Diabetes, Obesity & Metabolism最新文献

{"title":"Body mass index and mental disorders: A Danish cohort study.","authors":"Sigrid Bjerge Gribsholt, Kristina Laugesen, Oleguer Plana-Ripoll, Sinna Pilgaard Ulrichsen, Mogens Vestergaard, Bjørn Richelsen, Ola Ekholm, Henrik Toft Sørensen","doi":"10.1111/dom.70189","DOIUrl":"https://doi.org/10.1111/dom.70189","url":null,"abstract":"<p><strong>Aims: </strong>Low and high body weight present significant global health challenges and may be linked to specific mental disorders. Thus, we aimed to examine the associations between body mass index (BMI) and specific mental disorders.</p><p><strong>Materials and methods: </strong>In this Danish, population-based cohort study using questionnaire and registry data, we included participants (N = 290 468, 18-79 years of age, 49.8% male) in the Danish National Health Survey (2010/2013). BMI was modelled as a cubic spline and a categorical variable (underweight <18.5 kg/m², normal weight 18.5 to <25 kg/m² [reference], overweight 25 to <30 kg/m², and obesity ≥30 kg/m²). Participants were followed up until December 2018 and the median follow-up time was 5 years. Incidence rates per 1000 person-years and adjusted hazard ratios (aHRs) were estimated for specific mental disorders using cause-specific Cox proportional hazard regression.</p><p><strong>Results: </strong>We found U-shaped associations of BMI with schizophrenia, mood disorders, anxiety, stress-related, and somatoform mental disorders, eating disorders, and personality disorders. For people with low but not high BMI (≥25 kg/m²), we observed associations with organic and substance use disorders. All associations were more prominent among women than men, and most associations attenuated with advancing age.</p><p><strong>Conclusions: </strong>Both underweight and obesity were associated with elevated risk of mental disorders, although the patterns of specific mental disorders differed. Our findings underscore the importance of monitoring mental health in people with underweight and obesity.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257035","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":"Acute effects of GIP and GLP-1 receptor antagonism in totally pancreatectomized individuals: A randomized double-blind, placebo-controlled crossover study.","authors":"Liva S L Krogh, Mads M Helsted, Anders Englund, Natasha C Bergmann, Kirsa Skov-Jeppesen, Casper K Nielsen, Carsten P Hansen, Mette M Rosenkilde, Bolette Hartmann, Jens J Holst, Filip K Knop, Asger B Lund, Lærke S Gasbjerg","doi":"10.1111/dom.70186","DOIUrl":"https://doi.org/10.1111/dom.70186","url":null,"abstract":"<p><strong>Aims: </strong>The incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) influence metabolism through strong effects on pancreatic hormone secretion but also in a pancreas-independent manner. Here, we investigated the isolated extrapancreatic effects of endogenous GIP and GLP-1 by applying hormone receptor antagonists in totally pancreatectomized individuals.</p><p><strong>Methods: </strong>Twelve totally pancreatectomized individuals each underwent four 270-min liquid mixed meal tests (480 kcal) in a randomized study design with infusions of the GIP receptor antagonist GIP(3-30)NH₂ (800 pmol/kg/min), the GLP-1 receptor antagonist exendin(9-39)NH₂ (450 pmol/kg/min), GIP(3-30)NH₂ + exendin(9-39)NH₂, and saline (placebo), respectively. Blood samples, appetite-related measures, heart rate, blood pressure, and ad libitum food intake data were collected. Participants continued their basal insulin but omitted bolus insulin in the morning of the experiment.</p><p><strong>Results: </strong>Infusions of GIP(3-30)NH₂ and GIP(3-30)NH₂ + exendin(9-39)NH₂ attenuated meal-induced inhibition of bone resorption (carboxy-terminal collagen crosslinks) (nadir [mean ± SD] to 84 ± 9% and to 85 ± 8% of baseline, compared to placebo (64 ± 15%) (ps <0.05)). During exendin(9-39)NH₂ and exendin(9-39)NH₂ + GIP(3-30)NH₂ co-infusion, GLP-1 plasma responses increased (ps <0.05). Infusion of GIP(3-30)NH₂ or exendin(9-39)NH₂ did not affect other measurements.</p><p><strong>Conclusion: </strong>Endogenous GIP contributes to the regulation of postprandial bone resorption independently of pancreatic factors. In contrast, GIP receptor and/or GLP-1 receptor antagonism had no measurable effects on glucose metabolism, gastric emptying, appetite, food intake, triglycerides, or haemodynamics, supporting a pancreatic contribution to some of these effects of the endogenous hormones, although the surgical reconstruction may have influenced the sensitivity of the targets.