Diabetes Care最新文献

{"title":"Impact of Body Size on Preclinical Type 1 Diabetes Development and Progression","authors":"Raquel M. Gupta, Heba M. Ismail, Alejandro F. Siller, Jonah Pesikoff, Sridevi Devaraj, Ashok Balasubramanyam, Maria J. Redondo","doi":"10.2337/dci25-0134","DOIUrl":"https://doi.org/10.2337/dci25-0134","url":null,"abstract":"Type 1 diabetes arises from the interplay of genetic susceptibility and environmental exposures, leading to autoimmune β-cell destruction. Although disease-modifying therapies (DMTs) can delay progression to clinical (stage 3) type 1 diabetes, treatment responses remain inconsistent and transient. The marked heterogeneity of type 1 diabetes, shaped by age, sex, race/ethnicity, and genetic background, underscores the need to elucidate distinct mechanistic pathways. Among environmental contributors, obesity stands out as a compelling modifiable target. Data from The Environmental Determinants of Diabetes in the Young (TEDDY), Type 1 Diabetes TrialNet, and other longitudinal cohorts link BMI and adiposity to the onset of islet autoimmunity, progression through preclinical stages, and development of stage 3 type 1 diabetes. These associations are not uniform; heightened susceptibility to adiposity-related risk is seen among younger children, Hispanic populations, and individuals with specific HLA genotypes. Despite robust epidemiologic evidence, the biological pathways connecting elevated BMI to autoimmune β-cell destruction remain incompletely defined. Emerging data implicate a network of immunologic and metabolic disturbances, including insulin resistance, β-cell stress, chronic adipose tissue inflammation, altered adipokine signaling, and gut microbiome changes, that collectively heighten β-cell vulnerability, amplify autoreactive immune responses, and drive metabolic decompensation toward clinical disease. Elucidating these mechanisms and identifying related biomarkers are critical to advancing precision prevention. In future studies, investigators should evaluate whether modifying elevated BMI or targeting obesity-associated immunologic and metabolic pathways can alter the preclinical trajectory of type 1 diabetes. Such mechanistic understanding may help curb type 1 diabetes incidence and improve outcomes for populations most vulnerable to obesity-related risk.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"5 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147586655","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 Ambient Temperature and Hypoglycemia in People Living With Type 1 Diabetes: A Case Time Series Analysis Using Real-Time Continuous Glucose Monitoring","authors":"Harriet E. Daultrey, Nick S. Oliver, Ali J. Chakera, Arturo de la Cruz Libardi, Collins C. Iwuji, Antonio Gasparrini","doi":"10.2337/dc25-2383","DOIUrl":"https://doi.org/10.2337/dc25-2383","url":null,"abstract":"OBJECTIVE To investigate the short-term association between ambient temperature and risk of hypoglycemia in adults with type 1 diabetes mellitus (T1DM). We hypothesized that higher ambient temperature would increase the odds of hypoglycemia developing. RESEARCH DESIGN AND METHODS We applied a case time series design to assess the longitudinal association between ambient temperature and hypoglycemia measured using routine continuous glucose monitoring data from individuals with T1DM. A quasi-binomial fixed-effect regression with distributed lag nonlinear models was used to estimate potentially nonlinear and lagged risks of nonoptimal temperature on hypoglycemic episodes, defined as ≥15 min of glucose concentration <3.9 mmol/L. The model was adjusted for long-term trends, seasonality, day of the week, and public holidays. A secondary outcome was change in daily mean glucose concentration. RESULTS We analyzed 32,966,282 glucose readings from 679 adults with T1DM attending two National Health Service clinics in Sussex, England, between 2017 and 2024. Higher ambient temperatures were associated with an increased risk of hypoglycemia. The risk increased nonlinearly for temperatures above 13°C, with the odds ratio reaching 1.26 (95% CI 1.13–1.26) at 25°C. The strongest effect was observed on the same day of the exposure, and it diminished over subsequent days. In the secondary analysis, higher temperatures were associated with lower mean glucose levels. CONCLUSIONS Elevated ambient temperature significantly increases the short-term risk of hypoglycemia in adults with T1DM. These findings are specific to the U.K. population and climate, which may limit generalizability. Our results support anticipatory insulin adjustments during hot weather and consideration of ambient temperature in hybrid closed-loop insulin algorithms.