Diabetes Care最新文献

{"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}

{"title":"How to Fix a Broken Health Care System: Pathways to Maximize Health and Well-being for All","authors":"Marshall H. Chin, Joseph D. Bruch, Colleen M. Grogan, Elbert S. Huang, Namratha R. Kandula, David D. Kim, Monica E. Peek, Harold A. Pollack","doi":"10.2337/dci25-0001","DOIUrl":"https://doi.org/10.2337/dci25-0001","url":null,"abstract":"The U.S. health care system is broken, with particularly low performance for health outcomes, access to care, equity, and administrative efficiency in comparison with other high-income countries, despite high cost. By virtue of the many elements required for optimal care, the poor diabetes care quality and outcome metrics of the U.S. are canaries in the coal mine for the health care system. The fundamental problem with the U.S. health care system is that it does not prioritize the long-term health and well-being of all individuals and communities. Three intertwined elements are foundational for an understanding of why the U.S. health care system is built the way it is and what changes are necessary to improve it: 1) ethics and culture; 2) political economy, the underlying political and economic structures that shape our nation and thus our health system; and 3) the definition and measurement of value in health care. This article recommends that health care policies around health insurance and payment be designed to support, incentivize, and sustain effective population health models that address medical, social, psychological, and behavioral needs of all individuals and communities. Good governance is essential to assure that payer and provider market incentives are explicitly aligned to prioritize the health and well-being of individuals and communities and cost-effectiveness of care, beyond short-term financial gain for health care systems and investors. Equitable access allows for health care resource distribution according to need, enabling all individuals to have a fair and just opportunity for health.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"5 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337512","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":"Glucose Control, Sulfonylureas, and Insulin Treatment in Older Adults With Type 2 Diabetes and Risk of Falls and Fractures: An Observational Study","authors":"Sharmin Shabnam, Suping Ling, Clare Gillies, Francesco Zaccardi, Pratik Choudhary, Kamlesh Khunti, Samuel Seidu","doi":"10.2337/dc25-0517","DOIUrl":"https://doi.org/10.2337/dc25-0517","url":null,"abstract":"OBJECTIVE To estimate the association among glucose control, sulfonylureas, and insulin treatment with the risk of hospitalization for falls and fractures in older adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS This observational cohort study used U.K. Clinical Practice Research Datalink GOLD data linked to hospital and death records. Older adults (≥70 years) with T2D, identified between 2000 and 2017, were considered exposed if they had three consecutive HbA1c measurements <7% (53 mmol/mol) while receiving treatment with insulin or sulfonylureas. Each exposed individual was matched with to three nonexposed individuals. Outcomes included hospitalizations for falls and fractures. Flexible parametric survival models, adjusted for sociodemographic and clinical factors, and associated estimated relative (hazard ratio [HR]) and absolute risks. RESULTS Among 21,365 individuals (n = 5,833 [27.3%] in the exposed group), the adjusted relative risks of hospitalization for falls and fractures were marginally higher compared with those nonexposed (HR 1.04 [95% CI 0.96–1.11] and 1.07 [95% CI 0.97–1.17], respectively). The 10-year absolute risk values of hospitalization for falls were slightly higher in the exposed (range 15.6–36.8% in those aged 70–85 years) than nonexposed (15.1–36.0%) individuals. Absolute risk differences remained minimal (0.2–0.6% at 5 years and 0.5–0.8% at 10 years). CONCLUSIONS We found no evidence of an association between sustained HbA1c <7% while receiving insulin or sulfonylurea therapy and clinically meaningful increased risks of falls or fractures in older adults with T2D. Clinicians should continue to balance the benefits of glycemic control with the risks of complications in older adults.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"5 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319863","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":"Is Screening for Heart Failure and Peripheral Artery Disease Warranted in Asymptomatic Adults With Diabetes? A Perspective on the 2025 American Diabetes Association “Standards of Care in Diabetes”","authors":"William H. Herman, Shihchen Kuo","doi":"10.2337/dci24-0103","DOIUrl":"https://doi.org/10.2337/dci24-0103","url":null,"abstract":"The American Diabetes Association (ADA) publishes the “Standards of Care in Diabetes” (SOC) annually to offer clinicians, patients, and payers evidence-based guidelines for diabetes management. The 2025 SOC recommends that clinicians consider screening asymptomatic adults with diabetes for heart failure using natriuretic peptide levels, and that they screen asymptomatic adults with diabetes ≥65 years of age with any microvascular disease, foot complications, or end-organ damage from diabetes for peripheral artery disease (PAD) using ankle-brachial index (ABI) testing. This perspective evaluates those recommendations using established screening principles and the published literature. The recommendation to screen for heart failure using natriuretic peptide lacks robust evidence in several key