Acta Diabetologica最新文献

{"title":"Increasing incidence and clinical burden of paediatric type 1 diabetes in Italy: insights from a large administrative database","authors":"Enza Mozzillo,&nbsp;Clara Trimarchi,&nbsp;Raffaella Buzzetti,&nbsp;Riccardo Candido,&nbsp;Valentino Cherubini,&nbsp;Basilio Pintaudi,&nbsp;Luca Degli Esposti,&nbsp;Melania Leogrande,&nbsp;Valentina Perrone,&nbsp;Chiara Capodaglio,&nbsp;Georgia Fousteri,&nbsp;Gian Paolo Fadini","doi":"10.1007/s00592-026-02776-4","DOIUrl":"10.1007/s00592-026-02776-4","url":null,"abstract":"<div><h3>Background</h3><p>Paediatric type 1 diabetes (T1D) is a chronic disease that represents a global public health concern. Italian data describing epidemiology, comorbidity burden, and healthcare resource utilisation (HCRU) of paediatric T1D remain fragmented, mostly deriving from regional registries or limited cohorts.</p><h3>Methods</h3><p>A retrospective observational analysis was conducted using Italian administrative databases corresponding to ~ 12,000,000 individuals. Patients with T1D aged &lt; 18 years were identified during 2010–2023 using diagnostic proxies (insulin prescriptions or diabetes-related hospitalisations). Epidemiological analyses were restricted to healthcare entities with continuous data availability during 2018–2022. Demographic and clinical characteristics were evaluated at baseline. Comorbidity onset, HCRU, and direct costs were assessed during follow-up.</p><h3>Results</h3><p>A total of 3,220 paediatric patients with T1D were identified. Between 2018 and 2022, T1D incidence increased from 16.4 to 22.4 cases/100,000 individuals aged &lt; 18 years (compound annual growth rate [CAGR] + 8.1%), while the prevalence reached 256 cases/100,000 in 2022 (CAGR + 10.0%). Most patients had minimal comorbidity at diagnosis. During follow-up, autoimmune conditions were the most common comorbidities, especially thyroid (8.9%) and coeliac disease (6.0%), often emerging within the first year post-diagnosis.</p><p>HCRU was the highest during the first year, with frequent diabetes-related hospitalisations and prescriptions of diabetes medications. Hospitalisation-related costs declined, whereas pharmaceutical costs increased over time.</p><h3>Conclusions</h3><p>Paediatric T1D is an expanding chronic condition in Italy, characterised by early clustering of autoimmune comorbidities and substantial healthcare utilisation at diagnosis. These findings highlight the need for structured surveillance and coordinated care pathways to support long-term management and healthcare planning.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 11","pages":"1959 - 1968"},"PeriodicalIF":3.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-026-02776-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different gestational diabetes phenotypes: which relationship with maternal hemodynamics?","authors":"Serena Ottanelli,&nbsp;Laura Angeli,&nbsp;Paola Palazzo,&nbsp;Laura Avagliano,&nbsp;Sara Zullino,&nbsp;Herbert Valensise,&nbsp;Felice Petraglia,&nbsp;Federico Mecacci","doi":"10.1007/s00592-026-02760-y","DOIUrl":"10.1007/s00592-026-02760-y","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;GDM is one of the most common complications of pregnancy affecting around 14% of pregnancies worldwide. GDM is increasingly recognized as a heterogeneous metabolic disorder rather than a uniform clinical entity. We hypothesize that different phenotypes of GDM can exhibit different clinical features and longitudinal maternal hemodynamic adaptation profiles. Thus, the aim of our study was to investigate the relationship between maternal hemodynamic pathways and GDM phenotype.