Diabetes Care最新文献

{"title":"Trends in Cystic Fibrosis–Related Diabetes Epidemiology Between 2003 and 2018 From the U.S. Cystic Fibrosis Foundation Patient Registry","authors":"Celia L. Kohler, Tim Vigers, Laura Pyle, Kristen Miller, Edith T. Zemanick, Antoinette Moran, Scott D. Sagel, Christine L. Chan","doi":"10.2337/dc25-0044","DOIUrl":"https://doi.org/10.2337/dc25-0044","url":null,"abstract":"OBJECTIVE A number of disease-modifying therapies have been introduced for people with cystic fibrosis (CF) over the past two decades. The cumulative effects of this changing landscape on CF–related diabetes (CFRD) are unclear. We examined trends in CFRD epidemiology over time using data from the U.S. Cystic Fibrosis Foundation Patient Registry (CFFPR). RESEARCH DESIGN AND METHODS CFFPR data from 2003 to 2018 were queried to determine annual screening, incidence, and prevalence rates of CFRD. Individuals with incident CFRD were compared with individuals without CFRD. Survival analyses were performed to estimate the cumulative hazard of CFRD given predictors of interest over the 15 years of study. Data were also grouped into three time periods (2003–2008, 2009–2013, and 2014–2018) to investigate whether the hazard of developing CFRD varied over time. RESULTS CFRD screening rates increased from 2003 to 2018, particularly in 10- to 18-year-olds. Although screening rates increased in adults, overall rates remained low. In 10- to 18-year-olds, the incidence of CFRD was stable over time, while incident cases in adults steadily decreased, approaching incident rates in adolescents. Despite this, the prevalence of CFRD has gradually increased in adults, likely reflecting increased longevity. Age, female sex, Black race, severe mutation class, liver disease, poorer lung function, pancreatic insufficiency, enteric feeds, and low and high BMI were all risk factors associated with CFRD. CONCLUSIONS Findings support the need for the development of tailored CFRD screening algorithms and increased subspecialists to care for a growing population of adults with CF and CF-associated comorbidities.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"29 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066520","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":"Diet, Gut Microbiota, and Histidine Metabolism Toward Imidazole Propionate Production in Relation to Type 2 Diabetes","authors":"Hongbo Yang, Kai Luo, Brandilyn A. Peters, Yi Wang, Yanbo Zhang, Martha Daviglus, Amber Pirzada, Christina Cordero, Bing Yu, Robert D. Burk, Robert Kaplan, Qibin Qi","doi":"10.2337/dc24-2816","DOIUrl":"https://doi.org/10.2337/dc24-2816","url":null,"abstract":"OBJECTIVE To examine associations of serum imidazole propionate (ImP), histidine, and their ratio with incident type 2 diabetes (T2D) and related dietary and gut microbial factors in U.S. Hispanic/Latino people. RESEARCH DESIGN AND METHODS In the Hispanic Community Health Study/Study of Latinos, we evaluated serum ImP, histidine, and ImP-to-histidine ratio at baseline (2008–2011) and their cross-sectional associations with dietary intake and prospective associations with incident T2D over ∼12 years (n = 4,632). In a subsample with gut microbiota data during a follow-up visit (2016–2018), we examined gut microbial species associated with serum ImP and their potential interactions with dietary intake. RESULTS Serum ImP and ImP-to-histidine ratio were positively associated with incident T2D (hazard ratio [95% CI] = 1.17 [1.00–1.36] and 1.33 [1.14–1.55], respectively, comparing highest and lowest tertiles), whereas histidine was inversely associated with incident T2D (hazard ratio = 0.75 [95% CI 0.64–0.86]). A higher amount of fiber intake was associated with lower serum ImP level and ImP-to-histidine ratio, whereas histidine intake was not associated with serum ImP level in the overall sample. Fifty-three bacterial species, including 19 putative ImP producers, were associated with serum ImP. Histidine intake was positively associated with serum ImP and ImP-to-histidine ratio only in participants with a high ImP-associated gut microbiota score (P = 0.03 and 0.02, respectively, for interaction). The associations of fiber intake with serum ImP and ImP-to-histidine ratio were partly mediated by ImP-associated gut microbiota (proportion mediated = 31.4% and 19.8%, respectively). CONCLUSIONS This study suggested an unfavorable relationship between histidine metabolism toward ImP production, potentially regulated by dietary intake and gut microbiota, and risk of T2D in U.S. Hispanics/Latino people.