Diabetes Therapy最新文献

{"title":"Clinical Performance of the IWGDF Risk Stratification System for Diabetic Foot Ulceration: A Gender-Disaggregated Study of 713 Patients.","authors":"Fatimah Z Alenazi, Thamer Alslamah, Basmah Alharbi, Wafa Ibrahim Alotaibi, Metab Algeffari, Yasir S Alsalamah, Faisal I Almohaileb, Mirna Awni Fawaz, António Raposo","doi":"10.1007/s13300-026-01925-w","DOIUrl":"https://doi.org/10.1007/s13300-026-01925-w","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic foot ulceration (DFU) is a major complication of diabetes and is a leading cause of lower-extremity amputation. This study evaluated the cross-sectional discriminative performance of the International Working Group on the Diabetic Foot (IWGDF) risk classification for prevalent active DFU, described gender-disaggregated ulcer prevalence, and identified factors independently associated with moderate/high IWGDF risk in a specialist diabetes center.</p><p><strong>Methods: </strong>In this retrospective cross-sectional study, 713 adults with diabetes mellitus who attended the diabetic foot service of a university diabetes center were classified according to the IWGDF risk system. The prevalence of active DFU was compared across risk categories using the Cochran-Armitage trend test. Multivariable logistic regression was used to identify factors associated with moderate/high IWGDF risk and active DFU.</p><p><strong>Results: </strong>Active DFU was present in 21 patients (2.9%), with no significant difference between men (3.8%) and women (2.1%). Overall, 17.3% of the patients were classified as having moderate or high risk. Ulcer prevalence increased progressively across the IWGDF categories, from 0.0% in the very-low-risk group to 38.5% in the high-risk group (p < 0.001). The IWGDF classification showed excellent cross-sectional discrimination for prevalent active DFU (c-statistic 0.938), with 90.5% sensitivity and 99.7% negative predictive value at the moderate/high-risk threshold. Older age and higher glycated hemoglobin (HbA1c) levels were independently associated with moderate/high IWGDF risk, whereas gender was not.</p><p><strong>Conclusion: </strong>The IWGDF classification showed excellent cross-sectional discrimination for prevalent active DFU. Older age and poorer glycemic control, but not gender, were independently associated with moderate/high IWGDF risk. These findings support routine IWGDF-guided risk stratification in specialist diabetes care, although prospective studies are required to establish its performance in predicting future ulceration.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206653","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 Bidirectional Relationship Between Diabetes and Cancer: Mechanistic Insights, Epigenetic Intermediaries, and Therapeutic Approaches.","authors":"Prahallad Mishra, Thyparambil Aravindakshan PramodKumar, Bhagyashree Pradhan, Utpal Ghosh, Pradyumna K Mishra, Pujarini Dash, Ranjit Mohan Anjana, Samir Kumar Patra, Viswanathan Mohan","doi":"10.1007/s13300-026-01926-9","DOIUrl":"https://doi.org/10.1007/s13300-026-01926-9","url":null,"abstract":"<p><strong>Objectives: </strong>The global rise in diabetes mellitus parallels an increasing cancer burden, highlighting an incompletely understood relationship between these two complex diseases. Accumulating epidemiological evidence indicates that diabetes is associated with an increased incidence and mortality of several site-specific cancers, whereas cancer and its treatment may contribute to dysglycemia and diabetes through diverse mechanisms. In addition, shared metabolic and environmental risk factors further contribute to the observed association between these conditions.</p><p><strong>Methodology: </strong>This narrative review comprehensively examined peer-reviewed literature retrieved from PubMed, Scopus, Web of Science, and Google Scholar, focusing on the epidemiological, mechanistic, and epigenetic links between diabetes and cancer.</p><p><strong>Results: </strong>Beyond shared lifestyle risk factors, converging molecular mechanisms-including chronic hyperglycemia, insulin resistance, low-grade inflammation, oxidative stress, and metabolic reprogramming-provide a biological framework linking diabetes and cancer. Emerging evidence suggests that epigenetic dysregulation acts as a central intermediary in this relationship by integrating metabolic stress with sustained alterations in gene expression through DNA methylation, histone modifications, non-coding RNAs, chromatin remodeling, and epigenetic aging. Diabetes-related epigenetic memory, microbiome-driven epigenetic modulation, and sex-specific epigenetic signatures may further contribute to cancer susceptibility and disease heterogeneity, although the strength of evidence varies across experimental and clinical studies.