Diabetes Care最新文献

{"title":"Gestational Diabetes Mellitus: Early Risk Factors, Prevention, Optimal Treatment, and Long-term Consequences for Mothers and Offspring: Reflections on 25 Years of Research: The 2025 Norbert Freinkel Award Lecture","authors":"Monique M. Hedderson","doi":"10.2337/dci25-0050","DOIUrl":"https://doi.org/10.2337/dci25-0050","url":null,"abstract":"Gestational diabetes mellitus (GDM) has long been viewed as a metabolic condition first recognized during pregnancy. However, research now demonstrates that underlying metabolic abnormalities are detectable during the preconception period in individuals who subsequently develop GDM and that GDM carries long-term implications for both mothers and offspring. In this article, I provide an overview of the work that my colleagues and I have conducted over the past 25 years, aimed at understanding when GDM risk emerges, how risk can be modified, and how intrauterine exposure to hyperglycemia and its treatment influences health across the life course. This work spans population-based epidemiology, preconception biomarker studies, efficacy prevention trials, and pragmatic interventions embedded within an integrated health care system. Together, these findings affirm Norbert Freinkel’s concept of fuel-mediated teratogenesis and underscore the need for precision prevention and treatment strategies that address biological, behavioral, and social determinants of health risk factors.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"169 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148768038","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":"Waist Circumference, Relative Fat Mass Index, and BMI as Classifiers of Diabetes Status: A Comparative, Cross-sectional Analysis in 82 Low- and Middle-Income Countries","authors":"Jacqueline A. Seiglie, Till Seuring, Felix Teufel, Maja E. Marcus, Michaela Theilmann, Pascal Geldsetzer, Kokou Agoudavi, Glennis Andall-Brereton, Krishna K. Aryal, Brice Wilfried Bicaba, Pascal Bovet, Luisa Campos Caldeira Brant, Garry Brian, Albertino Damasceno, Maria Dorobantu, Farshad Farzadfar, Gladwell Gathecha, Ali Golestani, Mongal Singh Gurung, Mahsa Heidari-Foroozan, Corine Houehanou, Dismand Houinato, Nahla Hwalla, Jutta Jorgensen, Kibachio J. Mwangi, Gibson B. Kagaruki, Khem B. Karki, Nuno Lunet, Deborah C. Malta, Joao S. Martins, Mohammed Msaidie, Omar Mwalim, Bolormaa Norov, Sarah Quesnel-Crooks, Sahar Saeedi Moghaddam, Abla Sibai, Lela Sturua, Lindiwe Tsabedze, Chea Stanford Wesseh, Roy Wong McClure, Sang Gune Yoo, Rifat Atun, Justine I. Davies, Sebastian Vollmer, Till W. Bärnighausen, David Flood, Orison O. Woolcott, Jennifer Manne-Goehler","doi":"10.2337/dc26-0106","DOIUrl":"https://doi.org/10.2337/dc26-0106","url":null,"abstract":"OBJECTIVE Waist circumference–based measures can improve diabetes risk assessment beyond BMI. Yet, evidence to guide their integration into screening guidelines in low- and middle-income countries (LMICs) is limited, particularly to assess risk among individuals at intermediate BMI ranges. We evaluated the associations of waist circumference (WC), relative fat mass (RFM), and BMI with diabetes across 82 LMICs. RESEARCH DESIGN AND METHODS Individual-level data were analyzed from nationally representative surveys across 82 LMICs, comprising 598,883 adults aged ≥25 years with a BMI of 18.5–29.9 kg/m2. Associations of anthropometric measures with diabetes were estimated as risk ratios using Poisson regression and area under the curve (AUC), stratified by sex and geographic region. RESULTS Pooled diabetes prevalence was 9.1% (95% CI 8.51–9.68). Overall, risk of diabetes was greatest for WC and RFM at the highest quintile, compared with BMI. The AUC for WC and RFM as a classifier of diabetes status was higher than the AUC for BMI in men (AUC: WC 0.69, RFM 0.69, BMI 0.64) and women (AUC: WC 0.69, RFM 0.69, BMI 0.63). Generally, the AUC for RFM was higher than the AUC for BMI and either higher than or equal to WC across regions and sex. CONCLUSIONS WC and RFM outperformed BMI as classifiers of diabetes status among adults with a BMI of 18.5–29.9 kg/m2 across 82 LMICs. Inclusion of WC-based measures in diabetes screening guidelines could improve timely diabetes detection and resource allocation in LMICs among individuals at intermediate BMI ranges.