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257051","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":"Glucagon-like peptide-1 receptor agonist and respiratory complications after endoscopy: A Japanese nationwide cohort study.","authors":"Hiroyuki Hisada, Kazuhiko Ikeuchi, Yosuke Tsuji, Nobutake Yamamichi, Naomi Kakushima, Kazuya Okushin, Seiichi Yakabi, Chihiro Takeuchi, Daisuke Ohki, Hiroya Mizutani, Yuko Miura, Dai Kubota, Takeya Tsutsumi, Mitsuhiro Fujishiro","doi":"10.1111/dom.70194","DOIUrl":"https://doi.org/10.1111/dom.70194","url":null,"abstract":"<p><strong>Aims: </strong>While discontinuation of glucagon-like peptide-1 receptor agonists (GLP-1RAs) before esophagogastroduodenoscopy (EGD) is not universally mandated, safety concerns persist. Evidence remains insufficient for managing specific patient subgroups, particularly in Asian populations. We aimed to provide evidence for stratified risk assessment in a large Japanese cohort.</p><p><strong>Materials and methods: </strong>This nationwide retrospective cohort study used the Japan Medical Data Center database. We performed 1:4 propensity score matching based on age, sex, insulin use, HbA1c level, chronic respiratory disease, and body mass index to compare patients with diabetes receiving GLP-1RAs (n = 3568) with non-users (n = 14 246). Respiratory and severe complications within 14 days post-EGD were assessed via logistic regression.</p><p><strong>Results: </strong>GLP-1RA was not associated with an increased risk of overall (0.39% vs. 0.50%; odds ratio [OR] 0.79, 95% confidence interval [CI] 0.44-1.40; p = 0.41) or severe (0.11% vs. 0.077%; 1.45, 0.46-4.56; p = 0.52) respiratory complications. While no subgroup analysis reached statistical significance, numerical trends towards a higher risk were observed in new users (OR 1.43; 95% CI, 0.51-3.98) and patients with severe diabetes (OR 1.28; 95% CI, 0.64-2.52).</p><p><strong>Conclusions: </strong>GLP-1RA was not associated with increased post-EGD respiratory complications, suggesting that routine discontinuation may be unnecessary for many stable, long-term users. However, our findings do not support a uniform conclusion of safety for all subgroups. The non-significant trends in new users and patients with severe diabetes warrant a cautious, individualised approach for these potentially vulnerable populations. Further research is needed to definitively clarify this risk.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145256987","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":"Partial non-adherence to antidiabetic therapy undermines diabetes management and correlates with treatment complexity: A cross-sectional study using blood plasma analysis.","authors":"Vojtěch Škop, Ivana Laňková, Simona Antalová, Iva Míšková, Kateřina Malá-Ládová, Josef Malý, Terezie Pelikánová, Jiří Hricko, Tomáš Čajka, Martin Haluzík","doi":"10.1111/dom.70174","DOIUrl":"https://doi.org/10.1111/dom.70174","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate medication adherence in patients with type 2 diabetes (T2D) using plasma drug measurements and assess the clinical impact of partial non-adherence on glycemic control and complications.</p><p><strong>Materials and methods: </strong>This cross-sectional study included 641 T2D outpatients attending routine follow-up visits. After overnight fasting, blood samples were collected and analysed by LC-MS to quantify plasma concentrations of 13 oral antidiabetic drugs. Adherence was defined as the detection of a prescribed drug above the limit of quantification. Self-reported lifestyle factors, dosing regimens, and clinical outcomes were assessed in relation to drug presence.</p><p><strong>Results: </strong>Metformin adherence was very high, with the drug undetected in only 1.9% of patients. In contrast, adherence rates were lower for sulfonylureas (94%), DPP-4 inhibitors (90%), pioglitazone (82%), and SGLT2 inhibitors (73%). Non-adherence was predominantly partial: only one of the analysed antidiabetics taken by patients was not detected in 93% of non-adherent patients. Adherence declined with increasing numbers of prescribed agents and daily doses, suggesting treatment complexity as a key factor. No other tested lifestyle or drug management parameters were significantly associated with adherence. Glycemic control was worse in non-adherent patients: 63% did not reach target glucose and HbA1_c levels, compared to 37% of fully adherent patients. Non-adherence was also associated with a higher prevalence of diabetic kidney disease.