Diabetes & Metabolism Journal

Original Articles

Basic and Translational Research
Sleeve Gastrectomy with Fundoplication Enhances Metabolic Health in Obese Rats via Ghrelin Pathway Modulation and Multi-Organ Regulation: Xin Li, Aikebaier Aili, Yusujiang Tusuntuoheti, Yusunjiang Aierken, Kelimu Abudureyimu, Weihui Liu; Received May 4, 2025 Accepted November 23, 2025 Published online January 15, 2026; DOI: https://doi.org/10.4093/dmj.2025.0392 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
Obesity serves as a predominant factor in the progression of metabolic syndrome and type 2 diabetes mellitus. While sleeve gastrectomy (SG) is a well-established surgical intervention, its impact on appetite-regulating hormones, such as ghrelin (GHRL), is limited. Sleeve gastrectomy combined with fundoplication (SGFD) has emerged as a potential strategy to improve metabolic outcomes by modifying both gastric anatomy and gut-brain signaling.
Methods
Sixty-five Sprague-Dawley rats were enrolled. After 8 weeks of high-fat feeding, 48 rats developed diet-induced obesity (DIO). These rats were randomized into four experimental groups: DIO control, sham-operated, SG, and SGFD, alongside a normal control cohort. Biochemical indicators, hormonal fluctuations, and insulin responsiveness were analyzed. Molecular expressions were evaluated through quantitative real-time polymerase chain reaction and Western blotting.
Results
SGFD reduced body weight (−24.7%), food intake (−28.3%), fasting glucose (−37.5%), triglycerides (−42.6%), and serum GHRL (−51.2%) compared with the DIO group (P<0.01). Gastric GHRL, preproghrelin, and ghrelin O-acyltransferase (GOAT) expression were suppressed. Hypothalamic neuropeptide Y (NPY) was downregulated, and AMP-activated protein kinase (AMPK) signaling was robustly enhanced across various tissues. SGFD also improved insulin receptor substrate-1 (IRS-1), glucose transporter type 4 (GLUT4), β-cell function, hepatic lipid oxidation, and brown adipose thermogenesis. SGFD outperformed SG in most metabolic and molecular outcomes (P<0.05).
Conclusion
SGFD provides superior metabolic benefits over SG alone by suppressing GHRL signaling and activating systemic AMPK pathways. SGFD represents a promising surgical strategy for obesity and metabolic syndrome.

Complications
Global, Regional, and National Temporal Trends in Incidence for Type 2 Diabetes Mellitus Related Chronic Kidney Disease from 1992 to 2021: Yu Cao, Huiting Chen, Hui Liu, Hao Wu, Wei Gao; Diabetes Metab J. 2025;49(4):848-861. Published online March 11, 2025; DOI: https://doi.org/10.4093/dmj.2024.0593

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Abstract PDF Supplementary Material PubReader ePub

Background
Type 2 diabetes mellitus (T2DM) is a major cause of declining renal function.
Methods
Temporal trends in T2DM-related chronic kidney disease (CKD-T2DM) incidence across 204 countries and territories from 1992 to 2021 were analyzed using data from the Global Burden of Disease 2021. The impact of macro-factors (demographic change, age, period, and birth cohort) on CKD-T2DM incidence trends was assessed using decomposition analyses and age-period- cohort modeling, highlighting opportunities to improve incidence and reduce regional disparities.
Results
In 2021, global CKD-T2DM incidence cases reached 2.01 million, a 150.92% increase since 1992, with population growth and aging contributing to 80% of this rise. The age-standardized incidence rate (ASIR) ranged from 15.09 per 100,000 in low sociodemographic index (SDI) regions to 23.07 in high SDI regions. China, India, the United States, and Japan have the most incidence cases, accounted for 69% of incidence cases globally. With 175 countries showing an increasing ASIR trend. Unfavorable trend in ASIR increase were generally found in most high-middle and middle SDI countries, such as China and Mexico (net drift=0.15% and 1.17%, per year). Age-period-cohort analyses indicated a high incidence risk near age 80, with worsening risks for recent periods and birth cohorts, except in high SDI areas.
Conclusion
The CKD-T2DM incidence burden continues to rise globally, with significant variations between countries, posing major global health implications. CKD-T2DM is largely preventable and treatable, warranting greater attention in global health policy, particularly for older populations and in low and middle SDI regions.

Citations

Citations to this article as recorded by

Expert perspectives on incorporating glucagon-like peptide-1 receptor agonist in diabetes and chronic kidney disease: challenges and opportunities
Jean-Michel Halimi, Laurent Fauchier, Alexandre Karras, Chloé Amouyal, Dominique Eladari, Patrick Rossignol, Gabriel Choukroun, Philippe Zaoui, Nicolas Girerd, Samy Hadjadj
European Journal of Preventive Cardiology.2026; 33(1): 8. CrossRef
Frailty and incident diabetes among middle-aged and older adults: Evidence from a large prospective cohort in China
Yingzhen Gu, Xiaorong Han, Jinxing Liu, Yifan Li, Wei Zhang, Naqiang Lv, Aimin Dang
Nutrition, Metabolism and Cardiovascular Diseases.2025; 35(10): 104114. CrossRef
Addressing Inequities in Early‐Onset Diabetic Kidney Failure in Australia: A Response to Ellis et al.
Gokhan Koker
Nephrology.2025;[Epub] CrossRef
An Overview of Sex-Based Differences in the Onset and Progression of DKD in the Well-Known Model, ZSF1 Rats
Arunita Chatterjee, Sharma S. Prabhakar
Life.2025; 15(10): 1627. CrossRef
Electroacupuncture ameliorates glycolipid metabolism disorder in skeletal muscle of type 2 diabetic rats via modulation of the AMPK/PGC-1α/TFAM signaling pathway
Fang Luo, Junjie Feng, Jumahan Nverjiang, Jiangnan Ye, Chang Liu, Hanhan Chen, Zhuoxuan Li, Qunwen Lu, Wei Zhang, Furong Zhang, Jun Zhu, Chengguo Su
Diabetology & Metabolic Syndrome.2025;[Epub] CrossRef

Cardiovascular Risk/Epidemiology
Appraisal of Guidelines for the Management of Blood Pressure in Patients with Diabetes Mellitus: The Consensuses, Controversies and Gaps: Menghui Liu, Shaozhao Zhang, Xiaohong Chen, Yue Guo, Xiangbin Zhong, Zhenyu Xiong, Yifen Lin, Huimin Zhou, Yiquan Huang, Zhengzhipeng Zhang, Lichun Wang, Xiaodong Zhuang, Xinxue Liao; Diabetes Metab J. 2021;45(5):753-764. Published online April 23, 2021; DOI: https://doi.org/10.4093/dmj.2020.0134

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Abstract PDF Supplementary Material PubReader ePub: Background
Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations.
Methods
Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
Results
In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients.
Conclusion
The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.

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