Diabetes Therapy最新文献

{"title":"Blood Glucose Monitoring Expert Group and Best Practice Recommendation-FITTER BiG.","authors":"Siew Pheng Chan, Tri Juli Edi Tarigan, Beena Bansal, Joy Arabelle Castillo Fontanilla, Sueziani Zainudin, Uoonjeong Shin, Supawadee Likitmaskul","doi":"10.1007/s13300-026-01867-3","DOIUrl":"https://doi.org/10.1007/s13300-026-01867-3","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes mellitus presents a growing public health challenge across geographies including Asia, particularly in countries where blood glucose monitoring (BGM)-referring to capillary finger-prick self-monitoring of blood glucose (SMBG) using a meter and test strips-is underutilized. Having evolved and improved over recent decades, glucose monitoring (GM)-including SMBG and continuous glucose monitoring (CGM)-has become an essential tool for effective diabetes management, yet remains underutilized because of systemic, economic, and educational barriers. This work synthesizes expert insights and published evidence to develop best practice recommendations for BGM.</p><p><strong>Methods: </strong>A targeted literature review (TLR) was conducted across five thematic domains: monitoring practices, clinical decision-making, patient engagement and adherence, technology and innovation, and policy and reimbursement. Insights were complemented by a structured expert forum involving clinicians from seven Asian countries, underscoring larger implications in geographies where SMBG remains underutilized within the diabetes care continuum. The forum highlighted disparities in device access, affordability, and insurance coverage, and emphasized the need for structured diabetes self-management education (DSME) and digital integration.</p><p><strong>Results: </strong>Findings support the use of structured SMBG for non-insulin-treated type 2 diabetes and CGM for insulin-treated individuals and those at risk of hypoglycemia. Evidence from the literature review also highlighted the importance of proper SMBG technique, with common errors such as inadequate handwashing, repeated lancet use, and excessive finger squeezing contributing to inaccurate readings and finger-site injuries. Hybrid models combining CGM and SMBG for calibration or confirmation are pragmatic solutions balancing clinical utility and affordability. Digital platforms, AI-driven analytics, and mobile apps enhance patient engagement and glycemic control but face challenges of scalability and regulation.</p><p><strong>Conclusion: </strong>Policy reforms, including inclusion of BGM in national health benefit packages, expanded insurance coverage, and public-private partnerships, are critical to improving access. The recommendations advocate for personalized, context-specific monitoring strategies that balance clinical efficacy with affordability and infrastructure realities. This consensus-based framework aims to guide healthcare professionals in optimizing BGM practices and improving long-term outcomes for people living with diabetes. FITTER BiG is a new extension of the long-standing FITTER initiative, which has provided insulin injection technique recommendations for more than two decades. FITTER BiG complements this work by focusing specifically on best practice recommendations for blood glucose monitoring. FITTER BiG will provide BGM-specific recommendations designed ","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835009","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":"Real-World Effectiveness and Safety of Escalating Once-Weekly Semaglutide from 0.5 to 1.0 mg in Type 2 Diabetes.","authors":"Genki Sato, Hiroshi Uchino, Kota Takuma, Manabu Saito, Ayako Fuchigami, Yoko Iwata, Fukumi Yoshikawa, Takahisa Hirose","doi":"10.1007/s13300-026-01864-6","DOIUrl":"10.1007/s13300-026-01864-6","url":null,"abstract":"<p><strong>Introduction: </strong>Real-world data on escalation of once-weekly semaglutide from 0.5 to 1.0 mg remain limited. Therefore, we aimed to evaluate the effectiveness and safety of this dose escalation in routine clinical practice.</p><p><strong>Methods: </strong>This was a single-center, retrospective cohort study involving adults with type 2 diabetes who received an escalated once-weekly semaglutide dose from 0.5 to 1.0 mg in routine clinical care. The primary outcome was within-patient change in glycated hemoglobin (HbA1c) level 24 weeks after the initial prescription of 1-mg semaglutide. Secondary outcomes included changes in metabolic parameters and the incidence of newly documented adverse events after escalation to 1.0 mg. Efficacy was analyzed in a prespecified on-treatment set, and safety was assessed in an all-exposed set.