Diabetes, Obesity & Metabolism最新文献

{"title":"Recurrent Diabetes-Related Hospital Admissions and Diabetes Distress: Real-World Evidence From the Association of British Clinical Diabetologists (ABCD) National Freestyle Libre Audit.","authors":"Jude Wellens-Mensah, Harshal Deshmukh, Emmanuel Ssemmondo, Chris Walton, Robert E J Ryder, Emma G Wilmot, Thozhukat Sathyapalan","doi":"10.1111/dom.71198","DOIUrl":"10.1111/dom.71198","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the association between prior diabetes-related hospital admissions and diabetes distress and determine whether structured diabetes education modifies this relationship.</p><p><strong>Materials and methods: </strong>We analysed 14 460 adults from the Association of British Clinical Diabetologists (ABCD) National FreeStyle Libre Audit. High diabetes distress was defined using the two-item Diabetes Distress Scale (DDS-2; mean score ≥ 3). Diabetes-related hospital admissions during the preceding 12 months were categorised as none, single or recurrent (≥ 2). Multivariable logistic regression examined associations between admissions and distress after adjustment for demographic and clinical factors. Interaction between admissions and structured education was assessed using likelihood ratio testing.</p><p><strong>Results: </strong>Participants had a mean age of 42.3 ± 18.1 years, 47.7% were female and most had type 1 diabetes. High diabetes distress was present in 51.5% of participants. In the complete-case cohort (n = 8017), recurrent diabetes-related admissions were independently associated with high diabetes distress (adjusted odds ratio [aOR] 1.94, 95% CI 1.48-2.57), whereas single admissions were not. Recurrent non-diabetes admissions were not independently associated with distress. Significant interaction was observed between admissions and structured education (p < 0.001). Among individuals with recurrent admissions, distress prevalence was lower among those reporting structured education (64.1% vs. 80.4%). Hypoglycaemia-related and other diabetes-related admissions were independently associated with distress.</p><p><strong>Conclusions: </strong>Recurrent diabetes-related hospital admissions are strongly associated with diabetes distress, with the independent association driven by recurrent rather than isolated events. Lower distress among individuals reporting structured education supports further evaluation of integrated psychosocial and educational approaches following acute diabetes-related hospital admission.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10028-10036"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148710622","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":"Quality Plus Quantity: Evaluation of a Virtual GLP-1 Programme With Physical Activity Support to Promote Healthy Body Composition Change During GLP-1 Weight Loss.","authors":"Lisa A Stanton, Jeanean B Naqvi, Susan M Devaraj, Amanda McGuill, Todd Norwood, Sarah Linke","doi":"10.1111/dom.71152","DOIUrl":"10.1111/dom.71152","url":null,"abstract":"<p><strong>Aims: </strong>Glucagon-like peptide-1 (GLP-1) receptor agonists can produce rapid weight loss, but this loss is frequently accompanied by disproportionate loss of lean mass, particularly during the early phase of GLP-1-treatment. Physical activity (PA), particularly resistance training, is the most effective behavioural strategy for enhancing fat reduction while preserving lean mass. Our primary aim was to evaluate whether a 12-week virtual GLP-1 lifestyle companion programme that includes PA coaching was associated with increased weight and fat loss coupled with preservation of muscle mass among adults with obesity who initiated GLP-1 therapy for weight loss ≤ 8 weeks prior to baseline.</p><p><strong>Materials and methods: </strong>In this quasi-experimental trial, 245 adults (151 intervention and 94 control) received either a virtual GLP-1 lifestyle companion programme with personalised, strength-focused PA coaching or usual care. Body composition was captured using home bioelectrical impedance analysis scales. Primary outcomes were 12-week between-group differences in change in weight, percent body fat and percent muscle mass.