Acta Diabetologica最新文献

{"title":"Therapeutic footwear in patients with diabetes: a position statement from the Italian diabetic foot study group","authors":"Laura Giurato,&nbsp;Alessia Scatena,&nbsp;Roberto De Giglio,&nbsp;Giuseppe Murdolo,&nbsp;Marco Mastinu,&nbsp;Maurizio Gicchino,&nbsp;Desiree Gabriele,&nbsp;Cristiana Vermigli,&nbsp;Andrea Panunzi,&nbsp;Luigi Uccioli,&nbsp;Roberto Da Ros,&nbsp;SID-AMD Diabetic Foot Study Group","doi":"10.1007/s00592-026-02722-4","DOIUrl":"10.1007/s00592-026-02722-4","url":null,"abstract":"<div><p>Prevention of diabetic foot ulcers is crucial, given the high risk of ulcer development (34%) and recurrence (&gt; 40%), with up to 85% of amputations being preceded by ulceration. The most effective preventive intervention is the use of therapeutic footwear combined with custom-made insoles, which should be considered a true therapeutic strategy, comparable to metabolic control. Scientific evidence demonstrates that therapeutic footwear, particularly rigid-soled models with multilayer total-contact insoles, significantly reduces the risk of ulcer recurrence, provided that specific plantar pressure targets are achieved (&lt; 200 kPa or a ≥ 30% reduction). Moreover, treatment adherence (at least 60–80% of daily active time) represents a critical determinant of effectiveness. This document aims to provide a practical approach to orthotic therapy by identifying the most appropriate prescription according to the patient’s ulceration risk level (IWGDF classification) and the presence of foot deformities, while matching orthotic features to the clinical status of the foot for protective purposes. Prescriptions should be individualized and validated by a multidisciplinary team.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 9","pages":"1553 - 1562"},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300356","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":"Adjunctive use of glucagon-like peptide-1 receptor agonists after bariatric surgery: updated systematic review and meta-analysis of randomized controlled trials.","authors":"Sakshi Arora, Fnu Amna, Fatemeh Akbarpoor, Dhvanit Rajdeep, Muhammad Khalid, Gabriel Moura Machado, Niman Maalin, Asad Ur Rehman, Marconi Abreu","doi":"10.1007/s00592-026-02730-4","DOIUrl":"https://doi.org/10.1007/s00592-026-02730-4","url":null,"abstract":"<p><strong>Aims: </strong>We meta-analyzed randomized trials to assess efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) after bariatric surgery.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Cochrane Central for randomized trials comparing GLP-1 RAs with placebo after bariatric surgery. Primary outcomes were change in body weight (kg) and HbA1c (%) at 6 and 12 months. We also assessed percent total body weight loss (%TBWL), quality of life, and adverse events. We pooled mean differences (MDs) with 95% confidence intervals (CIs) using random effects and assessed heterogeneity with I² statistic. We also performed an exploratory subgroup analysis that compared very early (≤ 2 months) versus late (≥ 18 months) initiation after surgery.</p><p><strong>Results: </strong>Seven RCTs (n = 460) met inclusion criteria; all evaluated liraglutide. GLP-1 RAs increased weight loss at 6 months (MD - 5.33 kg; 95% CI - 9.42 to - 1.23; p = 0.02) but not at 12 months (MD - 5.05 kg; 95% CI - 22.14 to 12.05; p = 0.33). GLP-1 RAs increased %TBWL at 6 months (MD 5.13%; 95% CI 2.14 to 8.11; p = 0.007) but not at 12 months (MD 3.96%; 95% CI - 3.33 to 11.26; p = 0.18). HbA1c did not differ at 6 or 12 months. Quality of life improved at 6 months in the trials reporting this outcome. Gastrointestinal adverse events were similar between groups. Subgroup analyses suggested differences by initiation timing.</p><p><strong>Conclusion: </strong>GLP-1 RA therapy improved short-term weight outcomes after bariatric surgery, with no statistically significant between-group differences at 12 months. Timing of initiation may influence response and should be explored in trials with longer follow up.</p><p><strong>Trial registry: </strong>PROSPERO ID CRD420251251321.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300647","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":"Maternal and neonatal outcomes in migrant women with gestational diabetes. A retrospective cohort study in Italy","authors":"Fabrizia Citro,&nbsp;Natalia Placenza,&nbsp;Caterina Venturi,&nbsp;Federico Galleano,&nbsp;Michele Aragona,&nbsp;Lorella Battini,&nbsp;Piero Marchetti,&nbsp;Giuseppe Penno,&nbsp;Cristina Bianchi,&nbsp;Alessandra Bertolotto","doi":"10.1007/s00592-026-02727-z","DOIUrl":"10.1007/s00592-026-02727-z","url":null,"abstract":"<div><h3>Background</h3><p>Migrant women have a higher risk of gestational diabetes (GDM), and often poorer metabolic control during pregnancy. However, evidence on neonatal outcomes compared to Italian women is limited and inconsistent. This study aimed to compare neonatal outcomes between migrant and Italian women, and to identify predictors of adverse outcomes.