Diabetes Care最新文献

{"title":"A Multimodal Predictive Model for Chronic Kidney Disease and Its Association With Vascular Complications in Patients With Type 2 Diabetes: Model Development and Validation Study in South Korea and the U.K.","authors":"Jaehyeong Cho, Selin Woo, Seung Ha Hwang, Soeun Kim, Hayeon Lee, Jiyoung Hwang, Jaewon Kim, Min Seo Kim, Lee Smith, Sooji Lee, Jinseok Lee, Hong-Hee Won, Sang Youl Rhee, Dong Keon Yon","doi":"10.2337/dc25-0355","DOIUrl":"https://doi.org/10.2337/dc25-0355","url":null,"abstract":"OBJECTIVE To develop a multimodal model to predict chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM), given the limited research on this integrative approach. RESEARCH DESIGN AND METHODS We obtained multimodal data sets from Kyung Hee University Medical Center (n = 7,028; discovery cohort) for training and internal validation and UK Biobank (n = 1,544; validation cohort) for external validation. CKD was defined based on ICD-9 and ICD-10 codes and/or estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2. We ensembled various deep learning models and interpreted their predictions using explainable artificial intelligence (AI) methods, including shapley additive explanations (SHAP) and gradient-weighted class activation mapping (Grad-CAM). Subsequently, we investigated the potential association between the model probability and vascular complications. RESULTS The multimodal model, which ensembles visual geometry group 16 and deep neural network, presented high performance in predicting CKD, with area under the receiver operating characteristic curve of 0.880 (95% CI, 0.806–0.954) in the discovery cohort and 0.722 in the validation cohort. SHAP and Grad-CAM highlighted key predictors, including eGFR and optic disc, respectively. The model probability was associated with an increased risk of macrovascular complications (tertile 1 [T1]: adjusted hazard ratio, 1.42 [95% CI, 1.06–1.90]; T2: 1.59 [1.17–2.16]; T3: 1.64 [1.20–2.26]) and microvascular complications (T3: 1.30 [1.02–1.67]). CONCLUSIONS Our multimodal AI model integrates fundus images and clinical data from binational cohorts to predict the risk of new-onset CKD within 5 years and associated vascular complications in patients with T2DM.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"49 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533067","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":"High Prevalence of Prediabetes Among Asian and Pacific Islander Adolescents With Overweight or Obesity in a Primary Care Population","authors":"Adrian Matias Bacong, Veronica Njuguna, Jeanne Darbinian, Luis A. Rodriguez, Erica P. Gunderson, Louise C. Greenspan, Nitya Rajeshuni, Latha Palaniappan, Joan C. Lo","doi":"10.2337/dc25-0343","DOIUrl":"https://doi.org/10.2337/dc25-0343","url":null,"abstract":"OBJECTIVE To compare prediabetes prevalence among disaggregated U.S. Asian and Pacific Islander (Asian/PI) adolescents with non-Hispanic White (NHW) adolescents with overweight or obesity in a primary care population. RESEARCH DESIGN AND METHODS This retrospective, cross-sectional study used Kaiser Permanente Northern California health record data. The cohort comprised 20,540 NHW and 16,508 Asian/PI adolescents aged 10–17 years with overweight (BMI 85th to <95th percentile) or obesity (BMI ≥95th percentile) at a pediatric visit (2012–2019) and HbA1c measured within 1 year. Those with HbA1c ≥6.5%, a diabetes diagnosis, or diabetes pharmacotherapy were excluded. Prediabetes was classified as HbA1c 5.7–6.4%. Adjusted prevalence ratios (aPRs) with 95% CIs for prediabetes were examined for Filipino, Chinese, South Asian, Vietnamese, and Native Hawaiian/Pacific Islander (NHPI) compared with NHW using modified Poisson regression, adjusting for age, sex, BMI, neighborhood deprivation index, and visit year. RESULTS Asian/PI adolescents with overweight or obesity had a higher prediabetes prevalence (26.9%) than NHW adolescents (11.9%) (P < 0.001), with variation among Asian subgroups of 31.0% for South Asian, 32.0% for NHPI, 28.2% for Filipino, 25.9% for Chinese, and 18.4% for Vietnamese adolescents. In multivariable analyses, the aPRs for prediabetes (vs. NHW) were 2.80 (95% CI, 2.57–3.05) for South Asian, 2.44 (2.23–2.67) for NHPI, 2.18 (2.06–2.32) for Filipino, 2.18 (1.99–2.39) for Chinese, and 1.68 (1.38–2.04) for Vietnamese adolescents. These findings were similar by sex, and patterns were similar within overweight or obesity subgroups. CONCLUSIONS Asian/PI adolescents with overweight or obesity have considerably higher prediabetes prevalence than NHW adolescents, independent of BMI. Findings varied by ethnicity. Prediabetes screening is essential for the high-risk population of Asian/PI adolescents with overweight or obesity.