Diabetes Care最新文献

Pilot Pragmatic Trial of a Community Paramedic Diabetes Self-Management Education Program for Adults With Diabetes 糖尿病成人社区护理人员糖尿病自我管理教育项目的试点实用试验

IF 16.2 1区医学

Diabetes Care Pub Date : 2025-10-07 DOI: 10.2337/dc25-1580

Allison Ducharme-Smith, Michael Juntunen, Anna Espinoza, Chad Liedl, Karen Fischer, Angela Meilander, Jaxon Quillen, Rozalina G. McCoy

引用次数: 0

Glycemic Level Modifies the Relationship Between Maternal Gestational Weight Gain and Neonatal Birth Weight in Type 2 Diabetes–Complicated Pregnancies 血糖水平改变2型糖尿病合并妊娠孕妇妊娠期体重增加与新生儿体重的关系

IF 16.2 1区医学

Diabetes Care Pub Date : 2025-10-01 DOI: 10.2337/dc25-1086

Xinyu Shu, Juan Juan, Mi Yao, Chenglong Li, Xin Kang, Xu Chen, Zhuo Wei, Lingyi Kong, Haitian Chen, Shihong Cui, Fengchun Gao, Ping Zhu, Jianying Yan, Xia Xu, Li Zhang, Yanxia Wang, Yang Mi, Huixia Yang

{"title":"Glycemic Level Modifies the Relationship Between Maternal Gestational Weight Gain and Neonatal Birth Weight in Type 2 Diabetes–Complicated Pregnancies","authors":"Xinyu Shu, Juan Juan, Mi Yao, Chenglong Li, Xin Kang, Xu Chen, Zhuo Wei, Lingyi Kong, Haitian Chen, Shihong Cui, Fengchun Gao, Ping Zhu, Jianying Yan, Xia Xu, Li Zhang, Yanxia Wang, Yang Mi, Huixia Yang","doi":"10.2337/dc25-1086","DOIUrl":"https://doi.org/10.2337/dc25-1086","url":null,"abstract":"OBJECTIVE To examine whether glycemic level modifies the association between gestational weight gain (GWG) and pregnant outcomes in type 2 diabetes–complicated pregnancies. RESEARCH DESIGN AND METHODS This multicenter retrospective study stratified 1,642 pregnant women with diabetes by third-trimester glycemic control. Associations between excessive GWG (eGWG) and pregnant outcomes were analyzed by group. RESULTS Although birth weight and odds of macrosomia and cesarean delivery were higher for all women with eGWG relative to those with adequate GWG, the effect estimates for birth weight and macrosomia were significantly higher with suboptimal glycemic control compared with optimal control (birth weight increase: 361.04 vs. 126.07 g, respectively, P = 0.007; adjusted odds ratio for macrosomia: 4.26 vs. 2.73, P = 0.002; cesarean delivery: 1.86 vs. 1.52, P = 0.738). CONCLUSIONS Overly stringent weight control should be treated with caution if optimal glycemic control is not achieved.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"72 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203254","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}

引用次数: 0

Low-Carbohydrate Diets of Varying Macronutrient Quality and Risk of Type 2 Diabetes in Three U.S. Prospective Cohort Studies 美国三项前瞻性队列研究：不同常量营养素质量的低碳水化合物饮食与2型糖尿病的风险

IF 16.2 1区医学

Diabetes Care Pub Date : 2025-09-30 DOI: 10.2337/dc25-1401

Binkai Liu, Yeli Wang, Yang Hu, Yi Wan, Cuilin Zhang, Eric B. Rimm, Frank B. Hu, Qi Sun

