Diabetic Medicine最新文献

{"title":"Residual insulin secretion in long-standing type 1 diabetes","authors":"Petra Augstein,&nbsp;Natalie Buschmann,&nbsp;Janik Riese,&nbsp;Sabine Bochnig,&nbsp;Peter Heinke,&nbsp;Michael Schlosser,&nbsp;Wolfgang Kerner","doi":"10.1111/dme.70104","DOIUrl":"10.1111/dme.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Studies involving the use of sensitive C-peptide assays have revealed that a significant number of persons with long-standing type 1 diabetes have measurable serum C-peptide concentrations. We investigated meal-stimulated C-peptide levels in persons with diabetes duration of more than 30 years and whether they were associated with the presence of diabetes-associated autoantibodies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an observational study of 105 participants with a clinical diagnosis of type 1 diabetes and a diabetes duration ≥30 years. Participants underwent mixed-meal tolerance tests (MMTTs) with measurements of C-peptide at 0 and 90 min. The levels of autoantibodies against GAD, IA-2 and ZnT8 were measured with radio-binding assays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants were divided into tertiles of post-meal (90 min) C-peptide values as non-responders (NR), low-responders (LR) and high-responders (HR). Compared with the NRs and HRs, the LRs had significantly lower BMI values (<i>p</i> &lt; 0.001), plasma triglyceride concentrations (<i>p</i> = 0.010) and triglyceride/HDL-cholesterol ratios (<i>p</i> = 0.004). Twenty-nine and eight participants were positive for one or 2–3 antibodies, respectively. The presence of antibodies was not associated with post-meal C-peptide levels, as evidenced by the fact that the proportions of antibody-positive participants did not differ between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We conclude that a subgroup of type 1 diabetes participants with long-standing diabetes (&gt;30 years) has residual beta-cell function. Participants with type 1 diabetes and low stimulated C-peptide concentrations are characterized by lower BMI, triglyceride concentrations and higher insulin sensitivity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621702","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":"Effectiveness of dietary interventions in individuals with diabetes for preventing and healing chronic wounds; a systematic review with meta-analysis","authors":"Hailey R. Donnelly,&nbsp;Clare E. Collins,&nbsp;Erin D. Clarke,&nbsp;Prudence I. Morrissey,&nbsp;Natalie Gilbertson-Viljevac,&nbsp;Lucy Leigh,&nbsp;Peta E. Tehan","doi":"10.1111/dme.70100","DOIUrl":"10.1111/dme.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Optimising the nutritional status of individuals with diabetes is essential to optimise glycaemic control, as well as to prevent and promote wound healing. A variety of nutrition interventions are available. This systematic review and meta-analysis aimed to describe and synthesise the effectiveness of nutrition interventions for the prevention and management of chronic wounds in people with diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Five databases and four clinical trial registries were searched for nutrition intervention studies. Included studies involved a nutrition intervention, such as personalised medical nutrition therapy, education and/or nutrient supplementation for those with diabetes and a chronic wound. Meta-analysis was completed utilising mean wound size at follow-up and non-adjusted data where available. Quality was appraised using RoB 2 and ROBINS, and certainty of evidence was assessed using GRADE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-three studies were included; all included studies were in diabetes-related foot ulcer populations. Meta-analyses demonstrated nutrient supplements, including single and multi-nutrient supplements, significantly reduced wound depth (MWD −0.200 [95% CI −0.364, −0.035], <i>p</i> = 0.0172), width (WMD −0.466 [95% CI −0.724, −0.208], <i>p</i> = 0.0004) and length (−0.443 [95% CI −0.841, −0.045], <i>p</i> = 0.0292), the quality of included studies was low and the certainty of evidence was very low. While substantial heterogeneity was detected (<i>I</i>² = 56%–68%), a random-effects meta-analysis was conducted to account for between-study variability, providing an overall estimate while acknowledging differences in study characteristics. Two studies evaluating the effect of nutrition education demonstrated significant wound size reduction (<i>n</i> = 1) and proportion of people healed (<i>n</i> = 1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is low-quality evidence that nutrient supplementation improves wound healing. Nutrition education may have a role in enhancing wound size reduction. Further studies are needed using robust methodologies to comprehensively determine the effectiveness of nutrition interventions for wound healing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593765","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":"Concordance of molecular microbiology and conventional culture techniques for infected diabetic foot ulcer management","authors":"Angela Oates,&nbsp;Sarah T. Brown,&nbsp;Colin C. Everett,&nbsp;Fran Game,&nbsp;Jane E. Nixon,&nbsp;Tim Sloan,&nbsp;Michelle M. Lister,&nbsp;Michael Backhouse,&nbsp;Benjamin A. Lipsky,&nbsp;David Russell,&nbsp;Howard Collier,&nbsp;Joanna Dennett,&nbsp;Rachael Gilberts,&nbsp;E. Andrea Nelson","doi":"10.1111/dme.70089","DOIUrl":"10.1111/dme.