The Lancet Diabetes & Endocrinology最新文献

{"title":"Strengthening diabetes care in sub-Saharan Africa: health systems, digital innovations, lifestyle interventions, and socioeconomic dimensions","authors":"Shabana Cassambai, Pamela Godia, Silver Bahendeka, Damilola Omodara, Deborah Ikhile, Samuel Seidu, Kamlesh Khunti","doi":"10.1016/s2213-8587(26)00035-5","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00035-5","url":null,"abstract":"The prevalence of diabetes, particularly type 2, in sub-Saharan Africa is rising at an alarming rate. This surge has exposed deep structural challenges, including an over-reliance on hospital-based services and strong cultural and faith-based influences that shape health-seeking behaviours. These factors, combined with socioeconomic inequalities and urbanisation, contribute to poor glycaemic control. Several strategies have been proposed to tackle this problem, including task shifting, integrated models that make use of HIV care infrastructure, digital health tools such as SMS reminders, culturally adapted lifestyle and nutrition programmes, community-based and faith-based interventions, and public–private partnerships. Despite these promising approaches, evidence of long-term sustainability, scalability, cost-effectiveness, and the impact of these interventions remains scarce. Additionally, stigma, gender-related barriers, and patient-reported outcomes are insufficiently studied in sub-Saharan Africa. Large-scale, longitudinal research is urgently needed to assess health system strengthening and culturally grounded models. Achieving effective diabetes care will require resilient, inclusive systems that integrate clinical, community, and digital innovations within the sociocultural and economic realities of the region.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"22 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety, tolerability, pharmacokinetics, and efficacy of burosumab in infants with X-linked hypophosphataemia: an open-label, multicentre, non-randomised study.","authors":"Agnès Linglart, Francesco Emma, Justine Bacchetta, Francisco de la Cerda, Wesley Hayes, Moira Cheung, Alessandra Cocca, Wolfgang Högler, Raja Padidela, Lucy Henderson, Alina Tudor, Hiroki Okada, Wei Sun, Emilia Quattrocchi","doi":"10.1016/S2213-8587(26)00013-6","DOIUrl":"https://doi.org/10.1016/S2213-8587(26)00013-6","url":null,"abstract":"<p><strong>Background: </strong>Burosumab, a human anti-fibroblast growth factor 23 monoclonal antibody, is approved in Europe for treating X-linked hypophosphataemia (XLH) in patients aged at least 1 year. Early initiation might further improve clinical outcomes. This study investigated the safety and efficacy of administering burosumab to patients younger than 12 months.</p><p><strong>Methods: </strong>This open-label, non-randomised, phase 1/2 study included infants from clinical sites in Austria, France, Italy, Spain and the UK. Key eligibility criteria were age less than 12 months, presence of a pathogenic or likely pathogenic variant, or variant of uncertain importance in the PHEX gene in either the participant or a directly related family member with appropriate X-linked inheritance, and hypophosphataemia. Participants received burosumab every 2 weeks for up to 48 weeks: cohorts 1 and 2 (infants aged from 6 to less than 12 months with starting doses 0·4 or 0·8 mg/kg) and cohort 3 (infants younger than 6 months with starting dose 0·4 mg/kg). The primary endpoint was safety and tolerability assessed in the full-analysis set of all participants who received at least one dose of burosumab and had at least one serum phosphate measurement after treatment, was safety, with a focus on treatment-emergent adverse events (TEAEs). The study is registered with ClinicalTrials.gov (NCT04188964) and is completed.</p><p><strong>Findings: </strong>Study recruitment was initiated on Feb 26, 2020, and the study was completed on March 6, 2024. Of 17 participants assessed for eligibility, 16 were enrolled and assigned to cohorts 1, 2, and 3, which included three, nine, and four participants, respectively (n=16); seven of 16 were female, 15 of 16 completed the study, one discontinued and transitioned to receive burosumab in a local hospital. All participants had TEAEs with no differences in incidence across cohorts; four had at least one treatment-related TEAE, one developed antidrug antibodies. No TEAEs led to treatment discontinuation or death. The most common TEAE was pyrexia, reported in 12 (75%) of 16 (95% CI 47·6-92·7) participants. The most common treatment-related TEAE was blood parathyroid hormone increase, reported in three (19%) of 16 (4·0-45·6) participants.