Diabetologia最新文献

{"title":"Glucagon-like peptide-1 receptor agonists and gastrointestinal cancer risk in individuals with type 2 diabetes.","authors":"Chia-Chih Kuo, Min-Hsiang Chuang, Chun-Hsien Li, Ya-Wen Tsai, Po-Yu Huang, Hsing-Tao Kuo, Chih-Cheng Lai","doi":"10.1007/s00125-025-06453-z","DOIUrl":"https://doi.org/10.1007/s00125-025-06453-z","url":null,"abstract":"<p><strong>Aims/hypothesis: </strong>Although benefits of glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been demonstrated in treatment of type 2 diabetes and weight management, their potential role in cancer prevention remains inadequately explored.</p><p><strong>Methods: </strong>Using the TriNetX Research Network, we conducted a retrospective cohort study comparing new users of GLP-1RAs with users of other glucose-lowering medications. Propensity score matching was performed for demographic factors, socioeconomic factors, family history, lifestyle factors and cancer risk factors. The primary outcome was the incidence of obesity-related gastrointestinal cancers, and secondary outcomes were the incidence of individual cancer types.</p><p><strong>Results: </strong>Using adjusted HRs (aHRs), GLP-1RA use was found to be associated with a significantly lower risk of overall gastrointestinal cancer compared with all other glucose-lowering medications (insulin: aHR 0.29; 95% CI 0.23, 0.37; metformin: aHR 0.84; 95% CI 0.71, 0.99; sulfonylureas: aHR 0.71; 95% CI 0.62, 0.80; thiazolidinediones: aHR 0.86; 95% CI 0.74, 0.99; dipeptidyl peptidase-4 inhibitors: aHR 0.80; 95% CI 0.70, 0.91; sodium-glucose cotransporter-2 inhibitors: aHR 0.80; 95% CI 0.68, 0.96). The protective effect was most pronounced compared with insulin therapy, with significant risk reductions across all individual cancers.</p><p><strong>Conclusions/interpretation: </strong>GLP-1RA use is associated with a reduced risk of gastrointestinal cancers in individuals with type 2 diabetes. These findings suggest potential cancer-protective benefits of GLP-1RAs beyond their established roles in glycaemic management and weight reduction.</p>","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224606","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":"ApoC-III and ectopic fat accumulation in individuals with type 2 diabetes: an exploratory analysis from the MEDEA randomised controlled study.","authors":"Giuseppina Costabile, Dominic Salamone, Giuseppe Della Pepa, Roberta Testa, Marilena Vitale, Valentina Brancato, Marco Salvatore, Andrea Soricelli, Giovanni Annuzzi, Angela A Rivellese, Lutgarda Bozzetto","doi":"10.1007/s00125-025-06464-w","DOIUrl":"https://doi.org/10.1007/s00125-025-06464-w","url":null,"abstract":"<p><strong>Aims/hypothesis: </strong>We aimed to investigate the effects of an isoenergetic multifactorial diet, previously shown to reduce liver and pancreatic fat content, compared with a monounsaturated fatty acid (MUFA)-rich diet, on plasma apolipoprotein C-III (ApoC-III) levels and their relationship with ectopic fat and beta cell function in people with type 2 diabetes.</p><p><strong>Methods: </strong>In this randomised controlled, parallel group study, 36 individuals with type 2 diabetes (20 men, 16 women), aged 35-75 years, were assigned to an 8 week intervention with either an isoenergetic MUFA-rich diet (n=16) or a multifactorial diet rich in MUFA, polyunsaturated fats, fibre, polyphenols and vitamins (n=20). Fasting and postprandial (3 h test meal reflecting the assigned diet) plasma glucose, insulin and ApoC-III concentrations were measured before and after the intervention. Beta cell function was assessed as the insulin-to-glucose total AUC ratio. Liver and pancreatic fat content were quantified using magnetic resonance techniques.</p><p><strong>Results: </strong>Compared with the MUFA diet, the multifactorial diet led to a decrease (8 week minus baseline) in fasting ApoC-III levels (-0.006 ± 0.040 vs +0.007 ± 0.048 g/l, p=0.070) and postprandial ApoC-III AUC (-1.34 ± 6.01 vs +1.60 ± 5.56 g/l × 180 min, p=0.043). Regardless of dietary intervention, changes in fasting ApoC-III positively correlated with changes in liver fat (r=0.357, p=0.032) and pancreatic fat (r=0.385, p=0.020). Both fasting and postprandial ApoC-III changes were inversely correlated with beta cell function (r=-0.384, p=0.026; r=-0.402, p=0.018, respectively).</p><p><strong>Conclusions/interpretation: </strong>A multifactorial diet significantly reduced plasma ApoC-III levels in individuals with type 2 diabetes. Independent of dietary intervention, lower ApoC-III levels were associated with reduced liver and pancreatic fat accumulation and improved beta cell function.