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The management of infected diabetic foot ulcers (DFUs) requires balancing the need for timely interventions against the desire for targeted antibiotic therapy, which relies on laboratory results. This study aimed to evaluate concordance between molecular and conventional culture and sensitivity (C&amp;S) methods in identifying bacteria from infected DFUs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was conducted alongside CODIFI2, a Phase III randomised controlled trial comparing tissue sampling with wound swabbing. It assessed C&amp;S and metagenomic 16S rRNA gene sequencing (M16S) in DFUs with suspected mild or moderate infections using both tissue and swab samples.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 145 participants, C&amp;S identified 248 microorganisms across 25 genera including eight anaerobic genera. M16S identified a greater number and diversity of microorganisms, detecting 455 across 40 genera, including 173 anaerobes from 15 distinct genera. No bacterial growth was reported in 25.5% (95% CI: 18.0%–32.3%) of C&amp;S samples, whereas M16S identified at least one organism in all samples. While the observed agreement between methods was high (75%), Cohen's Kappa revealed low concordance overall, except for <i>Pseudomonas</i> spp. and <i>Streptococcus</i> spp. (Kappa ≥ 0.5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>M16S detected a broader microbial spectrum, including fastidious anaerobes, but its low concordance with C&amp;S and lack of antibiotic sensitivity data, challenge its suitability as a replacement for C&amp;S in mild or moderate DFU infections. It may offer advantages in infections where increased sensitivity is beneficial, particularly where extended culture approaches are recommended to detect fastidious or low-abundance organisms. For mild to moderate DFU infections, our findings support continued reliance on conventional C&amp;S testing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602776","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":"Partial starch substitution with resistant starch lowers postprandial glucose and glycaemic variability in people with type 2 diabetes","authors":"Sineaid M. Collins,&nbsp;M. Bernadette Egan,&nbsp;Martin B. Whyte,&nbsp;M. Denise Robertson","doi":"10.1111/dme.70079","DOIUrl":"10.1111/dme.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Approximately 40% of the caloric intake of the UK diet consists of starch. Most of which is readily digestible, thereby raising blood glucose. However, resistant starch (RS) evades metabolism in the small intestine, and in healthy adults, partial substitution of the diet with RS lowers postprandial glycaemia. The effect of RS in adults with type 2 diabetes is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated the effect of substituting ~15% of dietary starch with RS on glycaemic measures in adults with type 2 diabetes in a controlled but free-living setting. This was a single-blinded, crossover design, comparing 4-day RS and control diets. Proportions of resistant and digestible starch in identical food products were the only difference. IPro™2 continuous glucose monitors captured glycaemic excursions and glycaemic variability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty adults with type 2 diabetes, HbA_1c (52 ± 2 mmol/mol; 6.9 ± 0.3%), age 58 ± 11 years, were enrolled, with 95% completing arms. Mean amplitude of glycaemic excursion (MAGE) was lower over lunch with RS (0.94 mmol/L; <i>p</i> = 0.004), as was SD glucose (0.31 mmol/L; <i>p</i> = 0.027), and peak glucose (0.94 mmol/L; <i>p</i> = 0.028). RS prolonged the time it took glucose to peak by 18 min at lunch (<i>p</i> = 0.046) and 28 min at dinner (<i>p</i> = 0.002). Time in range (TIR; glucose 3.9–10.0 mmol/L) was 7.8% greater with RS (<i>p</i> = 0.021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Substituting a proportion of starch with RS lowers blood glucose without changing the sensory attributes of foods significantly. There is potential to develop a functional diet for adults with type 2 diabetes to aid glycaemic control.