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"35 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930755","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":"Persistent Hyperglycemia and Insulin Resistance With the Risk of Worsening Cardiac Damage in Adolescents: A 7-Year Longitudinal Study of the ALSPAC Birth Cohort","authors":"Andrew O. Agbaje, Justin P. Zachariah, Alan R. Barker, Craig A. Williams, Dimitris Vlachopoulos, Christoph Saner, Tomi-Pekka Tuomainen","doi":"10.2337/dc24-2459","DOIUrl":"https://doi.org/10.2337/dc24-2459","url":null,"abstract":"OBJECTIVE Insulin resistance (IR) and dysglycemia can induce cardiac remodeling in adulthood, but little evidence exists with respect to cardiac remodeling in youth with and without evidence of new-onset glucose metabolic alterations. This study investigated whether changes in metabolic status from adolescence to young adulthood are associated with the risk of progressive cardiac remodeling and examined potential mechanistic pathways. RESEARCH DESIGN AND METHODS From the Avon Longitudinal Study of Parents and Children (ALSPAC), U.K. cohort, 1,595 adolescents, mean (SD) age 17.7 (0.4) years, who had data on fasting plasma glucose and insulin levels, and echocardiography left ventricular (LV) mass indexed for height raised to the power of 2.7 (LVMI2.7) and in whom these factors repeatedly were measured at a clinic visit when they were aged 24 years were included. HOMA-IR was computed, hyperglycemia was defined as glucose concentration of ≥5.6 mmol/L and ≥6.1 mmol/L, and LV hypertrophy was defined as LVMI2.7 ≥51g/m2.7. RESULTS The prevalence of LV hypertrophy increased from 2.4% at baseline to 7.1% at follow-up. Each unit increase of glucose (β = 0.37 g/m2.7 [95% CI 0.23–0.52]; P < 0.001) and HOMA-IR (1.10 g/m2.7 [0.63–1.57]; P < 0.001) was independently associated with increased LVMI2.7 over 7 years. Persistent hyperglycemia of 5.6 mmol/L and 6.1 mmol/L was associated with higher odds (odds ratio [OR] 1.46 [95% CI 1.35–1.47], P < 0.001; and 3.10 [95% CI 1.19–8.08], P = 0.021, respectively) of worsening LV hypertrophy over 7 years. Increased fat mass (62% mediation) significantly mediated the association of increased HOMA-IR with increased LVMI2.7. CONCLUSIONS Persistent adolescent hyperglycemia and worsening IR were associated with the risk of worsening structural and functional cardiac damage, and these were largely explained by increased fat mass.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"41 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920099","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 the Current Lifestyle Modification Approach to Diabetes Prevention in the U.S. a Success?","authors":"Justin B. Echouffo-Tcheugui, Rosette J. Chakkalakal, Mohammed K. Ali","doi":"10.2337/dci24-0040","DOIUrl":"https://doi.org/10.2337/dci24-0040","url":null,"abstract":"Prediabetes is an intermediate stage between normal glycemia and diabetes and is highly prevalent, especially in adults, but is also increasingly common in young individuals. Randomized clinical trials have demonstrated that lifestyle modification is cost-effective in preventing diabetes. Implementation studies showed the feasibility of delivering real-world structured lifestyle modification programs adapted from the U.S. Diabetes Prevention Program trial. However, the current approach to diabetes prevention in the U.S. has been largely inadequate thus far, as evidenced by the stagnant numbers of people with prediabetes and the growing number of those with diabetes. The many gaps in the implementation of the National Diabetes Prevention Program (NDPP) can be characterized as due to macro-level barriers (failures of pay-for-performance reimbursement, an undersupply of lifestyle change programs), micro-level barriers (low and disparate reach, low referral and retention rates in the program), variable fidelity in implementation, and limitations of a one-size-fits-all intervention. All of these issues point to a need for reexamining strategies for diabetes prevention in the U.S., which is yet to show benefits or value at the population level. This article details how prediabetes is currently suboptimally addressed in clinical practice and communities in the U.S. and articulates why there is an urgent need to rethink our approach to addressing prediabetes, possibly through integration of synergistic individual- and societal-levels approaches.