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT03380416.</p>","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224604","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":"Interventions to improve diabetes care and self-management for individuals experiencing homelessness: a scoping review with systematic search of qualitative and quantitative literature.","authors":"Nada A El Tobgy, Eshleen K Grewal, Pablo M Gonzalez, Tadios Tibebu, Gillian L Booth, Kerry A McBrien, Stephen W Hwang, Carolyn Ziegler, David J T Campbell","doi":"10.1007/s00125-025-06449-9","DOIUrl":"https://doi.org/10.1007/s00125-025-06449-9","url":null,"abstract":"<p><strong>Aims/hypothesis: </strong>Optimal diabetes management for people experiencing homelessness can be a challenge. Our aim was to summarise the existing literature on, highlight emerging evidence for and identify gaps in diabetes care for people experiencing homelessness.</p><p><strong>Methods: </strong>We undertook a comprehensive and systematic search of 11 databases of published academic literature up to 24 September 2024. Only English and French studies were included. We used defined search and selection criteria to identify interventions or recommendations targeted towards diabetes care in people experiencing homelessness. We also conducted an extensive grey-literature search. Articles were screened at the abstract and full-text stages by two reviewers. We conducted descriptive analysis of the included studies.</p><p><strong>Results: </strong>In total, 2367 records were identified in the initial search of the published literature (1182 after de-duplication), of which 75 met the criteria for inclusion. In addition, 194 records from the grey-literature sources met the criteria for inclusion, yielding a total of 269 documents included in the review. Most interventions were conducted in the USA (n=186) and were simple programme descriptions (n=173). Sixteen intervention categories were identified; the most common included mobile clinics, street medicine and outreach (n=68), multidisciplinary care (n=35), recommendations for providers (n=29) and foot care/assessment programmes (n=31). Of the 51 quantitative studies, 11 examined the effects of an intervention on HbA_1c, with seven showing reductions in HbA_1c, although these observations were statistically significant in only three studies. Risk of bias assessment of the quantitative studies revealed an overall high risk of bias, mainly secondary to attrition. Fifteen qualitative studies emphasised the need for specialised diabetes care for people experiencing homelessness, including the use of multidisciplinary teams to provide diabetes care and longer appointment times with health professionals.</p><p><strong>Conclusions/interpretation: </strong>A broad spectrum of interventions have been implemented with the goal of improving diabetes care in people experiencing homelessness. There is an ongoing need for more structured evaluations of programmes that provide care for this population.</p>","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215220","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":"Quinine: rediscovery of an old glucose-lowering drug. Reply to Henquin J-C [letter].","authors":"Javad Anjom-Shoae, Michael Horowitz, Christine Feinle-Bisset","doi":"10.1007/s00125-025-06415-5","DOIUrl":"10.1007/s00125-025-06415-5","url":null,"abstract":"","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":" ","pages":"1357-1358"},"PeriodicalIF":8.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708992","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":"Quinine: rediscovery of an old glucose-lowering drug.","authors":"Jean-Claude Henquin","doi":"10.1007/s00125-025-06416-4","DOIUrl":"10.1007/s00125-025-06416-4","url":null,"abstract":"","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":" ","pages":"1355-1356"},"PeriodicalIF":8.