The triglyceride-glucose(TyG) index, a surrogate marker of insulin resistance, has been linked to cardiac dysfunction; however, its underlying associated pathways in patients with type 2 diabetes mellitus(T2DM) remain unclear. This study used cardiac magnetic resonance(CMR) to explore the association of TyG index with subclinical left ventricular(LV) myocardial dysfunction and whether imaging indicators statistically mediate this relationship.

In this retrospective cross-sectional study, a total of 235 T2DM patients who underwent CMR examination were included and assigned to three groups based on the tertiles of their TyG indexes as follows: low(< 8.73, n = 78), moderate(8.73-9.36, n = 79), and high TyG index(≥ 9.36, n = 78) groups. LV geometry, function, myocardial energetic efficiency index (MEEi), resting first-pass perfusion, and global peak strain in radial(GRPS), circumferential(GCPS), and longitudinal(GLPS) directions were measured. Univariate and multivariate linear regression models and exploratory mediation analysis were used to analyze the associations of TyG index on LV global strain.

Compared with the low and moderate TyG index groups, the high TyG index group had significantly higher LV remodeling index, lower LV global function index, lower MEEi, impaired resting myocardial perfusion, and reduced LV global peak strain (all p ≤ 0.002). Multivariate analysis showed that TyG index remained independently associated with reduced LV strain after adjusting for confounders (GRPS β = -0.261; GCPS β = 0.271; GLPS β = 0.381; all p < 0.001). And MEEi and upslope were also independently associated with reduced LV GRPS and GLPS (all p < 0.05). Further mediation analysis revealed the statistically mediated proportions of the association between the TyG index and LV global strain were 8.2-8.6% for MEEi and 4.3% to 12.5% for upslope. In model comparison analyses, the TyG index demonstrated substantially better model fit than either component alone across all strain directions (all Akaike Information Criterion difference > 150).

In patients with T2DM, a higher TyG index is independently associated with decreased LV global strain, and this relationship is statistically mediated by reduced MEEi and impaired resting perfusion upslope. These findings generate hypotheses regarding myocardial energetics and resting perfusion as potential pathways associated with diabetic myocardial dysfunction that warrant prospective investigation.

The aim of this review is to summarize current knowledge on the diagnostic and therapeutic significance of antibodies against advanced glycation end-products (anti-AGEs). AGEs are formed through non-enzymatic reactions of reducing sugars with proteins, lipids, and nucleic acids, and their accumulation has been implicated in the pathogenesis of chronic diseases such as diabetes, atherosclerosis, cancer, and neurodegenerative disorders. This paper discusses anti-MGO modified proteins, anti-imidazolone, anti-pentosidine, anti-CML (including SIWA318H), anti-CEL, anti-CMA, and anti-GA-pyridine antibodies, with a focus on their potential applications in diagnostics (biomarkers, disease progression monitoring) and therapy (e.g., SIWA318H in pancreatic cancer). The review also highlights current limitations, particularly regarding clinical use in humans, and outlines perspectives for further research in this promising field.

We aimed to compare heart rate variability (HRV) between adolescents with type 1 diabetes and healthy age- and sex-matched control participants. We were also interested in how HRV may change during puberty.

Eighty-five adolescents with type 1 diabetes (mean diabetes duration 7.0 ± 3.6 years) and 103 healthy age- and sex-matched youths consented to this cross-sectional study. We derived HRV data for time domain and power spectra analyses from Holter recordings (mean duration 17.8 h) and analyzed associated risk factors for HRV deterioration during total recording time and nighttime separately.

Total low frequency (LF) and very low frequency (VLF) domains (ms²) were significantly lower in children with type 1 diabetes than in healthy controls (LF, P = 0.049 and VLF, P = 0.005, respectively), whereas no differences were found in the measurements taken at night. The most significant predictors for untoward changes in power spectra were skinfold sum and lipids. Mean heart rate (beats/min), or any of the time domain variables did not differ significantly between study groups. Compared with those in the lowest HbA1c tertile, adolescents with type 1 diabetes in the highest HbA1c tertile had significantly lower LF and VLF power spectra results.