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A prospective, observational cohort study was conducted on GDM singleton pregnancies referred to the our Maternal–Fetal Medicine Unit between December 2022 and August 2023. GDM phenotypes were categorized based on the timing of clinical diagnosis: “early-onset GDM” (eGDM; diagnosed at 16–18 weeks of gestation) or “standard GDM” (sGDM; diagnosed at 24–28 weeks of gestation). eGDM cases were further stratified according to the presence/absence of insulin resistance (IR). IR was identified in presence of: BMI &gt; 30 kg/m2 and/or HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) &gt; 2.5 and/or fasting glucose at OGTT &gt; 100 mg/dl. Maternal hemodynamic assessment was performed using an UltraSonic Cardiac Output Monitor (USCOM Ltd. Coffs Harbour, Australia); we evaluated cardiac output (CO), total vascular resistance (TVR) and inotropy index (INO) at 24–28 and 36–39 weeks. We defined as delta (△) the difference in the value of the considered hemodynamic parameter between 24 and 28 weeks and 36–39 weeks. eGDM group also received an early hemodynamic assessment at 18–20 weeks.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;During the study period 180 women affected by GDM with singleton pregnancy participated. The diagnosis of GDM was performed early in 44 cases and at the standard time in 136 cases. 23 women were affected by early GDM with IR (eGDM-IR), 21 women were affected by early GDM without IR (eGDM-noIR) and 136 women were affected by “standard” GDM (sGDM). No significant differences in CO, TVR, or INO were seen among the three GDM phenotypes at 24–28 and 36–39 weeks. The early assessment of maternal hemodynamic parameters showed significantly higher cardiac output in eGDM-IR group than in eGDM-noIR group (p &lt; 0.05) at 18–20 weeks of gestation. Comparing longitudinal adaptation from mid-to-late gestation, the eGDM-IR cohort exhibited significantly blunted changes in CO and INO accompanied by a significantly restricted trajectory of TVR reduction compared to both the eGDM-noIR and sGDM groups. This pattern is highly suggestive of a more restricted, less compliant cardiovascular adaptive trajectory in this metabolically compromised phenotype.&lt;/p&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Our findings suggest that an insulin-resistant state combined with early-onset GDM may affect maternal hemodynamic adaptation during pregnancy. Identifying these distinct phenotypic trajectories could help clinicians develop targeted cardiovascular surveillance strategies and ","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 11","pages":"1949 - 1957"},"PeriodicalIF":3.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expression profiles of selected circulating microRNAs (miR-192-5p and miR-155-3p) in NAFLD and their association with obesity and type 2 diabetes mellitus","authors":"Rana Mohamed,&nbsp;Mohamed M. Sadaty,&nbsp;Emad El-Zayat,&nbsp;Sahar H. Ahmed,&nbsp;Mohamed Awadein,&nbsp;Nahla O. Mousa","doi":"10.1007/s00592-026-02774-6","DOIUrl":"10.1007/s00592-026-02774-6","url":null,"abstract":"<div><h3>Background</h3><p>Non-alcoholic fatty liver disease (NAFLD) is a prevalent systemic metabolic disorder closely linked to obesity and type 2 diabetes mellitus (T2DM). Circulating microRNAs have emerged as potential biomarkers reflecting disease progression and metabolic risk.</p><h3>Objectives</h3><p>This study aimed to investigate the clinical, biochemical, and molecular profiles of NAFLD patients, focusing on miRNA-155-3p and miRNA-192-5p, and to evaluate their diagnostic and predictive value.</p><h3>Methods</h3><p>A total of 200 participants were enrolled: 50 healthy controls, 50 NAFLD, 50 NAFLD with obesity, and 50 NAFLD with T2DM. Clinical, biochemical (liver enzymes, lipid profile, HOMA-IR, CRP, 25(OH) vitamin D) and circulating miRNA levels were measured. Statistical analyses included Kruskal-Wallis tests, ROC curves, and univariate and multivariate multinomial logistic regression.</p><h3>Results</h3><p>NAFLD patients, particularly with obesity and T2DM, showed elevated BMI, SGPT/SGOT, cholesterol, TG, LDL, HOMA-IR, and CRP (<i>p</i> &lt; 0.001), and reduced vitamin D (<i>p</i> &lt; 0.001). miRNA-155-3p and miRNA-192-5p were significantly upregulated (Kruskal-Wallis, <i>p</i> &lt; 0.001). ROC analysis showed: miRNA-155-3p, AUC = 0.763, specificity 100% at 11.68; miRNA-192-5p, AUC = 0.727, sensitivity 83% at 1.057. Multivariate regression confirmed both miRNAs as independent risk predictors (miRNA-155-3p OR = 1.147–1.151, <i>p</i> = 0.023–0.027; miRNA-192-5p OR = 1.639–1.774, <i>p</i> = 0.001–0.006), while adjustment for HOMA-IR attenuated associations.