Diabetes Care最新文献

{"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}

{"title":"Dynamic Relationships Among Continuous Glucose Metrics and Momentary Cognitive Performance in Diverse Adults With Type 1 Diabetes","authors":"Claire J. Hoogendoorn, Raymond Hernandez, Stefan Schneider, Anne Peters, Meredith Hawkins, Elizabeth A. Pyatak, Jeffrey S. Gonzalez","doi":"10.2337/dc24-2431","DOIUrl":"https://doi.org/10.2337/dc24-2431","url":null,"abstract":"OBJECTIVE Despite established relationships between glycemia and cognition, few studies have evaluated within-person changes over time. We paired continuous glucose monitoring (CGM) with ambulatory cognitive testing to examine bidirectional associations among adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Participants wore blinded CGM and completed ambulatory tests of perceptual speed and sustained attention five or six times daily for 14 days. CGM metrics were calculated over 3-h periods (mean glucose, %time in range [70–180 mg/dL], %time in low [<70 mg/dL], %time in high [181–250 mg/dL], %time in very high [>250 mg/dL], and coefficient of variation). Immediate glucose values within 15 min of cognitive assessments were also examined. Dynamic structural equation models evaluated bidirectional relationships over sequential 3-h periods. RESULTS Among 182 diverse adults with T1D (age 40 ± 14 years, 46% male, 41% Latino, 29% White, 15% Black), more time in low glucose over 3 h was associated with slower perceptual speed at the end of that interval (P < 0.05) but not 3 h later. More time in high glucose (>250) was associated with faster perceptual speed initially but slower speed 3 h later (P < 0.05). Physical activity partially mediated the effect of high glucose on slower perceptual speed. Glycemia did not predict attention scores within persons. Lower attention and higher perceptual speed predicted higher mean glucose and more time in very high glucose over the following 3 h (P < 0.05). CONCLUSIONS These novel observations of significant bidirectional association between glycemia and cognitive performance over the course of the day among adults with T1D emphasize the importance of examining within-person longitudinal effects over different time frames.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"1 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745076","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":"Community-Based Peer Support for Diabetes Management: 24-Month Changes Relative to Comparison Communities","authors":"Yuexing Liu, Chun Cai, Jiahe Tian, Li Shen, Patrick Y. Tang, Muchieh Maggy Coufal, Hongli Chen, Megan S. Evans, Yiqing Qian, Wenya Yu, Xiaoyu Wu, Xiaobing Wu, Edwin B. Fisher, Weiping Jia","doi":"10.2337/dc24-2748","DOIUrl":"https://doi.org/10.2337/dc24-2748","url":null,"abstract":"OBJECTIVE To evaluate the effectiveness of community-based peer support for diabetes self-management with HbA1c and other clinical and psychosocial outcomes over 24 months. RESEARCH DESIGN AND METHODS This study used an intervention comparison design with 12 intervention communities and 4 comparison communities matched according to location in urban or suburban areas. A community organization approach was used to integrate standardization of key messages and patient education protocols, along with adaptation and innovation among multiple community partners. The primary outcome was HbA1c; secondary outcomes included BMI, fasting plasma glucose (FPG), systolic and diastolic blood pressure, LDL cholesterol (LDL-C), depressive symptoms (PHQ-8), diabetes distress, and general quality of life (EQ-5D). RESULTS The analyses included 967 participants completing both the baseline and follow-up assessment. Intervention communities versus comparison communities were older (mean age 66.43 vs. 63.45 years), included more women (57.1% vs. 45.5%), and had longer diabetes duration (mean 7.95 vs. 6.40 years). Significant improvements were found for HbA1c (7.42% [58 mmol/mol] vs. 7.95% [63 mmol/mol]), BMI (25.31 vs. 25.94 kg/m2), FPG (7.91 vs. 8.59 mmol/L), and depressive symptoms (PHQ-8 score 1.39 vs. 1.41), favoring intervention communities, after adjusting for baseline values of outcome measures and confounders (P ≤ 0.028). No interactions were found with age (<65 vs. ≥65 years). Men showed modestly greater diastolic blood pressure reduction, and women showed a minor increase of LDL-C in intervention communities. These