Diabetes & metabolism最新文献

{"title":"Prevalence and predictive factors of computed tomography-detected pancreatopathy in a cohort of adult patients hospitalized for newly diagnosed or uncontrolled non-auto-immune diabetes","authors":"Noëmie Lemétayer ,&nbsp;Lucille Quénéhervé ,&nbsp;Jean-Romain Risson ,&nbsp;Charlotte Nachtergaele ,&nbsp;Geneviève Crouzeix ,&nbsp;Emmanuel Sonnet ,&nbsp;Nathalie Roudaut ,&nbsp;Véronique Kerlan ,&nbsp;Vianney Deméocq ,&nbsp;Philippe Thuillier","doi":"10.1016/j.diabet.2025.101699","DOIUrl":"10.1016/j.diabet.2025.101699","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the prevalence of pancreatic lesions in patients hospitalized for newly diagnosed or uncontrolled diabetes mellitus and identify potential predictive factors for pancreatic pathology.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-center observational study at Brest University Hospital between February 2016 and February 2022. Adult patients hospitalized for newly diagnosed diabetes or uncontrolled diabetes mellitus who underwent a computed tomography (CT) scan within six months of admission were included. Patients with type 1 diabetes, prior pancreatectomy, or a known history of pancreatic adenocarcinoma were excluded. Clinical, biological, and imaging data were analyzed.</div></div><div><h3>Results</h3><div>Among 412 patients analyzed, 53 (12.9 %) presented pancreatic abnormalities (PA), including 11 cases (2.7 %) of malignant pancreatic lesion. Predictive factors for PA (<em>P</em> &lt; 0.05) included (odds ratio [95 % confidence interval]): age ≥ 65 years (2.00 [1.52;5.27]); body mass index ≤ 26.4 kg/m² (2.65 [1.1;4.98]); LDL/HDL ratio ≤ 3.0 (4.75 [2.03;11.10]); and presence of at least one clinical warning sign (alcoholic use, steatorrhea, abdominal pain) (2.29 [1.21;4.33]). Using all four criteria together, 68 of 412 CT scans would have been avoided, with no missed cases.</div></div><div><h3>Conclusions</h3><div>The prevalence of pancreatic lesions in patients hospitalized for diabetes-related glycemic imbalance was significant although malignancy remained low. Age ≥ 65 years, low body mass index, and altered lipid profile may help identify patients requiring pancreatic imaging. Future prospective studies should refine these criteria to develop screening strategies for early pancreatic cancer detection in high-risk selected diabetic populations.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101699"},"PeriodicalIF":4.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SGLT2 inhibitors and the risk of hepatocellular carcinoma in patients with MASLD and Type 2 diabetes","authors":"Ruey-Shyang Soong ,&nbsp;Wan-Ming Chen ,&nbsp;An-Tzu Jao ,&nbsp;Ming-Che Lee ,&nbsp;Szu-Yuan Wu ,&nbsp;Chih-Lang Lin","doi":"10.1016/j.diabet.2025.101698","DOIUrl":"10.1016/j.diabet.2025.101698","url":null,"abstract":"<div><h3>Background</h3><div>- Hepatocellular carcinoma (HCC) is increasingly driven by non-viral causes, especially metabolic dysfunction–associated steatotic liver disease (MASLD), which is common in type 2 diabetes mellitus (T2D). No pharmacologic agent is currently approved for HCC chemoprevention.</div></div><div><h3>Objective</h3><div>- To evaluate the association between sodium–glucose cotransporter-2 inhibitor (SGLT2i) use and risks of HCC and all-cause mortality in patients with MASLD and T2D.</div></div><div><h3>Design</h3><div><em>-</em> Multinational, retrospective cohort study using the TriNetX federated electronic health record network (2005–2025). Adults aged 18–90 years with non-viral MASLD and pre-existing T2D were identified. We applied a 1-year washout, used an active-comparator design, and performed 1:1 propensity score matching. Adjusted hazard ratios (aHRs) were estimated with Cox models.</div></div><div><h3>Results</h3><div>- After matching, 93,930 SGLT2i users were compared with 93,930 active comparators with excellent covariate balance. Median follow-up was 3.24 years (IQR 1.72–5.09) in the SGLT2i group and 3.25 years (IQR 1.72–5.08) in comparators. HCC occurred in 43 (0.05 %) SGLT2i users vs 74 (0.08 %) comparators (aHR 0.43; 95 % CI 0.29–0.63). All-cause mortality was 5.32 % vs 10.50 % (aHR 0.34; 95 % CI 0.33–0.35). Results were consistent across subgroups and sensitivity analyses, including time-anchored landmark analyses. Risk reductions were also observed for liver fibrosis/cirrhosis and hepatic nodules.