Diabetes Care最新文献

{"title":"Effects of Continuous Glucose Monitoring on Impaired Awareness of Hypoglycemia in Older Adults With Type 1 Diabetes: A Post Hoc Analysis of the WISDM Study","authors":"Anika Bilal, Fanchao Yi, Keri Whitaker, Zahra A. Khan, Richard E. Pratley, Anna Casu","doi":"10.2337/dc25-0971","DOIUrl":"https://doi.org/10.2337/dc25-0971","url":null,"abstract":"OBJECTIVE Although continuous glucose monitoring (CGM) reduces hypoglycemia and may improve impaired awareness of hypoglycemia (IAH), its effectiveness in older adults at high risk remains unknown. RESEARCH DESIGN AND METHODS This post hoc analysis of the WISDM study focuses on CGM use over 52 weeks. IAH was assessed using the Clarke original score (Clarke-full) and its subscales, Hypoglycemia Awareness Factor (HAF) and Severe Hypoglycemia Experienced Factors (SHEF), at baseline, 26 weeks, and 52 weeks. RESULTS After 26 (n = 184) and 52 weeks (n = 94) of CGM use, Clarke-SHEF decreased significantly (P = 0.02 and P < 0.0001, respectively), whereas Clarke-full and Clarke-HAF remained unchanged. After 52 weeks, Clarke-full but not Clarke-HAF improved in the IAH subgroup, highlighting the importance of selecting the appropriate scoring method for IAH. CONCLUSIONS In older adults with type 1 diabetes, CGM improves hypoglycemia; however, its role in improving IAH is variable, depending on the scoring method. This study highlights the limitations of the Clarke score.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"4 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144987414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Diabetes, Fetal Growth and Stillbirth Risk: A Population-Wide Retrospective Cohort Study From Victoria, Australia","authors":"Hannah G. Gordon, Alexis Shub, Susan P. Walker, Richard J. Hiscock, Jessica Atkinson, Stephen Tong, Roxanne M. Hastie, Anthea C. Lindquist, Natasha L. Pritchard","doi":"10.2337/dc25-0833","DOIUrl":"https://doi.org/10.2337/dc25-0833","url":null,"abstract":"OBJECTIVE To determine the relationships between diabetes in pregnancy, birth weight, and stillbirth risk, using population-based data. RESEARCH DESIGN AND METHODS All singleton births in Victoria, Australia, between 2009 and 2020 were linked with perinatal and diabetes data. For each diabetes subgroup (type 1, type 2, and gestational diabetes [diet-controlled, insulin-controlled]), we assessed the proportion of infants with a birth weight in <10th or >97th centile, the probability of stillbirth by birth weight centile, and stillbirth rate per 1,000 pregnancies across gestational age. RESULTS Our study cohort of 860,042 included 100,856 pregnancies (11.7%) complicated by diabetes in pregnancy. Compared with no diabetes, women with diabetes in pregnancy gave birth earlier (median gestation 38.7 weeks vs. 39.4) and had more iatrogenic births (65% vs. 44%). Gestational diabetes was associated with a lower overall risk of stillbirth compared with no diabetes (diet-controlled: relative risk [RR] 0.75 [95% CI 0.64–0.89]; insulin-controlled: RR 0.37 [95% CI 0.25–0.50]). Compared with no diabetes, preexisting diabetes was associated with an increased risk of stillbirth (RR 2.68 [95% CI 2.01–3.56]), with this trend persisting across all gestational ages and birth weights. This was particularly observed among infants in the >97th centile (type 1 diabetes: RR 3.96 [95% CI 1.23–12.76]; type 2 diabetes: RR 4.02 [95% CI 1.71–9.47]). CONCLUSIONS In our cohort, gestational diabetes was associated with a lower stillbirth risk compared with no diabetes, which potentially can be explained by increased monitoring and earlier iatrogenic delivery. Preexisting diabetes was associated with a higher overall risk of stillbirth, with macrosomic fetuses in the >97th centile representing a particularly high-risk group requiring close monitoring.