analyses by age or sex and sensitivity analyses with missing data imputation supported the robustness of findings. CONCLUSIONS Culturally adapted and appropriate community-based peer support for diabetes management may improve clinical and psychosocial outcomes at 24 months among people with diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"22 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745077","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":"Association Between Use of Sodium–Glucose Cotransporter 2 Inhibitors and Epilepsy: A Population-Based Study Using Target Trial Emulation","authors":"Houyu Zhao, Baixue Zhang, Lin Zhuo, Yueqi Yin, Yexiang Sun, Peng Shen, Zhiqin Jiang, Siyan Zhan","doi":"10.2337/dc24-2532","DOIUrl":"https://doi.org/10.2337/dc24-2532","url":null,"abstract":"OBJECTIVE Preclinical studies in animals have suggested potential neuroprotective effects of sodium–glucose cotransporter 2 inhibitors (SGLT-2is), but no epidemiological study has investigated the potential effects of SGLT-2is on epilepsy risk. We aimed to assess the association between use of SGLT-2is and epilepsy incidence. RESEARCH DESIGN AND METHODS We emulated a target trial comparing SGLT-2is and dipeptidyl peptidase 4 inhibitors (DPP-4is) based on the Yinzhou Regional Health Care Database. Cohorts of patients with type 2 diabetes mellitus who were new users of an SGLT-2i or a DPP-4i were assembled. Inverse probability of treatment weighting (IPTW) and Cox proportional hazards regression modeling were applied to estimate the hazard ratio (HR) and 95% CI of the association between use of SGLT-2is and incidence of epilepsy. RESULTS The final cohort included 24,930 new users of SGLT-2is and 28,924 initiators of DPP-4is. A total of 243 patients with incident epilepsy were found during a median follow-up of 2.0 (interquartile range 0.8–3.3) years, with the incidence of epilepsy being 174.2 and 231.5 per 100,000 person-years in users of SGLT-2is and DPP-4is, respectively. After controlling for potential confounding using IPTW, SGLT-2i use was associated with a lower incidence of epilepsy, with an HR of 0.71 (95% CI 0.52–0.97). Various subgroup analyses and sensitivity analyses supported the results in primary analyses. CONCLUSIONS SGLT-2is were associated with a reduced incidence of epilepsy in the study population. More studies are needed to confirm and replicate the study results.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"4 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702770","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":"The Modern Role of Basal Insulin in Advancing Therapy in People With Type 2 Diabetes","authors":"Geremia B. Bolli, Philip D. Home, Francesca Porcellati, Matthew C. Riddle, Hertzel C. Gerstein, Paola Lucidi, Carmine G. Fanelli, David R. Owens","doi":"10.2337/dci24-0104","DOIUrl":"https://doi.org/10.2337/dci24-0104","url":null,"abstract":"Insulin deficiency, often aggravated by insulin resistance, results in type 2 diabetes mellitus (T2DM). With the availability of glucagon-like peptide 1 receptor agonists and sodium–glucose cotransporter 2 inhibitors, basal insulin (BI) therapy is no longer the first-line option after lifestyle modification plus oral agents is insufficient. In contrast to BI, the newer medications require minor titration, lower hyperglycemia in a glucose-dependent manner, and reduce body weight. Importantly, the newer agents reduce cardiorenal events in the short term. Nonetheless, insulin therapy continues to play a key role in control of hyperglycemia and therefore long-term prevention of vascular complications. Its use is essential in many circumstances, including metabolic emergencies, new diabetes onset, latent autoimmune diabetes (LADA), pregnancy, and when other agents are less desirable due to comorbidities. BI is needed in the frequent condition of failure of other therapies to keep HbA1c to target and/or intolerance of them. There are several advantages to the combination of BI with the newer medications given their different but complementary mechanisms of action, primarily, the lower dose of each, improving adherence and outcomes while decreasing the side effects. Multiple choices for single or combination use can better meet the variety of clinical phenotypes in the heterogeneous T2DM population, using the tenets of precision medicine.