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602777","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":"Arterial stiffness and atherosclerosis and incident cardiovascular events and all-cause mortality in individuals with manifest cardiovascular disease with and without type 2 diabetes","authors":"Jan F. de Leijer,&nbsp;Frank L. J. Visseren,&nbsp;Birgitta K. Velthuis,&nbsp;Ynte M. Ruigrok,&nbsp;Jaco J.M. Zwanenburg,&nbsp;Manon G. van der Meer,&nbsp;Martin Teraa,&nbsp;Pim A. de Jong,&nbsp;Thomas T. van Sloten,&nbsp;the UCC-SMART study group","doi":"10.1111/dme.70067","DOIUrl":"10.1111/dme.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It is unclear if arterial stiffness and atherosclerosis are differentially related to cardiovascular events and mortality in individuals with manifest cardiovascular disease with and without type 2 diabetes (T2DM) and to what extent they mediate the relation between T2DM and these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective data were used from the UCC-SMART cohort, including individuals with manifest cardiovascular disease (<i>n</i> = 9465). Arterial stiffness (brachial pulse pressure and carotid artery distensibility coefficient (DC)) and atherosclerosis (presence of carotid plaque and ankle-brachial index &lt;0.9) were determined. Cardiovascular events included non-fatal stroke, non-fatal myocardial infarction and cardiovascular death. Cox regression and structural equation models were used with adjustment for confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a median follow-up of 10.3 years, 2087 cardiovascular events and 2808 deaths occurred. Higher brachial pulse pressure was related to cardiovascular events and mortality in individuals with T2DM and without T2DM (HRs ≥ 1.09; 95% confidence intervals (CIs) between 1.03 and 1.30). Lower carotid artery DC was related to mortality in individuals with T2DM and without T2DM (hazard ratios (HRs) ≥ 1.20; 95% CI between 1.00 and 1.48), but only related to cardiovascular events in individuals without T2DM (HR 1.34; 95% CI between 1.20 and 1.49). Carotid and lower extremity atherosclerosis were both related to cardiovascular events and mortality in individuals with T2DM and without T2DM (HRs ≥ 1.52; 95% CI between 1.27 and 2.21). Up to 8.1% and 16.3% of the relation between T2DM and outcomes was mediated through arterial stiffness and atherosclerosis, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Arterial stiffness and atherosclerosis are independently, but not differentially, related to cardiovascular events and mortality in individuals with manifest cardiovascular disease with and without T2DM. Atherosclerosis explained a larger proportion of the relation between T2DM and outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565544","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 women with type 2 diabetes during the pre-pregnancy, pregnancy and postpartum periods: A systematic review of qualitative studies","authors":"Lily Hopkins,&nbsp;Noreen O'Leary,&nbsp;Aileen Burton,&nbsp;Eleanor Dyer,&nbsp;Angela C. Flynn,&nbsp;Sowmiya Gunabalasingam,&nbsp;Nicola Heslehurst,&nbsp;Artemis Kyrka,&nbsp;Rivka Lebrett,&nbsp;Claire L. Meek,&nbsp;Danielle A. J. M. Schoenaker,&nbsp;Sara L. White,&nbsp;Rita Forde","doi":"10.1111/dme.70094","DOIUrl":"10.1111/dme.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the experiences of women with type 2 diabetes prior to, during and after pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Six databases were systematically searched in September 2023. Qualitative studies involving women of childbearing age living with type 2 diabetes in the pre-pregnancy, pregnancy and postpartum periods were included. A thematic synthesis was conducted to inductively generate themes related to the experiences of women with type 2 diabetes. Descriptive themes were mapped to the Socio-Ecological Model to generate analytical themes relating to the personal, interpersonal and organisational level impacts that underlie women's experiences. Study quality was assessed using the CASP checklist for qualitative studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven papers from seven countries met the inclusion criteria. Four themes containing six subthemes were generated. At a personal level, women prioritised their desire to plan a family over <i>‘family planning’</i>; however, once pregnant they were fearful for the future health of their children. At the interpersonal level, women reported that their self-efficacy was influenced by family and socio-cultural factors which often lacked diabetes-specific information. At the organisational level, women described a fragmented healthcare system and felt that healthcare professionals' unfamiliarity with the reproductive health needs of women with type 2 