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708988","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":"Comparative effectiveness of alternative second-line oral glucose-lowering therapies for type 2 diabetes: a precision medicine approach applied to routine data.","authors":"Stephen O'Neill, Patrick Bidulka, David G Lugo-Palacios, Orlagh Carroll, Ignacio Leiva-Escobar, Richard Silverwood, Andrew Briggs, Amanda I Adler, Kamlesh Khunti, Richard Grieve","doi":"10.1007/s00125-025-06447-x","DOIUrl":"https://doi.org/10.1007/s00125-025-06447-x","url":null,"abstract":"<p><strong>Aims/hypothesis: </strong>National clinical guidelines recommend that second-line treatment for type 2 diabetes mellitus is chosen according to individuals' characteristics but there is limited evidence available to inform this choice. This paper's aim is to compare the effects on HbA_1c of sulfonylureas (SU), dipeptidyl peptidase-4 inhibitors (DPP4i) or sodium-glucose cotransporter-2 inhibitors (SGLT2i) added to metformin as second-line oral glucose-lowering treatments according to an individual's age, baseline HbA_1c and presence of multiple long-term conditions (MLTCs).</p><p><strong>Methods: </strong>We accessed primary care-hospital linked data for 41,790 individuals from the Clinical Practice Research Datalink (CPRD) in England who initiated second-line treatment after metformin between 2015 and 2021. We combined target trial emulation with instrumental variable analysis to reduce the risk of confounding. The outcome was change in HbA_1c between baseline and 1 year follow-up. We reported results stratified by age (18-49 years, 50-69 years and ≥70 years), baseline HbA_1c (<67 mmol/mol [<8.3%], 67-77 mmol/mol [8.3-9.2%] and >77 mmol/mol [>9.2%]) and presence of MLTCs.</p><p><strong>Results: </strong>The mean (95% CI) difference in HbA_1c change for SGLT2i vs SU was larger for people aged 18-49 years (-5.74 mmol/mol [-7.47, -4.01]) (-0.5% [-0.7, -0.4]) than for those aged 50-69 years (-4.03 mmol/mol [-5.61, -2.44]) (-0.4% [-0.5, -0.2]) and for those aged 70 years or over (-2.68 mmol/mol [-4.50, -0.86]) (-0.3% [-0.4, -0.07]). The mean (95% CI) difference in HbA_1c change for SGLT2i vs DPP4i was -5.80 mmol/mol (-7.60, -4.00) (-0.5% [-0.7, -0.4]) for those aged 18-49 years, -4.13 mmol/mol (-5.82, -2.45) (-0.4% [-0.5, -0.2]) for those aged 50-69 years and -3.13 mmol/mol (-5.01, -1.24) (-0.3% [-0.4, -0.1]) for those aged ≥70 years. The mean difference (improvement) in HbA_1c was similar across subgroups defined by baseline HbA_1c or presence of MLTCs. For SGLT2i vs SU, the mean (95% CI) difference was -5.37 mmol/mol (-7.13, -3.62) (-0.5% [-0.6, -0.3]) for people without MLTC and -3.72 mmol/mol (-5.34, -2.10]) (-0.3% [-0.5, -0.2]) for people with MLTC. For SGLT2i vs DPP4i the corresponding estimated differences (95% CI) were -5.44 mmol/mol (-7.27, -3.61) (-0.5% [-0.7, -0.3]) for those without MLTC and -3.93 mmol/mol (-5.64, -2.21) (-0.3% [-0.5, -0.2]) for those with MLTC.</p><p><strong>Conclusions/interpretation: </strong>Second-line treatment with SGLT2i is more effective than SU or DPP4i in reducing HbA_1c across subgroups of people defined by age, baseline HbA_1c and presence of MLTCs. Our evidence complements RCTs in using routinely available information on demographic characteristics, biomarkers and comorbidities to inform an individualised approach.</p>","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191631","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":"Prevention of diabetic ketoacidosis in relatives screened for islet autoantibodies and followed up in the TrialNet Pathway to Prevention study at a single institution in Italy.","authors":"Sabina Martinenghi, Aurora Merolla, Pauline Grogan, Eleonora Bianconi, Elisa Senni, Anastasia Goncharova, Francesco Massara, Francesca Ragogna, Elena Bazzigaluppi, Matteo R Pastore, Riccardo Bonfanti, Emanuele Bosi","doi":"10.1007/s00125-025-06461-z","DOIUrl":"10.1007/s00125-025-06461-z","url":null,"abstract":"<p><strong>Aims/hypothesis: </strong>Screening for islet autoantibodies is an effective method for identifying individuals with pre-symptomatic (stage 1 and 2) type 1 diabetes. This approach offers a valuable opportunity for education and monitoring, which can help to reduce the severity of clinical manifestations at clinical onset (stage 3), including diabetic ketoacidosis. The aim of the study was to evaluate the progression to stage 3 and the incidence of diabetic ketoacidosis in relatives of individuals with type 1 diabetes screened and followed up at a single institution in Italy.</p><p><strong>Methods: </strong>This was a single-centre observational study conducted at San Raffaele Hospital, Milan, Italy, within the international multisite TrialNet Natural History Study-Pathway to Prevention. First-degree (aged 1-45 years) and second-degree (aged 1-20 years) relatives were screened primarily for GADA, IAA and IA-2A. In the event of a positive result, subsequent testing was conducted for ICA and ZnT8A. Periodic autoantibody testing, metabolic monitoring and educational support were offered to all autoantibody-positive participants. Participants were screened between July 2005 and February 2020, with the latest update obtained between January 2023 and June 2024.