Diabetes, Obesity & Metabolism最新文献

Background: Real-world glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapies face substantial attrition rates in commercial digital weight loss services (DWLSs). Conversational artificial intelligence (AI) has been proposed to enhance patient support at production scale, but robust evidence of its effectiveness in improving medication retention is scarce.

Objectives: To evaluate the effect of integrating an asynchronous AI patient support agent (Junebot) into a commercial DWLS on 6-month medication adherence and to assess the independent relationship of digital engagement on retention.

Methods: This retrospective analysis evaluated 16 556 adults prescribed semaglutide within an Australian DWLS between May 2024 and October 2025. The primary endpoint was 6-month medication adherence (≥ 6 orders fulfilled within 183 days). Analytical protocols featured a multivariate binary logistic regression on the full intention-to-treat cohort and three distinct 1:1 propensity score matching (PSM) sensitivity analyses to isolate era-based and tier-specific engagement effects.

Results: Six-month adherence was higher post-Junebot than in the pre-Junebot control (53.2% vs. 47.3%; p < 0.001). However, the full cohort model (R ² = 0.2236) revealed that the post-Junebot operational era was independently associated with an increase in the odds of attrition (OR: 1.178; 95% CI [1.052-1.318]; p = 0.004), a trend corroborated by the era-matched PSM model (OR of attrition: 1.309; p = 0.038). Non-automation factors dominated retention trajectories: high-intensity tracking during month 1 (> 25 tracks) dramatically predicted attrition (OR: 15.753; p < 0.001), alongside program pauses (OR: 2.508; p < 0.001) and higher program cost (OR: 2.458; p < 0.001). Within-cohort analysis demonstrated a profound, linear curve for active interaction; structured digital engagement spanning 50%-74.99% of weeks significantly optimised adherence odds across both medication-only (OR: 32.016) and medication plus health coaching cohorts (OR: 13.311).

Conclusion: Integrating an AI digital assistant did not independently improve medication adherence; programmatic costs, program pauses and initial tracking anxiety were stronger predictors of long-term retention. After matching post-Junebot cohorts, moderate, active digital engagement appeared to correlate with 6-month retention. Digital providers should prioritise proactive behavioural risk screening and financial accessibility over baseline AI integration.

Aims: To quantify the extent to which cardiac autonomic markers account for the associations between adiposity and liver enzyme levels in non-diabetic adults with overweight or obesity.

Materials and methods: The clinical discovery cohort included 432 non-diabetic adults with overweight or obesity. Body mass index (BMI) and waist-to-height ratio (WHtR) were exposures; alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) were outcomes. Resting mean heart rate and heart rate variability (HRV) were assessed as cardiac autonomic markers. Multivariable regression and mediation analyses were performed. Supportive analyses included 21 383 UK Biobank participants.

Results: Higher BMI and WHtR were associated with higher liver enzyme levels, higher resting mean heart rate and lower HRV in the clinical cohort. Resting mean heart rate was the most consistent cardiac autonomic mediator, accounting for 16.6%-27.5% of the associations between BMI and liver enzyme levels and 17.8%-36.9% of those for WHtR. HRV indices accounted for 10.1%-28.2% and 8.8%-29.9% of the corresponding associations, respectively. After inclusion of the homeostatic model assessment of insulin resistance (HOMA-IR) as a parallel mediator, indirect effects through cardiac autonomic markers remained statistically significant, particularly for ALT. In UK Biobank, resting pulse rate accounted for 5.83%-9.47% of the associations between adiposity and liver enzyme levels.

Conclusions: Higher resting heart rate and lower HRV partly accounted for cross-sectional associations between adiposity and liver enzyme levels. Cardiac autonomic markers warrant further evaluation as complementary physiological measures in studies of obesity-related liver enzyme variation.

Aim: We aimed to examine the association between glucagon-like peptide-1 receptor agonists (GLP1-RA) use and diabetic retinopathy and non-arteritic anterior ischemic optic neuropathy (NAION), using dipeptidyl peptidase-4 inhibitors (DPP4i) as active comparators.

