Diabetes Care最新文献

{"title":"Impact of Metabolic Bariatric Surgery on Weight Loss and Glycemic Control in Adults With Type 1 Diabetes: A Multicenter Retrospective Cohort Study","authors":"Rieneke van der Meer, Sofia Pazmino, Nele Steenackers, Amar van Laar, Maarten Sluis, Luna Tolenaars, Jonathan Rosen, Carmen Hurtado del Pozo, Carel W. le Roux, Jumana Al Kandari, Mohammad Irshad, Matthias Lannoo, Ellen Deleus, Bruno Dillemans, Yves Van Nieuwenhove, Arianne van Bon, Eric Hazebroek, Ebaa Al Ozairi, Roel Hoogma, Chantal Mathieu, Ronald Liem, Bart Van der Schueren","doi":"10.2337/dc25-2295","DOIUrl":"https://doi.org/10.2337/dc25-2295","url":null,"abstract":"OBJECTIVE To assess the effect of metabolic bariatric surgery (MBS) in people living with type 1 diabetes (T1D) and obesity. RESEARCH DESIGN AND METHODS From retrospective multicenter data, total weight loss, daily insulin requirement, HbA1c, and cardiometabolic parameters were assessed before and after surgery. Longitudinal models were used to identify response determinants. RESULTS This study included 162 people living with T1D and obesity. One year after surgery, mean total weight loss percentage was 29.7% (interquartile range (IQR) = 29.4, 30.3). Insulin requirements dropped from 0.75 (IQR = 0.58, 1.00) units/kg/day to 0.32 (IQR = 0.23, 0.43) units/kg/day (P < 0.001), and HbA1c from 64.0 (IQR = 57.0, 74.0) mmol/mol to 60.0 (IQR = 53.4, 68.0) mmol/mol (P < 0.001). LDL, HDL, total cholesterol, and triglyceride levels significantly improved after surgery (P < 0.001). Greater total weight loss was associated with reduced insulin requirements, and higher baseline HbA1c was associated with poorer postsurgery glycemic control. CONCLUSIONS MBS was associated with substantial metabolic improvement in people with T1D and obesity, in particular in those with high HbA1c and insulin need at baseline.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"180 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215706","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 an Additional Pregnancy on the Natural History of Insulin Sensitivity, β-Cell Function, and Glycemia in Parous Women","authors":"Ravi Retnakaran, Junwei Shen, Anthony J. Hanley, Bernard Zinman","doi":"10.2337/dc25-2354","DOIUrl":"https://doi.org/10.2337/dc25-2354","url":null,"abstract":"OBJECTIVE It has been postulated that pregnancies may contribute to the lifetime risk of type 2 diabetes mellitus (T2DM) in women, although direct evidence is lacking. In this context, we hypothesized that pregnancy may impact the long-term natural history of the pathophysiologic determinants of T2DM: insulin sensitivity and β-cell function. We sought to evaluate 10-year trajectories of these features in parous women with and without an additional pregnancy. RESEARCH DESIGN AND METHODS Metabolic characterization was done in 303 women at 1 year postpartum and on three or more occasions over the decade thereafter. Each assessment included an oral glucose tolerance test, enabling serial evaluation of insulin sensitivity/resistance (Matsuda index; HOMA-insulin resistance [IR]), β-cell function (Insulin Secretion-Sensitivity Index-2; insulinogenic index/HOMA-IR), and glycemia. Linear mixed-effect models adjusted for diabetes risk factors were constructed to evaluate the natural time trend of these measures over 10 years in those with (n = 78) and without (n = 225) an additional pregnancy. RESULTS At baseline, women who subsequently had an additional pregnancy were younger (P < 0.001) and more likely to be primiparous (P < 0.001) than their peers. Notably, they had higher covariate-adjusted insulin sensitivity (Matsuda index) at baseline (estimated adjusted average difference 1.64; 95% CI 0.22–2.86) and at 1.5 years’ follow-up (1.28; −0.15 to 2.50), but this difference disappeared by 3.5 years and 5.5 years. The 10-year trajectory of the Matsuda index differed between the groups (time-group interaction P = 0.02), with no differences in trajectories of β-cell function and glycemia. CONCLUSIONS Pregnancy is associated with worsening of the long-term trajectory of insulin sensitivity, revealing both a pathophysiologic basis for enhanced diabetes risk and a target for risk modification.