Diabetic Medicine最新文献

{"title":"Understanding women's sex hormone physiology—A priority in diabetes care","authors":"Céline Isabelle Laesser, Bettina Weber, David Studer, Reem Jalal Alshareef, Lia Bally","doi":"10.1111/dme.70109","DOIUrl":"10.1111/dme.70109","url":null,"abstract":"<p>Women experience profound, dynamic changes in sex hormone exposure throughout their lifespan that directly influence diabetes pathophysiology and management. In the pre-pubertal period, sex hormone levels remain consistently low, but with the onset of puberty, women begin experiencing the remarkable fluctuations characteristic of reproductive biology. The menstrual cycle alone produces 5- to 50-fold variations in oestradiol and progesterone,<span><sup>1</sup></span> while hormonal contraceptives, except for local intrauterine devices, alter these patterns. Pregnancy elevates oestradiol 100- to 200-fold and progesterone 15-fold,<span><sup>2</sup></span> with assisted reproduction achieving even higher levels. The menopausal transition then precipitates a sharp decline in oestradiol exposure to levels that actually fall below those of age-matched men. While menopausal hormone therapy can restore sex hormone concentrations approximating premenopausal follicular phase levels, the achieved exposure shows substantial variability depending on formulation specifics, dosage and administration route.<span><sup>3</sup></span> Additionally, body weight changes represent another important modifier of oestrogen exposure, with weight loss consistently associated with decreased oestrogen levels.<span><sup>4</sup></span></p><p>Beyond their reproduction functions, female sex hormones, particularly oestradiol, interact extensively with glucose and energy metabolism pathways.<span><sup>5, 6</sup></span> Oestradiol enhances insulin sensitivity, increases insulin secretion, improves β-cell viability, delays gastric emptying and promotes favourable adipose tissue distribution—all collectively promoting glucose homeostasis. These metabolic advantages are further amplified by oestradiol's critical role in modulating energy expenditure and promoting satiety.<span><sup>5</sup></span> While many mechanistic insights originate from preclinical models, human evidence from studies of the impact of menopause and anti-oestrogenic cancer therapies on diabetes incidence, and investigations on the glycaemic effect of oestradiol replacement (including menopausal hormone therapy) generally corroborate the glycaemic benefits of oestradiol.<span><sup>7</sup></span> In contrast to oestradiol's beneficial effects, progesterone demonstrates a less well-characterized and predominantly unfavourable metabolic profile, with its characteristic mid-luteal phase surge consistently linked to decreased insulin sensitivity.<span><sup>8</sup></span> Similarly, both androgenic progestins (frequently utilized in hormonal contraceptives) and states of hyperandrogenism, as clinically seen in polycystic ovary syndrome (PCOS), have been associated with impaired insulin sensitivity.<span><sup>9</sup></span></p><p>While sex hormones demonstrably influence diabetes risk and manifestations, this relationship is fundamentally bidirectional, as impaired glucose homeostasis substantially affects the hypothala","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661733","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":"“It is a constant battle”: A qualitative study of the lived experience of individuals with diabetic foot ulcer and post-healing challenges in primary care","authors":"Xiaoli Zhu,&nbsp;Eng Sing Lee,&nbsp;Phoebe X. H. Lim,&nbsp;Frederick H. F. Chan,&nbsp;Yee Chui Chen,&nbsp;Konstadina Griva","doi":"10.1111/dme.70096","DOIUrl":"10.1111/dme.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the lived experiences of primary care patients with active diabetic foot ulcer (DFU) and post-healing in remission (PHIR) to inform tailored interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative interview study was conducted with primary care patients with DFU and PHIR in Singapore. In-depth interviews were held with 27 participants (15 with active DFU and 12 with PHIR) from April to July 2022. Transcripts were analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The lived experiences of individuals with DFU across its stages (active DFU and PHIR) were encapsulated in the notion of ‘<i>a cyclical lifelong illness threat alongside a vicious foot cycle</i>’, reflected in three key themes. The first theme, <i>Making Sense of DFU</i>, captured participants' varied perceptions of their condition—from misattributing in DFU management to seeing it as a constant battle, an unavoidable terminal