Diabetic medicine : a journal of the British Diabetic Association最新文献

{"title":"Predictive performance of the Saint Elian Wound Score System adjusted for age for major amputation in diabetic foot: A competing risks analysis.","authors":"Gabriela Carro, Fermín Martinez De Jesús, María Gabriela Rodriguez Rey, Federico Caporaso, Ruben Saurral","doi":"10.1111/dme.70503","DOIUrl":"https://doi.org/10.1111/dme.70503","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the prognostic performance of Saint Elian Wound Score System (SEWSS) adjusted for age in predicting major amputation (MA) in patients with diabetic foot (DF).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, including 406 patients with DF treated at a hospital in Argentina in 2025. The primary outcome was MA, with wound healing and death considered competing events. A Fine and Gray model was used to assess the association between SEWSS and MA, adjusted for age. Model performance was evaluated in terms of discrimination, calibration and global precision. Internal validation was performed using bootstrap resampling. Sensitivity analyses were conducted to assess the impact of early loss to follow-up.</p><p><strong>Results: </strong>During follow-up, 14.3% of patients underwent MA, 57.1% achieved wound healing and 3.5% died. In the competing risks model, each one-point increase in the SEWSS was associated with a 41% increase in the subdistribution hazard of MA (sHR 1.41; 95% CI 1.31-1.51; p < 0.001), adjusted for age. The model demonstrated a 180-day good discriminative ability, with a bootstrap-corrected AUC of 0.848 and a Brier score of 0.097. Calibration was adequate in low and intermediate-risk ranges.</p><p><strong>Conclusions: </strong>The SEWSS, when adjusted for age and analysed using a competing risks framework, shows good prognostic performance for predicting MA in patients with DF. The model may support risk stratification and clinical decision-making, although external validation in independent populations is required.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70503"},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New insights into β-cell vulnerability in type 1 diabetes-Lessons from nature.","authors":"Kathryn Murrall, Teifion Luckett, Christiana Lekka, Stephanie L Hunter, Sylvie Agnello, Peter Ferris, Emma Haxton, Christine S Flaxman, Abirami Kannan, Xinpeng Dun, Sarah J Richardson","doi":"10.1111/dme.70509","DOIUrl":"https://doi.org/10.1111/dme.70509","url":null,"abstract":"<p><p>Type 1 diabetes results from an autoimmune-mediated destruction of pancreatic β-cells, yet considerable heterogeneity exists regarding disease onset, progression and severity. Emerging evidence suggests that this variability reflects not only differences in immune responses, but also differences in the architecture and immune landscape of the endocrine pancreas. Our recent Steve Morgan Foundation Grand Challenge studies have provided important 'lessons from nature', revealing that the endocrine tissue in the human pancreas exists as a continuum of endocrine objects (EOs), ranging from isolated endocrine cells and small clusters to large islets. These structures differ in their cellular composition, vascularisation, innervation and maturity, creating distinct β-cell microenvironments that evolve throughout life and may shape susceptibility to autoimmune attack. Strikingly, β-cells in small EOs are preferentially lost in type 1 diabetes, suggesting EO size and organisation contribute to β-cell vulnerability. In parallel, we are advancing our understanding of changes in classical and non-classical human leukocyte antigen (HLA-I) expression in type 1 diabetes which can impact β-cell visibility to autoreactive T cells, and have demonstrated that soluble forms of HLA-I can be released from β-cells under inflammatory conditions associated with type 1 diabetes. Taken together, our findings support a model in which disease progression is shaped by interactions between a heterogeneous immune response and a heterogeneous endocrine landscape that can vary across the life course. Improving our understanding of how endocrine architecture, immune niches and HLA-mediated antigen presentation interact could identify new opportunities to protect and expand β-cell populations through targeted therapies in the future.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70509"},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Islet-exocrine crosstalk in diabetes: Distinguishing whole-pancreas pathology from causal communication.","authors":"Sophia Bigot, Amin Ardestani","doi":"10.1111/dme.70505","DOIUrl":"https://doi.org/10.1111/dme.70505","url":null,"abstract":"<p><strong>Aims: </strong>To critically evaluate how communication between the endocrine and exocrine pancreas contributes to diabetes and to distinguish whole-pancreas involvement from mechanistically demonstrated crosstalk.