Diabetic Medicine最新文献

{"title":"Association between mortality and diabetes in patients with acute diseases treated by emergency medical services: A multicenter, prospective cohort study","authors":"Carmen Barbero Linares,&nbsp;José Luis Martín-Conty,&nbsp;Begoña Polonio-López,&nbsp;Cristina Rivera Picón,&nbsp;Miguel Antonio Sampedro-Nuñez,&nbsp;Fernando Sebastián-Valles,&nbsp;Jorge García-Criado,&nbsp;María Cubillo-Jiménez,&nbsp;Juan F. Delgado Benito,&nbsp;Francisco Martín-Rodríguez,&nbsp;Ancor Sanz-García","doi":"10.1111/dme.70427","DOIUrl":"10.1111/dme.70427","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Diabetes mellitus (DM) significantly impacts emergency medical services (EMS) and complicates acute illness prognoses. This study aimed to evaluate the effect of DM on 2-year mortality in patients admitted to emergency departments (EDs), compare diabetic and nondiabetic groups, and identify key mortality predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective cohort study in Spain (2019–2022) included adults with acute illnesses transported by the EMS. Diabetic patients were grouped by the presence of complications. The primary outcome was 2-year mortality; secondary outcomes included ICU and ward admissions. Survival and mortality predictors were assessed via Kaplan–Meier and Cox regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5963 patients, 25.4% (<i>n</i> = 1513) died within a 2-year period. Mortality was significantly greater in diabetic patients with complications (41.5%) than in diabetic patients without complications (27.6%) and nondiabetic patients (21.8%) (<i>p</i> &lt; 0.001). The main risk factors for mortality include advanced age and elevated lactate, leukocyte, and bilirubin levels in diabetic patients with complications. The protective factors were higher Glasgow Coma Scale (GCS) scores and hemoglobin levels. Survival curves revealed a sharp decline in the group of diabetic patients with complications during the acute phase.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Diabetes, particularly complications, significantly increases short- and medium-term mortality in patients with acute illnesses treated with emergency services. The results of this study highlight the need for a more thorough and early risk assessment in these patients, as the factors influencing their prognosis differ significantly from those in nondiabetic patients. This differential approach could improve clinical management and long-term outcomes.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148458338","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 multi-omics risk score enables early and personalized screening for type 2 diabetes: A population-based cohort study","authors":"Fan Bu,&nbsp;Chen Fang,&nbsp;Xiao Zheng,&nbsp;Xiu-Juan Yu,&nbsp;Shan-Juan Yuan,&nbsp;Chao-Jie Liu,&nbsp;Zi-Tong Song,&nbsp;Yue-Ping Shen,&nbsp;Lei Zhang,&nbsp;Yu-Fang Pei","doi":"10.1111/dme.70323","DOIUrl":"10.1111/dme.70323","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to develop a multi-omics model to predict type 2 diabetes onset using multi-omics data, beyond established clinical and genetic factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the UK Biobank cohort (<i>N</i> = 21,312,893 incident type 2 diabetes cases), Ridge Cox regression models were constructed based on clinical factors defined by the Finnish Diabetes Risk Score (CliS), plasma metabolomics (MetS), proteomics (ProS) and polygenic risk score (PRS). Model performance was evaluated by C-index and net reclassification improvement (NRI). Clinical utility was assessed through net benefit, risk stratification and screening initiation ages. Independent validation of protein markers was performed in the Liyang Cohort (<i>N</i> = 10,056).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ProS was the top-performing single-omics predictor (C-index: 0.80). ComS (Combined risk score) achieved the highest discriminative ability (C-index: 0.84), significantly outperforming the CliS (C-index: 0.76, NRI: 0.328, <i>p</i> &lt; 0.001). ComS reclassified 73 additional type 2 diabetes cases per 1000 participants not receiving intervention, without increasing false positives. Kaplan–Meier analysis confirmed superior risk stratification of ComS (Log-rank <i>p</i> &lt; 0.0001). Critically, both MetS and ProS identified high-risk individuals missed by the conventional CliS. Screening initiation before age 40 was warranted for individuals in the top risk quintile of MetS, ProS, or ComS. In the Liyang Cohort, plasma FGF23 levels were significantly elevated in type 2 diabetes cases (<i>p</i> &lt; 0.05), corroborating its role as a key proteomic contributor to risk prediction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The combined multi-omics model enables more precise, earlier type 2 diabetes risk stratification, supporting personalized screening strategies years before clinical onset.