Neurology Department, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200082, People’s Republic of China

The recent study published by Li et al1 in the Journal of Diabetes Metab SyndrObes has aroused my great interest.In recent times, although there have been many studies on cognitive dysfunction and diverse opinions on its causes, there has been no phased progress in the treatment and prevention of cognitive dysfunction.2

First, this article mainly studied the mechanism of Yiqi Bushen Recipe (YQBS) based on network pharmacology and experimental verification in treating diabetes nephropathy with cognitive dysfunction. The data used in the study may only include information from specific databases, and there may be issues with incomplete database coverage, resulting in certain relevant targets or pathways not being included in the analysis. Sprague Dawley rats3 were used as the model in the study. Although this model is commonly used, it may not be able to completely simulate the complexity of human diabetes nephropathy with cognitive dysfunction. The article is mainly based on animal experiments and network pharmacology analysis, lacking clinical trial data to support its conclusions. We would like to further understand if there are more clinical methods to validate experimental results.

Secondly, the study mainly focused on the impact of YQBS on diabetes nephropathy and cognitive dysfunction in the short term, and the evaluation of long-term treatment effect and safety was insufficient. The study may not have fully considered the differences in individual responses to YQBS, such as genetic polymorphisms, lifestyle habits, and environmental factors. Although molecular docking can predict the interaction between drugs and targets, the results of this computer simulation need to be further validated through experiments. Although research has focused on TNF - α and IL-6, two key inflammatory factors, diabetes nephropathy and cognitive dysfunction involve multiple inflammatory factors,4 and the interaction and network between these factors may not be fully explored in the article.

Finally, in practical clinical applications, patients may use multiple drugs simultaneously, and the article did not discuss the potential interactions between YQBS and other drugs. We also want to know if there are more drugs with similar effects,5 and whether it is necessary to add or subtract drugs in clinical use.

Therefore, we hope to see the improvement and supplement of further methods in the later stage, which can improve the reliability of the research and better explain and understand the relationship between diabetes nephropathy and cognitive dysfunction.

The author has confirmed that the approval of an institutional review board was not required for this work. The author also confirms that informed patient consent was not necessary for this work. The authors affirm they have read the journal’s guidelines on ethical publication and affirm that this work is consistent with those guidelines.

The Science and Technology Development Fund of Shanghai University of Traditional Chinese Medicine (No.23KFKP09), Shanghai Hongkou District Science and Technology Committee major project Hongwei (No.2301-02), The 22nd Course Construction of Shanghai University of Traditional Chinese Medicine (No. 2023SHUTCMKCJS155).

The authors report no conflicts of interest in this communication.

1. Li W, Liu Z, Song M, et al. Mechanism of Yi-Qi-Bu-Shen recipe for the treatment of diabetic nephropathy complicated with cognitive dysfunction based on network pharmacology and experimental validation. Diabetol Metab Syndr Obes. 2024;17:3943–3963. doi:10.2147/DMSO.S481740

2. Casagrande SS, Lee C, Stoeckel LE, Menke A, Cowie CC. Cognitive function among older adults with diabetes and prediabetes, NHANES 2011–2014. Diabet Res Clin Pract. 2021;178:108939. PMID: 34229005; PMCID: PMC8429258. doi:10.1016/j.diabres.2021.108939

3. Warmink K, Rios JL, van Valkengoed DR, Korthagen NM, Weinans H. Sprague Dawley rats show more severe bone loss, osteophytosis and inflammation compared to Wistar han rats in a high-fat, high-sucrose diet model of joint damage. Int J Mol Sci. 2022;23(7):3725. PMID: 35409085; PMCID: PMC8999132. doi:10.3390/ijms23073725

4. Song Y, Wang X, Qin S, Zhou S, Li J, Gao Y. Esculin ameliorates cognitive impairment in experimental diabetic nephropathy and induces anti-oxidative stress and anti-inflammatory effects via the MAPK pathway. Mol Med Rep. 2018;17(5):7395–7402. PMID: 29568860. doi:10.3892/mmr.2018.8727

5. Jash K, Gondaliya P, Kirave P, Kulkarni B, Sunkaria A, Kalia K. Cognitive dysfunction: a growing link between diabetes and Alzheimer’s disease. Drug Dev Res. 2020;81(2):144–164. PMID: 31820484. doi:10.1002/ddr.21579