Methods: We created a retrospective propensity score (PS)-matched cohort study of patients who initiated either GLP1-RA or DPP4i (years 2006-2021). Using new-users, we created two PS-matched cohorts: patients with diabetes (overall cohort) and patients with diabetes and chronic kidney disease (CKD-cohort); the latter represents patients at higher likelihood of diabetes microvascular complications. Primary outcomes were non-vision-threatening diabetic retinopathy (NVTDR), vision-threatening diabetic retinopathy and diabetic macular edema (VTDR/DME), and NAION. Secondary outcomes included vision impairment or blindness and occurrence of retinopathy procedures.

Results: PS-matched overall cohort included 98 082 pairs of GLP1-RA or DPP4i users. GLP1-RA users had higher risk of NVTDR (11.05% vs. 9.98%; odds ratio [OR] 1.12, 95% confidence interval [95% CI]: 1.09-1.15), VTDR/DME (2.17% vs. 1.98%; OR 1.09, 95% CI: 1.03-1.16), and occurrence of retinopathy procedures (4.16% vs. 3.68%, OR 1.14, 95% CI: 1.09-1.19). There was no significant difference in risk of NAION (OR 1.11, 95% CI: 0.96-1.29) or vision impairment or blindness (OR 1.04, 95% CI: 0.97-1.11). In the CKD cohort (15 440 matched pairs), GLP1-RA was associated with high risk of NVTDR (OR 1.10, 95% CI: 1.03-1.18), and occurrence of retinopathy procedures (OR 1.14, 95% CI: 1.03-1.26), but not other outcomes.

Conclusions: GLP1-RA use was associated with a modest increase in risk of diabetic retinopathy and retinopathy-related procedures, independent of the presence of retinopathy at baseline. However, GLP1-RA use was not associated with vision impairment or blindness, although administrative codes notably have low validity for blindness diagnosis.

Aims: Financial constraints often limit healthy eating among individuals with Type 2 diabetes (T2D) and lower socioeconomic status (SES). Produce Prescription Programs (PRx), which provide financial support for healthy foods, have shown promise in the United States but remain understudied in Europe. This study assessed the feasibility of a 3-month PRx intervention among adults with T2D and low SES, and explored its potential effects on dietary intake, metabolic outcomes and quality of life.

Materials and methods: In this 3-month RCT, conducted in primary care in Rotterdam, the Netherlands, adults with T2D, BMI > 25 kg/m² and low SES were assigned to either PRx or usual care. Both groups received three dietitian consultations and were advised to follow a Mediterranean diet. PRx additionally provided weekly plant-based food boxes, cooking workshops and educational support. Feasibility outcomes included recruitment, retention, adherence and acceptability. Exploratory efficacy outcomes included nutritional intake, anthropometric measures, metabolic outcomes and quality of life at three and 6 months.

Results: Seventy-seven individuals were screened and 35 participants (57.3 ± 11.8 years; 74% female; BMI 32.6 ± 6.0 kg/m²) were included, of whom 17 were allocated to PRx. Participants collected an average of 10.9 out of 12 food boxes (91%) and attended 1.8 out of 3 workshops (59%). Among the 11 participants (69%) who completed the evaluation questionnaire, satisfaction scores ranged from 4.3 to 4.7 out of 5. Exploratory between-group comparisons favoured the PRx group for dietary intake, weight, BMI and physical quality of life, while no clear differences were observed for glycaemic outcomes. These findings were supported by favourable within-group changes in dietary and anthropometric outcomes in the PRx group, several of which appeared to be maintained at 6-month follow-up.

Conclusions: This pilot RCT demonstrates that a 3-month PRx intervention providing plant-based food boxes is feasible and acceptable among adults with T2D and low SES. As the first European RCT evaluating a PRx intervention in this population, it provides preliminary evidence of potential benefits for dietary, anthropometric and quality of life outcomes, warranting further investigation in adequately powered trials.

Trial registration: OMON: NL-OMON57037; 8 October 2024.

Aims: Tirzepatide is a once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist (GLP-1 RA) approved in the US for the treatment of Type 2 diabetes (T2D), weight loss and obstructive sleep apnoea. This study aimed to assess the utilisation and effectiveness of tirzepatide among individuals in a large US commercially insured population.