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"33 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148768037","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":"Clinical Utility of a Type 1 Diabetes Genetic Risk Score Measured as Part of MODY Genetic Testing","authors":"Jacques Murray Leech, Aparajita Sriram, Kevin Colclough, Andrew T. Hattersley, Jayne A. L. Houghton, Thomas W. Laver, Kashyap A. Patel","doi":"10.2337/dc26-1081","DOIUrl":"https://doi.org/10.2337/dc26-1081","url":null,"abstract":"OBJECTIVE To evaluate the clinical utility of incorporating a type 1 diabetes genetic risk score (T1DGRS) into monogenic diabetes gene panel testing for individuals referred for suspected maturity-onset diabetes of the young (MODY) from routine clinical practice. RESEARCH DESIGN AND METHODS We studied 1,129 individuals treated with insulin referred for MODY genetic testing. All underwent gene panel testing that included 10 variants to calculate T1DGRS. We compared T1DGRS distributions with reference populations to estimate the T1D prevalence within referred individuals. We defined age-specific T1DGRS thresholds to identify probable T1D (positive predictive value ≥80%) and applied them in individuals genetically unsolved MODY to assess its utility as a pregenetic testing triage tool. RESULTS T1DGRS in MODY referral individuals was intermediate between reference populations with and without T1D, consistent with an estimated 20% (95% CI 14.9–25.2%) T1D in this real-world setting. After genetic testing, no excess T1DGRS was observed in individuals with genetically solved MODY, whereas those with unsolved MODY showed enrichment consistent with 26.0% T1D, with highest values in children (76.2%) and lowest in adults (16.8%). Age-specific T1DGRS thresholds identified 16.1% (95% CI 13.8–18.5%) of genetically unsolved MODY as probable T1D. As a pretesting tool, T1DGRS showed limited discrimination overall (area under the curve [AUC] 0.60) but performed well in children aged <10 years (AUC 0.83), where >50% of tests could be avoided without missing MODY. CONCLUSIONS Incorporating a T1DGRS into routine MODY gene panel testing is feasible and clinically valuable. This approach broadens genomic diagnostics beyond monogenic disease by identifying T1D in individuals with genetically unsolved MODY. Pregenetic testing utility is age dependent and may reduce unnecessary testing in pediatric patients.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"2 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754772","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 Burden and Phenotype of Type 2 Diabetes in the Western Pacific Region","authors":"Andrea On Yan Luk, Lee-Ling Lim, Juliana Chung Ngor Chan, Edith Wing Kar Chow, Soo Heon Kwak, Rinki Murphy","doi":"10.2337/dci26-0055","DOIUrl":"https://doi.org/10.2337/dci26-0055","url":null,"abstract":"The International Diabetes Federation estimated that in 2024, 215 million adults—more than one-third of the global diabetes population—were living with diabetes within the Western Pacific Region (WPR), which includes nations with some of the highest prevalence worldwide. Rapid urbanization and economic development have profoundly reshaped lifestyles, which interact with biological predispositions resulting in an earlier onset of type 2 diabetes. These predispositions are not uniform across the heterogeneous populations within the WPR. Asian individuals tend to have a β-cell secretory failure phenotype with type 2 diabetes arising at lower adiposity, distinct from the high-adiposity phenotype with pronounced insulin resistance common among Pacific peoples. Improvements in diabetes care in high-income countries have reduced vascular complications and improved survival, shifting the clinical profile of individuals with type 2 diabetes toward an older population characterized by multimorbidity. In contrast, low-income settings continue to face a high prevalence of type 2 diabetes, compounded by limited access to medications and diagnostic tools, shortage of trained health care professionals, and other logistical barriers to care. In this diverse region where countries are at different stages of health care development, there are considerable opportunities for sharing of best practices through collaborative and translational research. These may include social and public health policies, health care delivery, use of registers to track disease patterns and care standards, and use of technologies to support self-management. For implementation of these actions, a major shift is required, toward prevention, capacity building, and demonstrating the impact of value-based prevention and data-driven care.