</p><p><strong>Results: </strong>In the efficacy set (n = 126), the HbA1c level decreased by 0.40% ± 0.70% and body weight by 2.2 ± 2.7 kg at week 24 (both p < 0.01). Additionally, reductions were observed in alanine aminotransferase and γ-glutamyl transpeptidase levels, total number of concomitant glucose-lowering agents, and total daily insulin dose. In the safety set (n = 128), gastrointestinal adverse events were the most frequent (20.3%), particularly nausea (14.1%). Dose reduction was required in 12.5% of patients, mostly owing to gastrointestinal symptoms, and discontinuation for any reason occurred in 5.5%; only one patient (0.8%) discontinued treatment because of an adverse event. No serious drug-related adverse events were recorded.</p><p><strong>Conclusions: </strong>In this real-world cohort, escalation of once-weekly semaglutide dose to 1.0 mg was associated with additional reductions in HbA1c level and body weight, without serious adverse events. Although causal incremental benefit cannot be established because of the single-arm design without a 0.5-mg maintenance comparator, these findings may support clinical decision-making regarding dose intensification in patients experiencing suboptimal control with 0.5-mg semaglutide.</p><p><strong>Trial registration: </strong>UMIN Clinical Trials Registry (UMIN-CTR), UMIN000059813, retrospectively registered on November 18, 2025.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"753-770"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632872","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":"Glucagon-Like Peptide-1 Receptor Agonists: Their Potential Role in Prediabetes.","authors":"Theodoros Panou, Evanthia Gouveri, Djordje S Popovic, Dimitrios Papazoglou, Nikolaos Papanas","doi":"10.1007/s13300-026-01865-5","DOIUrl":"10.1007/s13300-026-01865-5","url":null,"abstract":"<p><p>Prediabetes is a frequently occurring condition with increased risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are established antidiabetic agents, also used to treat obesity. There is limited, yet promising evidence on their use in prediabetes. T2DM was less frequent among subjects on liraglutide, semaglutide and tirzepatide compared with the control arm. Delayed progression to T2DM has also been observed. Furthermore, normoglycaemia was achieved for subjects on liraglutide (up to 66%), semaglutide (up to 81%) and tirzepatide (up to 93.3%). However, this effect was only partially sustained following drug withdrawal. GLP-1RAs have led to modest decreases in glycated haemoglobin (HbA_1c), fasting glucose, weight and fat mass loss, as well as increased insulin sensitivity and improved β-cell glucose-insulin dynamics. Decreased risk for atherosclerotic cardiovascular disease and heart failure was also demonstrated, mostly for subjects on tirzepatide. There is experimental evidence on improvements in liver dysfunction, pointing to potential benefits for metabolic dysfunction-associated steatotic liver disease (MASLD) in prediabetes. The safety profile was acceptable with mild-to-moderate gastrointestinal adverse effects being mostly reported. Future large randomised controlled trials are needed to ascertain the exact role of GLP-1RAs in prediabetes.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"641-669"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688737","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":"Correction: Comparative Safety of SGLT2 Versus DPP4 Inhibitors in Patients with Type 2 Diabetes: A Meta‑Analysis of Randomized Controlled Trials.","authors":"Yue Li, Jie Chen, Yuying Gao, Jun Zhang, Siqiong Deng, Hao Li, Xin Zhang, Rui Li","doi":"10.1007/s13300-026-01862-8","DOIUrl":"10.1007/s13300-026-01862-8","url":null,"abstract":"","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"711-713"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688758","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":"Comparative Safety of SGLT2 Versus DPP4 Inhibitors in Patients with Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials.","authors":"Yue Li, Jie Chen, Yuying Gao, Jun Zhang, Siqiong Deng, Hao Li, Xin Zhang, Rui Li","doi":"10.1007/s13300-025-01836-2","DOIUrl":"10.1007/s13300-025-01836-2","url":null,"abstract":"<p><strong>Introduction: </strong>Type 2 diabetes mellitus (T2DM) necessitates long-term pharmacological management, with drug safety now a pivotal factor in therapy selection. Sodium‒glucose cotransporter 2 inhibitors (SGLT2is) and dipeptidyl peptidase 4 inhibitors (DPP4is) are widely prescribed oral antidiabetic agents; however, their comparative safety profiles remain under debate.