Diabetes Care最新文献

{"title":"Subphenotype-Dependent Benefits of Bariatric Surgery for Individuals at Risk for Type 2 Diabetes","authors":"Leontine Sandforth, Violeta Raverdy, Arvid Sandforth, Pierre Bauvin, Estelle Chatelain, Helene Verkindt, Geltrude Mingrone, Caterina Guidone, Ornella Verrastro, Karin Zhou, Rami Archid, André Mihaljevic, Robert Caiazzo, Gregory Baud, Camille Marciniak, Mikael Chetboun, Marlene Ganslmeier, Vitória Minelli Faiao, Martin Heni, Louise Fritsche, Anja Moller, Konstantinos Kantartzis, Andreas Peter, Rainer Lehmann, Robert Wagner, Katsiaryna Prystupa, Andreas Fritsche, Norbert Stefan, Hubert Preissl, Andreas L. Birkenfeld, Reiner Jumpertz von Schwartzenberg, François Pattou","doi":"10.2337/dc25-0160","DOIUrl":"https://doi.org/10.2337/dc25-0160","url":null,"abstract":"OBJECTIVE Bariatric surgery is an effective treatment option for individuals with obesity and type 2 diabetes (T2D). However, whether outcomes in subtypes of individuals at risk for T2D and/or comorbidities (Tübingen Clusters) differ, is unknown. Of these, cluster 5 (C5) and cluster 6 (C6) are high-risk clusters for developing T2D and/or comorbidities, while cluster 4 (C4) is a low-risk cluster. We investigated bariatric surgery outcomes, hypothesizing that high-risk clusters benefit most due to great potential for metabolic improvement. RESEARCH DESIGN AND METHODS We allocated participants without T2D but at risk for T2D, defined by elevated BMI, to the Tübingen Clusters. Participants had normal glucose regulation or prediabetes according to American Diabetes Association criteria. Two cohorts underwent bariatric surgery: a discovery (Lille, France) and a replication cohort (Rome, Italy). A control cohort (Tübingen, Germany) received behavioral modification counseling. Main outcomes included alteration of glucose regulation parameters and prediabetes remission. RESULTS In the discovery cohort, 15.0% of participants (n = 121) were allocated to C4, 22.3% (n = 180) to C5, and 62.4% (n = 503) to C6. Relative body weight loss was similar among all clusters; however, reduction of insulin resistance and improvement of β-cell function were strongest in C5. Prediabetes remission rate was lowest in low-risk C4 and highest in high-risk C5. Individuals from high-risk clusters changed to low-risk clusters in both bariatric surgery cohorts but not in the control cohort. CONCLUSIONS Participants in C5 had the highest benefit from bariatric surgery in terms of improvement in insulin resistance, β-cell function, and prediabetes remission. This novel classification might help identify individuals who will benefit specifically from bariatric surgery.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"27 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822734","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":"M120 Risk Score Improves Identification of Children at High Risk of Developing Clinical Type 1 Diabetes and Reports Short-Term Response to Preventive Immunotherapy","authors":"Minh V. Le, Leonard C. Harrison, Tim Spelman, John M. Wentworth","doi":"10.2337/dc24-2794","DOIUrl":"https://doi.org/10.2337/dc24-2794","url":null,"abstract":"OBJECTIVE Approval of teplizumab as disease-modifying therapy for type 1 diabetes heralds a new therapeutic era. To facilitate prevention trials, we determined if the M120 risk score could enrich for type 1 diabetes risk and define early treatment effects. RESEARCH DESIGN AND METHODS M120, based on age, sex, BMI, IA-2 antibody status, HbA1c, blood glucose, and C-peptide 120 min after oral glucose, was determined in TrialNet participants with multiple islet autoantibodies and those who joined the teplizumab prevention trial. RESULTS Compared with the oral glucose tolerance test, M120 identified 26% more children at high risk of progression. When applied to data from the teplizumab trial, M120 improved after teplizumab (P = 0.0362) and deteriorated after placebo (P = 0.0489) to reveal a significant treatment effect after 6 months (P < 0.001). CONCLUSIONS M120 improves risk stratification and identifies early effects of immunotherapy. It could be applied to increase prevention trial efficiency and guide treatment decisions in the clinic.