areas. N-terminal pro-B-type natriuretic peptide, or NT-proBNP, itself performs poorly as a screening test in asymptomatic adults. Furthermore, there is ambiguity in treatment recommendations and insufficient evidence showing improved outcomes with sodium–glucose cotransporter 2 inhibitor treatment in adults with diabetes and stage B heart failure. Finally, the costs involved are high and may not be economically justifiable. Similarly, the recommendation to screen for PAD in asymptomatic adults with diabetes is not backed by rigorous scientific evidence. The evidence cited combines ABI screening with other effective screening tests and has limited generalizability. There is no guidance on how to interpret the results of ABI testing or how the information gained should be used to direct treatment. While the intent to improve health care through screening is commendable, these recommendations are inadequately supported by the principles of screening and the published literature. It is imperative that the ADA uses the greatest scientific rigor to prepare its SOC.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"7 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278335","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":"Detecting Hyperglycemia Using Biomarkers Versus Continuous Glucose Monitoring","authors":"Natalie Rula Daya, Michael Fang, Jung-Im Shin, James S. Pankow, Pamela L. Lutsey, Arielle Valint, Justin B. Echouffo-Tcheugui, Scott Zeger, Elizabeth Selvin","doi":"10.2337/dc25-0595","DOIUrl":"https://doi.org/10.2337/dc25-0595","url":null,"abstract":"OBJECTIVE To evaluate the concordance of glycated albumin, fructosamine, 1,5-anhydroglucitol (1,5-AG), and hemoglobin A1c (HbA1c) with continuous glucose monitor (CGM) metrics of hyperglycemia and glycemic control in a diverse population of adults with type 2 diabetes. RESEARCH DESIGN AND METHODS This was a pooled cross-sectional analysis of 552 adults, ages 30 to 97 years old, with diabetes. Participants wore a CGM for up to 2 weeks, and we evaluated the agreement between blood biomarkers (glycated albumin, fructosamine, and 1,5-AG) with CGM-defined metrics of hyperglycemia and glycemic control. RESULTS Of the 552 participants (mean age 74 years, 53% women, 36% Black), the median of mean CGM glucose was 132 mg/dL, and participants spent on average 84% of their time in range (70–180 mg/dL). CGM mean glucose was strongly related to HbA1c (r = 0.72), glycated albumin (r = 0.64), and fructosamine (r = 0.64) but weakly related to 1,5-AG (r = 0.46). Results were similar for time above range (>180 mg/dL). Glycated albumin and fructosamine performed similarly to HbA1c in the detection of target time in and above range (c-statistics ranged from 0.85 to 0.94). CONCLUSIONS Glycated albumin and fructosamine had similar associations with CGM-defined metrics of hyperglycemia compared with HbA1c. These three biomarkers performed similarly in the detection of time above range and in range. Our results provide evidence for the utility of glycated albumin and fructosamine as alternate measures of hyperglycemia.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"36 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278339","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":"Health Expenditures Decline After Bariatric Surgery for Patients With Type 2 Diabetes","authors":"Caroline E. Sloan, Lindsay Zepel, Valerie A. Smith, David E. Arterburn, Aileen Baecker, Amy G. Clark, Aniket A. Kawatkar, Ryan M. Kane, Christopher R. Daigle, Karen J. Coleman, Matthew L. Maciejewski","doi":"10.2337/dc25-0254","DOIUrl":"https://doi.org/10.2337/dc25-0254","url":null,"abstract":"OBJECTIVE Bariatric surgery lowers the risk of developing microvascular and macrovascular complications of type 2 diabetes, but it is unclear whether it also lowers long-term health expenditures in this population. RESEARCH DESIGN AND METHODS In a retrospective cohort study of 6,690 patients with obesity and type 2 diabetes who underwent bariatric surgery in 2012–2019 and 19,122 matched nonsurgical patients, we compared total, outpatient, inpatient, and medication expenditures 3 years presurgery and 5.5 years postsurgery, using generalized estimating equations. Expenditures were estimated in 6-month intervals. RESULTS Surgical and nonsurgical cohorts were well-matched, with 73% female, average BMI 44 kg/m2, mean age 50 years, and 32% on insulin. Estimated total expenditures were similar between surgical and nonsurgical patients up to 1 year presurgery. Total expenditures were significantly lower for surgical patients starting 1 year postsurgery and up to 5.5 years postsurgery compared with controls ($566 lower per 6-month interval at 5.5 years; 95% CI −$807, −$316). Expenditure differences were largely attributable to a 56% drop in medication expenditures for surgical patients, from $2,204 in the 6 months presurgery to $969 per 6-month interval at 5.5 years postsurgery. Surgical patients had a higher probability of inpatient admission throughout the postsurgical period (4.0–6.5% vs. 2.4–3.1% per 6-month interval). CONCLUSIONS Patients with type 2 diabetes undergoing bariatric surgery have significantly lower total postsurgical expenditures than matched controls, primarily because of substantial reductions in pharmacy expenditures. The long-term cost savings associated with bariatric surgery are likely to increase further, given the rapidly escalating costs of diabetes pharmacotherapy.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"221 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278344","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}