</p><p><strong>Conclusions: </strong>Partial non-adherence is common in T2D and strongly associated with treatment complexity and poor glycemic outcomes. These findings emphasize the need for individualized strategies to support adherence and improve long-term diabetes care. Our study further indicates that plasma analysis using LC-MS methods may serve as a robust tool for adherence assessment.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257005","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":"Impact of Semaglutide on fat mass, lean mass and muscle function in patients with obesity: The SEMALEAN study.","authors":"Mathieu Alissou, Thomas Demangeat, Vanessa Folope, Hélène Van Elslande, Hélène Lelandais, Julia Blanchemaison, Pierre-Emmanuel Cailleaux, Suzan Guney, Alexandra Aupetit, Agnès Aubourg, Clément Rapp, André Petit, Morgane Godin, Luc Vignal, Sébastien Grigioni, Pierre Déchelotte, Guillaume Colange, Moïse Coëffier, Najate Achamrah","doi":"10.1111/dom.70141","DOIUrl":"https://doi.org/10.1111/dom.70141","url":null,"abstract":"<p><strong>Aims: </strong>Semaglutide, a GLP-1 receptor agonist, has shown efficacy in promoting weight loss. However, limited data exist on its impact on lean mass, muscle function, and metabolic adaptations. The SEMALEAN study aims to evaluate these parameters in patients with obesity treated with Semaglutide (2.4 mg).</p><p><strong>Materials and methods: </strong>This prospective study enrolled 115 patients with obesity between February 2022 and November 2024. Body weight, body composition (measured by DXA), muscle function (handgrip strength), and resting energy expenditure (REE) were assessed at baseline (M0), 7 months (M7), and 12 months (M12). Subgroup analyses examined the impact of sex, type 2 diabetes, previous GLP-1 use, and history of bariatric surgery.</p><p><strong>Results: </strong>A total of 106 patients (68.9% female; mean BMI 46.3 kg/m²) completed the study. Weight loss was significant, with mean reductions of 10% at M7 and 13% at M12; 59% of patients achieved ≥10% weight loss. Total fat mass decreased by 14% at M7 and 18% at M12, while lean mass initially declined (-3 kg at M7) but stabilised thereafter. Handgrip strength improved significantly (+4.5 kg at M12), and the prevalence of sarcopenic obesity decreased from 49% at baseline to 33% at M12. REE normalised to lean mass increased significantly from M7 to M12. Subgroup analyses revealed greater weight and fat mass loss in women, while patients with type 2 diabetes or prior GLP-1 analogue use showed attenuated responses. Patients with a history of bariatric surgery exhibited the most pronounced reductions in body composition parameters.</p><p><strong>Conclusions: </strong>The SEMALEAN study highlights the significant impact of Semaglutide 2.4 mg on weight loss, fat mass reduction, and muscle function improvement, with preserved lean mass and metabolic efficiency. These findings underscore the importance of a comprehensive approach to obesity management, addressing not only weight loss but also functional and metabolic adaptation.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257012","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":"Semaglutide withdrawal in adults with type 1 diabetes on pump therapy: A post-hoc analysis from a double-blinded randomized controlled trial.","authors":"Melissa-Rosina Pasqua, Michael A Tsoukas, Ahmad Haidar","doi":"10.1111/dom.70185","DOIUrl":"https://doi.org/10.1111/dom.70185","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249017","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":"A systematic literature review and meta-analysis of real-world evidence on commercially available automated insulin delivery systems in people with type 1 diabetes.","authors":"Johannes Pöhlmann, Jayne Smith-Palmer, Erik H Serné, Anna-Kaisa Tuomaala, Johan Jendle, Pratik Choudhary, Emanuele Bosi, Viswanathan Mohan, Tim van den Heuvel, Ohad Cohen, Richard F Pollock","doi":"10.1111/dom.70161","DOIUrl":"https://doi.org/10.1111/dom.70161","url":null,"abstract":"<p><strong>Aims: </strong>Automated insulin delivery (AID) is part of the standard of care for type 1 diabetes (T1D), but real-world evidence (RWE) comparing AID systems remains limited. A systematic review and meta-analysis was conducted for outcomes across commercially available AID systems in real-world settings.