Diabetes Therapy最新文献

{"title":"Real-World Effectiveness of Tirzepatide versus Semaglutide on HbA1c and Weight in Patients with Type 2 Diabetes.","authors":"Meredith M Hoog, Carlos Vallarino, Juan M Maldonado, Michael Grabner, Chia-Chen Teng, Kendra Terrell, Emma L Richard","doi":"10.1007/s13300-025-01794-9","DOIUrl":"https://doi.org/10.1007/s13300-025-01794-9","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate real-world hemoglobin A1c (HbA1c) and weight change in adults initiating treatment with tirzepatide (dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist [GLP-1 RA]) or injectable semaglutide (GLP-1 RA) indicated for type 2 diabetes (T2D) management.</p><p><strong>Methods: </strong>This retrospective analysis utilized the Healthcare Integrated Research Database® to identify adults with T2D starting tirzepatide or injectable semaglutide between May 13, 2022 and May 29, 2023. GLP-1 RA naïve and non-naïve cohorts were identified based on the history of GLP-1 RA use within ≤ 6 months of initiation. Propensity score matching balanced 6-month baseline characteristics between groups. HbA1c and weight changes were assessed from initiation to 12 months for matched patients with HbA1c and weight data at both time points.</p><p><strong>Results: </strong>Both matched naïve cohorts were comprised of 10,702 patients (tirzepatide: 1399 with HbA1c data and 454 with weight data; semaglutide: 1173 with HbA1c data and 432 with weight data). Mean baseline HbA1c and weight were 7.8% and 112.4 kg, respectively, for the tirzepatide group and 7.8% and 110.7 kg for the semaglutide group. Both matched non-naïve cohorts were comprised of 5577 patients (tirzepatide: 792 with HbA1c data and 296 with weight data; semaglutide: 738 with HbA1c data and 224 with weight data). Mean baseline HbA1c and weight were 7.7% and 112.5 kg for tirzepatide, and 7.9% and 108.5 kg for semaglutide. Tirzepatide was associated with greater mean reductions in HbA1c (naïve: - 1.3% vs. - 0.9%; non-naïve: - 0.9% vs. - 0.6%; p < 0.001) and weight (naïve: - 10.2 kg vs. - 6.1 kg; non-naïve: - 7.9 kg vs. - 3.7 kg; p < 0.001) than semaglutide.</p><p><strong>Conclusions: </strong>Patients with T2D starting tirzepatide had greater HbA1c and weight reductions at 12 months post-initiation than those on injectable semaglutide, regardless of previous GLP-1 RA use, consistent with previous clinical trial results.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pragmatic Approach to Improving Management and Patient Flow for Painful Diabetic Neuropathy in UK Primary Care.","authors":"Kevin Fernando, Heather Bell, Sarah Davies, Patrick Holmes, Beth Kelly, Samuel Seidu","doi":"10.1007/s13300-025-01797-6","DOIUrl":"https://doi.org/10.1007/s13300-025-01797-6","url":null,"abstract":"<p><strong>Introduction: </strong>Painful diabetic peripheral neuropathy (pDPN) affects approximately 25% of individuals with diabetes in the UK and remains underdiagnosed and suboptimally managed in primary care. The condition causes chronic pain, limits daily functioning, impairs quality of life, and increases the risk of complications like foot ulcers and amputations due to underlying neuropathy. Current care pathways are fragmented, leading to delays in diagnosis and limited access to evidence-based therapies. This article aims to address the challenges of screening, diagnosis, and management of pDPN in UK primary care by proposing a consensus-driven, five-step pragmatic strategy.</p><p><strong>Methods: </strong>An expert panel of general practitioners and a diabetes nurse practitioner from across the UK convened to review and discuss strategies for improving pDPN care. Consensus was reached through an evaluation of barriers in clinical practice, supported by real-world experience and examples of innovative care delivery models, resulting in the development of practical recommendations and workflow.