</p><h3>Methods</h3><p>Clinical and metabolic data of pregnant women, who underwent selective screening (based on risk factors) for GDM at the University Hospital of Pisa from 2014 to 2022, were retrospectively collected. Neonatal outcomes (preterm delivery, large (LGA) and small (SGA) for gestational age, caesarean delivery, Apgar score 5’) were compared between Italian and migrant women, with a specific focus on high-risk ethnic groups.</p><h3>Results</h3><p>Among 3499 women (78% Italian and 22% non-Italian), 1419 (41%) had GDM. Neonatal outcomes were comparable between Italian and migrant women, both in the whole cohort and in the subgroup with GDM. However, women with high-risk ethnicity reported a higher rate of SGA infants, both overall (12% vs. 7%, p = 0.001) and in the GDM subgroup (11% vs. 6%, p = 0.046), without significant differences in the Ponderal Index. At multivariable analysis, high-risk ethnicity was independently associated with an almost twofold increased risk of SGA (OR: 1.843 [1.196–2.838], p = 0.006).</p><h3>Conclusions</h3><p>Close monitoring during gestation, management by a multidisciplinary team and free access to healthcare services may explain the similarity of neonatal outcomes in Italian and migrant women. The lack of ethnic-specific guidelines for fetal growth may explain the greater risk of SGA among women with high-risk ethnicity.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 9","pages":"1563 - 1568"},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300388","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":"Bidirectional association between obstructive sleep apnea and diabetic retinopathy: a severity-stratified systematic review and meta-analysis with GRADE assessment.","authors":"Abdelaziz Abdelaal, Yahya A Mahmoud, Weam Alsouri, Mutaz Al-Nawaflh, Kais Al Issa, Luke Yaldo, Osama Elaraby, Hashem Abu Serhan","doi":"10.1007/s00592-026-02732-2","DOIUrl":"https://doi.org/10.1007/s00592-026-02732-2","url":null,"abstract":"<p><strong>Purpose: </strong>To synthesise the bidirectional evidence on the association between obstructive sleep apnea (OSA) and diabetic retinopathy (DR), separating studies framing OSA as the exposure for DR (Arm 1) from studies framing DR as the exposure for OSA (Arm 2).</p><p><strong>Methods: </strong>Systematic review and meta-analysis of observational studies (PROSPERO: CRD420251135427). PubMed, Scopus, Web of Science, and Google Scholar were searched from inception to July 13, 2025, supplemented by structured re-screening of five prior systematic reviews and forward and backward citation searching. Eligible studies enrolled individuals with diabetes mellitus and reported binary OSA (or, in Arm 2, DR) exposure with an unexposed comparator. Within each arm, exposure and outcome were severity-stratified; unadjusted and adjusted odds ratios (ORs) were pooled separately using random-effects models in MetaAnalysisOnline.com. Risk of bias was assessed with the Newcastle-Ottawa Scale (NOS) and certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.</p><p><strong>Results: </strong>Twenty-six studies met eligibility criteria. In Arm 1 (OSA → DR), the unadjusted pooled OR for any DR with OSA classified as a binary exposure was 2.41 (95% confidence interval [CI] 1.53-3.80; 10 studies; very low certainty), but attenuated to 1.03 (95% CI 0.64-1.66; 2 studies; low certainty) in confounder-adjusted analyses. OSA-severity-stratified Arm 1 estimates for mild, moderate, and severe OSA were directionally consistent but not statistically significant in either unadjusted or adjusted pooling. DR-stage-specific Arm 1 analyses (background DR, mild/moderate/severe non-proliferative DR [NPDR], proliferative DR [PDR]) were directionally aligned with the overall Arm 1 finding but imprecise. In Arm 2 (DR → OSA), pooled estimates showed inverse or null associations across DR severity strata; severe OSA as an outcome of DR yielded a pooled OR of 1.24 (95% CI 0.92-1.68; 4 studies; low certainty).</p><p><strong>Conclusions: </strong>The OSA-DR association is sensitive to the direction of the framed exposure-outcome relationship, to confounder adjustment, and to severity classification. Substantial attenuation of the unadjusted Arm 1 signal after adjustment, together with the inverse or null Arm 2 pattern, indicates that previously reported pooled estimates were influenced by confounding and by directional misclassification. Polysomnography-confirmed prospective cohorts with uniform DR grading and individual-participant-level adjustment for body mass index, diabetes duration, and metabolic comorbidities are needed to clarify the direction and magnitude of the relationship.