</p><p><strong>Results: </strong>Participants in the GLP-1 lifestyle companion programme lost an adjusted mean of 6.0% of their baseline body weight versus 3.3% in the control group (between-group difference 2.8%, p < 0.001). Compared with controls, they also experienced a larger decline in body fat percentage (-3.3% vs. -1.6%, p < 0.001), a greater increase in muscle mass percentage (+0.6% vs. +0.2%, p < 0.01) and greater improvements in psychosocial and behavioural outcomes.</p><p><strong>Conclusions: </strong>Personalised, virtually delivered PA programming may meaningfully improve the quantity and quality of weight loss during GLP-1 therapy.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10636-10647"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872431","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":"Priorities, Expectations, Perceptions of Time in Tight Range and Support Needs Relating to Closed-Loop Therapy Among Adults With Type 1 Diabetes: The SELECT HCL Study.","authors":"Alexandros L Liarakos, Iskandar Idris, Emma G Wilmot","doi":"10.1111/dom.71263","DOIUrl":"10.1111/dom.71263","url":null,"abstract":"<p><strong>Aims: </strong>To assess factors influencing closed-loop system choice, perceptions of treatment satisfaction and glycaemic targets, perceived benefits and expectations of therapy, and support needs among adults with Type 1 diabetes (T1D) using, awaiting initiation of or considering closed-loop therapy.</p><p><strong>Materials and methods: </strong>SELECT HCL was a cross-sectional survey study conducted at a specialist secondary care diabetes service between September 2025 and February 2026. Adults with T1D completed an anonymous online questionnaire assessing experiences and perspectives relating to closed-loop therapy. Descriptive, subgroup, and multivariable logistic regression analyses were performed.</p><p><strong>Results: </strong>Overall, 166 participants were included (median age 47 years; HbA1c 52 mmol/mol [6.9%]). Sensor accuracy (39.3%), glycaemic performance (37.6%) and patch pump without tubing (27.5%) were the most commonly prioritised factors when selecting sensors, algorithms and insulin pumps, respectively. Treatment satisfaction priorities differed by age (p = 0.006), with younger participants more frequently prioritising reduction in burden and quality of life (QoL), whereas older participants prioritised hypoglycaemia-related outcomes. Although 63.8% perceived time in tight range (TITR, 3.9-7.8 mmol/L) ≥ 50% as beneficial for their health, only 36.1% considered it an achievable target. Most participants reported that closed-loop therapy improved QoL (78.6%), reduced hyperglycaemia (75.0%) and hypoglycaemia (72.3%), and met expectations (81.1%). Adequate support during closed-loop initiation was associated with therapy meeting participants' expectations (OR 16.6, 95% CI 5.0-52.4, p < 0.001).</p><p><strong>Conclusions: </strong>Adults with T1D reported diverse priorities and experiences relating to closed-loop therapy, extending beyond glycaemic outcomes alone. Adequate support during closed-loop initiation may represent an important component of successful implementation in routine clinical care.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10439-10448"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811372","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":"Real-World Glycemic Outcomes of Open-Source Automated Insulin Delivery During 12 Months Among People With Type 1 Diabetes Across Age Groups.","authors":"Qiongyan Lin, Ziqing Lin, Ping Ling, Ying Ni, Mengyun Lei, Yanli Cao, Daizhi Yang, Wen Xu, Hongrong Deng, Yongwen Zhou, Jinhua Yan","doi":"10.1111/dom.71281","DOIUrl":"10.1111/dom.71281","url":null,"abstract":"<p><strong>Aims: </strong>To assess glycemic outcomes across different age groups and explore factors associated with glycemic target achievement during 12-months open-source android artificial pancreas (AAPS) use among people with type 1 diabetes (T1D).