Diabetes Care最新文献

{"title":"Effect of Semaglutide on Insulin Dose Reduction in Adults With Type 1 Diabetes and Obesity Using Automated Insulin Delivery Systems: ADJUST-T1D Post Hoc Analysis","authors":"Kagan E. Karakus, Halis K. Akturk, Davida Kruger, Andrew Ahmann, Anuj Bharvaga, Christine R. Langel, Courtney A. Ackeifi, Jonathan Rosen, Laura Pyle, Janet K. Snell-Bergeon, Viral N. Shah","doi":"10.2337/dc25-2249","DOIUrl":"https://doi.org/10.2337/dc25-2249","url":null,"abstract":"OBJECTIVE In this post hoc analysis, we used the data from the Adjunct Semaglutide Treatment in Type 1 Diabetes (ADJUST-T1D) trial, a double-blind, multicenter, randomized, placebo-controlled trial of semaglutide 1 mg/week in adults with type 1 diabetes [[T1D]and obesity), to evaluate the relationship between insulin dose reduction and weight loss. RESEARCH DESIGN AND METHODS Changes between semaglutide and placebo groups over 26 weeks in total daily insulin dose (TDD), basal and bolus insulin doses, carbohydrate intake, and user-initiated bolus counts were analyzed using linear mixed models. Mediation analysis was used to attribute direct effects of semaglutide versus weight loss on insulin dose reduction. RESULTS From baseline to week 26, there was a significant 22.6% reduction in TDD (95% CI −28.3 to −17.0), which was driven by greater reductions in bolus insulin (−30.5%; 95% CI −39.5 to −21.5) than basal insulin (−15.6%; 95% CI −21.5 to −9.7). The basal/TDD ratio increased from 0.56 to 0.62 (P < 0.001) and insulin dose (in units/kg/day) decreased from 0.72 to 0.60 (P < 0.001) in the semaglutide group. At week 4, an 83% (−11.1 U/day) reduction in TDD was due to a direct drug effect, and 17% (−2.3 U/day) was attributed to weight loss, whereas at week 26, the difference was split evenly between direct effect (−11.4 U/day; 52%) and weight loss (−10.5 U/day; 48%). Daily carbohydrate intake decreased from 137 g (95% CI 107–167) at baseline to 107 g (95% CI 76–137) at 26 weeks. CONCLUSIONS Semaglutide produced rapid, sustained, and primarily bolus-driven insulin dose reductions, with early effects being largely independent of weight loss in adults with T1D and obesity.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"3 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807423","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 of Insulin Resistance and Insulin Secretion Indices and Glucose Metrics From Continuous Glucose Monitoring in People With Obesity","authors":"Renata Belfort-DeAguiar, Catherine W. Yeckel, Ahmed Elshafie, Ana Paula Comarella, Janice J. Hwang","doi":"10.2337/dc25-1395","DOIUrl":"https://doi.org/10.2337/dc25-1395","url":null,"abstract":"OBJECTIVE To investigate the relationship between free-living glucose metrics obtained with continuous glucose monitoring (CGM) and validated indices of insulin resistance and insulin secretion in individuals with obesity: OB(+T2D) or OB(−T2D) for with and without type 2 diabetes, respectively. RESEARCH DESIGN AND METHODS Thirty-seven individuals (17 OB(+T2D) and 20 OB(−T2D) wore a CGM device and had a 2-h oral glucose tolerance test (OGTT). Of these, 27 also underwent a two-step hyperglycemic-euglycemic clamp. CGM metrics calculated with EasyGV software were correlated with indices of insulin secretion and insulin resistance from OGTT and clamp. RESULTS CGM metrics, such as mean and glycemic variability indices, were higher in OB(+T2D) than in OB(−T2D) (P < 0.001). CGM mean inversely correlated with insulin resistance indices (insulin sensitivity index from OGTT and glucose infusion rate [GIR] from the clamp) when analyzing all participants together (GIR: r = −0.82, P < 0.001) or separately (P < 0.01). CGM mean negatively correlated with insulin secretion indices only when the two groups were analyzed together (P < 0.05). When analyzing each group separately, CGM mean positively correlated with insulin levels during the OGTT and hyperglycemic step of the clamp in the OB(−T2D), but not the OB(+T2) group. CONCLUSIONS Our findings suggest that CGM metrics, in particular, the simplest metric, CGM mean, was associated with the degree of insulin resistance. Further research is needed to determine whether CGM mean could be a tool to identify normal glucose-tolerant individuals with obesity potentially at risk for progressing to prediabetes and diabetes, and whether its convergence with increased glycemic variability can further contribute to risk prediction of glycemic disorders.