</p><p><strong>Methods: </strong>We conducted a narrative review of anatomical, imaging, histological, molecular and experimental evidence on endocrine-exocrine communication, prioritising recent primary human and mechanistic studies.</p><p><strong>Results: </strong>Islets and exocrine tissue communicate through local vascular, neural, stromal and extracellular matrix routes. Diabetes is associated with distinct whole-pancreas phenotypes: type 1 diabetes (T1D) shows reduced pancreatic volume, acinar loss, exocrine immune infiltration and periductal or perivascular fibrosis, whereas type 2 diabetes (T2D) more often shows acinar-to-ductal metaplasia, lobular or parenchymal fibrosis, angiopathy and increased pancreatic fat fraction on imaging, although histological adiposity is inconsistent. The strongest mechanistic evidence supports insulin-mediated acinar protection, acinar protease effects on β-cells and transfer of mutant carboxyl ester lipase in maturity-onset diabetes of the young type 8 (MODY8), while stromal, matrix and immune signals represent important but less fully validated amplifying pathways. In T1D and T2D, crosstalk most plausibly acts as a stage-dependent amplifier rather than a universal initiating event.</p><p><strong>Conclusions: </strong>Diabetes should be studied as a multicellular pancreatic disorder without interpreting associated pathology as evidence of causation. Longitudinal human studies and multicellular models that allow selective perturbation are required to identify clinically actionable interactions.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70505"},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world observational study evaluating metabolic and kidney outcomes in patients living with chronic kidney disease and type 2 diabetes mellitus with obesity prescribed tirzepatide.","authors":"Jack E Carruthers, Xi Yan Ooi, Dawn Goodall, Jo Reed, Rachna Bedi, Adrian McGrath, Michelle Willicombe, Parizad Avari, Andrew H Frankel","doi":"10.1111/dme.70500","DOIUrl":"https://doi.org/10.1111/dme.70500","url":null,"abstract":"<p><strong>Background: </strong>Obesity and type 2 diabetes mellitus (T2DM) accelerate chronic kidney disease (CKD) progression. Tirzepatide, a dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist, has demonstrated metabolic and potential renoprotective benefits in clinical trials. There have been limited reports of the implications of prescribing tirzepatide in a real-world cohort of patients with advanced CKD.</p><p><strong>Methods: </strong>This observational study includes a multi-ethnic cohort of 62 adults with CKD stages 1-5 who initiated tirzepatide indicated for T2DM with concurrent obesity in a general nephrology clinic between June 2024 and October 2025. Patients were followed for a median of 21.4 weeks. Clinical outcomes including weight, glycated haemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (uACR), blood pressure, lipid profile and insulin requirements were collected.</p><p><strong>Results: </strong>Tirzepatide significantly reduced median weight (103-100 kg; p < 0.0001), HbA1c (63 [7.9%] to 54 [7.1%] mmol/mol; p = 0.002) and uACR (111-44 mg/mmol; p = 0.008), while eGFR remained stable. Significant improvements were also observed in triglycerides, total cholesterol, LDL cholesterol and total daily insulin dose. Gastrointestinal symptoms and decreased serum bicarbonate were the most common adverse events.</p><p><strong>Conclusions: </strong>In this real-world, multi-ethnic cohort, including patients with advanced CKD, tirzepatide was associated with clinically meaningful improvements in weight, glycaemic control, albuminuria, lipid profile and insulin requirements without adversely affecting kidney function. The introduction of tirzepatide to patients with CKD should be guided by a multidisciplinary team.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70500"},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key safety outcomes of SGLT2 inhibitors versus DPP-4 inhibitors in general and vulnerable participants with T2DM: A target trial emulation study.","authors":"Chieh-Li Yen, Pei-Ru Li, Chao-Yi Wu, Chung-Ying Tsai, Jia-Jin Chen, Chang-Chyi Jenq, Hsiang-Hao Hsu, Chang-Fu Kuo, Lai-Chu See, Huang-Yu Yang","doi":"10.1111/dme.70504","DOIUrl":"https://doi.org/10.1111/dme.70504","url":null,"abstract":"<p><strong>Aims: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2i), a class of oral hypoglycaemic agents (OHAs), have demonstrated cardiovascular and renal benefits. However, safety concerns may hinder their broader adoption, particularly among frail populations. We evaluated key safety outcomes associated with SGLT2i compared with dipeptidyl peptidase-4 inhibitors (DPP4i), an OHA class with low risks of complications.