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"635 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520353","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":"Prediction of Weight Loss and Regain Based on Multiomic and Phenotypic Features: Results From a Calorie-Restricted Feeding Trial","authors":"Lin Li, Ruyi Li, Zixin Qiu, Kai Zhu, Rui Li, Shiyu Zhao, Jiajing Che, Tianyu Guo, Kun Xu, Tingting Geng, Yunfei Liao, An Pan, Gang Liu","doi":"10.2337/dc25-0728","DOIUrl":"https://doi.org/10.2337/dc25-0728","url":null,"abstract":"OBJECTIVE To identify baseline multiomic and phenotypic predictors and develop prediction models for weight and body composition loss and regain in the Low-Carbohydrate Diet and Time-Restricted Eating (LEAN-TIME) trial. RESEARCH DESIGN AND METHODS A post hoc analysis was conducted of the LEAN-TIME feeding trial using data from 88 adults with overweight/obesity completing a 12-week calorie-restricted weight-loss phase and 79 completing a 28-week weight-regain phase. Baseline dietary, metabolic, fecal metabolome, and gut microbiome data were candidate predictors of changes in weight, body fat mass (BFM), and soft lean mass (SLM). Multivariable regression and the least absolute shrinkage and selection operator model were used to identify predictors and develop weighted-sum prediction models. RESULTS Multiomic and phenotypic models significantly outperformed phenotype-only models (P < 0.05), demonstrating strong predictive performance during both phases. During weight loss, the multiomic and phenotypic model yielded R2 values of 0.49, 0.61, and 0.54 for changes in weight, BFM, and SLM, respectively, with corresponding root mean square errors (RMSEs) of 1.59, 1.41, and 0.98 kg. For binary classification of clinically meaningful weight loss (≥5%), the model achieved an area under the curve of 0.95 (sensitivity 94.12%; specificity 86.79%). During weight regain, R2 values reached 0.72, 0.73, and 0.66 for weight, BFM, and SLM (RMSEs 1.40, 1.62, and 0.73 kg), respectively. Several key baseline predictors, primarily gut microbes and fecal metabolites, such as N-acetyl-l-aspartic acid, Ruminococcus callidus, and Bifidobacterium adolescentis, were shared for weight and body composition changes during both phases. CONCLUSIONS Baseline multiomic and phenotypic data effectively predict weight and body composition loss and regain, offering insights for personalized weight management.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"27 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520334","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":"Impaired Rest–Activity Rhythm Characteristics Predict Higher Risk of Incident Type 2 Diabetes in UK Biobank Participants","authors":"Chris Ho Ching Yeung, Alison K. Wright, Daniel P. Windred, Angus C. Burns, Andrew J.K. Phillips, Sean W. Cain, Martin K. Rutter, Qian Xiao","doi":"10.2337/dc25-0309","DOIUrl":"https://doi.org/10.2337/dc25-0309","url":null,"abstract":"OBJECTIVE Circadian rhythms play a key role in metabolic health. Rest–activity rhythms, which are in part driven by circadian rhythms, may be associated with diabetes risk. There is a need for large prospective studies to comprehensively examine different rest–activity metrics to determine their relative strength in predicting risk of incident type 2 diabetes. RESEARCH DESIGN AND METHODS In actigraphy data from 83,887 UK Biobank participants, we applied both parametric and nonparametric algorithms to derive 13 different metrics characterizing different aspects of rest–activity rhythm. Diabetes cases were identified using both self-reported data and health records. We used Cox proportional hazards models to assess associations between rest–activity parameters and type 2 diabetes risk and random forest models to determine the relative importance of these parameters in risk prediction. RESULTS We found that multiple rest–activity characteristics were predictive of a higher risk of incident diabetes, including lower pseudo-F statistic (hazard ratio [HR] of quintile 1 ([Q1] vs. Q5 1.27; 95% CI 