</p><p><strong>Conclusions: </strong>This review synthesizes current epidemiological, mechanistic, and epigenetic evidence linking diabetes and cancer, with particular emphasis on metabolic-epigenetic crosstalk and clinically relevant signaling pathways. It also critically evaluates the dual metabolic and oncologic effects of antidiabetic and anticancer therapies while highlighting current evidence gaps and the need for precision medicine approaches in the prevention and management of both diseases.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165191","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":"Off-label Use of U-500 Regular Insulin with a Tubeless Automated Insulin Delivery System in Type 1 Diabetes and Severe Insulin Resistance: A Case Report.","authors":"Bleuenn Dreves, Michael Joubert","doi":"10.1007/s13300-026-01924-x","DOIUrl":"https://doi.org/10.1007/s13300-026-01924-x","url":null,"abstract":"<p><strong>Introduction: </strong>U-500 regular insulin (U-500R) can overcome reservoir-capacity constraints in people with severe insulin resistance, but its delayed and prolonged action is poorly matched to automated insulin delivery (AID) algorithms developed for rapid-acting U-100 insulin analogs. Experience in type 1 diabetes (T1D) is particularly limited.</p><p><strong>Methods: </strong>We report the off-label transition to Omnipod 5 AID while continuing U-500R in a 46-year-old man with autoimmune T1D, obesity, severe insulin resistance, impaired hypoglycemia awareness (Gold score 6), and frequent isolated overnight work. Before transition, he was receiving approximately 245 units/day of U-500R through an Omnipod DASH patch pump. Initial adaptations included a 6-h active insulin duration, higher overnight glucose targets, semi-quantitative meal announcements, and proactive use of activity mode.</p><p><strong>Results: </strong>Before AID initiation, continuous glucose monitoring showed a mean glucose of 137 mg/dl, glucose management indicator of 6.6%, time in range of 75%, and time below range of 9%. After 12 months, time in range increased to 79.1% and time below range decreased to 5.7%, with 0.4% below 54 mg/dl. Automated mode was active for more than 95% of the time. The patient reported substantially fewer symptomatic hypoglycemic episodes, although occasional hypoglycemia persisted during overnight shifts.</p><p><strong>Conclusions: </strong>Carefully supervised use of U-500R in an AID system may preserve patch-pump therapy and reduce hypoglycemia exposure in selected people with T1D and very high insulin requirements. This off-label approach requires explicit dose-conversion procedures, conservative individualized settings, close follow-up, and recognition that residual hypoglycemia risk remains.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170688","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":"Impact of Ascorbic Acid and Exercise on Accuracy of a Glucose Monitoring System with GDH-FAD Technology in Adult Patients with Type 1 Diabetes Mellitus: A Double-Blinded, Randomized Trial.","authors":"Ronald Brazg, Tina Mitchell, Jiangfeng Fei, Jiyun Zheng, Fei Gao, Ao Gao, Siting Zhu, Frank Flacke, Leon Shi, Poul Strange","doi":"10.1007/s13300-026-01918-9","DOIUrl":"https://doi.org/10.1007/s13300-026-01918-9","url":null,"abstract":"<p><strong>Introduction: </strong>The performance of a new continuous glucose monitoring system (CGM) with flavin adenine dinucleotide-dependent glucose dehydrogenase (GDH-FAD) technology in adults with type 1 diabetes mellitus (T1DM) was assessed, with a focus on the impact of ascorbic acid and exercise on the accuracy of glucose measurements relative to Yellow Springs Instrument (YSI) 2300 control.</p><p><strong>Methods: </strong>Adults with T1DM aged 18-65 years using a stable glucose management treatment regimen for at least 3 months with multiple daily injections or continuous subcutaneous insulin infusion participated in this study at a single center. Participants attended a screening visit and three in-clinic visits for frequent blood sampling with blood glucose measurements using YSI measurements as the reference measurement as endorsed by the Food and Drug Administration (FDA). Participants had two meals at each clinic visit leading to pronounced glucose excursions. On the second and third in-clinic visits, participants performed moderate exercise in between the two meals and were randomized to receive 1000 mg of ascorbic acid orally at either of those visits. Accuracy evaluation included the proportion of CGM values within 15% of YSI glucose values > 100 mg/dL or within 15 mg/dL of YSI values ≤ 100 mg/dL (%15/15), along with %20/20, %30/30, and %40/40 agreement rates (AR) across CGM ranges. The mean absolute difference (MAD) and mean absolute relative difference (MARD) with and without ascorbic acid and exercise, as well as their differences, are presented across glucose ranges.</p><p><strong>Results: </strong>Data from 16 participants were analyzed. In the overall CGM range (35-450 mg/dL), the %20/20 AR was 92.0%. The overall changes in MAD between the exercise/nonexercise and the ascorbic acid/nonascorbic acid conditions were -1.3 mg/dL and -1.1 mg/dL. The overall changes in MARD between those two sets of conditions were -1.5% and -1.6%, respectively, none of which were considered to be clinically relevant. There were no serious adverse events.