</p><p><strong>Methods: </strong>We conducted a target trial emulation (TTE) study using Taiwan's National Health Insurance Research Database (NHIRD) and enrolled participants with type 2 diabetes mellitus (T2DM). Eligible participants were categorized according to newly initiated SGLT2i (n = 224,510) or newly initiated DPP4i (n = 698,012) with continuous use for at least 30 days. Propensity score overlap weighting (PSOW) was used to balance baseline characteristics.</p><p><strong>Results: </strong>In the intention-to-treat analysis, the SGLT2i group showed significantly lower incidence rate (per person-years) of several safety outcomes than the DPP4i group, including urinary tract infection (UTI) (23.84‰ vs. 27.88‰; hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.84-0.87), fractures or falls (16.55‰ vs. 17.79‰; HR, 0.93; 95% CI, 0.91-0.95), acute kidney injury (AKI) (1.06‰ vs. 1.91‰; HR, 0.55; 95% CI, 0.51-0.59), bullous pemphigoid (0.02‰ vs. 0.07‰; HR, 0.35; 95% CI, 0.23-0.54), and all-cause mortality (13.05‰ vs. 19.72‰; HR, 0.66; 95% CI, 0.65-0.67). Conversely, the risk of genital infection was higher in the SGLT2i group (2.96‰ vs. 2.05‰; HR, 1.44; 95% CI, 1.38-1.51). These findings remained consistent in the per-protocol analysis, across most vulnerable subgroups and individual SGLT2i and DPP4i agents.</p><p><strong>Conclusions: </strong>SGLT2i, compared with DPP4i, demonstrated a favourable safety profile across most evaluated outcomes, except for genital infections.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70504"},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What do administrative diabetes indicators measure? Treatment-side and screening-side evidence from nationwide NDB Open Data in Japan.","authors":"Haruki Saito, Tetsuya Ohira","doi":"10.1111/dme.70501","DOIUrl":"https://doi.org/10.1111/dme.70501","url":null,"abstract":"<p><strong>Aims: </strong>Regional administrative diabetes indicators are increasingly used for population surveillance and planning, yet they are generated through the healthcare system rather than measuring disease directly. We examined what two complementary indicator families-treatment-side prescription quantities and screening-side HbA1c-measure across 47 Japanese prefectures.</p><p><strong>Methods: </strong>Cross-sectional ecological study using the 10th NDB Open Data release. Indicator A was oral antidiabetic agent dispensing volume per population (drug classification 396), related to ageing, income, education and population density by ordinary least squares with VIF assessment and AIC-based comparison. Indicator B comprised the HbA1c high-value rate, mean HbA1c and the D005 laboratory-testing rate, related to three claim-rate outcomes by ordinary least squares with HC3 errors (five sensitivity specifications).</p><p><strong>Results: </strong>For Indicator A, ageing was the only significant univariable predictor (β = 9961; R² = 0.324); the lowest-AIC model retained ageing and income (R² = 0.394; VIF = 2.18; income β = 56.6, p = 0.030). For Indicator B, the HbA1c high-value rate was associated with chronic dialysis management (β = 195.1/%pt., p = 0.006, R² = 0.271); mean HbA1c showed a comparable association; the primary association was stable across all five specifications.</p><p><strong>Conclusions: </strong>Neither indicator family provided a direct estimate of disease burden. Prescription quantities reflected demographic and income structure, whereas HbA1c indicators showed a selective ecological association with downstream service use. Both are better interpreted as ecological surveillance indicators than direct measures of disease burden or prevalence.