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"20 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215828","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":"National Trends in Expenditures on Glucose-Lowering Medications in U.S. Adults With Diabetes: 2000–2022","authors":"Yu Wang, Kai McKeever Bullard, Ping Zhang","doi":"10.2337/dc25-2016","DOIUrl":"https://doi.org/10.2337/dc25-2016","url":null,"abstract":"OBJECTIVE Expenditures on glucose-lowering prescriptions may have changed because of the introduction of new medication classes and changes in insurance policies. This study analyzed national trends in per capita expenditures on glucose-lowering medications among U.S. adults with diabetes during 2000–2022. RESEARCH DESIGN AND METHODS Using Medical Expenditure Panel Surveys data, we analyzed annual per capita expenditures on glucose-lowering medications among persons aged ≥18 years with self-reported diabetes. Expenditures were calculated overall and by subgroups defined by age, race and ethnicity, income, and insurance status. Medications were grouped as older oral agents (metformin, sulfonylureas, thiazolidinediones, α-glucosidase inhibitors, meglitinides), newer noninsulin agents (dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, amylin analogs, combination products), human insulin, and analog insulin. Joinpoint regression was used to identify trend changes. We also estimated the change in number of users and expenditure per user for each medication category. Expenditures were adjusted to 2022 U.S. dollars. RESULTS Total per capita expenditures on glucose-lowering medications increased by 335%, from $856 in 2000 to $3,725 in 2022. Expenditures rose by $29 per year during 2000–2012, then accelerated by $224 annually. Expenditures increased substantially on newer noninsulin agents while declining on older oral agents, and human insulin expenditures declined. Analog insulin expenditures rose initially but plateaued after 2016. The upward trend in newer high-cost therapies was primarily driven by an increased number of users. CONCLUSIONS Per capita expenditures on newer medications have risen markedly. Identifying key drivers of these expenditures may enhance affordability and access to effective diabetes treatments.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"325 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146210488","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":"Glucagon-Like Peptide 1 Receptor Agonists and Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients With Type 2 Diabetes","authors":"Yunha Noh, Hui Yin, Inès Ben Ghezala, Oriana H.Y. Yu, Samy Suissa, Laurent Azoulay","doi":"10.2337/dc25-2577","DOIUrl":"https://doi.org/10.2337/dc25-2577","url":null,"abstract":"OBJECTIVE To estimate the effect of initiating glucagon-like peptide 1 receptor agonists (GLP-1 RAs) versus dipeptidyl peptidase 4 (DPP-4) inhibitors on incident nonarteritic anterior ischemic optic neuropathy (NAION) among adults with type 2 diabetes. RESEARCH DESIGN AND METHODS This active-comparator, new-user cohort emulated a pragmatic target trial using the U.K. Clinical Practice Research Datalink. Patients aged ≥18 years with a physician diagnosis of type 2 diabetes who newly initiated a GLP-1 RA or a DPP-4 inhibitor were included. DPP-4 inhibitors were selected as the comparator because they may be used as second-line treatment, like GLP-1 RAs, and have no established association with NAION. We estimated risks, risk differences (RDs), and risk ratios (RRs) of incident NAION, adjusted using propensity-score fine-stratification weighting. RESULTS At 1 year, there were 14 NAION events among 106,858 GLP-1 RA initiators (18.5 per 100,000) and 53 among 416,369 DPP-4 inhibitor initiators (7.2 per 100,000). GLP-1 RAs were associated with an increased risk of NAION compared with DPP-4 inhibitors (RR 2.56; 95% CI 1.44–4.86; RD 11.3 per 100,000). The risk of NAION was higher during the first 6 months of use, diminishing with longer duration of use, and was higher in patients aged <50 years, men, ever-smokers, and those with ≥1% hemoglobin A1c reduction. CONCLUSIONS GLP-1 RAs were associated with an increased 1-year risk of NAION compared with DPP-4 inhibitors among adults with type 2 diabetes, particularly in younger patients, men, ever-smokers, and patients with a marked hemoglobin A1c reduction.