</p><p><strong>Results: </strong>In total, 4046 relatives were screened at a median (IQR) age of 17.6 (7.9-38.0) years. At first screening, 4.9% were found to be positive, with 3.1% having a single autoantibody and 1.8% multiple autoantibodies. Follow-up data were available for 78.5% of the participants, with a median (IQR) follow-up time of 9.9 (6.5-13.5) years. Progression to stage 3 was observed in 51 (1.6%) participants. Disease onset occurred in 0.4% of autoantibody-negative, 6.5% of single-positive and 43.1% of multiple-positive participants after a median (IQR) time of 7.8 (5.4-10.4), 7.9 (2.1-11.8) and 2.9 (0.9-6.5) years, respectively (p=0.012). The Kaplan-Meier survival free of clinical diabetes at 15 years was 99.5% (95% CI 99.1, 99.7), 87.3% (95% CI 74.4, 94.0) and 45.9% (95% CI 31.1, 59.6), respectively (p<0.001). At the time of disease onset, no occurrences of diabetic ketoacidosis were documented. Median (IQR) HbA_1c was 64 (52-86) mmol/mol (8.0 [6.9-10.0]%) and median (IQR) venous pH at onset was 7.37 (7.35-7.39). Hospitalisation occurred in 22 paediatric participants, as part of standard practice for newly diagnosed patients at our institution aiming to provide disease education and insulin therapy optimisation.</p><p><strong>Conclusions/interpretation: </strong>The early identification of individuals at risk for type 1 diabetes through a single-centre approach, combining autoantibody screening and regular monitoring, completely prevented diabetes-associated ketoacidosis at disease onset in relatives of individuals with type 1 diabetes.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT00097292.</p>","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172930","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":"European Association for the Study of Diabetes (EASD) Standard Operating Procedure for the development of guidelines.","authors":"Thomas Karagiannis, Andrew Advani, Melanie J Davies, Stefano Del Prato, Sean F Dinneen, Oliver Kuss, Valentina Lorenzoni, Chantal Mathieu, Didac Mauricio, Tsvetalina Tankova, Francesco Zaccardi, Richard I G Holt, Apostolos Tsapas","doi":"10.1007/s00125-025-06370-1","DOIUrl":"https://doi.org/10.1007/s00125-025-06370-1","url":null,"abstract":"<p><p>The European Association for the Study of Diabetes (EASD) has developed a Standard Operating Procedure (SOP) for the development of clinical practice guidelines, ensuring adherence to rigorous methodological standards based on the principles of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Key components include a transparent process for managing conflicts of interest, the incorporation of multidisciplinary panels including individuals with lived experience of diabetes, an evidence synthesis based on comprehensive systematic reviews, and an explicit peer review process. This SOP delineates the roles and responsibilities of the main structures involved, including the Guidelines Oversight Committee, Guideline Development Panels, and Evidence Synthesis Teams. Additionally, the SOP describes the main stages in guideline development, namely scoping of the guideline topic, evidence synthesis, development of Evidence-to-Decision frameworks for the formulation of clear, patient-centred recommendations, writing of the guideline document and the review process.</p>","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186775","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":"Clinical guidelines and other guidance from the European Association for the Study of Diabetes (EASD).","authors":"Richard I G Holt,Apostolos Tsapas,Manuela Meireles,Hindrik Mulder,Chantal Mathieu","doi":"10.1007/s00125-025-06378-7","DOIUrl":"https://doi.org/10.1007/s00125-025-06378-7","url":null,"abstract":"","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":"56 1","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136834","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 era of European Association for the Study of Diabetes (EASD) clinical guidance documents.","authors":"Manuela Meireles,Richard I G Holt,Apostolos Tsapas,Hindrik Mulder,Chantal Mathieu","doi":"10.1007/s00125-025-06452-0","DOIUrl":"https://doi.org/10.1007/s00125-025-06452-0","url":null,"abstract":"","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":"9 1","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136869","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}