</p><p><strong>Results: </strong>Key barriers identified include insufficient training of healthcare professionals in pDPN, underutilisation of validated screening tools such as the DN4 questionnaire, and inconsistent and outdated treatment guidelines. To address these challenges, a five-step approach was proposed to include screening high-risk patients using validated questionnaires, following up on these patients to enable early diagnoses, initiating early treatments with first-line therapies while monitoring responses, referring complex cases to secondary care on the basis of structured criteria, and ensuring coordinated follow-up to streamline and optimise care delivery. Case studies demonstrate the practical application of these strategies in improving early detection, treatment adherence, and long-term care for individuals with pDPN.</p><p><strong>Conclusion: </strong>Current practices have fallen short in providing adequate care for one in four individuals with diabetes. Implementing a straightforward five-step approach can significantly improve diagnostic accuracy and treatment outcomes, reducing the burden of pDPN on both patients and society.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetic Characteristics of a Once-Weekly Combination Therapy of Insulin Icodec and Semaglutide Versus Its Separate Components in Chinese Individuals with Type 2 Diabetes.","authors":"Fangfang Wang, Zijian Luan, Raluca Maltesen, Asbjørn T Reenberg, Lisbet Westergaard, Dongyang Liu","doi":"10.1007/s13300-025-01803-x","DOIUrl":"https://doi.org/10.1007/s13300-025-01803-x","url":null,"abstract":"<p><strong>Introduction: </strong>IcoSema is under development as a once-weekly injectable combination therapy of icodec (basal insulin) and semaglutide (glucagon-like peptide 1 receptor agonist). This study assessed the pharmacokinetic characteristics of icodec and semaglutide following IcoSema administration vs. administration of icodec and semaglutide alone in Chinese individuals with type 2 diabetes (T2D).</p><p><strong>Methods: </strong>In a randomized, double-blind, three-period crossover study, 20 Chinese individuals with T2D (18-64 years, body mass index 18.5-34.9 kg/m², glycated hemoglobin ≤ 9.0%) were given single subcutaneous administrations of IcoSema, icodec, or semaglutide separated by 6-9 weeks. Blood was drawn for pharmacokinetic measurement until 840 h post dose.</p><p><strong>Results: </strong>Combining icodec with semaglutide had no impact on icodec pharmacokinetics. The ratio and 90% confidence interval of IcoSema/icodec was 1.04 [0.99;1.08] for area under the curve from zero to last quantifiable observation (AUC_0-t) and 1.02 [0.96;1.09] for maximum concentration (C_max), i.e., within the bioequivalence acceptance interval of 0.80-1.25. Likewise, combining semaglutide with icodec had no impact on semaglutide AUC_0-t (IcoSema/semaglutide 0.99 [0.94;1.05]). However, semaglutide C_max was higher for IcoSema vs. semaglutide alone (1.42 [1.31;1.53]) and occurred earlier for IcoSema (12 vs. 66 h). All three treatments were safe with no differences in frequency, severity or outcome of adverse events, or relationship to study product.</p><p><strong>Conclusion: </strong>In Chinese individuals with T2D, icodec pharmacokinetics and semaglutide total exposure are unaffected when combining icodec and semaglutide in IcoSema. However, maximum semaglutide concentration is higher and occurs earlier with IcoSema. This information may help to ensure suitable dose recommendations for IcoSema.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier, NCT05435677.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic Platelets: Pathophysiology, Clinical Significance, and Therapeutic Perspectives.","authors":"Neha Sharma, Suneet Kumar Verma, Sourabh Sharma, Nitin Kapoor, Sanjay Kalra","doi":"10.1007/s13300-025-01801-z","DOIUrl":"https://doi.org/10.1007/s13300-025-01801-z","url":null,"abstract":"<p><p>Platelets are crucial for haemostasis and thrombosis. They acquire a distinct prothrombotic and proinflammatory platelet phenotype in individuals with diabetes mellitus, particularly type 2 diabetes mellitus (T2DM). Such platelets in people with diabetes (diabetic platelets) contribute to the pathogenesis of micro- and macro-vascular complications in T2DM. Chronic hyperglycaemia, oxidative stress, advanced glycation end-products (AGEs) and insulin resistance converge to reprogram platelet function at the molecular level. This results in platelet