Diabetes Therapy最新文献

{"title":"Modern Management of CKM Syndrome: Use of GLP-1 Receptor Agonists in a Multidisciplinary Setting-Expert Group Recommendations from Kuwait.","authors":"Waleed A Aldahi, Abdullah Alenezi, Thamer Alessa, Rashed Alhamdan, Khaldoon A Al-Humood, Ahmed Alqallaf, Torki Alotaibi, Heba Alrajab, Abdulmuhsen M Alshammari, Anas M Alyousef, Asrar Alsayed Hashem, Manfredi Rizzo","doi":"10.1007/s13300-025-01838-0","DOIUrl":"10.1007/s13300-025-01838-0","url":null,"abstract":"<p><p>Obesity, type 2 diabetes (T2D), cardiovascular disease (CVD), and chronic kidney disease (CKD) are overlapping conditions that drive premature morbidity and mortality worldwide. Care remains siloed and reactive despite shared risk factors and strong evidence for early intervention. To support integrated disease management, the American Heart Association (AHA) recently introduced the concept of cardiovascular-kidney-metabolic (CKM) syndrome, recognizing the bidirectional links between metabolic, kidney, and cardiovascular health. Kuwait faces one of the highest burdens of CKM-related diseases globally. Three-quarters of adults are overweight or have obesity, and 28% have diabetes, both of which are leading causes of mortality and health system strain. Yet multidisciplinary care remains limited, and innovative pharmacotherapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), are underused. A panel of Kuwaiti endocrinologists, cardiologists, and nephrologists convened to assess barriers to optimal CKM care and define practical recommendations. Discussions focused on current gaps in screening, care coordination, provider education, and access to therapies. Evidence on GLP-1 RAs was reviewed, considering the demonstrated benefits for weight loss, glycemic control, cardiovascular outcomes, and CKD progression. The expert group agreed that multidisciplinary, risk-stratified, and patient-centered approaches are urgently needed. Recommendations include earlier screening and diagnosis, improved integration across specialties, healthcare provider upskilling, public awareness campaigns, and broader access to GLP-1 RAs. Semaglutide was highlighted as a clinically valuable option owing to its broad efficacy and safety profile. Adopting a CKM care model tailored to Kuwait's specific challenges, with appropriate use of GLP-1 RAs, can reduce disease burden, improve outcomes, and increase healthcare system efficiency. The local implementation of evidence-based, cross-specialty strategies is key to altering the trajectory of CKM syndrome in high-risk populations.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"373-389"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164620","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":"Letter to the Editor regarding \"Accuracy and Reliability of the Sinocare iCan i3 Continuous Glucose Monitoring System\".","authors":"Fatih Gürbüz","doi":"10.1007/s13300-026-01840-0","DOIUrl":"10.1007/s13300-026-01840-0","url":null,"abstract":"","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"461-463"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146194416","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":"Innovative Diabetes Therapies and Impact on Peripheral and Autonomic Diabetic Neuropathies: A State-of-the-Art Review.","authors":"Jelena Vekic, Aleksandra Zeljkovic, Viviana Maggio, Manfredi Rizzo, Sanja Medenica","doi":"10.1007/s13300-025-01828-2","DOIUrl":"10.1007/s13300-025-01828-2","url":null,"abstract":"<p><p>As a leading complication of diabetes mellitus, diabetic neuropathy (DN) represents a major public health challenge due to its high prevalence and impact on patients' quality of life. The most common form, diabetic peripheral neuropathy (DPN), is characterized by progressive sensory loss, neuropathic pain, and autonomic dysfunction, all of which can significantly increase the risk of serious complications, such as foot ulcers and amputations. Traditionally, therapeutic strategies for DN have been largely limited to symptomatic management. However, recent advancements in diabetes therapy have opened promising avenues for disease-modifying interventions. In particular, incretin-based therapies and sodium-glucose co-transporter 2 (SGLT2) inhibitors have attracted increasing interest not only for their glucose-lowering effects, but also for their broader metabolic, renal, and cardiovascular benefits. In this narrative review, we synthesize emerging evidence on the potential role of these innovative therapies in the management of DN. Preclinical models, clinical trials and real-world observational studies strongly support the hypothesis that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and SGLT2 inhibitors may confer neuroprotective benefits. Beyond these established classes, novel agents such as dual and triple receptor agonists are currently being investigated. Although clinical data on their effects in DN are still limited, the simultaneous activation of multiple metabolic pathways suggests the potential for synergistic neuroprotective effects through enhanced regulation of glucose and lipid metabolism, attenuation of systemic inflammation and oxidative stress, improvement of mitochondrial function and reduction of neuronal damage. Although innovative diabetes therapies are still in early stages of development, they reflect a rapidly evolving landscape in the management of DN in the future.