</div></div><div><h3>Conclusions</h3><div>- Among patients with MASLD and T2D, SGLT2 inhibitor use was associated with lower risks of HCC and all-cause mortality compared with active comparators. While residual confounding cannot be excluded, these findings support prospective evaluation of SGLT2 inhibitors for liver-related risk reduction in this population.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101698"},"PeriodicalIF":4.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketoacidosis associated with type 2 sodium-glucose cotransporter inhibitors (SGLT2i) in patients aged 65 and older: Evidence from the French national pharmacovigilance database","authors":"Nathanaël Bassas Letissier ,&nbsp;Nassir Mirfendereski ,&nbsp;Marie-Laure Laroche ,&nbsp;Jean- Luc Faillie ,&nbsp;Marc Paccalin ,&nbsp;Pierre-Jean Saulnier ,&nbsp;Marion Allouchery ,&nbsp;Helena Mosbah","doi":"10.1016/j.diabet.2025.101697","DOIUrl":"10.1016/j.diabet.2025.101697","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been widely used in the management of type 2 diabetes, with proven cardiovascular and renal benefits. However, their use has been associated with a risk of diabetic ketoacidosis (DKA).</div></div><div><h3>Aim</h3><div>This study aims to describe the characteristics of DKA cases associated with SGLT2i use in patients aged 65 and over, based on data from the French pharmacovigilance database.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on all cases of DKA reported with SGLT2i in patients aged 65 years and older. Cases were retrieved from 2020 onward; 55 were analyzed. Patient characteristics, drug exposure, adverse drug reaction (ADR) reports, hospitalization details, and precipitating factors were examined.</div></div><div><h3>Results</h3><div>Median patient age was 74.0 years (IQR: 69.0; 77.5), with a predominance of males (63.4 %). The median Charlson comorbidity index was 8.0 (IQR: 6.0; 10.0), and polypharmacy was common, with a median of nine drugs per patient. Infections (36.4 %), dehydration (20.0 %), and fasting (18.2 %) were the main precipitating factors. All cases required hospitalization, with 36.4 % admitted to an intensive care unit (ICU). Among ICU patients, 35.0 % required orotracheal intubation and/or vasopressor therapy. One case (1.8 %) resulted in death. Factors significantly associated with ICU admission included younger age (71.3 vs. 75.4 years, <em>P</em> = 0.009), lower pH at admission (<em>P</em> = 0.003), and infection as a precipitating factor (<em>P</em> = 0.007).</div></div><div><h3>Conclusion</h3><div>This study highlights the clinical characteristics and risk factors of SGLT2i-associated DKA in older adults. Infections and severe acidosis were key predictors of ICU admission. The findings underscore the importance of careful patient selection and monitoring to mitigate DKA risk in older patients receiving SGLT2i therapy.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101697"},"PeriodicalIF":4.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are GLP-1 receptor agonists and diabetic retinopathy foes or friends?","authors":"Kai Liu ,&nbsp;Shu Liu ,&nbsp;Dong Wang ,&nbsp;Hong Qiao","doi":"10.1016/j.diabet.2025.101696","DOIUrl":"10.1016/j.diabet.2025.101696","url":null,"abstract":"<div><div>With the increasing number of patients with diabetes worldwide, the number of patients with diabetic retinopathy (DR) is also increasing, which affects the lives of patients. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are anti-diabetic drugs that mimic the action of endogenous glucagon-like peptide-1, which significantly improve glycemic control in patients with type 2 diabetes. GLP-1RAs can repair the blood-retinal barrier function by activating the GLP-1 receptor in retinal endothelial cells and nerve cells, inhibiting the RhoA/ROCK signaling pathway, up-regulating the tight junction protein occludin and ZO-1, and inhibiting the activation of microglia, reducing the release of pro-inflammatory factors, and reducing neuroinflammation and vascular leakage. However, some GLP-1RAs may increase the risk of DR, such as diabetic macular edema and proliferative DR, and may increase the risk of DR deterioration, especially during rapid glucose lowering. Although the new GLP-1/GIP dual-receptor agonists and GLP-1/GIP/glucagon tri-receptor agonists show comprehensive benefit potential by effectively improving body metabolism, the short-term negative effect of sudden blood glucose drop still needs to be paid attention to. For patients with moderate to severe DR, it is necessary to strengthen ophthalmic monitoring to avoid rapid blood glucose decline in the initial treatment. In the long-term treatment, metabolic benefits and retinal risks need to be weighed, and the patient's condition needs to be evaluated before treatment. Therefore, GLP-1RAs has a duality of \"mechanism protection and clinical risk\" on DR, and individualized treatment strategy should take into consideration drug characteristics, DR severity and glucose control.