Diabetic Medicine最新文献

{"title":"Limited impact of the PEP1 structured physical activity program on perceived barriers to physical activity in people living with type 1 diabetes.","authors":"C Guédet, S Tagougui, C Suppère, V Boudreau, M-E Mathieu, A-S Brazeau, R Rabasa-Lhoret","doi":"10.1111/dme.70044","DOIUrl":"https://doi.org/10.1111/dme.70044","url":null,"abstract":"","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70044"},"PeriodicalIF":3.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991221","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":"Facilitators and barriers to establishing lactation among women with diabetes?","authors":"Denise McGuinness, Usha Daniel, Denise O Brien","doi":"10.1111/dme.70045","DOIUrl":"https://doi.org/10.1111/dme.70045","url":null,"abstract":"<p><strong>Aim: </strong>To identify the facilitators and barriers to establishing lactation among women with diabetes in pregnancy.</p><p><strong>Methods: </strong>A qualitative descriptive study involving face-to-face semi-structured interviews with 13 postpartum women. An inductive, data-driven content analysis approach was utilised. This study followed the consolidated criteria for reporting qualitative research (COREQ) guidelines.</p><p><strong>Results: </strong>Facilitators to breastfeeding and establishing lactation among women with diabetes included antenatal colostrum harvesting during the antenatal period and support from health care professionals. Barriers included emotional self-efficacy challenges and a lack of support from healthcare professionals in the hospital setting.</p><p><strong>Conclusion: </strong>Women with diabetes report further challenges establishing breastfeeding due to delayed lactogenesis ll (secretory activation), hypoglycaemia and self-efficacy challenges. Given the adverse health risks for mother and infant associated with not breastfeeding, women with diabetes require individualised person-centred lactation care plans to maximise their opportunity to experience a successful breastfeeding journey.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70045"},"PeriodicalIF":3.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990619","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":"Barriers and facilitators to attending postpartum diabetes screening among women with previous gestational diabetes in China: A qualitative analysis.","authors":"Jing Huang, Rita Forde, Angus Forbes, Judith Parsons","doi":"10.1111/dme.70043","DOIUrl":"https://doi.org/10.1111/dme.70043","url":null,"abstract":"<p><strong>Introduction: </strong>Gestational diabetes mellitus (GDM) is a common complication of pregnancy associated with a higher risk of developing type 2 diabetes (T2DM) in the future. Postpartum diabetes screening is important to identify glucose intolerance and introduce diabetes prevention support. However, screening uptake is suboptimal, including in China where the prevalence of GDM is high. There is limited evidence on the barriers and facilitators to screening uptake among Chinese women.</p><p><strong>Aims: </strong>To explore the barriers and facilitators of postpartum diabetes screening uptake among Chinese women with GDM to inform the development of an intervention to increase screening attendance.</p><p><strong>Methods: </strong>Women with current or previous GDM were recruited from social network platforms and pregnancy groups in China. Data were collected using semi-structured interviews and analysed using Framework Analysis to identify themes related to the barriers and facilitators for screening uptake.</p><p><strong>Results: </strong>Twenty-four women with current (n = 4) or previous (n = 20) GDM participated. The postpartum glucose screening attendance rate was 35% among those with previous GDM. Screening uptake was influenced by: risk awareness of T2DM and its complications, interactions with healthcare providers (HCPs), screening-related factors (understanding and beliefs, accessibility and acceptability of the test) and motivation to maintain personal health, which was influenced by fear of T2DM, lack of symptoms, confidence in self management without support, and prioritisation of the child's needs.</p><p><strong>Conclusion: </strong>Postpartum screening uptake after GDM could be boosted through raising risk awareness, more constructive communication from HCPs, increasing the acceptability and accessibility of screening procedures, and addressing psychological factors related to attendance.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70043"},"PeriodicalIF":3.