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"14 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144987389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Type 1 Diabetes Management: Integrating Novel Therapies, Technologies, and Adjunctive Approaches","authors":"Jennifer R. Snaith, Phoom Narongkiatikhun, Petter Bjornstad, Jerry R. Greenfield, Kalie L. Tommerdahl","doi":"10.2337/dci25-0015","DOIUrl":"https://doi.org/10.2337/dci25-0015","url":null,"abstract":"In type 1 diabetes, a condition that necessitates lifelong exogenous insulin replacement, there is heavy reliance on technology-assisted insulin delivery and glucose monitoring. Yet, people living with type 1 diabetes still face dysglycemia, weight gain, vascular complications, ketoacidosis and severe hypoglycemia, and psychological distress. Cardiovascular and kidney disease remain the leading causes of morbidity and mortality, yet traditional risk factors (smoking, hypertension, hyperlipidemia, obesity, hyperglycemia) incompletely explain this excess burden. Emerging evidence highlights the role of insulin resistance, inflammation, and endothelial dysfunction exacerbated by current subcutaneous insulin therapies in type 1 diabetes, independent of overweight/obesity status. This has fueled interest in addressing metabolic challenges in type 1 diabetes through novel insulin analogs, adjunctive noninsulin therapies, and integrated technologies. Our review explores the potential synergy between technologies and adjunctive therapeutics to address unique physiologic drivers of metabolic dysfunction in type 1 diabetes. Innovations such as multihormonal systems, dynamic glucose and ketone monitoring, and automated insulin titration hold promise. However, leveraging emerging insights from nutrient-stimulated hormone-based therapies and other drug classes such as insulin-sensitizing agents and sodium–glucose cotransporter 2 inhibitors could pave the way for designing combination type 1 diabetes–specific therapies. Large, placebo-controlled trials are needed to progress the field toward use of combination therapies that reduce metabolic and vascular complications and ease patient burden in type 1 diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"8 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144919053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plant-Based Dietary Patterns Associated With Reduced Risk of All-Cause Mortality in Diabetes Subgroups: A Prospective Cohort Study From the UK Biobank","authors":"Edyta Schaefer, Janett Barbaresko, Michael Roden, Oliver Kuss, Sabrina Schlesinger","doi":"10.2337/dc25-0344","DOIUrl":"https://doi.org/10.2337/dc25-0344","url":null,"abstract":"OBJECTIVE To investigate the association between adherence to a plant-based dietary index (PDI), healthy PDI, and unhealthy PDI with all-cause mortality in people with type 2 diabetes and to assess whether associations varied by diabetes subgroups. RESEARCH DESIGN AND METHODS We included 4,829 UK Biobank participants with type 2 diabetes and at least two 24-h dietary recalls. We generated overall, healthy, and unhealthy scores. Multivariable Cox regression estimated hazard ratios (HRs) and 95% CIs for all-cause mortality, comparing the highest tertile (T3) with the lowest T1 of adherence to PDI, a healthy PDI, and an unhealthy PDI. Interactions between PDI adherence and diabetes subgroups (HbA1c, waist circumference, age at diagnosis, diabetes duration) were assessed by two-dimensional B-splines and by including product terms into the model. RESULTS During a mean follow-up of 11.3 years, 679 deaths occurred. Individuals with the highest PDI adherence, compared with those with lowest, were at lower risk of all-cause mortality (T3 vs. T1: HR 0.79 [95% CI 0.63; 0.99]), and a similar direction was observed for those with a healthy PDI (0.82 [0.67; 1.02]) but the 95% CI included the null value. Unhealthy PDI was associated with increased mortality risk (1.24 [1.00; 1.54]). The associations of PDI, healthy PDI, and unhealthy PDI with all-cause mortality risk were more pronounced for those with poorer glycemic control, higher waist circumference, diagnosis earlier in life, and longer diabetes duration. CONCLUSIONS Higher PDI adherence was associated with decreased mortality risk and higher unhealthy PDI adherence with an increased mortality risk. There was an indication for differences in these association depending on diabetes subgroups.