Diabetes Therapy最新文献

{"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":4.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156381/pdf/","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":"OA","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":4.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156370/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Once-Weekly IcoSema Versus Once-Daily IDegLira in People with Type 2 Diabetes: Systematic Literature Review and Network Meta-analysis.","authors":"Saikrishna Kandalam, Malik Benamar, Corinne Le Reun, Lauren Rengger, Palvi Gupta, Sunita Nair","doi":"10.1007/s13300-026-01847-7","DOIUrl":"10.1007/s13300-026-01847-7","url":null,"abstract":"<p><strong>Introduction: </strong>For people with type 2 diabetes (T2D), combination therapy with a basal insulin and a glucagon-like peptide 1 receptor agonist (GLP-1 RA) can improve glycaemic control, lower hypoglycaemia risk, and improve adherence. IcoSema is the first once-weekly combination of basal insulin and GLP-1 RA in a single injection. To compare once-weekly IcoSema and once-daily IDegLira for the management of T2D in the absence of head-to-head trials, we performed a network meta-analysis (NMA).</p><p><strong>Methods: </strong>A systematic literature review was conducted in November 2023, updated in August 2025, to identify randomised controlled trials (RCTs) of people with T2D, investigating basal insulin and GLP-1 RA combination therapies. Data were extracted for change from baseline in glycated haemoglobin (HbA_1c), body weight, systolic blood pressure, end-of-treatment basal insulin dose, rate ratio (RR) of clinically significant or severe hypoglycaemia and discontinuation due to adverse events (DDAEs). The NMA scope included multinational RCTs with evidence at 52 ± 4 weeks. Fixed and random effects Bayesian NMAs were fitted.</p><p><strong>Results: </strong>At 52 weeks, compared with IDegLira, IcoSema was associated with significantly greater HbA_1c reduction (- 0.4%; 95% credible interval [CrI] - 0.56, - 0.24), significantly greater body weight reduction (- 3.2 kg; 95% CrI - 3.91, - 2.5), significantly lower daily insulin dose (- 9 units/day; 95% CrI - 13, - 5) and significantly lower rates of clinically significant or severe hypoglycaemia (RR 0.35; 95% CrI 0.26, 0.46). There was no difference in the odds of DDAEs. No 52 ± 4-week IGlarLixi trials were identified.</p><p><strong>Conclusion: </strong>These results indicate that once-weekly IcoSema is an efficacious treatment option for adults with T2D requiring insulin intensification. IcoSema was associated with improved glycaemic control, weight reduction, and lower hypoglycaemia risk compared with once-daily IDegLira, as well as a reduction in insulin and injection requirements. Weekly IcoSema offers the potential to reduce treatment burden and increase adherence, thereby improving long-term disease control and patient outcomes.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"547-561"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316798","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":"Implementation of a Gestational Diabetes Virtual Care Clinic: A Before-After Comparative Study.","authors":"Ciara Coveney, Shauna Callaghan, Eimear Rutter, Catherine Chambers, Joy Adekanmbi, Hannah Rooney, Ricardo Segurado, Mary F Higgins, Mensud Hatunic","doi":"10.1007/s13300-026-01845-9","DOIUrl":"10.1007/s13300-026-01845-9","url":null,"abstract":"<p><strong>Introduction: </strong>Gestational diabetes mellitus (GDM) is common diagnosis during pregnancy and has a substantial effect on maternal and fetal morbidity. Advancements in healthcare technology, such as Bluetooth-enabled glucometers, telemedicine, and virtual clinics, have emerged as efficient tools for GDM management.</p><p><strong>Methods: </strong>This is a retrospective study of clinical outcomes in women with GDM across two time points (January-June 2019 and January-June 2021) following the introduction of a virtual care pathway in a tertiary referral maternity hospital. Demographic, GDM management and birth outcomes data were collected anonymously from electronic hospital records and analysed.</p><p><strong>Results: </strong>A total of 583 patients were included, 2019 (n = 227) and 2021 (n = 356). We found higher rates of attendance at GDM education via the virtual platform (99.4% vs 95.6%, p < 0.01), faster access to GDM care and initiation of treatment (p < 0.001) in 2021.</p><p><strong>Conclusion: </strong>Our study shows higher rates of attendance at our virtual GDM education pathway led to a faster initiation of pharmacological therapy.