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"4 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819372","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 Adverse Pregnancy Outcomes Among Asian Individuals With Gestational Diabetes Mellitus in the U.S., 2016–2021","authors":"Kartik K. Venkatesh, Xiaoning Huang, Nilay S. Shah,, Mark B. Landon, William A. Grobman, Sadiya S. Khan","doi":"10.2337/dc25-0060","DOIUrl":"https://doi.org/10.2337/dc25-0060","url":null,"abstract":"OBJECTIVE The risk of adverse pregnancy outcomes (APOs) differs among race and ethnic groups with gestational diabetes mellitus (GDM). Heterogeneity in APOs may be masked by aggregating these groups. We assessed whether the frequency and risk of APOs differed among Asian groups with GDM. RESEARCH DESIGN AND METHODS This is a serial cross-sectional analysis of U.S. birth certificate data (2016–2021) from individuals with a singleton first livebirth. The exposure was self-reported maternal race and ethnicity stratified by Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese versus non-Hispanic White as the reference. Maternal outcomes included: primary cesarean delivery, hypertensive disorders of pregnancy (HDP), intensive care unit admission, and transfusion. Neonatal outcomes included large-for-gestational-age (LGA), small-for-gestational-age (SGA), preterm birth, and neonatal intensive care unit (NICU) admission. RESULTS The study population included 29,370 Indian, 16,146 Chinese, 9,082 Filipino, 6,497 Vietnamese, 3,754 Korean, and 1,253 Japanese individuals, and 254,433 White individuals. Between 2016 and 2021, the frequency of HDP, but not other APOs, increased among most Asian groups. In multivariable analyses, individuals in all Asian groups had higher likelihood of SGA and lower likelihood of LGA compared with White individuals. Findings for other APOs were heterogeneous. The risk of APOs was generally highest among Filipino individuals, followed by Indian individuals, and lowest among Chinese individuals among Asian groups. CONCLUSIONS There was significant heterogeneity in the frequency and risk of APOs among Asian individuals with GDM in the U.S. Disaggregation of the Asian population in diabetes and pregnancy research and surveillance is necessary to identify opportunities for intervention.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"24 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819373","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":"Effect of Marked Weight Loss on Adipose Tissue Biology in People With Obesity and Type 2 Diabetes","authors":"Dmitri Samovski, Gordon I. Smith, Hector Palacios, Terri Pietka, Anja Fuchs, Gary J. Patti, Allah Nawaz, C. Ronald Kahn, Samuel Klein","doi":"10.2337/dc24-2739","DOIUrl":"https://doi.org/10.2337/dc24-2739","url":null,"abstract":"OBJECTIVE Weight loss improves insulin sensitivity in people with obesity and type 2 diabetes. However, the mechanisms responsible for this effect are unclear. We hypothesized that alterations in adipose tissue biology and adipose tissue-related factors in plasma are involved in mediating the systemic metabolic benefits of weight loss. RESEARCH DESIGN AND METHODS We evaluated blood and adipose tissue samples obtained from 10 adults with obesity and type 2 diabetes before and after marked (16–20%) weight loss and >50% increase in whole-body insulin sensitivity, assessed by using the hyperinsulinemic-euglycemic clamp procedure. RESULTS Weight loss 1) decreased adipose tissue expression of genes related to extracellular matrix remodeling; 2) decreased adipose tissue expression of SERPINE 1, which encodes plasminogen activator inhibitor 1 (PAI-1); 3) did not decrease adipose tissue immune cell content or expression of genes involved in inflammation; 4) decreased adipose tissue ceramide content; 5) decreased plasma PAI-1 and leptin concentrations and increased plasma high-molecular weight (HMW) adiponectin; and 6) decreased plasma small extracellular vesicle (sEV) concentration and the sEV content of microRNAs proposed to inhibit insulin action, and completely reversed the inhibitory effect of plasma sEVs on insulin signaling in myotubes. CONCLUSIONS These findings suggest that weight loss increases insulin sensitivity in people with obesity and type 2 diabetes by modifying adipose tissue biology, with concomitant alterations in circulating PAI-1, leptin, HMW adiponectin, and sEV microRNAs.