Diabetes, Obesity & Metabolism最新文献

{"title":"Impact of SGLT2 inhibitors on the risk of age-related ocular diseases in patients with type 2 diabetes mellitus: A target trial emulation study.","authors":"Yueh-Tsung Lee, Jheng-Yan Wu, Tsung W Chang, Cheng-Hsien Hung","doi":"10.1111/dom.70131","DOIUrl":"https://doi.org/10.1111/dom.70131","url":null,"abstract":"<p><strong>Aims: </strong>Chronic ocular diseases such as age-related macular degeneration (AMD) are leading causes of vision loss in older adults. While sodium-glucose co-transporter 2 inhibitors (SGLT2i) are widely prescribed in the management of type 2 diabetes mellitus (T2DM), their effects on ocular disease risk remain largely unknown.</p><p><strong>Materials and methods: </strong>This retrospective cohort study evaluated the association between SGLT2i use and the risk of AMD and other age-related ocular conditions in adults aged ≥60 with T2DM, using a target trial emulation framework based on the TriNetX global health research network (2013-2025). Patients initiating SGLT2i or dipeptidyl peptidase-4 inhibitors (DPP4i) were propensity-matched 1:1. Primary outcomes were incident non-exudative, exudative, and atrophic AMD, and secondary outcomes included cataract, ocular hypertension, and primary open-angle glaucoma.</p><p><strong>Results: </strong>In 12 156 matched patients, SGLT2i use was associated with significantly lower risks of non-exudative AMD (HR 0.64; 95% CI 0.49-0.84) and exudative AMD (HR 0.56; 95% CI 0.33-0.96) compared with DPP4i use. A slight increase in the risk of cataract was observed (HR 1.08; 95% CI 1.02-1.15), while no significant differences were found for atrophic AMD, ocular hypertension, or glaucoma.</p><p><strong>Conclusions: </strong>These findings suggest that SGLT2i may offer retinal protective effects in older adults with T2DM, supporting further mechanistic and prospective clinical studies.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032591","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":"Supporting evidence for the association between GLP-1 agonists and NAION: Insights from a large national cohort.","authors":"Artur Dziewierz, Zbigniew Siudak","doi":"10.1111/dom.70128","DOIUrl":"https://doi.org/10.1111/dom.70128","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028653","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":"An SGLT2 inhibitor, canagliflozin, reduces blood glucose level in the renal capillaries and protects the capillary network in the diabetic rats.","authors":"Anqi Zhang, Bi Zhichen, Satoshi Kidoguchi, Akira Nishiyama, Xiaopeng Hu, Daisuke Nakano","doi":"10.1111/dom.70118","DOIUrl":"https://doi.org/10.1111/dom.70118","url":null,"abstract":"<p><strong>Aim: </strong>Sodium-glucose cotransporter 2 (SGLT2) inhibitors consistently demonstrate renal protection against progressive kidney disease. We hypothesised that SGLT2 inhibition reduces blood glucose levels in peri-proximal tubular capillaries by limiting reabsorption from the tubular filtrate, thereby safeguarding the renal microvasculature from hyperglycaemic stress.</p><p><strong>Materials and methods: </strong>In anaesthetised streptozotocin-induced type 1 and Otsuka-Long Evans fatty (OLETF) type 2 diabetic rats, we measured the arterial-to-renal venous glucose ratio (RV/A) to evaluate the effects of canagliflozin, a SGLT2 inhibitor.</p><p><strong>Results: </strong>In fasting OLETF rats, three-day oral canagliflozin treatment at both glycaemic and subglycaemic doses significantly lowered the RV/A glucose ratio compared with vehicle. During anaesthesia, duodenal glucose infusion increased the RV/A glucose ratio in diabetic OLETF rats, an effect prevented by canagliflozin but not by acute insulin infusion. Moreover, 4-week canagliflozin therapy preserved renal capillary density more effectively than insulin in OLETF rats.</p><p><strong>Conclusion: </strong>These findings indicate that canagliflozin offers superior protection of the renal microvasculature from hyperglycaemic stress, independent of its systemic glucose-lowering action.