disease (active DFU) or a wake-up call (PHIR). The second theme, <i>Emotional Consequences</i>, highlighted the significant psychological burden experienced by participants, encompassing emotional exhaustion leading to self care burnout, as well as chronic anxiety and persistent fear of recurrence. The third theme, <i>Behavioural Challenges,</i> illustrated the complexities of self management, with participants describing their efforts as a constant struggle to maintain self care routines, often marked by ambivalence towards long-term adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights the persistent psychosocial and behavioural challenges faced by individuals with DFU and PHIR, underscoring the need for autonomy-supportive and empowerment-focused interventions to reshape perceptions of DFU, alleviate emotional distress and enhance adherence to self care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661732","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":"THR1VE!: Randomized controlled trial to reduce diabetes distress in adolescents with type 1 diabetes","authors":"Sarah S. Jaser,&nbsp;Karishma Datye,&nbsp;James C. Slaughter,&nbsp;Lauren LeStourgeon,&nbsp;Randi Streisand","doi":"10.1111/dme.70107","DOIUrl":"10.1111/dme.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate the effects of a positive psychology intervention to treat diabetes distress (DD) and improve glycaemic outcomes among adolescents with type 1 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adolescents ages 13–17 with elevated DD and their caregivers from 2 sites (<i>n</i> = 198 dyads) were randomized to receive enhanced usual care (Diabetes Education) or a Diabetes Education + Positive Affect intervention, delivered via automated text messages. Psychosocial and glycaemic data were collected at baseline, 3 months, 6 months and 12 months. The primary outcomes were changes in diabetes distress (DD) and HbA1c over 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adolescents demonstrated high levels of engagement in the trial; overall response to text messages was 91%, and retention was 90% over 12 months. Adolescents in both groups reported reductions in DD from baseline to 12 months (effect size <i>d</i> = 0.40), and they were significantly more likely to move from clinically relevant levels into the normal range of DD than to report increased DD (OR = 2.2, <i>p</i> = 0.002). Adolescents' HbA1c was stable over 12 months. We did not observe significant differences in outcomes between groups. Improvement in DD was associated with decreased HbA1c over time (β = 1.89, <i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was no significant intervention effect on DD or HbA1c. Adolescents in both the Diabetes Education and Diabetes Education + Positive Affect arms reported reduced DD over 12 months. Future studies are needed to determine how to employ the least burdensome, engaging intervention for distressed adolescents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652031","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":"Type 2 diabetes risk communication following a diagnosis of gestational diabetes mellitus: A qualitative study","authors":"Molly Caba,&nbsp;Alison Northern,&nbsp;Amar Virdee,&nbsp;Kamlesh Khunti,&nbsp;Melanie Jane Davies,&nbsp;Michelle Hadjiconstantinou","doi":"10.1111/dme.70105","DOIUrl":"10.1111/dme.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gestational diabetes mellitus (GDM) increases women's risk of developing type 2 diabetes (T2DM) tenfold. Understanding of T2DM risk in women with GDM is variable and can impact health behaviours. To better understand how T2DM risk is communicated by healthcare professionals, we explored women's experiences of T2DM risk communication and support following a diagnosis of GDM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative study was conducted utilising semi-structured interviews. Participants were 10 women previously diagnosed with GDM. Transcripts were analysed following reflexive thematic analysis guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three themes and four sub-themes were created to describe women's experiences of, and responses to, T2DM risk communication and support following a diagnosis of GDM. Minimal T2DM risk communication during GDM and postnatally was a common experience, and as a result, women forgot about their increased risk and felt forgotten by the health service. The lack of correspondence and support further fostered a dearth of knowledge and misunderstandings regarding what T2DM is, how it affects a person's body, and the necessity of preventative actions, all of which could impact women's management of their risk. Several strategies were suggested by women to remedy the currently absent communication and support. This included group education sessions, tangible and digital support resources, providing individualised information, and continuous and harmonious T2DM risk communication from healthcare professionals and health services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Current deficiencies for communicating T2DM risk and providing avenues of support following a diagnosis of GDM leaves many women feeling under-supported. Improvements to current care are recommended to ameliorate this.