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"199 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146210312","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":"Maternal Diabetes and Early Neurodevelopment: Differential Milestone Attainment in Offspring by Diabetes Type","authors":"Liya Kerem, Joshua Guedalia, Michal Lipschuetz, Dvora R. Sehtman-Shachar, Adva Cahen-Peretz, Sarah M. Cohen, Michal Novoselsky-Persky, Hagai Amsalem, Galit Shefer, Sofia Drawshy, Ronit Calderon-Margalit, Ofer Beharier","doi":"10.2337/dc25-2456","DOIUrl":"https://doi.org/10.2337/dc25-2456","url":null,"abstract":"OBJECTIVE Maternal diabetes increases offspring risk for neurodevelopmental disorders, but its association with delayed developmental milestones is unknown. We examined milestone attainment in offspring of mothers with gestational diabetes mellitus (GDM) and pregestational type 1 and type 2 diabetes compared with unexposed controls. RESEARCH DESIGN AND METHODS We examined a nationwide retrospective cohort study of 466,462 term singleton infants born January 2018 to December 2021 using linked national maternal-child health clinic and hospital discharge data. Developmental data were obtained from nurse-administered structured assessments at routine well-child visits through 24 months of age. Adjusted hazard ratios (aHRs) and 95% CIs for failure to attain developmental milestones were estimated by diabetes type and infant sex. RESULTS Pregestational diabetes was associated with increased risk for delayed milestone attainment in language, personal-social, and gross motor domains compared with control groups. Offspring of mothers with type 1 diabetes showed the highest risk, followed by those with type 2 diabetes. The association between type 1 diabetes and developmental delay was primarily driven by female offspring, with elevated risks in personal-social (aHR, 1.64; 95% CI, 1.14–2.36), language (aHR, 1.44; 95% CI, 1.09–1.89), and gross motor (aHR, 1.41; 95% CI, 1.05–1.89) domains. GDM was associated with modestly increased risk limited to the fine motor domain (aHR, 1.11; 95% CI, 1.06–1.16). CONCLUSIONS Pregestational diabetes is associated with delayed milestone attainment, with risk varying by diabetes type, developmental domain, and infant sex. Further research should explore long-term trajectories to inform early intervention for children exposed to maternal diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"29 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146169369","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":"Estimated Optimal Individualized Diabetes Risk Prediction From Preventive Interventions in the U.S. General Population","authors":"Jeanette M. Stafford, Byron Jaeger, Ramon Casanova, Yitbarek Demesie, Brian Wells, Michael P. Bancks","doi":"10.2337/dc25-2268","DOIUrl":"https://doi.org/10.2337/dc25-2268","url":null,"abstract":"OBJECTIVE To calculate 3-year predicted risk for diabetes with a model including individualized preventive intervention effects for metformin therapy and intensive lifestyle among U.S. adults with prediabetes. RESEARCH DESIGN AND METHODS We included 2,778 participants with prediabetes from the National Health and Nutrition Examination Survey cycles 2015–2020. Using a validated type 2 diabetes risk prediction model, we calculated predicted risk and summarized the optimal prevention strategy (lowest predicted risk). RESULTS Mean predicted risk in this sample was 18.4% (95% CI 17.6, 19.3) for standard lifestyle recommendations (placebo), 14.4% (95% CI 13.9, 14.8) for metformin, 8.0% (95% CI 7.6, 8.4) for intensive lifestyle, and 7.6% (95% CI 7.2, 7.9) for participants’ respective optimal intervention. The optimal intervention strategy was intensive lifestyle for 91% of the analytic sample. CONCLUSIONS We demonstrate the potential population health benefits for diabetes prevention with use of a clinical decision tool, a diabetes risk prediction model with individualized preventive intervention effects.