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982589","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":"m6A demethylase ALKBH5 reduces ferroptosis in diabetic retinopathy through the m6A-YTHDF1-ACSL4 axis.","authors":"Qinghui Liao, Yan Li, Meijing Cui, Min Liu","doi":"10.1111/dme.70033","DOIUrl":"https://doi.org/10.1111/dme.70033","url":null,"abstract":"<p><strong>Aim: </strong>Diabetic retinopathy (DR) represents the main ocular complication of diabetes. Targeting ferroptosis is a promising treatment of choice for various diabetic complications. N6-methyladenosine (m6A) demethylase alkylation repair homolog protein 5 (ALKBH5) functions as a pivotal regulator of ferroptosis, and we investigated its role and molecular mechanisms in ferroptosis in DR.</p><p><strong>Methods: </strong>A DR mouse model was developed by streptozotocin (STZ) intraperitoneal injection. High glucose (HG)-induced human retinal pigment epithelial cells (ARPE-19) were used as a DR model in vitro. ALKBH5, YTH N6-methyladenosine RNA binding protein 1 (YTHDF1) and acyl-CoA synthetase long-chain family member 4 (ACSL4) expression levels were examined by RT-qPCR and Western blot. The biological functions of ALKBH5 in vitro and in vivo were investigated by gain-of-function and loss-of-function analyses. ALKBH5's downstream regulatory mechanisms were detected by bioinformatics analysis, RNA pull-down, MeRIP-qPCR and actinomycin D assay.</p><p><strong>Results: </strong>ALKBH5 was under-expressed while YTHDF1 and ACSL4 were up-regulated in the retinal tissues of STZ-induced DR mice and HG-stimulated ARPE-19 cells. Ectopically expressed ALKBH5 or YTHDF1 knockdown partially reversed the increased ferroptosis in vitro and in vivo, evidenced by decreased levels of Fe²⁺, malondialdehyde and reactive oxygen species yet increased glutathione level. ALKBH5 mediated m6A modification of ACSL4 mRNA and disrupted its stability in a YTHDF1-dependent manner. Importantly, in vivo data demonstrated that overexpression of ALKBH5 or YTHDF1 knockdown repressed ferroptosis and alleviated DR by down-regulating ACSL4.</p><p><strong>Conclusion: </strong>These findings suggest that ALKBH5 may delay DR progression by reducing ferroptosis through the m6A-YTHDF1-ACSL4 axis, offering therapeutic paradigms for the treatment of DR.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70033"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972647","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":"No COVID-19 pandemic-associated increase of childhood type 1 diabetes incidence in Western Australia","authors":"Ewan Cameron,&nbsp;Aveni Haynes,&nbsp;Song Zhang","doi":"10.1111/dme.70047","DOIUrl":"10.1111/dme.70047","url":null,"abstract":"","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981253","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":"A validation study of the Intentional Nonadherence Scale among people with type 2 diabetes in the United Kingdom","authors":"Vivien Teo,&nbsp;Anna Hodgkinson,&nbsp;John Weinman,&nbsp;Mark Chamley,&nbsp;Kai Zhen Yap","doi":"10.1111/dme.70040","DOIUrl":"10.1111/dme.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To examine the psychometric properties of the Intentional Nonadherence Scale (INAS) among people with type 2 diabetes mellitus (PwT2D) in the United Kingdom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This validation study recruited 260 PwT2D at diabetes intermediate care team clinics in London. Thirty of them participated in the test–retest reliability analysis in 2–4 weeks, while 124 were followed up in 3–6 months for the predictive validity analysis. The psychometric evaluation also comprised internal reliability, structural validity and construct validity that assessed the relationship between the INAS and other established measures, such as the Medication Adherence Report Scale-5 (MARS-5), Beliefs about Medicine Questionnaire (BMQ)-specific, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-2 (PHQ-2) and glycated haemoglobin (HbA1c).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Exploratory factor analysis revealed four factors, namely ‘Resisting illness’, ‘Resisting medication’, ‘Testing treatment’ and ‘Sensitivity to medication’. All INAS factors demonstrated high internal reliability (Cronbach's alpha = 0.92–0.96). Their test–retest reliability varied between &lt;0.001 and 0.92. Construct validity was demonstrated by its relationship with other measures, including its negative correlations with medication adherence and positive correlations with medication concerns. Significant correlations were also found with HbA1c, as well as with PwT2D's perceptions of diabetes consequences, treatment control, identity and emotional responses to diabetes. ‘Testing Treatment’ showed a trend towards statistical significance with adherence in 3–6 months (coefficient = −0.34, <i>p</i> = 0.09).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The INAS performed well on a number of psychometric properties in this study. It may be a helpful tool for clinicians in identifying specific drivers of intentional nonadherence among PwT2D.