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"563-570"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431393","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 Highly Effective Glucose-Lowering Agents: Do Current Practices Optimize Clinical and Economic Outcomes?","authors":"Meredith Hoog, Alice Minghetti, William J Valentine","doi":"10.1007/s13300-026-01846-8","DOIUrl":"10.1007/s13300-026-01846-8","url":null,"abstract":"<p><strong>Introduction: </strong>Advances in type 2 diabetes (T2D) treatment have expanded therapeutic options, but evidence on optimal treatment sequencing for long-term outcomes remains limited. This study evaluated six common T2D treatment pathways in the US using long-term modeling.</p><p><strong>Methods: </strong>A literature review of guidelines and published data identified 495 treatment sequences across 77 studies. The six most frequently reported pathways were selected for modeling analyses using the PRIME T2D Model. Metformin was first-line therapy in all modeled pathways. Empagliflozin 10 mg (EMPA) was added as second-line therapy in four pathways, followed by either tirzepatide 10 mg (TZP), liraglutide 1.8 mg (LIRA), semaglutide 1.0 mg (SEMA) or dulaglutide 3.0 mg (DULA) as third-line therapy. In two pathways, TZP or SEMA were introduced as second-line agents, followed by EMPA as the third-line therapy. Basal and basal-bolus insulin were fourth- and fifth-line therapies in all analyses. Treatment intensification was modeled every 3 years or when glycated hemoglobin (HbA1c) exceeded 7.5%.</p><p><strong>Results: </strong>When used as third-line treatment, more efficacious agents improved clinical outcomes and increased costs relative to comparators. As the most efficacious third-line therapy, TZP was associated with incremental cost-effectiveness ratios (ICERs) of $50,545, $25,563, and $8,173 per quality-adjusted life years (QALYs) gained versus LIRA, SEMA and DULA, respectively, assuming intensification every 3 years. When used as second-line therapy, more efficacious agents further improved clinical outcomes but also contributed to higher direct costs over patients' lifetimes. Second-line TZP was associated with ICERs of $59,434 per QALY gained versus second-line SEMA, when intensification at HbA1c 7.5% was applied.</p><p><strong>Conclusions: </strong>Initiating more efficacious therapies early in T2D treatment may improve long-term outcomes. Though associated with higher upfront costs, these therapies may reduce complication-related costs over time. Use of modern, efficacious therapies earlier in disease management may be a cost-effective strategy for healthcare payers.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"571-585"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431388","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":"Improved Glycaemic Control with IDegLira in Chinese Adults with Type 2 Diabetes in Real-World Settings: A Retrospective, Database Cohort Study.","authors":"Shanshan Wang, Bei Sun, Dongdong Zhu, Zewei Shen, Xing Zhong, Liming Chen","doi":"10.1007/s13300-026-01852-w","DOIUrl":"10.1007/s13300-026-01852-w","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate glycaemic control and safety in Chinese adults with type 2 diabetes (T2D) receiving fixed-ratio combination of insulin degludec and liraglutide (IDegLira) in real-world clinical practice.</p><p><strong>Methods: </strong>The Tianjin Health and Medical Big Data Super Platform was utilised to assess clinical characteristics, glycaemic control, and safety of Chinese adults with T2D receiving IDegLira between March 5, 2022 and June 30, 2024. The primary endpoint was change in glycated haemoglobin (HbA1c) from baseline to day 180. Secondary endpoints included change in HbA1c by baseline characteristics; change in fasting plasma glucose (FPG), postprandial glucose (PPG), and daily insulin dose; and treatment persistence. Exploratory endpoints included hypoglycaemic events and gastrointestinal adverse events (GI AEs).</p><p><strong>Results: </strong>Eligible participants were included in the full analysis set and safety analysis set (both n = 12,103), and participants receiving IDegLira for 180 days were included in the effectiveness analysis set (n = 3062). The mean (SD) change in HbA1c, FPG, PPG, and insulin dose after 180 days from baseline was - 1.08% (1.87, p < 0.001), - 2.34 mmol/L (3.61, p < 0.001), - 2.10 mmol/L (4.86, p < 0.001), and - 4.95 U/day (21.93, p < 0.001), respectively. Subgroup analyses of HbA1c change demonstrated that IDegLira decreased HbA1c significantly, irrespective of prior treatment, age, most baseline HbA1c, daily insulin dose, and fasting C-peptide quartiles. Median treatment persistence duration was 141.67 days (95% CI 135.67-146.67). Low percentages of patients reported hypoglycaemia (0.7%) or GI AEs (11.1%).</p><p><strong>Conclusions: </strong>IDegLira statistically improved glycaemic control by reducing HbA1c, FPG, and PPG levels in the Chinese population with T2D, with a favourable safety profile.