.007, p < 0.001).ConclusionAIP shows an independent positive association with DKD in individuals with T2DM, demonstrating a linear dose–response relationship, but the incremental predictive value is limited. The association between AIP and DKD still needs to be further validated by larger-scale prospective studies.

Ethnopharmacological relevance Mudan granules are Chinese patented medicines approved by the National Medical Product Administration, used to treat diabetic peripheral neuropathy (DPN) with Qi deficiency and collateral obstruction syndrome. However, placebo-controlled studies definitively establishing efficacy and safety are lacking. Aim of the study To evaluate the efficacy and safety of Mudan granules as an adjunct treatment for DPN with qi deficiency and collateral obstruction syndrome. Methods This multicenter, placebo-controlled, double-blind, randomized, controlled clinical trial recruited patients from 13 clinical centers in mainland China. 400 participants were randomly assigned in a 1:1 ratio to either the Mudan (Mudan granules + mecobalamin) or control group (placebo + mecobalamin), and were reassessed after the 24-week intervention. The primary outcome was the Michigan Diabetic Neuropathy Score (MDNS). Results The complete analysis set comprised 357 participants. The mean baseline MDNS of the Mudan and control groups were 9.69 and 9.43, respectively. The mean change in MDNS from baseline to week 24 was -4.80 in the Mudan and -2.66 in the control group. Using a covariate-adjusted analysis of covariance model, the least squares mean for the Mudan and control groups were -4.74 (-5.33 to -4.15) and -2.72 (-3.33 to -2.11), respectively. There was a statistically significant difference between the two groups. After 24 weeks of follow-up, the Mudan group showed a significant improvement in MDNS compared to the control group. Conclusion These findings suggest that Mudan granules may improve the clinical symptoms of DPN. Given this, Mudan granules may be helpful in the management of DPN.

Gout is an inflammatory disease characterized by the deposition of monosodium urate crystals in the joints. Probiotics have the potential effect of alleviating inflammation. The aim of this study was to investigate the potential beneficial effects of oral administration of the multi-strain probiotic Bifico and single-strain FN041 in a model of MSU-induced gout inflammation in mice and explore the underlying mechanism. To investigate the mechanisms by which gut microbiota alleviates gouty inflammation, mice were orally administered Bifidobacterium, Lactobacillus FN041, colchicine, or distilled water daily for 21 days. Acute inflammation models were established by injecting monosodium urate (MSU) crystals into the peritoneal cavity and subcutaneous air pouch to induce peritonitis and localized gouty inflammation, respectively. Peritoneal lavage fluid, serum, and subcutaneous tissue were collected and analyzed by H E staining, ELISA, immunohistochemistry, PCR, and Western blot to assess inflammatory responses. The results confirmed that Bifico and FN041 reduced the inflammatory cell infiltration in the peritoneal cavity and synovial tissues of mice. The results of PCR and western blot analysis showed that Bifico and FN041 significantly downregulated the expression of NLRP3 and IL-1β, thereby alleviating gout inflammation. Immunohistochemical results also confirmed that Bifico and FN041 reduced the expression of inflammatory elements such as IL-1β, NLRP3, and caspase-1 in synovial tissue. In conclusion, probiotics Bifico and FN041 reduced the inflammatory response in gout, with the potential mechanism being the regulation of the NLRP3/IL-1β pathway to control inflammation. Multi-strain Bifico has a stronger anti-inflammatory efficacy than single-strain FN041.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have become an important option in clinical use for type 2 diabetes due to their dual benefits of glycaemic management and metabolic improvements. Efsubaglutide alfa, a novel long-acting GLP-1RA, was developed for sustained glycaemic management. This study aimed to confirm its recommended clinical dose and evaluate its efficacy and safety in drug-naive individuals with type 2 diabetes that was inadequately managed through lifestyle interventions. This two-stage Phase IIb/III trial employed an operationally seamless adaptive design and enrolled adults who had been newly diagnosed with type 2 diabetes and whose diabetes was inadequately managed by diet and exercise. In the Phase IIb stage, participants were randomised in a 2:2:2:1 ratio to receive once-weekly subcutaneous injections of efsubaglutide alfa (1, 2 or 3 mg) or placebo for 12 weeks. Based on an interim analysis, two recommended Phase III doses (RP3Ds) were selected by an independent data monitoring committee. In the Phase III stage, participants were randomised in a 2:2:1 ratio to receive efsubaglutide alfa at one of the two RP3Ds or to receive placebo. Participants, investigators and sponsors were masked to drug/placebo allocation throughout the trial. The primary endpoint was the change in HbA1c from baseline to week 24. Secondary endpoints included changes in body weight and metabolic parameters at weeks 24 and 52. Safety was monitored throughout. In the Phase IIb stage, 140 participants were randomised to efsubaglutide alfa (1 mg, n=41; 2 mg, n=39; 3 mg, n=41) or placebo (n=19). Based on interim analysis, 1 and 3 mg were selected as the RP3Ds. In the Phase III stage, 297 participants were randomised to efsubaglutide alfa (1 mg, n=118; 3 mg, n=117) or placebo (n=62). At week 24, the HbA1c reductions from baseline were −18.91 mmol/mol (1.73