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"41 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101414","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":"Global, Regional, and National Estimates of Undiagnosed Diabetes in Adults: Findings From the 2025 IDF Diabetes Atlas","authors":"Felix Teufel, Katherine Orgutsova, Irini Genitsaridi, Rodrigo M. Carrillo-Larco, Jithin Sam Varghese, Maja E. Marcus, Julian W. Sacre, Seyedeh Forough Sajjadi, Faraja Chiwanga, Jennifer Manne-Goehler, Jacqueline Seiglie, David Flood, Jessica Harding, Paraskevi Salpea, Agus Salim, Edward J. Boyko, Dianna J. Magliano, Mohammed K. Ali","doi":"10.2337/dc25-2583","DOIUrl":"https://doi.org/10.2337/dc25-2583","url":null,"abstract":"OBJECTIVE Undiagnosed diabetes leads to delayed treatment and increased risk of complications, exacerbating global disease burdens. In this study, we estimated the prevalence and absolute numbers of individuals with undiagnosed diabetes globally and across regions and quantified gaps in national diabetes detection efforts. RESEARCH DESIGN AND METHODS We systematically compiled estimates of biomarker-based diabetes prevalence and self-reported diabetes diagnosis using 2003–2024 data from all eligible population-based studies and gray literature. We calculated proportions of individuals with undiagnosed diabetes and case numbers among adults aged 20–79 years. For countries without data, we extrapolated estimates using available data within the same geographic region and country income group. Country-level estimates were benchmarked against the World Health Organization 80% diagnosis target. RESULTS We identified 193 data sources on undiagnosed diabetes from 109 countries. Across all 215 countries/territories, 42.8% of individuals with diabetes were undiagnosed in 2024, equating to 251.7 million (95% uncertainty interval [UI] 250.4–253.0 million) adults. Proportions undiagnosed ranged from 16.2% in Colombia to 90.4% in Burkina Faso and 29.1% in North America and the Caribbean to 72.6% in Africa. A larger proportion of individuals were undiagnosed in low-income (58.7%) compared with high-income countries (28.9%). Middle-income countries accounted for 206.0 million (95% UI 202.3–209.7 million) adults with undiagnosed diabetes (81.8% of all individuals), including 127.1 million (95% UI 121.2–133.0 million [or 50.5%]) adults in China, India, and Indonesia alone. Less than 5% of all countries attained diabetes diagnosis levels ≥80%. CONCLUSIONS Substantial global variability in undiagnosed diabetes indicates opportunities to close existing care gaps, likely requiring context-specific solutions and investments.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"78 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089882","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":"GLP-1 Receptor Agonists and Risk of Optic Nerve or Vision-Threatening Events in Patients With Type 2 Diabetes or Cardiometabolic Diseases: A Meta-analysis of Randomized Controlled Trials","authors":"Hoi-Ying Li, Tsz-Kwan Chan, Kendrick Co Shih, Bernard M.Y. Cheung, Kai-Hang Yiu, Hung-Fat Tse, Yap-Hang Chan","doi":"10.2337/dc25-1929","DOIUrl":"https://doi.org/10.2337/dc25-1929","url":null,"abstract":"BACKGROUND Data concerning glucagon-like peptide 1 receptor agonists (GLP-1 RAs) on risk of ischemic optic neuropathy (ION) are conflicting. PURPOSE We synthesize current evidence of GLP-1 RAs on risk of optic nerve or vision-threatening events from randomized controlled trials (RCTs) in patients with type 2 diabetes or cardiometabolic diseases. DATA SOURCE A total of 83,288 participants with type 2 diabetes/cardiometabolic diseases from 20 published RCTs were analyzed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). STUDY SELECTION RCTs investigating GLP-1 RAs for type 2 diabetes/cardiometabolic disease populations and reported optic nerve or vision-related adverse events were assessed. DATA EXTRACTION Primary outcome was a composite of optic nerve and/or vision-threatening serious adverse events, including ION, ocular ischemic syndrome, papilledema, blindness, blurred vision, visual impairment, and reduced visual acuity. Odds ratios (ORs) were derived. DATA SYNTHESIS Type 2 diabetes occurred in 76.4% of participants. Over mean follow-up duration of 2.97 years (estimated cumulative exposure of 240,334 patient-years), GLP-1 RA use was not associated with increased risk of primary end point (OR 1.20, 95% CI 0.73–1.97, I2 = 0%). Prespecified individual adverse events, including ION (OR 1.50, 95% CI 0.49–4.63), and vision loss/disturbance events (OR 1.08, 95% CI 0.60–1.94) were not significantly associated with GLP-1 RA use. LIMITATIONS RCTs reported vision-threatening events as adverse events rather than as prespecified outcomes. CONCLUSIONS Based on a large number of patients who contributed to a meta-analysis of RCTs involving participants with type 2 diabetes and cardiometabolic disease, GLP-1 RAs were not associated with an increased risk of optic nerve/vision-threatening events.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"217 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047916","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":"New Perspectives: Four Unsung Heroes of Diabetes Research","authors":"Vanessa Heggie","doi":"10.2337/dci25-0055","DOIUrl":"https://doi.org/10.2337/dci25-0055","url":null,"abstract":"This article explores four little-known stories about research into, and treatment for, diabetes. Progressing in order from the participant about whose story we know the most to those about whom we know the least demonstrates that clinical research and therapeutic development are collaborative enterprises and that often key innovations and discoveries happen outside the laboratory setting. The role of unlikely individuals and collectives in reforming diabetes care is revealed, to nudge researchers into new and fruitful pathways. Further, this article shows how with a historical approach we can find the right stories of discovery to help both patients and researchers gain new insights into the prevention, management, and treatment of diabetes in all its forms.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"96 1","pages":"216-222"},"PeriodicalIF":16.2,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005903","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":"Assessing Time Below Range as a Predictor of Severe Hypoglycemia: Insights From Six Clinical Trials","authors":"Eslam Montaser, Clarence Williams, Viral N. Shah","doi":"10.2337/dc25-2353","DOIUrl":"https://doi.org/10.2337/dc25-2353","url":null,"abstract":"OBJECTIVE To evaluate whether baseline continuous glucose monitoring (CGM)–derived time below range (TBR) metrics—TBR level 1 (TBR1) (<70 mg/dL) and TBR level 2 (TBR2) (<54 mg/dL)—predicts severe hypoglycemia (SH) during follow-up of individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS Baseline CGM TBR levels and their association with SH adverse events during six clinical trials were analyzed using Wilcoxon rank-sum tests and Spearman correlations. Analyses were stratified by sex, race, and age group. Sensitivity, specificity, and false-positive rates (FPRs) were calculated for thresholds (1–5%), and receiver operating characteristic (ROC) analysis assessed discrimination. RESULTS Participants (n = 1,433; median age 4–43 years; 50–62% female sex; 83–96% White race) had a baseline median TBR2 range of 0.1% to 0.7% and TBR1 from 1.2% to 4.1% across the six clinical trials. Those who developed SH had slightly higher baseline TBR2 (0.41% vs. 0.32%; P = 0.022) and TBR1 (2.58% vs. 2.23%; P = 0.044). Predictive accuracy was limited: sensitivity of TBR2 fell from 48.9% at a 1% cutoff to 18.2% at 5% (specificity 75.9–95.0%), and TBR1 sensitivity declined from 81.8% to 44.3% (specificity 29.6–77.7%), with modest discrimination by ROC analysis (area under the curve = 0.62 [95% CI 0.55–0.69] for TBR2; and 0.65 [95% CI: 0.58–0.71] for TBR1). CONCLUSIONS Baseline TBR1 and TBR2 had limited predictive value for SH. No threshold achieved strong discrimination, a finding that supports the need to integrate additional clinical factors for SH risk stratification.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"32 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961654","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}