hyperreactivity, enhanced aggregation and a diminished therapeutic response to standard antiplatelet medications. Platelets in people with diabetes play a central role in the development and progression of cardiovascular disease (CVD), the most common cause of mortality in such patients. This manuscript explores the structural and functional changes in platelets in people with diabetes, underlying molecular mechanisms, their role in vascular complications and therapeutic perspectives in patients with diabetes. Also, we introduce the concept of 'haematobolomics' to drive more research in the metabolic profile of platelets in people with diabetes, being a potential avenue for personalised therapeutics.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Once-Weekly Insulin Icodec in Indian Participants with Diabetes: Results from ONWARDS 1, 4, and 6 Studies.","authors":"Viswanathan Mohan, Jothydev Kesavadev, L Sreenivasa Murthy, Gayathri Anil, Manu Chandrappa, Soumitra Kar, Sunil Mishra","doi":"10.1007/s13300-025-01799-4","DOIUrl":"https://doi.org/10.1007/s13300-025-01799-4","url":null,"abstract":"<p><strong>Introduction: </strong>These analyses explored the efficacy and safety of once-weekly insulin icodec (icodec) in Indian participants with type 1 or type 2 diabetes (T1D/T2D) from the global ONWARDS 1, 4, and 6 studies.</p><p><strong>Methods: </strong>This was a subgroup analysis of Indian participants enrolled in the multicentre, randomised, treat-to-target phase 3a studies: ONWARDS 1 (insulin-naïve T2D), ONWARDS 4 (basal-bolus treated T2D), and ONWARDS 6 (basal-bolus treated T1D). Participants were randomised 1:1 to receive once-weekly insulin icodec or once-daily comparator insulin (glargine U100 [ONWARDS 1 and 4] or degludec [ONWARDS 6]). The primary outcome was change in glycated haemoglobin (HbA_1c) from baseline to week 52 for ONWARDS 1, week 26 for ONWARDS 4 and 6.</p><p><strong>Results: </strong>A total of 217 Indian participants were included. The estimated treatment differences (95% confidence interval, CI) in HbA_1c change for icodec versus once-daily comparator were 0.04% [- 0.46; 0.54], - 0.04% [- 0.41; 0.32], and 0.08% [- 0.67; 0.82] in ONWARDS 1, 4, and 6 studies, respectively. Time in range was similar between groups in the three studies. Icodec showed numerically lower rates of clinically significant hypoglycaemia compared to glargine U100 in ONWARDS 1 and 4, though a numerically higher rate of hypoglycaemic events was noted in ONWARDS 6 compared with degludec; results were consistent with global populations. Adverse event profiles were similar between groups, and no new safety findings were reported in the Indian subpopulation.</p><p><strong>Conclusion: </strong>Icodec demonstrated comparable efficacy and safety to once-daily basal insulins in Indian participants with T1D and T2D. These findings support icodec as a viable option for insulin initiation or intensification in Indian clinical practice.</p><p><strong>Trial registrations: </strong>ONWARDS 1: NCT04460885; ONWARDS 4: NCT04880850; ONWARDS 6: NCT04848480.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Mechanisms of Inflammatory Factors and the Total Load of Cerebral Small Vessel Disease in Diabetic Retinopathy and Cognitive Impairment.","authors":"Junjun Miao, Shi Chen, Xinyi Sun, Yun She, Lijuan Wang, Siman Liu, Jiangyi Yu, Jing Ge, Zhenguo Qiao","doi":"10.1007/s13300-025-01802-y","DOIUrl":"https://doi.org/10.1007/s13300-025-01802-y","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to explore the roles and methods of inflammatory factors and total load of cerebral small vessel disease (CSVD) in diabetic retinopathy (DR) and cognitive impairment.</p><p><strong>Materials and methods: </strong>In total, 1860 patients with type 2 diabetes mellitus (T2DM) were divided into a DR group and a non-diabetic retinopathy (NDR) group, and nonproliferative DR was divided into mild and moderate-to-severe according to the severity. The patients' baseline data were recorded, and imaging indicators were collected to evaluate CSVD. Monofactor analysis was performed to identify the risk factors associated with DR and cognitive impairment, and a logistic regression model was used to determine independent risk factors. Finally, Nomogram and receiver operating characteristic (ROC) curves were constructed to evaluate the prediction effect of the model.