1.09–1.46; Ptrend < 0.001), lower amplitude (HRQ1 vs. Q5 2.56; 95% CI 2.21–2.97; Ptrend < 0.001), lower midline estimating statistic of rhythm (HRQ1 vs. Q5 2.59; 95% CI 2.24–3.00; Ptrend < 0.001), lower relative amplitude (HRQ1 vs. Q5 4.64; 95% CI 3.74–5.76; Ptrend < 0.001), lower M10 (HRQ1 vs. Q5 3.82; 95% CI 3.20–4.55; Ptrend < 0.001), higher L5 (HRQ5 vs. Q1 1.88; 95% CI 1.62–2.19; Ptrend < 0.001), and later L5 start time (HRQ5 vs. Q1 1.20; 95% CI 1.04–1.38; Ptrend = 0.004). Random forest models ranked most of the rest–activity metrics as top predictors of diabetes incidence, when compared with traditional diabetes risk factors. The findings were consistent across subgroups of age, sex, BMI, and shift work status. CONCLUSIONS Rest–activity rhythm characteristics measured from actigraphy data may serve as digital biomarkers for predicting type 2 diabetes risk.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"31 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500380","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":"Glucagon-Like Peptide 1 Receptor Agonists and the Risk of Emergency Department Visits and Hospitalization in Patients With Chronic Kidney Disease","authors":"Kevin Yau, Joel G. Ray, Nivethika Jeyakumar, Bin Luo, Sheikh Abdullah, Eric McArthur, Stephanie N. Dixon, Sara Wing, Kristin K. Clemens, Fabio Castrillon-Ramirez, Jacob A. Udell, Alejandro Meraz-Munoz, Ann Young, Ziv Harel, Jeffrey Perl, Vikas S. Sridhar, Huajing Ni, Tae Won Yi, Lawrence A. Leiter, Amit X. Garg, David Z.I. Cherney, Ron Wald","doi":"10.2337/dc24-2811","DOIUrl":"https://doi.org/10.2337/dc24-2811","url":null,"abstract":"OBJECTIVE The aim of this study was to evaluate the effect of glucagon-like peptide 1 receptor agonist (GLP-1RA) versus dipeptidyl peptidase 4 inhibitor (DPP4i) initiation on emergency department (ED) visits and all-cause hospitalizations across the spectrum of kidney disease. RESEARCH DESIGN AND METHODS This was a retrospective population-based observational cohort study in adults with an estimated glomerular filtration rate <90 mL/min/1.73 m2 using inverse probability of treatment weighting. The Prentice-Williams-Peterson (PWP) gap time model was used for the primary analysis. RESULTS The cohort included 24,576 new users of a GLP-1RA and 23,600 DPP4i new users. GLP1RA initiation was associated with a lower risk of all-cause ED encounters or hospitalizations (hazard ratio [HR] 0.90; 95% CI 0.87–0.94; P < 0.0001). This finding was consistent in confirmatory analyses using the Andersen-Gill model and the PWP calendar time model. CONCLUSIONS GLP-1RA initiation was associated with a reduction in all-cause ED visits and hospitalizations compared with new use of a DPP4i.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"22 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500442","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":"Diabetes-Related Distress and Glycemic Dysregulation in Everyday Life With Type 1 Diabetes: Which Comes First?","authors":"Jeffrey S. Gonzalez, Claire J. Hoogendoorn, Raymond Hernandez, Stefan Schneider, Fayel Mustafiz, Megha Siddhanta, Elizabeth A. Pyatak","doi":"10.2337/dc25-0559","DOIUrl":"https://doi.org/10.2337/dc25-0559","url":null,"abstract":"OBJECTIVE In an observational study, we paired ecological momentary assessment (EMA) and continuous glucose monitoring (CGM) to examine lagged effects of glycemic regulation on diabetes-related distress (DD), and vice versa, among adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Participants (N = 182; median ± SD age 40 ± 14 years; 54% women; 41% Latino; 29% White and 15% Black) wore a blinded CGM device for 14 days and completed five to six EMA surveys per day. We tested expected associations between momentary DD ratings and relevant patient-reported outcomes on validated questionnaires. Using multilevel cross-lagged modeling, we evaluated within-person lagged effects of CGM metrics (mean glucose mean; percentage of time in range [TIR; i.e., 70–180 mg/dL] and percentages of time 181–250, >250, and <70 mg/dL; and coefficient of variation [CV]) over 3-h periods on DD rated 0–100 at the end of that interval and 3 h later. We also examined lagged effects of DD on subsequent CGM metrics. RESULTS Momentary DD ratings were significantly associated with results of questionnaires for DD, well-being, functional and mental health, and quality of life. Higher mean glucose, less TIR, greater percentage of time 181–250 and >250 mg/dL, and higher CV over 3 h each predicted greater DD at the end of that interval; higher 3-h mean glucose also predicted more DD 3 h later (P < 0.05). Greater DD unexpectedly predicted a lower percentage of time in hypoglycemia over the next 3 h (P < 0.05) but predicted no other CGM metrics. CONCLUSIONS Findings support the validity of EMA of DD in adults with T1D and suggest glucose dysregulation is linked to subsequent increased DD over the short term, not vice versa. These findings have implications for interventions targeting DD.