Materials and methods: This retrospective, observational study used administrative claims and electronic health records from the Healthcare Integrated Research Database (HIRD). Adults with ≥ 1 prescription claim for tirzepatide (for obesity/overweight, without T2D), between November 2023-June 2024 and continuous medical/pharmacy enrollment for ≥ 12 months pre-index and ≥ 6 months post-index were included. Descriptive analyses included baseline demographic and clinical characteristics, treatment patterns and tirzepatide effectiveness (change from baseline in weight, BMI, cardiometabolic risk factors evaluated among persistent individuals) and were stratified by individuals who were GLP-1 RA naïve and individuals who switched to tirzepatide from a GLP-1 RA obesity medication.

Results: Of the 22 512 individuals who initiated tirzepatide (mean age: 46 years, 73% female), 55% (n = 12 292) were adherent (PDC ≥ 80%) and 68% (n = 15 208) were persistent during the 6-month follow-up period. Of the overall population, 91% (n = 20 554) had ≥ 1 obesity-related complication at baseline, with dyslipidaemia, hypertension and anxiety being the most frequent complications. Clinically meaningful mean weight reduction (10.5%; n = 808) and numerical reductions in most cardiometabolic risk factors were observed among persistent individuals with available pre- and post-index measurements, including 12.0% body weight reduction in the GLP-naïve subgroup.

Conclusions: Over half of US adults with obesity or overweight who initiated tirzepatide were adherent (PDC ≥ 80%) and had a favourable persistence profile during a 6-month follow-up period. Persistent users achieved clinically meaningful weight reduction and numerical reductions in most cardiometabolic risk factors.

Background: Genetic clusters related to Type 2 diabetes (T2D) have differential impact on cardiovascular diseases (CVDs), although the underlying mechanisms, such as proteomic perturbation, remain unexplored. We conducted a network Mendelian randomisation (MR) study to identify proteomic mediators linking T2D genetic clusters and CVDs.

Methods: We assessed the associations between genetic liability to T2D and eight genetic clusters (N = 2 535 601) with 12 CVDs (N ≤ 1 946 349). For significant pairs, we performed a two-step MR (mediation) to identify proteins mediating these associations. Inverse-variance weighted method was the main analysis, with sensitivity analyses including genetic colocalisation. Robustness was evaluated in European-specific analyses as well as using Olink-measured proteomic data. False discovery rate (FDR) was used to correct for multiple comparisons.

Results: Obesity cluster was linked to most CVDs (except haemorrhage strokes), with similar patterns for body fat, metabolic syndrome and lipodystrophy clusters. Majority of the protein signals (2739 out of 4907) were related to obesity cluster although glycemia-related clusters were only associated with a few proteomic signals (≤ 13). Amongst 16 proteins supported by genetic colocalisation (PP_H4 > 0.8), the proportion mediated ranged from 1.2% to 36.8%. APOC3, ADH1B, F11 and KLKB1 appeared to be shared across the different genetic clusters, implicating their shared role in CVDs risk. Sensitivity and replication analyses gave similar estimates.

Conclusion: This proteogenomic MR study delineates protein-mediated pathways linking cluster-stratified T2D genetic predisposition to cardiovascular risk, which can inform preventive strategies by stratifying individuals based on distinct biological pathways represented by these genetic clusters.

Background: To evaluate and recalibrate commonly used 10-year cardiovascular disease (CVD) risk prediction models in two Chinese cohorts: the general population and adults with type 2 diabetes.

Methods: We analysed data from the Wuzhong subcohort of the China Kadoorie Biobank (CKB) and the Jiangsu Biobank for the Prevention and Control of Diabetes (JBPCD). After excluding participants with baseline CVD, baseline diabetes in CKB or missing predictors, 42 937 CKB participants and 14 125 JBPCD participants were included. We evaluated CKB-CVD, Globorisk, Framingham General CVD and WHO 2019 in both cohorts, and SCORE2-Diabetes in JBPCD. Performance of original and recalibrated models was assessed by 10-year inverse probability of censoring weighting (IPCW) C-statistic, calibration measures including the expected-to-observed (E/O) event ratio and Brier score. In JBPCD, overlap in high-risk classification was examined using a 20% predicted 10-year risk threshold.