</p><p><strong>Methods: </strong>This study included people with T1D who had used AAPS continuously for 12 months. Glycemic outcomes were assessed at 3, 6, and 12 months post-initiation by age stratification (2-7, 8-12, 13-18, 19-30, 31-45, and > 45 years). Factors associated with achieving composite target of time in range of 70-180 mg/dL[TIR] > 70% and time below range of 70 mg/dL [TBR70] < 4% at 12 months were explored.</p><p><strong>Results: </strong>A total of 190 individuals were enrolled, with median age of 26.1 (11.9, 36.7) years and T1D duration of 2.1 (0.2, 8.4) years. Mean TIR remained high and stable during 12 months (79.9% ± 11.8%, 77.8% ± 13.9%, and 77.2% ± 13.5% at 3, 6, and 12 months), with TBR70 of 3.8 (1.9, 6.1)%, 3.3 (1.6, 5.8)% and 3.6 (2.0, 6.6)% respectively. However, outcomes varied by age. At 12 months, TIR was 72.8% ± 15.5% in 13-18 years group, with TBR70 of 4.2 [2.7, 6.3]%, while > 45 years group had TIR of 78.9% ± 11.8% and relatively less hypoglycemia (TBR70, 2.5 [1.2, 5.9]%). In exploratory analyses, higher target achievement rate of the composite target was associated with longer time in automation in adults (OR 1.04; p = 0.03) and higher meal announcement frequency in paediatrics under 18 years (OR 1.35; p < 0.01).</p><p><strong>Conclusions: </strong>Open-source AAPS achieved sustained glycemic improvement across age groups in T1D people. Age-related differences in influencing factors highlight the need for age-tailored strategies to optimise long-term outcomes.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10625-10635"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838771","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":"Associations of Circadian-Disruptive Behaviours With Plasma Glycemic Parameters and Continuous Glucose Monitoring Measures Among Pregnant Women.","authors":"Yu-En Chen, Chee Wai Ku, Ruther Teo Zheng, Jerry Kok Yen Chan, Fabian Yap, See Ling Loy, Ling-Wei Chen","doi":"10.1111/dom.71264","DOIUrl":"10.1111/dom.71264","url":null,"abstract":"<p><strong>Aims: </strong>Circadian-disruptive behaviours (CDBs) may impair glucose regulation via central and peripheral clocks. This study investigated the association between CDB burden and glycemic outcomes during pregnancy.</p><p><strong>Materials and methods: </strong>In this prospective cohort study, 246 pregnant women were recruited at 18-24 weeks' gestation. Four CDBs were assessed using dietary records and questionnaires: eating jetlag, predominant night-eating, social jetlag, and electronic media use before bedtime. Outcomes included oral-glucose-tolerance-test (OGTT) and insulin parameters (24-28 weeks' gestation) and continuous-glucose-monitoring (CGM) metrics (18-24 weeks' gestation). Skewed outcomes were log-transformed, and associations with the number of CDBs were examined using multivariable regression.</p><p><strong>Results: </strong>Compared with women without CDBs, those with two CDBs had higher fasting insulin [geometric mean ratio 1.23 (95% CI 1.02, 1.48)] and updated-homeostasis-model-assessment-of-insulin-resistance (HOMA2-IR) [1.23 (1.02, 1.47)]. Women with three or four CDBs had significantly higher fasting glucose [1.09 (1.04, 1.15)], 1-h glucose [1.17 (1.03, 1.33)], glucose area-under-the-curve [1.14 (1.03, 1.26)], and lower updated-homeostasis-model-assessment-of-β-cell-function (HOMA2-%B) [0.76 (0.62, 0.93)]. Furthermore, fetal sex modified the associations between CDBs and CGM-derived glycemic control measures, including mean glucose, glucose management indicator (GMI), and J-index (all p _interaction < 0.1). In stratified analyses, a higher cumulative CDB measure was significantly associated with higher glycemic control measures among women carrying female foetuses.</p><p><strong>Conclusions: </strong>Higher CDB burden was associated with less favourable glycemic profiles and lower HOMA2-%B during pregnancy. These findings support investigating circadian-aligned lifestyle strategies to improve maternal metabolic health.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT03803345.