</p><p><strong>Materials and methods: </strong>PubMed and Embase were searched to March 2025 for RWE studies of commercial AID systems in ambulatory people with T1D. Eligible studies had n ≥ 250 with ≥10 days of continuous glucose monitoring data. Main outcomes were time in range (TIR) and glycated haemoglobin (HbA1c). Random-effects meta-analyses with AID system as moderator were performed, including scenario analyses by age and optimal device settings.</p><p><strong>Results: </strong>Thirty-six records covering 34 studies with 635 463 users were included. Studies evaluated MiniMed™ 780G (n = 16), Control-IQ™ (n = 9), MiniMed™ 670G (n = 6), and other systems (≤3 studies each). Meta-analysis demonstrated frequently statistically significant between-system differences in TIR, ranging from 60.1% (95% confidence interval [CI] 54.0 to 65.9) for Omnipod® 5 to 73.9% (95% CI 72.3 to 75.5) for MiniMed 780G. For HbA1c, estimates ranged from 6.5% (95% CI 5.4 to 7.7) for Loop to 7.0% (95% CI 6.7 to 7.4) for MiniMed 780G, although differences were not significant. Significant residual heterogeneity was observed. Age was an important effect modifier, with younger users experiencing less favourable outcomes. Optimal device settings improved glycaemic outcomes.</p><p><strong>Conclusions: </strong>RWE demonstrated differences in glycaemic outcomes, including TIR, between commercially available AID systems. User age influenced outcomes for all systems. Results must be interpreted cautiously given challenges and potential biases with RWE.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243398","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":"Evaluating global epidemiology of type 2 diabetes mellitus among the working-age population: A 60-year study by interpretable machine learning framework.","authors":"Xuan Zhong, Yijin Zheng, Li Wang, Binfa Ouyang, Yingjie Luo, Hongen Chen, Shan Xu, Dan Zhao, Xiaolin Peng, Liegang Liu","doi":"10.1111/dom.70155","DOIUrl":"https://doi.org/10.1111/dom.70155","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to characterise the epidemiology in the trends of type 2 diabetes mellitus (T2DM) burden among working-age population (WAP) from 1990 to 2021 and to forecast future patterns up to 2050 using interpretable machine learning, with an emphasis on providing key drivers for public health strategies.</p><p><strong>Materials and methods: </strong>Granular data were extracted from the Global Burden of Disease 2021 study. We built the eXtreme Gradient Boosting (XGBoost) models to predict T2DM burden in WAP and clarified the driving factors using SHapley Additive exPlanations (SHAP) to enhance interpretability.</p><p><strong>Results: </strong>Global incident cases in WAP are projected to increase five-fold from 6.33 million (1990) to 32.38 million (2050), with North Africa/Middle East showing the fastest growth (estimated annual percentage change, EAPC = 3.45). Notably, the traditional inverse relationship between socio-demographic index and T2DM burden is reversing (p < 0.01), with high-income regions like the UK facing accelerating age-standardised DALY rates by 2050 (EAPC = 1.43). SHAP analysis identified age as the predominant contributor, while high blood glucose, BMI, and air pollution remained consistently influential. High temperature and alcohol consumption emerged as increasingly significant factors.</p><p><strong>Conclusions: </strong>Global T2DM burden among the WAP shows alarming trends, particularly in ageing societies where labour forces are highly valued. Tailored WAP guidelines may reduce T2DM burden worldwide, but stronger efforts on obesity and climate change are essential for effective T2DM management.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249059","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":"Histological efficacy of anti-diabetic agents in MASH and the mediating role of weight loss: A network meta-analysis.","authors":"Mainak Banerjee, Rimesh Pal, Sandip Pal","doi":"10.1111/dom.70187","DOIUrl":"https://doi.org/10.1111/dom.70187","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive liver disease with rising global prevalence, closely linked to type 2 diabetes. While several anti-diabetic agents show promise, a comprehensive analysis comparing their efficacy on biopsy-confirmed histological outcomes, including dose-dependent effects and the mediating role of weight loss, remains unexplored.