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"102 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147586640","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":"Accuracy of Continuous Glucose Monitoring in Adults With Postbariatric Hypoglycemia After Roux-en-Y Gastric Bypass Surgery Under Stable and Dynamic Glucose Conditions","authors":"Aritz Lizoain, Martina Vettoretti, Antonio Ferreira, Katja A. Schönenberger, Olivia Streicher, Eva Rolfes, Vincent Braunack-Mayer, Andrea Facchinetti, David Herzig, Martina Rothenbühler, Lia Bally","doi":"10.2337/dc25-2724","DOIUrl":"https://doi.org/10.2337/dc25-2724","url":null,"abstract":"OBJECTIVE Although continuous glucose monitors (CGMs) are increasingly used to detect and manage postbariatric hypoglycemia (PBH) and associated glucose variability, data on their accuracy in this population remain scarce. RESEARCH DESIGN AND METHODS We retrospectively assessed the accuracy of the Dexcom G6 CGM system in adults with PBH after Roux-en-Y gastric bypass (RYGB) surgery (n = 70). Glucose excursions were induced using a standardized solid mixed-meal test, and reference blood glucose (BG) values were obtained through repeated venous whole-blood sampling. CGM accuracy was analyzed separately during stable and dynamic postmeal glucose periods, with dynamic phases stratified according to magnitude and direction of the rate of change (RoC). We further estimated the lag time for each sensor and examined predictive factors affecting CGM accuracy. RESULTS A total of 1,822 CGM-BG pairs obtained with 70 individuals were included in the analysis. Mean absolute relative differences at stable and dynamic levels were 9.6% and 16.4%, respectively. After the meal test, 67.6% of pairs had CGM values within 15%, or 15 mg/dL of the reference BG; 78.0% within 20%, or 20 mg/dL; and 90.8% within 30%, or 30 mg/dL. Performance was worse at rapid plasma glucose decline (>1.5 mg/dL/min), and CGM values at the time of plasma glucose nadir were systematically higher (bias, 8.2 mg/dL). Plasma-interstitium time delay was estimated at 9.8 min. No participant or sensor characteristic had a significant impact on CGM accuracy. CONCLUSIONS Meal-induced glucose dynamics, particularly rapid declines, challenge CGM accuracy in people with PBH and must be carefully considered when diagnosing or managing the condition.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"12 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147586639","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":"Genetic Susceptibility to Diabetes Subtypes and Risk of Developing Coronary Artery Disease","authors":"Mengyu Pan, Dania Al-Sharify, Gunnar Engström, Emma Ahlqvist, Luca Lotta, Jan Nilsson, Isabel Goncalves, Jiangming Sun, Andreas Edsfeldt","doi":"10.2337/dc25-1711","DOIUrl":"https://doi.org/10.2337/dc25-1711","url":null,"abstract":"OBJECTIVE Diabetes significantly increases the risk for atherosclerotic complications, including coronary artery disease (CAD). Previous studies have suggested that adult-onset diabetes can be classified into five different clinical subtypes, including moderate obesity-related diabetes (MOD). The aim of this study was to investigate the genetic associations between the five diabetes subtypes and the risk of developing CAD and diabetes in the general population. RESEARCH DESIGN AND METHODS The Malmö Diet and Cancer cohort (N = 24,025) was used to assess whether polygenic risk scores (PRSs) for the five diabetes subtypes could predict future diabetes and CAD. Genetic correlations and causal effects of the MOD subtype on CAD were investigated using data from large genome-wide association studies of the MOD subtype (N = 4,116) and CAD (N = 296,525). RESULTS During follow-up, 4,105 participants (17.1%) developed diabetes (median follow-up 24.0 years) and 3,841 (16.0%) developed CAD (median follow-up 24.6 years). PRS for MOD (PRSMOD) was associated with incident diabetes and CAD. In addition, participants in the third tertile of PRSMOD had a 1.10-fold higher risk of developing CAD compared with those in the first tertile. A positive genetic correlation between MOD and CAD was observed, and Mendelian randomization analyses suggested a causal effect of MOD on CAD. CONCLUSIONS The current study showed that the genetic susceptibilities for all five diabetes subtypes were associated with incident diabetes. However, only the MOD subtype was associated with incident CAD. These findings underscore the significance of a high genetic risk for MOD as an early marker for CAD.