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788054","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 multifactorial intervention to improve cardiovascular outcomes in adults with type 2 diabetes and current or previous diabetic foot ulcer disease: Protocol for a multi-centre randomised control trial (MiFoot study)","authors":"Tolu Onuwe,&nbsp;Patrick J. Highton,&nbsp;David Batchelor,&nbsp;Alan Brennan,&nbsp;Molly Caba,&nbsp;Melanie J. Davies,&nbsp;Mark P. Funnell,&nbsp;Frances Game,&nbsp;Clare L. Gillies,&nbsp;Agnieszka Glab,&nbsp;Laura J. Gray,&nbsp;Edward Gregg,&nbsp;Michelle Hadjiconstantinou,&nbsp;Vicky Hall,&nbsp;Vicki Johnson,&nbsp;John R. Petrie,&nbsp;Dan Pollard,&nbsp;Hannah Rowntree,&nbsp;Solomon Tesfaye,&nbsp;Jonathan Valabhji,&nbsp;David Webb,&nbsp;Francesco Zaccardi,&nbsp;Kamlesh Khunti","doi":"10.1111/dme.70028","DOIUrl":"10.1111/dme.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the United Kingdom, the prevalence of diabetes-related foot ulcer disease (DFUD) is 6.3%, and cardiovascular disease (CVD) is the leading cause of mortality in people with DFUD. This study aims to evaluate the effectiveness of a multifactorial intervention to reduce CVD events and mortality in adults with type 2 diabetes (T2D) and DFUD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The MiFoot study is a multi-centre, pragmatic randomised controlled trial to test intervention effectiveness and cost-effectiveness compared to usual care that will include an internal feasibility study and a process evaluation. English-speaking adults (≥18 years; <i>n</i> = 392) with T2D and current/previous (within 5 years) DFUD will be recruited from multiple sites across the United Kingdom and randomised 1:1 to intervention (MiFoot multifactorial intervention plus usual care) or control (usual care), with data collected at baseline, 12- and 24-month follow-up. The MiFoot intervention comprises an individualised assessment with a healthcare practitioner to optimise treatment and assess the suitability of physical activity participation; group-based disease self management education and physical activity sessions; and a digital-based programme, consisting of cohort-relevant topics, physical activity guidance and peer support functionality. The primary outcome will be extended major adverse cardiovascular events (MACE, i.e. myocardial infarction, stroke, cardiovascular death, peripheral arterial bypass, coronary artery bypass, coronary angioplasty or peripheral artery angioplasty) at 24 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> DISCUSSION</h3>\u0000 \u0000 <p>This study will provide evidence on the feasibility and clinical effectiveness, and cost-effectiveness of a multifactorial intervention to prevent or slow the progression of CVD-related complications in the extremely high-risk population with T2D and DFUD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788069","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 role of willpower beliefs in diabetes distress and general emotional well-being in adults with type 2 diabetes.","authors":"Ralph Geerling, Elizabeth Holmes-Truscott, Jane Speight, Tim Skinner","doi":"10.1111/dme.70035","DOIUrl":"https://doi.org/10.1111/dme.70035","url":null,"abstract":"<p><strong>Aims: </strong>To examine the role implicit theories of willpower play in the experience of diabetes distress and general emotional well-being using a cross sectional study design.</p><p><strong>Methods: </strong>Australian adults with type 2 diabetes (N = 270; 56% women; age: 61 ± 12 years), recruited via a national diabetes registry, completed an online survey assessing: willpower beliefs, general emotional well-being, diabetes distress, personality, general self-efficacy and diabetes self-efficacy. Analyses included bivariate correlations and linear regression, adjusted for demographic, clinical and psychological variables.</p><p><strong>Results: </strong>Unadjusted analyses showed willpower beliefs have moderate correlations with general emotional well-being, emotionality and general self-efficacy; and weak correlations with diabetes distress, diabetes self-efficacy, extraversion, conscientiousness and age. Adjusted analyses showed willpower beliefs are a significant predictor of general emotional well-being, but not diabetes distress, independent of self-efficacy and diabetes distress, and potentially mediated by personality and diabetes self-efficacy.</p><p><strong>Conclusions: </strong>Willpower beliefs predict general emotional well-being, but not diabetes distress. Further research is needed to confirm these pathways.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70035"},"PeriodicalIF":3.