Adolescents with type 1 diabetes have depressed HRV from low to very low frequencies. Deterioration of autonomic nervous system function in adolescents with type 1 diabetes, measured with HRV power spectra is mainly associated with metabolic factors, although it is not possible to establish causal links between these variables.

Information on the safety profile of antidiabetic medications is essential for informed treatment decisions in type 2 diabetes mellitus. Although this information is available in regulatory documents of individual drugs, a comprehensive overview across all approved antidiabetics is lacking. Such an overview is important for clinicians and regulators to compare safety profiles across antidiabetics and to understand how safety information evolves over time.

Safety information for 27 first-in-class antidiabetics approved in the European Union (1995-2024) was extracted from the summary of product characteristics (SmPCs) and three clinical practice guidelines (CPGs: European Association for the Study of Diabetes, American Diabetes Association and National Institute for Health and Care Excellence). We assessed changes in safety outcomes over time, with these classified using the Medical Dictionary for Regulatory Activities (preferred term [PT] level).

A total of 326 unique safety outcomes were identified, with 63 of these also reported in CPGs. The number of safety outcomes increased post-marketing for most classes, notably in SGLT-2 inhibitors (+21 PTs) and GLP-1 RAs (+18 PTs). Hypoglycaemia (96%) and skin reactions (e.g., 59.3% rash) were commonly reported. Less frequent outcomes included genital infections (SGLT-2i) and acute haemolytic anaemia (sulfonylureas). Severe but rare outcomes such as Stevens-Johnson syndrome (DPP-4 inhibitors) and Fournier's gangrene (SGLT-2 inhibitors) were added post-marketing.

The safety profile of antidiabetics is similar, with small divergence including some serious safety outcomes, and has expanded over time by approximately one-third. On the contrary, CPGs incorporated only a few safety outcomes, reflecting their distinctive different role in clinical practice.

the appropriate anthropometric indicator for identifying prevalent type 2 diabetes mellitus (T2DM) in Chinese adults, who often develop the disease at lower BMI levels, remains uncertain.

we conducted a dual-study analysis integrating longitudinal and cross-sectional evidence. First, using the Global Burden of Disease (GBD) 2023 data, we assessed the long-term trends (1990-2023) in T2DM burden attributable to high BMI among Chinese adults aged ≥ 45 years. Second, using cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS, 2015 wave, n = 8,841), we evaluated and compared the associations of eight anthropometric indices-BMI, waist circumference (WC), waist-to-height ratio (WHtR), body roundness index (BRI), conicity index (CI), weight-adjusted waist index (WWI), tri-ponderal mass index (TMI), and a body shape index (ABSI)-with prevalent T2DM.

GBD analysis showed a sustained increase in the age-standardized burden of high BMI-attributable T2DM from 1990 to 2023, with greater rises in men than in women. In the CHARLS analysis, central obesity-related indices-particularly BRI, WC, and WHtR-showed relatively strong associations with prevalent T2DM and slightly higher discriminative performance (areas under the curve [AUC] ≈ 0.67) than BMI (AUC = 0.66) and other indices. BRI, WC, and WHtR demonstrated robust, stable associations across all demographic and lifestyle subgroups. ABSI showed the lowest discriminative ability (AUC = 0.59).

central obesity-related anthropometric indices, especially BRI, WC, and WHtR, showed slightly better performance than BMI in identifying prevalent T2DM among middle-aged and older Chinese adults. These findings, against the backdrop of a longitudinally increasing population-level burden, highlight the value of incorporating simple waist-based indices into diabetes screening and prevention strategies in China.