diabetes resulted in ineffective integration into their diabetes care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The provision of appropriate care to women with type 2 diabetes prior to and during pregnancy is inadequate, leaving them vulnerable to increased health risks and emotional distress. Innovative ways are needed to embed reproductive healthcare into mainstream diabetes management for women with type 2 diabetes prior to and post-pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556493","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 fenofibrate versus standard care for reducing the progression of diabetic retinopathy: An economic evaluation based on data from the LENS trial","authors":"Graham Scotland,&nbsp;Mekazin Tsehaye,&nbsp;Caroline Styles,&nbsp;Jennifer Logue,&nbsp;Emily Sammons,&nbsp;Mohammed Zayed,&nbsp;Jonathan Emberson,&nbsp;Rachel Wade,&nbsp;Karl Wallendszus,&nbsp;Will Stevens,&nbsp;Rosanna Cretney,&nbsp;Simon Harding,&nbsp;Graham Leese,&nbsp;Gemma Currie,&nbsp;Jane Armitage,&nbsp;David Preiss,&nbsp;for the LENS Collaborative Group","doi":"10.1111/dme.70098","DOIUrl":"10.1111/dme.70098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The LENS trial demonstrated that fenofibrate slowed the progression of diabetic retinopathy compared to placebo in participants with early diabetic eye disease. We assessed its cost-effectiveness for reducing the progression of diabetic retinopathy versus standard care from a UK National Health Service perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Resource use and outcome data were collected over follow-up for participants enrolled in LENS. Mean costs were compared at 2 years and per 6-month follow-up (median 4.0 years). Within the trial, cost-effectiveness was assessed in terms of the incremental cost per case of referable disease averted. A microsimulation model, with inputs derived primarily from LENS trial data, was used to assess the incremental cost per quality-adjusted life year (QALY).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fenofibrate resulted in a mean (95% confidence interval) reduction in health service costs of -£254 (−1062 to 624) at 2 years and -£101 (−243 to 42) per 6-month follow-up. This was accompanied by a 4.4% (1.3% to 8.0%) absolute reduction in any referable diabetic retinopathy or treatment thereof at 2 years, and a 27% (9%–42%) relative reduction over follow-up. Modelled over 10 years, fenofibrate use cost an additional £6 per patient for an expected QALY gain of 0.02, costing £406 per QALY versus standard care under base case assumptions. The probability of cost-effectiveness varied from 70% to 79% at a threshold of £20,000 per QALY, depending on the price discount applied to anti-VEGF drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fenofibrate is likely to offer a cost-effective treatment for slowing the progression of diabetic retinopathy in people with early to moderate diabetic retinopathy or maculopathy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556492","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":"Dorothy Hodgkin lecture 2024: Insulin regulation of mitochondrial biogenesis and function—Impact of dysregulation of mitochondrial function in diabetes and its complications","authors":"K. Sreekumaran Nair","doi":"10.1111/dme.70086","DOIUrl":"10.1111/dme.70086","url":null,"abstract":"<p>Skeletal muscle atrophy was a characteristic of type 1 diabetes (T1DM) prior to insulin discovery and replacement. Indirect calorimetry during the post-absorptive state demonstrated that increased fuel oxidation during transient insulin deprivation in T1DM caused depletion of energy stores. Further, insulin has a critical role in preserving muscle mitochondrial content and function by enhancing mitochondrial biogenesis and proteostasis. Insulin deficiency not only inhibits mitochondrial biogenesis but also accelerates the degradation of mitochondrial proteins, causing a decline in mitochondrial content and efficiency. Inefficient mitochondrial respiration, reflected by the uncoupling of oxidative phosphorylation and consequent decline in ATP production, adversely affects many cellular functions and causes high oxidative stress. Oxidative stress adversely affects cardiovascular functions and damages many skeletal muscle proteins, accelerating their degradation and explaining muscle atrophy. Increased degradation of muscle proteins increases amino acid efflux that stimulates the liver to synthesize many non-insulin-dependent proteins, potentially contributing to macrovascular complications. This phenomenon explains a paradoxical increase in whole-body protein synthesis during insulin deficiency. Further, the mitochondrial biology of brain regions rich in insulin receptors concurrent with accelerated transport of ketones and lactate across the blood–brain barrier during insulin deficiency seems to protect the brain from oxidative stress. In contrast, insulin resistance associated with less ketone and lactate production renders the brain susceptible to protein oxidative damage. Oxidative damage and reduced ATP production potentially explain the higher prevalence of dementia in insulin-resistant people. Enhancement of insulin sensitivity by aerobic exercise and metformin in pre-clinical studies prevents mitochondrial dysfunction and oxidative damage to the brain.