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101696"},"PeriodicalIF":4.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced risks of colorectal cancer with GLP-1RAs in type 2 diabetes: A nationwide cohort study using a target trial emulation framework","authors":"Chih-Chien Wu ,&nbsp;Chien-Chou Su ,&nbsp;Yu-Ching Chang ,&nbsp;Pei-Ting Lee ,&nbsp;Yi-Chia Su","doi":"10.1016/j.diabet.2025.101695","DOIUrl":"10.1016/j.diabet.2025.101695","url":null,"abstract":"<div><h3>Aim</h3><div><em>-</em> Type 2 diabetes (T2D) is associated with increased risk of colorectal cancer (CRC). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) may reduce CRC risk compared to insulin therapy; however, current evidence is controversial. We aimed to evaluate the association between CRC and the use of GLP-1RAs and long-acting insulins (LAIs).</div></div><div><h3>Methods</h3><div><em>-</em> This target trial emulation employed nationwide data from a Taiwanese T2D cohort. We identified new GLP-1RA and LAI users from 2013 to 2021, and applied propensity score (PS) matching to ensure comparable baseline characteristics. The primary outcome was CRC. Follow-up lasted until outcome occurrence, death, or study end in 2022, whichever came first. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated to assess the association between treatment and outcomes. Sensitivity analyses—including stabilized inverse probability weighting, time-dependent survival analysis, E-values, and negative control outcome analyses—were conducted to test the robustness of findings.</div></div><div><h3>Results</h3><div><em>-</em> We included 11,726 PS-matched pairs of GLP-1RA and LAI users and found no significant baseline disparities between cohorts. Compared to LAIs, GLP-1RAs were associated with significantly reduced CRC risk (HR [95 % CI]: 0.66 [0.48–0.92]), with the association limited to the rectum (HR: 0.53 [0.28–0.92]) but not observed in the right- or left-sided colon (right, HR: 0.69 [0.41–1.19]; left, HR: 0.77 [0.44–1.33]). These findings were consistent across sensitivity analyses and among patients with varying baseline characteristics.</div></div><div><h3>Conclusion</h3><div><em>-</em> Among patients with T2D requiring injectable glucose-lowering agents, GLP-1RA use, compared to LAIs, was associated with reduced CRC risk, particularly in the rectum.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101695"},"PeriodicalIF":4.7,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body weight trends in individuals with type 1 diabetes using automated insulin delivery vs. traditional insulin pumps","authors":"Charles Thivolet ,&nbsp;Zoé Henry ,&nbsp;Nathalie Bendelac ,&nbsp;Sylvie Villar Fimbel","doi":"10.1016/j.diabet.2025.101693","DOIUrl":"10.1016/j.diabet.2025.101693","url":null,"abstract":"<div><h3>Objective</h3><div>This study analyzed the determinants of weight gain among participants initiating an automated insulin delivery (AID) system.</div></div><div><h3>Research design and methods</h3><div>In this observational study, we evaluated 928 persons with type 1 diabetes initiating an insulin pump therapy, including 467 with AID, 98 with pumps with predictive low-glucose suspend (PLGS) algorithm and 363 initiating a sensor-augmented pump (SAP).</div></div><div><h3>Results</h3><div>After 3 months, median (95CI) TIR increased from 50.69 % [49.2–52.3] to 67.9 % [66.7–69.1] in the AID group and HbA1c levels showed a mean reduction of 0.82 %. AID resulted in equivalent body weight gain to SAP and PLGS despite significant improvements in glucose control. Multivariable analysis revealed that weight gain was linked to baseline HbA1C (<em>P</em> &lt; 0.001) and age but not to the type of pump system. During follow-up, percentage increase in body weight at 12 months were similar between groups</div></div><div><h3>Conclusions</h3><div>In persons with T1D, AID did not increase weight gain in comparison to other pump systems.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101693"},"PeriodicalIF":4.