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"20 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672363","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":"ATLANTIC DIP, Changing the Landscape for Better Maternal and Infant Health: The 2024 Norbert Freinkel Award Lecture","authors":"Fidelma Dunne","doi":"10.2337/dci24-0047","DOIUrl":"https://doi.org/10.2337/dci24-0047","url":null,"abstract":"The Norbert Freinkel Award recognizes contribution of research, clinical practice, and advocacy to improving pregnancy outcomes for women with diabetes. This award honors a man of outstanding achievements. Norbert was a forward-thinking investigator, a concise and precise writer, and a gifted clinical practitioner. His philosophy stated that a research question should be framed around an unsolved patient problem, a solution should be sought at several levels and across several disciplines, and the solution should be shared and applied to the problem. The Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network has followed this philosophy. Women now achieve better pregnancy preparation and have lower blood glucose and lower glycated hemoglobin with improved pregnancy outcomes. Screening and follow-up for gestational diabetes mellitus (GDM) is consistent. The trial on early metformin in addition to usual care in the reduction of GDM effects (A Randomized Placebo-Controlled Trial of the Effectiveness of Metformin in Addition to Usual Care in the Reduction of Gestational Diabetes Mellitus Effects [EMERGE]) provides evidence for metformin use in pregnancies complicated by GDM as an alternative to insulin. Learnings and evidence from ATLANTIC DIP have shaped national policy and guidelines and have contributed to global knowledge in this area. We continue to strive for excellence and equity of care and normalization of perinatal outcomes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"53 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672383","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":"Management of Diabetes and Hyperglycemia in the Hospital: A Systematic Review of Clinical Practice Guidelines","authors":"Linnea M. Wilson, Shoshana J. Herzig, Edward R. Marcantonio, Michael A. Steinman, Mara A. Schonberg, Brianna X. Wang, Ella Hileman-Kaplan, Timothy S. Anderson","doi":"10.2337/dc24-2510","DOIUrl":"https://doi.org/10.2337/dc24-2510","url":null,"abstract":"BACKGROUND Inpatient hyperglycemia is common among adults, and management varies. PURPOSE To systematically identify guidelines on inpatient hyperglycemia management. DATA SOURCES MEDLINE, Guidelines International Network, and specialty society websites were searched from 1 January 2010 to 14 August 2024. STUDY SELECTION Clinical practice guidelines pertaining to blood glucose management in hospitalized adults were included. DATA EXTRACTION Two authors screened articles and extracted data, and three assessed guideline quality. Recommendations on inpatient monitoring, treatment targets, medications, and care transitions were collected. DATA SYNTHESIS Guidelines from 10 organizations met inclusion criteria, and 5 were assessed to be of high quality per the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument. All guidelines recommended monitoring blood glucose for patients with diabetes and nine for admission hyperglycemia. Eight guidelines recommended an upper blood glucose target of 180 mg/dL, five with a lower limit of 100 mg/dL and three of 140 mg/dL. Guidelines were in agreement on using capillary blood glucose monitoring, and three guidelines included discussion of continuous monitoring. Hyperglycemia treatment with basal-bolus insulin alone (n = 3) or with correction (n = 5) was most commonly recommended, while sliding scale insulin was advised against (n = 5). Guidance on use of oral diabetes medications was inconsistent. Five guidelines included discussion of transitioning to home medications. Recommendations for hypoglycemia management and diabetes management in older adults were largely limited to outpatient guidance. LIMITATIONS Non-English-language guidelines were excluded. CONCLUSIONS While there is consensus on inpatient blood glucose monitoring and use of basal-bolus insulin, there is disagreement on treatment targets and use of home medications and little guidance on how to transition treatment at discharge.