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"3 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819374","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 Urogenital Infections in People With Type 2 Diabetes Initiating SGLT2i Versus GLP-1RA in Routine Clinical Care: A Danish Cohort Study","authors":"Christine Ljungberg, Frederik Pagh Bredahl Kristensen, Michael Dalager-Pedersen, Christina Vandenbroucke-Grauls, Henrik Toft Sørensen, Mette Nørgaard, Reimar Wernich Thomsen","doi":"10.2337/dc24-2169","DOIUrl":"https://doi.org/10.2337/dc24-2169","url":null,"abstract":"OBJECTIVE Anticipated risks of urinary tract infections (UTI) and genital tract infections (GTI) associated with sodium–glucose cotransporter 2 inhibitors (SGLT2i) may prevent their use in clinical practice. We investigated whether initiation of SGLT2i, compared with glucagon-like peptide 1 receptor agonists (GLP-1RAs), was associated with an elevated risk of UTI and GTI in people with type 2 diabetes. RESEARCH DESIGN AND METHODS In this cohort study emulating a target trial, we included all adult metformin users initiating SGLT2i or GLP-1RAs in Denmark in 2016–2021 and used inverse-probability of treatment (IPT) weighting to balance potential confounders. We estimated IPT-weighted risk and risk ratios of community- or hospital-treated UTI and GTI, performing both intention-to-treat and on-treatment analyses. RESULTS This study included 52,414 SGLT2i initiators and 27,023 GLP-1RA initiators with a median follow-up of 2.9 to 3.9 years. The estimated risks of UTI within the first year were nearly identical: 10.0% in SGLT2i and 10.2% in GLP-1RAs in intention-to-treat analyses corresponding to a risk ratio of 0.98 (95% CI 0.94, 1.03). For GTI, the 1-year risks were elevated under SGLT2i therapy at 2.0% vs. 0.7% (risk ratio 2.95 [95% CI 2.52, 3.44]). During the 5-year follow-up, the relative UTI risk remained almost constant (0.96 [95% CI 0.94, 0.99]) whereas the GTI risk ratio with SGLT2is decreased to 1.64 (95% CI 1.49, 1.80). CONCLUSIONS In routine clinical care, SGLT2i initiation is not associated with increased risk of UTI compared with GLP-1RA initiation. However, early GTI risk is up to threefold larger in SGLT2i users.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"183 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766479","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":"Symptoms of Autonomic Nervous System Dysregulation and Diabetes Distress in Adults With Type 1 and Type 2 Diabetes","authors":"Mary de Groot, Barbara A. Myers, Timothy E. Stump, Deb Dana, Greg Lewis, Jacek Kolacz, Lauren Baker, Kelly A. Fox, Stephen W. Porges","doi":"10.2337/dc24-2614","DOIUrl":"https://doi.org/10.2337/dc24-2614","url":null,"abstract":"OBJECTIVE To test the association of autonomic nervous system (ANS) dysregulation symptoms and diabetes distress (DD) in adults with type 1 diabetes (T1D; study 1) and type 2 diabetes (T2D; study 2). RESEARCH DESIGN AND METHODS A total of 556 adults with T1D and 299 with T2D completed the Body Perception Questionnaire (BPQ) to assess ANS reactivity symptoms, diabetes distress (via Diabetes Distress Scale T1 [DDS-T1], and DDS-17), anxiety (via General Anxiety Disorder 7 [GAD-7]) scale, depression (via Patient Health Questionnaire-8 [PHQ-8]), and demographic variables via internet surveys. RESULTS In study 1, participants’ mean age was 45.1 (SD 15.7) years and most were female (73.2%) and White (95.3%). The mean self-reported A1c was 6.7% (SD = 1.0%); mean duration of T1D diagnosis 20.6 (SD 14.7) years; and 72.5% of participants reported using an insulin pump. The mean DDS-T1 score was 2.3 (SD 0.8; moderate severity). The BPQ mean T score was 48.9 (SD 8.4) for supradiaphragmatic and 50.6 (SD 8.9) for subdiaphragmatic reactivity subscales. In study 2, participants’ mean age was 60.2 (SD 13.6) years, 58.7% were female, and 82.9% were White. The mean self-reported A1c was 7.0% (SD 1.2%), and 51.8% of participants were treated with oral hypoglycemic agents and 39.9% used oral and injectable medications. The mean duration of T2D diagnosis was 15.0 (SD 10.0) years. The mean DDS-17 score was 2.3 (SD 1.0; moderate severity) and BPQ mean T score was 49.9 (SD 9.4) for supradiaphragmatic and 52.0 (SD 8.8) for subdiaphragmatic reactivity subscales. Controlling for covariates, severity of DDS-T1/DDS-17 significantly predicted elevations in ANS symptom T scores on all subscales (P ≤ 0.05 for all), with “high” DDS having the highest BPQ scores. CONCLUSIONS These findings demonstrate a relationship between ANS reactivity and DDS in T1D and T2D samples.