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between smoking status and suicide mortality in patients with type 2 diabetes: A nationwide population-based cohort study","authors":"Chaiho Jeong ,&nbsp;Bongseong Kim ,&nbsp;Dae Jong Oh ,&nbsp;Tae-Seo Sohn ,&nbsp;Kyungdo Han ,&nbsp;Hyuk-Sang Kwon","doi":"10.1016/j.diabet.2025.101692","DOIUrl":"10.1016/j.diabet.2025.101692","url":null,"abstract":"<div><h3>Background</h3><div>Patients with type 2 diabetes (T2D) are at greater risk of suicide due to stresses associated with disease management. Smoking adds to this burden. However, its association with suicide mortality in this population remains unclear. This study aimed to evaluate the relationship between smoking and suicide mortality in this high-risk group.</div></div><div><h3>Methods</h3><div>This cohort study utilized the Korean National Health Insurance Service (NHIS) database. A total of 2,524,769 participants aged ≥ 20 years with T2D who underwent national health examinations in 2015–2016 were included. Participants were followed until suicide death or the end of the study period.</div></div><div><h3>Results</h3><div>Over 5.8 years mean follow-up, 5,578 individuals died by suicide. Risk of suicide mortality was significantly higher—adjusted hazard ratio [95 % confidence interval]—in current smokers compared to never-smokers: 1.55 [1.44;1.67]. A dose–response pattern was observed among current smokers: 1.41 [1.22;1.63] for light smokers (&lt;10 cigarettes/day) and 1.66 [1.52;1.81] for heavy smokers (≥20/day). In ex-smokers, only those with a smoking history of ≥ 30 years exhibited an elevated risk: 1.12 [1.02;1.24]. The association was particularly strong in women: 2.97 [2.39;3.69]; and individuals aged &lt;65 years: 1.76 [1.61;1.92].</div></div><div><h3>Conclusions</h3><div>Current smoking was significantly associated with increased suicide mortality in patients with T2D, particularly among heavy smokers, women and those younger than 65 years. Long-term smoking history was also associated with elevated risk among ex-smokers.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101692"},"PeriodicalIF":4.7,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conduction disturbances in Type 1 and Type 2 Diabetes in two large independent nationwide and international databases","authors":"Lucile Accoceberry ,&nbsp;Uazman Alam ,&nbsp;Grégoire Fauchier ,&nbsp;Lisa Lochon ,&nbsp;Arnaud Bisson ,&nbsp;Pierre Henri Ducluzeau ,&nbsp;Gregory Y.H. Lip ,&nbsp;Laurent Fauchier","doi":"10.1016/j.diabet.2025.101690","DOIUrl":"10.1016/j.diabet.2025.101690","url":null,"abstract":"<div><h3>Aim</h3><div>Type 1 (T1D) and type 2 diabetes (T2D) are associated with increased cardiovascular risk, but limited data exist on their independent association with conduction disturbances. We evaluated the association between diabetes and conduction disorders, comparing T1D and T2D populations with non-diabetic controls in two independent databases.</div></div><div><h3>Methods</h3><div>Observational study using two large databases with matched cohorts: the French PMSI and the international TriNetX network. PMSI captures nationwide hospital admissions in France, while TriNetX includes patients from over 120 healthcare organizations worldwide. We identified &gt; 440,000 patients with T2D from PMSI and &gt; 900,000 patients with T2D and &gt; 20,000 patients with T1D from TriNetX. Using 1:1 propensity score matching, these patients were matched to non-diabetic controls based on demographics and comorbidities</div></div><div><h3>Results</h3><div>Compared to no DM, T2D was associated with a higher risk of conduction disturbances, including atrioventricular block (HR 1.22 [1.19–1.25], PMSI; HR 1.50 [1.45–1.55], TriNetX), left bundle branch block (BBB), (HR 1.12 [1.08–1.17], PMSI; HR 1.50 [1.47–1.54], TriNetX), and right BBB (HR 1.14 [1.09–1.18], PMSI; HR 1.38 [1.34–1.43], TriNetX). Patients with T2D also had a higher risk of myocardial infarction (HR 1.29 [1.25–1.32], PMSI; HR 2.14 [2.08–2.19], TriNetX). Conversely, T1D was not associated with an increased risk of conduction disorders in the TriNetX cohort.</div></div><div><h3>Conclusion</h3><div>T2D is independently associated with conduction disturbances and a higher incidence of coronary events compared to no DM, whereas T1D does not appear to confer the same risk. This suggests distinct pathophysiological mechanisms and the possible need for enhanced monitoring in T2D patients.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101690"},"PeriodicalIF":4.