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"70 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672350","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":"Association Between Diabetes and Anemia: Evidence From NHANES and the UK Biobank","authors":"Danyang Wang, Jedidiah I. Morton, Agus Salim, Jonathan E. Shaw, Dianna J. Magliano","doi":"10.2337/dc24-2535","DOIUrl":"https://doi.org/10.2337/dc24-2535","url":null,"abstract":"OBJECTIVE To explore the association between diabetes and anemia. RESEARCH DESIGN AND METHODS We included 9,026 and 389,616 participants from the U.S. National Health and Nutrition Examination Surveys and the UK Biobank study (UKB), respectively. Multivariable logistic regression was used to examine the cross-sectional association of diabetes with anemia, as defined by hemoglobin measurement. For the UKB follow-up, multivariable Cox proportional hazards regression was performed to estimate hazard ratios (HRs) and 95% CIs of incident anemia, as defined by hemoglobin levels or diagnosis records, in relation to diabetes. We further assessed the impact of inflammation, renal dysfunction, and medication use on this association in both populations. RESULTS Among White people aged 40–69 years in the U.S. and U.K., the adjusted odds of study participants with diagnosed diabetes also having anemia was two to four times higher than in those with normal glycemia. Over a median follow-up of 13.6 years in the UKB, 42,354 people developed anemia. The adjusted HRs for incident anemia comparing diagnosed diabetes with normal glycemia were 3.05 (95% CI 2.90–3.21) for iron deficiency anemia, 3.02 (95% CI 2.51–3.63) for anemia of chronic disease, and 4.88 (95% CI 4.23–5.63) for vitamin B12 deficiency anemia. Further adjustment for inflammation, renal dysfunction, and medication use partially attenuated these associations, but they remained strong and significant. CONCLUSIONS Diabetes was associated with several major types of anemia. Further studies are warranted to identify the mechanisms.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"34 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672378","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":"Early Fasting Serum Glucose or Weight Reduction With Tirzepatide and Metabolic Outcomes in People With Type 2 Diabetes: A Post Hoc Analysis of the SURPASS Trials","authors":"Francesco Giorgino, Ildiko Lingvay, Luc F. Van Gaal, Palash Sharma, Ángel Rodríguez, Jacek Kiljański, Amelia Torcello-Gómez, Joshua A. Levine","doi":"10.2337/dc24-2790","DOIUrl":"https://doi.org/10.2337/dc24-2790","url":null,"abstract":"OBJECTIVE To evaluate late (week 40 or 42; hereafter, week 40/42) metabolic outcomes by early glycemic response (<20% or ≥20% fasting serum glucose [FSG] reduction at week 4) or weight response (<5% or ≥5% weight reduction at week 8), respectively, in tirzepatide-treated participants with type 2 diabetes in the SURPASS trials. RESEARCH DESIGN AND METHODS This post hoc analysis used pooled data across trials. Baseline characteristics, change from baseline to week 40/42 for efficacy parameters, and gastrointestinal (GI) adverse events (AEs) were described and analyzed by early response in terms of FSG (SURPASS-1 to -4; n = 3,676) or weight (SURPASS-1 to -5; n = 4,121) in the efficacy and safety analysis set, respectively. RESULTS Early responders in FSG (50%) were younger, with higher glycemic parameters and lower weight at baseline. Early responders in weight (31%) had lower glycemic parameters and weight at baseline, and a greater percentage were women and White. Early versus nonearly responders in FSG or weight achieved better HbA1c (−2.6% vs. −2.0% or −2.5% vs. −2.2%, respectively) and weight (−11% vs. −10% or −15% vs. −8%, respectively) responses at week 40/42 and greater improvements in blood pressure and lipids profile. Nonearly responders also had clinically meaningful HbA1c and weight reductions with all tirzepatide doses. The incidence of GI AEs (generally mild to moderate events) decreased over time and was, in general, comparable between early and nonearly responders. CONCLUSIONS Both early glucose and weight responses with tirzepatide were associated with better longer-term metabolic outcomes. Early response may be a good clinical indicator that could help inform treatment individualization to achieve therapeutic goals.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"14 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653591","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}