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028655","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 attenuates diabetic retinopathy progression via ameliorating retinal vasculopathy and oxidative stress in vivo and in vitro.","authors":"Xiao Cheng, Zhuoxin Fu, Yucai Chen, Jiawei Wang, Furong Han","doi":"10.1111/dom.70107","DOIUrl":"https://doi.org/10.1111/dom.70107","url":null,"abstract":"<p><strong>Background: </strong>Diabetic retinopathy (DR) is a major complication of diabetes mellitus, characterised by retinal vasculopathy and oxidative stress. Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), has demonstrated cardiovascular benefits but has also been associated with mixed effects on DR progression. This study investigates the potential of semaglutide to attenuate DR progression by ameliorating retinal vasculopathy and oxidative stress in both in vivo and in vitro models.</p><p><strong>Methods: </strong>In vivo, a streptozotocin-induced DR rat model was used, and semaglutide (100 μg/kg/week) was administered for 5 weeks. The retinal pathological symptoms, vascular lesions, neuronal apoptosis, and inflammation were evaluated by HE staining, PAS staining, immunohistochemistry staining, and ELISA assay. In vitro, human retinal microvascular endothelial cells (HRMECs) exposed to a high glucose (HG) environment were treated with semaglutide (5 nM) to assess oxidative stress, vascular endothelial conditions, and inflammation by immunofluorescence and ELISA assay.</p><p><strong>Results: </strong>Semaglutide significantly reduced the blood glucose levels of DR rats and improved their retinal function. It increased the thickness of the inner nuclear layer of the retina and alleviated neuronal apoptosis. Semaglutide also alleviated retinal vascular lesions and inflammatory responses, which were demonstrated by the increase in retinal vascular tight junction markers and the reduction in pro-inflammatory cytokines. In high glucose-treated HRMECs, semaglutide inhibited oxidative stress and cellular inflammation, and simultaneously downregulated the expression of VFGFA. In the semaglutide-treated group, the expression of ZO-1 was restored.</p><p><strong>Conclusion: </strong>Semaglutide slows the progression of diabetic retinopathy by improving retinal vascular lesions and reducing oxidative stress. Its mechanism of action may involve the reduction of inflammation and apoptosis. Its overall protective effect on retinal function and oxidative stress highlights its potential as a therapeutic drug for diabetic retinopathy. Further mechanisms and clinical studies are needed to validate these findings and assess the long-term effects.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032557","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":"The healthcare and economic burden associated with inadequate risk factor control for type 2 diabetes in Hong Kong: A population-based modelling study.","authors":"Aidi Liu, Yumeng Shao, Jiayin Chen, Carmen S Ng, Yanyan Wu, Xuechen Xiong, Cindy L K Lam, Eric Y F Wan, Jianchao Quan","doi":"10.1111/dom.70081","DOIUrl":"https://doi.org/10.1111/dom.70081","url":null,"abstract":"<p><strong>Aim: </strong>To estimate the healthcare and economic burden associated with improved risk factor control for people with type 2 diabetes in Hong Kong over 10 years.</p><p><strong>Materials and methods: </strong>We obtained population-based data from electronic healthcare records of the Hong Kong Hospital Authority. Risk factor targets were defined by American Diabetes Association guidelines. We applied a validated patient-level diabetes outcomes model (Chinese Hong Kong Integrated Modelling and Evaluation) to estimate the health and economic outcomes for all individuals with type 2 diabetes (n = 526 672) in Hong Kong in 2021. Immediate risk factor control was compared to baseline over 10 years. Costs were estimated from a healthcare provider perspective.</p><p><strong>Results: </strong>Most people (84.9%) failed to achieve optimal combined risk factors control (glycated haemoglobin, blood pressure and low-density lipoprotein-cholesterol) at baseline. Combined control was associated with population-level increases in quality-adjusted life-years (QALYs) of 17 605 and healthcare cost savings of US$ 106.7 million over 10 years. Glycaemic control solely yielded the greatest QALY increases and had the highest cost savings (US$ 29.0 million) over 10 years.