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"29 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145785836","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":"Stratifying the Rate of Disease Progression by Progression Likelihood Scores in Children and Adolescents With Stage 1 and Stage 2 Type 1 Diabetes in Germany","authors":"Andreas Weiss, Lenche Chakievska, Peter Achenbach, Maja Hergl, Sandra Hummel, Raffael Ott, Marlon Scholz, Christiane Winkler, Ezio Bonifacio, Anette-Gabriele Ziegler","doi":"10.2337/dc25-2184","DOIUrl":"https://doi.org/10.2337/dc25-2184","url":null,"abstract":"OBJECTIVE To stratify the progression rate to clinical stage 3 type 1 diabetes in children with early-stage disease. RESEARCH DESIGN AND METHODS The Fr1da study tested 211,464 children aged 1.75–10 years for islet autoantibodies. Children with early-stage type 1 diabetes were classified as stage 1 or stage 2 by oral glucose tolerance test (OGTT) and hemoglobin A1c (HbA1c) using current American Diabetes Association criteria and were followed 3–6 months. We applied our previously developed progression likelihood score (PLS), a composite of HbA1c, 90-min OGTT glucose, and islet antigen 2 antibodies (IA-2A) titer, and developed a non–OGTT-based score using multivariable Cox proportional hazards models to stratify progression rates to stage 3. RESULTS Of 485 children who participated in staging, 360 (74.2%) were diagnosed with stage 1. Of these, stage 3 developed in 105 (median follow-up 3.3 years). PLS stratified the 2-year risk for stage 3 from 43.7% (95% CI 24.3–58.1) in children with high PLS to 4.7% (1.7–7.7) and 0% in those with intermediate or low PLS. Adding the variable obesity improved the existing model. In children with stage 2 with a single dysglycemic abnormality, PLS could stratify 2-year risk for stage 3 from 42.4% (95% CI 22.8–57.0) to 5.6% (0.0–15.6). A non–OGTT-based score based on IA-2A titer categories, HbA1c, obesity, and autoantibody positivity for IA-2 juxtamembrane epitopes could identify individuals with low (1.7%) and moderate (24.6%) 2-year risk. CONCLUSIONS The PLS and a novel non–OGTT-based score can stratify the short- to medium-term progression rates to stage 3 and should be considered for guiding monitoring practices and clinical trial eligibility.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"9 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765334","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":"Gestational Diabetes Mellitus and Accelerated Biological Aging in Middle-Aged and Elderly Women","authors":"Bin Wang, Ningjian Wang, Xin Yin, Yuhui Huang, Guoqi Yu, Jiaxi Yang, Yap Seng Chong, Yingli Lu, Michelle A. Williams, Frank B. Hu, Cuilin Zhang","doi":"10.2337/dc25-1842","DOIUrl":"https://doi.org/10.2337/dc25-1842","url":null,"abstract":"OBJECTIVE To evaluate the association between gestational diabetes mellitus (GDM) and accelerated biological aging in middle-aged and elderly women. RESEARCH DESIGN AND METHODS We included parous women with a baseline survey on history of GDM and biological aging biomarkers from the UK Biobank. Information regarding prior GDM was collected via a touchscreen questionnaire and linkage to hospital admission records. Biological aging was evaluated using validated phenotypic age (PhenoAge) based on chronological age and nine biomarkers measured at baseline (2006–2010). Biological aging acceleration was determined as the residual by regressing PhenoAge estimates on chronological age. All-cause mortality and incident cardiometabolic disease during follow-up were also assessed. RESULTS Among the 178,363 women (mean age, 57.0 [SD 7.9] years), 1,141 had a history of GDM. In a multivariable-adjusted model, a history of GDM was associated with an increase in PhenoAge acceleration by 2.34 (95% CI 2.02, 2.66) years. The association persisted regardless of the occurrence of type 2 diabetes and related comorbidities after GDM. Consistent results were observed across subgroups, while the GDM-related PhenoAge acceleration was more prominent among women with less physical activity and obesity (both Pinteraction < 0.01). The mediation analysis demonstrated that PhenoAge acceleration explained 57.0% (95% CI 21.0, 86.9), 12.4% (7.3, 