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"331-355"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910888","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":"A Retrospective Analysis of the Clinical Characteristics and Treatment Patterns Among Individuals with Diabetes Receiving Insulin Therapy in Japan: The Insulin JP2DB Study.","authors":"Michiaki Fukui, Satoshi Tsuboi, Yuiko Yamamoto, Yasuo Terauchi","doi":"10.1007/s13300-026-01839-7","DOIUrl":"10.1007/s13300-026-01839-7","url":null,"abstract":"<p><strong>Introduction: </strong>This retrospective database study investigated trends in insulin and use of concomitant noninsulin glucose-lowering medication (NIGLM) among Japanese individuals with diabetes.</p><p><strong>Methods: </strong>The study comprised two analyses: (1) a serial cross-sectional analysis of patterns in insulin treatment by year (database: Real World Data); and (2) a longitudinal retrospective cohort analysis that examined insulin treatment and individuals' characteristics (database: DeSC). Individuals initiating insulin in an inpatient or outpatient setting were followed up for 9 months (type 2 diabetes [T2D]) or 21 months (type 1 diabetes [T1D]) to evaluate treatment changes over time.</p><p><strong>Results: </strong>The serial cross-sectional analysis included 4953 individuals (T2D, n = 4693; T1D, n = 260). The proportion of participants with T2D receiving concomitant NIGLMs increased from 31% in 2002 to 61% in 2021; from 2014 onwards, more than 30% of insulin-treated and basal-insulin-treated individuals treated with concomitant NIGLMs received dipeptidyl peptidase-4 inhibitors. Since 2018, use of concomitant NIGLMs in T1D has increased. The longitudinal retrospective cohort analysis included 27,492 individuals (T2D, n = 27,031; T1D, n = 461). Among participants with T2D who initiated insulin in an inpatient setting, 70.8% received bolus insulin at initiation, with this proportion declining to 17.3% after 9 months; proportions of participants receiving basal insulin and of those receiving basal-bolus insulin increased over the same period (6.3-31.1% and 17.0-23.4%, respectively). The majority of participants with T2D who initiated insulin in an outpatient setting received basal insulin at initiation (hospital, 53.9%; clinic, 58.9%). Among participants with T1D who initiated insulin in an inpatient setting, 57.9% received bolus insulin, and basal-bolus insulin was the predominant regimen after 1 month (85.0%); in outpatient settings, basal-bolus insulin was the predominant regimen throughout the study.</p><p><strong>Conclusion: </strong>In Japan, the most prominent insulin regimen at initiation varied across settings in T2D but not in T1D; use of concomitant NIGLMs increased over time in both.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"411-429"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146060629","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":"Real-World Weight Loss Outcomes by Obesity Management Approaches in Japan: Descriptive Findings from the J-ORBIT Database Linked to Electronic Medical Records (J-ORBIT2).","authors":"Yushi Hirota, Seiji Nishikage, Satoshi Osaga, Ambrish Singh, Tomotaka Shingaki, Taisuke Kojima, Masamichi Ishii, Kengo Miyo, Wataru Ogawa","doi":"10.1007/s13300-025-01837-1","DOIUrl":"10.1007/s13300-025-01837-1","url":null,"abstract":"<p><strong>Introduction: </strong>The current clinical reality and burden of obesity disease in Japan are poorly understood. To address this knowledge gap, in this real-world study we describe the characteristics of Japanese individuals with obesity disease (IwOD) and their obesity disease treatments using data from the Japan Obesity Research Based on electronIc healTh record (J-ORBIT) database.</p><p><strong>Methods: </strong>This retrospective observational study (January 2019 to January 2024) assessed data of ≥ 18-year-old IwOD registered in J-ORBIT and diagnosed with primary obesity per the criteria of the Japan Society for the Study of Obesity (JASSO). IwOD were grouped according to the most advanced treatment received during the study period, including the index date: lifestyle intervention, pharmacotherapy, or bariatric surgery. Demographic and clinical characteristics, degree of weight reduction, and percent change in metabolic parameters from baseline to the latest follow-up timepoint were described.