</p><p><strong>Interpretation: </strong>This study confirms the safety and tolerability of burosumab in patients with XLH initiating treatment aged less than 12 months and is consistent with previous reports with no new safety concerns.</p><p><strong>Funding: </strong>Kyowa Kirin Pharmaceutical Development.</p>","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":" ","pages":""},"PeriodicalIF":41.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes-related complications and multiple long-term conditions in sub-Saharan Africa: determinants and management strategies","authors":"Deborah Ikhile, Samuel Seidu, Damilola Omodara, Jean Claude Katte, Kaushik Ramaiya, Kamlesh Khunti","doi":"10.1016/s2213-8587(26)00036-7","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00036-7","url":null,"abstract":"Saharan Africa is experiencing a rapid increase in the burden of diabetes, accompanied by increasing rates of microvascular, macrovascular, and pregnancy-related complications. This Series paper synthesises current evidence on diabetes-related complications in sub-Saharan Africa and examines shared cardiometabolic risks, mental health comorbidities, and interactions with communicable diseases through a multiple long-term conditions lens. Widespread late diagnosis and inadequate control of key cardiometabolic risk factors (eg, hypertension, dyslipidaemia, obesity, and hyperglycaemia) drive high complication rates—whereas mental health disorders and infectious disease comorbidities further exacerbate susceptibility. Although risk factor reduction is central to preventing diabetes complications in sub-Saharan Africa, progress is impeded by multilevel barriers spanning individual, interpersonal, health system, societal, and policy domains. To address this growing complexity, we identify priorities for research and implementation, including the development of context-specific guidelines, scalable integrated care models, strengthened surveillance systems, and long-term cohorts co-designed with communities, health-care providers, and policy makers.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"11 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous glucose monitoring versus self-monitoring of blood glucose in individuals with type 2 diabetes: a randomised, multicentre, open-label, superiority trial.","authors":"Emma G Wilmot, Patrick Moore, Thozhukat Sathyapalan, Pratik Choudhary, Jonathan Z M Lim, Sankalpa Neupane, Thomas S J Crabtree, Ahmed Iqbal, Mark L Evans, Gerry Rayman, Hermione C Price, Ramzi A Ajjan, Yee S Cheah, Alistair Lumb, Samiul Mostafa, Iqbal Malik, Iain Cranston, Thinzar Min, Edward B Jude, Shivshankar Seechurn, James McLaren, Katharine Barnard-Kelly, Thomas Yates, Rachel A Elliott, Lalantha Leelarathna","doi":"10.1016/S2213-8587(26)00076-8","DOIUrl":"https://doi.org/10.1016/S2213-8587(26)00076-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Type 2 diabetes is the most common metabolic disorder worldwide, accounting for about 90% of people living with diabetes. Glycated haemoglobin (HbA&lt;sub&gt;1c&lt;/sub&gt;), a measure of chronic glycaemic exposure, correlates with the risk of long-term complications, which can result in substantial morbidity for people with diabetes and major costs to health-care systems. The value of continuous glucose monitoring (CGM) in people with type 2 diabetes managed with basal insulin and modern therapies remains unclear. FreeDM2 aimed to evaluate the effectiveness of real-time CGM in adults with type 2 diabetes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This open-label, parallel-design, randomised controlled trial conducted across 24 primary and secondary care centres in the UK enrolled adults with type 2 diabetes managed with basal insulin and SGLT2 inhibitors or GLP-1 receptor agonists or dual GIP/GLP-1 receptor agonists with HbA&lt;sub&gt;1c&lt;/sub&gt; 7·5-11·0%. Participants were assigned (2:1; using permuted block randomisation by study site, generated by Sealed Envelope) to CGM (intervention) or continuation of self-monitoring of