Medicine (Abingdon, England : UK ed.)最新文献

Glycaemic management of type 2 diabetes – an update 2型糖尿病的血糖管理——最新进展

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-09-18 DOI: 10.1016/j.mpmed.2026.08.008

Priscilla Sarkar, Dame Melanie J Davies

{"title":"Glycaemic management of type 2 diabetes – an update","authors":"Priscilla Sarkar, Dame Melanie J Davies","doi":"10.1016/j.mpmed.2026.08.008","DOIUrl":"10.1016/j.mpmed.2026.08.008","url":null,"abstract":"<div><div>The management paradigm for type 2 diabetes mellitus (T2DM) has undergone a profound shift in recent years, transitioning from a strictly gluco-centric focus to a holistic, complications-driven approach that prioritizes long-term organ protection. Landmark clinical evidence and recently updated national and international guidelines have completely restructured the traditional treatment algorithm. Rather than relying solely on a sequential approach of adding medications, dual-therapy pairing modified-release metformin with a sodium–glucose cotransporter 2 (SGLT2) inhibitor is now recommended as first line for most patients. Concurrently, the therapeutic landscape has been revolutionized by glucagon-like peptide 1 (GLP-1)-based therapies being promptly incorporated as first line to target obesity, mitigate atherosclerotic cardiovascular risks and manage early-onset T2DM. This change reflects evidence demonstrated in recent trials of the cardiorenal protective benefits of SGLT2 inhibitors and GLP-1 receptor antagonists. Lifestyle management and self-management structured education programmes continue to play a major role in diabetes treatment pathways throughout the lifetime of someone living with T2DM, and should be reviewed at least annually alongside medications. Modern T2DM care has therefore evolved into a highly individualized, proactive model to balance glycaemic control with aggressive cardiometabolic risk reduction and weight management to reduce long-term morbidity and mortality.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 10","pages":"Pages 724-733"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125145","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}

引用次数: 0

Diabetic ketoacidosis and hyperosmolar crisis in adults 成人糖尿病酮症酸中毒和高渗危象

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-08-31 DOI: 10.1016/j.mpmed.2026.07.006

Ketan Dhatariya

{"title":"Diabetic ketoacidosis and hyperosmolar crisis in adults","authors":"Ketan Dhatariya","doi":"10.1016/j.mpmed.2026.07.006","DOIUrl":"10.1016/j.mpmed.2026.07.006","url":null,"abstract":"<div><div>Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) remain two of the most commonly encountered metabolic emergencies. They are potentially life-threatening when not managed correctly. DKA occurs most frequently in people with type 1 diabetes mellitus, but about a third of cases occur in those with type 2 diabetes. HHS occurs most frequently (but not exclusively) in older people with type 2 diabetes, who have insufficient insulin concentrations to lower blood glucose, but enough to prevent ketone production. DKA, or less commonly HHS, can be the first presentation of diabetes, but they more often occur in people known to have diabetes. The most common causes are infection and other intercurrent illnesses, or non-concordance with medication. The initial treatment of DKA and HHS differs because they are biochemically distinct. In DKA with increasing access to bedside capillary ketone monitors, the emphasis of treatment is reduction of β-hydroxybutyrate, rather than blood glucose, concentrations. In HHS, glucose lowering should be undertaken predominantly using rehydration, with insulin being gently introduced only when the rate of glucose lowering has stabilized.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 10","pages":"Pages 743-748"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125148","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}

引用次数: 0

Epidemiology of diabetes 糖尿病流行病学

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-08-31 DOI: 10.1016/j.mpmed.2026.07.003

Nita Gandhi Forouhi, Nicholas J. Wareham

{"title":"Epidemiology of diabetes","authors":"Nita Gandhi Forouhi, Nicholas J. Wareham","doi":"10.1016/j.mpmed.2026.07.003","DOIUrl":"10.1016/j.mpmed.2026.07.003","url":null,"abstract":"<div><div>Diabetes mellitus, a metabolic disorder characterized by hyperglycaemia, is a major contributor to morbidity and among the top 10 leading causes of death globally. The latest estimates show a global prevalence of 589 million adults with diabetes in 2024, with a projected rise to 853 million by 2050. This poses a substantial public health burden, placing unsustainable demands on affected individuals, carers, health systems and society. This burden is distributed unequally, with three-quarters of adults with diabetes living in low- and middle-income countries. Increasing diabetes prevalence is fuelled by population ageing together with rising levels of obesity and suboptimal health behaviours including poor-quality diets and physical inactivity; these are in turn promoted by wider societal determinants, including urbanization. The aetiological classification of diabetes mellitus includes two main types: 1 and 2. Type 2 diabetes accounts for >90% of the total diabetes mellitus prevalence. These common forms of diabetes can lead to multisystem complications: microvascular endpoints including retinopathy, nephropathy, neuropathy and macrovascular endpoints (e.g. ischaemic heart disease, stroke, peripheral vascular disease). The aetiology of type 1 diabetes is incompletely understood. The role of modifiable factors in the causation of type 2 diabetes makes prevention a realistic public health goal.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 10","pages":"Pages 712-718"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125156","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}