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"103 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577899","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":"Screening for Diabetes and Prediabetes in Cystic Fibrosis Using a Nonfasting 50-Gram 1-Hour Oral Glucose Challenge Test","authors":"Monique D. Maher, Timothy Vigers, Celia Kohler, Arlene A. Stecenko, Antoinette Moran, Christine L. Chan, Lawrence S. Phillips","doi":"10.2337/dc25-2806","DOIUrl":"https://doi.org/10.2337/dc25-2806","url":null,"abstract":"OBJECTIVE Cystic fibrosis (CF)-related diabetes (CFRD) affects nearly half of adults with CF, but screening rates with the recommended oral glucose tolerance test (OGTT) are low. We evaluated the utility of a nonfasting, 50-g, 1-h oral glucose challenge test (GCT) as first-line screening for CFRD and pre-CFRD. The objectives were to define a cutoff that provides high sensitivity and reasonable specificity, and to determine how GCT compares with other opportunistic tests. RESEARCH DESIGN AND METHODS Participants with CF ≥10 years old, without known diabetes, had baseline random plasma and capillary glucose (RPG and RCG), then underwent an in-clinic GCT for collection of 1-h plasma glucose (GCTpl). This was followed by hemoglobin A1C (HbA1c) and OGTT on a separate day. Receiver operating characteristic (ROC) curves were generated for identifying CFRD and pre-CFRD. RESULTS Of 185 participants, 94 had normal glucose tolerance, 81 had pre-CFRD, and 10 had CFRD. For detecting pre-CFRD or CFRD, GCTpl had an area under the ROC curve (ROC-AUC) of 0.73 (95% CI 0.65–0.80), higher than ROC-AUCs for RPG of 0.56 (0.48–0.65, P = 0.003), RCG of 0.55 (0.46 = 0.63, P = 0.002), and HbA1c of 0.62 (0.53–0.67, P = 0.02). The ROC-AUC for detecting CFRD was 0.75 (0.64–0.86) for GCTpl, 0.64 (0.42–0.87) for RPG, and 0.56 (0.39–0.73) for HbA1c. A GCTpl of 147 mg/dL provides 90% sensitivity and 58% specificity for detecting CFRD and could reduce the OGTTs needed by 56%. CONCLUSIONS GCT offers a practical, in-clinic method for CFRD screening. This spares low-risk individuals from OGTT, while maintaining high sensitivity for CFRD.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"7 4 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577901","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":"Impact of Missing Data and Monitoring Duration on Downstream Analyses in Continuous Glucose Monitoring","authors":"Neo Kok, Walter T. Williamson, Joyce M. Lee, Irina Gaynanova","doi":"10.2337/dc25-2935","DOIUrl":"https://doi.org/10.2337/dc25-2935","url":null,"abstract":"OBJECTIVE Consensus guidelines recommend at least 14 consecutive days of continuous glucose monitoring (CGM) monitoring with 70% completeness to represent 90-day glycemic exposure. This study quantifies bias and uncertainty introduced into downstream analyses by using CGM metrics from incomplete or reduced monitoring, relative to a 90-day complete profile. RESEARCH DESIGN AND METHODS Using a type 1 diabetes cohort with 1,010 complete 90-day CGM profiles, we simulated incomplete profiles by varying monitoring duration and data completeness. Consensus CGM metrics were computed on incomplete and complete profiles to quantify measurement error, which was propagated into two downstream regression models: 1) CGM metric is an outcome for a binary treatment (clinical trial setting); 2) CGM metric is an explanatory variable (covariate) for another continuous outcome. Bias was quantified using observed-to-true effect size ratios and uncertainty by the sample size increase required to maintain precision. RESULTS In the clinical trial setting, treatment effects remain unbiased but lose precision; for time in range (TIR), 14 days required ≥16% more participants versus 90 days; 30 days required ≥6.5%. When the CGM metric is a covariate, associations with outcomes are attenuated (biased toward zero up to 14% at 14 days and 6% at 30 days for TIR) and less precise. CONCLUSIONS Representing 90 days of glycemic exposure with 14 days can lead to bias and loss of precision in downstream analyses. We recommend study protocols require at least 30 days of CGM monitoring with 70% completeness. If 30 days is not feasible, studies should plan for increased sample sizes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"21 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577900","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":"Safety of Semaglutide After Dialysis Initiation: An Individual-Level Pooled Analysis","authors":"Klara R. Klein, Anna Menacher, John B. Buse, Johannes F.E. Mann, Katherine R. Tuttle, Kajsa Kvist, Margit R. Andersen, Manuel Mayrdorfer, Ildiko Lingvay","doi":"10.2337/dc26-0112","DOIUrl":"https://doi.org/10.2337/dc26-0112","url":null,"abstract":"OBJECTIVE People receiving dialysis are at high risk of cardiovascular and all-cause mortality. Semaglutide reduces major adverse cardiovascular events (MACE) in people with type 2 diabetes (T2D) and those