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Article History

Received: 23 July 2025

Accepted: 17 December 2025

First Online: 24 February 2026

Acknowledgements

: We would like to express our gratitude to L. Huang and W. Li from the Department of Biostatistics at Zhongshan Hospital, Fudan University, for their supervision and guidance in the statistical analysis of this study. We would also like to extend our thanks to all the individuals who participated in this experiment and the medical staff involved in this study.

: The individual de-identified participant data (including the data dictionary) and statistical code underlying the results reported in this article are not publicly available. However, they will be made available by the corresponding authors upon reasonable request. The datasets generated during and/or analysed in the current study are available from the corresponding authors upon reasonable request.

: This study was financially supported by the National Key Research and Development programme (2023YFA1802000), the National Natural Science Foundation of China (Youth Fund 82200909), the Young and Middle-aged Diabetes project from the Bethune Foundation (Z04JKM2022E002), the Joint Research Development project between Shenkang and United Imaging on Clinical Research and Translation (SKLY2022CRT201), the Shanghai Municipal ‘Explorer plan’ (the second batch) project in 2024 (24TS1411000) and the Shanghai Pujiang programme (21PJD012). The study funders were not involved in the design of the study; the collection, analysis, and interpretation of data; writing the report; and did not impose any restrictions regarding the publication of the report.

: The authors declare that this study received funding support from Merck & Co., Inc., but they were not involved in the study design; collection, analysis, and interpretation of the data; writing of the report; or the decision to submit the report for publication. The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

: All authors made substantial contributions to conception and design of the paper. YC, MSZ and HMY were involved in the conception, design and conduct of the study and the analysis and interpretation of the results. HMY, JJL, YYC and ZTZ wrote the first draft of the manuscript; ZTZ, XXC, SSC and JJL conducted the statistical analysis; HMY, YC, XYL, HJ, SSC and YYC contributed to the analysis and interpretation of the data; HMY, JJL, ZTZ, XYL, SSC and XXC contributed to discussions and reviewed and edited the manuscript. All authors edited, reviewed and approved the final version of the manuscript. HMY is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.