</p><p><strong>Conclusions: </strong>The substantial population health and economic burden of inadequate risk factor control for individuals with diabetes in Hong Kong can potentially be mitigated through enhanced adherence, highlighting the need for effective and intensive interventions.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028662","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":"Obesity is associated with increased brain glucose uptake and activity but not neuroinflammation (TSPO availability) in monozygotic twin pairs discordant for BMI-Exercise training reverses increased brain activity.","authors":"Jaakko Hentilä, Jouni Tuisku, Ronja Ojala, Lihua Sun, Martin S Lietzén, Heidi Virtanen, Riikka Lautamäki, Kalle Koskensalo, Lauri Nummenmaa, Eliisa Löyttyniemi, Semi Helin, Kirsi H Pietiläinen, Jaakko Kaprio, Leo Lahti, Tarja Malm, Juha O Rinne, Jarna C Hannukainen","doi":"10.1111/dom.70109","DOIUrl":"https://doi.org/10.1111/dom.70109","url":null,"abstract":"<p><strong>Aims: </strong>Obesity is associated with increased insulin-stimulated brain glucose uptake (BGU) which is opposite to decreased GU observed in peripheral tissues. Increased BGU was shown to be reversed by weight loss and exercise training, but the mechanisms remain unknown. We investigated whether neuroinflammation (TSPO availability) and brain activity drive the obesity-associated increase in BGU and whether this increase is reversed by exercise training.</p><p><strong>Materials and methods: </strong>Twelve monozygotic twin pairs mean age 40.4 (SD) years discordant for BMI (leaner mean 29.1 (SD) 6.3, heavier 36.7 (SD) 7.0 kg·m^-2) performed 6-month long exercise intervention. Insulin-stimulated BGU during euglycaemic-hyperinsulinaemic clamp, brain inflammation (translocator protein (TSPO) availability) and brain resting state activity were studied by [¹⁸F]FDG-PET, [¹¹C]PK11195-PET, and fMRI, respectively. Cognitive function was assessed by an online survey.</p><p><strong>Results: </strong>Exercise training had no effect on insulin-stimulated BGU, brain neuroinflammation (TSPO availability), or BMI. Exercise improved VO_2peak, whole-body insulin sensitivity, and cognitive function similarly in both groups (all, p <0.05) as well as decreased resting state brain activity in heavier co-twins (p <0.05). At baseline, heavier co-twins had worse whole-body insulin sensitivity (p <0.01), increased BGU in the parietal cortex and caudatus, as well as increased resting state brain activity (both, p <0.05) and no difference in cognitive function. Leaner co-twins had higher TSPO availability in white matter and the hippocampus (p <0.05).</p><p><strong>Conclusions: </strong>Exercise training had no effect on insulin-stimulated BGU or neuroinflammation (TSPO availability) but it reversed increased resting state brain activity in heavier co-twins. At baseline, obesity was associated with increased insulin-stimulated BGU and resting state brain activity, independent of genetics.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028632","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":"Long-term efficacy and safety of tirzepatide in participants with type 2 diabetes with inadequate glycaemic control on metformin and/or sulfonylurea: Post-hoc analysis of SURPASS-4.","authors":"Haixia Guan, Hongwei Jiang, Huijuan Yuan, Jie Sun, Jiawei Xu, Linong Ji","doi":"10.1111/dom.70047","DOIUrl":"https://doi.org/10.1111/dom.70047","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the long-term efficacy and safety data at 104 weeks in tirzepatide-treated participants with type 2 diabetes who had inadequate glycaemic control on metformin and/or sulfonylurea.</p><p><strong>Materials and methods: </strong>This post-hoc analysis was based on the SURPASS-4 data (NCT03730662), a multicenter, Phase III trial. Participants were randomised to receive tirzepatide (5, 10, or 15 mg) or insulin glargine. The primary efficacy endpoint was change in HbA1c levels from baseline to 104 weeks. Key secondary endpoints were changes in body weight and the proportion of participants achieving HbA1c <7.0%. Safety endpoints included the incidence of treatment-emergent adverse events (AEs) and hypoglycaemia.