</p><p><strong>Results: </strong>Among the 782 IwOD included in this study, 274, 487, and 21 had received advanced treatment in the form of lifestyle intervention, pharmacotherapy, and bariatric surgery, respectively. At baseline, across treatment groups the mean age ranged from 45 to 57 years, female proportion ranged from 45% to 76%, and body mass index (BMI) ranged from 31 to 39 kg/m², respectively. Across treatment groups, 62-69% had ≥ 3 obesity-related health disorders (ORHDs) at baseline. Mean follow-up periods in these groups ranged from 846 to 1211 days. Mean weight and BMI numerically decreased from baseline to follow-up across groups. In the lifestyle intervention , pharmacotherapy, and bariatric surgery groups, 38%, 45%, and 65% of IwOD achieved ≥ 3% weight reduction at the latest follow-up timepoint. IwOD with baseline BMI ≥ 30 kg/ m² tended to achieve greater weight reduction. Triglyceride, high-density lipoprotein-cholesterol, blood glucose, hemoglobin A1c, and uric acid levels tended to improve in IwOD with ≥ 3% weight reduction and greater categories.</p><p><strong>Conclusion: </strong>Obesity-associated burden in terms of ORHDs was common among Japanese IwOD. Although IwOD tended to have the highest weight reduction after bariatric surgery, this treatment is indicated for a highly restrictive population and requires specific criteria to be met, leaving many IwOD with unmet needs. These IwOD may need pharmacotherapy for better weight management than that provided by current options.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"391-410"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997503","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":"Evaluating the Effects of Glucagon-Like Peptide 1 Receptor Agonists as a Secondary Prevention in Peripheral Arterial Disease: A Meta-Analysis.","authors":"Beth Elliott, Ellie Tomlinson, Nirali Desai, Adrian Heald, Benjamin C Field, Christian Heiss, Martin B Whyte","doi":"10.1007/s13300-026-01843-x","DOIUrl":"10.1007/s13300-026-01843-x","url":null,"abstract":"<p><strong>Introduction: </strong>GLP-1 receptor agonists (GLP-1 RAs) are hypothesized to reduce peripheral arterial disease (PAD) complications through mechanisms, including enhanced cardiac function, improved cardiovascular risk factors and inflammation, and local vascular effects such as angiogenesis. We assessed the effectiveness of GLP-1 RAs in lowering the risk of major adverse limb events (MALE) among individuals with diabetes and diagnosed PAD.</p><p><strong>Methods: </strong>This was a meta-analysis of a structured search of MEDLINE, PubMed, and SCOPUS databases until 16 June 2025. Eligibility criteria were randomized controlled trials of GLP-1 RAs reporting major adverse limb events from PAD. We identified five articles published up to June 2025 that met the inclusion and exclusion criteria. Study selection, data extraction, and quality assessment were carried out by two reviewers working independently and in duplicate, to assess eligibility and risk of bias, and extract data from eligible studies. Random-effects models were used to pool estimates across the included studies. Meta-analyses were performed using Cochrane-RevMan.</p><p><strong>Results: </strong>Five studies were included in the meta-analysis, comprising 25,067 patients in total. There were 433 revascularization events. Compared with the control group, the overall log odds ratio for revascularization with GLP-1 RA treatment was 0.87 (95% confidence interval [CI]: 0.73, 1.05; p = 0.13). Two of the studies reported amputation rates (comprising 224 events), with an overall log odds ratio of 0.82 (95% CI: 0.53, 1.27; p = 0.37) for GLP-1 RA treatment.</p><p><strong>Conclusions: </strong>In this meta-analysis of randomized trials, GLP-1 RAs were not associated with statistically significant differences in revascularization or amputation outcomes in individuals with diabetes and PAD.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"449-459"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200079","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":"Evaluation of Overall Health State, Treatment Burden, and Satisfaction with Insulin Efsitora Alfa (Efsitora) vs. Daily Comparator in Adults with Type 2 Diabetes in the QWINT Clinical Trial Program.","authors":"Eden Miller, Michael B Davidson, Harpreet S Bajaj, Julio Rosenstock, Athena Philis-Tsimikis, Richard M Bergenstal, Michael Case, Liza Ilag, Rebecca Threlkeld, Esther Levasseur, Felicia Gelsey","doi":"10.1007/s13300-025-01833-5","DOIUrl":"10.1007/s13300-025-01833-5","url":null,"abstract":"<p><strong>Introduction: </strong>Once-weekly efsitora resulted in similar efficacy and safety compared with daily basal insulins glargine or degludec in the treatment of adults with type 2 diabetes in the QWINT phase 3 development program. To fully assess once-weekly insulin's potential and address common barriers associated with insulin therapy (e.g., clinical inertia, fear of injections, treatment complexity), other aspects of the participants' treatment experiences were investigated using patient-reported outcome (PRO) measurements. The results of these PROs from QWINT-1 to -4 are presented here.