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was performed up to June 2, 2025. Forty-two randomized controlled trials (RCTs) that compared SGLT2is with DPP4is in adults with T2DM were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Review Manager (RevMan) 5.3. Heterogeneity was assessed with I², and publication bias with funnel plots and Egger's test.</p><p><strong>Results: </strong>SGLT2is were associated with a higher overall risk of total adverse events (AEs) (RR 1.05, 95% CI 1.01-1.08). Infection-related risks included increased genital infections (RR 5.31, 95% CI 3.93-7.18) and urinary tract infections (UTIs) (RR 1.45, 95% CI 1.25-1.70), with no difference in upper respiratory tract infections (URTIs) (RR 0.78, 95% CI 0.61-1.02). For organ injury, a non-significant trend toward renal injury was noted (RR 1.83, 95% CI 0.92-3.67), with no difference in liver injury (RR 0.64, 95% CI 0.28-1.46) or fracture (RR 0.83, 95% CI 0.25-2.70). Severe outcomes-including hypoglycemia (RR 1.07, 95% CI 0.88-1.29), mortality (RR 1.48, 95% CI 0.59-3.71), diabetic ketoacidosis (DKA) (RR 2.99, 95% CI 0.31-28.45), and major adverse cardiovascular events (MACEs) (RR 1.21, 95% CI 0.35-4.19)-did not differ. Hypersensitivity risk was also comparable (RR 1.25, 95% CI 0.65-2.42).</p><p><strong>Conclusion: </strong>SGLT2is have an overall favorable safety profile but increase the risks of genitourinary infections and transient renal impairment. Risk stratification and monitoring are essential for high-risk individuals, for whom DPP4is may be safer. These findings provide robust RCT-based evidence to inform individualized treatment and guideline updates.</p><p><strong>Trial registration: </strong>This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. The protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420251115623).</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"685-709"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164647","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":"Ten-Year Trends in Healthcare Use and Costs for People Living with Diabetes in France: Results from the Epicodiab Study Based on National Claims Data.","authors":"Michael Joubert, Pierre Serusclat, Emilie Casarotto, Oriane Bretin, Barbara Roux, Pascaline Rabiéga, Yolaine Rabat, Cécile Berteau, Antoine Pouyet, Guy Fagherazzi","doi":"10.1007/s13300-026-01850-y","DOIUrl":"10.1007/s13300-026-01850-y","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes remains a global public health concern, with increased prevalence and a significant economic burden. Yet, most studies do not differentiate between type 1 (T1D) and type 2 diabetes (T2D), despite distinct clinical trajectories and care needs. This study aimed to provide up-to-date data on healthcare use and diabetes care-related costs in France from 2011 to 2019 by type of diabetes.</p><p><strong>Methods: </strong>A 10-year retrospective study was conducted on adults identified with T1D and T2D between 1 January 2010, and 31 December 2019, in a 1/10th sample of the French nationwide claims database (SNDS, Système National des Données de Santé). In the hospital database, reimbursement data are available only from 2011, so resource use and cost analyses were conducted starting from 2011 to 2019 in this present study. Diabetes was identified through hospital diagnoses, specific treatments, and/or long-term conditions. A machine-learning algorithm was specifically developed through a linkage between SNDS data and primary data from a network of French general practitioners to better predict the type of diabetes.</p><p><strong>Results: </strong>In 2019, among the 290,486 treated individuals, 12,102 (4.2%) had T1D, 62,479 (21.5%) had insulin-treated type 2 diabetes (T2Di), and 215,905 (74.3%) had noninsulin-treated type 2 diabetes (T2Dni). Average total reimbursed costs per individual varied significantly by diabetes group: €10,033 (T1D), €13,424 (T2Di), and €5091 (T2Dni), primarily owing to primary care settings (63.6% to 71.8% of the total cost). Between 2011 and 2019, total reimbursement costs increased (+ 9.6% for T1D, + 29.8% for T2Di, and + 13.8% for T2Dni), while average cost per individual decreased (-9.6% for T1D, -7.7% for T2Di, and -1.0% for T2Dni).</p><p><strong>Conclusions: </strong>As its prevalence continues to rise, the economic burden of diabetes also grows overall, despite the reduction in individual costs.