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"17 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144479185","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":"Upper-Limb Complications in Diabetes: A Narrative Review","authors":"Barbara H. Braffett, Tore Julsrud Berg, Malin Zimmerman, Kasper Olesen, Søren Gregersen, Michael R. Krogsgaard, Lars B. Dahlin, Kirsten Nørgaard","doi":"10.2337/dci25-0012","DOIUrl":"https://doi.org/10.2337/dci25-0012","url":null,"abstract":"Upper-limb complications (ULCs) in diabetes, affecting joints, tendons, muscles, connective tissue, nerves, and skin, are underrecognized but prevalent conditions in type 1 and type 2 diabetes. Advances in diabetes care have extended life expectancy, leading to an aging population with diabetes with increased susceptibility to long-term complications beyond traditional vascular issues. Despite some data on ULCs epidemiology, understanding of their pathogenesis, prevention, and impact on quality of life remains limited, and treatments are often based on clinical experience rather than robust evidence. ULCs, including frozen shoulder, trigger finger, carpal tunnel syndrome, ulnar nerve entrapment, Dupuytren disease with contracture, and limited joint mobility, occur two to three times more frequently in diabetes, with higher rates in individuals aged>50 years and those with longer diabetes duration. Chronic hyperglycemia, glycation of collagen, and low-grade inflammation are hypothesized contributors. Modifiable risk factors include poor glycemic control, smoking, and obesity. Individuals with diabetes face slower symptom resolution, higher recurrence rates, and a greater likelihood of bilateral or multiple conditions. Awareness among clinicians and patients is critical, with emphasis on routine screening and proactive management. Early diagnosis, patient education, and targeted interventions can mitigate long-term complications and improve quality of life. Future guidelines should integrate ULC monitoring into routine diabetes care and prioritize clinical trials to establish evidence-based management strategies. Addressing ULCs comprehensively will enhance outcomes for individuals with diabetes, ensuring better functional health and reduced societal burden.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"16 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370511","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":"Cardiovascular Outcomes and Efficacy of the PCSK9 Inhibitor Evolocumab in Individuals With Type 1 Diabetes: Insights From the FOURIER Trial","authors":"Yu Mi Kang, Robert P. Giugliano, Xinhui Ran, Prakash Deedwania, Gaetano M. De Ferrari, Jyothis T. George, Ioanna Gouni-Berthold, Gabriel Paiva da Silva Lima, Yehuda Handelsman, Basil S. Lewis, E. Magnus Ohman, Huei Wang, J. Antonio G. López, Maria Laura Monsalvo, Marc S. Sabatine, Lawrence A. Leiter","doi":"10.2337/dc25-0942","DOIUrl":"https://doi.org/10.2337/dc25-0942","url":null,"abstract":"OBJECTIVE To evaluate the clinical efficacy of intensive LDL cholesterol (LDL-C) lowering in type 1 diabetes mellitus (T1DM). RESEARCH DESIGN AND METHODS Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) randomized participants with atherosclerotic cardiovascular disease (ASCVD) on statins to evolocumab or placebo (median follow-up 2.2 years). The primary end point (PEP) was cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. RESULTS Of 27,564 participants, 10,834 (39.3%) had type 2 diabetes mellitus (T2DM), and 197 (0.7%) had T1DM. In the placebo arm, there was a stepwise increase in the 2.5-year PEP Kaplan-Meier rate from 11.0% to 15.2% to 20.4% in participants with no diabetes, T2DM, and T1DM, respectively (P < 0.0001). Hazard ratios for PEP with evolocumab were 0.87 (95% CI 0.79–0.96), 0.84 (0.75–0.93), and 0.66 (0.32–1.38) in the no diabetes, T2DM, and T1DM groups, and absolute risk reduction was 1.3%, 2.5%, and 7.3%, respectively. CONCLUSIONS Intensive LDL-C lowering may provide substantial clinical benefit in individuals with T1DM and ASCVD. Additional randomized controlled cardiovascular outcomes trials are needed in this population.