</p><p><strong>Results: </strong>(1) 693 patients (37.26%) had DR and 1167 patients (62.74%) had no DR. In the DR group, hypertension, disease course, low-density lipoprotein cholesterol (LDL-C), uric acid (UA), glycosylated hemoglobin (HbA1c), triglyceride glucose index (TyG), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were all significantly higher than in the NDR group (p < 0.001). Multivariate logistic regression analysis further verified that hypertension, LDL-C, PLR, and SII were independent risk factors for DR. (2) Among 612 patients with nonproliferative DR, the levels of hypertension, UA, HbA1c, TyG index, interleukin-6 (IL-6), monocyte-to-lymphocyte ratio (MLR), and SII in the moderate-to-severe nonproliferative DR group were significantly higher than those in the mild nonproliferative DR group (p < 0.01). (3) Patients with moderate-to-severe nonproliferative DR were divided into a cognitive impairment group and a non-cognitive impairment group. Smoking history, drinking history, fasting blood glucose, HbA1c, TyG index, PLR, MLR, SII, total CSVD magnetic resonance imaging (MRI) load, and white matter hyperintensities (WMHs) were significantly associated with cognitive impairment (p < 0.01). Smoking history, fasting blood glucose, HbA1c, TyG index, SII, total CSVD load, and lacunar infarction (LI) were independent risk factors for cognitive impairment in patients with moderate-to-severe DR. In addition, total MRI load (r = 0.711, p < 0.05), TyG index (r = 0.712, p < 0.05), SII (r = 0.703, p < 0.05), and PLR (r = 0.724, p < 0.05) were significantly negatively correlated with Montreal Cognitive Assessment (MoCA) score.</p><p><strong>Conclusions: </strong>This study identified hypertension history, LDL-C, PLR, and SII as factors independently associated with the presence of DR in patients with T2DM. In addition, UA, TyG, SII, total CSVD load, and WMHs were significantly associated with more severe stages of DR.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Automated Insulin Delivery System Therapy at Diagnosis on Metabolic Control in Children and Adolescents with Type 1 Diabetes.","authors":"Ugur Cem Yilmaz, Günay Demir, Deniz Özalp Kızılay, Samim Özen, Damla Gökşen","doi":"10.1007/s13300-025-01800-0","DOIUrl":"https://doi.org/10.1007/s13300-025-01800-0","url":null,"abstract":"<p><strong>Introduction: </strong>The primary goal of managing type 1 diabetes mellitus (T1D) is to achieve glycemic control and prevent both acute and chronic complications. In recent years, automated insulin delivery (AID) systems, such as the 780G AID system, have significantly improved glycemic control and patient safety. Despite being the most advanced treatment option, AID initiation is often delayed until the honeymoon stage (partial remission phase). This study evaluated the impact of initiating MiniMed™ 780G at diagnosis on metabolic control and glycemic metrics in children newly diagnosed with T1D. It compares early AID initiation with continuous glucose monitoring (CGM) and multiple daily injection (MDI) therapy over a 1-year follow-up period.</p><p><strong>Methods: </strong>This retrospective study included children and adolescents (age range 0.87-17.72 years) newly diagnosed with T1D between January 2023 and August 2024. Ten patients who were initiated on AID therapy at diagnosis were included, with eight patients completing a 1-year follow-up. Data from these eight patients and seven patients on CGM + MDI therapy were analyzed at baseline and at 3, 6, and 12 months.</p><p><strong>Results: </strong>The mean age at diagnosis was 6.98 ± 3.22 years (0.87-9.82) for the AID group and 9.77 ± 4.89 years (3.70-17.72) for the CGM + MDI group (p = 0.14). The AID system was initiated at an average of 3.33 ± 7.73 days (2-23) after diagnosis, while sensor use in the CGM + MDI group began an average of 17.37 ± 8.86 days (1-29) after diagnosis. At 12 months, mean hemoglobin A1c (HbA1c) was 6.10% (43 mmol/mol) in the AID group compared with 7.73% (61 mmol/mol) in the CGM + MDI group. Time in range (TIR) was 79.0% vs. 50.7%, and time above range (TAR) was 13.4% vs. 30.7%, based on 2-week CGM data prior to the 12-month visit (p = 0.02, p = 0.009, p = 0.02). No case of diabetic ketoacidosis or severe hypoglycemia was reported during the follow-up period.