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"11 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sight-Threatening Diabetic Retinopathy During and After Pregnancy—A Nationwide Matched-Cohort Study","authors":"Janni E. Larsson, Lonny Stokholm, Toke Bek, Nis Andersen, Jens Andresen, Javad Hajari, Steffen Heegaard, Kurt Højlund, Ryo Kawasaki, Sören Möller, Frederik N. Pedersen, Katja C. Schielke, Anne Thykjær Petersen, Jakob Grauslund, Elisabeth R. Mathiesen, Caroline S. Laugesen","doi":"10.2337/dc25-0758","DOIUrl":"https://doi.org/10.2337/dc25-0758","url":null,"abstract":"OBJECTIVE To evaluate the risk of treatment of sight-threatening diabetic retinopathy (DR) defined as panretinal photocoagulation for proliferative DR or anti–vascular endothelial growth factor injections for diabetic macular edema (DME) during and after pregnancy compared with nonpregnant control participants. RESEARCH DESIGN AND METHODS This was a matched cohort study of women with type 1 diabetes who gave birth in 2013–2022 and who had DR levels recorded in the national Danish Registry of Diabetic Retinopathy during and after pregnancy. Control participants consisted of nonpregnant women with type 1 diabetes, individually matched by baseline DR level. Data were collected from relevant national registers from 36 months before pregnancy until 36 months after. RESULTS We included 1,041 pregnant women and 1,041 matched control participants. At baseline, the median duration (interquartile range [IQR]) of diabetes was 13 (6, 19) and 10 (5, 17) years for cases and control participants. Median baseline HbA1c (IQR) was 57 (50, 67) compared with 64 (55, 79) mmol/mol (7.4% vs. 8%), and DR was present in 42.7% of both groups. During and after pregnancy, treatment of proliferative DR with panretinal photocoagulation occurred to a similar extent in both groups (pregnant women vs. control participants: during treatment: 1.2% vs. 1.1%, respectively, OR 1.18 [95% CI 0.53, 2.66]); and after treatment: 2.7% vs. 2.9%, respectively, OR 0.93 [95% CI 0.55, 1.57]). Treatment of DME was rare in both groups. Progression to proliferative DR was not higher in the pregnant group (adjusted hazard ratio 0.64 [95% CI 0.32, 1.31]). CONCLUSIONS In this nationwide register study of women with type 1 diabetes, pregnant women and retinopathy-matched, nonpregnant control participants had a similar risk of developing sight-threatening DR requiring treatment during and within 36 months after pregnancy.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"19 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144906061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Dose Glucagon to Prevent and Treat Exercise-Associated Hypoglycemia in Individuals With Type 1 Diabetes: A Systematic Review and Meta-analysis","authors":"Sissel Banner Lundemose, Ajenthen Gayathri Ranjan, Ole Nørgaard, Tommi Suvitaival, Kirsten Nørgaard","doi":"10.2337/dc25-0702","DOIUrl":"https://doi.org/10.2337/dc25-0702","url":null,"abstract":"OBJECTIVE People with type 1 diabetes (T1D) struggle to manage exercise because of hypoglycemia risk. RESEARCH DESIGN AND METHODS This systematic review and meta-analysis evaluated low-dose glucagon's efficacy for preventing and treating exercise-induced hypoglycemia in T1D. Medline, Embase, and Cochrane CENTRAL were searched for randomized controlled trials and crossover studies until September 2024. The analysis included T1D adolescents and adults treated with