{"title":"Low-Carbohydrate Diets of Varying Macronutrient Quality and Risk of Type 2 Diabetes in Three U.S. Prospective Cohort Studies","authors":"Binkai Liu, Yeli Wang, Yang Hu, Yi Wan, Cuilin Zhang, Eric B. Rimm, Frank B. Hu, Qi Sun","doi":"10.2337/dc25-1401","DOIUrl":"https://doi.org/10.2337/dc25-1401","url":null,"abstract":"OBJECTIVE To prospectively examine associations between five low-carbohydrate diets (LCDs), differentiated by macronutrient quality, and type 2 diabetes (T2D) risk. RESEARCH DESIGN AND METHODS This cohort study included 199,006 U.S. adults from the Nurses’ Health Study (NHS) (1984–2018), NHSII (1991–2019), and Health Professionals Follow-up Study (1986–2018); free of T2D, cardiovascular disease, and cancer at baseline; and followed over 30 years. Diet was assessed every 2–4 years using validated food frequency questionnaires since baseline. Five LCD scores were derived based on intakes of protein, fat, and carbohydrates from contrasting food sources. The primary outcome was incident T2D. RESULTS During 4,987,761 person-years of follow-up, 20,452 T2D cases were documented. After adjustments for baseline BMI and other covariates, higher overall LCD score was associated with higher T2D risk (hazard ratio comparing highest vs. lowest quintile 1.31 [95% CI 1.25–1.37]; P-trend &lt; 0.001). An animal-based LCD emphasizing animal protein and fat and an unhealthy LCD score further deemphasizing whole grains and other high-quality carbohydrates were associated with higher T2D risk (1.39 [1.32–1.45] and 1.44 [1.37–1.51]; both P-trend &lt; 0.001). In contrast, a vegetable-based LCD emphasizing plant protein and fat was associated with a 6% lower T2D risk (0.94 [0.90–0.98]; P-trend = 0.004), and a healthy LCD further deemphasizing refined carbohydrates was associated with a 16% lower T2D risk (0.84 [0.81–0.88]; P-trend &lt; 0.001]). Associations for overall, animal-based, and unhealthy LCDs were stronger among participants with lower baseline BMI and were partially mediated by weight change. CONCLUSIONS LCDs may not be beneficial for primary prevention of T2D unless they prioritize plant-based protein, healthy fats, and high-quality carbohydrates.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"72 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145195380","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}

引用次数: 0

Development and Internal Validation of the Multiethnic Type 2 Diabetes Outcomes Model for the U.S. (DOMUS) 美国多种族2型糖尿病结局模型（DOMUS）的建立和内部验证

IF 16.2 1区医学

Diabetes Care Pub Date : 2025-09-25 DOI: 10.2337/dc25-0911

Aaron N. Winn, Zachary Newman, Amber Deckard, Melissa I. Franco-Galicia, Erin M. Staab, Monica E. Peek, Anirban Basu, Philip Clarke, Wen Wan, Elbert S. Huang, Andrew J. Karter, Donald Miller, M. Reza Skandari, Howard H. Moffet, Mengqi Zhu, Jennifer Y. Liu, Jyoti Sarker, Wael Mohammed, Robert Smith, Neda Laiteerapong

{"title":"Development and Internal Validation of the Multiethnic Type 2 Diabetes Outcomes Model for the U.S. (DOMUS)","authors":"Aaron N. Winn, Zachary Newman, Amber Deckard, Melissa I. Franco-Galicia, Erin M. Staab, Monica E. Peek, Anirban Basu, Philip Clarke, Wen Wan, Elbert S. Huang, Andrew J. Karter, Donald Miller, M. Reza Skandari, Howard H. Moffet, Mengqi Zhu, Jennifer Y. Liu, Jyoti Sarker, Wael Mohammed, Robert Smith, Neda Laiteerapong","doi":"10.2337/dc25-0911","DOIUrl":"https://doi.org/10.2337/dc25-0911","url":null,"abstract":"OBJECTIVE The objective of this study was to develop and internally validate a mathematical model of the relationships between patient clinical and social risk factors and outcomes using data from a multiethnic population with type 2 diabetes. RESEARCH DESIGN AND METHODS We constructed an incidence cohort of all adults (18 years or older) with newly diagnosed type 2 diabetes in the Kaiser Permanente Northern California (KPNC) health care system between 2005 and 2016 (n = 129,000), following patients for at least 1 year, but up to 12 years. Using this cohort, we modeled 17 distinct diabetes-related outcomes related to micro- and macrovascular disease, as well as atrial fibrillation, depression, dementia, relevant biomarkers, and mortality. RESULTS Data were randomly split into 50%, 25%, and 25% samples to perform model estimation, calibration, and validation, respectively. Empirical and simulated data were similar for the events and biomarkers, but some factors required calibration. After calibration, they closely aligned with empirical estimates. CONCLUSIONS The resulting Diabetes Outcome Model of the U.S. (DOMUS) is a major step forward in understanding diabetes progression and the role of social determinants of health. This model can be used by scientists, policymakers, and health system managers to better understand how choices can affect population health and health disparities, including the broad diversity of U.S. races and ethnicities. Moreover, this model can be used to realize longer-term comparative effectiveness in cost-effectiveness analyses for diabetes management in the future.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"89 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145141547","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}