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"12 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920104","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":"Capillary Ketone Level and Future Ketoacidosis Risk in Patients With Type 1 Diabetes Using Sodium–Glucose Cotransporter Inhibitors","authors":"Priya Bapat, Sharon Dhaliwal, Cimon Song, Yucheng Zhang, Daniel Scarr, Abdulmohsen Bakhsh, Dalton Budhram, Natasha J. Verhoeff, Alanna Weisman, Michael Fralick, Noah M. Ivers, David Z.I. Cherney, George Tomlinson, Doug Mumford, Leif Erik Lovblom, Bruce A. Perkins","doi":"10.2337/dc25-0125","DOIUrl":"https://doi.org/10.2337/dc25-0125","url":null,"abstract":"OBJECTIVE We aimed to determine if routine capillary blood ketone testing on well days predicts future diabetic ketoacidosis (DKA) in type 1 diabetes (T1D) using sodium–glucose cotransporter inhibitors (SGLTi). RESEARCH DESIGN AND METHODS We examined previously collected data from empagliflozin-assigned participants in a T1D trial that included weekly fasted ketone levels. Over 6–12 months, ketone levels were subdivided into 28-day periods, and the outcome was subsequent adjudicated DKA or severe ketosis. RESULTS Among 1,194 participants, 325 had 49 DKA and 568 severe ketosis events. On-treatment maximum ketone levels were higher in the 28 days before an outcome compared with levels in those without an outcome, with area under receiver operating characteristic curve of 0.76 (95% CI 0.71–0.82). Maximum ketone level ≥0.8 mmol/L had sensitivity of 66.0%, specificity of 79.6%, and diagnostic odds ratio of 7.6. CONCLUSIONS Routine surveillance of capillary ketone levels in T1D using SGLTi may represent a DKA mitigation strategy and implies a potential threshold for continuous ketone monitoring.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"4 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920105","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":"Cellular Versus Acellular Matrix Products for Diabetic Foot Ulcer Treatment: The Dermagraft and Oasis Longitudinal Comparative Efficacy Study (DOLCE)—A Randomized Clinical Trial","authors":"Harrison Shawa, Ramanjot Kaur, Catherine Tchanque-Fossuo, Hadar Lev-Tov, Kaitlyn West, Pallas Sulgi Lim, Nuen Tsang Yang, Mirabel Dafinone, Rawlings Everett Lyle, Chin-Shang Li, David Rocke, Sara Dahle, Roslyn Rivkah Isseroff","doi":"10.2337/dc24-1233","DOIUrl":"https://doi.org/10.2337/dc24-1233","url":null,"abstract":"OBJECTIVE To determine whether cellular matrix (CM) products result in better healing rates than acellular matrix (ACM) products for nonhealing diabetic foot ulcers. RESEARCH DESIGN AND METHODS The Dermagraft and Oasis Longitudinal Comparative Efficacy Study (DOLCE) was a randomized, single-blinded, three-arm controlled trial. Patients (aged ≥18 years) with a full-thickness nonhealing diabetic foot ulcer who met inclusion/exclusion criteria were enrolled. RESULTS Of 169 eligible patients, 138 were enrolled and 117 randomly assigned. For 12 weeks, patients received standard of care (SOC), CM, or ACM. The primary outcome was the percentage of wounds healed by 12 weeks. Of the 117 participants, 41 were in the CM group, 48 in the ACM group, and 28 in the SOC group. There were 21 withdrawals, but seven had reached the first primary end point. Complete re-epithelialization of the ulcer by 12 weeks occurred in 59% of the 117 total participants: 49% in the CM group, 69% in the ACM group, and 57% in the SOC group (P = 0.16 by χ2 test). At 28 weeks, 25 participants (61%) in the CM group, 27 (56%) in the ACM group, and 18 (64%) in the SOC group had healed (P = 0.78). No differences were found in wound recidivism or adverse event occurrence between groups. CONCLUSIONS No difference in efficacy was found between SOC, ACM, and CM, suggesting that SOC can reduce the economic burden of diabetic foot ulcer treatment.