Charlotte B. Schmidt , Eva Keijsper , Judith E. Bosmans , Bert Jan Potter van Loon , Frank J. Snoek , Adriaan Honig
{"title":"Medical costs and health care utilization in Dutch diabetes patients with high levels of diabetes-distress","authors":"Charlotte B. Schmidt , Eva Keijsper , Judith E. Bosmans , Bert Jan Potter van Loon , Frank J. Snoek , Adriaan Honig","doi":"10.1016/j.jdiacomp.2025.109086","DOIUrl":"10.1016/j.jdiacomp.2025.109086","url":null,"abstract":"<div><h3>Aims</h3><div>Diabetes-distress is prevalent in persons with diabetes. However, studies on the association between diabetes-distress, costs and healthcare utilization are scarce. We aim to explore whether diabetes-distress is related to healthcare utilization and medical costs.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, diabetes patients completed the Problem Areas in Diabetes Short Form (PAID5) and the Patient Health Questionnaire (PHQ9). Healthcare utilization (in number of yearly visits) was measured using the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness (TiC-P), and extraction from the hospital's medical records. Healthcare costs were calculated using Dutch standard costs. Generalized linear models (Gamma log link) were used to estimate the associations while adjusting for confounders.</div></div><div><h3>Results</h3><div>Diabetes-distress was related to healthcare utilization, mean difference 10, 95 % CI 9 to 14, but not to healthcare costs, mean difference €467, 95 % CI -71 to 1006. When controlling for depressive symptoms, comorbidity, age, ethnicity, socioeconomic status and diabetes duration, diabetes-distress remained associated with healthcare utilization, mean difference 9, 95 % CI 2 to 16.</div></div><div><h3>Conclusions</h3><div>This is the first study to evaluate associations between diabetes-distress and healthcare utilization and costs in diabetes patients. Diabetes-distress was significantly related to an increased amount of healthcare utilization, but not costs.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 8","pages":"Article 109086"},"PeriodicalIF":2.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116912","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":"Prevalence of cardiovascular and renal comorbidities among patients with type 2 diabetes routinely treated in the primary care setting in Greece: An epidemiological study (the RECARDIA study)","authors":"Nikolaos Papanas , Vasileios Tsimihodimos , Niki Katsiki , John Doupis , Emmanouil Pagkalos , Nikos Nikas , Nikos Papakonstantopoulos , George Karpouzos , Nikolaos Tentolouris","doi":"10.1016/j.jdiacomp.2025.109087","DOIUrl":"10.1016/j.jdiacomp.2025.109087","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to generate real-world data on the prevalence of cardiovascular disease (CVD), including atherosclerotic CVD (ASCVD) and heart failure (HF), as well as chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) routinely treated in Greece.</div></div><div><h3>Methods</h3><div>This was a non-interventional, epidemiological, multicentre, cross-sectional and retrospective chart review study of T2DM patients attending a routine clinical visit at 198 outpatient primary care settings across Greece from November 2020 to February 2022.</div></div><div><h3>Results</h3><div>Among 2000 enrolled T2DM outpatients, the prevalence of ASCVD was 20.40 % (95 % confidence interval [CI]: 18.67 %–22.25 %), of HF 8.03 % (95 % CI: 6.67 %–9.63 %), and of CKD 49.55 % (95 % CI: 47.36 %–51.74 %). Hypertension was correlated with increased risk of ASCVD, HF or CKD, dyslipidaemia with ASCVD and CKD, obesity solely with HF, and smoking with ASCVD. Patients over 65 years were at higher risk of ASCVD, HF or CKD, whereas those with T2DM for ≥10 years had a higher risk of ASCVD or HF. Finally, males were more likely to have ASCVD</div></div><div><h3>Conclusions</h3><div>The present study confirms the high prevalence of CVD and CKD among Greek T2DM patients managed in primary care, that potentially qualify for new antidiabetic treatments with cardiovascular or renal benefits.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 8","pages":"Article 109087"},"PeriodicalIF":2.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124027","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}
Hilma Tillqvist , Miska Vuorlaakso , Mika Helminen , Juha Kiiski , Ilkka Kaartinen