引用次数: 0

What is type 1 diabetes? 什么是1型糖尿病？

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-09-01 DOI: 10.1016/j.mpmed.2026.07.007

Josephine Elliott, Lauren M Quinn, Sally L Thrower, Renuka Dias, Parth Narendran

{"title":"What is type 1 diabetes?","authors":"Josephine Elliott, Lauren M Quinn, Sally L Thrower, Renuka Dias, Parth Narendran","doi":"10.1016/j.mpmed.2026.07.007","DOIUrl":"10.1016/j.mpmed.2026.07.007","url":null,"abstract":"<div><div>Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by hyperglycaemia secondary to absolute insulin deficiency. It is the result of T cell-mediated autoimmune destruction of the insulin-producing β-cells that reside in the islets of Langerhans. T1DM is associated with circulating autoantibodies to β-cell antigens. It results from an interplay between genetic and environmental factors. Screening for T1DM has led to the detection of T1DM before symptoms occur, resulting in a reclassification of early T1DM into three stages based on evidence of dysglycaemia and symptoms. The classic symptoms of T1DM are caused by rapid β-cell failure: weight loss, polyuria, polydipsia and risk of ketoacidosis. Although T1DM is the most common form of dysglycaemia in children and young adults, it can present at any age. Indeed, more than half of cases present in people aged ≥30 years. The clinical presentation in adults can be less acute, and there is potential for diagnostic confusion. The long preclinical prodrome raises the possibility of intervention to prevent the clinical onset of disease. General population research screening programmes are being established globally, and the first disease-modifying therapy for early T1DM, teplizumab, has been recommended by the National Institute for Health and Care Excellence in the UK for individuals aged 8 years and above with stage 2 T1DM.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 10","pages":"Pages 695-699"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125153","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}

引用次数: 0

What is type 2 diabetes? 什么是2型糖尿病？

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-09-01 DOI: 10.1016/j.mpmed.2026.07.005

Obada Charaf, Adrian Vella

{"title":"What is type 2 diabetes?","authors":"Obada Charaf, Adrian Vella","doi":"10.1016/j.mpmed.2026.07.005","DOIUrl":"10.1016/j.mpmed.2026.07.005","url":null,"abstract":"<div><div>Type 2 diabetes mellitus (T2DM) is a common metabolic disorder characterized by chronic hyperglycaemia. It is associated with reduced life expectancy owing to a greater risk of microvascular and macrovascular complications. The best-known predictors of increased diabetes risk are elevated fasting plasma glucose, elevated 1- and 2-hour plasma glucose concentrations after an oral glucose tolerance test, obesity and evidence of impaired insulin action. However, the mechanisms by which people with impaired fasting glucose and/or abnormal glucose tolerance ‘progress’ to overt T2DM are not completely understood. Moreover, T2DM is defined in a ‘negative’ sense (hyperglycaemia not accounted for by autoimmune destruction of islet cells or other known causes). Therefore it is important to remember that, first, T2DM is a heterogeneous group of hyperglycaemic disorders with multiple different mechanisms; and second, defining such a complex disease affecting many different metabolic pathways simply in terms of hyperglycaemia may overlook the pathogenesis of the condition. In this review, we explore some of the mechanisms that underlie T2DM and attempt to remind readers that hyperglycaemia is only one of its characteristics.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 10","pages":"Pages 700-704"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125154","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}

引用次数: 0

What is diabetes? 什么是糖尿病？

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-08-31 DOI: 10.1016/j.mpmed.2026.07.002

Aoife M Egan, Seán F Dinneen

引用次数: 0

Modern strategies for management of glycaemia in type 1 diabetes 1型糖尿病血糖管理的现代策略

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-09-01 DOI: 10.1016/j.mpmed.2026.07.004

