Diabetes Care最新文献

{"title":"Empagliflozin in Patients With Type 2 Diabetes Undergoing On-Pump CABG: The POST-CABGDM Randomized Clinical Trial","authors":"Fabio Grunspun Pitta, Eduardo Gomes Lima, Caio Assis Moura Tavares, Eduardo Bello Martins, Fabiana Hanna Rached, Eduardo Martelli Moreira, Bruno Mahler Mioto, Simão Augusto Lottenberg, Paula Mathias Paulino Bolta, Larissa Gonçalves Justino, Desiderio Favarato, Letícia Neves Solon Carvalho, Henrique Trombini Pinesi, Camila Talita Machado Barbosa, Luís Alberto Oliveira Dallan, Luís Roberto Palma Dallan, Marcelo Henrique Moreira Barbosa, Roberto Kalil Filho, James A. de Lemos, Carlos Vicente Serrano","doi":"10.2337/dc24-2807","DOIUrl":"https://doi.org/10.2337/dc24-2807","url":null,"abstract":"OBJECTIVE To evaluate the efficacy and safety of empagliflozin in patients with type 2 diabetes mellitus (T2DM) undergoing elective on-pump coronary artery bypass grafting (CABG). RESEARCH DESIGN AND METHODS Investigator-initiated, pragmatic, single-center, randomized, open-label trial with blinded outcome adjudication conducted in Brazil. A total of 145 patients with T2DM scheduled for elective on-pump CABG were randomized to receive empagliflozin 25 mg daily plus standard care (n = 71) for at least 3 months, which was discontinued 72 h before surgery, or to received standard care alone (n = 74). The primary outcome was postoperative acute kidney injury (AKI) within 7 days of surgery, defined by creatinine-based criteria (namely, Acute Kidney Injury Network; Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease; or Kidney Disease: Improving Global Outcomes). Secondary outcomes included 30-day postoperative atrial fibrillation and type 5 myocardial infarction (MI). Safety outcomes were ketoacidosis, urinary tract infection, hospital-acquired pneumonia, and wound infection within 30 days after CABG. RESULTS AKI occurred in 22.5% of the empagliflozin group vs. 39.1% in the control group (relative risk [RR] 0.57 [95% CI 0.34–0.96]; P = 0.03). Rates of atrial fibrillation (15.4% vs. 13.5%; RR 1.15 [95% CI 0.52–2.53]; P = 0.73) and type 5 MI (1.4% vs. 4.1%; RR 0.35 [95% CI 0.04–3.26]; P = 0.62) were similar between groups. No statistically significant differences between groups were observed for safety events. Three deaths occurred, all in the control group. CONCLUSIONS Empagliflozin use before on-pump CABG in patients with T2DM was associated with a reduced incidence of postoperative AKI without an increase in safety events. These findings warrant confirmation in larger clinical trials.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"16 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837061","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":"Islet Autoantibodies and Their Association With β-Cell Function and Diabetes Measures in Children With Acute Recurrent and Chronic Pancreatitis","authors":"Gila Ginzburg, Lindsey Hornung, Lee Denson, Amy S. Shah, Sarah Swauger, Jonathan Tatum, Siobhan Tellez, Deborah Elder, Melena D. Bellin, Maisam Abu-El-Haija","doi":"10.2337/dc24-2672","DOIUrl":"https://doi.org/10.2337/dc24-2672","url":null,"abstract":"OBJECTIVE In children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP), circulating islet autoantibodies (auto-Ab) may influence β-cell function. This study reports Ab prevalence in youth with ARP/CP, and investigates effects on indices of insulin secretion during mixed meal tolerance testing (MMTT) and diabetes status. RESEARCH DESIGN AND METHODS This was a retrospective cross-sectional analysis of 234 youth with ARP/CP who had islet Ab testing. Ab+ group n = 28 (12%), and Ab− group n = 206 (88%). Fasting glucose and HbA1c were collected. MMTT was performed in 78% (183 of 234). MMTT-derived indices were calculated and compared between groups. RESULTS The Ab+ and Ab− groups did not differ in age, sex, race, ethnicity, BMI percentile, or fasting glucose. Of Ab+ patients, 54% had one Ab+ and 46% had multiple Ab+. Comparing the Ab+ to Ab− groups, HbA1c was higher (median 5.7 vs. 5.2%, P < 0.01), and C-peptide was lower (median 2.4 vs. 3.7 ng/mL, P = 0.01) in the Ab+ group. The Ab+ compared with the Ab− group had a higher proportion of prediabetes/diabetes (57% vs. 32%, P < 0.001). In survival analysis, the Ab+ group had significantly shorter time from first acute pancreatitis episode to diabetes development (P = 0.02). CONCLUSIONS In children with ARP/CP, Ab+ was associated with higher risk of diabetes/diabetes development, and shorter time to diabetes development, suggesting that islet Ab+ is associated with β-cell dysfunction in this patient cohort. Islet Ab+ was also associated with higher HbA1c and lower C-peptide levels. Future studies are needed to validate the role of islet Ab positivity in pancreatitis.