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"13 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754404","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":"Excess Burden of Inpatient Admissions and Emergency Department Visits Associated With Diabetes Across the Age Spectrum","authors":"Rithik Patel, Tegveer S. Uppal, Dunya Tomic, Mohammed K. Ali, Agus Salim, Dianna J. Magliano, Jessica L. Harding","doi":"10.2337/dc26-0861","DOIUrl":"https://doi.org/10.2337/dc26-0861","url":null,"abstract":"OBJECTIVE The epidemiology of diabetes and its complications is changing due to increasingly younger ages of diagnosis and increased life expectancy. How this changing landscape affects health care use, and for which conditions, is unclear. We examined age-specific excess burdens of cause-specific inpatient and emergency department (ED) visits associated with diabetes. RESEARCH DESIGN AND METHODS We used 2019 Behavioral Risk Factor Surveillance System, National Inpatient Sample, and Nationwide Emergency Department Sample data to derive national U.S. estimates of inpatient admissions and ED visits in adults with and without diabetes. Complications were categorized as traditional, conditions emerging as diabetes associated, or other conditions co-occurring with diabetes. We calculated age-standardized absolute risk differences (ARDs) in people with versus without diabetes to identify leading causes of diabetes-related hospital use by age and setting. RESULTS Traditional complications were dominated by sepsis, cardiorenal disease, acute kidney failure, myocardial infarction, and stroke, with ARDs ranging from 296 to 2,623 per 100,000 people with diabetes. Emerging conditions included pneumonia, device- and procedure-related complications (ARD range 125–473), and schizoaffective or other mental health disorders in younger adults only (ARD range 80–312). Other conditions included respiratory and fluid/electrolyte disorders across all ages (ARD range 100–363), while digestive and urinary disorders were more prominent in older adults (ARD range 229–482). ED visits showed a similar pattern, with lower ARD than inpatient admissions (ARD range 101–707). CONCLUSIONS Diabetes drives substantial, age-specific excess inpatient and ED use, increasingly due to nontraditional rather than classic vascular and renal complications.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"15 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754771","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":"Beyond Health Outcomes: Broader Societal Impacts in Economic Evaluations of Type 1 Diabetes Technologies","authors":"Faith Ross, Maddalena Ferranna, Jee H. Choe, Daniel Tortorice, Ella Zomer, Sophia Zoungas, Anthony Pease, Jeffrey W. Cannon, Jeffrey Braithwaite, Yvonne Zurynski, Tony Huynh, Jennifer Couper, Timothy W. Jones, Elizabeth Davis, David E. Bloom","doi":"10.2337/dci26-0027","DOIUrl":"https://doi.org/10.2337/dci26-0027","url":null,"abstract":"Type 1 diabetes imposes a significant burden through morbidity, mortality, and high health care costs while also generating additional health, economic, and social costs, ranging from mental health conditions to risk of financial hardship to social stigma. Many of these outcomes may also spill over to families and caregivers. The economic literature increasingly recognizes the importance of including broader societal impacts in economic evaluations, including some guidelines for assessment of health interventions. However, in practice, societal impacts are incorporated in a limited way in assessments of type 1 diabetes therapies, most commonly through certain productivity-related measures, with limited consideration of broader impacts. In this article, we review the wider impacts of type 1 diabetes and examine how recent evaluations of novel technologies apply different perspectives. We find that economic assessments inconsistently incorporate broader societal impacts, such as psychosocial effects, informal caregiving, and long-term economic consequences. Consideration of a broader range of societal impacts may provide a more comprehensive evidence base for evaluating type 1 diabetes treatments and technologies, including in decisions related to their development, distribution, and reimbursement.