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300689","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":"Health-related quality of life in adults with type 2 diabetes mellitus: the role of multi morbidity, glycaemic control and insulin therapy in an Albanian outpatient cohort","authors":"Zamira Shabani,&nbsp;Edona Haxhija,&nbsp;Elvisa Drishti","doi":"10.1007/s00592-026-02734-0","DOIUrl":"10.1007/s00592-026-02734-0","url":null,"abstract":"<div><h3>Aims</h3><p>To describe health-related quality of life (HRQoL) across the eight SF-36 domains in Albanian adults with type 2 diabetes mellitus (T2DM), identify demographic and clinical correlates of HRQoL, and assess whether associations with multimorbidity were robust to an alternative principal component analysis (PCA)-derived weighted multimorbidity index.</p><h3>Methods</h3><p>In this cross-sectional study, 176 adults with T2DM completed the SF-36 questionnaire. Sociodemographic characteristics, diabetes duration, HbA1c, insulin therapy and physician-confirmed comorbidities were recorded. Multivariable linear regression models with robust standard errors examined adjusted associations between clinical characteristics and SF-36 domains. To address limitations of an unweighted comorbidity count, a PCA-derived weighted multimorbidity index was constructed and used in sensitivity analyses. Interaction analyses were considered exploratory.</p><h3>Results</h3><p>Participants had a mean age of 65.1 years, mean diabetes duration of 10.8 years, and mean HbA1c of 7.74%; 54.0% were receiving insulin therapy and 43.8% had multimorbidity. General Health, Role-Physical and Vitality were the most impaired SF-36 domains. In adjusted analyses, multimorbidity was independently associated with lower Physical Functioning, Vitality, Mental Health, Social Functioning, Bodily Pain and General Health scores. Older age was also associated with poorer HRQoL across several domains. After adjustment, neither insulin therapy nor HbA1c was independently associated with most physical HRQoL domains. Findings were materially unchanged when multimorbidity was operationalised using the PCA-derived weighted index.</p><h3>Conclusions</h3><p>In this Albanian outpatient cohort, multimorbidity was the strongest independent cross-sectional correlate of impaired HRQoL across both physical and psychosocial domains. The association remained robust to alternative operationalisations of comorbidity burden. Given the cross-sectional design, modest sample size and potential residual confounding, findings should be interpreted as hypothesis-generating and warrant confirmation in larger longitudinal studies.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 9","pages":"1569 - 1575"},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300317","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":"Clarifying metformin exposure when interpreting glycemic responses after imeglimin initiation","authors":"Jingyi Zheng,&nbsp;Jun Zhang","doi":"10.1007/s00592-026-02724-2","DOIUrl":"10.1007/s00592-026-02724-2","url":null,"abstract":"","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 10","pages":"1683 - 1684"},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300359","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":"Metabolic–inflammatory axis linking diabetes and sarcopenia: cross-population evidence and explainable ai-based risk modeling","authors":"Lei He,&nbsp;Shiping Wang,&nbsp;Yuang Cao,&nbsp;Shihong Zhang,&nbsp;JiaJia Li,&nbsp;Zhenhong Zhao,&nbsp;Shun Yue","doi":"10.1007/s00592-026-02717-1","DOIUrl":"10.1007/s00592-026-02717-1","url":null,"abstract":"<div><h3>Background</h3><p>Diabetes and sarcopenia frequently coexist in aging populations and share intertwined metabolic and inflammatory pathways. However, the mechanisms underlying their coexistence and the ability to predict functional decline across populations remain poorly understood.</p><h3>Methods</h3><p>Data were obtained from two nationally representative cohorts—NHANES (19,931 participants) and CHARLS (96,628 participants). Diabetes and sarcopenia were defined according to international standards, yielding four groups: control, diabetes only, sarcopenia only, and comorbidity. Metabolic–inflammatory profiles were characterized by CRP, HDL, triglycerides, albumin, and BMI. Cross-sectional and longitudinal analyses were performed to evaluate metabolic–inflammatory–muscle interactions. Logistic, LASSO, and XGBoost models were trained in NHANES to predict functional decline, and their performance and feature importance patterns were evaluated for consistency in CHARLS, with model calibration, decision-curve, and SHAP-based explainability.