</p><h3>Conclusions</h3><p>Circulating miRNA-155-3p and miRNA-192-5p are potential molecular markers and risk predictors for NAFLD, linking metabolic dysregulation with hepatic pathology.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 11","pages":"1933 - 1947"},"PeriodicalIF":3.1,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium–glucose cotransporter 2 inhibitor-associated erythrocytosis in type 2 diabetes: a retrospective cohort study","authors":"Maria Pompea Antonia Baldassarre,&nbsp;Federica Carrieri,&nbsp;Andrea Sablone,&nbsp;Annalisa Marotta,&nbsp;Paola Ranalli,&nbsp;Fabrizio Febo,&nbsp;Agostino Consoli,&nbsp;Marta Di Nicola,&nbsp;Gloria Formoso","doi":"10.1007/s00592-026-02762-w","DOIUrl":"10.1007/s00592-026-02762-w","url":null,"abstract":"<div><h3>Aims</h3><p>Sodium–glucose cotransporter 2 inhibitors (SGLT2i) increase haematocrit and may cause erythrocytosis, creating uncertainty in type 2 diabetes management. Most available data derive from administrative registries or mixed, non-diabetic and/or non-European population. This study aimed to assess the onset, clinical characteristics and management outcomes of people with type 2 diabetes developing SGLT2i-associated erythrocytosis in a routine clinical setting.</p><h3>Methods</h3><p>This retrospective, single-centre cohort study included adults with type 2 diabetes who developed at least one episode of erythrocytosis (haematocrit ≥ 48% in women, ≥ 49% in men) during the first year after initiation of SGLT2i therapy. Haemoglobin and haematocrit were collected at baseline, at erythrocytosis onset, and at 6 and 12 months with the first erythrocytosis episode defined as the “index date”. No time effect or effect modification across predictive variables was observed. Management included no intervention in 84.1%, SGLT2i discontinuation in 5.3%, and phlebotomy in 4.5%. JAK2 V617F testing was performed in 19 cases, yielding negative results.</p><h3>Results</h3><p>Erythrocytosis was detected in 3.4% of subjects (<i>n</i> = 132 out of 3,848). The cohort was predominantly male (87.9%), with a median age of 68.4 years and diabetes duration of 10.5 years. Cardiovascular comorbidities were common. The median time from SGLT2i initiation to erythrocytosis was 11.9 months. Over 12 months, haematocrit and haemoglobin levels remained stable, with no thrombotic events.</p><h3>Conclusions</h3><p>SGLT2i-associated erythrocytosis is an uncommon, stable, and seemingly low-risk phenomenon. However, it may trigger unnecessary interventions, including treatment discontinuation. These findings highlight a gap between the benign nature of this effect and real-world practice, supporting the need for evidence-based, multidisciplinary guidelines to preserve SGLT2i cardiorenal benefits and optimise patient management.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 11","pages":"1923 - 1931"},"PeriodicalIF":3.1,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-026-02762-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of bedtime melatonin treatment on blood pressure and arterial stiffness: a three-month, randomized, placebo-controlled crossover study in individuals with type 2 diabetes mellitus","authors":"Esben Stistrup Lauritzen,&nbsp;Julie Støy,&nbsp;Niels Møller,&nbsp;Per Løgstrup Poulsen,&nbsp;Ulla Kampmann","doi":"10.1007/s00592-026-02750-0","DOIUrl":"10.1007/s00592-026-02750-0","url":null,"abstract":"<div><h3>Aim</h3><p>Blood pressure is regulated in part by circadian rhythms, and melatonin has been reported to exert blood pressure–lowering effects. The underlying mechanisms, however, remain unclear. We hypothesized that melatonin would lower blood pressure in individuals with type 2 diabetes with or without hypertension, and that this effect would be mediated by a reduction in arterial stiffness.