low-dose glucagon versus nonglucagon treatments. Studies with glucagon-like peptides, noninsulin combinations, or uncontrolled exercise settings were excluded. Two authors extracted the data. The methodological quality was assessed with the Risk of Bias-2 tool and Grading of Recommendations Assessment, Development and Evaluations framework. Risk of Bias 2 informed a sensitivity analysis. The meta-analysis employed a random effects model to estimate the pooled treatment effects on hypoglycemia and time below range (TBR) (glucose <3.9 mmol/L), as well as secondary outcomes and adverse effects. RESULTS Of 6,792 records, 12 studies involving 248 individuals (mean age: 36 ± 10.5 years) met inclusion criteria. The meta-analysis showed significant reductions in hypoglycemia risk (risk ratio 0.54; 95% CI 0.35, 0.84) and TBR (−3.91 percentage points; 95% CI −6.27, 1.54) with low-dose glucagon. Sensitivity analysis yielded a slightly more confident effect size for hypoglycemia and TBR. However, overall adverse events increased with low-dose glucagon (risk ratio 2.75; 95% CI 1.07, 7.08). The included studies were few and heterogeneous, which may have influenced the overall outcomes. CONCLUSIONS Low-dose glucagon reduces exercise-induced hypoglycemia and TBR in T1D individuals. Future research should optimize glucagon dosage and timing for various exercise types and durations to confirm real-world effectiveness.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"46 1","pages":"1637-1645"},"PeriodicalIF":16.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144901568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Metabolomics Study of Cardiac Dysfunction in Hyperglycemia—Findings From the Atherosclerosis Risk in Communities (ARIC) Study and the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)","authors":"Yilin Yoshida, Ngoc Quynh Nguyen, Eun Hye Moon, Casey Rebholz, Hicham Skali, Victoria Arthur, Justin B. Echouffo-Tcheugui, Christie Ballantyne, Elizabeth Selvin, Amil Shah, Robert Kaplan, Carlos J. Rodriguez, Qibin Qi, Susan Cheng, Bing Yu","doi":"10.2337/dc25-0730","DOIUrl":"https://doi.org/10.2337/dc25-0730","url":null,"abstract":"OBJECTIVE Hyperglycemic states (prediabetes and diabetes) are associated with heart failure (HF) risk. We aimed to identify distinct metabolites for subclinical cardiac dysfunction, a precursor of HF, in hyperglycemic or euglycemic individuals. RESEARCH DESIGN AND METHODS We conducted cross-sectional and prospective analyses of 2,492 HF-free participants from the Atherosclerosis Risk in Communities (ARIC) study visit 5, 2011–2013. A total of 1,297 participants were hyperglycemic (assessed on the basis of hemoglobin A1c >5.7%, fasting glucose >100 mg/dL, use of diabetes medication, or diagnosis), and 1,195 were euglycemic. We used logistic regression for analysis of association between 790 metabolites and cardiac dysfunction, defined according to echocardiographic abnormalities (left ventricular hypertrophy, systolic or diastolic dysfunction) or elevated NT-proBNP or troponin T, in two glycemic groups separately. We used Cox regression for prospective association between cardiac dysfunction–related metabolites identified in the prior step and HF risk, adjusting for clinical risk factors. Analyses were replicated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (n = 5,167). RESULTS Microvascular disease–related metabolites (e.g., pseudouridine, N6-carbamoylthreonyladenosine, N6-acetyllysine, N2,N5-diacetylornithine) were associated with cardiac dysfunction in hyperglycemic individuals. Carbohydrate and cofactor-derived metabolites (e.g., gulonate, erythrocyte) were associated with cardiac dysfunction in euglycemic individuals. These cardiac dysfunction–related metabolites were prospectively associated with HF risk in the two glycemic groups (follow-up 7.5 years, 137 and 94 HF cases, per-SD increase hazards ratios range 1–1.9 and 