</p><p><strong>Results: </strong>This post-hoc analysis included 1,500 participants. At Week 104, participants in the tirzepatide groups had significantly greater mean reduction in HbA1c (5 mg: -2.3%, 10 mg: -2.5%, 15 mg: -2.6%) compared with the insulin glargine group (-1.0%) (p < 0.001). Participants in the tirzepatide groups had significantly greater reduction in body weight (5 mg: -7.6 kg, 10 mg: -10.0 kg, 15 mg: -11.4 kg) compared with the insulin glargine group (2.1 kg) (p < 0.001). Significantly more participants in the tirzepatide group achieved HbA1c <7.0% compared with the insulin glargine group (p < 0.001). The incidence of hypoglycaemia was lower in the tirzepatide groups, and gastrointestinal AEs were mild or moderate in severity.</p><p><strong>Conclusions: </strong>Tirzepatide significantly improved glycaemic control and body weight reduction compared to insulin glargine over 104 weeks in participants with type 2 diabetes inadequately controlled on metformin and/or sulfonylurea. The safety profile of tirzepatide was acceptable, with a lower incidence of hypoglycaemia than insulin glargine.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028690","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":"Lower risk of cardiovascular events in patients initiated on semaglutide 2.4 mg in the real-world: Results from the SCORE study (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity in the Real World).","authors":"Kim G Smolderen, Carlos Mena-Hurtado, Zhenxiang Zhao, Wojciech Michalak, Mads Faurby, B Gabriel Smolarz, Mikhail N Kosiborod, Jinlin Song, Yan Chen, Joanna Boland, Michael G Nanna","doi":"10.1111/dom.70080","DOIUrl":"https://doi.org/10.1111/dom.70080","url":null,"abstract":"<p><strong>Aims: </strong>In this first interim analysis of the SCORE study, we investigated the risk of major adverse cardiovascular events (MACE) among individuals with atherosclerotic cardiovascular disease (ASCVD) and overweight/obesity but without diabetes who initiated semaglutide 2.4 mg in real-world settings.</p><p><strong>Materials and methods: </strong>Individuals initiating semaglutide 2.4 mg aged ≥45 years with ASCVD and overweight/obesity but without diabetes were identified in a US database (01/01/2016-12/31/2023) and matched 1:2 to those not on semaglutide based on a non-parsimonious propensity-score model. The primary outcomes included revised 3-point MACE (rMACE-3: myocardial infarction, stroke, and all-cause mortality) and revised 5-point MACE (rMACE-5: rMACE-3, coronary revascularisation, and hospitalisation for heart failure). Secondary outcomes included MACE-3 and MACE-5, defined similarly to rMACE-3 and rMACE-5 but replacing all-cause mortality with cardiovascular-related mortality. Exploratory outcomes included incident type 2 diabetes, major adverse kidney events, and major obesity-related adverse events.</p><p><strong>Results: </strong>A total of 9321 individuals on semaglutide 2.4 mg were matched to 18,642 individuals not on semaglutide; patient characteristics were well-balanced between cohorts. Over a mean follow-up of 200 days, semaglutide 2.4 mg was associated with significantly lower risks of rMACE-5 (hazard ratio: 0.55; p < 0.001), rMACE-3 (0.43; p < 0.001), MACE-5 (0.65; p < 0.001), and MACE-3 (0.58; p < 0.01). Semaglutide 2.4 mg was also associated with lower risks of all-cause mortality, cardiovascular-related mortality, hospitalisation for heart failure, and all exploratory outcomes.</p><p><strong>Conclusions: </strong>In this real-world study of US individuals with ASCVD and overweight/obesity but without diabetes, semaglutide 2.4 mg was associated with significantly reduced risk of MACEs and other obesity-related morbidities (NCT06874751).</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028643","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 risk reduction with glucagon-like peptide-1 receptor agonists is proportional to HbA1c lowering in type 2 diabetes: An updated meta-regression analysis incorporating FLOW and SOUL trials.","authors":"Masashi Hasebe, Chen-Yang Su, Yamato Keidai, Hiroto Minamino, Daisuke Yabe, Nobuya Inagaki, Satoshi Yoshiji","doi":"10.1111/dom.70121","DOIUrl":"https://doi.org/10.1111/dom.70121","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate relationships of cardiovascular and kidney outcomes with glycemic or bodyweight reductions in randomised placebo-controlled trials of glucagon-like peptide-1 receptor agonists (GLP-1RAs), incorporating data from FLOW and SOUL trials.