</p><h3>Methods</h3><p>We conducted a double-blinded, randomized, placebo-controlled crossover trial involving 17 individuals with type 2 diabetes. Participants completed two treatment phases: three months of 10 mg melatonin taken one hour before nighttime, and three months of placebo taken at the same time separated by a four-week washout period. On the last day of each period, participants underwent 24-hour ambulatory blood pressure monitoring, including measurement of arterial stiffness, using the Arteriograph 24. Fifteen participants completed the 24-hour ambulatory blood pressure monitoring (hypertension <i>n</i> = 6).</p><h3>Results</h3><p>Melatonin treatment was associated with numerical, non-significant reductions in mean nighttime systolic blood pressure (-6 [-13:1] mmHg, <i>p</i> = 0.08, ≈ 5% decrease) and diastolic blood pressure (-5 [-11:1] %, <i>p</i> = 0.11). The pulse wave velocity as a measure for arterial stiffness was unaffected by melatonin treatment (<i>p</i> = 0.83).</p><h3>Conclusion</h3><p>In this randomized placebo-controlled trial of individuals with type 2 diabetes, 3 months of treatment with 10 mg melatonin administered one hour before bedtime did not significantly affect blood pressure or pulse wave velocity. Although numerical reductions in nighttime blood pressure were observed, these hypothesis-generating findings were not statistically significant and warrant confirmation in larger studies specifically powered for blood pressure outcomes.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 11","pages":"1915 - 1921"},"PeriodicalIF":3.1,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-026-02750-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Modified Delphi consensus on early management of combined cardiovascular risk factors in adult patients with type 2 diabetes in Italy","authors":"Stefano Del Prato,&nbsp;Stefano Genovese,&nbsp;Carlotta Galeone,&nbsp;Paolo Mariani,&nbsp;Tommaso Acquaviva,&nbsp;Marco Antonutti,&nbsp;Massimiliano Anzaldi,&nbsp;Loredana Bucciarelli,&nbsp;Diego Carleo,&nbsp;Arturo Cesaro,&nbsp;Vera Frison,&nbsp;Enrico Gabellieri,&nbsp;Egidio Imbalzano,&nbsp;Marco Marini,&nbsp;Vincenzo Maria Monda,&nbsp;Nicola Riccardo Pugliese,&nbsp;Paolo Severino,&nbsp;Gian Pio Sorice,&nbsp;Mattia Squillace,&nbsp;Emanuele Tizzani,&nbsp;Alessia Ventricini,&nbsp;Pasquale Perrone Filardi","doi":"10.1007/s00592-026-02770-w","DOIUrl":"10.1007/s00592-026-02770-w","url":null,"abstract":"<div><h3>Background</h3><p>Type 2 diabetes (T2D) is a complex chronic disease often associated with other metabolic conditions that increase the risk of cardiovascular (CV) disease and early mortality. Hence, early, integrated management of T2D may prevent long-term CV complications.</p><h3>Methods</h3><p>To determine the appropriateness of early multifactorial intervention in people with T2D we conducted an online modified Delphi study. The study involved a multidisciplinary panel of 17 Italian experts, ensuring maintenance of study design and rigorous execution throughout the consensus process, in line with the core principles of Delphi studies. Main areas of investigation included: (1) targets of disease control for adults with T2D; (2) early treatment, CV risk assessment, and multi-factorial strategy; (3) unmet needs, including treatment adherence; and (4) public health aspects.</p><h3>Results</h3><p>Consensus was unanimous (100% agreement) regarding T2D management based on the simultaneous control of glycemia, body weight, blood pressure, and lipids through an early multi-factorial approach as well as maintenance of target levels over time. Most panelists agreed on the need for a simplified therapeutic approach (88% agreement), supported by improved availability of appropriate pharmacological treatments and increased adherence (82% agreement).