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

{"title":"Under- and overdosing insulin in the hospital: A retrospective cohort study of dose deviation and patient outcomes.","authors":"Hussein Zaitoon, Sher Matsri, Shira Nagler, Matteo M Lalovich, Ralph A DeFronzo, Eugene Feigin","doi":"10.1111/dme.70403","DOIUrl":"10.1111/dme.70403","url":null,"abstract":"<p><strong>Aims: </strong>Glycaemic abnormalities during hospitalization are common and linked to morbidity and mortality, yet little is known about how deviations from guideline-recommended insulin dosing affect outcomes. The aim of this study is to examine whether deviation from an expected insulin dose in non-critically ill hospitalized adults with type 2 diabetes, compared with guideline-concordant dosing, is associated with mortality, length of stay or dysglycaemias.</p><p><strong>Methods: </strong>This retrospective cohort study included adults with type 2 diabetes hospitalized at a tertiary academic medical centre (2010-2025) who received ≥ 24 h of subcutaneous insulin. The expected total daily insulin dose (TDID) was calculated based on guideline-concordant dosing using the ADA-recommended range (0.3-0.6 units/kg/day), and the observed TDID was derived from medication records. Patients were classified as undertreated (< 0.3 units/kg/day), guideline-concordant (0.3-0.6 units/kg/day) or overtreated (> 0.6 units/kg/day). Outcomes included length of stay, and 30-day mortality, hypoglycaemia and hyperglycaemia.</p><p><strong>Results: </strong>Among 3430 hospitalized adults with type 2 diabetes receiving subcutaneous insulin, 37.6% received guideline-concordant dosing, 43.7% were undertreated, and 18.7% were overtreated. Undertreatment was independently associated with increased 30-day mortality (aHR 1.273, 95% CI 1.024-1.583; p = 0.03), while overtreatment was not. Undertreated patients had more hyperglycaemia and longer hospital stays (p < 0.001), whereas hypoglycaemia rates were similar between groups.</p><p><strong>Conclusion: </strong>Deviation from guideline-based insulin dosing is common in hospitalized adults with type 2 diabetes. Undertreatment was associated with increased 30-day mortality and prolonged hospitalization. Monitoring insulin dose deviation may help identify patients at risk for adverse outcomes.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70403"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High blood glucose index stratifies glycaemic severity and identifies occult type 2 diabetes risk in prediabetes via single-day continuous glucose monitoring: A multi-cohort study.","authors":"Weiming Wu, Shihan Wang, Junxiang Gao, Shuoning Song, Yating Zhang, Yong Fu, Mengmeng Zhang, Tao Yuan, Weigang Zhao","doi":"10.1111/dme.70437","DOIUrl":"10.1111/dme.70437","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the platform-independent robustness of the continuous glucose monitoring (CGM)-derived High Blood Glucose Index (HBGI) and the predictive utility of a single day for progression to type 2 diabetes.</p><p><strong>Methods: </strong>We analysed 365 valid CGM records from three devices across four independent cohorts. Linear mixed-effects modelling partitioned HBGI variance by device, dataset and metabolic status. Cross-sectional analyses, utilizing full monitoring periods to ensure biological robustness, evaluated HBGI gradients across glycaemic stages. Longitudinal analyses, utilizing single-day recordings, evaluated its predictive accuracy for progression to overt diabetes.</p><p><strong>Results: </strong>Device type accounted for only 3.4% of total HBGI variance, compared with 31.8% for metabolic status. Cross-sectionally, HBGI demonstrated a robust stepwise increase from healthy through prediabetes to diabetes (p < 0.001). Longitudinally, baseline HBGI significantly differentiated metabolic progressors from non-progressors (p = 0.005) and showed moderate predictive accuracy (area under the curve = 0.74; 95% confidence interval: 0.61-0.85). Discriminative performance was comparable to mean glucose and superior to the M-value, time in range (70-180 mg/dL) and coefficient of variation. Notably, among prediabetic individuals with established glycaemic indices within recommended ranges, elevated HBGI (>0.174) identified an occult high-risk subgroup with a 5.39- to 6.13-fold higher progression risk.</p><p><strong>Conclusions: </strong>HBGI is a device-agnostic metric that effectively stratifies glycaemic severity. A single-day HBGI assessment provides complementary risk stratification by unmasking occult risk in prediabetes with established CGM indices within recommended ranges. However, given the limited progression events, its predictive threshold requires validation in larger, independent cohorts.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70437"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765581","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":"Associations between diabetic retinopathy and modifiable risk factors: Correction based on updated information.","authors":"M Trott, S Pardhan","doi":"10.1111/dme.70353","DOIUrl":"10.1111/dme.70353","url":null,"abstract":"","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70353"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, duration, and clinical implications of continuous glucose monitor measurement limit capping in type 1 diabetes.","authors":"John F Mulley","doi":"10.1111/dme.70412","DOIUrl":"10.1111/dme.70412","url":null,"abstract":"<p><strong>Aims: </strong>CGM devices report glucose only within fixed limits (typically 40-400 mg/dL; 2.2-22.2 mmol/L), truncating extreme values to a boundary ('capping'). We characterised prevalence, duration, and consequences of capping in type 1 diabetes trial data.