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"9 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144341055","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":"Improving Affordability of Pharmaceutical Treatments for Diabetes: A Call for Action","authors":"Mariana P. Socal, Namratha R. Kandula, Pineal I. Bareamichael, Jeromie Ballreich, Ilina Odouard, So-Yeon Kang, Joy O. Acha, Kelly E. Anderson, Michael DiStefano, Fernando Gerchman, Joseph F. Levy","doi":"10.2337/dci25-0002","DOIUrl":"https://doi.org/10.2337/dci25-0002","url":null,"abstract":"Unaffordability of pharmaceutical treatments remains as a critical barrier to diabetes care in the U.S. Through a synthesis of recent evidence on affordability of diabetes drugs, with particular attention to emergent reforms, this call for action focuses on structural solutions to improve the affordability of pharmaceutical treatments for diabetes in the U.S. that providers should be aware of and consider supporting. Incentivizing competition in biosimilars and generics markets, increasing transparency, reforming pricing models that influence drug coverage, and expanding federal negotiation of drug prices, among other actions, can help make prescription drugs more affordable for patients, reduce budgetary impacts on payors, and increase access, ultimately helping to improve the health of all Americans living with diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"632 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337509","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":"Benefit of Semaglutide in Symptomatic Peripheral Artery Disease by Baseline Type 2 Diabetes Characteristics: Insights From STRIDE, a Randomized, Placebo-Controlled, Double-Blind Trial","authors":"Neda Rasouli, Ecenur Guder Arslan, Andrei-Mircea Catarig, Kim Houlind, Bernhard Ludvik, Joakim Nordanstig, Harald Sourij, Sebastian Thomas, Subodh Verma, Marc P. Bonaca","doi":"10.2337/dc25-1082","DOIUrl":"https://doi.org/10.2337/dc25-1082","url":null,"abstract":"OBJECTIVE The Semaglutide and Walking Capacity in People with Symptomatic Peripheral Artery Disease and Type 2 Diabetes (STRIDE) trial (NCT04560998) showed that once-weekly subcutaneous semaglutide 1.0 mg significantly improved functional outcomes, symptoms, and quality of life in individuals with symptomatic peripheral artery disease (PAD) and type 2 diabetes. Whether these benefits are consistent across diabetes-related characteristics remains unclear. RESEARCH DESIGN AND METHODS The primary outcome was the ratio to baseline (ETR) in maximum walking distance (MWD), with pain-free walking distance (PFWD) as a key secondary end point. Both were measured at 52 weeks using a constant load treadmill. Subgroup analyses were performed by diabetes duration, BMI, HbA1c, and diabetes medications. A mixed model for repeated measurements was used, incorporating treatment, region, and subgroup as fixed factors, and baseline value as covariate, along with the treatment-by-subgroup interaction. RESULTS Among 792 participants (median diabetes duration 12.2 years, HbA1c 7.1%, and BMI 28.7 kg/m2), 35.1% used sodium–glucose cotransporter 2 inhibitors and 31.7% used insulin. Semaglutide significantly improved MWD regardless of diabetes duration (ETR of 1.15 vs. 1.13 for <10 vs. ≥10 years, P = 0.80), BMI (1.12 vs. 1.16 for <30 vs. ≥30 kg/m2, P = 0.58), HbA1c (1.13 for <7% and ≥7%, P = 0.99), or medication use. Semaglutide also improved PFWD across subgroups (P > 0.1 for all interactions). BMI reduction correlated weakly with MWD improvements and was more pronounced in the controls with higher baseline BMI. Safety outcomes were consistent across subgroups. CONCLUSIONS Semaglutide improved walking function in people with PAD and type 2 diabetes, including nonobese individuals and those with well-controlled HbA1c. Benefits were consistent across BMI and HbA1c categories, supporting effectiveness beyond weight or glycemic changes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"26 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337510","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}