without T2D with obesity and high cardiovascular risk. Data to establish safety and efficacy in dialysis-dependent kidney failure are scarce. We aimed to assess the safety of semaglutide in people who initiate dialysis. RESEARCH DESIGN AND METHODS In this post hoc analysis of four randomized, placebo-controlled trials (Trial to Evaluate Cardiovascular and Other Long-term Outcomes With Semaglutide in Subjects With Type 2 Diabetes [SUSTAIN-6], Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity [SELECT], Evaluate Renal Function With Semaglutide Once Weekly [FLOW], and Semaglutide Cardiovascular Outcomes [SOUL]), we evaluated systematically collected adverse events (AEs) from participants who initiated dialysis during study follow-up. We compared the proportion and event rates of systematically collected serious AEs (SAEs), including adjudicated MACE, and AEs leading to permanent treatment discontinuation in participants originally randomized to semaglutide or placebo who remained on treatment after dialysis initiation. RESULTS Among 34,064 participants randomized across the trials, 307 initiated dialysis, of whom 165 participants randomized to semaglutide (n = 71) or placebo (n = 94) remained on treatment. After dialysis initiation, SAEs were reported in 32 of 71 (45%) and 54 of 94 (57%) participants, and the proportion of participants who permanently discontinued trial medication was 8.5% and 10.6% in the semaglutide and placebo groups, respectively. The MACE event rates were 9.7 and 16.1 events per 100 person-years, and all-cause mortality event rates were 13.8 and 18.1 events per 100 person-years, in the semaglutide and placebo groups, respectively. CONCLUSIONS Although more evidence is needed, continuation of semaglutide after dialysis initiation appears safe and warrants efficacy testing regarding reduction in MACE and death.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"19 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524322","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":"Metabolomic Profile of Genetic Liability to Type 2 Diabetes Among 125,000 Mexican Adults: A Mendelian Randomization Study","authors":"Fiona Bragg, Jesus Alegre-Diaz, Eirini Trichia, Jason M. Torres, Paulina Baca, Adrián Garcilazo-Ávila, Carlos González-Carballo, Raul Ramirez-Reyes, Fernando Rivas, Diego Aguilar-Ramirez, Louisa Gnatiuc Friedrichs, William G. Herrington, Michael Hill, Tabitha Hubbard, Alejandra Vergara, Rachel Wade, Rory Collins, Richard Peto, Jaime Berumen, Pablo Kuri-Morales, Roberto Tapia-Conyer, Jonathan R. Emberson","doi":"10.2337/dc25-2933","DOIUrl":"https://doi.org/10.2337/dc25-2933","url":null,"abstract":"OBJECTIVE The Mexican population experiences a notably high prevalence of type 2 diabetes (T2D) and high T2D-associated disease risks. We used targeted plasma nuclear magnetic resonance metabolomics data within a Mendelian randomization framework to characterize the metabolomic profile of genetically predicted liability to T2D in this population. RESEARCH DESIGN AND METHODS Between 1998 and 2004, 50,000 men and 100,000 women aged ≥35 years were recruited from Mexico City. Mendelian randomization analyses used a genetic risk score (GRS) comprising 1,055 established T2D-associated risk variants and eight pathway-specific T2D GRSs constructed from nonoverlapping subsets of these variants to estimate associations with 143 metabolic biomarkers (including lipids, lipoproteins, fatty acids, amino acids, ketone bodies, and other low-molecular-weight biomarkers). RESULTS Among 125,587 included participants, the T2D GRS explained 6.0% of T2D liability and was not associated with major potential confounders of the relationships of T2D with the circulating metabolome. Genetically predicted liability to T2D was strongly positively associated with concentrations of VLDL particles and lipids within these, with triglycerides, branch-chain amino acids, and glycoprotein acetyls, and more modestly positively associated with intermediate-density lipoprotein and LDL, particularly small LDL, particles. Inverse associations were found with relative concentrations of several fatty acids. Pathway-specific T2D GRSs all associated with higher T2D risk but showed differential relationships with circulating metabolic biomarkers. CONCLUSIONS T2D is associated with widespread changes in the circulating metabolome among adults in Mexico, reflecting diverse biological mechanisms and highlighting the importance of effective T2D management, including control of T2D-associated dyslipidemia, in this population.