What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Diabetes (Type 1 and Type 2) (n=485). Intervention: Diabetes (T1D and T2D) vs. Non-diabetes controls. Primary outcome: Prevalence of Torque teno virus viremia (TTVv) (p=0.03).

What does this research mean for the field?

Diabetes is associated with a significantly higher prevalence of Torque teno virus viremia compared to non-diabetic controls, although viral load paradoxically correlates negatively with poor glycemic control and obesity in type 2 diabetes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the associations between torquetenovirus load and metabolic variables across different diabetes types.

April 13, 2026Open Access

Metabolic determinants of torque teno virus load across the diabetes spectrum: insights from a cross-sectional analysis

Key Result

Diabetes was associated with a significantly higher prevalence of Torque teno virus viremia compared to non-diabetic controls (78.0% vs 69.0%).

Key Points

To assess the associations between torquetenovirus load and metabolic variables across different diabetes types.
Conducted a cross-sectional, multicentre analysis of 485 individuals.
Quantified plasma TTV-DNA using real-time PCR.
Adjusted for confounding factors including age, sex, BMI, and HbA1c.
Analyzed associations using uni- and multivariable statistical models.
TTVv was present in 74.4% of individuals, with higher prevalence in type 2 (79.0%) and type 1 diabetes (73.8%) compared to non-diabetes (69.0%).
In T2D, negative correlations were found between TTVv and BMI/HbA1c.
Obese individuals with poor glycaemic control showed significantly lower TTVv.
DPP-IV inhibitors were associated with higher TTVv presence and titers.

Study Design

Type

Cross-Sectional (n=485)

Multicenter

Yes

Structured PICO

How does Torquetenovirus viremia correlate with metabolic determinants across the diabetes spectrum?

Population

485 individuals including type 2 diabetes (n=277), type 1 diabetes (n=61), and non-diabetes controls (n=147)

Comparator

Non-diabetes controls (n=147)

Outcome

Torquetenovirus viremia (TTVv) prevalence and titers quantified by real-time PCR, and its clinical/metabolic associationssurrogate

Torquetenovirus viremia is more prevalent in diabetes but inversely correlates with poor glycemic control and obesity in type 2 diabetes, suggesting it may serve as a marker of immunometabolic balance.

Main Result

Absolute Event Rate: 78% vs 69%

p-value: p=0.03

Abstract

Torquetenovirus (TTV) is a ubiquitous non-pathogenic DNA virus whose replication mirrors immune competence. We profiled TTV viremia (TTVv) across type 1 diabetes (T1D), type 2 diabetes (T2D), and non-diabetes (ND) controls and assessed clinical associations. Cross-sectional, multicentre analysis of 485 individuals (T2D n. 277; T1D n. 61; ND n. 147). Plasma TTV-DNA was quantified by real-time PCR. Clinical/metabolic variables were harmonized across cohorts. Associations with TTVv were tested with uni- and multivariable models adjusting for age, sex, body mass index (BMI), glycated haemoglobin (HbA1c), and antidiabetic therapies. TTVv was detectable in 74.4%, with higher prevalence in T2D (79.0%) and T1D (73.8%) versus ND (69.0%). Age was an independent predictor. In T2D, unlike T1D, TTVv correlated negatively with BMI and HbA1c; those with poor control (HbA1c ≥ 8%) had significantly lower TTVv. Dipeptidyl peptidase-4 inhibitors (DPP-IVi) were independently associated with both TTVv presence and higher titers. Among T2D, individuals with TTVv < 4.0 log copies/ml were more often obese, female, and less frequently treated with DPP-IVi. TTVv is more prevalent and higher in diabetes, yet lower with poor glycaemic control and obesity, suggesting a directionality paradox. TTVv may index immunometabolic balance in diabetes; longitudinal and mechanistic studies are warranted.

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