糖尿病足的分阶段综合管理

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18 9月 2019

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Author : 伤口世界

DF 中山二院糖尿病足中心

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Latest from 伤口世界

The role of fecal microbiota transplantation in diabetes
Relationship between liver fat, pancreatic fat, and new-onset type 2 diabetes mellitus in patients with metabolic dysfunction-associated fatty liver disease
Switching patterns of GLP-1 receptor agonists from 2018 to 2025 in the largest private healthcare network in Poland
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The role of fecal microbiota transplantation in diabetes 2026-05-22 00:00

Gabriele Angelo Vassallo1 · Tommaso Dionisi2,3 · Vittorio De Vita4 · Giuseppe Augello1 ·Antonio Gasbarrini3,5 · Dario Pitocco6 · Giovanni Addolorato2,3

Received: 25 January 2025 / Accepted: 29 March 2025 / Published online: 19 April 2025 © The Author(s) 2025

Abstract

Fecal microbiota transplantation (FMT) has emerged as a potential therapeutic strategy for modulating gut dysbiosis in diabetes mellitus. This review critically evaluates preclinical and clinical evidence on FMT in type 1 (T1D) and type 2 dia-betes (T2D). Studies suggest that FMT can restore microbial diversity, improve glycemic control, and modulate immune responses, with varying effects across diabetes subtypes. In T1D, preclinical models demonstrate that FMT influences regulatory T-cell expansion and β-cell preservation, though clinical translation remains limited. In T2D, FMT has shown transient improvements in insulin sensitivity, with sustained effects observed only in patients with specific microbiome signatures. However, heterogeneity in patient responses, donor variability, and methodological limitations complicate its clinical application. This review highlights the interplay between FMT, immune modulation, and microbial metabolism, advocating for phenotype-stratified trials and multi-omics integration to enhance therapeutic precision.

Keywords Fecal microbiota transplantation · Intestinal Microbiome · Diabetes · Insulin sensitivity · Metabolic syndrome · Beta-cell

Abbreviations

FMT Fecal microbiota transplantation TUDCA Tauroursodeoxycholic acid VEGF Vascular endothelial growth factor SCFAs Short-chain fatty acids MMTT Mixed meal tolerance test FVT Fecal virome transplantation OGTT Oral glucose tolerance test SRB Sulfate-reducing bacteria LSI Lifestyle intervention
Relationship between liver fat, pancreatic fat, and new-onset type 2 diabetes mellitus in patients with metabolic dysfunction-associated fatty liver disease 2026-05-21 00:00

Huanjia Qu1 · Lingling Zhou1 · Dong Tang2 · Qiuling Zhang1 · Pu Yang3 · Boyi Yang3 · Junping Shi4

Received: 25 December 2024 / Accepted: 22 March 2025 / Published online: 19 April 2025 © The Author(s) 2025

Abstract

Purpose Type 2 diabetes mellitus (T2DM) is associated with ectopic fat deposition, especially in the liver and pancreas.Therefore, this study aimed to evaluate the relationship between liver fat fraction (LFF), pancreatic fat fraction (PFF), and new-onset T2DM in metabolic dysfunction-associated fatty liver disease (MAFLD) by magnetic resonance imaging (MRI).

Methods This is a retrospective study of patients with MAFLD who underwent abdominal MRI between 2022 and July 2024. LFF and PFF were measured using an axial multi-echo Dixon-based sequence. All participants underwent routine medical history, anthropometric measurements, and laboratory tests. Multivariable stepwise selection models were con-structed to predict PFF and T2DM status based on variables of clinical interest.

Results This study included 80 MAFLD patients with 40 untreated new-onset T2DM and 40 non-T2DM controls. LFF, PFF, and homeostasis model assessment of insulin resistance (HOMA-IR) index were higher in the T2DM group than in the control group. In the new-onset T2DM group, PFF was linearly positively correlated with LFF (rs=0.321, P=0.04) and HOMA-IR (rs=0.350, P=0.03). After adjustment for several metabolic variables, PFF remained an independent risk factor for incident T2DM in MAFLD patients (all P<0.05). The area under the receiver operating characteristic curve for PFF and LFF to predict T2DM was 0.889 and 0.633 (P<0.001 and P=0.03), respectively.

Conclusion In MAFLD patients, PFF, and LFF play a prominent role in new-onset T2DM with high predictive and diag-nostic value.

Keywords Metabolic dysfunction-associated fatty liver disease · Type 2 diabetes mellitus · Liver fat fraction ·Pancreatic fat fraction · Ectopic fat deposition · MRI
Switching patterns of GLP-1 receptor agonists from 2018 to 2025 in the largest private healthcare network in Poland 2026-05-20 00:00

Krzysztof Łupina1 · Artur Dziewierz2,3 · Jakub Janczura1 · Zbigniew Siudak1,4

Received: 6 March 2026 / Accepted: 26 April 2026

© The Author(s) 2026

Abstract

Aims To characterize switching among GLP-1 receptor agonists (GLP-1 RAs) in a large private-sector cohort in Poland and to quantify therapy- and patient-level associations with switching while accounting for switching opportunity and calendar-time dynamics.

Methods We conducted a retrospective analysis of GLP-1 RA prescription records from the LUX MED network (2018–2025). Switching was defined as any change in agent between consecutive prescriptions. Patients with more than one pre-scription were included (n=42,423). The primary analysis used a transition-level discrete-time hazard model in which each prescription-to-prescription interval contributed one observation, and the outcome was switching at that interval. Current-therapy contrasts were reported relative to subcutaneous semaglutide. Sensitivity analyses examined alternative temporal parameterizations and additional adjustment for elapsed time.

Results Overall, 29.7% of patients switched at least once and 14.3% switched two or more times. In the transition-level analysis, 12,620 patients contributed 27,095 transitions. After adjustment for opportunity and calendar time, liraglutide was associated with substantially lower odds of switching compared with subcutaneous semaglutide (OR, 0.02; 95% CI, 0.01–0.03), whereas oral semaglutide (OR, 1.30; 95% CI, 0.78–2.17) and dulaglutide (OR, 1.70; 95% CI, 0.95–3.04) did not differ significantly. Temporal analyses revealed peaks consistent with episodic substitution and accelerated tirzepatide uptake after market entry. The principal associations remained directionally consistent in sensitivity analyses.

Conclusions Switching among GLP-1 RAs is common and time-dependent. Time-aware modelling identified therapy-spe-cific switching patterns and pronounced temporal variation; reasons for switching remain unmeasured, and the observed associations should be interpreted as hypothesis-generating.

Keywords Glucagon-like peptide-1 receptor agonists · Tirzepatide · Treatment switching · Real-world evidence · Private healthcare · Obesity

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主任医师、教授、博导，南方医科大学第三附属医院（广东省骨科医院）院长

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糖尿病足的分阶段综合管理

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