Diabetes Care最新文献

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

{"title":"Tirzepatide Treatment and Associated Changes in β-Cell Function and Insulin Sensitivity in People With Obesity or Overweight With Prediabetes or Normoglycemia: A Post Hoc Analysis From the SURMOUNT-1 Trial","authors":"Andrea Mari, Adam Stefanski, Daniel H. van Raalte, Xiaosu Ma, Elizabeth S. LaBell, Ludi Fan, Clare J. Lee, Melissa K. Thomas, Mathijs C. Bunck, Ele Ferrannini","doi":"10.2337/dc25-0763","DOIUrl":"https://doi.org/10.2337/dc25-0763","url":null,"abstract":"OBJECTIVE We assessed insulin sensitivity and β-cell function in adults with obesity/overweight, without diabetes, treated with tirzepatide for 72 weeks. RESEARCH DESIGN AND METHODS This post hoc analysis from the Study of Tirzepatide (LY3298176) in Participants With Obesity or Overweight (SURMOUNT-1) trial investigated tirzepatide versus placebo in 2,539 participants with BMI ≥27 kg/m2 and either prediabetes or normoglycemia at baseline. Model-derived parameters of β-cell function and insulin sensitivity were assessed from oral glucose tolerance tests. RESULTS At week 72, tirzepatide treatment was associated with body weight reduction and improvements in insulin sensitivity and β-cell function measures overall and in participants with prediabetes or normoglycemia. In multivariate regression models, improvements in insulin sensitivity were associated mostly with weight reduction and partly with tirzepatide treatment, whereas enhancement in β-cell function was mostly associated with tirzepatide treatment. CONCLUSIONS In adults with obesity/overweight without type 2 diabetes, tirzepatide treatment was associated with improved β-cell function and insulin sensitivity, partly independent of weight reduction.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"52 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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

{"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}