{"title":"Clinical frailty scale as a tool to predict outcomes after lower extremity amputation among patients with diabetes: A retrospective cohort study","authors":"Hilma Tillqvist , Miska Vuorlaakso , Mika Helminen , Juha Kiiski , Ilkka Kaartinen","doi":"10.1016/j.jdiacomp.2025.109084","DOIUrl":"10.1016/j.jdiacomp.2025.109084","url":null,"abstract":"<div><h3>Aims</h3><div>The primary aim of this study was to investigate how the Clinical Frailty Scale (CFS) associates with survival of patients with diabetes after lower extremity amputation (LEA).</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients with diabetes undergoing nontraumatic LEA at Tampere University Hospital during 2007–2020. Kaplan-Meier and Cox regression analyses were performed to evaluate the effect of CFS on overall survival (OS), amputation-free survival (AFS) and leg salvage (LS).</div></div><div><h3>Results</h3><div>A total of 1043 patients with mean age 71.0 years were included. Compared to patients with low CFS (1, 2), scores 3–4 and 5–9 were associated with reduced OS (HR 1.821, <em>p</em> < 0.001; HR 4.585, <em>p</em> < 0.001), AFS (HR 1.575, <em>p</em> < 0.001; HR 4.031, <em>p</em> < 0.001) and LS (HR 1.435, <em>p</em> = 0.049; HR 2.478, <em>p</em> < 0.001). The multivariable Cox regression analysis showed that CFS remained a significant predictor of OS, AFS and LS.</div></div><div><h3>Conclusions</h3><div>This study demonstrates a high prevalence of frailty among patients with diabetes undergoing LEA, suggesting that frailty assessment should be integrated into clinical decision-making for this patient population. The CFS score appears to be a promising tool for evaluating patients facing amputation to enhance survival rates.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 8","pages":"Article 109084"},"PeriodicalIF":2.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099303","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":"Joint effect of nicotine use and diabetes distress on glycemic control in young adults with type 1 diabetes","authors":"Enzo G. Plaitano , Catherine Stanger","doi":"10.1016/j.jdiacomp.2025.109083","DOIUrl":"10.1016/j.jdiacomp.2025.109083","url":null,"abstract":"<div><div>Nicotine inhibits glucose metabolism. In this national cross-sectional analysis of 388 young adults with type 1 diabetes and above target glycemic control, vaping was the most common route of nicotine use, and heavy nicotine use plus higher type 1 diabetes distress was related to worse objective measures of glycemic control.</div><div><strong>Trial registration</strong>: <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> <span><span>NCT04646473</span><svg><path></path></svg></span>; <span><span>https://clinicaltrials.gov/ct2/show/NCT04646473</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 8","pages":"Article 109083"},"PeriodicalIF":2.9,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090287","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":"Differential impact of short-term and long-term glycemic variability on peripheral nerve function in type 2 diabetes: A 5-year cohort study","authors":"Takamasa Iwamoto , Machiko Morita , Shuji Hidaka , Kentaro Sada , Miyuki Iwamoto , Hirotaka Shibata","doi":"10.1016/j.jdiacomp.2025.109081","DOIUrl":"10.1016/j.jdiacomp.2025.109081","url":null,"abstract":"<div><h3>Aims</h3><div>Several studies have demonstrated the association between glycemic variability (GV) and diabetic peripheral neuropathy (DPN). However, none has compared the effects of short-term and long-term GV on DPN in a cohort. This study evaluates the association between short-term and long-term GV and peripheral nerve function in a cohort of outpatients with type 2 diabetes.</div></div><div><h3>Methods</h3><div>Overall, 230 patients who had continuously attended the outpatient hospital for 5 years were enrolled. Short-term GV was assessed using continuous glucose monitoring (FreeStyle Libre Pro®), focusing on metrics such as the glucose levels’' standard deviation and time in range. Long-term GV was evaluated by using visit-to-visit variability in glycated hemoglobin (HbA1c), including the HbA1c standard deviation and coefficient of variation. Nerve conduction was assessed using DPNCheck™ by measuring sural nerve action potential (SNAP) amplitude and sensory conduction velocity (SCV). Multiple regression models were built to determine independent associations of GV and HbA1c variability metrics with SCV and SNAP amplitude.</div></div><div><h3>Results</h3><div>Most short-term GV indices were not associated with SNAP amplitude but significantly correlated with SCV; these associations were not evident after adjusting for HbA1c. Long-term GV showed minimal correlation with SCV, while strong associations with SNAP amplitude persisted after adjusting for the 5-year mean HbA1c.