Alwyn Choo, Mark L. Evans, Sankalpa Neupane

{"title":"Modern strategies for management of glycaemia in type 1 diabetes","authors":"Alwyn Choo, Mark L. Evans, Sankalpa Neupane","doi":"10.1016/j.mpmed.2026.07.004","DOIUrl":"10.1016/j.mpmed.2026.07.004","url":null,"abstract":"<div><div>Recent years have seen significant advances and rapid development in the management of type 1 diabetes mellitus (T1DM). Continuous glucose monitoring is now widely used and increasingly integrated with insulin pump therapy through automated insulin delivery systems, with targets of improving time in range and reducing hypoglycaemia. These automated insulin delivery systems are becoming the standard of care in healthcare, supported by observations, clinical trials and updated guidelines. Furthermore, significant advances in glucose sensor technologies have improved accuracy, connectivity and data sharing to enable remote monitoring, individualized care and healthcare equity and equality. Continuing use of ‘smart pens’ and increasing connectivity and synchronization with digital platform ecosystems such as healthcare apps and cloud platforms are also improving monitoring accuracy, adherence, engagement and personalized and shared care with patients. Treatments that target disease progression, such as immunotherapy, have showed promising results and are now starting to be approved for use in delaying the requirement for insulin in T1DM. Structured education and support remain important in the management of T1DM. Finally, it is important to highlight the influence of psychological factors in supporting self-management of T1DM, and the value of a multidisciplinary team approach.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 10","pages":"Pages 719-723"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125146","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}

引用次数: 0

Diagnosis and management of monogenic diabetes 单基因糖尿病的诊断和治疗

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-09-01 DOI: 10.1016/j.mpmed.2026.07.009

Foteini K. Kavvoura, Katharine R. Owen

{"title":"Diagnosis and management of monogenic diabetes","authors":"Foteini K. Kavvoura, Katharine R. Owen","doi":"10.1016/j.mpmed.2026.07.009","DOIUrl":"10.1016/j.mpmed.2026.07.009","url":null,"abstract":"<div><div>Most people with diabetes mellitus have type 1 or type 2 diabetes; however, there are a number of other inherited forms of diabetes and insulin resistance syndromes, which represent up to about 5% of all cases of diabetes. Monogenic forms of pancreatic β-cell dysfunction include maturity-onset diabetes of the young (MODY) and neonatal diabetes mellitus (NDM), with MODY being the most common form of inherited diabetes. The long-term response to sulfonylurea drugs in MODY caused by <em>HNF1A</em> and <em>HNF4A</em> mutations and NDM caused by <em>KCNJ11</em> and <em>ABCC8</em> mutations is an excellent example of precision medicine. Mitochondrial diabetes is maternally inherited and usually associated with sensorineural deafness and other neurological features. Monogenic severe insulin resistance can be divided into adipose tissue defects (lipodystrophies, characterized by abnormal fat distribution) and disorders of insulin signalling. The molecular diagnosis of inherited diabetes has important implications for patients, allowing personalized management and screening of their relatives. Misclassification of monogenic diabetes or severe insulin resistance as type 1 or 2 diabetes is common, and new tools for prioritizing suspected cases for genetic testing are needed.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 10","pages":"Pages 705-711"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125155","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}

引用次数: 0

Self-assessment/CPD answers 自我评价/ CPD答案

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-08-31 DOI: 10.1016/j.mpmed.2026.07.010

引用次数: 0

Glycaemic management in patients with diabetes in hospital 住院糖尿病患者的血糖管理

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-09-03 DOI: 10.1016/j.mpmed.2026.07.008

Sanjeev Sharma, Gerry Rayman

{"title":"Glycaemic management in patients with diabetes in hospital","authors":"Sanjeev Sharma, Gerry Rayman","doi":"10.1016/j.mpmed.2026.07.008","DOIUrl":"10.1016/j.mpmed.2026.07.008","url":null,"abstract":"<div><div>Approximately 20–30% of all acute hospital beds in England and Wales are occupied by people with diabetes mellitus, despite the condition only affecting roughly 6.5% of the UK population. This high prevalence means that diabetes patients are significantly overrepresented in inpatient settings, often requiring specialized care for the presenting condition unrelated to their diabetes as well as direct metabolic consequences of diabetes mellitus, including hyperglycaemia and hypoglycaemic episodes arising during the admission. Consequently, diabetes is associated not only with a considerable increase in morbidity and mortality, but also an increase in cost related to healthcare delivery and length of stay. National organizations, such as the Joint British Diabetes Societies for Inpatient Care, American Diabetes Association and Endocrine Society, have recognized this increasing problem and have produced guidelines and consensus statements for improving inpatient care. This overview of inpatient diabetes management focuses on current practices in the UK and gives recommendations for improving diabetes care, including the choice of various diabetes therapies and technologies, as well as summarizing newer evolving topics of perioperative care.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 10","pages":"Pages 734-742"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125147","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}

引用次数: 0