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10486-10497"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148816714","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":"Community-Based Personalised Lifestyle Intervention Guided by Intermittent Continuous Glucose Monitoring in Adults With Type 2 Diabetes: A Multicentre Randomised Controlled Trial.","authors":"Yaqing Liu, Shan Zheng, Zifu Yu, Ran Zhao, Qian Li, Suyun Li, Liangxia Chen","doi":"10.1111/dom.71221","DOIUrl":"10.1111/dom.71221","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate whether a community-based personalised lifestyle intervention guided by intermittent continuous glucose monitoring (CGM) improves glycaemic and cardiometabolic outcomes in adults with type 2 diabetes.</p><p><strong>Materials and methods: </strong>In this multicentre, open-label randomised trial, 180 adults with type 2 diabetes and pre-randomisation HbA1c > 7.0% were assigned 1:1 to the CGM-guided intervention or usual community diabetes management and followed for 12 months. The intervention combined FreeStyle Libre 2 use at baseline, after the Month 3 assessment and at Month 6 with personalised lifestyle guidance and supervised exercise concentrated in the first 3 months. The primary outcome was HbA1c at Month 3, analysed using multiple-imputation ANCOVA adjusted for baseline HbA1c and community site.</p><p><strong>Results: </strong>The primary analysis set included 171 participants. The adjusted intervention-minus-control difference in Month 3 HbA1c was -0.09 percentage points (95% CI, -0.38 to 0.21; p = 0.573). Supportive complete-data ANCOVA in 125 participants yielded a similar estimate of -0.12 percentage points (95% CI, -0.44 to 0.20; p = 0.472). No significant between-group HbA1c differences were observed at Months 6 or 12, and secondary outcomes showed no consistent benefit. Two Month 3 responder outcomes nominally favoured the intervention, but neither remained significant after multiplicity adjustment (both q = 0.104). Exploratory analyses identified no baseline subgroup with greater Month 3 benefit.</p><p><strong>Conclusions: </strong>The intervention did not significantly improve glycaemic or cardiometabolic outcomes beyond usual community care. Whether more sustained feedback and engagement can improve effectiveness requires evaluation before routine implementation.</p><p><strong>Trial registration: </strong>ChiCTR2400085258.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10070-10080"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148719831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bowel Obstruction/Ileus Associated With the Use of Glucagon-Like Peptide-1 Receptor Agonists: A Nationwide Database Study.","authors":"Yuichiro Matsuo, Akira Okada, Takashi Sakamoto, Hideo Yasunaga","doi":"10.1111/dom.71189","DOIUrl":"10.1111/dom.71189","url":null,"abstract":"<p><strong>Aims: </strong>The association between glucagon-like peptide-1 receptor agonist (GLP-1RA) use and the development of bowel obstruction/ileus remains unclear, and evidence for specific bowel obstruction/ileus subtypes remains limited. We examined the association between GLP-1RA use and the incidence of bowel obstruction/ileus subtypes across different subgroups of individuals.</p><p><strong>Methods: </strong>Using the commercially available Japanese administrative claims DeSC database, we identified individuals aged ≥ 18 years with type 2 diabetes who newly initiated either GLP-1RAs or sodium-glucose cotransporter 2 inhibitors (SGLT2is) between April 2016 and February 2024. An active-comparator new-user design was adopted, designating GLP-1RA users as the exposure group and SGLT2i users as the control group. The primary outcome was bowel obstruction/ileus requiring tube decompression or surgery within 1 year. Secondary outcomes included specified small bowel obstruction, small bowel obstruction requiring surgery, paralytic ileus and colonic volvulus. Inverse probability weighting with propensity scores was used to adjust for confounding. Adjusted cumulative incidence was estimated using Kaplan-Meier methods; hazard ratios were estimated using Cox regression.