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"37 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920102","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":"Type 1 Diabetes TrialNet: Leading the Charge in Disease Prediction, Prevention, and Immunotherapeutic Mechanistic Understanding","authors":"Laura M. Jacobsen, Jamie L. Felton, Brandon M. Nathan, Cate Speake, Jeffrey Krischer, Kevan C. Herold","doi":"10.2337/dc24-2908","DOIUrl":"https://doi.org/10.2337/dc24-2908","url":null,"abstract":"Established by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in 2001, Type 1 Diabetes TrialNet (TrialNet) is an international consortium of clinical research centers that studies the development of type 1 diabetes and performs clinical studies aimed at delaying or preventing the disease. In recognition of NIDDK’s 75th anniversary, this review will summarize the major findings, accomplishments, and future opportunities of its long-running program TrialNet. More than 20 intervention, observational, and mechanism-directed clinical studies have been conducted in collaboration with thousands of people living with type 1 diabetes and their families. New and repurposed immunotherapies have been successful in stages 2 and 3 of type 1 diabetes, contributing to the U.S. Food and Drug Administration approval of the first disease-modifying therapy to delay the onset of type 1 diabetes. Mechanistic findings continue to drive ongoing and future trial designs including novel combination therapies. TrialNet has several ongoing trials, with several for early stages of type 1 diabetes in development. There are new initiatives within TrialNet for community engagement, increasing clinical trial representation, personalizing treatments, and training the next generation of translational investigators.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"44 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920103","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":"Comparison of Insulin Titration Strategies for Glycemic Control in Type 2 Diabetes: A Systematic Review and Network Meta-analysis","authors":"Kansak Boonpattharatthiti, Kirana Wechkunanukul, Noramon Mayang, E Lyn Lee, Anjana Fuangchan, Alice Y.Y. Cheng, Nathorn Chaiyakunapruk, Teerapon Dhippayom","doi":"10.2337/dc24-2661","DOIUrl":"https://doi.org/10.2337/dc24-2661","url":null,"abstract":"BACKGROUND Adjusting basal insulin doses is essential for lowering blood glucose while minimizing the risk of hypoglycemia. Despite various basal insulin titration strategies being available, their comparative effectiveness remains unclear. PURPOSE To compare the effectiveness of different basal insulin titration strategies on glycemic control in patients with type 2 diabetes. DATA SOURCES PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and EBSCO Open Dissertations were searched from inception to January 2024. STUDY SELECTION We included published trials with evaluation of basal insulin titration strategies for glycemic control in type 2 diabetes. DATA EXTRACTION Data on HbA1c and severe hypoglycemia were extracted. DATA SYNTHESIS Studies were categorized with the theme, intensity, and provider/platform (TIP) framework. “Theme” referred to conventional titration (Conv) or self-titration (ST), “intensity” was categorized as high (Conv, >1/month; ST, ≥2/week) or low (Conv, ≤1/month; ST, <2/week), and for “provider/platform” categories included supported by health care provider (HCP for Conv or S-HCP for ST), patient led (Pt), and supported by application (S-App). The ST/High/S-HCP strategy resulted in the greatest HbA1c reduction in comparison with all others (e.g., ST/High/S-App, mean difference −0.75 [95% CI −1.26, −0.25], and Conv/Low/HCP, −1.19 [95% CI −1.67, −0.72]). Severe hypoglycemia risk did not differ significantly across strategies. LIMITATIONS The number of studies per network meta-analysis was limited, and not all TIP combinations were evaluated. CONCLUSIONS Self-titration at least twice a week with health care provider support leads to superior HbA1c reduction in comparison with other strategies, without increasing the risk of severe hypoglycemia. This approach should be considered for clinical practice, where appropriate, to achieve optimal glycemic control in patients with type 2 diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"25 1","pages":"837-845"},"PeriodicalIF":16.