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"735-752"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510401","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":"Fixed-Dose Combination Therapy as a Strategy to Improve Antidiabetic Medication Adherence in People with Type 2 Diabetes: A Narrative Review.","authors":"Patrick J Highton, Mark P Funnell, Kamlesh Khunti","doi":"10.1007/s13300-026-01863-7","DOIUrl":"10.1007/s13300-026-01863-7","url":null,"abstract":"<p><p>Type 2 diabetes mellitus (T2DM) is a metabolic condition associated with increased morbidity, mortality and healthcare costs, with poor medication adherence to antidiabetic medications being a major barrier to optimal risk-factor control. Treatment complexity, due to polypharmacy and burdensome dosing regimens, is a key contributor to medication non-adherence in people with T2DM. Fixed-dose combination (FDC) therapy, in which two or more drugs are co-formulated into a single dosage, has emerged as a key strategy to reduce treatment burden, simplify dosing and potentially improve adherence in T2DM. This narrative review evaluates the evidence for FDC therapy as a means of improving medication adherence in people with T2DM. We summarise the development of FDCs, commonly used antidiabetic regimens, patient-reported benefits and their role in clinical practice. Evidence from randomised controlled trials (RCTs) assessing medication adherence is limited, but observational studies consistently demonstrate improved adherence among patients prescribed FDCs compared with free-equivalent combination regimens. Systematic reviews and meta-analyses support these findings, showing that FDCs attenuate the decline in medication adherence observed when transitioning from monotherapy to combination therapy. Additional benefits of FDC therapy include greater treatment satisfaction, potential cost-effectiveness and safety profiles comparable to their individual components. However, challenges associated with FDC therapy remain, including limited dosing flexibility, difficulties in titration and a paucity of long-term adherence data. Further research, particularly RCTs comparing FDCs with equivalent separate combinations and long-term follow-up data, are needed to confirm these benefits and inform clinical guidelines. Overall, FDC therapy is beneficial for simplifying diabetes treatment and improving medication adherence in T2DM.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"627-640"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644060","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":"Tirzepatide as an Add-on for Participants with Inadequate Glycemic Control Using Basal Insulin: Pooled Subgroup Analysis of SURPASS-5 and -6.","authors":"Harpreet S Bajaj, Liana K Billings, Palash Sharma, Joshua A Levine, Angel Rodriguez, Hiren Patel","doi":"10.1007/s13300-026-01859-3","DOIUrl":"10.1007/s13300-026-01859-3","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to assess the efficacy and hypoglycemia safety of tirzepatide as an add-on to basal insulin in people with inadequate glycemic control, across subgroups of baseline age, type 2 diabetes (T2D) duration, HbA1c, and basal insulin dosage using pooled data from the SURPASS-5 and -6 studies.</p><p><strong>Methods: </strong>This exploratory post hoc analysis compared data from 1072 participants treated with tirzepatide as an add-on to basal insulin in SURPASS-5 and SURPASS-6. In SURPASS-5, tirzepatide was compared against placebo, while in SURPASS-6, it was compared with insulin lispro. Insulins were titrated to the target in both trials. Subgroups were divided by baseline HbA1c (≤ 8.5% and > 8.5%), age (< 65 years and ≥ 65 years), duration of T2D (< 10 years and ≥ 10 years), and insulin glargine dose (< 50 IU/day and ≥ 50 IU/day).</p><p><strong>Results: </strong>At the primary endpoint, tirzepatide added to basal insulin glargine was associated with significant reductions in HbA1c, fasting serum glucose, and insulin glargine dose across all subgroups (P < 0.001), with no significant heterogeneity (all interaction P values > 0.1). Clinically significant hypoglycemia incidence rates were highest in younger participants with a baseline HbA1c above 8.5% and duration of T2D ≥ 10 years.</p><p><strong>Conclusions: </strong>In this study, tirzepatide combined with basal insulin glargine was associated with reductions in HbA1c, fasting serum glucose, and insulin glargine dose from baseline, with a low incidence of hypoglycemia, regardless of baseline age, HbA1c, duration of T2D, or basal insulin dose.</p><p><strong>Trial registration: </strong>Trials were registered at ClinicalTrials.gov under the identifiers NCT04039503 (SURPASS-5) and NCT04537923 (SURPASS-6).</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"787-797"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644117","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":"Clinical and Metabolic Characteristics of Spontaneous Remission in Type 2 Diabetes: A Real-World Study from South India.","authors":"Saravanan Jebarani, Bhavadharini Balaji, Viswanathan Baskar, Raghavan Bhuvaneswari, Coimbatore Subramanian Shanthi Rani, AnandaPerumal Lavonya, Sadasivam Ganesan, Ananthakrishnan Subramanian Akshay, Manodip Acharyya, Phillips Routray, Ranjit Unnikrishnan, Viswanathan Mohan, Ranjit Mohan Anjana","doi":"10.1007/s13300-026-01858-4","DOIUrl":"10.1007/s13300-026-01858-4","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate clinical characteristics and outcomes of individuals with type 2 diabetes (T2D) who achieved spontaneous remission without structured intervention.