Results: During a median follow-up of 11.96 years in the general population cohort and 10.03 years in the type 2 diabetes cohort, 3740 and 2794 ischemic heart disease or stroke events occurred, with 10-year risks of 6.04% and 19.72%, respectively. Discrimination was higher in the general population cohort than in the type 2 diabetes cohort (C-statistic 0.723-0.778 vs. 0.584-0.629). Original models were poorly calibrated, with systematic overprediction in the general population cohort (E/O 1.47-3.78) and heterogeneous miscalibration in the type 2 diabetes cohort (E/O 0.32-2.70). Recalibration markedly improved calibration and reduced Brier scores, with little change in discrimination. In the type 2 diabetes cohort, recalibrated CKB-CVD classified 48.4% as high risk, with an observed 10-year risk of 25.7%.

Conclusion: Widely used 10-year CVD risk models showed acceptable or modest discrimination but substantial miscalibration in Chinese populations, especially among adults with type 2 diabetes. Recalibration is essential before threshold-based clinical or public-health use.

Aims: To establish age- and sex-specific reference percentiles for body shape indices in Chinese adults and to develop a composite body shape index (CBSI) for age-related chronic diseases screening.

Materials and methods: From the China National Health Survey, we recruited adults across six provinces from 2023 to 2025. Sex- and age-specific percentile curves for body shape indicators were constructed using the Lambda-Mu-Sigma method. CBSI was derived by sex-stratified exploratory factor analysis with varimax rotation, integrating adiposity, muscle function, and body proportion. Associations with chronic diseases were assessed in a training population (n = 11 220) and validated in an independent population (n = 5745). Incremental value over BMI was evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI).

Results: Body shape index trajectories differed substantially by sex. Compared with CBSI < -0.5, CBSI > 0.5 was associated with elevated odds of hypertension (OR 6.42, 95% CI 5.51-7.48), diabetes (2.76, 2.25-3.38), dyslipidemia (3.86, 3.37-4.41), hyperuricemia (5.44, 4.67-6.34), abnormal ECG (1.63, 1.24-2.13), coronary heart disease (2.31, 1.62-3.27), stroke (3.05, 1.95-4.78), chronic kidney disease (3.06, 1.79-5.23), and musculoskeletal disorders (1.67, 1.09-2.55). These associations persisted in the validation set and individuals aged > 60 years. Adding CBSI to BMI-based models improved disease identification, with positive IDI and category-free NRI.

Conclusions: Age- and sex-specific reference centiles for body shape indicators can reflect trajectories of body composition and muscle health across the lifespan, which facilitates sarcopenia screening. The CBSI serves as an integrated screening tool for high-risk populations.

Aims: Diabetes prediction tools are valuable for prevention and resource planning. Few tools exist to predict long-term diabetes risk for British adults. We aim to develop and validate a diabetes prediction tool for short- and long-term risk.

Materials and methods: Prediction model development (Training, n = 4502) and internal validation (Test, n = 1929) used Whitehall II data (WHII); external validation used English Longitudinal Study of Ageing (ELSA) data, with incident diabetes as outcome. Predictors were selected using LASSO-Cox, random survival forests (RSF) and best subset selection. Three candidate Cox models were built from these predictor sets and compared. Performance was assessed with C-indices, calibration and decision curve analysis (DCA). A continuous risk score and quartile-based risk groups were derived; a nomogram was created.

Results: Across WHII Test (235 events) and ELSA (255 events), three models showed broadly similar discrimination, calibration and DCA patterns. LASSO- and RSF-selected models performed comparably and slightly better than best subset. LASSO and RSF both selected ethnicity, body mass index, waist-to-height ratio, height, triglyceride-glucose index, fasting glucose, family history of diabetes and socioeconomic status; LASSO additionally selected smoking, whereas RSF also included age, triglycerides, high-density lipoprotein cholesterol, systolic and diastolic blood pressure. In ELSA, risk-score C-indices (95% CIs) were 0.800 (0.773-0.827) for the LASSO-selected model and 0.801 (0.774-0.827) for the RSF-selected model; risk-group C-indices were 0.737 (0.715-0.759) and 0.727 (0.707-0.748), respectively.

Conclusions: We developed and externally validated a tool to estimate 5-, 10- and 15-year diabetes risk in British middle-aged adults, which may support primary care decision-making.