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70501"},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity and sleep patterns in women 1 year after gestational diabetes: Results from the Face-it study.","authors":"Fiona Ryom Eskildsen, Majken Lillholm Pico, Jan Christian Brønd, Marie Borg Bugge, Ulla Kampmann, Christina Anne Vinter, Per Glud Ovesen, Peter Damm, Elisabeth Reinhardt Mathiesen, Dorte Møller Jensen, Helle Terkildsen Maindal, Karoline Kragelund Nielsen, Inger Katrine Dahl-Petersen","doi":"10.1111/dme.70487","DOIUrl":"https://doi.org/10.1111/dme.70487","url":null,"abstract":"<p><strong>Aims: </strong>Moderate-to-vigorous physical activity (MVPA) and adequate, high-quality sleep are important for cardiometabolic health in women with recent gestational diabetes mellitus (GDM) but are likely reduced during early motherhood. These behaviours may be associated; however, device-measured sleep data and studies of these associations remain scarce in this population. This cross sectional study characterised MVPA and sleep patterns and examined their associations in women with recent GDM.</p><p><strong>Methods: </strong>In the Face-it trial, 185 women provided device-measured MVPA and sleep data 1 year after delivery. Sleep variables included duration and efficiency, reflecting sleep quantity and quality. Duration was categorised as <6, 6-8 (reference) and >8 h/night. Associations with MVPA were analysed using linear mixed-effects models with site as a random intercept, adjusted for potential confounders.</p><p><strong>Results: </strong>Two-thirds (61.6%) met WHO recommendations for moderate-intensity physical activity (PA), whereas few (3.2%) met recommendations for vigorous-intensity PA. Most met recommendations for sleep duration (87.6%) and sleep efficiency (83.8%). Compared to 6-8 h/night, there was no difference in MVPA among those sleeping <6 h/night (β = -2.5, 95% CI = -11.8, 6.7, p = 0.593). Durations >8 h/night were associated with less MVPA (β = -13.5, 95% CI = -23.0, -4.0, p = 0.006). Sleep efficiency was positively associated with MVPA (β = 0.6, 95% CI = 0.1, 1.1, p = 0.018).</p><p><strong>Conclusions: </strong>The association between high-quality sleep and greater MVPA suggests that PA and sleep may not only independently be relevant to cardiometabolic health but may also be associated in women with recent GDM.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70487"},"PeriodicalIF":3.4,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the long-term cost-effectiveness of a free online Diabetes Self-Management Education and Support service in England: Healthy living for people with type 2 diabetes, using a matched cohort study design.","authors":"Luke Paterson, Salwa S Zghebi, Evangelos Kontopantelis, Sarah Cotterill, Eric Lowndes, Brian McMillan, Martin K Rutter, Rachel A Elliott","doi":"10.1111/dme.70490","DOIUrl":"https://doi.org/10.1111/dme.70490","url":null,"abstract":"<p><strong>Aims: </strong>The National Health Service (NHS) offers Healthy Living, an online Diabetes Self-Management Education and Support service, to help people Self Manage Type 2 Diabetes, with modest 1-year reductions in HbA1c levels, systolic blood pressure and body mass index. We aim to assess the cost-effectiveness of Healthy Living compared with usual care.</p><p><strong>Methods: </strong>A patient-level economic simulation model (UKPDS-OM2.1) was used to conduct an economic analysis from the NHS perspective over a lifetime horizon, discounted at 3.5%. The model translated risk factor reductions to long-term cost and quality-adjusted life year (QALY) estimates. Additional analyses estimated intervention and medication cost consequences.</p><p><strong>Results: </strong>The UKPDS-OM2.1 predicted a modest improvement in health (0.016 QALYs) and a small reduction in lifetime healthcare costs (-£4 per person). Offsetting with intervention costs (£7 per user) and increased medication costs (£212 per user) yielded a net cost of £216 per user. The cost-per-QALY of £13,192 was below the lower NICE threshold (£25,000/QALY), indicating that the programme is cost-effective. Sensitivity analyses largely demonstrated robustness, but the finding was sensitive to structural assumptions about disease progression post-intervention with the inclusion of medication costs.</p><p><strong>Conclusion: </strong>Healthy Living appears to be a low-cost, online intervention for self managing type 2 diabetes, generating modest health benefits that are likely to be considered cost-effective use of NHS resources. While there is some uncertainty in the cost-effectiveness and the modelling is based on effectiveness estimated from observational data, improvements in uptake and adherence has the potential to improve the value for money to the NHS.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70490"},"PeriodicalIF":3.