</p><h3>Conclusions</h3><p>Italian experts strongly support the adoption of an early, multi-factorial approach to disease management to reduce long-term CV risk. To this end, the need for simplified treatment regimens and improved adherence to therapy emerged as key unmet needs.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 11","pages":"1905 - 1913"},"PeriodicalIF":3.1,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-026-02770-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How the genetic diagnosis of familial hypercholesterolemia can be guided by clinical features. Preliminary evidences from an Italian single-center experience","authors":"Antonella Marucci,&nbsp;Francesca Irene Rampolli,&nbsp;Irene Rutigliano,&nbsp;Morena Luce Mansueto,&nbsp;Pamela Piscitelli,&nbsp;Grazia Fini,&nbsp;Claudia Menzaghi,&nbsp;Rosa Di Paola,&nbsp;Vincenzo Trischitta","doi":"10.1007/s00592-026-02771-9","DOIUrl":"10.1007/s00592-026-02771-9","url":null,"abstract":"<div><h3>Aim</h3><p>Familial Hypercholesterolemia (FH) is highly prevalent in humans. To date, the need for genetic testing is indicated by widely used clinical scores (different for adults and children) that support the diagnosis of FH. The performance of genetic testing is a matter of debate and is likely dependent on different clinical, ethnic and environmental contexts, with sparse data from Italy. Our aims were to evaluate: (i) the performance of genetic testing in Italian patients with a clinical diagnosis of FH; (ii) the role of clinical features on the genetic testing performance.</p><h3>Methods</h3><p>Pathogenic (P) or likely pathogenic (LP) variants in <i>ABCG5</i>, <i>ABCG8</i>, <i>APOB</i>, <i>APOE</i>, <i>LDLR</i>, <i>LDLRAP1</i>, <i>LIPA</i>, <i>PCSK9</i> were investigated by WES and confirmed by Sanger sequencing.</p><h3>Results</h3><p>The pick-up rate was 39.8%, progressively increasing (<i>p</i> &lt; 0.001) with increasing clinical score. Discrimination of clinical score was excellent (AU-ROC = 0.897; 95% CI: 0.831, 0.963; <i>p</i> = 3.4 × 10^− 11). Positive predictive value was 95% in people with a clinical score ≥ 8 and only 45% with score 5–7. Negative predictive value was 95% in people with clinical score &lt; 4 and only 55% with score 5–7. Adding age at diagnosis, BMI, and triglycerides (that differed significantly between positive and negative genetic testing patients) to the clinical score tended to improve AU-ROC.</p><h3>Conclusion</h3><p>Our preliminary evidences suggest that patients with intermediate levels on the currently available clinical scores are best suited for genetic testing for familial hypercholesterolemia (FH) and that the discriminatory power of these clinical scores might be improved by adding further clinical characteristics.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 11","pages":"1897 - 1903"},"PeriodicalIF":3.1,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148696783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wearable sensor-derived continuous physical activity dimensions and all-cause mortality in adults with diabetes and hypertension: insights from two population-based accelerometry cohorts","authors":"Tianchen Niu,&nbsp;Lingjie Fan,&nbsp;Rongna Lian,&nbsp;Fengyi Wang,&nbsp;Junhan Zhao,&nbsp;Tao Lin","doi":"10.1007/s00592-026-02768-4","DOIUrl":"10.1007/s00592-026-02768-4","url":null,"abstract":"<div><h3>Aims/Introduction</h3><p>Adults with coexistent diabetes mellitus and hypertension (DM-HTN) have a substantially elevated risk of all-cause mortality. Physical activity (PA) is a key modifiable factor, yet conventional self-reported or categorical measures may fail to capture clinically relevant variation. We investigated associations between sensor–derived continuous PA dimensions and all-cause mortality in DM-HTN.</p><h3>Materials and Methods</h3><p>We analysed 4,294 DM-HTN and 1,482 diabetes-alone adults from the UK Biobank (median follow-up 85.2 months; 731 deaths) and 530 DM-HTN and 235 diabetes-alone participants from NHANES 2011–2014 (mean follow-up 63.5 months; 123 deaths), all with device-measured wrist accelerometry. Continuous sensor-derived metrics included Daily MET/MIMS (volume) and Peak-30 MET/MIMS (peak intensity). Associations with all-cause mortality were examined using multivariable Cox regression, restricted cubic spline modelling, and GBDT models with SHAP attribution.