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784354","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":"Psychological and self care outcomes for children and adolescents living with type 1 diabetes and their caregivers attending diabetes camp: A mixed methods study","authors":"Rita Sigley,&nbsp;Anna L. Boggiss,&nbsp;Benjamin Albert,&nbsp;Dug Yeo Han,&nbsp;Craig Jefferies","doi":"10.1111/dme.70038","DOIUrl":"10.1111/dme.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Diabetes camps for children and adolescents living with Type 1 Diabetes (T1D) offer an important opportunity to foster self-efficacy and ‘common humanity’, a sense that they are not alone in their challenges. The current study primarily aimed to assess whether psychological wellbeing, diabetes self care behaviours and HbA1c improved amongst campers and their caregivers, and whether these would be sustained at 3- and 6-months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Children and adolescents aged 7–13 years who attended the 2023 diabetes camp in Auckland, Aotearoa New Zealand and one of their caregivers were invited to participate. Campers and caregivers were assessed at camp enrolment and then at 1-week, 3-months and 6-months post-camp. Guided by the Theoretical Framework of Acceptability, optional qualitative interviews were also used to explore campers' experiences of camp.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 31 children and adolescents who attended the 2023 camp, 27 (87%) participated in the study with a caregiver. Campers showed reduced feelings of isolation (<i>p</i> = 0.036) and overidentification (<i>p</i> = 0.036) 6 months. Caregivers demonstrated overall improvements in self-efficacy (<i>p</i> = 0.034), caregiver distress and burden (<i>p</i> = 0.006) and caregiver quality of life (<i>p</i> = 0.039). Qualitative findings confirmed high acceptability, with participants reporting positive camp experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Diabetes camps can improve caregivers' self-efficacy, diabetes distress and quality of life, and reduce feelings of isolation and overidentification among campers. Future work is needed to promote cultural inclusivity within camps and improve their accessibility, to be able to optimise the wellbeing of all children and adolescents living with T1D and their families.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771590","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 early metformin in addition to usual care in the reduction of gestational diabetes mellitus effects (EMERGE)—A randomised placebo-controlled clinical trial","authors":"Paddy Gillespie,&nbsp;Ronan Mahon,&nbsp;Christine Newman,&nbsp;Alberto Alvarez-Iglesias,&nbsp;John Ferguson,&nbsp;Andrew Smyth,&nbsp;Paula O'Shea,&nbsp;Declan Devane,&nbsp;Aoife Egan,&nbsp;Martin O'Donnell,&nbsp;Fidelma Dunne","doi":"10.1111/dme.70036","DOIUrl":"10.1111/dme.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To investigate the cost-effectiveness of early initiation of metformin and usual care for gestational diabetes mellitus (GDM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Economic evaluation from a healthcare perspective, based on the EMERGE randomised controlled trial. In total, 535 women with GDM were randomised to placebo in addition to usual care or metformin in addition to usual care. Economic outcomes included incremental healthcare costs and quality adjusted life years (QALYs) and expected cost-effectiveness at cost-effectiveness threshold values of €20,000, €45,000 and €100,000 per QALY gained. Uncertainty was explored using parametric, non-parametric, deterministic and probabilistic methods and heterogeneity using subgroup analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>On average, relative to the placebo arm, the early metformin arm was associated with non-statistically significant mean increases of €193.07 (95% CI: −€789.88, €1176.01; <i>p</i> = 0.700) and 0.002 QALYs (95% CI: −0.009, 0.013; <i>p</i> = 0.771). In terms of expected cost-effectiveness at threshold values of €20,000, €45,000 and €100,000 per QALY gained, the probability of the early metformin arm being more cost-effective was estimated at 0.423, 0.452 and 0.524. Exploratory subgroup analyses provided more favourable but not definitive evidence in favour of the early metformin arm for cohorts with previous GDM and previous caesarean section.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We do not find definitive evidence that early initiation of metformin in addition to usual care for GDM was more cost-effective than usual care alone. The clinical and economic evidence may be considered equivocal, but worthy of further examination.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 6","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771602","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}