20.4), and 21.9% (14.0, 32.5) of the positive associations between GDM and all-cause mortality, type 2 diabetes, and cardiovascular disease, respectively. CONCLUSIONS Women with a history of GDM were biologically older than their non-GDM counterparts. The biological aging acceleration partially accounted for the associations between GDM and adverse health outcomes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"154 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765335","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 Effect of Substituting Water for Artificially Sweetened Beverages on Glycemic and Weight Measures in People With Type 2 Diabetes: The Study of Drinks With Artificial Sweeteners (SODAS), a Randomized Trial","authors":"Andrew O. Odegaard, Jenny Chang, Luohua Jiang, Syma Rashid, Sarah Rydell, N. Reed Mitchell, Anne E. Bantle, Elizabeth Seaquist, Andrew Reikes, Mark A. Pereira","doi":"10.2337/dc25-1516","DOIUrl":"https://doi.org/10.2337/dc25-1516","url":null,"abstract":"OBJECTIVE To test the effect of substituting plain water (the ideal standard) for habitual artificial sweetened beverage (ASB) intake by people with type 2 diabetes (T2D) on primary measures of diabetes control. RESEARCH DESIGN AND METHODS The Study of Drinks with Artificial Sweeteners in People with T2D (SODAS) was conducted at two academic health centers and was a randomized, two-arm, parallel trial with a 2-week run-in period and a 24-week active intervention period. Adults with T2D (n = 181; HbA1c 6.5–8.5%; aged ≥35 years) who regularly consumed commercial ASBs were randomized to receive and consume 24 oz daily for 24 weeks of either 1) a commercial ASB of choice (control); or 2) an unflavored, sparkling or still, bottled or canned water of choice in place of ASBs. The outcomes measures were collected at baseline, 12, and 24 weeks and included the primary measure (HbA1c) and related secondary measures (fructosamine, fasting glucose and insulin, body weight, and continuous glucose monitor metrics). RESULTS A total of 179 participants provided complete data over 24 weeks. From baseline to 24 weeks, the mean difference in change of HbA1c was 0.29% (SE 0.12; P = 0.013) higher in the water arm compared with the ASB arm. There were no significant effects on secondary clinical measures, but data were directionally consistent with the primary results. CONCLUSIONS For people with T2D and HbA1c <8.5% who regularly consume ASBs, this trial provided no evidence that substituting water would improve glycemic-related clinical care measures over 24 weeks.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"113 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711358","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":"Integrative Metabolomics of Targeted and Non-Targeted Analyses in T2D Progression","authors":"Jianhong Ge, Siyu Han, Mengya Shi, Makoto Harada, Shixiang Yu, Jiaqi Zheng, Cornelia Prehn, Jerzy Adamski, Gabi Kastenmüller, Sabrina Schlesinger, Wolfgang Koenig, Birgit Linkohr, Barbara Thorand, Karsten Suhre, Christian Gieger, Annette Peters, Rui Wang-Sattler","doi":"10.2337/dc25-1707","DOIUrl":"https://doi.org/10.2337/dc25-1707","url":null,"abstract":"OBJECTIVE This study aimed to identify metabolites characterizing the progression from normal glucose metabolism (NORM) to prediabetes (PreT2D) and type 2 diabetes (T2D), focusing on stage-specific metabolic shifts (early: NORM to PreT2D; late: PreT2D to T2D) and mechanistic relevance. RESEARCH DESIGN AND METHODS We analyzed 8,240 observations from the KORA cohort, profiling 104 targeted and 312 non-targeted metabolites across three time points: baseline (S4) and follow-ups (F4 and FF4) spanning 14 years. Trajectory analyses of 1,050 individuals identified 211 incident PreT2D and 112 incident T2D cases. Linear mixed-effects models (basic: adjusted for age, sex, BMI, lifestyle; sensitivity: additionally adjusted for glycemic factors like fasting glucose, and cardiovascular factors such as systolic blood pressure (BP) were used to evaluate metabolic differences across glycemic states. Mediation and Mendelian randomization (MR) analyses examined mechanistic and causal relationships. RESULTS We identified 140 Bonferroni-significant metabolites (45 targeted, 109 non-targeted, 14 overlapping), including 68 early-stage metabolites (significant in PreT2D/T2D