引用次数: 0

The Effect of Midpregnancy Screening for Gestational Diabetes Mellitus on Pregnancy Outcomes: The TESGO Randomized Controlled Trial 妊娠中期筛查妊娠糖尿病对妊娠结局的影响：TESGO随机对照试验

IF 16.2 1区医学

Diabetes Care Pub Date : 2025-09-23 DOI: 10.2337/dc25-0084

Chun-Heng Kuo, Ming-Wei Lin, Szu-Chieh Chen, I-Weng Yen, Kang-Chih Fan, Chih-Yao Hsu, Chien-Nan Lee, Chin-Hao Chang, Yu-Han Chang, Yi-Yun Tai, Chin-Ho Cheng, Kuan-Ying Huang, Wen-Wei Hsu, Jessica Kang, Jin-Chung Shih, Ming-Hua Ho, Tzu-Yi Chen, Shin-Yu Lin, Hung-Yuan Li

{"title":"The Effect of Midpregnancy Screening for Gestational Diabetes Mellitus on Pregnancy Outcomes: The TESGO Randomized Controlled Trial","authors":"Chun-Heng Kuo, Ming-Wei Lin, Szu-Chieh Chen, I-Weng Yen, Kang-Chih Fan, Chih-Yao Hsu, Chien-Nan Lee, Chin-Hao Chang, Yu-Han Chang, Yi-Yun Tai, Chin-Ho Cheng, Kuan-Ying Huang, Wen-Wei Hsu, Jessica Kang, Jin-Chung Shih, Ming-Hua Ho, Tzu-Yi Chen, Shin-Yu Lin, Hung-Yuan Li","doi":"10.2337/dc25-0084","DOIUrl":"https://doi.org/10.2337/dc25-0084","url":null,"abstract":"OBJECTIVE Newborns delivered by women with gestational diabetes mellitus (GDM) have accelerated intrauterine growth earlier than the current recommended screening period. We aimed to determine whether universal GDM screening using a single oral glucose intolerance test (OGTT) at 18–20 weeks’ gestation improves pregnancy outcomes compared with standard screening at 24–28 weeks’ gestation. RESEARCH DESIGN AND METHODS We conducted a dual-center, parallel, randomized controlled trial with a planned interim analysis in singleton pregnant women to compare the effect of midpregnancy screening for GDM at 18–20 weeks’ gestation and standard screening at 24–28 weeks’ gestation. GDM was universally screened and diagnosed using 75-g OGTTs and the International Association of the Diabetes and Pregnancy Study Groups criteria. The primary outcome was a composite measure of primary cesarean delivery, birth weight &gt;90th percentile, neonatal hypoglycemia, cord serum C-peptide &gt;90th percentile, gestational hypertension, preeclampsia, and birth trauma. RESULTS The trial was stopped early for futility after the interim analysis. Of the 967 women included in the intention-to-treat analysis, the primary outcome was not significantly different between the two groups. Neonatal hypoglycemia was significantly lower and neonatal adiposity in women with GDM was higher in the midpregnancy screening group compared with the standard screening group. Adverse event rates were similar between the two groups. CONCLUSIONS Advancing universal GDM screening to midpregnancy at 18–20 weeks’ gestation may not improve pregnancy outcomes, except for a reduction in neonatal hypoglycemia. Newborns of women diagnosed with GDM through midpregnancy screening had higher neonatal adiposity.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"99 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127770","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}