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"603-616"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480138","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":"Renal Outcomes of GLP-1 Receptor Agonists and Tirzepatide Across CKD Stages and Metabolic Phenotypes (Type 2 Diabetes and/or Overweight/Obesity): A Scoping Review.","authors":"Jorge Rico-Fontalvo, Rodrigo Daza-Arnedo, Alicia Elbert, Ricardo Correa-Rotter, Eliana Dina-Batlle, Eduardo Lorca-Herrera, Thyago Proença de Moraes, Vicente Sánchez-Polo, Carlos E Builes-Montaño","doi":"10.1007/s13300-026-01854-8","DOIUrl":"10.1007/s13300-026-01854-8","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes mellitus is the leading global cause of chronic kidney disease (CKD) and end-stage renal disease. Although cardiovascular outcomes have improved substantially, renal risk remains high. Glucagon-like peptide 1 (GLP-1) receptor agonists and the dual GLP-1/GIP agonist tirzepatide have demonstrated potential cardiorenal benefits, but renal evidence has not been systematically mapped across CKD stages and metabolic phenotypes. This scoping review aimed to identify and describe clinical evidence on renal outcomes associated with GLP-1-based therapies in adults with type 2 diabetes and/or overweight/obesity, with or without CKD.</p><p><strong>Methods: </strong>Following the Joanna Briggs Institute framework and PRISMA-ScR guidelines (protocol: OSF.IO/SZ87J), we searched PubMed, Embase, and CENTRAL from inception to October 2025. Eligible studies included phase 2-4 randomized controlled trials (RCTs), post hoc RCT analyses, and comparative observational studies reporting kidney outcomes. Data were charted using a structured extraction form with AI-assisted screening and manual validation. Risk of bias and certainty were appraised using RoB 2, ROBINS-I, and GRADE frameworks.</p><p><strong>Results: </strong>Of 607 records identified, 35 studies met inclusion criteria. Randomized evidence supports renal benefits for semaglutide, dulaglutide, and liraglutide, including reductions in composite kidney outcomes and slower eGFR decline. Tirzepatide demonstrated consistent albuminuria reductions and attenuation of eGFR decline compared with insulin glargine. Efpeglenatide, cotadutide, exenatide, and lixisenatide showed class-consistent antiproteinuric effects. Observational data extended findings to real-world and advanced CKD populations. Across agents, renal benefits were partly independent of glycemic and weight effects.</p><p><strong>Conclusion: </strong>GLP-1-based therapies demonstrate consistent renoprotective signals across CKD stages and metabolic phenotypes, particularly in type 2 diabetes. Evidence is strongest for semaglutide and dulaglutide, with emerging data for tirzepatide and other incretin-based agents. These findings provide a structured evidence map to inform future consensus and clinical decision-making.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"499-528"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480149","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":"Gut Microbiota and Metabolic Health: From Dysbiosis to Therapeutics.","authors":"Sabitha Sasidharan Pillai, Ambika P Ashraf","doi":"10.1007/s13300-026-01851-x","DOIUrl":"10.1007/s13300-026-01851-x","url":null,"abstract":"<p><p>The gut microbiota (GM) is a pivotal regulator of host metabolism and a contributor to the pathophysiology of obesity, type 2 diabetes (T2D), and metabolic syndrome (MS). Disruptions in GM composition and function are collectively termed dysbiosis. This review synthesizes current evidence on GM dysbiosis, moving beyond simple taxonomic associations, to examine functional drivers of metabolic dysfunction. Dysbiosis impairs metabolic health through several interconnected pathways: enhanced dietary energy extraction, compromised intestinal barrier integrity leading to metabolic endotoxemia, chronic low-grade \"meta-inflammation,\" and the disruption of circadian rhythms and neuro-immune signaling. Beyond bacteria, dysbiosis of the gut virome and mycobiota may further modulate metabolic risk. Animal and emerging human studies indicate that reduced virome diversity and altered phage-bacteria interactions can amplify dysbiosis, promote inflammatory signaling, and impair metabolic homeostasis. Recognition of GM dysbiosis as a contributor to metabolic disease has prompted development of therapeutic strategies aimed at restoring microbial balance and function. These interventions span a spectrum from established clinical approaches with indirect microbiota effects to experimental therapies designed to directly manipulate microbial composition or activity. We evaluate the clinical readiness of GM-targeted therapies, including dietary patterns, prebiotics, probiotics, and fecal microbiota transplantation. While established metabolic treatments such as glucagon-like peptide-1 (GLP-1) receptor agonists and bariatric surgery significantly reshape the GM, direct microbial manipulations often yield variable results in human trials. We conclude that the future of metabolic management lies in personalized microbiomics, utilizing artificial intelligence and precision-based interventions to restore specific functional microbial deficits tailored to the individual host profile.