</p><p><strong>Conclusions: </strong>This study provides evidence that neither exercise nor ascorbic acid results in any clinically significant interference on glucose measurements using the iCan CGM system.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier, NCT05348928.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147810","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":"Associations of Glycemic Control, Age, and Sex with Diabetic Foot Risk and Active Foot Ulceration among Patients with Diabetes in Saudi Arabia: A Cross-Sectional Study.","authors":"Fatimah Z Alenazi, Thamer Alslamah, Basmah Alharbi, Wafa I Alotaibi, Mirna Fawaz, Metab Algeffari, Yasir S Alsalamah, António Raposo","doi":"10.1007/s13300-026-01923-y","DOIUrl":"https://doi.org/10.1007/s13300-026-01923-y","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic foot disease is one of the most severe complications of diabetes mellitus, contributing substantially to hospitalization, lower limb amputation, and premature mortality. This study evaluated the associations of glycemic control (glycated hemoglobin [HbA1c]), age, and sex with diabetic foot risk and ulceration among patients attending a tertiary diabetes center in Qassim, Saudi Arabia.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included a census sample of 710 eligible electronic medical records of patients with a confirmed diagnosis of diabetes mellitus and a documented diabetic foot assessment between January 2022 and December 2024. No a priori sample size calculation was performed. The primary outcome was at-risk diabetic foot status (International Working Group on the Diabetic Foot category ≥ 1), and the secondary outcome was active foot ulceration. Multivariable logistic regression was used to identify factors independently associated with each outcome.</p><p><strong>Results: </strong>The mean age was 57.6 ± 14.0 years; 337 patients (47.5%) were male and 373 (52.5%) were female, and 93.2% had type 2 diabetes mellitus. At-risk diabetic foot status was present in 53.2% of patients, and active foot ulceration was present in 3.0%. Ulcer prevalence increased across HbA1c categories (1.9%, 2.6%, and 6.3%), and at-risk status increased with age (39.6-62.1%). Older age (odds ratio [OR] = 1.028; 95% confidence interval [CI] 1.016-1.039; P < 0.001) and male sex (OR = 1.403; 95% CI 1.036-1.901; P = 0.029) were independently associated with the at-risk status. HbA1c was not independently associated with at-risk status (P = 0.422) or ulceration (P = 0.077).</p><p><strong>Conclusions: </strong>Ulcer prevalence increased with poorer glycemic control; however, the adjusted HbA1c-ulceration association was not significant in the primary model. Key confounders were unavailable in the dataset, including diabetes duration, neuropathy and peripheral arterial disease severity, and renal function. Therefore, residual confounding cannot be excluded, and HbA1c's role in diabetic foot risk should not be discounted. These findings suggest that diabetic foot screening and preventive care should be tailored to specific age and sex groups, involving multiple healthcare disciplines.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147137","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 Complex Interplay Between Dyslipidemic Subjects Living with Type 2 Diabetes and Metabolic Syndrome and Statin Treatment: A Reflection on Adherence and Persistence in the Real World.","authors":"Felice Strollo, Giuseppina Guarino, Ersilia Satta, Giuseppe Caccavale, Maria Chiarello, Maria Carla Sibilio, Carmine Romano, Roberta Di Martino, Rosina De Luca, Raffaele Marfella, Sandro Gentile","doi":"10.1007/s13300-026-01904-1","DOIUrl":"10.1007/s13300-026-01904-1","url":null,"abstract":"<p><strong>Introduction: </strong>High levels of blood cholesterol are a major risk factor for atherosclerotic cardiovascular disease and require early and consistent utilization of statins as first-line medications to avoid disabling or even deadly consequences. Nevertheless, real-world treatment adherence is significantly lower than that reported in clinical trials. The present paper aims to improve understanding of the reasons behind this phenomenon to help physicians reduce morbidity, mortality, and healthcare costs by reversing this trend.</p><p><strong>Methods: </strong>We conducted a real-life, observational, noninterventional, retrospective, multicenter study of statin prescription, adherence, persistence, potential side effects, and the rate of early discontinuation in 1959 individuals with type 2 diabetes mellitus (T2D), metabolic syndrome (MS), and moderate hypercholesterolemia, free of prior cardiovascular events in the observation period 2023-2025. In greater detail, we assessed three main areas: the history and features of the underlying pathology-understood as the \"clinical condition\"-the knowledge and beliefs, and the socioeconomic status of the patients by analyzing anonymized clinical records from the databases routinely used in our joint network units.