blood glucose (SMBG; control), across two phases: weeks 1-16, self-management with basal insulin self-titration; and weeks 17-32, clinician-supported where additional therapies could be initiated in line with national guidance. Participants and study site staff were not masked to group allocation. The primary outcome was difference between groups in HbA&lt;sub&gt;1c&lt;/sub&gt; concentrations at 16 weeks, and the key secondary outcome was the difference between groups at 32 weeks, both in the treatment policy estimand. Safety analysis included all randomly assigned participants. The FreeDM2 randomised controlled trial is registered at ClinicalTrials.gov (NCT05944432) and is complete.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between July 26, 2023, and Jan 31, 2025, 469 individuals underwent screening for potential study inclusion, 140 were excluded due to not meeting inclusion criteria, and 329 were included in the baseline phase of the study. 26 individuals were then excluded due to insufficient data capture or withdrawal, and 303 participants were randomly assigned; 198 to the CGM intervention group and 105 to the SMBG control group. 204 (67%) participants were male and 99 (33%) were female, the mean age of the cohort was 60·7 years (SD 9·8), and mean diabetes duration was 16·7 years (6·9). Baseline HbA&lt;sub&gt;1c&lt;/sub&gt; concentration was 8·8% (SD 1·0) in the CGM group and 8·8% (1·1) in the control group, decreasing to 8·0% (0·9) in the CGM group and to 8·7% (1·1) in the control group at week 16 (adjusted difference -0·6 [95% CI -0·8 to -0·3]; p&lt;0·0001) and decreasing further to 7·8% (0·9) in the CGM group and to 8·3% (1·2) in the control group at week 32 (adjusted difference -0·5 [95% CI -0·7 to -0·2]; p&lt;0·0001). There was a similar incidence of non-device-related adverse events in both groups, and two instances of severe hypoglycaemia in the c","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":" ","pages":""},"PeriodicalIF":41.8,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Freedom through technology: transforming management of type 2 diabetes.","authors":"Charlotte K Boughton","doi":"10.1016/S2213-8587(26)00080-X","DOIUrl":"https://doi.org/10.1016/S2213-8587(26)00080-X","url":null,"abstract":"","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":" ","pages":""},"PeriodicalIF":41.8,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A conceptual framework for modernising and right-sizing global diabetes care","authors":"Mohammed K Ali, Rodrigo M Carillo-Larco, Troels Krarup Hansen, Nikhil Tandon, Martin Ridderstråle","doi":"10.1016/s2213-8587(26)00070-7","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00070-7","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"9 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What REDEFINE 5 signals for obesity trials in Asia and beyond","authors":"Yu Mi Kang, Vanita R Aroda","doi":"10.1016/s2213-8587(26)00012-4","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00012-4","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"7 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147708650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of co-administered cagrilintide and semaglutide versus semaglutide alone in adults with overweight or obesity with or without type 2 diabetes in Japan and Taiwan (REDEFINE 5): a multicentre, randomised, active-controlled, phase 3a trial","authors":"Toshimasa Yamauchi, Niels-Peter Becker, Christoffer Andersen Hagemann, Kuo-Chin Huang, Arihiro Kiyosue, Soo Lim, Yukiko Onishi, Ananda Kosuvaripalli, Tomoko Takano, Yasushi Ishigaki","doi":"10.1016/s2213-8587(25)00402-4","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00402-4","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;The combination of cagrilintide and semaglutide has been shown in global studies to induce reductions in bodyweight. We assessed the efficacy and safety of a fixed-dose combination of cagrilintide 2·4 mg and semaglutide 2·4 mg versus semaglutide 2·4 mg for weight management in an east Asian population.