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663540","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":"Long non-coding RNA GAS5 binds to miR-137 and regulates Nrf2 to ameliorate insulin resistance in adipose tissue in gestational diabetes mellitus","authors":"Yuanyuan Guo,&nbsp;Jingru Jiao,&nbsp;Xian Zheng","doi":"10.1111/dme.70451","DOIUrl":"10.1111/dme.70451","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to explore whether GAS5 improves gestational diabetes mellitus (GDM)-associated insulin resistance (IR) via the miR-137/Nrf2 axis, thereby elucidating a potential novel mechanism underlying GDM pathogenesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>GAS5 and Nrf2 expression was compared between GDM patients and normal glucose tolerance pregnant women, and their correlations with IR and lipid metabolism indexes were analysed. A dexamethasone-induced adipocyte IR model was constructed. Cellular functional changes in glucose uptake, fatty acid metabolism and lipid deposition were detected following GAS5 overexpression and miR-137/Nrf2 intervention to validate the regulatory mechanism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>GAS5 and Nrf2 were markedly decreased in GDM peripheral blood and closely correlated with IR and lipid metabolic phenotypes. GAS5 overexpression increased adipocyte glucose uptake and alleviated IR and lipid disorders. Mechanistically, GAS5 directly binds and inhibits miR-137 to upregulate Nrf2. Rescue assays showed that miR-137 elevation or Nrf2 suppression partially reversed the protective effects of GAS5, reducing glucose uptake and fatty acid oxidation while increasing free fatty acid release and lipid accumulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>GAS5 and Nrf2 are lowly expressed in GDM patients. This study demonstrates that GAS5 ameliorates adipocyte IR and lipid metabolic dysfunction by sponging miR-137 to elevate Nrf2 expression, providing a novel mechanistic insight for GDM.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893013","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":"Real-world completion of diabetes self management education and its impact on patient-reported outcomes: A scoping review","authors":"Gemma Lewis,&nbsp;David M. Hughes,&nbsp;Greg Irving,&nbsp;John Wilding,&nbsp;Kevin Hardy","doi":"10.1111/dme.70312","DOIUrl":"10.1111/dme.70312","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Diabetes self management education (DSME) is recommended for type 2 diabetes, with completion widely accepted as ≥60% engagement. This review utilising PRISMA extension for scoping reviews maps the literature on the impact of full and partial completion of DSME on patient-reported outcomes (PROMs) versus a control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Core search terms for type 2 diabetes were combined with DSME and PROMs (self care, diabetes distress and QOL) using the AND Boolean operator. Searches of CINAHL, MEDLINE and EMBASE 1 February, 2024, were checked September 2025. No restrictions were applied to study quality, location or sex. We examined quantitative studies comparing outcomes based on DSME completion [100%] vs. control [0%] vs. partial completion [1%–99%]. Studies employing ITT analyses or pre-post designs without controls were excluded to focus on outcomes by programme completion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Databases yielded 1307 records with an additional 12 through hand-searching key journals, reference lists and websites. Twenty-four records met inclusion criteria. No studies reported outcomes for partial DSME completion. Evidence suggests 100% DSME completion improves self management skills and QOL over 3–6 months, with greater gains in self care behaviours and mental health-related QOL. Medication adherence and physical health improved less consistently.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Evidence of short-term improvements in self management skills and QOL was constrained by programme heterogeneity, methodological variability and predominantly high-income settings. Evidence supporting sustained benefits beyond 6–12 months is limited and impact on diabetes distress is uncertain. No studies reported the effectiveness of partial completion of DSME on PROMs, despite a widely accepted benchmark suggesting ≥60% engagement constitutes completion.