</p><p><strong>Methods: </strong>We analysed 46,990,617 CGM readings from 948 participants across four publicly available clinical trial datasets (Dexcom G4 Platinum or G6 sensors). Capping prevalence, run duration, and associations with age, HbA1c, and sex were characterised across all datasets. In the 77 participants of the Replace-BG trial, CGM-plus-blood glucose monitor (BGM) arm, CGM-derived metrics were compared with contemporaneous BGM measurements across 1162 non-overlapping 14-day windows.</p><p><strong>Results: </strong>Between 93.5% and 100% of participants had at least one capped reading, and capped values comprised 0.47-0.98% of all readings. In the three datasets for which duration could be calculated, over 70% of upper-cap runs exceeded 15 min and over one third exceeded 60 min. Upper-limit capping was inversely associated with age (Spearman ρ -0.20 to -0.47, p ≤ 0.002) in three of the datasets, and positively associated with baseline HbA1c (ρ 0.39-0.62, p < 0.001) in all four datasets. A within-participant analysis showed that capping burden did not predict CGM-BGM divergence in any summary metric (all p > 0.2), and a systematic CGM-BGM offset in mean glucose and time in range (TIR) reflected the physiological lag between blood and interstitial fluid rather than capping artefact.</p><p><strong>Conclusions: </strong>Sensor limit capping is near-universal in type 1 diabetes, produces sustained periods of right-censored glucose data disproportionately affecting younger participants, and does not substantially distort standard summary metrics at the population level. Clinicians and trialists should be aware that CGM data can confirm extreme glucose events but cannot quantify their severity.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70412"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148379446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining metabolic-response signals after liraglutide therapy in type 1 diabetes.","authors":"Jingyi Zheng, Jun Zhang","doi":"10.1111/dme.70417","DOIUrl":"10.1111/dme.70417","url":null,"abstract":"","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70417"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383417","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":"Diabetic chronic kidney disease in women with pregestational diabetes and risk of pre-eclampsia.","authors":"Kleoniki I Athanasiadou, Charlotte Jones, Caroline Ovadia, Anita Banerjee, Sara L White, Anna Brackenridge","doi":"10.1111/dme.70470","DOIUrl":"10.1111/dme.70470","url":null,"abstract":"","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70470"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852274","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":"Diabetes overtreatment and flags for deprescribing glucose-lowering treatment in geriatric inpatients with type 2 diabetes: Prognostic insights from a longitudinal cohort.","authors":"Christophe de Terwangne, Séverine Henrard, Sophie Marien, Michael A Steinman, Benoit B Boland, Antoine Christiaens","doi":"10.1111/dme.70435","DOIUrl":"10.1111/dme.70435","url":null,"abstract":"<p><strong>Aims: </strong>The study investigated diabetes overtreatment (excessively intensive therapy) and flags for considering deprescribing glucose-lowering treatment (GLT) (clinical features identifying patients most likely to benefit from reducing treatment) in older adults with type 2 diabetes (T2D) and their association with five-year survival in geriatric inpatients.</p><p><strong>Methods: </strong>Single-centre retrospective cohort study including geriatric inpatients hospitalised between 2008 and 2015, aged ≥75 years with T2D on GLT. Diabetes overtreatment, according to the 2019-Endocrine Society guidelines, was retrospectively defined based on the patient's health status, level of HbA1c and presence of inducing hypoglycaemia GLT. Flags for deprescribing were selected from a systematic review of recommendations for GLT deprescribing in older diabetic adults.</p><p><strong>Results: </strong>Of the 447 inpatients (women: 52.8%; median age: 83 years), 89% had a poor health status, 55.2% were overtreated, and 99.5% had at least one deprescribing flag, and 44% of patients with ≥1 deprescribing flag were not overtreated. Over the five-year follow-up, median survival time after hospitalisation was 1.83 years [IQR, 1.56-2.09], with an 18% five-year survival [95%CI, 15%-22%]. Both overtreatment (HR [95%CI] 1.29 [1.04;1.58]) and accumulation of flags for deprescribing (HR [95%CI] 1.20 [1.11;1.29] per additional flag) were associated with increased mortality. Patients meeting both ≥4 flags for deprescribing and overtreated had the worst survival outcomes (10% five-year survival rate).</p><p><strong>Conclusion: </strong>The cumulative burden of deprescribing flags provided complementary information beyond the current overtreatment definition. Patients classified as overtreated and combining several deprescribing criteria highlight a particularly vulnerable subgroup of patients with poor survival in which GLT use should be systematically reassessed.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70435"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564318","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":"Association between depression and the development of end-stage kidney disease in people with diabetes: A population-based cohort study.","authors":"Hellena Hailu Habte-Asres, Sarah Afuwape, Adrian Heald, David C Wheeler, Angus Forbes","doi":"10.1111/dme.70481","DOIUrl":"https://doi.org/10.1111/dme.70481","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes is the leading cause of end-stage kidney disease (ESKD; CKD stage 5). Depression is common among people with diabetes and CKD and is associated with poorer outcomes. However, its relationship with progression to ESKD remains unclear, particularly given the competing risk of death. We examined the association between depression and progression to ESKD in people with diabetes and CKD.