</p><p><strong>Results: </strong>Determinants significantly associated with insufficient or no adherence in the first area included older age, complex therapy involving multiple medications, and a history of myalgias and joint pain. In the second area, significant factors were low education, income levels, widowed/divorced, retired/unemployed conditions, and living alone. Finally, in the third area, a lack of awareness regarding cardiovascular disease (CVD) risk, previous negative experiences with statins, negative influence from social media, fear of side effects, a general rejection of medications, and a preference for \"natural supplements,\" along with the belief that diet is sufficient and that therapy is of short duration, were identified.</p><p><strong>Conclusions: </strong>Our results prompted the decision to follow up with a prospective phase in which as many subjects as possible from this cohort will be contacted and interviewed to verify the consistency of the observations and to explore adherence further.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"1559-1577"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817495","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":"Considering Deintensification and Deprescribing with Higher HbA1c Targets in Vulnerable Older Adults with Type 2 Diabetes: A Retrospective Database Study.","authors":"Ruriko Koto, Shiori Yoshida, Akihiro Nakajima, Ken Sugimoto","doi":"10.1007/s13300-026-01905-0","DOIUrl":"10.1007/s13300-026-01905-0","url":null,"abstract":"<p><strong>Introduction: </strong>In older adults with diabetes mellitus, guidelines recommend individualized hemoglobin (Hb) A1c targets based on cognitive impairment, functional status, and comorbidity burden, which collectively represent vulnerability. However, adherence to these recommendations in real-world clinical practice has not been well characterized. We aimed to investigate the association between vulnerability and incidence of severe hypoglycemia and to evaluate the distribution of HbA1c stratified by vulnerability- and drug-based categories.</p><p><strong>Methods: </strong>Using a Japanese claims database, we identified adults aged ≥ 65 years with type 2 diabetes who were prescribed outpatient glucose-lowering drugs with a 1-year baseline and up to 1-year follow-up. The most vulnerable patients were classified as category III (moderate-to-severe dementia or ≥ 4 of 8 comorbidities); all others were classified as category I + II. The outcome was incidence of severe hypoglycemia. Incidence rate ratios (IRRs) were estimated using negative binomial regression adjusted for covariates including age, comorbidities, prior severe hypoglycemia, and use of glucose-lowering drugs. HbA1c was summarized from health checkup results.</p><p><strong>Results: </strong>Among 61,351 patients, 5221 (8.5%) were category III. Incidence of severe hypoglycemia was higher in category III than in category I + II (24.96 vs. 4.76 per 1000 person-years), and category III remained associated with severe hypoglycemia after adjustment (IRR 2.71, 95% confidence interval 2.00-3.68). Insulin/sulfonylurea/glinide-containing regimens and prior severe hypoglycemia were major risk factors. HbA1c levels were available for 15,372 patients, and category III more often had HbA1c < 6.5% (category III vs. category I + II, 315/649 [48.5%] vs. 5734/14,723 [38.9%]). Among 173 category III patients receiving insulin, sulfonylureas, or glinides, 133 (76.9%) had HbA1c below the recommended lower limit (7.5%).</p><p><strong>Conclusion: </strong>Vulnerable older adults with high comorbidity burden were at substantially higher risk of severe hypoglycemia. A large proportion of patients treated with hypoglycemia-prone agents had HbA1c levels below the recommended lower bounds, supporting medication review to guide deintensification and deprescribing.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"1595-1610"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789421","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":"Effect of Combination Therapy with SGLT2 Inhibitors and GLP-1 Receptor Agonists on Myocardial Infarction and Stroke in Type 2 Diabetes: A Systematic Review and Meta-Analysis.","authors":"Roya Ghafoury, Mobin Naghshbandi, Mojtaba Malek, Sanjay Kalra, Faramarz Ismail-Beigi, Mohammad E Khamseh","doi":"10.1007/s13300-026-01911-2","DOIUrl":"10.1007/s13300-026-01911-2","url":null,"abstract":"<p><strong>Introduction: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer cardioprotection in type 2 diabetes mellitus (T2DM). We evaluated their monotherapy versus their combined use for prevention of myocardial infarction (MI) and stroke.</p><p><strong>Methods: </strong>Conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines, five databases were systematically searched through November 2025 for studies evaluating use of SGLT2i and GLP-1RA in combination versus their monotherapy in adults with T2DM. Hazard ratios (HRs) for MI and stroke were pooled utilizing random-effects models. Subgroup interaction testing and grading of recommendations assessment, development, and evaluation (GRADE) certainty assessments were performed.