</p><p><strong>Methods: </strong>A frequentist random-effects network meta-analysis (NMA) was conducted to explore histological efficacy of anti-diabetic agents in biopsy-confirmed MASH without cirrhosis. The primary outcome was fibrosis improvement (≥1 stage) without worsening steatohepatitis; the secondary outcome was MASH resolution without fibrosis worsening. Incretin-based agents were dose-stratified. Treatment ranking used surface-under the cumulative-ranking curve (SUCRA). Meta-regression investigated the impact of percentage weight loss and baseline covariates on the proportion of individuals achieving histological end-points.</p><p><strong>Results: </strong>Data from five RCTs (N = 1667) were included. All active treatments, including Dapagliflozin 10 mg, Survodutide (2.4 mg/wk, 4.8-6 mg/wk), Tirzepatide (5 mg/wk, 10-15 mg/wk), and Semaglutide (0.7-1.4 mg/wk, 2.4 or 2.8 mg/wk), improved fibrosis versus placebo (I² = 0%). For MASH resolution, dose-dependent effects led to significant heterogeneity (I² = 73%), with lower-dose Semaglutide demonstrating no benefits and Dapagliflozin showing benefits in the F2-F3 subgroup only on sensitivity analysis. Survodutide exhibited the highest ranking (SUCRA = 0.822-0.849), followed by Tirzepatide (SUCRA = 0.622-0.681) and higher-dose Semaglutide (SUCRA = 0.327) for MASH resolution. Meta-regression using data from 16 interventions, including placebo arms, showed that weight loss significantly explained heterogeneity in treatment effects on fibrosis improvement (R² = 54.26%) and MASH resolution (R² = 78.16%).</p><p><strong>Conclusions: </strong>SGLT2 inhibitor and incretin-based agents improved fibrosis in MASH, with weight loss being a significant mediator. Targeting multiple incretin pathways, especially involving glucagon receptors, may offer greater MASH resolution. Dose-dependent effects were more prominent for MASH resolution than fibrosis improvement, indicating potential weight-loss-independent anti-fibrotic pathways.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249097","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":"Addressing the risk of ocular complications of GLP-1RAs; a multi-disciplinary expert consensus.","authors":"Patrice Carter, Rafael Simó, Monica Lövestam-Adrian, Ian Pearce, Stephen C Bain, Christiana Dinah, Sarah Jane Davies, W David Strain, Philip Burgess, Amy Gamble, Chloe Hembury, Marc Evans","doi":"10.1111/dom.70160","DOIUrl":"https://doi.org/10.1111/dom.70160","url":null,"abstract":"<p><strong>Aims: </strong>There is current apprehension among some clinicians and conflicting evidence regarding ocular complications in relation to Glucagon-like peptide-1 receptor agonists (GLP-1RAs). We aimed to generate multi-disciplinary, expert-led consensus recommendations relating to ocular complications to facilitate optimum prescribing of GLP-1RAs.</p><p><strong>Materials and methods: </strong>A modified Delphi was conducted following the ACcurate COnsensus Reporting Document (ACCORD) for Delphi research. A structured literature review informed an anonymous online Delphi questionnaire, followed by a virtual consensus meeting. Eligible participants included ophthalmologists, diabetologists, and obesity specialists practising in Europe.</p><p><strong>Results: </strong>Responses from 58 participants across 17 countries were analysed. Respondents agreed that diabetic retinopathy (DR) worsening events are primarily linked to rapid blood glucose-lowering, rather than a direct drug effect. The benefits of GLP-1RAs were deemed to outweigh potential ocular risks and should not limit access to these medicines. Prescribers should ensure that people with diabetes are screened for diabetic retinopathy before commencing GLP-1RAs, particularly in high-risk populations (>10 years duration and/or poor glucose control, (haemoglobin A1c [HbA1c] >10% or 86 mmol/mol)). When prescribing GLP-1RA to those with sight loss in one eye and/or prior history of non-arteritic anterior ischaemic optic neuropathy (NAION), the risk of ocular complications should be discussed. The Delphi study highlighted current uncertainty in the evidence, with some topics on the relationship between GLP-1RAs and ocular complications reaching limited consensus.</p><p><strong>Conclusions: </strong>Further research is needed into the direct effects of GLP-1RAs on the retina and ocular complications. New evidence should be disseminated rapidly to optimise outcomes and safety.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243428","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}