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate that short-term and long-term GVs have differential impacts on peripheral nerve function in outpatients with type 2 diabetes; with short-term GV associated with SCV and long-term with SNAP amplitude.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 8","pages":"Article 109081"},"PeriodicalIF":2.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147529","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":"Contents/Barcode","authors":"","doi":"10.1016/S1056-8727(25)00127-8","DOIUrl":"10.1016/S1056-8727(25)00127-8","url":null,"abstract":"","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 7","pages":"Article 109074"},"PeriodicalIF":2.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069210","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}
Nick S.R. Lan , Jonathan Hiew , Ivana Ferreira , J. Carsten Ritter , Laurens Manning , P. Gerry Fegan , Girish Dwivedi , Emma J. Hamilton
{"title":"Achievement of low-density lipoprotein cholesterol goals in patients with diabetes-related foot ulceration","authors":"Nick S.R. Lan , Jonathan Hiew , Ivana Ferreira , J. Carsten Ritter , Laurens Manning , P. Gerry Fegan , Girish Dwivedi , Emma J. Hamilton","doi":"10.1016/j.jdiacomp.2025.109069","DOIUrl":"10.1016/j.jdiacomp.2025.109069","url":null,"abstract":"<div><div>Despite their elevated risk for cardiovascular complications, two-thirds of patients with diabetes-related foot ulceration in this contemporary real-world study were not achieving guideline-recommended goals for low-density lipoprotein cholesterol. Implementation research is needed to identify the barriers and facilitators to optimal lipid management in this high priority population.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 8","pages":"Article 109069"},"PeriodicalIF":2.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068943","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}
Zahra Majd , Hua Chen , Michael L. Johnson , Kim K. Birtcher , Omar Serna , Bilqees Fatima , Susan Abughosh
{"title":"Effect of initial combination therapy vs. step-therapy on adherence and persistence in drug naïve type 2 diabetes patients","authors":"Zahra Majd , Hua Chen , Michael L. Johnson , Kim K. Birtcher , Omar Serna , Bilqees Fatima , Susan Abughosh","doi":"10.1016/j.jdiacomp.2025.109080","DOIUrl":"10.1016/j.jdiacomp.2025.109080","url":null,"abstract":"<div><h3>Background/objectives</h3><div>Emerging evidence supports the early use of intensive combination treatments among type 2 diabetes (T2D) patients for rapid and sustained glycemic control. However, the impact of initial combination therapy on treatment adherence and persistence has not been explored. Therefore, we aimed to compare adherence and persistence to antidiabetic treatments between patients receiving initial combination therapy vs. conventional step-therapy.</div></div><div><h3>Materials and methods</h3><div>A retrospective cohort study of MarketScan® research database (2017–2019) was conducted. We included drug naïve T2D patients who received step-therapy or initial combination therapy and were continuously enrolled in Commercial, Medicare, or Medicaid health plans during the pre-index and follow-up period. Primary outcomes of interest were antidiabetic treatment adherence and persistence during the first year of treatment initiation.</div></div><div><h3>Results</h3><div>In the Commercial/Medicare population, out of the total 116,597 patients, 52 % were nonadherent and 58 % were nonpersistent. Similarly, in the Medicaid population of 18,295 patients, 63 % were nonadherent and 67 % were nonpersistent. Patients receiving step-therapy were more likely to be adherent compared to the initial combination group in both populations (Commercial/Medicare: OR 1.52, 95 % CI 1.46–1.57; Medicaid: OR 1.24, 95 % CI 1.11–1.38). Additionally, in the Commercial/Medicare population, the multivariable Cox regression model showed that the step-therapy cohort had a significantly lower hazard for time to non-persistence compared to the initial combination cohort (HR 0.9, 95 % CI 0.86–0.94). However, this was not significantly different in the Medicaid population.</div></div><div><h3>Conclusions</h3><div>This study suggests that step-therapy as an initial pharmacotherapy approach may be associated with improved adherence and persistence in managing diabetes compared to initial combination therapy.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 9","pages":"Article 109080"},"PeriodicalIF":2.