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"483-497"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316756","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":"Insulin Pen Needle Reuse in U.S. Adults with Diabetes: A Cross-Sectional Survey Study on Patterns, Motivations, and Educational Implications.","authors":"Susan Guzman, Natalie Bellini, Lucille Hughes, Pasha Javadi, Camilla Schanche, Maria Muccioli, Lori Berard","doi":"10.1007/s13300-026-01841-z","DOIUrl":"10.1007/s13300-026-01841-z","url":null,"abstract":"<p><strong>Introduction: </strong>Effective insulin therapy relies on proper injection technique and the correct use of insulin delivery devices. Despite recommendations for a single-use device, the pen needle reuse remains common. This study explored pen needle reuse patterns, reasons for reuse, and motivators to changing reuse behavior, in order to provide actionable insights for clinical education and patient-support interventions.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted with 500 U.S. adults with type 1 diabetes (T1D) or type 2 diabetes (T2D) who inject insulin at least twice daily using an insulin pen and use insulin pen needles at least twice before replacing.</p><p><strong>Results: </strong>Approximately 70% of survey participants reported using needles 2-5 times before replacing, and about 30% used them six or more times, with higher reuse among participants with T1D. Despite most participants reporting initial insulin injection education (86.8%), the majority indicated limited follow-up regarding injection practices. Specifically, 73.6% indicated their injection sites were never examined by a healthcare professional (HCP), 72.8% reported their injection technique had never been reviewed, and 66.2% reported their HCP had never asked them about injection site problems. The main reported reasons for needle reuse include convenience (64.2%), habit (46.2%), environmental/waste concern (40.8%), and cost (40.6%). The most motivating educational messages for changing reuse include those around A1c improvement and lipohypertrophy prevention, with the most trusted sources of information being endocrinologists, followed by primary care physicians (PCP), diabetes educators (known in the U.S. as diabetes care and education specialists), and peers.</p><p><strong>Conclusions: </strong>Pen needle reuse is widespread and initial education alone is insufficient. Ongoing reinforcement and messaging from trusted HCPs, particularly around A1c and injection-site outcomes, provide a key opportunity to support behavior change.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"529-546"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282784","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":"Abdominal Pain After Bariatric Surgery and the Role of the Gut: A Review.","authors":"Bregje de Louweren, Max Nieuwdorp, Victor E A Gerdes","doi":"10.1007/s13300-026-01844-w","DOIUrl":"10.1007/s13300-026-01844-w","url":null,"abstract":"<p><p>Obesity is a major health concern, affecting over 1 in 8 people worldwide. Bariatric surgery (BS) is currently the most effective long-term treatment for morbid obesity. In addition to sustained weight loss, BS is beneficial in treating obesity related comorbidities including dyslipidemia and type 2 diabetes (T2DM). The beneficial effects of BS are a result of weight loss and surgery-induced shifts in the gut microbiota and its metabolites. At the same time, BS may also lead to complications and side effects. Abdominal pain is one of the most frequently reported complaints after BS with a prevalence of 33.8-54.4% within this patient group. However, in many patients the abdominal pain remains unexplained beyond gallstones, internal herniation, and ulcers. This raises the question whether the gut microbiota itself may play a direct role in the pathophysiology of unexplained abdominal pain. Over the years several studies have shown changes in the gut microbiota and related metabolites after BS. These include increased gut microbial diversity and altered microbial composition after BS. Higher abundances of Proteobacteria and Fusobacteria are reported, while a decrease in butyrate-producing Firmicutes is reported. Along with these changes in microbiota, BS causes higher plasma bile acid levels and altered short-chain fatty acid (SCFA) profiles. These metabolic shifts are believed to support weight control, glucose regulation, and lipid metabolism. More recently, specific microbial taxa and metabolite profiles were linked to abdominal complaints following BS. This suggests that dysbiosis and metabolites may play a role in unexplained abdominal pain after BS.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"465-481"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270019","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}