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546838","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":"Gestational diabetes mellitus in twin pregnancies versus singleton pregnancies—A retrospective case–control study","authors":"Ninna L. Larsen,&nbsp;Anna S. Koefoed,&nbsp;Ulla Kampmann,&nbsp;Ravi Retnakaran,&nbsp;Per G. Ovesen,&nbsp;Jens Fuglsang","doi":"10.1111/dme.70095","DOIUrl":"10.1111/dme.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To compare markers of glycaemic regulation in twin and singleton pregnancies in women with gestational diabetes mellitus (GDM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective case–control study was performed. 53 twin and 212 matched singleton pregnant women with gestational diabetes were included. Data were obtained from patient files. Twin and singleton pregnant women were compared regarding clinical characteristics and parameters related to glucose metabolism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to singleton pregnant women, twin pregnant women were diagnosed with GDM earlier in pregnancy (gestational age (GA) (weeks + days) 24 + 5 ± 5 + 2 vs. GA 27 + 2 ± 5 + 2; <i>p</i> = 0.002). The proportion of women treated with insulin was similar (24.1% vs. 24.5%, <i>p</i> = 1.0), but in twin pregnancies, insulin treatment was commenced earlier (GA 25 + 2 ± 4 + 6 vs. GA 30 + 1 ± 5 + 0; <i>p</i> = 0.003). At diagnosis, the HbA1c value was significantly lower in twin pregnant women (34 (5.3) ± 4.8 (2.6) vs. 35.9 (5.4) ± 5.4 (2.6), <i>p</i> = 0.03), but mean HbA1c values were similar in 2nd (33.9 (5.3) ± 4.6 (2.6) vs. 35.7 (5.4) ± 5.3 (2.6), <i>p</i> = 0.16) and 3rd trimester (35.1 (5.5) ± 4.2 (2.5) vs. 36.0 (5.4) ± 5.1 (2.6), <i>p</i> = 0.25).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We have characterized the effect of twin pregnancy on parameters of glucose metabolism and glycaemic control in GDM in one of the largest studies of twin pregnant women with GDM to date. We conclude that twin pregnant women may have the GDM diagnosis earlier, but diurnal insulin requirements and HbA1c levels are comparable with singleton pregnant women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478474","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":"Training DAFNEplus facilitators in novel behaviour change approaches: A template for training design and delivery","authors":"Nicole de Zoysa,&nbsp;Paul Chadwick,&nbsp;Carolin Ferguson,&nbsp;Carla Gianfrancesco,&nbsp;Julia Lawton,&nbsp;Simon Heller","doi":"10.1111/dme.70078","DOIUrl":"10.1111/dme.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The integration of behaviour change principles into diabetes structured education programmes is key to sustaining long-term improvements in glycaemic management. Good quality training for diabetes educators that enables them to understand and feel confident in behaviour change approaches, is fundamental to their delivery. Educator training programmes are rarely described in detail despite this information being needed to enable interpretation of trial/outcome data, fidelity analyses and replicability between centres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This paper presents an overview of a bespoke training programme developed for educators who delivered the DAFNEplus programme. DAFNEplus is a revised version of the Dose Adjustment for Normal Eating Programme (DAFNE) for people with type 1 diabetes. The revisions incorporate novel technology, behaviour change approaches and structured individualised follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This paper outlines the structure of the training provided to educators, a summary of its development and examples of training content and process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We provide a template for future training courses, where psychological approaches are integrated into standard diabetes education and delivered by healthcare professionals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The impact upon educators' perceptions and delivery of structured education, as well as the potential for ongoing training development, is also discussed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370059","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}