</p><p><strong>Methods: </strong>Six different PRO instruments were completed across the studies at primary timepoints and treatment period endpoint (QWINT-1, week 26/52; QWINT-2, week 26/52; QWINT-3, week 26/52/78; QWINT-4, week 26) by participants enrolled in the phase 3 QWINT clinical trials. The PRO instruments included Treatment Related Impact Measure-Diabetes (Trim-D) (QWINT-1, -2, and -3), Diabetes Treatment Satisfaction Questionnaire (DTSQ) (QWINT-1 and -3), Simplicity of Diabetes Treatment Questionnaire (SIM-Q) (QWINT-1, -2, and -3), Basal Insulin Experience (BIE) (all QWINTs), EQ-5D-5L (QWINT-2, -3, and -4), and Short Form-36 Health Survey Version 2(SF-36v2) (QWINT-2).</p><p><strong>Results: </strong>Efsitora-treated participants demonstrated greater or similar improvements than comparators for most of the measured PROs at the primary timepoint in all four studies, particularly in QWINT-3 and -4 (prior insulin experience). Notably, for those treated with efsitora, there were significantly larger improvements than comparators in the PRO domains of treatment burden, daily life, diabetes management, compliance, satisfaction, and psychological health, as measured using the TRIM-D and DTSQc. Participants treated with efsitora had similar scores across both health-related quality of life measures, EQ-5D-5L and SF-36v2, at the primary endpoint when evaluated versus the comparator.</p><p><strong>Conclusions: </strong>Participants in the QWINT-1 to -4 studies demonstrated a strong preference for efsitora, along with improved overall functioning, well-being, and treatment burden compared to daily basal insulins.</p><p><strong>Clinical trial registration number for qwint studies: </strong>QWINT-1: NCT05662332; QWINT-2: NCT05362058; QWINT-3: NCT05275400; QWINT-4: NCT05462756.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"431-447"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050828","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":"Optimizing Continuous Glucose Monitoring Adoption in India: From Current Challenges to Future Solutions.","authors":"Jothydev Kesavadev, V Mohan, Shashank Joshi, Banshi Saboo, Manoj Chawla, A G Unnikrishnan, Om Lakhani, Amit Gupta, Rakesh Parikh, Abhijith Bhograj, Anuj Maheshwari, Ameya Joshi, Timor Glatzer, Sandeep Sewlikar, Abin Augustine","doi":"10.1007/s13300-026-01842-y","DOIUrl":"10.1007/s13300-026-01842-y","url":null,"abstract":"<p><p>Despite revolutionizing diabetes care globally, continuous glucose monitoring (CGM) adoption in India remains limited, as a result of several economic, infrastructural, clinical, and sociocultural concerns. This narrative review aims to map unmet needs and propose practical, context-specific solutions. Continuous use of CGM remains the preferred approach for optimal glucose management and achieving long-term metabolic advantages, providing insights for proactive, data-driven, and preventive diabetes care. However, main barriers to CGM uptake include limited awareness among people with diabetes and healthcare providers, high costs, lack of reimbursement, limited device availability beyond major cities, and economic, infrastructural, and sociocultural access inequities across urban and rural populations. The psychological burden from frequent alarms, data fatigue, and stigma with noticeable or intrusive devices add to these challenges. Addressing these barriers necessitates a multifaceted strategy involving affordable, climate-adapted devices, interoperable digital ecosystems, India-specific reimbursement models, and robust educational infrastructure. The emergence of cost-effective CGM devices with a range of advanced features, such as predictive glucose algorithms and personalized pattern identification, is pivotal to this effort. These innovations improve clinical outcomes and quality of life by simplifying the user experience, addressing challenges, such as alarm fatigue while translating complex data into actionable insights, facilitating widespread CGM adoption in India.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"357-372"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104263","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":"Rewriting Diabetes Therapy: How Incretin Modulation is Transforming Cardiovascular and Renal Outcomes.","authors":"José Pablo Miramontes-González, Álvaro Rodrigo-Alaíz, Miriam Gabella-Martín, David González-Calle, Juana Carretero-Gómez, Luis Corral-Gudino","doi":"10.1007/s13300-025-01829-1","DOIUrl":"10.1007/s13300-025-01829-1","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with type 2 diabetes mellitus (T2DM), cardiovascular (CV) disease and chronic kidney disease (CKD) drive excess morbidity and mortality. Beyond glucose-lowering, incretin-based therapies may provide organ protection across the cardiorenal axis.