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"16 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524751","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":"Profiles of Social Determinants of Health and Change in Diabetes Status Among U.S. Hispanic/Latino Adults: HCHS/SOL, 2008–2024","authors":"Colette J. Brown, Scott C. Roesch, Carlos E. Rosas, Jessica L. McCurley, Christina Cordero, Gabriela Trifan, Fernando Testai, Beibo Zhao, Jianwen Cai, Carmen R. Isasi, Linda C. Gallo","doi":"10.2337/dc25-2797","DOIUrl":"https://doi.org/10.2337/dc25-2797","url":null,"abstract":"OBJECTIVE Social determinants of health (SDoHs) account for more than half of the variance in racial and ethnic disparities in health. However, few studies have examined how SDoHs may cluster in ways that affect health. We aimed to identify patterns of social adversity and their differential associations with both diabetes status at baseline and change in diabetes status across ∼12 years among Hispanic/Latino adults. RESEARCH DESIGN AND METHODS Participants were from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; N = 16,415; aged 18–74 years). Diabetes status (defined as normoglycemia, prediabetes, or diabetes per American Diabetes Association criteria) was measured by clinical assessment and self-reported medications at baseline (2008–2011) and two follow-up visits (2014–2017 and 2020–2024). SDoHs were assessed at baseline and as part of the HCHS/SOL Sociocultural Ancillary Study (2010–2012). RESULTS Latent class analyses of nine SDoHs (income, education, employment status, home ownership, language and social acculturation, chronic stressors, family cohesion, and social support) revealed four distinct patterns of social adversity: 1) low adversity, 2) social/educational strengths, 3) acculturated and underresourced, and 4) high adversity. Compared with the low-adversity group, the high-adversity group had the highest odds of worse diabetes status at baseline and had greater odds of worsening diabetes status over time. CONCLUSIONS SDoHs cluster in distinct ways that affect diabetes outcomes; social adversities must be addressed to mitigate diabetes burden among Hispanic/Latino adults.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"20 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147506745","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":"Data-Driven Phenotypic Clusters of Gestational Diabetes Mellitus and Associations With Risk of Perinatal Complications and Postpartum Diabetes","authors":"Yeyi Zhu, Amanda L. Ngo, Lauren D. Liao, Rachel Harvill, Ben J. Marafino, Rana F. Chehab, Mara B. Greenberg, Assiamira Ferrara","doi":"10.2337/dc25-2131","DOIUrl":"https://doi.org/10.2337/dc25-2131","url":null,"abstract":"OBJECTIVE Management of gestational diabetes mellitus (GDM) largely follows a uniform approach, despite growing recognition of GDM heterogeneity. We aimed to identify data-driven GDM clusters by using machine learning techniques and clinical data and to assess their associations with perinatal complications and postpartum diabetes risk. RESEARCH DESIGN AND METHODS In a population-based cohort study, 37,544 individuals with GDM were followed up through 12 years postpartum. In the discovery (70%) and validation (30%) sets, we applied dimension reduction and clustering methods using routinely available sociodemographic, behavioral, and clinical variables. Covariate-adjusted modified Poisson and Cox regression models were used to assess associations of GDM clusters with risk of perinatal complications and postpartum diabetes. RESULTS Four data-driven GDM phenotypic clusters were identified. Cluster 1 (C1) (65.6%), C2 (14.5%), C3 (12.0%), and C4 (7.8%) comprised the discovery set, with similar distributions in the validation set (C1–C4 66.7%, 14.0%, 12.0%, 7.4%, respectively). C2–C4 compared with C1 (late-diagnosed, lower-BMI, and postload hyperglycemia GDM) were associated with higher risks of perinatal complications and new-onset postpartum diabetes, especially C4 (early-diagnosed, comorbidity-related, and high–glucose challenge test GDM) (adjusted relative risks: severe maternal morbidity 1.43 [95% CI 1.19, 1.72] and neonatal intensive unit admission 1.53 [1.41, 1.66]; adjusted hazard ratio for diabetes 4.32 [95% CI 3.94, 4.73]). Within the largest cluster C1, three subclusters were identified, with differential risks of perinatal complications but not postpartum diabetes. CONCLUSIONS Our study identified distinct data-driven GDM phenotypic clusters with differential risks of perinatal complications and postpartum diabetes. These findings may inform personalized risk assessment and management strategies tailored to GDM phenotypic clusters to possibly reduce adverse health outcomes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"5 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470892","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}