</p><p><strong>Methods: </strong>We conducted a retrospective population-based cohort study using UK primary care data from the Clinical Practice Research Datalink. Adults aged ≥ 18 years with diabetes and CKD stages 1-4 were included. Depression was defined by the presence of a depression Read code together with ≥ 12 months of continuous antidepressant prescribing during the baseline period. The primary outcome was progression to ESKD. We compared the risk of progression to ESKD between people with and without depression, accounting for differences in demographic, socioeconomic and clinical characteristics, as well as the competing risk of death.</p><p><strong>Results: </strong>Among 58,769 individuals (mean age 76.8 ± 10.2 years; 45.5% male), 14.3% had depression. Over a mean follow-up of 5.6 ± 3.4 years, 1720 progressed to ESKD and 25,127 died before ESKD. Depression was associated with a lower sub-distribution hazard of ESKD in crude (SHR 0.67; 95% CI 0.57-0.78) and adjusted analyses (SHR 0.82; 95% CI 0.68-0.99). Older age was associated with a lower cumulative incidence of ESKD.</p><p><strong>Conclusions: </strong>After accounting for the competing risk of death, depression was associated with a lower observed cumulative incidence of ESKD. This paradoxical finding may reflect competing mortality or residual confounding.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70481"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122564","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":"Multisystem developmental abnormalities and insulin resistance in ADTKD-HNF1B with the p.E105K variant: A clinical conundrum.","authors":"YunZe Wang, KangChun Xu, PengFei Liu, Bin Wang, Yan Yang, ShanZhai Wei","doi":"10.1111/dme.70457","DOIUrl":"https://doi.org/10.1111/dme.70457","url":null,"abstract":"<p><strong>Aims: </strong>HNF1B variants cause autosomal dominant tubulointerstitial kidney disease (ADTKD-HNF1B), but the phenotypic spectrum of variants of uncertain significance (VUS) remains incompletely defined. We aimed to characterise the multisystem phenotype associated with the HNF1B p.E105K variant and to examine the mechanism underlying insulin resistance in this setting.</p><p><strong>Methods: </strong>A 15-year-old male proband with chronic kidney disease and multisystem developmental abnormalities underwent clinical, biochemical and genetic evaluation, including trio-based whole-exome sequencing. The identified variant was classified according to American College of Medical Genetics and Genomics/Association for Molecular Pathology criteria.</p><p><strong>Results: </strong>The proband presented with chronic kidney disease G3b, bilateral renal cysts, growth delay, delayed puberty and borderline intellectual disability. A heterozygous HNF1B c.313G⟩A (p.E105K) variant was identified, currently classified as a VUS (PM2_supporting + PS3_moderate + PP3). Oral glucose tolerance testing showed impaired glucose tolerance with postprandial hyperinsulinaemia (2-h insulin 3556 pmol/L) and preserved β-cell function. His mother, who has diabetes with normal renal morphology, carried the same variant.</p><p><strong>Conclusions: </strong>This case suggests a possible expansion of the p.E105K phenotypic spectrum and indicates that insulin resistance in ADTKD-HNF1B is best interpreted as multifactorial and predominantly chronic kidney disease-driven rather than variant-specific. Classification of p.E105K and its metabolic associations await confirmation in further cases and functional studies.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70457"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122613","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":"Awareness drives willingness: Results of the ISPAD JENIOUS-PREME T1D project on parents' perspectives on disease-modifying therapy in T1D.","authors":"Stefano Passanisi, Claudia Piona, Agata Chobot, Laura Cudizio, Apoorva Gomber, Bastian Hauck, Nathalie Bauer, Ana Alvarez Pagola, Manuela Battaglia, Linda A DiMeglio","doi":"10.1111/dme.70478","DOIUrl":"https://doi.org/10.1111/dme.70478","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate global caregivers' knowledge, perceptions and willingness to consider disease-modifying therapies for the prevention of clinical onset of type 1 diabetes.</p><p><strong>Methods: </strong>An online survey was translated into 13 languages and disseminated worldwide from June 2024 to February 2025 to parents and caregivers of youth living with type 1 diabetes.</p><p><strong>Results: </strong>Among 1281 respondents from 50 countries, awareness of available disease-modifying therapies was low, while the perceived importance of delaying clinical disease onset was high. Reflecting this limited knowledge, only 31% expressed unconditional willingness to accept disease-modifying treatments. Willingness to accept treatment was associated with higher educational attainment, residence in high-income countries and prior knowledge of these therapies. Safety concerns, route of administration and limited information were major barriers.</p><p><strong>Conclusion: </strong>Informational and socioeconomic barriers to caregivers' awareness and acceptance of disease-modifying therapies may hinder the equitable implementation of preventive immunotherapy, highlighting the need for accessible, multilingual education initiatives.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70478"},"PeriodicalIF":3.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077448","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}