引用次数: 0

Impact of Baseline GLP-1 Receptor Agonist Use on Albuminuria Reduction and Safety With Simultaneous Initiation of Finerenone and Empagliflozin in Type 2 Diabetes and Chronic Kidney Disease (CONFIDENCE Trial) 基线使用GLP-1受体激动剂对2型糖尿病和慢性肾病患者同时开始使用非尼伦酮和恩格列净时蛋白尿减少和安全性的影响（CONFIDENCE试验）

IF 16.2 1区医学

Diabetes Care Pub Date : 2025-09-19 DOI: 10.2337/dc25-1673

Rajiv Agarwal, Jennifer B. Green, Hiddo J.L. Heerspink, Johannes F.E. Mann, Janet B. McGill, Amy K. Mottl, Masaomi Nangaku, Julio Rosenstock, Muthiah Vaduganathan, Meike Brinker, Charlie Scott, Li Li, Na Li, Katja Rohwedder, Peter Rossing

{"title":"Impact of Baseline GLP-1 Receptor Agonist Use on Albuminuria Reduction and Safety With Simultaneous Initiation of Finerenone and Empagliflozin in Type 2 Diabetes and Chronic Kidney Disease (CONFIDENCE Trial)","authors":"Rajiv Agarwal, Jennifer B. Green, Hiddo J.L. Heerspink, Johannes F.E. Mann, Janet B. McGill, Amy K. Mottl, Masaomi Nangaku, Julio Rosenstock, Muthiah Vaduganathan, Meike Brinker, Charlie Scott, Li Li, Na Li, Katja Rohwedder, Peter Rossing","doi":"10.2337/dc25-1673","DOIUrl":"https://doi.org/10.2337/dc25-1673","url":null,"abstract":"OBJECTIVE The CONFIDENCE trial demonstrated additive benefits of simultaneous initiation of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, and a sodium–glucose cotransporter 2 (SGLT2) inhibitor compared with monotherapy in reducing the urinary albumin-to-creatinine ratio (UACR). This prespecified analysis evaluated whether safety and efficacy of combination therapy varies by baseline glucagon-like peptide 1 receptor agonist (GLP-1 RA) use. RESEARCH DESIGN AND METHODS Adults with chronic kidney disease (UACR ≥100 to &lt;5,000 mg/g; estimated glomerular filtration rate [eGFR] 30–90 mL/min/1.73 m2) and type 2 diabetes (glycated hemoglobin &lt;11% [97 mmol/mol]) were randomized (1:1:1) to once-daily finerenone, empagliflozin, or finerenone plus empagliflozin. RESULTS Among 800 participants, 182 (23%) used a GLP-1 RA at baseline. At day 180, UACR change from baseline in participants using a GLP-1 RA was −51% (95% CI −59 to −40%) with combination therapy, −34% (−48 to −18%) with finerenone, and −36% (−48 to −21%) with empagliflozin. Corresponding results in those not using a GLP-1 RA at baseline were −56% (−62 to −50%), −37% (−45 to −28%), and −33% (−41 to −23%), respectively. Hyperkalemia incidence rates with combination therapy were 9.0% and 9.5% among individuals with and without baseline GLP-1 RA use. eGFR changes were consistent among individuals with and without baseline GLP-1 RA use. Acute kidney injury was uncommon. Decreases in systolic blood pressure were observed and were more pronounced with combination therapy. CONCLUSIONS In CONFIDENCE, simultaneous initiation with finerenone and an SGLT2 inhibitor was effective and well tolerated compared with monotherapy, irrespective of background use of a GLP-1 RA.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"73 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084281","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}