</p><h3>Results</h3><p>Individuals with diabetes–sarcopenia comorbidity exhibited the most adverse metabolic–inflammatory pattern, characterized by higher CRP and triglycerides but lower albumin and HDL. Functional performance declined progressively from control to comorbidity groups. The XGBoost model achieved robust discrimination for functional decline (AUC = 0.80 in NHANES; 0.78 in CHARLS) and consistent calibration across subgroups. SHAP interpretation identified albumin, CRP, and HDL as dominant predictors. Mechanistic correlation analysis revealed strengthened negative coupling between glucose, inflammation, and muscle indices in the comorbidity phenotype, supporting an observed association of the metabolic–inflammatory–muscle axis.</p><h3>Conclusions</h3><p>Across two independent populations, diabetes–sarcopenia comorbidity was characterized by a convergent metabolic–inflammatory burden that predicted functional decline. The integrated model provided explainable and generalizable risk estimation, highlighting the metabolic–inflammatory–muscle axis as a potentially relevant associated pathway.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 8","pages":"1411 - 1420"},"PeriodicalIF":3.1,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293074","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":"Identification and functional characterization of a novel mutation in the NEUROD1 gene in a Chinese family with maturity-onset diabetes of the young","authors":"Jianhua Li,&nbsp;Juan Zhang,&nbsp;Shuxin Ren,&nbsp;Yanxia Liu,&nbsp;Cong Wu,&nbsp;Jie Dong,&nbsp;Chaofeng Zhu,&nbsp;Sufang Chen,&nbsp;Huijuan Zhang,&nbsp;Tianyi Li,&nbsp;Yanyan Jiang","doi":"10.1007/s00592-026-02731-3","DOIUrl":"10.1007/s00592-026-02731-3","url":null,"abstract":"<div><h3>Aims</h3><p>Few families with maturity-onset diabetes of the young (MODY) caused by neurogenic differentiation factor 1 (<i>NEUROD1</i>) mutations have been identified. The aim of this study is to identify the affected gene in a Chinese family with MODY using whole exome sequencing (WES) and explore the potential pathogenicity of the identified mutation.</p><h3>Methods</h3><p>WES was performed in patients with clinically suspected MODY, and candidate variants were verified with Sanger sequencing for family co-segregation. Structure-function alterations in the newly identified mutant protein were analyzed using three-dimensional modeling and dual luciferase reporter gene assays to assess pathogenicity.</p><h3>Results</h3><p>A novel heterozygous missense mutation, Y297D (c.889T &gt; G, p.Tyr297Asp), in the <i>NEUROD1</i> gene (NM_002500.5) was identified in a MODY proband and his affected relatives. Y297D mutation disrupted a C-H conjugated interaction and introduced a new hydrogen bond, altering the protein’s local structure. These alterations reduced transcriptional activity in the transactivation domain of the Y297D mutant compared with that of the wild-type protein (<i>P</i> &lt; .05).</p><h3>Conclusions</h3><p>A novel <i>NEUROD1</i> mutation has been identified in Chinese MODY, and the abnormal conformation of <i>NEUROD1</i>-Y297D reduced insulin transcription activity, impairing pancreatic β-cell function in patients with MODY6. Glucagon-like peptide-1 receptor agonist (GLP-1RAs) may be a precision hypoglycemic strategy to consider in diabetic patients with <i>NEUROD1</i> mutations.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 9","pages":"1525 - 1535"},"PeriodicalIF":3.1,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-026-02731-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293108","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":"Glycemic assessment in diabetic patients with secondary polycytheamia: limitations of HbA1c and the potential role of fructosamine—a prospective comparative study","authors":"Sertas Erarslan,&nbsp;Turkan P. Kilit,&nbsp;Aycan Acet","doi":"10.1007/s00592-026-02735-z","DOIUrl":"10.1007/s00592-026-02735-z","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to evaluate the reliability of haemoglobin A1c (HbA1c) for assessing glycaemic status in patients with type 2 diabetes mellitus (T2DM) and secondary polycythaemia, and to determine whether fructosamine serves as a more reliable complementary glycaemic marker in this population.</p><h3>Methods</h3><p>In this prospective observational study, patients with T2DM and secondary polycythaemia (<i>n</i> = 62) and T2DM controls with normal haematological indices (<i>n</i> = 40) were enrolled. HbA1c- and fructosamine-derived estimated mean plasma glucose (eMPG) were compared with structured home capillary blood glucose (CBG; 7 measurements/day × 5 days). Bland-Altman analysis and multivariate linear regression (adjusting for age, sex, diabetes duration, BMI, smoking, fasting glucose, haemoglobin, haematocrit) were performed.