vs. NORM), primarily energy metabolism markers such as fatty acid oxidation metabolites (e.g., 37 lipids) and TCA cycle metabolites (e.g., citrate). Twenty late-stage metabolites (significant in T2D vs. PreT2D/NORM) included amino acids like BCAAs and γ-glutamyl derivatives. Fewer significant associations were observed in incident cases. Sensitivity models validated 50% of early-stage but not late-stage metabolites. Fasting glucose mediated 35.1% of the γ-glutamyl-valine-T2D association, while MR analysis found no causal roles for C2, BCAAs, or γ-glutamyl-valine. CONCLUSIONS Energy metabolism shifts occur early, while amino acid alterations emerge later stages. These stage-specific signatures may guide diabetes prevention strategies.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"41 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145657319","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":"Erratum. Gradual Titration of Semaglutide Results in Better Treatment Adherence and Fewer Adverse Events: A Randomized Controlled Open-Label Pilot Study Examining a 16-Week Flexible Titration Regimen Versus Label-Recommended 8-Week Semaglutide Titration Regimen Diabetes Care 2025;48:1607–1611","authors":"Roy Eldor, Noa Avraham, Orit Rosenberg, Miriam Shpigelman, Avivit Golan-Cohen, Tali Cukierman-Yaffe, Eugene Merzon, Assaf Buch","doi":"10.2337/dc26-er02a","DOIUrl":"https://doi.org/10.2337/dc26-er02a","url":null,"abstract":"In the article cited above, the affiliations for author Assaf Buch were incorrectly given as Diabetes Unit, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel, and Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel. The sole affiliation for this author is Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel. The online version of the article (https://doi.org/10.2337/dc25-0690) has been updated with the correct affiliation information.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"29 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145664506","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 New Obesity Treatment Landscape: Challenges and Opportunities to Promote Shared Decision-Making in People With Obesity and Type 2 Diabetes","authors":"Leah M. Schumacher, Sarah Bauerle Bass, Jamy Ard, Daniel J. Rubin, Sharon J. Herring, Ajay D. Rao, Resa M. Jones, David B. Sarwer","doi":"10.2337/dci25-0094","DOIUrl":"https://doi.org/10.2337/dci25-0094","url":null,"abstract":"New obesity management guidelines, including those from the American Diabetes Association, advocate the use of shared decision-making (SDM) for obesity treatment. SDM is an evidence-based approach for promoting person-centered care and is widely recommended across medical specialties. However, a variety of issues challenge the use of SDM in daily practice. In this narrative review we discuss factors that may impede the use of SDM in adults with obesity and type 2 diabetes, as well as past efforts to address these barriers. Patient-level factors such as internalized weight bias and lack of knowledge about obesity and its treatment, provider-level factors such as limited training in obesity management and lack of confidence in sensitively discussing weight, and system-level factors like poor treatment access and limited care coordination stymie effective SDM around obesity management. A perceived power imbalance between patients and providers and medical mistrust are additional barriers for some. In the past, researchers have attempted to overcome these barriers to advancing SDM through approaches including patient decision aids, provider training, and clinical decision support systems, with moderate success. This article concludes with recommended strategies for clinical adoption of SDM for patients with obesity and type 2 diabetes, a call for system-level changes to create an environment more conducive to effective SDM, and directions for future research.