Feng-Chih Kuo

Sarcopenia is an underrecognized yet clinically significant complication in individuals with type 2 diabetes mellitus (T2DM), influenced in part by adverse alterations in body composition such as myosteatosis. This study examined sex-specific associations between regional fat-to-lean ratios, measured by dual-energy X-ray absorptiometry (DXA), and sarcopenia status in Taiwanese adults with T2DM. A cross-sectional study was conducted in 103 adults with T2DM (60 females, 43 males) aged 50–80 years. DXA quantified regional body composition, including appendicular skeletal muscle mass and regional fat mass. Dominant handgrip strength was assessed using a dynamometer. Sex-specific associations between sarcopenia and regional fat-to-lean ratios were analyzed using Spearman rank-order correlations and multivariable Firth penalized logistic regression models. Sarcopenia prevalence was 15.0% (n = 9/60) in females and 23.3% (n = 10/43) in males. Males exhibited higher lean mass, bone mineral content, and grip strength, whereas females had higher total body fat and fat-to-lean ratios. In males, arms and legs fat-to-lean ratios showed strong, body mass index (BMI)-independent correlations with sarcopenia ( r = 0.526 and r = 0.467, respectively; both p < 0.01). Multivariable Firth penalized logistic regression identified BMI as an independent factor inversely associated with sarcopenia odds in both sexes. Conversely, the arms fat-to-lean ratio (Z-score) emerged as an independent correlate specifically associated with higher odds of sarcopenia in males (OR: 14.183, 95% CI: 2.261–200.137, p = 0.002). Based on an illustrative mathematical translation, a 0.1-standard deviation increase in this ratio (equivalent to approximately 65 g of additional arm fat) was associated with a 30.4% increase in the odds of sarcopenia. Patients with T2DM demonstrate distinct sex-specific patterns in body composition associated with sarcopenia. The DXA-derived arms fat-to-lean ratio may represent an accessible, BMI-independent clinical surrogate marker to aid in identifying men with T2DM with higher odds of sarcopenia, underscoring the importance of regional body composition assessment in diabetes care.

Background/Objectives Carbohydrate-enriched diets and sedentary behavior contribute to diabetes risk. However, their impacts on glucose metabolism in abdominal (ASAT) and gluteal subcutaneous adipose tissues (GSAT), especially considering sex differences, remain unexplored. Subjects/Methods Twenty (median age 29.2 years, median BMI 23.1 kg/m²) healthy participants (10 females) underwent mixed-feeding trials lasting 320 min, with carbohydrate-enriched meals following either prolonged sitting (SIT) or interrupted prolonged sitting (ACTIVE) in a randomized crossover design. Continuous glucose monitoring (CGM) was inserted simultaneously at abdominal and gluteal fat depots. Body composition was quantified by dual-energy x-ray absorptiometry. Oral glucose tolerance test was performed for measuring insulin sensitivity and resistance. In vitro experiments using paired human abdominal and gluteal preadipocyte cell lines were conducted to investigate molecular mechanisms. Results In the SIT trial, GSAT CGM showed a slower increase in interstitial glucose during lunch compared to ASAT CGM, particularly in females. In the ACTIVE trial, intermittent brisk walking led to numerically lower interstitial glucose levels in both ASAT and GSAT CGM, with the most significant impact observed in female ASAT CGM. While males with higher hepatic insulin resistance or android fat displayed a notable correlation with decreased interstitial glucose levels in the ACTIVE trial. Our in vitro experiments further revealed steady glucose uptake (GLUT1 expression) and de novo lipogenesis (ChREBP protein) were specifically enhanced in gluteal adipocytes during post-feeding 3–6 h. Conclusions Breaking up prolonged sitting improves postprandial glucose control. Whereas gluteal fat depot may play roles to stabilize carbohydrate-enriched diets-induced hyperglycemia. The alternative text for this image may have been generated using AI.

While modern medicine emphasizes teamwork, expert performance in clinical reasoning may require periods of deliberate solitude to refine intuition, enhance diagnostic and/or management accuracy, and mitigate potential cognitive biases. Evidence from cognitive psychology, philosophy, and education suggests that cognitive withdrawal supports deep learning and problem-solving, yet its role in clinical reasoning learning and performance remains underexplored. Medicine often prioritizes speed and real-time collaboration, potentially limiting opportunities for independent time for thought. This article explores whether deliberate solitude could support the development and performance of clinical reasoning. Clinicians might consider engaging in diagnostic rehearsal, independent synthesis, and/or cognitive withdrawal during these solitary moments, but the specific opportunities and benefits remain uncertain. By drawing from research in other disciplines, we consider how solitude might help physicians refine their clinical reasoning, which, in turn, could potentially reduce errors. While no specific course of action can yet be made, this conceptual perspective suggests potential directions for future inquiry.

Background: Rickets is a growth disorder that imposes a global health burden and causes disability in affected children. However, issues related to the clinical epidemiology and mortality risk of nutritional versus hereditary rickets have not been fully investigated in large population studies, particularly in Asia.Purpose: This study aimed to investigate the nationwide incidence, demographic characteristics, and mortality-related risk factors of pediatric rickets stratified by nutritional and hereditary subtypes.Methods: This study utilized data of subjects aged 0–18 years taken from Taiwan’s National Health Insurance Research Database. The database includes records of 31,488,321 individuals from January 1, 2008, to December 31, 2018. We analyzed all cases and conducted subgroup analyses of nutritional and hereditary rickets to examine how different etiologies affect the risk of mortality (ROM).Results: Among the 1,551 patients with rickets, nutritional rickets accounted for twice as many cases as hereditary rickets. Nutritional rickets primarily affects preschoolers without sex-based differences, whereas hereditary rickets is often diagnosed later with a male predominance. ROM in rickets is associated with a low household income, anemia, chronic kidney disease (CKD), hyperparathyroidism secondary to renal tubulopathy, and a prolonged length of hospital stay (LOS). Between 2012 and 2018, the overall incidence of rickets increased and the mortality rates decreased.Conclusion: Increasing incidence and decreasing mortality rates of rickets were noted, suggesting improvements in clinical awareness and disease management. influencing ROM, such as family income, anemia, CKD, hyperparathyroidism secondary to renal tubulopathy, and LOS are important considerations in the clinical care of rickets.