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"21 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837064","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":"Influence of Maternal Glycemia on Breast Milk Composition and Volume Ingested by Infants of Mothers With Type 1 Diabetes","authors":"Lois E. Donovan, Rhonda C. Bell, Jennifer M. Yamamoto, Patricia Lemieux, Josephine Ho, Denice S. Feig, Heidi Virtanen, Susan Crawford, Raylene A. Reimer","doi":"10.2337/dc25-0096","DOIUrl":"https://doi.org/10.2337/dc25-0096","url":null,"abstract":"OBJECTIVE To examine relationships between maternal glucose and breast milk composition and volume ingested by infants of mothers with type 1 diabetes (T1D), and to compare breast milk composition in women with and without T1D. RESEARCH DESIGN AND METHODS Midfeed breast milk samples were collected from 11 mothers with T1D. Maternal continuous glucose monitoring data were correlated with breast milk composition and volume ingested. Breast milk composition was compared between the women with T1D and five without T1D. RESULTS Forty-seven breast milk samples from mothers with T1D were analyzed. Maternal glucose 90–120 min before breastfeeding correlated with breast milk glucose and fructose but not with lactose, protein, fatty acids, leptin, or volume consumed. Breast milk leptin correlated with volume of breast milk consumed (r = 0.394; P = 0.008). Higher breast milk glucose (1.0 ± 0.3 vs. 0.7 ± 0.3 mg/mL) and leptin (463.6 ± 480.0 vs. 114.4 ± 68.6 pg/mL) were found in women with versus without T1D. CONCLUSIONS Maternal glucose is associated with breast milk glucose and fructose in women with T1D but not with volume of breast milk consumed.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"108 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837060","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":"Visit-to-Visit Variability in Lipid Levels and Risk of Incident Heart Failure in Adults With Type 2 Diabetes","authors":"Arnaud D. Kaze, Chiadi E. Ndumele, Seth S. Martin, Prasanna Santhanam, Beeletsega T. Yeneneh, Mookadam Farouk, Roderick Tung, Gregg C. Fonarow, Justin B. Echouffo-Tcheugui","doi":"10.2337/dc24-2533","DOIUrl":"https://doi.org/10.2337/dc24-2533","url":null,"abstract":"OBJECTIVE Limited data exist on the relation between long-term variability in blood lipid fractions and incident heart failure (HF) in the setting of type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS Among 9,443 T2DM participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, with lipid measurements available at six time points (baseline, 4, 8, 12, 24, and 36 months), we assessed variability in total cholesterol (TC), LDL cholesterol, HDL cholesterol, and triglycerides (TG) across visits, using coefficient of variation (CV), SD, and variability independent of the mean. Cox proportional hazards models were employed to estimate adjusted hazard ratios (HRs) for incident HF. RESULTS During a median follow-up of 5.0 years, 345 participants developed HF. Participants in the highest quartile of CV of TC had a 68% higher relative risk of HF compared with those in the lowest quartile (adjusted HR [aHR] 1.68, 95% CI 1.22–2.30). Similarly, those in the highest quartile of LDL cholesterol CV had a 76% higher relative risk (aHR 1.76, 95% CI 1.27–2.42) of HF, while those in the highest quartile of HDL cholesterol CV had a 53% higher risk (aHR 1.53, 95% CI 1.13–2.06). For TG CV, participants in the highest quartile had a 49% higher risk of HF compared with the lowest quartile (aHR 1.49, 95% CI 1.09–2.04). Similar patterns were observed for other variability metrics. CONCLUSIONS Increased variability in TC, LDL- cholesterol, HDL- cholesterol, or TG is independently associated with a higher HF risk among individuals with T2DM.