Diabetic Medicine最新文献

{"title":"Australian healthcare professionals' perspectives and experiences on screening and monitoring islet autoimmunity: A qualitative exploration","authors":"Mia Majstorovic,&nbsp;Kelly J. McGorm,&nbsp;John M. Wentworth,&nbsp;Alyssa Sawyer,&nbsp;Melissa Oxlad,&nbsp;Jennifer J. Couper","doi":"10.1111/dme.70445","DOIUrl":"10.1111/dme.70445","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Islet autoantibodies characterise a period of immune-mediated destruction preceding clinical (symptomatic) type 1 diabetes. Screening and monitoring programmes for islet autoimmunity are being planned and implemented globally. The perspectives and experiences of healthcare professionals working in paediatric screening and monitoring of islet autoimmunity and clinical type 1 diabetes can inform these programmes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We interviewed 32 healthcare professionals (81% women) caring for children with islet autoimmunity and/or clinical type 1 diabetes in Australia (median of 13 years of type 1 diabetes clinical experience). Data were analysed using reflexive thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We developed seven themes: 1. implementing population screening and monitoring is contested, 2. considerations for the structure of screening and monitoring, 3. prioritising equitable access and convenience, 4. focus on managing children's testing experiences, 5. potential psychological impacts of islet autoimmunity on children, 6. caregivers' perceived coping ability and associated responses to screening and monitoring and 7. importance of relationships with and support from healthcare professionals. Participants expressed benefits, concerns and considerations necessary for the well-organised, equitable and acceptable implementation of screening and monitoring. They described varying effects of testing and islet autoimmunity on families, emphasising the importance of trusted relationships between families and healthcare professionals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Healthcare professionals' insights can guide how screening and monitoring programmes are designed and implemented, particularly in justifying their introduction, ensuring equitable care and reducing adverse impacts on families. Further research will focus on the experiences of children and caregivers to integrate wider input into the design of these programmes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 11","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70445","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877208","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":"Protective effects of 23-valent pneumococcal polysaccharide vaccination against mortality among elder patients with type 2 diabetes mellitus","authors":"Xiaoling Peng,&nbsp;Shujun Gu,&nbsp;Jingchao Liu,&nbsp;Deqi Kong,&nbsp;Guorong Yang,&nbsp;Ran Guo,&nbsp;Chaoqun Xu,&nbsp;Xulei Hu,&nbsp;Qiang Li,&nbsp;He Yang,&nbsp;Ning Zhang,&nbsp;Chen Dong","doi":"10.1111/dme.70341","DOIUrl":"10.1111/dme.70341","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older adults with type 2 diabetes mellitus are at elevated risk for severe pneumococcal disease, experiencing higher rates of complications and mortality. However, the evidence for the protective benefits of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against mortality in this demographic remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 8649 elderly people with type 2 diabetes mellitus in Soochow, China, comprising 3247 PPSV23-vaccinated individuals and 5402 unvaccinated patients. Cox proportional hazards analyses were performed to calculate the adjusted hazard ratios (HRs) of the association between PPSV23 vaccination and the risk of all cause mortality, pneumonia-related mortality, cardiovascular disease-related mortality and cancer mortality. Inverse probability weighting (IPW) was applied to estimate the average treatment effect (ATE) of universal PPSV23 vaccination compared to unvaccinated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the follow-up period, a total of 1557 deaths were recorded. Compared to unvaccinated elderly people with type 2 diabetes mellitus, those receiving PPSV23 vaccine exhibited significantly lower risks of all-cause mortality (HR: 0.47; 95% CI: 0.42–0.53), with reductions also observed in deaths related to cardiovascular disease (HR: 0.50; 95% CI: 0.41–0.62), pneumonia (HR: 0.62; 95% CI: 0.43–0.89) and cancer (HR: 0.54; 95% CI: 0.42–0.70). Furthermore, IPW estimates indicated that universal PPSV23 vaccination among the elderly people with type 2 diabetes mellitus could prevent an average of 11.4% of all-cause deaths (<i>p</i> &lt; 0.001), 4.0% of cardiovascular disease-related deaths (<i>p</i> &lt; 0.001), 0.8% of pneumonia-related deaths (<i>p</i> = 0.005) and 1.9% of cancer deaths (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PPSV23 vaccination is associated with a reduced risk of all cause mortality, cardiovascular disease-related mortality, pneumonia-related mortality and cancer mortality in elderly people with type 2 diabetes mellitus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 11","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826104","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":"Implementing Diabetes Eating Problem Survey - Revised in pediatric type 1 diabetes care: Clinician reflections on systematic screening and multidisciplinary management","authors":"Caroline Bruun Abild,&nbsp;Janni Hyldgaard Knudsen,&nbsp;Melissa Schødt,&nbsp;Sigrid Bjerge Gribsholt,&nbsp;Loa Clausen","doi":"10.1111/dme.70333","DOIUrl":"10.1111/dme.70333","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Adolescents