Gout is a growing global health challenge, yet the relative roles of metabolic/renal risks and burden inequalities across G20 nations remain unclear. This study quantifies gout burden from high BMI and impaired kidney function to inform equity-oriented public health strategies. It is grounded in the GBD comparative risk assessment framework, plus demographic transition, socioeconomic gradient theories, and biological mechanisms linking the two risk factors to hyperuricemia and gout disparities. We analyzed 1990-2021 GBD 2021 data for G20 countries, including disability-adjusted life years (DALYs), years lived with disability (YLDs), and age-standardized rates (ASRs), stratified by sex, age, Socio-Demographic Index (SDI). Temporal trends were quantified via estimated annual percentage change (EAPC), burden drivers decomposed, and 2022-2050 trends projected using multiple models. Gout burden exhibited marked geographic heterogeneity, with higher risks in adults >= 70 years and males. 1990-2021 attributable DALYs/YLDs rose steadily (high BMI as dominant driver), with epidemiological changes and aging as key contributors. 2050 projections show rising cases and persistent male predominance. Disparities stem from socioeconomic, policy, and genetic factors; gout-CVD comorbidities and pediatric cases are critical gaps. We advocate integrated strategies and embedding gout in chronic disease frameworks to reduce inequalities.

BACKGROUND AND AIM:The normalized creatinine-to-cystatin C ratio (NCCR) has recently emerged as a contributor to diabetes risk. However, its association with hypertension remains elusive. This study aimed to investigate this relationship in a large-scale prospective cohort. METHODS AND RESULTS:Based on the China Health and Retirement Longitudinal Study (CHARLS), a total of 4794 participants aged ≥45 years were enrolled from five CHARLS surveys in 2011, 2013, 2015, 2018 and 2020. Logistic regression models were used to investigate the association between NCCR and hypertension. The joint effects of body mass index and NCCR on the risk of hypertension were further analyzed. Additionally, the C-statistic was used to assess the predictive performance of NCCR for hypertension risk. During follow-up, 1318 (27.49 %) participants developed hypertension. After full adjustment for confounders, each per-SD increment in NCCR was associated with a significantly lower risk of hypertension (odds ratio [OR] = 0.81, 95% CI: 0.76 - 0.88, P < 0.001). Sex- and age-specific analyses revealed that the significant inverse associations between NCCR and hypertension were more pronounced in females and middle-aged individuals. Notably, non-obese participants with high NCCR experienced a more significant risk reduction than those who were obese with high NCCR. Moreover, incorporating NCCR into the basic model significantly improved the predictive ability for hypertension. CONCLUSIONS:Higher levels of NCCR were independently associated with a decreased risk of hypertension in middle-aged and older adults, especially in females and middle-aged individuals.

Diet and sleep disorders are associated with risks of metabolic diseases such as diabetes. The dietary index for gut microbiota (DI-GM) is a newly proposed index designed to assess dietary quality associated with maintaining a healthy gut microbiota. The authors aim to investigate the separate and joint prognostic effect of DI-GM and sleep disorders on the survival of US population with diabetes and pre-diabetes. Data were from the National Health and Nutrition Examination Survey (NHANES) 2007–2018 at baseline linked to the 2019 National Death Index records. Dietary recall data were collected to calculate the DI-GM and sleep disorders were assessed by self-reported questionnaires. The Cox proportional hazard model were used to evaluate the associations between separate and joint prognostic effects of DI-GM and sleep disorders with mortality outcomes among diabetic and pre-diabetic patients. A total of 10718 Participants with diabetes and pre-diabetes were ultimately included in this study (weighted population: 67,232,394, weighted mean age [SE]: 57.0 [0.1] years; weighted female proportion: 51.8

This review examines the strong association between metabolic dysfunction-associated steatotic liver disease (MASLD) and osteoporosis (OP), with a particular focus on the role of gut microbiota in linking these two disorders. Both MASLD and OP are closely linked to metabolic syndrome, and their pathogenesis involves multiple factors, such as inflammatory response, insulin resistance, altered intestinal permeability, and estrogen deficiency. Dysregulation of gut microbiota not only affects hepatic fat accumulation and bone metabolism disorders through metabolites, such as short-chain fatty acids, but also exacerbates systemic chronic inflammation by impairing the intestinal barrier function, thus accelerating the progression of both diseases. This article summarizes recent studies that highlight the central role of gut microbiota as a co-morbid factor in MASLD and OP, offering new perspectives for future diagnostic and therapeutic strategies.