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"21 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143832440","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":"Subphenotype-Dependent Benefits of Bariatric Surgery for Individuals at Risk for Type 2 Diabetes","authors":"Leontine Sandforth, Violeta Raverdy, Arvid Sandforth, Pierre Bauvin, Estelle Chatelain, Helene Verkindt, Geltrude Mingrone, Caterina Guidone, Ornella Verrastro, Karin Zhou, Rami Archid, André Mihaljevic, Robert Caiazzo, Gregory Baud, Camille Marciniak, Mikael Chetboun, Marlene Ganslmeier, Vitória Minelli Faiao, Martin Heni, Louise Fritsche, Anja Moller, Konstantinos Kantartzis, Andreas Peter, Rainer Lehmann, Robert Wagner, Katsiaryna Prystupa, Andreas Fritsche, Norbert Stefan, Hubert Preissl, Andreas L. Birkenfeld, Reiner Jumpertz von Schwartzenberg, François Pattou","doi":"10.2337/dc25-0160","DOIUrl":"https://doi.org/10.2337/dc25-0160","url":null,"abstract":"OBJECTIVE Bariatric surgery is an effective treatment option for individuals with obesity and type 2 diabetes (T2D). However, whether outcomes in subtypes of individuals at risk for T2D and/or comorbidities (Tübingen Clusters) differ, is unknown. Of these, cluster 5 (C5) and cluster 6 (C6) are high-risk clusters for developing T2D and/or comorbidities, while cluster 4 (C4) is a low-risk cluster. We investigated bariatric surgery outcomes, hypothesizing that high-risk clusters benefit most due to great potential for metabolic improvement. RESEARCH DESIGN AND METHODS We allocated participants without T2D but at risk for T2D, defined by elevated BMI, to the Tübingen Clusters. Participants had normal glucose regulation or prediabetes according to American Diabetes Association criteria. Two cohorts underwent bariatric surgery: a discovery (Lille, France) and a replication cohort (Rome, Italy). A control cohort (Tübingen, Germany) received behavioral modification counseling. Main outcomes included alteration of glucose regulation parameters and prediabetes remission. RESULTS In the discovery cohort, 15.0% of participants (n = 121) were allocated to C4, 22.3% (n = 180) to C5, and 62.4% (n = 503) to C6. Relative body weight loss was similar among all clusters; however, reduction of insulin resistance and improvement of β-cell function were strongest in C5. Prediabetes remission rate was lowest in low-risk C4 and highest in high-risk C5. Individuals from high-risk clusters changed to low-risk clusters in both bariatric surgery cohorts but not in the control cohort. CONCLUSIONS Participants in C5 had the highest benefit from bariatric surgery in terms of improvement in insulin resistance, β-cell function, and prediabetes remission. This novel classification might help identify individuals who will benefit specifically from bariatric surgery.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"27 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822734","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":"M120 Risk Score Improves Identification of Children at High Risk of Developing Clinical Type 1 Diabetes and Reports Short-Term Response to Preventive Immunotherapy","authors":"Minh V. Le, Leonard C. Harrison, Tim Spelman, John M. Wentworth","doi":"10.2337/dc24-2794","DOIUrl":"https://doi.org/10.2337/dc24-2794","url":null,"abstract":"OBJECTIVE Approval of teplizumab as disease-modifying therapy for type 1 diabetes heralds a new therapeutic era. To facilitate prevention trials, we determined if the M120 risk score could enrich for type 1 diabetes risk and define early treatment effects. RESEARCH DESIGN AND METHODS M120, based on age, sex, BMI, IA-2 antibody status, HbA1c, blood glucose, and C-peptide 120 min after oral glucose, was determined in TrialNet participants with multiple islet autoantibodies and those who joined the teplizumab prevention trial. RESULTS Compared with the oral glucose tolerance test, M120 identified 26% more children at high risk of progression. When applied to data from the teplizumab trial, M120 improved after teplizumab (P = 0.0362) and deteriorated after placebo (P = 0.0489) to reveal a significant treatment effect after 6 months (P < 0.001). CONCLUSIONS M120 improves risk stratification and identifies early effects of immunotherapy. It could be applied to increase prevention trial efficiency and guide treatment decisions in the clinic.