with type 1 diabetes have an increased risk of disordered eating; however, these symptoms may be underrecognized by clinicians. The aim of this study was to explore clinicians' perspectives and experiences on implementing the Diabetes Eating Problem Survey-Revised (DEPS-R) as a screening tool for disordered eating in a multidisciplinary care setting at a pediatric diabetes clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative approach using Interpretive Description methodology was employed. Semistructured interviews were conducted with 10 clinicians, including pediatricians, nurses, dietitians, psychologists and psychiatrists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four main themes were identified covering the relevance of DEPS-R as a supplement to the clinical expertise and intuition, enhancing conversations, interdisciplinary collaboration, engaging families and implementation challenges. Clinicians found DEPS-R valuable for detecting disordered eating, facilitating deeper patient conversations and supporting early intervention. Key challenges included time constraints and the need for further training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Clinicians found DEPS-R to be a valuable addition to their practice for identifying disordered eating in youths with type 1 diabetes, but effective implementation requires interdisciplinary collaboration, management support and continuous optimization for clinical use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 11","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795109","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 qualitative study exploring and understanding the experiences and unmet needs of adults with type 2 diabetes and diabetes-related foot ulcers","authors":"Molly Caba,&nbsp;Jane Speight,&nbsp;Agnieszka Glab,&nbsp;Patrick Highton,&nbsp;Kamlesh Khunti,&nbsp;Michelle Hadjiconstantinou","doi":"10.1111/dme.70343","DOIUrl":"10.1111/dme.70343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Diabetes-related foot ulcers (DFUs) are associated with depression, impaired health-related quality of life, an increased risk of cardiovascular disease and early mortality. To inform holistic care pathways, this qualitative study explored the experiences and unmet needs of adults living with type 2 diabetes mellitus (T2DM) and DFUs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted with 25 adults with T2DM and current or previous DFUs, and 20 healthcare professionals with experience treating DFUs. Topic guides were underpinned by the Theoretical Domains Framework. Data were analysed using reflexive thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four themes and three sub-themes were created relating to the impact of DFUs. DFUs were perceived as a ‘wake-up call’; the experience often came as a shock, prompting individuals to consider what was responsible for their development. DFUs impacted individuals' behaviours in multiple ways: for some, they were a catalyst for positive change; for others, they fostered behaviours that were unhealthful and/or discordant with professionals' advice. DFUs negatively affected the physical and psychosocial well-being of individuals with DFU; sedentary behaviours instigated by DFUs led to changes in mood and mental health, in addition to increased weight, mobility problems and an amplified risk of health complications. Regarding the unmet needs of people with T2DM and DFUs, three themes were developed, capturing the need for treatment plans created through shared decision making and improving access to physical well-being and psychological support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings identify several important areas of unmet need regarding care for adults with T2DM and DFUs, which can help inform improved support for this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 11","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849064","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":"Participants' experiences of a co-adapted group-based intervention to reduce diabetes distress in people with type 2 diabetes attending municipal rehabilitation services","authors":"M. Espenhein,&nbsp;R. A. S. Pals,&nbsp;B. Cleal,&nbsp;H. N. Grønbæk,&nbsp;M. Bejerholm,&nbsp;C. Glümer,&nbsp;M. Due-Christensen","doi":"10.1111/dme.70440","DOIUrl":"10.1111/dme.70440","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Diabetes distress affects approximately 30–40% of people with type 2 diabetes, yet interventions to address this issue are scarce. This study explored participants' experiences of a co-adapted, group-based intervention aimed at reducing diabetes distress in adults with type 2 diabetes attending municipal rehabilitation services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Trained health professionals facilitated eight groups, consisting of six weekly sessions. The sessions included psychoeducation, mindfulness techniques and facilitated discussions using visual dialogue tools to address diabetes distress. Interviews were conducted with 19 participants to explore their experiences of the intervention. Data were analysed using systematic text condensation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants experienced several benefits from taking part in the intervention, including improved self-care, greater self-compassion regarding their diabetes and a reduction in worries and negative emotions about living with diabetes. These changes were closely linked to three key elements of the intervention: (1) strategies for managing diabetes distress, (2) supportive and engaged health professionals and (3) a safe peer environment. However, some participants reported challenges in their interactions with other