Diabetic foot ulcers (DFUs) have become an important cause of disability and death in patients with diabetes. Traditional therapies are prone to problems such as recurrence and drug resistance, which result in unsatisfactory healing effects for DFUs. Although antibiotics are not the mainstay of treatment for DFUs, antibiotic resistance poses a critical clinical challenge for DFU patients who require long-term antibiotic therapy.

This review summarises the mechanism by which Cold Atmosphere Plasma (CAP) kills bacteria and activates healing ability through the production of reactive oxygen/nitrogen species (RONS). RONS, as the key active species of CAP, exert antibacterial effects in a series of bacterial, cellular, and animal experiments, promote cell migration and proliferation, stimulate angiogenesis, and exert anti-inflammatory effects. However, current high-quality clinical trials are still lacking, leaving substantial room for further clinical exploration of CAP in the treatment of DFUs. Finally, the challenges and prospects of CAP in treating diabetic foot ulcers are summarised.

As a comprehensive and innovative treatment method, the RONS produced by CAP offer a potential approach for treating DFUs and serve as a tool for promoting their healing. However, more clinical studies are needed for further verification.

Diabetic polyneuropathy is one of the most common complications of type 2 diabetes mellitus (DM) and represents a major cause of morbidity and impaired quality of life. This study aimed to investigate the associations between inflammation, oxidative stress, matrix metalloproteinases (MMPs), DNA damage, and the presence of distal symmetric diabetic polyneuropathy (DPNP) and diabetic neuropathic pain (DNP).

A total of 108 patients with Type 2 DM and 42 healthy controls (HC) were enrolled prospectively. Diabetic patients were classified as having DPNP based on clinical and electrodiagnostic findings. DNP was evaluated using the Douleur Neuropathique 4 (DN4) questionnaire. Serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), MMP-2, MMP-9, MMP-10, Oxidative Stress Index (OSI), and DNA damage were measured.

Levels of IL-6, TNF-α, IL-1β, MMP-9, MMP-10, OSI, and DNA damage were significantly higher in diabetic patients compared with HC (p < 0.001 for all). Among diabetic patients, all biomarkers except MMP-2 were significantly elevated in those with DPNP and DNP (p < 0.001 for all). In diabetic patients, the levels of IL-6, TNF-α and IL-1β showed strong correlations with each other and with MMP-9 and OSI levels. Multivariable analysis demonstrated that the presence of DPNP was independently associated with increased levels of MMP-9, MMP-10, and OSI whereas the presence of DNP was independently associated with increased OSI levels.

Inflammation, oxidative stress, and matrix metalloproteinase activation are strongly associated with DPNP and DNP in patients with Type 2 DM. Correlations among these parameters are consistent with the presence of an interconnected pathophysiological network. These findings provide additional insight into the complex pathophysiology of diabetic neuropathy.

Diabetic wound healing remains a significant clinical challenge because of persistent inflammation, excessive oxidative stress, and bacterial infection. This study aimed to develop a biomimetic nanocomposite with multifunctional properties of antioxidation, antibacterial activity, anti-inflammation, and pro-angiogenesis for photothermal synergistic repair of diabetic wounds.

Freeze-killed M2 macrophages were used to encapsulate MXene nanoparticles to prepare a biomimetic composite material (abbreviated as MM). Its structural characteristics, protein retention, and photothermal performance were characterized and analyzed. The anti-inflammatory, antioxidant, antibacterial, and pro-angiogenic abilities of the material were evaluated in vitro. A streptozotocin (STZ)-induced diabetic mouse wound model was established to systematically assess the effects of MM combined with near-infrared light (NIR) on wound healing, collagen deposition, and in vivo inflammation regulation.

MM successfully preserved the cellular structure and functional proteins of M2 macrophages and exhibited excellent photothermal conversion performance. In vitro, it significantly inhibited pro-inflammatory cytokine secretion, scavenged reactive oxygen species, efficiently eliminated Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), and effectively promoted angiogenesis. In vivo experiments demonstrated that MM combined with NIR irradiation accelerated diabetic wound closure, enhanced collagen deposition, and induced macrophage polarization toward the anti-inflammatory M2 phenotype, with favorable biocompatibility and no obvious toxicity at the experimental dose.