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645183","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":"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":"Socioeconomic deprivation results in high rates of diabetic ketoacidosis at type 1 diabetes diagnosis in England: A multicentre observational study","authors":"Chamila Balagamage,&nbsp;Chariklia Pieridou,&nbsp;Afiya Andrews,&nbsp;Prem Sundaram,&nbsp;Tabitha Randell,&nbsp;Fiona Campbell,&nbsp;James Young,&nbsp;Ruben H. Willemsen,&nbsp;Astha Soni,&nbsp;Meghan McGrath,&nbsp;M. Loredana Marcovecchio,&nbsp;Nisha Pargass,&nbsp;Dhaara Iyer,&nbsp;Renuka P. Dias","doi":"10.1111/dme.70102","DOIUrl":"10.1111/dme.70102","url":null,"abstract":"&lt;p&gt;The global incidence of type 1 diabetes continues to rise, yet a considerable proportion of children continue to present in diabetic ketoacidosis (DKA) at diagnosis despite improved recognition, education, and management strategies.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; DKA remains a significant contributor to morbidity, long-term glycaemic instability, and elevated healthcare costs.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Although international estimates of DKA incidence at diagnosis vary considerably, ranging from 13% to 80% in those under 20 years,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; the most recent UK data from the National Paediatric Diabetes Audit (NPDA) reported a 23.3% incidence of DKA at type 1 diabetes diagnosis in 2023.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; The reasons for this geographical variation are multifactorial and include delayed diagnosis due to non-specific symptoms, particularly in younger children, as well as disparities related to socioeconomic deprivation and ethnicity.&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; However, UK-based data exploring these associations in large, diverse cohorts are limited.&lt;/p&gt;&lt;p&gt;We conducted a retrospective, multicentre observational study to investigate the sociodemographic factors associated with DKA at the time of type 1 diabetes diagnosis in children and adolescents. Data were collected from nine paediatric diabetes units across five English regions: West Midlands, East Midlands, Yorkshire and Humber, London and the South East, and East of England. All individuals younger than 18 years diagnosed with stage 3 type 1 diabetes between January 2023 and August 2024 were included. Key variables included ethnicity (self-identified into 5 NHS-defined categories), socioeconomic status (determined using the 2019 Index of Multiple Deprivation [IMD] quintiles based on postcode), and interpreter requirement.&lt;/p&gt;&lt;p&gt;DKA severity was defined using the British Society for Paediatric Endocrinology and Diabetes (BSPED) criteria.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Of 539 eligible patients, 499 had complete data for full analysis (see Table 1). Overall, 45.5% presented in DKA, a rate substantially higher than national figures. The cohort was notably diverse (38.3% non-white) and socioeconomically deprived (54.9% from IMD quintiles 1 and 2). There was regional variation in deprivation (lowest seen in the East of England: 2.6% in IMD1 vs. the West Midlands: 51.2%).&lt;/p&gt;&lt;p&gt;This study is the largest contemporary analysis of DKA presentation at type 1 diabetes diagnosis in England, which identified socioeconomic deprivation as the most prominent risk factor for this acute presentation. While ethnicity, language, and family history did not significantly influence outcomes in our cohort, the persistent high rates of DKA, particularly among deprived communities, point to a broader public health issue. Efforts to reduce DKA incidence must focus on improving public and professional awareness, especially in high-risk populations.&lt;/p&gt;&lt;p&gt;We advocate for long-term, multi-stage awarenes","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 11","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586170","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}