</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.70312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611662","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":"Association between gestational diabetes, ethnicity and migrant length of residence: An Australian cohort study","authors":"Sheila Pham,&nbsp;Helena Qian,&nbsp;James Elhindi,&nbsp;Olivia Byrnes,&nbsp;Michelle de Vroome,&nbsp;Geraldine Gilroy,&nbsp;Tanya Nippita,&nbsp;Gayatri Talla,&nbsp;Lisa White,&nbsp;Dipti Zachariah,&nbsp;N. Wah Cheung,&nbsp;Dharmintra Pasupathy,&nbsp;Sarah J. Melov","doi":"10.1111/dme.70359","DOIUrl":"10.1111/dme.70359","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Investigate the relationship of gestational diabetes (GDM) risk for specific migrant groups compared to the Australian born of each ethnic group and length of residence (LOR) in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective observational cohort study from June 2020 to November 2023 at 10 Australian hospitals. Ethnicity was self-identified by participants. Log-binomial regression models were adjusted for confounding factors. Relative risk (RR) was determined for GDM by both ethnicity and duration of residency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 60,701 participants, 32,391 (53.4%) were Australian born with South Asian the highest reported ethnic group (18.3%, <i>n</i> = 11,121). Women who migrated ≥5 years ago made up 31.8% (<i>n</i> = 19,282) of the cohort. GDM prevalence was 18.2% (<i>n</i> = 11,076). The recent migrant GDM rate was 2068/9028 (22.9%), LOR ≥5 years migrants were 4835/19,282 (25.1%) with Australian born 4173/32391 (12.9%). The adjusted relative risk (aRR) for GDM in migrants with an LOR &lt;5 years was 1.37 (95%CI 1.31–1.43) when compared to Australian born. Among the ethnic groups, Middle Eastern women with LOR &lt;5 years had the highest risk for GDM compared to those from the same ethnic group born in Australia (aRR 1.86; 95%CI 1.84–1.88).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study identifies that the most ethnic migrant groups were at a higher risk of GDM than those of the same ethnicity born in Australia and this higher risk of GDM continued over time. Recognising migration effects may improve targeted and meaningful interventions to reduce GDM risk.</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.70359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950597","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 systematic review of breastfeeding prevalence, duration and determining factors in women with type 1 and type 2 diabetes mellitus","authors":"Fiona L. Britten,&nbsp;Emma Shipton,&nbsp;Madeline Duke,&nbsp;Emma L. Duncan,&nbsp;Leonie K. Callaway","doi":"10.1111/dme.70315","DOIUrl":"10.1111/dme.70315","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>There is evolving evidence of the metabolic benefit of breastfeeding for women with diabetes and their infants but little data about breastfeeding prevalence and duration in women with type 1 and type 2 diabetes. This is the first systematic review to examine prevalence and duration of breastfeeding in women with pregestational diabetes and variables associated with breastfeeding establishment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systemic literature review was conducted to assess breastfeeding prevalence in women with pregestational diabetes, and to describe variables reported to affect prevalence. The study was registered with the PROSPERO database (CRD42023447299).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Women with type 1 diabetes had lower prevalence and shorter duration of breastfeeding compared with normoglycaemic women. In contrast, there was insufficient evidence regarding prevalence and duration of breastfeeding in type 2 diabetes. Multivariate analysis identified variables associated with reduced breastfeeding prevalence or duration in pregestational diabetes. These included elevated body mass index, reduced maternal education, and less frequent early breastfeeding. Only two studies found an independent association with diabetes. No studies controlled for all likely confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Breastfeeding prevalence and duration are likely reduced in type 1 diabetes; however, evidence in type 2 diabetes is inconclusive. A significant knowledge gap remains in this area; further research is required to establish the prevalence of breastfeeding and associated variables in women with pregestational diabetes. Given the long-term metabolic benefit of lactation in women with type 1 and type 2 diabetes, and the increasing prevalence of pregestational type 2 diabetes, further data are needed to design effective interventions to support breastfeeding in this population.