BACKGROUND:Type 2 diabetic-associated chronic kidney disease (T2DM-Associated CKD), a leading cause of end-stage renal disease, is exacerbated by rising particularly high body mass index (BMI) rates. This study examines the global burden of T2DM-Associated CKD attributable to high BMI from 1990 to 2021 and projects future trends using the Global Burden of Disease (GBD) 2021 data. METHODS:GBD 2021 data from 204 countries were analyzed to assess mortality, disability-adjusted life years (DALYs) and corresponding age-standardized rates of T2DM-Associated CKD linked to high BMI. Bayesian Age-Period-Cohort modeling was used for projections, with stratification by age, gender, and Socio-Demographic Index (SDI). Statistical analyses were conducted using R software. RESULTS:In 2021, high BMI-related T2DM-Associated CKD caused 173,263 deaths and 4.3 million DALYs. Age-standardized rates declined globally but showed regional disparities, with Andean Latin America having the highest burden. Women had higher absolute burdens, while men showed higher standardized rates. Projections indicate continued increases in mortality and DALY rates through 2050. Emerging therapies, such as GLP-1 receptor agonists (RAs) and SGLT2 inhibitors (SGLT2i), could potentially alter these trends, especially in high-risk regions. CONCLUSIONS:High BMI significantly drives the T2DM-Associated CKD burden, necessitating targeted overweight/obesity prevention and improved healthcare access, particularly in high-risk regions. Monitoring trends is crucial for effective interventions.

ABSTRACT Type 2 diabetes (T2D) and hypertension often coexist, and insulin resistance (IR) plays an important role in their pathological progression. An increasing number of studies have focused on the relationship between different IR indices and hypertension. A natural log transformation of the glucose disposal rate (loge GDR) has been proposed as a new model for insulin sensitivity in patients with T2D. The study aimed to explore the relationship between loge GDR and hypertension in T2D patients. This cross‐sectional study included 1544 Chinese T2D patients. Clinical and biochemical characteristics were collected. The loge GDR was calculated based on triglycerides, urinary albumin to creatinine ratio, gamma‐glutamyl transferase, and body mass index. Patients were categorized into hypertension and nonhypertension groups stratified by gender. Among both females and males, compared with the nonhypertension group, the level of loge GDR was significantly decreased in the hypertension group (both p < 0.001). As the loge GDR increased, the levels of systolic and diastolic blood pressure, and the prevalence of hypertension were obviously increased (all p < 0.001). Univariate analysis displayed that loge GDR was negatively related to hypertension (correlation coefficient: −0.243, p < 0.001 in females; correlation coefficient: −0.181, p < 0.001 in males). Furthermore, the logistic regression analysis showed that loge GDR was independently associated with hypertension (OR: 0.456; 95% CI: 0.224–0.927 in females; OR: 0.544; 95% CI: 0.314–0.941 in males). This study revealed that loge GDR was closely related to hypertension, which might help monitor and manage hypertension in T2D patients.