participants due to age differences and varying levels of engagement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study provides valuable insight into the experiences of people with type 2 diabetes and highlights key supportive aspects of an intervention to reduce diabetes distress. Further research is needed to assess the impact on clinical and psychosocial outcomes of participants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 11","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623785","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":"Health, hope and worry: A qualitative study of people with diabetes' experiences with anti-VEGF treatment","authors":"J. K. Leksell,&nbsp;E. Granstam,&nbsp;T. Granström,&nbsp;E. Nerpin","doi":"10.1111/dme.70334","DOIUrl":"10.1111/dme.70334","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Diabetic macular edema (DME) is a leading cause of vision loss among individuals with diabetes. While anti-VEGF therapy is a widely used and effective treatment, limited research has explored participants' lived experiences throughout the treatment process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This qualitative study summarizes findings from longitudinal interviews conducted at 4 and 12 months after initiating intravitreal anti-VEGF therapy. The analysis focused on participants' emotional, physical and psychosocial responses to treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>An overarching theme, ‘health, hope, and worry’, captured the ambivalent experiences of participants. Two main categories were identified: ‘hope and anxiety during injection treatment’ and ‘uncertainty and variation in visual outcomes’. Participants described a spectrum of physical discomfort and emotional reactions, influenced by expectations, bodily sensitivity and clinical context. Trust in healthcare providers, consistent care and adequate information were crucial for emotional resilience. Perceived treatment effectiveness varied, with some experiencing significant visual improvement and regained independence, while others reported little or no change, leading to frustration and anxiety about future vision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Anti-VEGF treatment for DME is experienced not only as a clinical intervention but as an emotionally and physically complex journey. Participants' navigate fluctuating levels of hope and worry, shaped by their bodily experiences, emotional responses and expectations of outcomes. These findings highlight the need for empathetic communication, consistent care and individualized support to promote adherence and mitigate emotional distress. The insights from this study are especially relevant for multidisciplinary diabetes care teams.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 11","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731228","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":"Experiences of receiving and delivering a novel complex intervention for type 1 diabetes and disordered eating: Process evaluation of the Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY)","authors":"Natalie Zaremba,&nbsp;Amy Harrison,&nbsp;Jennie Brown,&nbsp;Divina Pillay,&nbsp;Emmanouela Konstantara,&nbsp;Janet Treasure,&nbsp;David Hopkins,&nbsp;Judith Prins,&nbsp;Bastiaan de Galan,&nbsp;Khalida Ismail,&nbsp;Giesje Nefs,&nbsp;Marietta Stadler","doi":"10.1111/dme.70377","DOIUrl":"10.1111/dme.70377","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY) intervention is a novel cognitive behaviour therapy (CBT) intervention for individuals with type 1 diabetes and disordered eating (T1DE). The aim of this mixed-method process evaluation is to assess the acceptability, appropriateness and feasibility of STEADY, and explore experiences of both participants and healthcare professionals during therapy delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants who received STEADY (<i>n</i> = 13) and healthcare professionals delivering STEADY therapy (<i>n</i> = 3) completed person-reported outcome measures (PROMs) to assess the acceptability (AIM), appropriateness (IAM) and feasibility (FIM) of STEADY and took part in semi-structured interviews to explore experiences, therapeutic processes and implementation considerations. Interviews were analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PROM scores indicated high ratings across participants (AIM = 18.36 ± 2.01; IAM = 18.18 ± 2.64; FIM = 18.00 ± 2.32) and healthcare professionals (AIM = 17.67 ± 2.08; IAM = 17.33 ± 2.31; FIM = 17.67 ± 2.08), suggesting high likelihood of implementation success. Thematic analysis showed significant overlap in participant and therapist experiences. Key themes included integrated T1DE-specific CBT delivery, specialist knowledge of T1DE and a strong therapeutic alliance. Both groups emphasised the need for tailored delivery, therapist expertise in T1DE and structural adaptations to standard CBT models. Participant's experiences also included a clear path of therapeutic growth and expectations of therapy. Therapists' experiences included considerations for clinical safeguarding and organisational factors impacting wider implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings demonstrate that STEADY is acceptable, appropriate and feasible for individuals with mild to moderate severity T1DE. The substantial alignment between participant and therapist perspectives offers clear directions for refining the intervention and support implementation in a full-scale RCT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 11","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70377","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148230213","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":"Diabetic