</p><p><strong>Results: </strong>Among 298 124 eligible individuals, 25 779 and 272 345 were classified into the GLP-1RA and SGLT2i groups, respectively. The adjusted 1-year incidence proportion of the primary outcome did not significantly differ between groups (0.14% vs. 0.17%; difference -0.03%, 95% confidence interval (CI), -0.10% to 0.04%; hazard ratio 0.80, 95% CI, 0.52-1.24). No significant between-group differences were observed for the secondary outcomes.</p><p><strong>Conclusions: </strong>GLP-1RA initiation in individuals with type 2 diabetes was not associated with an increased risk of bowel obstruction/ileus compared with SGLT2i initiation.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"9941-9954"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reasons for and Outcomes of Medicare Part D Appeals for Denied GLP-1 Receptor Agonist Claims.","authors":"Matthew J Klebanoff, John C Lin, Judith A Long, Eric Bressman, Jalpa A Doshi","doi":"10.1111/dom.71201","DOIUrl":"10.1111/dom.71201","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":"10878-10881"},"PeriodicalIF":6.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148704693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to 'Efficacy of CagriSema for Reaching Anthropometric Treatment Targets and Cardiometabolic Outcomes: A Secondary, Post Hoc Analysis of REDEFINE 1'.","authors":"","doi":"10.1111/dom.71438","DOIUrl":"https://doi.org/10.1111/dom.71438","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149222939","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":"Cardiovascular Outcomes of Insulin Degludec Versus Insulin Glargine in Trial-Eligible and Ineligible Populations: A DEVOTE-Inspired Target Trial Emulation Using the Swedish National Diabetes Register.","authors":"Thomas Nyström, Jens Michelsen, Henrik Imberg, Sara Hallström, Viktor Tasselius, Anna Norhammar, Max Petzold, Julia K Mader, Pratik Choudhary, Manal K Elzalabany, Jonathan Valabhji, Shivani Misra, Safoora Gharibzadeh, Puriya Daniel Würtz Yazdanfard, Kathrine Kold Sørensen, Christian Torp-Pedersen, Marcus Lind","doi":"10.1111/dom.71429","DOIUrl":"https://doi.org/10.1111/dom.71429","url":null,"abstract":"<p><strong>Aims: </strong>To compare cardiovascular outcomes associated with the initiation of insulin degludec versus insulin glargine using a target trial emulation approach in nationwide real-world data.</p><p><strong>Materials and methods: </strong>We conducted a nationwide observational cohort study using Swedish health registers, including the National Diabetes Register. Individuals with type 2 diabetes initiating insulin degludec or insulin glargine between 2012 and 2022 were included. Two complementary approaches were applied: a trial-eligible emulation cohort reflecting the eligibility criteria of the DEVOTE trial, and a trial-ineligible emulation cohort representing routine clinical practice. The primary outcome was major adverse cardiovascular events (MACE, i.e., myocardial infarction, stroke and cardiovascular mortality). Secondary outcomes included the individual components of MACE, all-cause mortality and heart failure. Average treatment effects were estimated using longitudinal targeted minimum loss-based estimation.</p><p><strong>Results: </strong>Among 96 731 individuals identified, 44 890 met the study eligibility criteria and were included in the analyses. In the trial-eligible cohort, degludec was associated with a similar risk of MACE compared with glargine (risk ratio: 1.10; 95% CI: 0.91-1.34; p = 0.34), but a significantly lower risk of all-cause mortality (risk ratio: 0.75; 95% CI: 0.62-0.92; p = 0.002). In the trial-ineligible emulation cohort, degludec was associated with lower risks of MACE (risk ratio: 0.80; 95% CI: 0.67-0.95; p = 0.004) as well as reduced risks of all-cause mortality, cardiovascular mortality, non-fatal stroke and heart failure.</p><p><strong>Conclusions: </strong>In this nationwide study, degludec was associated with a lower risk of all-cause mortality compared with glargine, consistently observed in both trial-eligible and trial-ineligible populations, despite similar cardiovascular risk in the trial-eligible cohort.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223028","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}