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920212","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":"Premeal Whey Protein Lowers Postprandial Blood Glucose in Women With Gestational Diabetes Mellitus: A Randomized, Crossover Clinical Trial","authors":"Stine Smedegaard, Ulla Kampmann, Per G. Ovesen, Louise B. Suder, Janni H. Knudsen, Gregers Wegener, Lise H. Brunsgaard, Nikolaj Rittig","doi":"10.2337/dc24-2831","DOIUrl":"https://doi.org/10.2337/dc24-2831","url":null,"abstract":"OBJECTIVE To examine how whey protein served as a premeal affects postprandial glucose excursions in women with gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS A placebo-controlled, single-blinded, crossover, randomized trial including women with and without GDM (20–36 weeks’ gestation) was performed. Participants were studied in the laboratory and at home. In the laboratory, women were randomized to consume 20 g of whey or placebo 30 min before undergoing, 7–14 days later, a 75-g oral glucose tolerance test (OGTT). Blood was sampled consecutively 3 hours following the OGTT. The primary end point was the incremental area under the curve (iAUC) for glucose. At home, participants wore continuous glucose monitors and, on subsequent days, randomly consumed 0, 10, 15, 20, and 30 g of whey 30 min before breakfast. RESULTS Twelve women with GDM and 12 pregnant women with normal glucose tolerance (NGT) to part in the trials. Intake of premeal whey resulted in lowered peak glucose by −1.0 mmol/L (95% CI −1.6 to −0.4) in women with GDM and −0.7 mmol/L (95% CI −1.3 to −0.1) in women without GDM compared with placebo. Insulin, glucose-dependent insulinotropic polypeptide, and glucagon-like peptide-1 levels increased rapidly after whey consumption in both groups. At home, a premeal of 30 g of whey dose-dependently reduced incremental glucose peaks with a maximum of −2.0 mmol/L (95% CI −2.5 to −1.5) in women with GDM compared with placebo. CONCLUSIONS Premeal whey consumption acutely lowers postprandial blood glucose in women with GDM and those with NGT, with 15–30 g lowering the glucose iAUC of women with GDM. These findings emphasize the need for long-term studies to assess the impact of whey premeals in pregnancies affected by GDM.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"12 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920106","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":"Energy Restriction, Weight Loss, Glycemia, and Breastfeeding Outcomes in Gestational Diabetes: A DiGest Trial Secondary Analysis","authors":"Sarah Dib, Laura C. Kusinski, Danielle L. Jones, Nooria Atta, Suzanne Smith, Emanuella De Lucia Rolfe, Helen R. Murphy, Roy Taylor, Claire L. Meek","doi":"10.2337/dc24-2625","DOIUrl":"https://doi.org/10.2337/dc24-2625","url":null,"abstract":"OBJECTIVE We aimed to assess whether energy restriction, weight loss, or maternal glycemia in late pregnancy were associated with breastfeeding outcomes. RESEARCH DESIGN AND METHODS This is a secondary analysis of the Dietary Intervention in Gestational Diabetes (DiGest) randomized controlled trial, which included 425 participants with gestational diabetes who were randomly assigned to receive a standard-energy (2,000 kcal/day) or reduced-energy (1,200 kcal/day) diet box from 29 weeks until delivery, with masked continuous glucose monitoring. Breastfeeding intentions and outcomes were documented (n = 304 of 425) and analyzed using regression models. RESULTS Energy restriction in late pregnancy did not affect breastfeeding outcomes. Achieving ≥90% time in range (3.5–6.7 mmol/L; 63–120 mg/dL) with a low glycemic variability (coefficient of variation and SD), but not weight loss, were associated with any breastfeeding at 3 months postnatally. CONCLUSIONS Improved late pregnancy glycemia and decreased glucose variability, but not weight loss or energy restriction, were associated with breastfeeding after gestational diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"228 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920113","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}