1.1–2.9), respectively. HCHS/SOL results were consistent with those from ARIC. CONCLUSIONS Metabolites known for microvascular complications were associated with cardiac dysfunction in hyperglycemic individuals but not among their euglycemic counterparts, supporting the premise that microvascular dysfunction contributes to HF pathogenesis in diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"50 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144737176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrasting Adult and Pediatric Populations in a Cohort of At-Risk Relatives in The T1D TrialNet Pathway to Prevention Study","authors":"Erin L. Templeman, Lauric A. Ferrat, Nicholas Thomas, Cate Speake, Diane K. Wherrett, Jennifer Sherr, John M. Wentworth, Maria J. Redondo, Hemang M. Parik, Jamie L. Felton, Carmella Evans-Molina, Jay Sosenko, Lu You, Richard A. Oram, Emily K. Sims","doi":"10.2337/dc25-0192","DOIUrl":"https://doi.org/10.2337/dc25-0192","url":null,"abstract":"OBJECTIVE More than half of incident type 1 diabetes (T1D) occurs in adults, yet research on disease progression predominantly focuses on at-risk children. We compared autoantibody screening outcomes and T1D progression in adults versus children. RESEARCH DESIGN AND METHODS We studied 135,914 children (aged <18 years) and 99,795 adult relatives of individuals with T1D screened in the TrialNet Pathway to Prevention study. In autoantibody positive participants, we compared progression rates, associations with risk factors, and performance of metabolic risk scores. RESULTS Adults were more likely than children to screen positive for a single autoantibody (4.0% vs. 2.6%) but less likely for multiple autoantibodies (0.83% vs. 2.8%; P < 0.001). Progression to stage 3 disease was lower in adults with single autoantibody positivity or stage 1 T1D than in children (5-year risks: single autoantibody, adults 8.2% vs. children 22%, P < 0.001; stage 1, adults 17% vs. children 47%, P < 0.001). However, adults with stage 2 T1D at initial staging oral glucose tolerance test had comparable 5-year progression risks to children (78% for both groups). A higher proportion of adults progressing to clinical diabetes were single autoantibody positive (40% vs. 15%; P < 0.0001); these individuals commonly had single glutamic acid decarboxylase positivity and had lower type 1 but higher type 2 genetic risk scores compared with multiple autoantibody positive adults. HbA1c and established risk indices more effectively identified progressors in adults compared with children. CONCLUSIONS Autoantibody positive adult relatives have distinct autoantibody trajectories and progression risks compared with children, suggesting the need for tailored monitoring and intervention strategies.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"11 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Diabetes Outcomes at 1 Year After Islet Autotransplantation: Data From a Multicenter Cohort Study","authors":"Piotr Witkowski, Anne Eaton, Sydney Porter, Maisam Abu-El-Haija, Syed A. Ahmad, Sri Prakash Mokshagundam, Martin Wijkstrom, Bashoo Naziruddin, Guru Trikudanathan, Vikesh K. Singh, Sarah J. Schwarzenberg, Timothy L. Pruett, Andrew Posselt, Jaimie D. Nathan, Katherine Morgan, Luis F. Lara, Timothy B. Gardner, Martin Freeman, Mayha Faghih, Elissa M. Downs, Srinath Chinnakotla, Appakalai N. Balamurugan, David Adams, Gregory J. Beilman, Melena D. Bellin","doi":"10.2337/dc25-0620","DOIUrl":"https://doi.org/10.2337/dc25-0620","url":null,"abstract":"OBJECTIVE Total pancreatectomy with islet autotransplantation (TPIAT) may relieve pain for patients with intractable recurrent acute or chronic pancreatitis. In this first multicenter cohort study of TPIAT, we aimed to identify predictors of favorable diabetes outcomes following TPIAT to aid in surgical counseling and decision making. RESEARCH DESIGN AND METHODS We included 384 patients (mean [SD] age 29.6 [17.1] years; 61.7% female) who underwent TPIAT and were enrolled in the National Institutes of Health–sponsored multicenter Prospective Observational Study of TPIAT (POST). Outcomes were reported for insulin use, HbA1c, and islet graft function. Univariable and multivariable modeling was performed to evaluate predictors of diabetes outcomes after TPIAT. RESULTS At 1 year post-TPIAT, 83% of patients retained islet function (C-peptide >0.3 ng/mL), 20% were off insulin, and 60% had HbA1c <7%. Outcomes were most favorable in those with normoglycemia pre-TPIAT and in children. In multivariable analysis, insulin independence at 1 year was associated with pediatric age (odds ratio [OR] 2.3 [95% CI 1.3–4.3] vs. adults) and pretransplant HbA1c (OR 4.0 [1.7–9.1] per 1% decrease HbA1c). The odds of achieving a goal HbA1c <7% was associated with White race (OR 4.3 [1.7–11]) and pre-TPIAT HbA1c (OR 2.2 [1.1–4.3] per 1% decrease). Islet graft function was associated with pre-TPIAT fasting C-peptide (OR 2.18 [1.42–3.35] per 1 ng/mL increase) and baseline HbA1c (OR 1.89 [1.18–3] per 1% decrease). CONCLUSIONS Patients with normoglycemia and children more often were off insulin. In multivariable models, pre-TPIAT HbA1c was strongly predictive of insulin independence, islet function, and HbA1c <7% at 1 year.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"103 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in β-Cell Function and Insulin Sensitivity During Treatment With Dapagliflozin Alone or in Combination With Exenatide in Type 2 Diabetes","authors":"Curtis Triplitt, Eugenio Cersosimo, Mariam Alatrach, John Adams, Andrea Hansis-Diarte, Gozde Baskoy, Amalia Gastaldelli, Alberto Chavez-Velazquez, Ralph A. DeFronzo","doi":"10.2337/dc25-0490","DOIUrl":"https://doi.org/10.2337/dc25-0490","url":null,"abstract":"OBJECTIVE To examine the effects of sodium–glucose cotransporter 2 inhibitors (SGLT2is) alone or with glucagon-like peptide 1 receptor agonists (GLP-1RAs) on β-cell function (BCF) in type 2 diabetes. The hypothesis was that an SGLT2i combined with a GLP-1RA provides superior improvement in BCF than either agent alone. RESEARCH DESIGN AND METHODS Ninety patients underwent a 180-min oral glucose tolerance test (OGTT) 1) after one drug dose (acute study) (placebo [n = 15], dapagliflozin [n = 25], exenatide [n = 25], and dapagliflozin/exenatide [n = 25]), and 2) after 1 and 4 months of therapy. Corrected Matsuda index (cMI) for urinary glucose loss, insulin secretion, and BCF indices were calculated during OGTT. RESULTS In the acute study, mean ± SEM cMI in dapagliflozin (2.29 ± 0.33), exenatide (2.03 ± 0.12), and dapagliflozin/exenatide (2.36 ± 0.14) was higher (P < 0.05) than placebo (1.63 ± 0.36). After 1 and 4 months, cMI remained similarly elevated in exenatide and increased further (P < 0.001) in dapagliflozin and dapagliflozin/exenatide. In the acute study, insulin secretion in dapagliflozin was similar to placebo but higher (P < 0.001 vs. both) in exenatide and dapagliflozin/exenatide. After 1 and 4 months in exenatide and in dapagliflozin/ exenatide, insulin secretion remained higher (P < 0.01 vs. both) than dapagliflozin. BCF index in the acute study was 0.40 ± 0.04 in placebo, 62% higher (P < 0.05) in dapagliflozin (0.65 ± 0.10), threefold higher in exenatide (1.17 ± 0.22), and fourfold higher in dapagliflozin/exenatide (1.69 ± 0.12) (all P < 0.001 vs. placebo). At 1 and 4 months, BCF rose further in dapagliflozin and exenatide but did not increase further in dapagliflozin/exenatide. CONCLUSIONS Dapagliflozin and exenatide monotherapy cause sustained improvements in BCF and insulin sensitivity. Combination therapy with dapagliflozin plus exenatide markedly augmented both BCF and insulin sensitivity above that with either agent alone.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"687 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}