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capability, opportunity and motivation to support adults with type 1 diabetes experiencing fear of hypoglycaemia: A survey of Australian diabetes healthcare professionals.","authors":"Uffe Søholm, Jennifer Halliday, Elizabeth Holmes-Truscott, Virginia Hagger, Alison Robinson, Caitlin Rogers, Christian Criado-Perez, Sienna Russell-Green, Sofianos Andrikopoulos, James A M Shaw, Jane Speight","doi":"10.1111/dme.70496","DOIUrl":"https://doi.org/10.1111/dme.70496","url":null,"abstract":"<p><strong>Aim: </strong>To explore the perceptions, experiences and unmet needs of diabetes healthcare professionals (DHPs) for supporting adults with type 1 diabetes (T1D) with fear of hypoglycaemia (FoH).</p><p><strong>Method: </strong>An online survey explored Australian DHPs' perceived capability, opportunity, motivation and behaviours related to supporting adults with T1D with FoH. DHPs were recruited via online advertisements, e-newsletters and at conferences. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed thematically.</p><p><strong>Results: </strong>A total of 106 eligible DHPs were included (83% credentialled diabetes educators, 92% women, mean (SD) age 49 (11) years), from all eight states/territories. DHPs indicated that FoH is experienced by almost two thirds of adults with T1D in their clinics. Most DHPs believe addressing FoH is within their scope of clinical practice (83%), and report motivation (89%) and capability (skills and confidence, 71% and 70% respectively) to do so. While more than half (50%-71%) perceive they have the social opportunity (e.g. social norms, workplace culture), few report physical opportunity (8%-24%), for example, access to validated screening tools; financial remuneration; affordable mental healthcare referral pathways. Free-text responses highlighted the need for affordable and timely access to mental health professionals with knowledge about diabetes. Approximately eight out of ten would be (very) likely to refer those experiencing FoH to online self-guided programs, if available.</p><p><strong>Conclusion: </strong>These findings show that Australian DHPs report the motivation and capability, but lack the opportunity to support adults with T1D experiencing FoH. Innovative referral pathways, including online self-guided programmes, are perceived positively and may be useful in the Australian healthcare context.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70496"},"PeriodicalIF":3.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The DePICtion study: Implementing a diabetes classification tool in UK primary care-A qualitative study with primary care staff and patients.","authors":"Charlotte Lee, Maddy Geen, Clare Timblin, Anita Hill, Katherine Young, Robin Humphreys, Angus Jones, Maggie Shepherd, Andrew T Hattersley, Nadeem Qureshi, Beverley M Shields, Katrina Turner","doi":"10.1111/dme.70493","DOIUrl":"https://doi.org/10.1111/dme.70493","url":null,"abstract":"<p><strong>Background: </strong>The correct classification of diabetes (type 1, type 2 or rarer genetic forms) is essential for optimal treatment, but misclassification is common. The Diabetes in Primary Care Improving Classification (DePICtion) tool uses routinely collected clinical data to flag patients at risk of misclassification and prioritise them for further diagnostic testing.</p><p><strong>Aim: </strong>To explore the acceptability and implementation of the DePICtion tool in primary care.</p><p><strong>Design and setting: </strong>A qualitative study in 11 general practices across the Southwest and East Midlands, UK.</p><p><strong>Method: </strong>Twelve practices were recruited to the study; 11 practices ran the tool and reviewed flagged patients. Semi-structured interviews were conducted with 10 staff and 11 patients to explore their experiences of the tool, reactions to the results and barriers and facilitators to use. Data were analysed thematically in NVivo.</p><p><strong>Results: </strong>Staff found the tool straightforward, compatible with existing workflows and clinically useful. Implementation required time and ownership of the process. Patients' responses were shaped by trust in staff and the personal meaning of their diabetes: Some viewed reclassification as a threat to their diagnostic identity, while others welcomed further diagnostic testing. Data privacy concerns were minimal but competing demands on staff time and resources were ubiquitously reported.</p><p><strong>Conclusion: </strong>The DePICtion tool is acceptable and clinically useful for improving diabetes classification in primary care. Routine implementation is technically feasible but will require protected time, clear pathways for follow-up and support for patient communication and engagement.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70493"},"PeriodicalIF":3.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}