引用次数: 0

Reimagining Acute Diabetes Care: Insights From the Victorian Virtual Emergency Department 重新想象急性糖尿病护理：来自维多利亚虚拟急诊科的见解

IF 16.2 1区医学

Diabetes Care Pub Date : 2025-09-08 DOI: 10.2337/dc25-0852

Ben Nash, Loren Sher, Steven James, Ziad Nehme, Jason Talevski, Zoe Schofield, David O’Neal, Leonid Churilov, Glen Noonan, Renza Scibilia, Rodney Kwok, Elif I. Ekinci

{"title":"Reimagining Acute Diabetes Care: Insights From the Victorian Virtual Emergency Department","authors":"Ben Nash, Loren Sher, Steven James, Ziad Nehme, Jason Talevski, Zoe Schofield, David O’Neal, Leonid Churilov, Glen Noonan, Renza Scibilia, Rodney Kwok, Elif I. Ekinci","doi":"10.2337/dc25-0852","DOIUrl":"https://doi.org/10.2337/dc25-0852","url":null,"abstract":"OBJECTIVE New approaches to diabetes care are needed to better identify and manage diabetes emergencies outside of hospitals. RESEARCH DESIGN AND METHODS A descriptive analysis of routinely collected data was conducted using data from the Victorian Virtual Emergency Department (VVED) Diabetes, a telehealth service that provides emergency care, including ketone testing by ambulance personnel, for patients across Victoria, Australia, experiencing non–life-threatening diabetes-related emergencies. RESULTS Between July and December 2024, VVED Diabetes managed 868 diabetes-related emergencies, with 82.5% treated in the community, avoiding a physical emergency department visit. Referrals came from various sources, including Ambulance Victoria (26%), aged care facilities (29%), and self-registrations (20%). Hyperglycemia accounted for 46% of presentations. No clinical adverse events were reported, and patients gave positive feedback in a postdischarge survey. CONCLUSIONS VVED Diabetes delivers safe, timely, and high-quality treatment for individuals with diabetes who are acutely unwell, while ensuring the efficient use of limited hospital resources.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"38 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017245","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}

引用次数: 0

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 连续血糖监测对老年1型糖尿病患者低血糖认知受损的影响：WISDM研究的事后分析

IF 16.2 1区医学

Diabetes Care Pub Date : 2025-09-03 DOI: 10.2337/dc25-0971

Anika Bilal, Fanchao Yi, Keri Whitaker, Zahra A. Khan, Richard E. Pratley, Anna Casu

{"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 &lt; 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}

引用次数: 0

Maternal Diabetes, Fetal Growth and Stillbirth Risk: A Population-Wide Retrospective Cohort Study From Victoria, Australia 孕妇糖尿病、胎儿生长和死产风险：一项来自澳大利亚维多利亚州的人群回顾性队列研究

IF 16.2 1区医学

Diabetes Care Pub Date : 2025-09-03 DOI: 10.2337/dc25-0833

Hannah G. Gordon, Alexis Shub, Susan P. Walker, Richard J. Hiscock, Jessica Atkinson, Stephen Tong, Roxanne M. Hastie, Anthea C. Lindquist, Natasha L. Pritchard

{"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 &lt;10th or &gt;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 &gt;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 &gt;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}

引用次数: 0

Advancing Type 1 Diabetes Management: Integrating Novel Therapies, Technologies, and Adjunctive Approaches 推进1型糖尿病管理：整合新疗法、技术和辅助方法

IF 16.2 1区医学

Diabetes Care Pub Date : 2025-08-29 DOI: 10.2337/dci25-0015

Jennifer R. Snaith, Phoom Narongkiatikhun, Petter Bjornstad, Jerry R. Greenfield, Kalie L. Tommerdahl

{"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}

引用次数: 0