Type 2 diabetes mellitus (T2DM) is an independent risk factor of knee osteoarthritis (KOA). This study was mainly based on data from the Taiwan National Health Insurance Database. Using big data analysis, we showed that glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment is helpful for patients with T2DM who have a lower risk of KOA or total knee replacement (TKR). A total of 35,762 patients with T2DM were included in this study. We divided these patients into 988 patients with T2DM without KOA and 372 patients with T2DM with KOA who received GLP-1RA treatment and those who did not receive GLP-1RA treatment. The patients were matched for sex, age, and inclusion date by 1:1 propensity score, which was included in the control group. Cox proportional hazards analyses were performed to compare KOA risk and TKR rate during a maximum follow-up period of 5 years. There were 1976/744 patients with T2DM without/with KOA who received and did not receive GLP-1RA treatment, including 1052/322 men (53.24/43.28%) and 924/422 women (46.76/56.72%). At the end of follow-up, there were 46/39 (4.66/10.48%) patients with T2DM without/with KOA who received GLP-1RA treatment and underwent KOA/TKR were lower than those without GLP-1RA treatment 87/70 (8.81/18.82%). Cox proportional hazard regression analysis showed a lower rate of KOA/TKR among patients with GLP-1RA treatment (adjusted hazard ratio [HR] = .852; 95% confidence interval [CI] = .784–.930, P < .001/ adjusted HR = .913; 95% CI = .885–.977, P = .015, respectively). Kaplan–Meier analysis showed that the cumulative risk of KOA/TKR in patient with/without GLP-1RA was significantly different (log-rank test, P < .001/P < .001, respectively). This study aimed to provide clinicians with the option of GLP-1RA as a treatment for patients with T2DM with or without KOA to reduce the risk of KOA or TKR among such patients.

Aims: Dynapenia is a noteworthy health issue contributing to increased risk of falling, but its co-occurrence with osteoporosis in elderly individuals with type 2 diabetes mellitus (T2DM) has not been well explored. Therefore, this study aimed to establish the association between osteoporosis and dynapenia, focusing on T2DM females due to their high prevalence of osteoporosis and fragility. Methods: We conducted a cross-sectional study to recruit a total of 103 T2DM patients (43 males and 60 females), aged between 50 and 80 years with median 68.0 years. Dual-energy X-ray absorptiometry (DXA) and dominant hand grip strength measurements were performed to define body composition, osteoporosis, and dynapenia in a sex-specific manner. Results: Higher prevalence of dynapenia and dyna-osteoporosis was observed in female T2DM patients with a significantly positive correlation between osteoporosis and dynapenia even after adjustment of body mass index (BMI). By performing a multivariate logistic regression analysis, both BMI and osteoporosis were identified as risk predictors for the development of dynapenia in female T2DM patients with odds ratios (95% CIs) of 1.234 (1.029–1.480) and 4.883 (1.352–17.630), respectively. Conclusions: Our results point out there is high, female-specific co-occurrence of osteoporosis and dynapenia in T2DM patients. Moreover, having osteoporosis and increased BMI might boost the risk of dynapenia in elderly females with T2DM.

Background: Diabetic neuropathy (DN) is one of the common chronic complications, leading to limb disability and increased risks of hospitalization and mortality. Traditional Chinese medicine (TCM) has been commonly applied in Taiwan as an adjunctive treatment to ameliorate diabetes-associated chronic complications, including neuropathy. Aim: We aimed to investigate whether the clinical treatment of DN combined with TCM can reduce the associated hospitalization and mortality using the National Health Insurance Research Database (NHIRD) of Taiwan. Methods: We selected 1,152 patients with DN who received TCM treatment as the study cohort group, and 4,940 patients with DN who did not receive TCM treatment from Taiwan NHIRD were further matched 1:1 for sex, age, and index year as the comparison cohort group. Cox proportional hazards analysis was performed to compare hospitalization and mortality during a mean follow-up period of 15 years. Results: A total of 687/225 enrolled patients (29.82%/9.77%) had hospitalization/mortality, including 298/97 in the TCM group (25.87%/8.42%) and 389/128 in the comparison group (33.77%/11.11%). Cox proportional hazard regression analysis showed a lower rate of hospitalization and mortality for patients in the TCM group (adjusted hazard ratio [HR] of 0.434, 95 confidence interval [CI] =0.172–0.798, P < 0.001; adjusted HR of 0.689, 95 CI = 0.372–0.981, P = 0.039). The Kaplan–Meier analysis showed that the cumulative risk of hospitalization and mortality in the study and comparison cohort groups was significantly different (log-rank P < 0.001 and P = 0.007, respectively). Conclusion: Our results suggest that the application of TCM might be beneficial for patients with DN to lower the risks of hospitalization and mortality; however, further prospective cohort studies are still required to confirm our observations.