</p><p><strong>Materials and methods: </strong>PubMed and EMBASE were searched up to 22 August 2025 for placebo-controlled randomized trials of oral or bolus-type, subcutaneous GLP-1RAs reporting major adverse cardiovascular events (MACE; a composite of cardiovascular death, myocardial infarction, and stroke) in adults with type 2 diabetes. The primary outcome was MACE; secondary outcomes included heart failure (HF) and kidney outcomes. Random-effects meta-analyses were followed by meta-regression evaluating associations with HbA1c and bodyweight reduction.</p><p><strong>Results: </strong>A total of 73 263 individuals were included from 10 trials (ELIXA, LEADER, SUSTAIN-6, EXSCEL, Harmony Outcomes, PIONEER 6, REWIND, AMPLITUDE-O, FLOW, and SOUL). GLP-1RAs reduced MACE by 14% (hazard ratio: 0.86; 95% CI: 0.82 to 0.91; p <0.001), as well as hospitalisation for HF and the composite kidney outcome (both p <0.001). Meta-regression showed that every 1% extra reduction in HbA1c corresponded to a 27% lower HR for MACE (p = 0.015; R² = 0.61). While HbA1c reduction was not significantly associated with secondary outcomes, the directionality was consistent with MACE. Bodyweight change was not associated with any of the analysed endpoints, including MACE (p = 0.13; R² = 0.21).</p><p><strong>Conclusions: </strong>HbA1c reduction, not bodyweight change, was significantly and proportionally associated with MACE risk reduction. HbA1c lowering may serve as a useful surrogate for the cardiovascular improvements associated with GLP-1RAs in type 2 diabetes.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028697","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":"Hypoglycemia incidence and behavioural adjustments during free-living unstructured physical activity in adults with type 1 diabetes using AID systems: Results from the RAPPID study.","authors":"Michael Joubert, Laurent Meyer, Said Bekka, Luc Rakotoarisoa, Nicolas Scheyer, Bleuenn Dreves, Bruno Guerci","doi":"10.1111/dom.70122","DOIUrl":"https://doi.org/10.1111/dom.70122","url":null,"abstract":"<p><strong>Aims: </strong>To assess the frequency and management of hypoglycaemia during unstructured physical activity (PA) in adults with type 1 diabetes (T1D) using automated insulin delivery (AID) systems in real-life settings.</p><p><strong>Materials and methods: </strong>RAPPID is a prospective, multicenter, observational study conducted over 1 month in four French tertiary care centres. Adults with T1D using one of three AID systems (MiniMed 780G, Tandem t:slim X2 with Control-IQ, or Ypsopump with CamAPS FX) and performing ≥2 unstructured PA sessions per week were included. Participants completed paper logbooks documenting each PA session (type, intensity, hypoglycemia, adjustments). Continuous glucose monitoring (CGM) and pump data were downloaded. Glycaemic control was assessed using CGM-derived metrics within predefined peri-exercise time windows.</p><p><strong>Results: </strong>Eighty-six participants (mean age 42.5 ± 14.3 years; 43% women; diabetes duration 23.6 ± 13.1 years; mean HbA1c 52 ± 7 mmol/mol (6.9% ± 0.6%)) reported 954 PA sessions (73% aerobic; 61% moderate intensity). TBR (<70 mg/dL) increased from 1% pre-exercise to 6% during and 5% post-exercise (early recovery phase). Clinical hypoglycaemia occurred in 20% of sessions (one-third of episodes were asymptomatic); 38% of participants experienced at least 1 level 2 event (<54 mg/dL). Anaerobic or high-intensity sessions were associated with lower hypoglycaemia risk. Temporary targets were used in 73% of sessions but initiated ≥1 h before PA in only 27%. Carbohydrate intake before and during PA was frequent but often suboptimally timed or dosed.</p><p><strong>Conclusions: </strong>Hypoglycemia remains common during and after PA in AID users. Suboptimal adjustment strategies and impaired symptom awareness contribute to risk. Individualised education remains essential to enhance safety.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028660","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}