</p><p><strong>Conclusion: </strong>This study highlights the potential benefits of initiating AID therapy at the time of diagnosis, offering novel insights into its safety and efficacy in the early management of T1D. These findings suggest that early initiation of AID therapy at the time of diagnosis is feasible and may improve glycemic outcomes.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Patient Preferences for Basal Insulin Treatments in Adults Living with Type 2 Diabetes: A Discrete Choice Experiment in Canada, Spain, France, and Japan.","authors":"Amy M Jones, Pam Hallworth, Sophi Tatlock, Morten Sall Jensen, Helen Kendal, Sophie Wallace, Elisabeth de Laguiche","doi":"10.1007/s13300-025-01779-8","DOIUrl":"10.1007/s13300-025-01779-8","url":null,"abstract":"<p><strong>Introduction: </strong>Basal insulin injections have historically been administered via once-daily (OD) or twice-daily (BD) injections. Once-weekly (OW) basal insulin injections have recently been developed. This study aimed to quantify the relative importance of the administration frequency in basal insulin treatment preferences of people living with T2D in Canada, Spain, France, and Japan, using a discrete choice experiment (DCE).</p><p><strong>Methods: </strong>Best-practice guidelines for patient preference studies were followed in a three-phase study design. Phases one (targeted literature review) and two (qualitative interviews) informed the development of an attributes and levels grid. Phase three consisted of pilot interviews to evaluate the feasibility of preference survey completion and DCE tasks among adults living with T2D across Canada, France, Spain, and Japan. Hierarchical Bayesian estimation was used to estimate part-worth utilities for attribute levels, then calculate the relative importance of each attribute among other attributes tested.</p><p><strong>Results: </strong>The DCE survey was completed by N = 513 participants (aged 20-90; 54% male, 45% female; mean time since diagnosis: 11.6 years). Participants were split into three treatment groups: basal insulin and injectable glucagon-like peptide-1 receptor agonist (GLP-1 RA) naïve (n = 176), basal insulin naïve but with injectable GLP-1 RA experience (n = 176) and basal insulin experienced (n = 161). The administration frequency had a relative importance of 40% across the full sample, double that of any other treatment attribute tested in this study. A preference for OW administration was found relative to OD and BD. Findings were consistent across treatment groups and countries.</p><p><strong>Conclusions: </strong>This study demonstrated the value and importance of administration frequency in making choices for basal insulin treatments when glycemic control is held constant. Per the pre-specified conditions, participants expressed a preference for OW basal insulin, making considered trade-offs between treatment risks (e.g., risk of a severe hypoglycemic event) and convenience (e.g., frequency of administration).</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"1933-1954"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12474790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacubitril/Valsartan-Induced Hypoglycemia After Gastric Bypass: A Case Report with Documented Endogenous Hyperinsulinemia.","authors":"Mona Guetlin, Michael Joubert, Julia Morera","doi":"10.1007/s13300-025-01782-z","DOIUrl":"10.1007/s13300-025-01782-z","url":null,"abstract":"<p><p>Post-bariatric hypoglycemia (PBH) is a frequent yet complex complication following Roux-en-Y gastric bypass, typically related to exaggerated insulin responses after rapid glucose absorption. Identifying alternative or contributing mechanisms is particularly challenging in this population due to altered anatomy and limited access to standard diagnostic tools. We describe the case of a 65-year-old man with a history of type 2 diabetes, obesity, and