Background:Soluble CD36 (sCD36), the circulating form of the scavenger receptor CD36, plays a key role in lipid accumulation and inflammation during the progression of diabetic kidney disease (DKD), and has been proposed as a promising non-invasive biomarker. The renoprotective effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) may involve modulation of sCD36. This study aimed to evaluate the impact of GLP-1RA and insulin treatment on sCD36 levels and their association with renal function in DKD patients. Methods:This single-center, prospective observational cohort study enrolled 191 patients with type 2 diabetes and early-stage DKD, who were stratified into three groups based on treatment regimen: control group (n = 63), insulin group (n = 71), and GLP-1RA group (n = 57). All patients received standard care with metformin, with the insulin and GLP-1RA groups receiving additional respective treatments for 12 weeks. Clinical parameters including sCD36, urinary albumin-to-creatinine ratio (UACR), lipid profile, glycemic markers, and islet function indices were assessed at baseline and post-treatment. Intra- and inter-group comparisons were performed using paired tests and analysis of covariance. Generalized linear regression models were applied to assess the relationship between sCD36 and renal function. Results:Baseline sCD36 and UACR levels were comparable across the three groups (P > 0.05). After 12 weeks, sCD36 levels significantly declined in the GLP-1RA group (median: 195.20 ng/mL, IQR: 160.45-314.75), compared to the insulin group (364.60 ng/mL, IQR: 279.10-394.10) and control group (386.10 ng/mL, IQR: 323.60-471.30) (P < 0.001). The GLP-1RA group also showed the most marked reduction in UACR (P < 0.001). Regression analysis demonstrated a significant positive association between sCD36 and UACR levels both before and after treatment (P < 0.001), and the change in sCD36 (ΔsCD36) was positively correlated with the improvement in UACR, suggesting a link to reduced renal lipotoxicity and inflammation. Conclusion:GLP-1RAs significantly reduce sCD36 and UACR levels in patients with early DKD, outperforming insulin in renoprotection. These findings raise the possibility that GLP-1RAs may exert renoprotective effects through modulation of CD36-related pathways, although direct mechanistic validation was not performed in this study.sCD36 may serve as a useful biomarker for monitoring DKD progression and therapeutic response, though further multicenter and long-term studies are needed to confirm its clinical utility.

The dawn phenomenon (DP), characterized by early morning hyperglycemia, poses a significant challenge in diabetes management and is associated with increased glycemic variability and long-term complications. Despite its clinical impact, effective therapeutic strategies remain limited. Chiglitazar, a novel pan-PPAR agonist, has demonstrated benefits in improving lipid metabolism and insulin sensitivity, but its potential role in mitigating DP remains unexplored. This study evaluates the regulatory effect of chiglitazar on DP and investigates its possible mechanisms beyond lipid modulation. This retrospective observational study included 22 hospitalized diabetic patients who received chiglitazar (20 mg). Blood glucose levels at 3:00 a.m. and fasting glucose levels over three consecutive days were measured pre- and post-treatment, and the dawn phenomenon intensity was calculated. Lipid profiles were assessed to explore potential correlations with glucose changes. Following chiglitazar administration, significant reductions were observed in LDL-C (43.82 ± 18.27 vs. 36.97 ± 16.90, p < 0.05), FFA (6.00 ± 2.38 vs. 5.06 ± 1.77, p < 0.05), mean 3:00 a.m. blood glucose (Z = – 2.03, p < 0.05), and fasting blood glucose (Z = – 2.96, p < 0.05). DP intensity also significantly improved (Z = – 3.48, p < 0.01). However, no significant correlation was found between glucose improvements and lipid profile changes (p > 0.05), suggesting an alternative mechanism of action. Chiglitazar effectively reduces DP intensity and improves glycemic control, independent of its effects on lipid metabolism. These findings suggest a potential link between chiglitazar’s mechanism and circadian rhythm regulation, possibly through the modulation of REV-ERB nuclear receptors. Further research is needed to confirm this hypothesis and evaluate the long-term clinical benefits of chiglitazar in diabetes management.

Background Previous research has shown a correlation between high visceral fat levels and hyperuricemia incidence. The Chinese Visceral Adiposity Index (CVAI) assessed visceral fat status in the Chinese population. Our study investigates the correlation between CVAI and asymptomatic hyperuricemia in type 2 diabetes patients. Methods This cross-sectional study analyzed 1,588 hospitalized type 2 diabetes patients to investigate the association between CVAI and hyperuricemia. CVAI was included in the logistic regression analysis as both a continuous and categorical variable, and restricted cubic splines were used to assess the dose-response relationship. Additionally, subgroup analyses were performed to investigate potential interactions among variables. The predictive capability of CVAI was assessed using the receiver operating characteristic (ROC) curve based on the basic model. Results The CVAI quartile group analysis revealed a higher prevalence of hyperuricemia with increasing CVAI levels. CVAI is significantly associated with hyperuricemia, as identified through multifactorial logistic regression analysis. After adjusting for all covariates, the odds ratios for CVAI in the second, third, and fourth quartiles were significantly higher than in the lowest quartile, with values of 2.688 (95% CI [1.301–5.554], p = 0.008), 2.752 (95% CI [1.320–5.739], p = 0.007), and 4.990 (95% CI [2.392–10.409], p < 0.001), respectively. No significant interactions were observed in the subgroup analysis. Incorporating CVAI into the basic model increased the ROC curve’s area under the curve to 0.714. Conclusion This study found a positive correlation between CVAI and hyperuricemia incidence in type 2 diabetes patients. Consequently, CVAI may reliably indicate hyperuricemia in this patient population.