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"4 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819372","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":"Risk of Adverse Pregnancy Outcomes Among Asian Individuals With Gestational Diabetes Mellitus in the U.S., 2016–2021","authors":"Kartik K. Venkatesh, Xiaoning Huang, Nilay S. Shah,, Mark B. Landon, William A. Grobman, Sadiya S. Khan","doi":"10.2337/dc25-0060","DOIUrl":"https://doi.org/10.2337/dc25-0060","url":null,"abstract":"OBJECTIVE The risk of adverse pregnancy outcomes (APOs) differs among race and ethnic groups with gestational diabetes mellitus (GDM). Heterogeneity in APOs may be masked by aggregating these groups. We assessed whether the frequency and risk of APOs differed among Asian groups with GDM. RESEARCH DESIGN AND METHODS This is a serial cross-sectional analysis of U.S. birth certificate data (2016–2021) from individuals with a singleton first livebirth. The exposure was self-reported maternal race and ethnicity stratified by Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese versus non-Hispanic White as the reference. Maternal outcomes included: primary cesarean delivery, hypertensive disorders of pregnancy (HDP), intensive care unit admission, and transfusion. Neonatal outcomes included large-for-gestational-age (LGA), small-for-gestational-age (SGA), preterm birth, and neonatal intensive care unit (NICU) admission. RESULTS The study population included 29,370 Indian, 16,146 Chinese, 9,082 Filipino, 6,497 Vietnamese, 3,754 Korean, and 1,253 Japanese individuals, and 254,433 White individuals. Between 2016 and 2021, the frequency of HDP, but not other APOs, increased among most Asian groups. In multivariable analyses, individuals in all Asian groups had higher likelihood of SGA and lower likelihood of LGA compared with White individuals. Findings for other APOs were heterogeneous. The risk of APOs was generally highest among Filipino individuals, followed by Indian individuals, and lowest among Chinese individuals among Asian groups. CONCLUSIONS There was significant heterogeneity in the frequency and risk of APOs among Asian individuals with GDM in the U.S. Disaggregation of the Asian population in diabetes and pregnancy research and surveillance is necessary to identify opportunities for intervention.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"24 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819373","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":"Effect of Marked Weight Loss on Adipose Tissue Biology in People With Obesity and Type 2 Diabetes","authors":"Dmitri Samovski, Gordon I. Smith, Hector Palacios, Terri Pietka, Anja Fuchs, Gary J. Patti, Allah Nawaz, C. Ronald Kahn, Samuel Klein","doi":"10.2337/dc24-2739","DOIUrl":"https://doi.org/10.2337/dc24-2739","url":null,"abstract":"OBJECTIVE Weight loss improves insulin sensitivity in people with obesity and type 2 diabetes. However, the mechanisms responsible for this effect are unclear. We hypothesized that alterations in adipose tissue biology and adipose tissue-related factors in plasma are involved in mediating the systemic metabolic benefits of weight loss. RESEARCH DESIGN AND METHODS We evaluated blood and adipose tissue samples obtained from 10 adults with obesity and type 2 diabetes before and after marked (16–20%) weight loss and >50% increase in whole-body insulin sensitivity, assessed by using the hyperinsulinemic-euglycemic clamp procedure. RESULTS Weight loss 1) decreased adipose tissue expression of genes related to extracellular matrix remodeling; 2) decreased adipose tissue expression of SERPINE 1, which encodes plasminogen activator inhibitor 1 (PAI-1); 3) did not decrease adipose tissue immune cell content or expression of genes involved in inflammation; 4) decreased adipose tissue ceramide content; 5) decreased plasma PAI-1 and leptin concentrations and increased plasma high-molecular weight (HMW) adiponectin; and 6) decreased plasma small extracellular vesicle (sEV) concentration and the sEV content of microRNAs proposed to inhibit insulin action, and completely reversed the inhibitory effect of plasma sEVs on insulin signaling in myotubes. CONCLUSIONS These findings suggest that weight loss increases insulin sensitivity in people with obesity and type 2 diabetes by modifying adipose tissue biology, with concomitant alterations in circulating PAI-1, leptin, HMW adiponectin, and sEV microRNAs.