</p><h3>Results</h3><p>Both continuous PA dimensions were independently associated with all-cause mortality in the DM-HTN group across cohorts. In the UK Biobank, fully adjusted hazard ratios were 0.66 for Daily MET and 0.43 for Peak-30 MET. In NHANES, Peak-30 MIMS showed robust associations (HR = 0.57, p &lt; 0.001), while Daily MIMS attenuated to non-significance (HR = 0.95, p = 0.116) after full adjustment. Non-linear dose–response modelling identified lower inflection points for peak intensity in DM-HTN compared with diabetes-alone individuals. SHAP analyses confirmed that continuous peak intensity maintained stable protective contributions across comorbidity strata.</p><h3>Conclusions</h3><p>Wearable sensor-derived continuous PA dimensions capture mortality risk gradients in DM-HTN that are inaccessible to conventional approaches. Population-specific, clinically attainable inflection thresholds identified through continuous monitoring support incorporating sensor-derived PA metrics as digital biomarkers in comorbidity-specific risk stratification frameworks.</p><h3>Graphical Abstract</h3><div><figure><div><div><picture><source><img></source></picture></div></div></figure></div></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 11","pages":"1887 - 1896"},"PeriodicalIF":3.1,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart rate variability changes precede nocturnal hypoglycemia in children with type 1 diabetes.","authors":"Sara Bachmann, Binbin Xu, Birgit Donner","doi":"10.1007/s00592-026-02757-7","DOIUrl":"10.1007/s00592-026-02757-7","url":null,"abstract":"","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart rate variability in adolescents with type 1 diabetes. A cross-sectional study.","authors":"Minna L Koivikko, Katri Helttula, Mikko Tulppo, Tytti Pokka, Mika Kallio, Päivi H Tossavainen","doi":"10.1007/s00592-026-02747-9","DOIUrl":"https://doi.org/10.1007/s00592-026-02747-9","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to compare heart rate variability (HRV) between adolescents with type 1 diabetes and healthy age- and sex-matched control participants. We were also interested in how HRV may change during puberty.</p><p><strong>Research design and methods: </strong>Eighty-five adolescents with type 1 diabetes (mean diabetes duration 7.0 ± 3.6 years) and 103 healthy age- and sex-matched youths consented to this cross-sectional study. We derived HRV data for time domain and power spectra analyses from Holter recordings (mean duration 17.8 h) and analyzed associated risk factors for HRV deterioration during total recording time and nighttime separately.</p><p><strong>Results: </strong>Total low frequency (LF) and very low frequency (VLF) domains (ms²) were significantly lower in children with type 1 diabetes than in healthy controls (LF, P = 0.049 and VLF, P = 0.005, respectively), whereas no differences were found in the measurements taken at night. The most significant predictors for untoward changes in power spectra were skinfold sum and lipids. Mean heart rate (beats/min), or any of the time domain variables did not differ significantly between study groups. Compared with those in the lowest HbA1c tertile, adolescents with type 1 diabetes in the highest HbA1c tertile had significantly lower LF and VLF power spectra results.</p><p><strong>Conclusions: </strong>Adolescents with type 1 diabetes have depressed HRV from low to very low frequencies. Deterioration of autonomic nervous system function in adolescents with type 1 diabetes, measured with HRV power spectra is mainly associated with metabolic factors, although it is not possible to establish causal links between these variables.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}