</p><p><strong>Results: </strong>Of the studies, eight comprising ten comparisons were included. Combination therapy was associated with a lower overall risk of MI (HR 0.79, 95% CI 0.70-0.88; I² = 72.8%) and stroke (HR 0.85, 95% CI 0.77-0.93; I² = 63.5%) compared with their monotherapy. For MI, combination therapy significantly outperformed SGLT2i monotherapy (HR 0.74, 95% CI 0.60-0.90) but not GLP-1RA monotherapy (HR 0.80, 95% CI 0.55-1.16). For stroke reduction, combination therapy outperformed both SGLT2i (HR 0.73, 95% CI 0.54-0.99) and GLP-1RA (HR 0.92, 95% CI 0.88-0.96) monotherapy. Cerebrovascular benefit appeared stronger in adults > 65 years (HR 0.50, 95% CI 0.37-0.68). Overall certainty of evidence was very low.</p><p><strong>Conclusions: </strong>In adults with T2DM, SGLT2i and GLP-1RA combination therapy may be associated with lower risks of MI and stroke compared with their monotherapy. While the MI benefit appears primarily to be driven by GLP-1RA, combination therapy yields an additive reduction in stroke risk, particularly in older adults. Given the very low certainty of evidence, these hypothesis-generating findings require confirmation through dedicated prospective trials.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420261320374 .</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"1449-1475"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873399","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":"Healthcare Cost Impacts of Telehealth-Delivered Nutrition Therapy among US Adults with Type 2 Diabetes or Obesity: A Matched Difference-in-Differences Analysis.","authors":"Priya V Shanmugam, Rebecca N Adams, Shaminie J Athinarayanan, Adam J Wolfberg, Jeromie M Ballreich","doi":"10.1007/s13300-026-01909-w","DOIUrl":"10.1007/s13300-026-01909-w","url":null,"abstract":"<p><strong>Introduction: </strong>Type 2 diabetes (T2D) and obesity are associated with substantial morbidity and healthcare spending. Although telehealth-delivered lifestyle interventions have demonstrated clinical benefits, evidence on their impact on healthcare costs and utilization remains limited. This study evaluated the association between participation in a comprehensive nutrition-first digital care model integrating individualized carbohydrate-reduced nutrition support, clinician-guided medication management, health coaching, and remote biometric monitoring on total healthcare costs and utilization over 1 year and 2 years.</p><p><strong>Methods: </strong>We conducted a claims-based, retrospective propensity score matched difference-in-differences analysis of cost and utilization outcomes among US adults with T2D or obesity who (1) enrolled in Virta Health's Individualized Nutrition Therapy (INT) program or (2) had a primary care visit for either condition between 2017 and 2025. Per-member, per-month (PMPM) outcomes included inpatient, outpatient, and prescription medication costs, as well as inpatient, emergency department, primary care, cardiology, and endocrinology visits. For the T2D cohort only, PMPM costs for each diabetes medication were also evaluated.</p><p><strong>Results: </strong>Among 3819 adults with T2D and 2761 adults with obesity, program participation was associated with $240 and $256 PMPM reductions in total cost of care at 12 months, respectively (-$230 and -$189 PMPM over 24 months; all p < 0.001). Among adults with T2D, savings were driven by reduced inpatient visits and deprescription of sodium-glucose cotransporter 2 (SGLT2) inhibitors (66.8% reduction from baseline cost), sulfonylureas (51.7%), insulin (43.9%), and glucagon-like peptide-1s (GLP-1s) (32.2%). Among adults without T2D and with obesity, reductions accrued across all cost categories.</p><p><strong>Conclusions: </strong>In this large, real-world analysis, enrollment in a comprehensive nutrition-first digital care model was associated with reductions in healthcare costs and utilization over 12 and 24 months, with prescription medication cost reductions emerging within the first quarter of treatment among adults with T2D. Together with prior evidence demonstrating clinical effectiveness, these findings suggest that comprehensive digital nutritional care models can generate meaningful economic value.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"1495-1518"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705727","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":"Correction to: Continuous Lumbar Sympathetic Blockade Enhances the Effect of Lumbar Sympatholysis on Refractory Diabetic Neuropathy: A Randomized Controlled Trial.","authors":"Haiyan Sun, Mingwei He, Jinlei Pang, Xiangfei Guo, Yansong Huo, Jun Ma","doi":"10.1007/s13300-026-01914-z","DOIUrl":"10.1007/s13300-026-01914-z","url":null,"abstract":"","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"1611"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891235","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}