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"35 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754409","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":"Efficacy and Safety of Time-Restricted Eating in Adults With Type 1 Diabetes: A Randomized Controlled Trial","authors":"Mary-Claire Runchey, Sarah Corapi, Vasiliki Pavlou, Sofia Cienfuegos, Shuhao Lin, Mark Ezpeleta, Kelsey Gabel, Lisa Tussing-Humphreys, Vanessa M. Oddo, Shaina J. Alexandria, Julienne Sanchez, Terry Unterman, Lisa S. Chow, Alaina P. Vidmar, Sirimon Reutrakul, Krista A. Varady","doi":"10.2337/dc26-1093","DOIUrl":"https://doi.org/10.2337/dc26-1093","url":null,"abstract":"OBJECTIVE Many adults with type 1 diabetes (T1D) have overweight or obesity, underscoring the need for effective dietary weight loss strategies in this population. Time-restricted eating (TRE) has emerged as a popular approach for weight loss; however, its efficacy and safety in T1D have not been evaluated. We examined whether TRE is more effective for reducing body weight than standard care (daily calorie restriction [CR]), or compared with a control group, in adults with T1D and overweight or obesity. RESEARCH DESIGN AND METHODS Participants were randomized to one of three groups for 6 months: 8-h TRE (eating only between 12:00 p.m. and 8:00 p.m., without calorie counting) versus CR (25% energy restriction daily), and compared with a no-intervention control group. The primary outcome was percent change in body weight by month 6. RESULTS Thirty-two participants were randomized. By month 6, body weight did not change significantly in the TRE group (−2.19% [95% CI −5.70, −1.31]) or CR group (−0.47% [95% CI −4.72, 3.78]) relative to a control group, or between TRE and CR groups (−1.73% [95% CI −5.37, 1.92]). HbA1c levels were significantly reduced by the TRE group when compared with the CR group (−0.46% [95% CI −0.80, −0.12]). There were no significant differences in total insulin dose or mean glucose levels across groups. TRE did not increase the risk for diabetic ketoacidosis, severe hypoglycemia, or severe hyperglycemia. CONCLUSIONS These findings suggest that TRE may be a safe approach for reducing HbA1c levels in T1D, although not more effective for weight loss compared with CR or a control group.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"5 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754408","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 in Motion: Characterizing Temporal Patterns in Real-World Glycemic Control in a Large Observational Cohort","authors":"Iben E. Giese, Stine Hangaard, Niels V. Hartvig, Irl B. Hirsch, Morten H. Jensen, Simon L. Cichosz","doi":"10.2337/dc26-0886","DOIUrl":"https://doi.org/10.2337/dc26-0886","url":null,"abstract":"OBJECTIVE To identify and characterize daily and weekly patterns in glycemic management in longitudinal real-world continuous glucose monitoring (CGM) data from people with diabetes to enhance clinical interpretation and support more effective personalized diabetes management. RESEARCH DESIGN AND METHODS This observational, retrospective study used two independent, multiyear, real-world CGM cohorts (T1DiabetesGranada and Connected Pen), comprising 86,779 participants with diabetes. Their mean age (SD) was 40.3 (15.8) and 44.0 (15.9), respectively, and there was a total of 21,011,021 measurement days. Weekly variations in CGM metrics and bolus insulin dose were examined using linear mixed-effects models, and daily temporal patterns were assessed. RESULTS Weekly and daily glycemic patterns emerged. Mid-week time in range was consistently higher (e.g., Wednesday: +0.96 percentage points [%-points]; 95% CI 0.93–0.99; P < 0.001), with deterioration during weekends and Mondays (e.g., Sunday: –1.74%-points; 95% CI –1.77, –1.72; P < 0.001), mirrored by shifts in other CGM metrics. Bolus insulin dose increased on weekend days (e.g., Sunday: +0.69 units; 95% CI 0.64–0.74; P < 0.001). Daily analyses revealed distinct diurnal profiles, with the most favorable glycemic control during morning and midday hours on weekdays and consistently poorer control during evening and nighttime periods, particularly on weekends. CONCLUSIONS Daily and weekly glycemic patterns revealed statistically robust and consistent temporal variations in glycemic control across two large real-world cohorts. Although the magnitude of these differences was small, the findings provide novel population-level evidence and underscore the value of longer-term CGM perspectives in routine care.