</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.70315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148612226","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 impact of frailty on glycaemic control in older adults with type 1 diabetes: An observational study","authors":"Jonathan A. Golding,&nbsp;Scarlett O. Long,&nbsp;Suzy V. Hope,&nbsp;Juliet E. Wright,&nbsp;Ali J. Chakera,&nbsp;Tom J. Levett","doi":"10.1111/dme.70406","DOIUrl":"10.1111/dme.70406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The type 1 diabetes population is ageing. Frailty is the age-related physiological decline that occurs across organ systems, increasing the body's vulnerability to stressors. Current consensus-based guidelines, derived from evidence in type 2 diabetes, prioritise hypoglycaemia avoidance, which increases falls, hospitalisation and mortality risk in older adults. This study assesses whether frailty is associated with increased hypoglycaemia in older adults with type 1 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Participants were over 65, with type 1 diabetes, confirmed by C-peptide measurement. Frailty was categorized as robust, prefrail or frail as per Fried Frailty Phenotype (gait speed, weight loss, hand-grip strength, exhaustion and physical activity). Secondary analyses used Clinical Frailty Scale and Short Physical Performance Battery. Cognition was assessed using Montreal Cognitive Assessment score (MoCA). Blinded continuous glucose monitors (CGM), Dexcom G6/G7, were worn for 10 days. CGM metrics were compared between frailty categories, focusing on percentage time below range (%TBR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>83 participants met the inclusion criteria. 38 were robust (45.8%), 29 prefrail (34.9%) and 16 frail (19.3%). Frail participants were older, with more comorbidities and diabetes complications. Frailty was associated with higher HbA1c (<i>p</i> = 0.025) and lower MoCA scores (<i>p</i> = &lt; 0.001). There was no difference between any CGM-derived glycaemic parameter across the frailty spectrum, regardless of frailty assessment used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While frailty is often associated with hypoglycaemia in diabetes, this was not demonstrated in our type 1 diabetes cohort. Raised HbA1c levels with frailty may reflect recommendations to relax glucose targets. However, no difference was found in %TBR with frailty.</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.70406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311225","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":"Women living with diabetes: Overlooked and under-recognised, the psychosocial impact","authors":"Rita Forde,&nbsp;Angus Forbes,&nbsp;Dawn Adams,&nbsp;Aycan Celik Esmer,&nbsp;Emma Davidsen,&nbsp;Maartje de Wit,&nbsp;Michelle Hadjiconstantinou,&nbsp;Rahab Hashim,&nbsp;Ana Munda,&nbsp;Giesje Nefs,&nbsp;Hermelinda C. Pedrosa,&nbsp;Anita Sabidi,&nbsp;Judith Parsons","doi":"10.1111/dme.70389","DOIUrl":"10.1111/dme.70389","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Diabetes intersects with women's reproductive and sexual health across the life course; however, the psychosocial implications of key reproductive transitions remain under-recognised in research and clinical practice. This review synthesised evidence on the psychosocial impacts of diabetes during menstruation, pregnancy, the menopausal transition and sexual functioning, with the aim of identifying critical gaps in research and care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A narrative review was conducted, informed by a semi-structured literature search.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Women living with diabetes experience substantial psychosocial burdens that extend beyond glycaemic management across all reproductive stages. During menstruation, hormonal fluctuations contribute to glycaemic variability, increased self-management demands and emotional distress, often without adequate clinical guidance. Pregnancy in women with type 1, type 2, and gestational diabetes is associated with heightened anxiety, diabetes distress, stigma and guilt, yet psychosocial needs remain largely unaddressed in routine care. The menopausal transition represents a further period of vulnerability, characterised by worsening glycaemic variability, increased psychological morbidity and elevated cardiovascular risk. Sexual dysfunction is highly prevalent across the lifespan in women with diabetes and is strongly associated with depression, anxiety and body image concerns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Overall, the evidence highlights a persistent disconnect between the psychosocial needs of women and the predominantly biomedical focus of current diabetes care models. Addressing this gap requires a person-centred approach that integrates psychosocial and women-specific health considerations into diabetes research, education and clinical practice. Strengthening this evidence base is essential to improving long-term health outcomes for women living with diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 9","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70389","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280652","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":"Embedding psychological care in diabetes services: Why it's time to innovate and integrate","authors":"Per Winterdijk,&nbsp;Henk-Jan Aanstoot,&nbsp;Christine Fransman,&nbsp;Andreia Mocan,&nbsp;Giesje Nefs","doi":"10.1111/dme.70411","DOIUrl":"10.1111/dme.70411","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This narrative review