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"3 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819374","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":"Risk of Urogenital Infections in People With Type 2 Diabetes Initiating SGLT2i Versus GLP-1RA in Routine Clinical Care: A Danish Cohort Study","authors":"Christine Ljungberg, Frederik Pagh Bredahl Kristensen, Michael Dalager-Pedersen, Christina Vandenbroucke-Grauls, Henrik Toft Sørensen, Mette Nørgaard, Reimar Wernich Thomsen","doi":"10.2337/dc24-2169","DOIUrl":"https://doi.org/10.2337/dc24-2169","url":null,"abstract":"OBJECTIVE Anticipated risks of urinary tract infections (UTI) and genital tract infections (GTI) associated with sodium–glucose cotransporter 2 inhibitors (SGLT2i) may prevent their use in clinical practice. We investigated whether initiation of SGLT2i, compared with glucagon-like peptide 1 receptor agonists (GLP-1RAs), was associated with an elevated risk of UTI and GTI in people with type 2 diabetes. RESEARCH DESIGN AND METHODS In this cohort study emulating a target trial, we included all adult metformin users initiating SGLT2i or GLP-1RAs in Denmark in 2016–2021 and used inverse-probability of treatment (IPT) weighting to balance potential confounders. We estimated IPT-weighted risk and risk ratios of community- or hospital-treated UTI and GTI, performing both intention-to-treat and on-treatment analyses. RESULTS This study included 52,414 SGLT2i initiators and 27,023 GLP-1RA initiators with a median follow-up of 2.9 to 3.9 years. The estimated risks of UTI within the first year were nearly identical: 10.0% in SGLT2i and 10.2% in GLP-1RAs in intention-to-treat analyses corresponding to a risk ratio of 0.98 (95% CI 0.94, 1.03). For GTI, the 1-year risks were elevated under SGLT2i therapy at 2.0% vs. 0.7% (risk ratio 2.95 [95% CI 2.52, 3.44]). During the 5-year follow-up, the relative UTI risk remained almost constant (0.96 [95% CI 0.94, 0.99]) whereas the GTI risk ratio with SGLT2is decreased to 1.64 (95% CI 1.49, 1.80). CONCLUSIONS In routine clinical care, SGLT2i initiation is not associated with increased risk of UTI compared with GLP-1RA initiation. However, early GTI risk is up to threefold larger in SGLT2i users.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"183 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766479","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":"Symptoms of Autonomic Nervous System Dysregulation and Diabetes Distress in Adults With Type 1 and Type 2 Diabetes","authors":"Mary de Groot, Barbara A. Myers, Timothy E. Stump, Deb Dana, Greg Lewis, Jacek Kolacz, Lauren Baker, Kelly A. Fox, Stephen W. Porges","doi":"10.2337/dc24-2614","DOIUrl":"https://doi.org/10.2337/dc24-2614","url":null,"abstract":"OBJECTIVE To test the association of autonomic nervous system (ANS) dysregulation symptoms and diabetes distress (DD) in adults with type 1 diabetes (T1D; study 1) and type 2 diabetes (T2D; study 2). RESEARCH DESIGN AND METHODS A total of 556 adults with T1D and 299 with T2D completed the Body Perception Questionnaire (BPQ) to assess ANS reactivity symptoms, diabetes distress (via Diabetes Distress Scale T1 [DDS-T1], and DDS-17), anxiety (via General Anxiety Disorder 7 [GAD-7]) scale, depression (via Patient Health Questionnaire-8 [PHQ-8]), and demographic variables via internet surveys. RESULTS In study 1, participants’ mean age was 45.1 (SD 15.7) years and most were female (73.2%) and White (95.3%). The mean self-reported A1c was 6.7% (SD = 1.0%); mean duration of T1D diagnosis 20.6 (SD 14.7) years; and 72.5% of participants reported using an insulin pump. The mean DDS-T1 score was 2.3 (SD 0.8; moderate severity). The BPQ mean T score was 48.9 (SD 8.4) for supradiaphragmatic and 50.6 (SD 8.9) for subdiaphragmatic reactivity subscales. In study 2, participants’ mean age was 60.2 (SD 13.6) years, 58.7% were female, and 82.9% were White. The mean self-reported A1c was 7.0% (SD 1.2%), and 51.8% of participants were treated with oral hypoglycemic agents and 39.9% used oral and injectable medications. The mean duration of T2D diagnosis was 15.0 (SD 10.0) years. The mean DDS-17 score was 2.3 (SD 1.0; moderate severity) and BPQ mean T score was 49.9 (SD 9.4) for supradiaphragmatic and 52.0 (SD 8.8) for subdiaphragmatic reactivity subscales. Controlling for covariates, severity of DDS-T1/DDS-17 significantly predicted elevations in ANS symptom T scores on all subscales (P ≤ 0.05 for all), with “high” DDS having the highest BPQ scores. CONCLUSIONS These findings demonstrate a relationship between ANS reactivity and DDS in T1D and T2D samples.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"30 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745079","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}