</p><p><strong>Methods: </strong>Narrative review of mechanistic pathways and randomized trials of GLP-1 receptor agonists (GLP-1RA), DPP-4 inhibitors, and newer dual/triple agonists, with targeted updates from recent pivotal programs (SELECT, FLOW, SOUL, SURPASS-CVOT) and emerging oral small-molecule GLP-1R agonists.</p><p><strong>Results: </strong>Long-acting GLP-1RA reduces major adverse CV events (MACE), all-cause and CV death, heart-failure hospitalization, and kidney composites across CV outcome trials and meta-analyses. A 2019 pooled analysis and a 2025 update confirm consistent reductions in MACE and hard kidney outcomes independent of baseline HbA1c. In obesity without diabetes, semaglutide 2.4 mg lowered MACE in SELECT, expanding prevention beyond glycemia. In CKD with T2DM, FLOW showed that semaglutide reduced major kidney disease events and death from CV/kidney causes. In T2DM with ASCVD and/or CKD, the SOUL cardiovascular outcome trial (CVOT) demonstrated that oral semaglutide reduced three-point MACE versus placebo. In head-to-head CVOT, tirzepatide was non-inferior to dulaglutide on MACE while achieving greater weight and HbA1c reductions. Mechanistically, GLP-1R signaling spans Gs-cAMP/PKA, β-arrestin-dependent pathways, and additional routes (including Gq contexts), aligning with anti-inflammatory, natriuretic, and antifibrotic effects observed preclinically and clinically. Oral non-peptide GLP-1R agonists (e.g., orforglipron) show phase 2 efficacy but lack long-term CV/renal outcome data.</p><p><strong>Conclusions: </strong>Incretin-based therapy has shifted care from glucose-centric targets to cardiorenal risk reduction. GLP-1RA are guideline-endorsed for patients with T2DM and high CV/renal risk irrespective of HbA1c; dual agonists and oral small-molecule agents may broaden indications pending definitive outcome evidence.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"317-330"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899272","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":"Cost-effectiveness of Freestyle Libre Systems for People with Type 2 Diabetes Mellitus on Basal Insulin Therapy in the Netherlands: An Economic Evaluation from a Societal Perspective Within a Publicly Funded Healthcare System.","authors":"Peter van Dijk, Chris Chesters, Jack Timmons, Kirk Szafranski, Julia Bakker, Fleur Levrat-Guillen","doi":"10.1007/s13300-025-01821-9","DOIUrl":"10.1007/s13300-025-01821-9","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare expenditure for the treatment of type 2 diabetes mellitus (T2DM) in the Netherlands is high, mainly due to the cost of treating diabetes-related complications. Guidelines recommend sensor-based glucose monitoring systems for people living with T2DM and using insulin, but these are not reimbursed in the Netherlands for those using basal insulin only. The objective of this study was to assess the cost-effectiveness of glucose monitoring with FreeStyle Libre systems (FSL), compared with capillary-based self-monitoring of blood glucose (SMBG), for people living with T2DM on basal insulin, from the perspective of the Dutch publicly funded healthcare system.</p><p><strong>Methods: </strong>The patient-level microsimulation model DEDUCE (DEtermination of Diabetes Utilities, Costs, and Effects) was used to estimate the incidence of complications and acute diabetes events (ADEs; hypoglycemia and diabetic ketoacidosis). The effect of FSL was modeled as a 0.5% reduction in glycated hemoglobin level, which DEDUCE translates to a lower rate of complications, and as reductions in ADEs and absenteeism. Costs (in 2024 euros) and utilities were discounted at 3% and 1.5%, respectively. Outcomes were assessed as quality-adjusted life years (QALYs).</p><p><strong>Results: </strong>FSL was associated with 0.53 more QALYs than SMBG (12.77 vs. 12.24), at an additional cost of €8021. The resulting incremental cost-effectiveness ratio (ICER) for FSL versus SMBG was €15,181/QALY. The increased acquisition cost of FSL (€19,738) was partially offset by reductions in costs associated with complications, ADEs, and absenteeism. Probabilistic sensitivity analysis showed that FSL was 52% likely to be cost-effective at a willingness-to-pay threshold of €20,000/QALY, and > 99% likely at thresholds ≥ €40,000/QALY. FSL had an ICER of below €50,000/QALY in all scenarios investigated.</p><p><strong>Conclusion: </strong>From a Dutch publicly funded healthcare system perspective, FSL can be considered to be cost-effective compared with SMBG for people living with T2DM on basal insulin therapy.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"217-229"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12909732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631161","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}