&lt;h3&gt;Methods&lt;/h3&gt;This double-blind, parallel-group, phase 3a trial (REDEFINE 5) was conducted across 21 sites (community, hospital) in Japan and one site in Taiwan. We included participants aged at least 18 years with a BMI of at least 27 kg/m&lt;sup&gt;2&lt;/sup&gt; and at least two obesity-related complications, or with a BMI of at least 35 kg/m&lt;sup&gt;2&lt;/sup&gt; and at least one obesity-related complication (per the Japan Society for the Study of Obesity guidelines), with or without type 2 diabetes. Participants were randomly assigned (1:1) to once-weekly subcutaneous injections of cagrilintide–semaglutide or semaglutide (both escalated to 2·4 mg), plus lifestyle intervention, for 68 weeks. Randomisation was done centrally using an interactive web response system and stratified according to planned CT scan, BMI of at least 35 kg/m&lt;sup&gt;2&lt;/sup&gt;, and type 2 diabetes status. Participants, site staff, investigators, and study funder were all masked to active study treatments. The primary endpoint was relative change in bodyweight from baseline to week 68. Efficacy analyses were done in all participants who underwent randomisation, using the trial product estimand (ie, assuming the treatment was taken as intended, regardless of dose) as the primary estimand. Missing data at week 68 were imputed. Safety analyses were done in all participants who underwent randomisation and received at least one dose of trial product. This trial is registered with &lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"&gt;&lt;path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt; (&lt;span&gt;&lt;span&gt;NCT05813925&lt;/span&gt;&lt;svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"&gt;&lt;path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;) and is complete.&lt;h3&gt;Findings&lt;/h3&gt;Between April 3, 2023, and Sept 15, 2023, we screened 355 individuals; 331 were randomly assigned to cagrilintide–semaglutide (n=164) or semaglutide (n=167). 226 (68%) participants were male and 105 (32%) were female; 80 (24%) had type 2 diabetes. 17 (10%) participants discontinued cagrilintide–semaglutide and ten (6%) discontinued semaglutide. The estimated mean change in bodyweight from baseline to week 68 was −18·4% (SE 0·7) in the cagrilintide–semaglutide group versus −11·9% (0·7) in the semaglutide group (estimated treatment difference [ETD] −6·5 percentage points [95% CI −8·4 to −4·6]; p&lt;0·0001). Adverse events were reported by 143 (87%) of 164 participants in the cagrilintide–semaglutide group and","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"224 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147708651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of microplastics as emerging endocrine disruptors.","authors":"Stefan R Bornstein, Kaomei Guan, Torsten Wuestefeld, Saravana K Ramasamy, Yusuf Ali, Joseph J Y Sung, Charlotte Steenblock","doi":"10.1016/S2213-8587(26)00074-4","DOIUrl":"https://doi.org/10.1016/S2213-8587(26)00074-4","url":null,"abstract":"","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":" ","pages":""},"PeriodicalIF":41.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary causes of diabetes: a crossroad of endocrinology and oncology","authors":"Nicholas Ken-Yoong Hee MBBS, Quan-Hziung Lim MBBS, Prof Kamlesh Khunti FMedSci, Ying-Guat Ooi MBBS, I-Weng Yen MD, Marniza Saad MD, Prof Elif I Ekinci PhD, Prof Hung-Yuan Li PhD, Prof Shireene R Vethakkan MD, Prof Juliana C N Chan MD, Prof Lee-Ling Lim PhD","doi":"10.1016/s2213-8587(26)00027-6","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00027-6","url":null,"abstract":"Cancer and diabetes share a bidirectional relationship, with cancer increasingly recognised as an associated factor of diabetes, both from the disease itself and its treatments. In this Review, we aim to: (1) summarise the distinct mechanisms of dysglycaemia arising from cancer and neuroendocrine tumour treatments, including targeted therapies such as PI3K–AKT–mTOR inhibitors, antibody–drug conjugates, immune checkpoint inhibitors, corticosteroids, and somatostatin receptor ligands; (2) examine the often overlooked aspect of the secondary cause of diabetes as an early manifestation of cancer; and (3) highlight research gaps and encourage a collaborative care approach to manage the rising rate of dysglycaemia as a result of cancer and its evolving treatments. To address the first two objectives, we incorporate relevant case vignettes to contextualise the discussions.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"130 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147681085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}