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"30 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745079","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":"Dynamic Relationships Among Continuous Glucose Metrics and Momentary Cognitive Performance in Diverse Adults With Type 1 Diabetes","authors":"Claire J. Hoogendoorn, Raymond Hernandez, Stefan Schneider, Anne Peters, Meredith Hawkins, Elizabeth A. Pyatak, Jeffrey S. Gonzalez","doi":"10.2337/dc24-2431","DOIUrl":"https://doi.org/10.2337/dc24-2431","url":null,"abstract":"OBJECTIVE Despite established relationships between glycemia and cognition, few studies have evaluated within-person changes over time. We paired continuous glucose monitoring (CGM) with ambulatory cognitive testing to examine bidirectional associations among adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Participants wore blinded CGM and completed ambulatory tests of perceptual speed and sustained attention five or six times daily for 14 days. CGM metrics were calculated over 3-h periods (mean glucose, %time in range [70–180 mg/dL], %time in low [<70 mg/dL], %time in high [181–250 mg/dL], %time in very high [>250 mg/dL], and coefficient of variation). Immediate glucose values within 15 min of cognitive assessments were also examined. Dynamic structural equation models evaluated bidirectional relationships over sequential 3-h periods. RESULTS Among 182 diverse adults with T1D (age 40 ± 14 years, 46% male, 41% Latino, 29% White, 15% Black), more time in low glucose over 3 h was associated with slower perceptual speed at the end of that interval (P < 0.05) but not 3 h later. More time in high glucose (>250) was associated with faster perceptual speed initially but slower speed 3 h later (P < 0.05). Physical activity partially mediated the effect of high glucose on slower perceptual speed. Glycemia did not predict attention scores within persons. Lower attention and higher perceptual speed predicted higher mean glucose and more time in very high glucose over the following 3 h (P < 0.05). CONCLUSIONS These novel observations of significant bidirectional association between glycemia and cognitive performance over the course of the day among adults with T1D emphasize the importance of examining within-person longitudinal effects over different time frames.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"1 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745076","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":"Community-Based Peer Support for Diabetes Management: 24-Month Changes Relative to Comparison Communities","authors":"Yuexing Liu, Chun Cai, Jiahe Tian, Li Shen, Patrick Y. Tang, Muchieh Maggy Coufal, Hongli Chen, Megan S. Evans, Yiqing Qian, Wenya Yu, Xiaoyu Wu, Xiaobing Wu, Edwin B. Fisher, Weiping Jia","doi":"10.2337/dc24-2748","DOIUrl":"https://doi.org/10.2337/dc24-2748","url":null,"abstract":"OBJECTIVE To evaluate the effectiveness of community-based peer support for diabetes self-management with HbA1c and other clinical and psychosocial outcomes over 24 months. RESEARCH DESIGN AND METHODS This study used an intervention comparison design with 12 intervention communities and 4 comparison communities matched according to location in urban or suburban areas. A community organization approach was used to integrate standardization of key messages and patient education protocols, along with adaptation and innovation among multiple community partners. The primary outcome was HbA1c; secondary outcomes included BMI, fasting plasma glucose (FPG), systolic and diastolic blood pressure, LDL cholesterol (LDL-C), depressive symptoms (PHQ-8), diabetes distress, and general quality of life (EQ-5D). RESULTS The analyses included 967 participants completing both the baseline and follow-up assessment. Intervention communities versus comparison communities were older (mean age 66.43 vs. 63.45 years), included more women (57.1% vs. 45.5%), and had longer diabetes duration (mean 7.95 vs. 6.40 years). Significant improvements were found for HbA1c (7.42% [58 mmol/mol] vs. 7.95% [63 mmol/mol]), BMI (25.31 vs. 25.94 kg/m2), FPG (7.91 vs. 8.59 mmol/L), and depressive symptoms (PHQ-8 score 1.39 vs. 1.41), favoring intervention communities, after adjusting for baseline values of outcome measures and confounders (P ≤ 0.028). No interactions were found with age (<65 vs. ≥65 years). Men showed modestly greater diastolic blood pressure reduction, and women showed a minor increase of LDL-C in intervention communities. These analyses by age or sex and sensitivity analyses with missing data imputation