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring perceived barriers to physical activity among individuals with type 1 diabetes in the era of new technologies: An analysis from the BETTER registry","authors":"C. Guédet ,&nbsp;L. Alexandre-Heymann ,&nbsp;J.E. Yardley ,&nbsp;V. Messier ,&nbsp;V. Boudreau ,&nbsp;T. Chahal ,&nbsp;M. Dostie ,&nbsp;M-E. Mathieu ,&nbsp;A-S. Brazeau ,&nbsp;S. Tagougui ,&nbsp;R. Rabasa-Lhoret","doi":"10.1016/j.diabet.2025.101677","DOIUrl":"10.1016/j.diabet.2025.101677","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to identify barriers to physical activity for people living with type 1 diabetes (PwT1D) and their relationship with sociodemographic and disease-specific factors.</div></div><div><h3>Methods</h3><div><em>-</em> Cross-sectional study with BETTER registry participants (&gt;14 years) who completed the BAPAD1 (Barriers to Physical Activity in T1D) questionnaire. An item with a score of 5 or more was defined as a barrier. Participants were categorized into 4 subgroups based on their insulin therapy and blood glucose monitoring modality: 1) multiple daily injections (MDI) without continuous glucose monitoring (CGM), 2) MDI with CGM, 3) continuous subcutaneous insulin infusion (CSII) with CGM, and 4) automated insulin delivery system (AID).</div></div><div><h3>Results</h3><div>Among 1117 participants, the main perceived barrier was fear of hypoglycemia. BAPAD1 scores were similar across all subgroups, but more individuals in the AID group perceived \"fear of hypoglycemia\" and \"loss of control over diabetes\" as barriers. Being female, having a low income or education level, being overweight or obese, taking medication for depression, younger diabetes, higher HbA1c, presence of microvascular complications, and lack of confidence in managing hypoglycemia were associated with higher BAPAD1 score.</div></div><div><h3>Conclusion</h3><div>Fear of hypoglycemia remains the main barrier to physical activity for PwT1D. Technological advances alone are not sufficient to reduce perceived barriers to physical activity, highlighting the need for complementary educational and behavioral interventions.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 5","pages":"Article 101677"},"PeriodicalIF":4.6,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between continuous glucose monitoring metrics and metabolic dysfunction-associated steatotic liver disease in adults with type 1 diabetes undergoing vibration-controlled transient elastography: a multicenter cross-sectional study","authors":"Alessandro Mantovani ,&nbsp;Stefano Ciardullo ,&nbsp;Elena Sani ,&nbsp;Alessandro Csermely ,&nbsp;Emigela Shtembari ,&nbsp;Ilaria Milani ,&nbsp;Paolo Sbraccia ,&nbsp;Gianluca Perseghin ,&nbsp;Frida Leonetti ,&nbsp;Giovanni Targher ,&nbsp;Valeria Guglielmi ,&nbsp;Danila Capoccia","doi":"10.1016/j.diabet.2025.101684","DOIUrl":"10.1016/j.diabet.2025.101684","url":null,"abstract":"<div><h3>Background</h3><div>There is uncertainty regarding the association between continuous glucose monitoring (CGM), derived glycemic metrics, and metabolic dysfunction-associated steatotic liver disease (MASLD) in individuals with type 1 diabetes (T1D).</div></div><div><h3>Methods</h3><div>We consecutively enrolled 262 adult individuals with established T1D undergoing vibration-controlled transient elastography (VCTE) with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). All participants underwent CGM. MASLD was defined as CAP ≥248 dB/m and the presence of at least one cardiometabolic risk factor. Significant liver fibrosis was defined as LSM ≥8 kPa.</div></div><div><h3>Results</h3><div>Participants had a mean age of 54±13 years, a mean body mass index (BMI) of 25.8 ± 5.6 kg/m² and a mean HbA1c of 7.7 ± 1.4 %. The prevalence of MASLD and significant liver fibrosis was 35.1 % (<em>n</em> = 92) and 4.6 % (<em>n</em> = 12), respectively. Using quantile regression analysis, time above range 180–250 mg/dl (TAR1) was significantly associated with increased CAP values (coefficient: 1.037; 95 % confidence interval [0.216;1.858]; <em>P</em> = 0.013). This association remained significant even after adjusting for age, sex, BMI, HbA1c, and total daily insulin dose. Other variables independently associated with CAP were older age, male sex, BMI, and total daily insulin dose. Using a random forest regression model, BMI was found to be the most important factor, followed by age, total daily insulin dose, and TAR1.</div></div><div><h3>Conclusions</h3><div>TAR1 was independently associated with increased CAP values, even after adjustment for age, BMI, sex, HbA1c, and total daily insulin dose, suggesting a potential role for glycemic variability in hepatic fat accumulation in adults with T1D.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 5","pages":"Article 101684"},"PeriodicalIF":4.6,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}