</p><p><strong>Methods: </strong>We examined electronic medical records of 243,400 adults with T2D attending a tertiary care center in India between 1993 and 2018. Spontaneous remission was defined as achieving glycated hemoglobin (HbA1c) < 6.5% for at least 3 months without glucose-lowering medication in those who earlier had HbA1c ≥ 6.5%. A matched group without remission was selected for comparison.</p><p><strong>Results: </strong>Among 243,400 individuals with T2D, 275 (0.11%) achieved spontaneous remission. Remission occurred in 0.34% of individuals with baseline HbA1c < 7.0%, 0.13% with HbA1c 7.0-7.9%, and 0.08% with HbA1c ≥ 8.0%. Diabetes recurred in 69%, 80%, and 87% of these respective groups, after a median remission duration of 2.1 years. Sustained remission was observed in 55 individuals (0.02%). Individuals who achieved remission were older, had lower body weight and glucose levels, shorter duration, higher C-peptide, and greater physical activity. Relapse was associated with higher body weight and postprandial glucose levels. Individuals who had longer remission had greater weight loss.</p><p><strong>Conclusion: </strong>Spontaneous remission of T2D is rare and mostly transient. Higher baseline HbA1c predicts relapse, while sustained weight loss is strongly associated with long-term remission.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"715-734"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510455","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":"Optimizing Type 2 Diabetes Management in Iraq: Expert Consensus on Initiation and Intensification of Insulin-Based Treatment Options.","authors":"Charles Saab, Abbas Ali Mansour, Abbas Mahdi Rahmah, Delman Raoof Al-Attar, Haidar Fadhil Al-Rubay'e, Haider Ayad Alidrisi, Hussein Ali Nwayyir, Mahmood Shakir Khudhair, Mazyar Jabbar Ahmed, Salim Marzouq Al-Ibrahimi, Taha Othman Mahwi","doi":"10.1007/s13300-026-01861-9","DOIUrl":"10.1007/s13300-026-01861-9","url":null,"abstract":"<p><strong>Introduction: </strong>Type 2 diabetes mellitus (T2DM) prevalence in Iraq is projected to rise significantly by 2045, creating urgent need for optimized use of latest insulin therapies. An expert panel of eleven diabetes specialists convened to assess the evolving landscape of insulin therapies and explore how each option fits into current strategies to optimize T2DM management in Iraq.</p><p><strong>Methods: </strong>The panel reviewed international guidelines and local practice patterns through pre-meeting surveys. Discussions focused on initiation and intensification of insulin-based treatment in Iraq's context, considering accessibility challenges and patient characteristics.</p><p><strong>Results: </strong>When hemoglobin A1c (HbA1c) is < 2% above target, basal insulin (BI) is recommended for patients with body mass index (BMI) ≤ 30. For BMI > 30, either GLP-1 receptor agonist (GLP-1 RA) monotherapy or a fixed ratio combination (FRC) of GLP-1 RA and BI is preferred. When HbA1c is ≥ 2% above target, initiation with BI and GLP-1 RA is advised across BMI groups. If glycemic targets are not achieved despite reaching 0.5 U/kg of BI, prandial insulin may be added via premixed regimen or basal-bolus regimens based on individual factors. Premix insulin remains an alternative when other options are unavailable. Key barriers in Iraq include high cost and limited availability of GLP-1 RAs, therapeutic inertia, and gaps in healthcare infrastructure. Final treatment decisions should consider disease severity, cardiovascular and renal comorbidities, and weight goals.</p><p><strong>Conclusion: </strong>The panel curated clinical practical recommendations about injectable insulin therapies and proposed a structured treatment algorithm tailored to Iraq's healthcare setting, prioritizing simplicity, efficacy, tolerability and accessibility. The panel emphasized the critical role of second-generation BIs and FRCs of BI and GLP-1 RA in Iraq's T2DM treatment algorithm, providing clear guidance on their optimal use and place in therapy, overcoming barriers, alongside enhanced education for healthcare providers and patients.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"671-684"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688825","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}