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"29 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145664507","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 Race/Ethnicity and Risk of Type 2 Diabetes in Women Varies by BMI: A Pooled Analysis of Individual Data From 15 Cohort Studies","authors":"Kazue Nagai, Hsin-Fang Chung, Kunihiko Hayashi, Annette J. Dobson, Yuki Ideno, Sven Sandin, Yvonne T. van der Schouw, Rebecca Hardy, Debra J. Anderson, Panayotes Demakakos, Eric J. Brunner, Ellen S. Mitchell, Nancy F. Woods, Sophie V. Eastwood, Samar R. El Khoudary, Monique M. Hedderson, Elisabete Weiderpass, Gita D. Mishra","doi":"10.2337/dc25-1478","DOIUrl":"https://doi.org/10.2337/dc25-1478","url":null,"abstract":"OBJECTIVE To examine the association between race/ethnicity and type 2 diabetes risk in women and assess the interaction between race/ethnicity and BMI. RESEARCH DESIGN AND METHODS We analyzed individual-level data from 730,408 women across 15 cohort studies. Six racial/ethnic groups were identified: White, Chinese, Japanese, South/Southeast Asian, Black, and mixed/other. Cox proportional hazards models with study as a random effect were used to estimate hazard ratios (HRs) for type 2 diabetes associated with race/ethnicity. The joint association of race/ethnicity and BMI was assessed using BMI categories incorporating Asian-specific cutoffs (<18.5, 18.5–22.9, 23.0–24.9, 25.0–27.4, 27.5–29.9, and ≥30 kg/m2), with White women having a BMI of 18.5–22.9 kg/m2as the reference. RESULTS Overall, 37,329 women (5.1%) were diagnosed with type 2 diabetes. By age 70, the cumulative incidence was highest among South/Southeast Asian (24.6%) and Black women (23.6%), with baseline obesity rates of 40.0% (BMI ≥27.5 kg/m2) and 45.6% (BMI ≥30 kg/m2), respectively. After adjusting for BMI, South/Southeast Asian women had the highest diabetes risk compared with White women (HR 4.13, 95% CI 3.78–4.51), while other racial/ethnic groups had about twice the risk. Joint effect analysis showed South/Southeast Asian women with a BMI ≥23 kg/m2had a substantially greater diabetes risk than other racial/ethnic groups with the same BMI, especially those with BMI 27.5–29.9 kg/m2(HR 23.17, 19.21–27.95) and ≥30 kg/m2(HR 35.52, 30.57–41.28). CONCLUSIONS South/Southeast Asian women have a markedly elevated risk of type 2 diabetes, further amplified by modestly higher BMI, highlighting the need for ethnicity-specific diabetes prevention strategies for women.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"154 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145657320","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":"Coronary Stent Failure in Patients With Diabetes: A Nationwide Observational Study From SWEDEHEART","authors":"Irene Santos-Pardo, Mikael Andersson Franko, Robin Hofmann, Thomas Nyström","doi":"10.2337/dc25-1624","DOIUrl":"https://doi.org/10.2337/dc25-1624","url":null,"abstract":"OBJECTIVE The association between diabetes and coronary stent failure is poorly established with second-generation drug-eluting stents (DES). We aimed to evaluate the risk of stent failure in patients with diabetes compared with those without diabetes after implantation of second-generation DES. RESEARCH DESIGN AND METHODS All patients in Sweden who received second-generation DES between 2010 and 2020 were included and categorized into three groups: type 1 diabetes, type 2 diabetes, and without diabetes (reference group). The primary end point was stent failure, defined as in-stent restenosis or stent thrombosis. Adjusted hazard ratios (HRs) with 95% CIs were estimated by Cox regression models. Sensitivity analyses were performed to address missing data in covariates and account for death as a competing risk. RESULTS The study included 160,523 patients: 2,406 with type 1 diabetes, 43,377 with type 2 diabetes, and 114,740 without diabetes. Seventy-one percent were male. Over a mean follow-up of 4.5 years, 5,510 stent failure events occurred. The fully adjusted HR for stent failure was 2.28 (95% CI 1.97–2.65) for patients with type 1 and 1.35 (95% CI 1.27–1.44) for patients with type 2 diabetes, compared with individuals without diabetes. Sensitivity analyses confirmed the robustness of the findings, with both in-stent restenosis and stent thrombosis contributing to the increased risk. CONCLUSIONS We observed a significantly higher risk of second-generation DES stent failure in individuals with type 1 diabetes followed by those with type 2 diabetes, compared with individuals without diabetes. This elevated risk was attributed to both in-stent restenosis and stent thrombosis.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"12 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145609840","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}