eye screening is working—Just not for the patients who need it most","authors":"Shameer Mohamed Naleer","doi":"10.1111/dme.70438","DOIUrl":"10.1111/dme.70438","url":null,"abstract":"","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 11","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148612242","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":"Maternal glycaemia and child educational attainment at age 5 in the Born in Bradford cohort","authors":"Claire A. Wilson,&nbsp;Gillian Santorelli,&nbsp;Emily Simonoff,&nbsp;Louise M. Howard,&nbsp;Khalida Ismail,&nbsp;Rebecca M. Reynolds","doi":"10.1111/dme.70317","DOIUrl":"10.1111/dme.70317","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>There is emerging evidence that maternal hyperglycaemia may be associated with adverse offspring neuro-behavioural outcomes, which are foundational to educational success. We hypothesised that higher levels of maternal glucose would be associated with poorer educational attainment in early childhood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample included 13,627 children from the UK's Born in Bradford cohort. Exposures included maternal fasting glucose, 2-h post-load glucose and a clinical diagnosis of gestational diabetes. The primary outcome was failure to achieve a ‘good level of development’ on the Early Years Foundation Stage Profile at age five. The association was tested using multivariable Poisson regression, accounting for sibling clusters and using multiple imputation for missing data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher maternal fasting glucose (at 26–28 weeks gestation) was associated with an increased risk of failing to achieve a good level of development (adjusted RR 1.04; 95% CI 1.00, 1.08; <i>p</i> = 0.034). This association appeared stronger in children of Pakistani ethnicity compared to White British ethnicity. No association was found for 2-h post-load glucose or gestational diabetes diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings offer insights into the developmental origins of inequalities in child educational outcomes and highlight potential opportunities to optimise future health and learning through interventions during pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 10","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625234","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":"The insulin-like growth factor system and the progression of renal complications of type 2 diabetes","authors":"Adrian Heald,&nbsp;Yasitha lllangasekera,&nbsp;Andreas Matheou,&nbsp;Ram Prakash Narayanan,&nbsp;Stephen White,&nbsp;Hellena Habte-Asres,&nbsp;Abigail Lay,&nbsp;Liliana Shalamanova,&nbsp;William Ollier,&nbsp;Graham A. Hitman,&nbsp;Ritwika Mallik,&nbsp;Philip A. Kalra,&nbsp;Martin Whyte,&nbsp;J. Martin Gibson","doi":"10.1111/dme.70318","DOIUrl":"10.1111/dme.70318","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Chronic kidney disease is associated with dysregulation of the insulin-like growth factor (IGF) system. Alterations in IGF bioavailability, driven by IGF binding proteins (IGFBPs), may influence the decline in renal function. However, the longitudinal relationship between baseline IGF-I, IGF-II, IGFBPs and progression of kidney dysfunction remains unclear. We evaluated how IGF/IGFBP profile relates to longitudinal changes in urinary albumin/creatinine ratio (ACR) and serum creatinine level in people with type 2 diabetes (T2D).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Individuals' measurements were performed in 436 individuals with T2D recruited from primary and secondary care (2002–2004), from the Salford and Manchester Integrated Care Record (GMCR), for laboratory and clinical data, as well as date of death. Baseline IGF/IGFBP profile was related to 2 primary outcomes: (i) change in albumin-to-creatinine ratio over time (urine ACR trend slope) and (ii) change in serum creatinine over time (creatinine trend slope). Trend slopes were derived for each participant, using repeated measures throughout follow-up for up to 24 years. Associations between IGF axis proteins and outcomes were evaluated with multivariate regression models. Cox proportional hazards models were constructed to determine mortality risk associated with the IGF system proteins studied.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;At baseline, 59.3% of participants were men. Age at baseline was 56.6 ± 9.4 years. Mean follow-up duration was 17.4 ± 5.2 years.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;IGF-II and IGFBP-3 were strongly correlated (Spearman rho = 0.80), and were therefore not included simultaneously in the multi-variate linear regression model to avoid co-linearity. Higher circulating IGFBP-2 was independently associated with faster rate of ACR progression (normalised beta (Β) = 0.007, &lt;i&gt;p&lt;/i&gt; = 0.002), while IGFBP-1 showed an inverse association (&lt;i&gt;B&lt;/i&gt; = −0.057, &lt;i&gt;p&lt;/i&gt; = 0.009). IGF-II also remained positively associated with ACR trend (&lt;i&gt;B&lt;/i&gt; = 0.005, &lt;i&gt;p&lt;/i&gt; = 0.013), whereas IGF-I showed no association. IGFBP-1 showed a significant inverse association with creatinine change when adjusted for effects of covariates (unstandardised &lt;i&gt;B&lt;/i&gt; = −0.038, &lt;i&gt;p&lt;/i&gt; = 0.04). Survival analysis revealed that higher IGFBP-2 levels were independently associated with higher all-cause mortality (hazard ratio [HR] per 1 standard deviation increase 1.306, 95% CI 1.151–1.483 &lt;i&gt;p&lt;/i&gt; = 0.0001).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 10","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719315","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}