</p><h3>Results</h3><p>Fasting plasma glucose and HbA1c were similar between groups (<i>p</i> = 0.352 and <i>p</i> = 0.816), while fructosamine (456.53 ± 90.18 vs. 404.18 ± 97.63 µmol/L; <i>p</i> = 0.001) and Home-CBG (207.23 ± 49.18 vs. 181.98 ± 55.31 mg/dL; <i>p</i> = 0.002) were significantly higher in the polycythaemia group. Bland-Altman analysis confirmed a systematic negative bias of HbA1c-derived eMPG (mean bias: −23.73 mg/dL; 95% LoA: −45.97 to − 1.48). On multivariate regression, polycythaemia group assignment was the strongest independent association with HbA1c underestimation (β=−16.80 mg/dL; 95% CI: −25.53 to − 8.07; <i>p</i> &lt; 0.001). Fructosamine-derived eMPG showed substantially better agreement with Home-CBG (bias: +7.68 mg/dL). Overall, 60% of polycythaemia patients would have been assigned to a different glycaemic control category based on fructosamine versus HbA1c.</p><h3>Conclusion</h3><p>HbA1c systematically underestimates glycaemic status in patients with polycythaemia and may lead to clinically relevant misclassification. In contrast, fructosamine appears to provide a more reliable estimate of glycaemic control in this population.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 9","pages":"1545 - 1552"},"PeriodicalIF":3.1,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-026-02735-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293040","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":"Identifying barriers to diabetes technology use: LIFESTEPS, a newly developed clinical support tool for healthcare professionals","authors":"Gallen Geraldine,&nbsp;Rosso Alice,&nbsp;Alonso-Carril Núria,&nbsp;Arbeli Sima,&nbsp;Bahon Virginie,&nbsp;Brown Vanessa,&nbsp;Endlich Kerstin,&nbsp;Schleicher Verena,&nbsp;Hansart Audrey,&nbsp;Jolley Amy,&nbsp;Jussila Rea,&nbsp;Stefanowicz-Bielska Anna,&nbsp;Taplin Julie,&nbsp;Cardano Paola,&nbsp;Cyranka Katarzyna","doi":"10.1007/s00592-026-02718-0","DOIUrl":"10.1007/s00592-026-02718-0","url":null,"abstract":"<div><h3>Background</h3><p>Psychosocial, behavioural, and lifestyle-related barriers can substantially affect the uptake, continued use, and discontinuation of diabetes technology in people with type 1 diabetes (PWT1D). However, structured tools to support healthcare professionals (HCPs) in systematically exploring these barriers in routine care remain limited. To address this gap, a clinically oriented questionnaire was developed by a multidisciplinary panel of diabetes experts. This paper describes the development of the questionnaire and its preliminary evaluation in terms of clarity, comprehensibility, usability, relevance, and perceived acceptability.</p><h3>Methods</h3><p>A panel of 12 diabetes experts from 11 countries across Europe, the Middle East, and Africa (EMEA) reviewed the literature on barriers to diabetes technology use, grouped these barriers into key thematic domains, and developed a structured questionnaire that was translated into multiple languages. The questionnaire then underwent a two-round end-user evaluation involving HCPs and PWT1D to assess clarity, comprehensibility, practicality, relevance, and potential bias. Feedback from the first round informed refinement of the questionnaire before reassessment in a second round. The evaluation was descriptive and focused on end-user feedback; formal psychometric testing and hypothesis-driven validation analyses were not undertaken.</p><h3>Results</h3><p>The expert panel named the questionnaire LIFESTEPS, reflecting its core thematic domains. The questionnaire covers the following areas of discussion related to barriers to technology: psychological and relational aspects of diabetes, experience with technology and body image, and anticipation and adaptation to new technology. In the first evaluation round, feedback was obtained from 19 HCPs and 37 PWT1D recruited by panel members. Following revision of the questionnaire, a second round involving 5 HCPs and 7 PWT1D was conducted to reassess clarity and usability. Overall, participants reported that the final version of the questionnaire was understandable, perceived as easy to complete, and potentially useful for supporting discussion of barriers to diabetes technology use in clinical practice.</p><h3>Conclusions</h3><p>LIFESTEPS is a newly developed, multilingual clinical support tool designed to facilitate structured discussion of psychosocial and lifestyle-related barriers to diabetes technology use. The findings provide preliminary support for its clarity, acceptability, and perceived clinical usefulness. Further psychometric and prospective clinical evaluation is needed before broader analytical or predictive applications can be considered. Accordingly, LIFESTEPS should be interpreted as a preliminary conversation-support tool rather than as a validated measurement instrument.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 8","pages":"1421 - 1434"},"PeriodicalIF":3.1,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-026-02718-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293157","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}