Diabetes Care最新文献

{"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}

{"title":"The Association Between Hemoglobin A1c and Complications Among Individuals With Diabetes and Severe Chronic Kidney Disease","authors":"Dea H. Kofod, Nicholas Carlson, Thomas P. Almdal, Tobias Bomholt, Christian Torp-Pedersen, Kirsten Nørgaard, Jesper H. Svendsen, Bo Feldt-Rasmussen, Mads Hornum","doi":"10.2337/dc25-0339","DOIUrl":"https://doi.org/10.2337/dc25-0339","url":null,"abstract":"OBJECTIVE The optimal glycemic target for individuals with severe chronic kidney disease (CKD) remains unclear. We investigated the association between HbA1c and complications in individuals with diabetes and severe CKD. RESEARCH DESIGN AND METHODS In a Danish nationwide registry-based cohort study, we included 27,113 individuals ≥18 years old with diabetes and severe CKD (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2) between 2010 and 2022. As reference groups, we included an age- and sex-matched cohort of 80,131 individuals with diabetes and mild-to-moderate CKD (eGFR 30–59 mL/min/1.73 m2) and 80,797 individuals with diabetes and no-to-mild CKD (eGFR ≥60 mL/min/1.73 m2). Multiple Cox regressions were used to estimate the standardized 1-year risk of major adverse cardiovascular events (MACE), microvascular complications, and hospitalizations due to hypoglycemia across strata of HbA1c levels. RESULTS For individuals with severe CKD, the risk of MACE significantly increased at HbA1c levels ≥7.2% (55 mmol/mol) (P < 0.01) and <5.8% (40 mmol/mol) (P < 0.001), compared with an HbA1c level of 6.3–6.6% (45–49 mmol/mol). The risk of microvascular complications significantly increased at HbA1c levels ≥7.2% (55 mmol/mol) (P < 0.001), and the risk of hospitalization due to hypoglycemia significantly increased at HbA1c levels ≥6.7% (50 mmol/mol) (P < 0.001). The association patterns between HbA1c and outcomes were similar in the severe CKD cohort compared with the matched cohorts with mild-to-moderate CKD and no-to-mild CKD. CONCLUSIONS Our data suggest an HbA1c range of 6.7–7.1% (50–54 mmol/mol) to be most favorable for reducing long-term complications in this high-risk population.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"521 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237340","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":"Risk of Thyroid Tumors With GLP-1 Receptor Agonists: A Retrospective Cohort Study","authors":"Daniel R. Morales, Fan Bu, Benjamin Viernes, Scott L. DuVall, Michael E. Matheny, Katherine R. Simon, Thomas Falconer, Lauren R. Richter, Anna Ostropolets, Wallis C. Y. Lau, Kenneth K. C. Man, Shounak Chattopadhyay, Nestoras Mathioudakis, Evan Minty, Akihiko Nishimura, Feng Sun, Can Yin, Sarah L. Seager, Yi Chai, Jin J. Zhou, Yuan Lu, Carlen Reyes, Andrea Pistillo, Talita Duarte-Salles, Clair Blacketer, Martijn J. Schuemie, Patrick B. Ryan, Harlan M. Krumholz, George Hripcsak, Rohan Khera, Marc A. Suchard","doi":"10.2337/dc25-0154","DOIUrl":"https://doi.org/10.2337/dc25-0154","url":null,"abstract":"OBJECTIVE To assess the association between glucagon-like peptide 1 receptor agonist (GLP-1RA) use and risk of incident thyroid tumors. RESEARCH DESIGN AND METHODS The retrospective, active-comparator new-user cohort study used international administrative claims and electronic health record databases. Participants included patients with type 2 diabetes mellitus (T2DM) with prior metformin therapy initiating a GLP-1RA versus new users of sodium–glucose cotransporter 2 inhibitors (SGLT2is), dipeptidyl peptidase 4 inhibitors (DPP-4is), and sulfonylureas (SUs). The outcome was incident thyroid tumor and thyroid malignancy. Propensity score matching and stratification were used to adjust for confounders with an intention-to-treat and on-treatment strategy. Cox regression was used to estimate hazard ratios (HRs) pooled using a random-effects meta-analysis. Unmeasured confounding was evaluated using negative outcomes, with calibration of the HR. RESULTS A total of 460,032 users of GLP-1RAs, 717,792 users of SGLT2is, 2,055,583 users of DPP-4is, and 1,119,868 users of SUs were included. Only U.S. cohorts passed study diagnostics. Thyroid tumor incidence ranged from 0.88 to 1.03 per 1,000 person-years in GLP-1RA cohorts. GLP-1RA exposure was not associated with an increased risk of thyroid tumors compared with SGLT2is, DPP-4is, or SUs (meta-analysis: GLP-1RA vs. SGLT2i HR range from 0.83 [95% CI 0.57–1.27] to 0.95 [0.85–1.06]; GLP-1RA vs. SU HR range from 0.95 [0.75–1.20] to 1.03 [0.87–1.23]; GLP-1RA vs. DPP-4i HR range from 0.78 [0.60–1.01] to 0.93 [0.83–1.04]). Analysis using thyroid malignancy and including a 1-year lag period produced similar conclusions. CONCLUSIONS In patients with T2DM initiating second-line treatments, we observed no increased risk of thyroid tumors with GLP-1RA exposure.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"56 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218869","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":"Effects of a Province-Wide Change in Gestational Diabetes Mellitus Screening Policy on Treatment and Newborn Birth Weight","authors":"Elizabeth Nethery, Jennifer A. Hutcheon, Julie Lee, Patricia A. Janssen, Laura Schummers","doi":"10.2337/dc25-0480","DOIUrl":"https://doi.org/10.2337/dc25-0480","url":null,"abstract":"OBJECTIVE To evaluate changes in gestational diabetes mellitus (GDM) treatment and newborn birth weight after a 2010 change in GDM screening recommendations from a two-step (50-g glucose challenge test + 3-h, 100-g oral glucose tolerance test [OGTT] with Carpenter-Coustan criteria) to a mix of one-step and two-step (2-h, 75-g OGTT with International Association for Diabetes in Pregnancy Study Group criteria). RESEARCH DESIGN AND METHODS We estimated effects of the screening change on the incidence of lifestyle or medication treatment, infant birth weight >90th percentile or <10th percentile for gestational age (large and small for gestational age), and endocrinologist visits using interrupted time series analysis in all 463,881 individuals with singleton pregnancies (>28 gestational weeks) from British Columbia, Canada, between 2004 and 2019. RESULTS After the screening change, lifestyle-treated GDM increased immediately (level change 1.85 [95% CI 1.19–2.51]), corresponding to a 1.85% increase in incidence. Medication-treated GDM increased gradually (trend change 0.23 [95% CI 0.09–0.37] per year), but there was no change in medication-treated GDM using a shorter (3-year) postpolicy period (level change −0.31 [95% CI −0.9 to 0.29]; trend change 0.03 [95% CI −0.36 to 0.43]). We detected no change in infant birth weight outcomes and endocrinology visits. CONCLUSIONS Changing the screening approach substantially increased diagnoses of lifestyle-treated GDM but did not impact medication-treated GDM or infant birth weight.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"11 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218875","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}