{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T03:34:32Z","timestamp":1793072072394,"version":"4.5.0"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270881"],"award-info":[{"award-number":["82270881"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate the longitudinal prognostic value of small\u2010 and large\u2010fiber peripheral nerve assessments for accelerated renal decline in patients with Type 2 diabetes (T2D).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      An initial cross\u2010sectional analysis evaluated concurrent neuro\u2010renal associations, while a subsequent longitudinal cohort assessed accelerated renal progression (eGFR loss &gt;\u20093\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      \/year) using paired baseline and follow\u2010up data. Prognostic predictors were selected via LASSO regression. Model utility was assessed using area under the curve (AUC), net reclassification improvement (NRI), and decision curve analysis (DCA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cross\u2010sectional sudomotor small\u2010fiber dysfunction accurately mirrored concurrent renal impairment (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.18, 95% CI: 0.10\u20130.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Longitudinally, ESCF demonstrated no independent prognostic value for accelerated renal decline, and its apparent longitudinal association with future eGFR was completely attenuated after adjusting for baseline renal function. LASSO regression retained right peroneal motor amplitude, serum albumin, platelet count, and SGLT2i use as robust prognostic factors. Notably, subgroup analyses revealed this large\u2010nerve predictive capacity was significant primarily in patients with established DKD (\n                      <jats:italic>p<\/jats:italic>\n                      for interaction\u2009=\u20090.006). Incorporating this neurofunctional phenotype into standard clinical models yielded a modest AUC improvement but achieved a clinically relevant continuous NRI of 30.35%, successfully recalibrating risk profiles. DCA confirmed a superior net clinical benefit.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A distinct prognostic dissociation exists within the diabetic neuro\u2010renal axis. Sudomotor small\u2010fiber dysfunction primarily reflects established microvascular impairment, whereas large motor nerve degeneration demonstrates independent prognostic value for future accelerated renal decline. Incorporating this neurofunctional phenotype into traditional clinical models yields substantial individualized risk reclassification, thereby potentially aiding in identifying high\u2010risk individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1753-0407.70286","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:21:06Z","timestamp":1792455666000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of Sudomotor Small\u2010Fiber Function and Large Nerves for Accelerated Renal Decline in Type 2 Diabetes: A Real\u2010World Cohort Study"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4760-4699","authenticated-orcid":false,"given":"Qingyun","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Beijing Hospital National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences  Beijing China"},{"name":"Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0816-0078","authenticated-orcid":false,"given":"Xiuqi","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Beijing Hospital National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences  Beijing China"},{"name":"Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1123-6053","authenticated-orcid":false,"given":"Sijia","family":"Fei","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Beijing Hospital National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanxiang","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Beijing Hospital National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6863-1798","authenticated-orcid":false,"given":"Lixin","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Beijing Hospital National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2567-1439","authenticated-orcid":false,"given":"Qi","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Beijing Hospital National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences  Beijing China"},{"name":"Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581\u2010024\u201000827\u2010z"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24\u2010S011"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.18"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581\u2010019\u20100248\u2010y"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572\u2010019\u20100092\u20101"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20108587(19)30081\u20106"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.01.036"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.09.030"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010025\u201022822\u20100"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2015.08.004"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010158\u201011\u2010201306040\u201000007"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.13089"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000437342"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2017.52"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2024816"}],"container-title":["Journal 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