cardiac sarcoidosis, who achieved diabetes remission after gastric bypass. Several months later, he developed frequent postprandial and nocturnal hypoglycemic episodes despite strict dietary adjustments. Continuous glucose monitoring showed 38% time below range. A 72-h fasting test revealed inappropriately high proinsulin and C-peptide levels, indicating endogenous hyperinsulinemia. The patient was receiving sacubitril/valsartan for heart failure. Upon discontinuation of this treatment due to worsening renal function, hypoglycemic episodes resolved completely, and a repeat fasting test was normal. This is, to our knowledge, the first case report describing sacubitril/valsartan-associated hypoglycemia in a patient post-gastric bypass surgery, and the first to document inappropriate insulin secretion under treatment using a fasting test. Preclinical data suggest that neprilysin inhibition may enhance insulin secretion, possibly via increased GLP-1 bioavailability. While sacubitril/valsartan has demonstrated cardiovascular benefit, its metabolic effects remain underrecognized. Given the growing number of patients who have undergone bariatric surgery and the widespread use of this medication, clinicians should consider its potential role in refractory hypoglycemia. Early identification may avoid unnecessary investigations and support appropriate therapeutic adjustments.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"2063-2070"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12474767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide Trends in Type 1 and Type 2 Diabetes in France (2010-2019): A Population-Based Study Using a Machine Learning Classification Algorithm.","authors":"Guy Fagherazzi, Pierre Serusclat, Barbara Roux, Oriane Bretin, Emilie Casarotto, Pascaline Rabiéga, Yolaine Rabat, Cécile Berteau, Antoine Pouyet, Michael Joubert","doi":"10.1007/s13300-025-01781-0","DOIUrl":"10.1007/s13300-025-01781-0","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes represents an increasing public health challenge in France, yet national data distinguishing type 1 from type 2 diabetes and insulin use remain limited. This study aimed to describe trends in the epidemiology, care pathways and health outcomes of adult individuals living with type 1 or type 2 diabetes in France from 2010 to 2019. It focused on individuals treated or not with insulin and applied a predictive classification algorithm to accurately distinguish between diabetes types using real-world data.</p><p><strong>Methods: </strong>A 10-year retrospective population-based cohort study was conducted from a representative one-tenth sample of the French national healthcare database (i.e. SNDS, Système National des données de Santé), covering nearly the entire French population. Adults (≥ 18 years) affiliated with the general insurance scheme were included. A machine learning algorithm, trained on clinical data from general practitioners, was applied to classify diabetes type. Annual trends in prevalence, incidence, comorbidities, treatments, outpatient care, complications and mortality were assessed.</p><p><strong>Results: </strong>Among an extrapolated 5.5 million individuals with diabetes in 2019, 3.5% had type 1 diabetes and 96.5% had type 2 diabetes. The prevalence of type 2 diabetes increased from 6.2% in 2010 to 8.0% in 2019, while type 1 diabetes remained stable. Comorbidity rates were high and increasing in insulin-treated individuals with type 2 diabetes. In 2019, 15.3% of insulin-treated individuals with type 2 diabetes had at least one complication-related hospitalisation. Specialist consultations were underused, especially in type 2 diabetes. The mortality rate in individuals with type 1 diabetes declined from 2.6% to 1.5%, with an increase in mean age at death.</p><p><strong>Conclusion: </strong>This national study provides updated insights into diabetes in France and highlights the need to improve access to specialised care and reinforce long-term surveillance strategies.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"1973-1991"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12474798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}