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178364","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":"Physical activity and albuminuria in individuals recently diagnosed with type 2 diabetes","authors":"T. Norlén , T.B. Olesen , S.L. Domazet , J.S. Nielsen , J.C. Brønd , M.H. Olsen , K. Højlund , J.V. Stidsen","doi":"10.1016/j.jdiacomp.2025.109065","DOIUrl":"10.1016/j.jdiacomp.2025.109065","url":null,"abstract":"<div><h3>Aims</h3><div>We aimed to investigate the association between objectively measured physical activity and the presence and development of albuminuria in individuals recently diagnosed with type 2 diabetes at baseline.</div></div><div><h3>Methods</h3><div>This study was based on data from The Danish Centre for Strategic Research in Type 2 diabetes cohort (N = 832). We assessed moderate to vigorous physical activity (MVPA) and sedentary time by 24-hour dual-monitor accelerometry at baseline and 4-years follow-up and investigated the association with albuminuria, defined as urine albumin/creatinine-ratio (UACR) ≥30 mg/g, measured from a urine sample. The odds ratio (OR) for the presence and development of albuminuria were investigated using multiple logistic regressions.</div></div><div><h3>Results</h3><div>We found an inverse association between baseline MVPA and both presence (OR: 0.82; 95 % CI: 0.69–0.98) and incidence of albuminuria (OR: 0.74; 95 % CI: 0.59–0.94), independent of known confounding factors. However, sedentary time was not significantly associated with increased development of albuminuria. Moreover, neither decrease in MVPA (OR: 0.79; 95 % CI: 0.42–1.49) nor increase in sedentary time (OR: 1.03; 95 % CI: 0.98–1.09) were significantly associated with development of albuminuria from baseline to 4-years follow-up.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate an inverse association between baseline MVPA and development of albuminuria in individuals recently diagnosed with type 2 diabetes. An increase in MVPA from baseline to follow-up inferred 21 % lower incidence of albuminuria after 4-years follow-up, albeit insignificant, likely due to the relatively small sample size at follow-up and the lack of larger changes in physical activity.</div></div><div><h3>Clinical trial registration number</h3><div><span><span>NCT02015130</span><svg><path></path></svg></span></div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 8","pages":"Article 109065"},"PeriodicalIF":2.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090396","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":"Age different effects of SGLT2 inhibitors on body composition in individuals with type 2 diabetes: A retrospective cohort study","authors":"Kengo Miyoshi, Tomohisa Aoyama, Saori Kameda, Nagisa Ishibashi, Yumi Sakai, Takao Yamanaka, Tomoya Kawaguchi, Yuri Kadowaki, Toshimasa Yamauchi","doi":"10.1016/j.jdiacomp.2025.109068","DOIUrl":"10.1016/j.jdiacomp.2025.109068","url":null,"abstract":"<div><h3>Purpose</h3><div>This study investigates the long-term impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i)on body composition in individuals with type 2 diabetes (T2D), with a focus on age-related differences. We evaluated changes in body mass index (BMI), body fat percentage, skeletal muscle mass and skeletal muscle mass index (SMI) over 4.4 years on average.</div></div><div><h3>Methods</h3><div>This retrospective, single-center clinical cohort study utilized electronic medical records from the University of Tokyo Hospital. 70 people with T2D treated with SGLT2i for more than two years were included. Body compositions were assessed using bioelectrical impedance analysis (BIA) at three time points: before SGLT2i therapy, 1 year after SGLT2 therapy initiation and the latest along with SGLT2i therapy.</div></div><div><h3>Results</h3><div>During the 4.4-year average treatment period, significant reductions were observed in BMI (30.5 to 29.1, <em>p</em> < 0.0001) and skeletal muscle mass (30.3 kg to 29.0 kg, <em>p</em> < 0.0001). ΔBMI was positively correlated with ΔBody fat percentage and ΔSkeletal muscle mass (all p < 0.0001). Age-stratified analysis showed that in younger individuals, ΔSkeletal muscle mass was significantly associated with both treatment duration and ΔBMI. In contrast, older individuals showed a weaker correlation between ΔSkeletal muscle mass and ΔBMI, and experienced significant muscle mass decline at an earlier point.</div></div><div><h3>Conclusion</h3><div>SGLT2i are effective in managing T2D and reducing BMI and body fat. However, careful monitoring of body composition is crucial, especially in older individuals, to mitigate the risk of sarcopenia and maintain overall health.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 8","pages":"Article 109068"},"PeriodicalIF":2.9,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937095","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}