supported the robustness of findings. CONCLUSIONS Culturally adapted and appropriate community-based peer support for diabetes management may improve clinical and psychosocial outcomes at 24 months among people with diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"22 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745077","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":"Association Between Use of Sodium–Glucose Cotransporter 2 Inhibitors and Epilepsy: A Population-Based Study Using Target Trial Emulation","authors":"Houyu Zhao, Baixue Zhang, Lin Zhuo, Yueqi Yin, Yexiang Sun, Peng Shen, Zhiqin Jiang, Siyan Zhan","doi":"10.2337/dc24-2532","DOIUrl":"https://doi.org/10.2337/dc24-2532","url":null,"abstract":"OBJECTIVE Preclinical studies in animals have suggested potential neuroprotective effects of sodium–glucose cotransporter 2 inhibitors (SGLT-2is), but no epidemiological study has investigated the potential effects of SGLT-2is on epilepsy risk. We aimed to assess the association between use of SGLT-2is and epilepsy incidence. RESEARCH DESIGN AND METHODS We emulated a target trial comparing SGLT-2is and dipeptidyl peptidase 4 inhibitors (DPP-4is) based on the Yinzhou Regional Health Care Database. Cohorts of patients with type 2 diabetes mellitus who were new users of an SGLT-2i or a DPP-4i were assembled. Inverse probability of treatment weighting (IPTW) and Cox proportional hazards regression modeling were applied to estimate the hazard ratio (HR) and 95% CI of the association between use of SGLT-2is and incidence of epilepsy. RESULTS The final cohort included 24,930 new users of SGLT-2is and 28,924 initiators of DPP-4is. A total of 243 patients with incident epilepsy were found during a median follow-up of 2.0 (interquartile range 0.8–3.3) years, with the incidence of epilepsy being 174.2 and 231.5 per 100,000 person-years in users of SGLT-2is and DPP-4is, respectively. After controlling for potential confounding using IPTW, SGLT-2i use was associated with a lower incidence of epilepsy, with an HR of 0.71 (95% CI 0.52–0.97). Various subgroup analyses and sensitivity analyses supported the results in primary analyses. CONCLUSIONS SGLT-2is were associated with a reduced incidence of epilepsy in the study population. More studies are needed to confirm and replicate the study results.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"4 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702770","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 Modern Role of Basal Insulin in Advancing Therapy in People With Type 2 Diabetes","authors":"Geremia B. Bolli, Philip D. Home, Francesca Porcellati, Matthew C. Riddle, Hertzel C. Gerstein, Paola Lucidi, Carmine G. Fanelli, David R. Owens","doi":"10.2337/dci24-0104","DOIUrl":"https://doi.org/10.2337/dci24-0104","url":null,"abstract":"Insulin deficiency, often aggravated by insulin resistance, results in type 2 diabetes mellitus (T2DM). With the availability of glucagon-like peptide 1 receptor agonists and sodium–glucose cotransporter 2 inhibitors, basal insulin (BI) therapy is no longer the first-line option after lifestyle modification plus oral agents is insufficient. In contrast to BI, the newer medications require minor titration, lower hyperglycemia in a glucose-dependent manner, and reduce body weight. Importantly, the newer agents reduce cardiorenal events in the short term. Nonetheless, insulin therapy continues to play a key role in control of hyperglycemia and therefore long-term prevention of vascular complications. Its use is essential in many circumstances, including metabolic emergencies, new diabetes onset, latent autoimmune diabetes (LADA), pregnancy, and when other agents are less desirable due to comorbidities. BI is needed in the frequent condition of failure of other therapies to keep HbA1c to target and/or intolerance of them. There are several advantages to the combination of BI with the newer medications given their different but complementary mechanisms of action, primarily, the lower dose of each, improving adherence and outcomes while decreasing the side effects. Multiple choices for single or combination use can better meet the variety of clinical phenotypes in the heterogeneous T2DM population, using the tenets of precision medicine.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"20 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672363","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}