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"15 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754411","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":"Housing Instability Associated With Cost-Related Nonadherence and Financial Toxicity in People With Uncontrolled Diabetes","authors":"Victoria H. Davis, Roshanak Mehdipanah, Minal R. Patel","doi":"10.2337/dc26-1152","DOIUrl":"https://doi.org/10.2337/dc26-1152","url":null,"abstract":"OBJECTIVE To assess the prevalence of housing instability and its associations with cost-related nonadherence and financial toxicity among adults with uncontrolled diabetes. RESEARCH DESIGN AND METHODS We analyzed baseline randomized controlled trial data from 600 adults with uncontrolled diabetes and cost-related barriers to care. Logistic and linear regression assessed associations of housing instability with cost-related nonadherence and financial toxicity. RESULTS Half (n = 298) reported housing instability, which was associated with greater odds of cost-related nonadherence (adjusted odds ratio 1.64; 95% CI 1.05, 2.56) and worse financial toxicity (B = −4.64; 95% CI −6.20, −3.09). Cost-related nonadherence was not significant after adjusting for diabetes distress and symptoms of depression and anxiety; financial toxicity remained significant. In sensitivity analyses, worry about housing costs, not housing or utility needs, was associated with financial toxicity. CONCLUSIONS Housing instability was associated with financial toxicity and, in primary models, with cost-related nonadherence. Findings should be validated in longitudinal, nationally representative samples.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"56 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754496","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":"Adult Complications of Childhood-Onset Type 1 Diabetes Vary With Age at Diagnosis: A Population-Based Study","authors":"Timothy C. Nielsen, Samantha J. Lain, Maria E. Craig, Kirstine J. Bell, Heather Baldwin, Alicia J. Jenkins, Gerald Liew, Kim C. Donaghue, Natasha Nassar","doi":"10.2337/dc26-0964","DOIUrl":"https://doi.org/10.2337/dc26-0964","url":null,"abstract":"OBJECTIVE To examine incidence of long-term complications among people with childhood-onset type 1 diabetes, focusing on age at diabetes onset. RESEARCH DESIGN AND METHODS A registry of children diagnosed with type 1 diabetes aged <16 years in New South Wales, Australia, between 1990 and 2009 linked to hospital, emergency department, public insurance, and death data from 2001 to 2019 to identify complications. Age at onset was categorized as <7 years, 7 to <13 years, and 13 to <16 years. Incidence rates and hazard ratios (HR), with 95% CI, for the risk of complications, were calculated from multivariable Cox regression models by 1) duration of diabetes 0 to <20 years and 2) attained age of 16–34 years, with HR adjusted for diagnosis year, sociodemographics, and acute diabetes complications. RESULTS Of 5,202 people identified, 1,694 (32.6%) were diagnosed at age <7 years, 2,538 (48.8%) age 7 to <13 years, and 970 (18.6%) age 13 to <16 years. Within 20 years of onset, incidence ranged from 9.2 per 10,000 person-years (95% CI 7.2, 11.7) for cardiac complications to 53.4 per 10,000 person-years (95% CI 48.2, 59.0) for kidney complications. Diabetes onset at age <7 years (vs. 13 to <16 years) was associated with lower 20-year risk of complications, except lower-limb infections; cardiac adjusted HR (aHR) was 0.32 (95% CI 0.15, 0.66), severe retinopathy aHR was 0.25 (0.17, 0.36), lower-limb vascular complications aHR was 0.41 (0.24, 0.69), peripheral neuropathy aHR was 0.16 (0.08, 0.32), and kidney complications aHR was 0.40 (0.30, 0.53). Risk of complications did not differ by attained age. CONCLUSIONS Children with type 1 diabetes onset at age <7 years had lower chronic complication risk in the first 20 years postdiagnosis, supporting a slower time to develop complications with prepubertal onset.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"194 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754499","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}