synthesizes current knowledge on the psychological dimensions of diabetes care, identifies gaps in evidence and practice and proposes innovative pathways for embedding psychological care into routine diabetes services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Drawing on the authors' expertise in diabetes and behavioral science, complemented by a semi-structured literature search, the review integrates findings from quantitative studies, qualitative research, clinical experience and lived experience perspectives. Evidence was analyzed across domains of care models, research and evaluation, implementation and policy and advances in person-reported outcome measurement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Psychological care in diabetes appears most effective when delivered through layered models: routine distress assessment, frontline psycho-education and access to specialist therapies when needed. Evidence suggests such approaches reduce distress and depressive symptoms, though glycaemic effects remain variable. Integration is constrained by structural barriers such as fragmented health systems, limited reimbursement and shortages of trained professionals. Scientific gaps include underrepresentation of older adults, migrant populations and rare diabetes subtypes, as well as a lack of longitudinal studies. Practical challenges (time pressures in clinics, digital inequality, stigma) further hinder uptake. Assessment issues also persist, with lengthy tools limiting routine use. Moving forward requires interdisciplinary and stepped/matched care models, inclusive and participatory research and policy frameworks that support reimbursement and workforce development. Advances in adaptive, streamlined and culturally sensitive measurement tools are essential to ensure psychological needs are systematically identified and addressed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Psychological care is not a luxury in diabetes care but a core component of effective, person-centred practice, critical to achieving holistic, equitable and sustainable services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 9","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633587","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":"From language matters to stigma-free communication in diabetes: Evolution, challenges, and next steps","authors":"Elizabeth Holmes-Truscott,&nbsp;Emmanuel Ekpor,&nbsp;Eloise Litterbach,&nbsp;Renza Scibilia,&nbsp;Partha Kar,&nbsp;Jane K. Dickinson,&nbsp;Susan Guzman,&nbsp;Matthew Garza,&nbsp;Mariam Asaad,&nbsp;Mark T. U. Barone,&nbsp;Chitra Selvan,&nbsp;Tejal Lathia,&nbsp;Amy McInerney,&nbsp;Peter Senior,&nbsp;Timothy Skinner,&nbsp;Jane Speight","doi":"10.1111/dme.70311","DOIUrl":"10.1111/dme.70311","url":null,"abstract":"<p>Language profoundly shapes how diabetes is perceived, experienced and managed, with the potential to perpetuate stigma or promote dignity and respect. This expert review, conducted by an international, multidisciplinary team, traces the evolution of the global diabetes <i>#LanguageMatters</i> movement and synthesises evidence on the effects of language on diabetes management, health and wellbeing, alongside community-preferred terminology. We identified 32 language position statements/guidance documents published in more than 19 countries. Most are applicable to all diabetes types, diverse audiences and address verbal communication; many also consider non-verbal, paraverbal and, to a lesser extent, visual communication. Beyond recommendations of terms to use or avoid, these statements articulate overarching principles grounded in person-centred, strengths-based, empathic and non-judgemental communication. Evidence of uptake is emerging, including incorporation into clinical standards and research presentation guidance, alongside gradual shifts in language use within some research and media contexts. However, implementation remains uneven, and stigmatising language persists across healthcare, research, policy and public discourse. Despite growing momentum, empirical evidence on community preferences and robust evaluation of adoption and impact remain limited. Language practices are also evolving alongside new technologies, screening approaches and therapeutics, creating additional challenges and opportunities. We identify key gaps in evidence, guidance and implementation mechanisms, and highlight persistent and emerging forms of hidden stigma within systems and structures. We propose a constructive agenda centred on community partnership and system-level implementation. Treating language as foundational to person-centred, equitable and compassionate diabetes care is essential to ending diabetes stigma and discrimination across all settings.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 9","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625242","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}