Freeze-killed M2 macrophage-encapsulated MXene nanocomposites can synergistically modulate the three key pathological hallmarks of diabetic wounds: persistent inflammation, oxidative stress, and bacterial infection. Triggered by NIR, they exert potent reparative effects, offering a safe, multifunctional, and translationally promising therapeutic strategy for chronic diabetic wounds.

Autoimmune polyglandular syndrome type-1 (APS-1) results from mutations in autoimmune regulator (AIRE), a transcription factor that drives thymic expression of tissue-restricted antigens, thus enabling deletion of self-reactive thymocytes to maintain tolerance. APS-1 typically manifests with hypoparathyroidism, adrenal insufficiency, and candidiasis, but presentation varies. In this study, we characterized the clinical, genetic, and immunologic features of 18 new APS-1 patients and reviewed all reported cases to identify additional manifestations and mutational hotspots useful for targeted sequencing. We report three previously unpublished mutations, reduced T cell function, and diminished Treg numbers in our patients. Furthermore, we identified alopecia, thyroid disease, and diabetes mellitus as additional diagnostic clues, and revealed five recurrent variants that account for over 80% of known mutations. Our findings highlight additional clinical and laboratory features and emphasize key mutational hotspots that can accelerate the diagnosis to improve the timely and cost-effective identification of APS-1, especially in settings with limited awareness or resources.

Type 2 diabetes mellitus complicated with chronic kidney disease (T2DM-CKD) is a common and severe complication of T2DM that predisposes patients to end-stage renal disease (ESRD), substantially increasing mortality risk and long-term medical economic burden. Currently, SGLT-2 inhibitors are used as the foundational treatment regimen in clinical practice. As validated by the global multicenter randomized controlled CONFIDENCE trial, simultaneous initiation of finerenone plus an SGLT-2 inhibitor can further enhance renal protection and delay kidney disease progression. Despite these advancements, long-term pharmacoeconomic data supporting this combination regimen in the Chinese population remain limited.

From the perspective of China's healthcare system, this study aimed to evaluate the cost-utility of the simultaneous initiation of finerenone and empagliflozin versus empagliflozin monotherapy in T2DM-CKD patients, based on the CONFIDENCE trial design.

A Markov model was constructed to simulate the natural history of T2DM-CKD. The model cycle was 1 year, with a simulation time horizon of 30 years. The willingness-to-pay (WTP) threshold was set at three times China's 2025 per capita GDP (¥299,100/QALY). Base-case analysis was performed, followed by one-way and probabilistic sensitivity analyses to assess the robustness of results.

Base-case analysis revealed that the incremental cost-effectiveness ratio (ICER, a measure comparing the cost to the health benefit gained) of the finerenone plus empagliflozin regimen was ¥35,082.44/QALY (quality-adjusted life year), well below the WTP (willingness-to-pay) threshold. One-way sensitivity analysis indicated that the kidney disease progression coefficient (which measures the rate of worsening kidney disease) and the cost of finerenone were the most influential parameters; all parameter fluctuations within reasonable ranges retained the cost-effectiveness advantage. Probabilistic sensitivity analysis showed that the combination regimen was acceptable in 99.1% of 1,000 Monte Carlo simulations (computer-generated scenarios that model uncertainty), with all incremental QALYs positive, indicating highly robust results.

Compared with empagliflozin monotherapy, the combined initiation of finerenone plus empagliflozin offers significant cost-utility advantages in treating T2DM-CKD. These findings provide high-quality evidence for standardized clinical care, rational pharmacotherapy, the formulation of medical insurance policies, and optimal health resource allocation in Chinese patients with T2DM-CKD.