BMJ Open Diabetes Research & Care最新文献

{"title":"Diabetes-specific nutritional formulas for tube feeding in patients with hyperglycemia: a systematic review and meta-analysis.","authors":"Osama Hamdy, Raveendhara R Bannuru, Elena A Christofides, Andrea J Glenn, Nuha El Sayed, Katherine Fazioli, Ka Hei Karen Lau, Meredith Noble, Tracy C Shields, Guillermo E Umpierrez, Jeffrey I Mechanick","doi":"10.1136/bmjdrc-2026-006281","DOIUrl":"10.1136/bmjdrc-2026-006281","url":null,"abstract":"<p><p>This systematic review was conducted to evaluate the effects of diabetes-specific nutritional formulas (DSNF) in tube feeding on multiple outcomes in patients with hyperglycemia in real-world clinical settings. Randomized controlled trials (RCTs) comparing outcomes of patients receiving tube feeding with DSNF versus standard formulas were evaluated. RCTs in critical care and long-term care settings were addressed separately. Outcomes reported by two or more RCTs per clinical setting were evaluated, and those addressed by three or more RCTs were assessed using meta-analysis. Five RCTs allocating 483 patients in critical care and three RCTs allocating 137 patients in long-term care met inclusion criteria. DSNF showed advantages over standard formulas for glycemic control in both populations. Meta-analysis of studies enrolling critically ill patients found reductions in mean blood glucose (mean difference (MD) -0.54 mmol/L (95% CI -0.78 to -0.31), p<0.001; I²=9%; moderate certainty), coefficient of variation of glucose (MD -6.56% (95% CI -12.55% to -0.57%), p=0.032; I²=98%; low certainty) and SD of glucose (-0.77 mmol/L (95% CI -1.49 to -0.06), p<i>=</i>0.035; I²=98%; low certainty). Meta-analysis of the studies enrolling patients in long-term care found a reduction in hemoglobin A1c (-0.92% (95% CI -1.72% to -0.13%), p<i>=</i>0.023; I²=85%; low certainty). Findings for other outcomes were uncertain due to a lack of reporting in the included publications, inconsistent findings across studies, small sample sizes or lack of overall statistical significance. Evidence from this review demonstrated that DSNF in tube feeding provides statistically significant improvements in glycemia in both critically ill and long-term care populations with hyperglycemia compared with standard formulas. However, small effect sizes, imprecision and substantial statistical heterogeneity reduced certainty in the strength of evidence for most outcomes. DSNF is an important clinical tool to control hyperglycemia among critically ill and long-term care patients and should continue to be assessed for effectiveness in improving outcomes.<b>PROSPERO registration number</b>CRD420251105442.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subtypes of pre-diabetes in rural adolescent girls from India (DERVAN-11).","authors":"Suvarna Patil, Netaji Patil, Dnyaneshwar Jadhav, Pallavi Bhat, Asmita Jadhav, Anup Nilawar, Charudatta Joglekar","doi":"10.1136/bmjdrc-2026-006211","DOIUrl":"10.1136/bmjdrc-2026-006211","url":null,"abstract":"<p><strong>Introduction: </strong>Pre-diabetes is becoming increasingly prevalent in adolescent populations. We recently reported a high prevalence of pre-diabetes among rural adolescent girls from the DERVAN cohort study established in the predominantly undernourished KONKAN region of India. We aimed to investigate the heterogeneity of pre-diabetes by identification of distinct subtypes.</p><p><strong>Research design and methods: </strong>Anthropometry (body mass index (BMI) and waist circumference) and body composition (adiposity), as well as glycemic parameters (glucose, insulin, and glycated hemoglobin), were measured at the recruitment stage. Indices for insulin resistance (homeostatic model assessment (HOMA)-IR), β-cell function (HOMA-β), insulin sensitivity (HOMA-S), and compensatory β-cell response for prevailing insulin insensitivity were calculated using the homeostasis model. Pre-diabetes was diagnosed using the American Diabetes Association criteria. Unsupervised K-means clustering and a subgrouping algorithm were applied to characterize pre-diabetes. We used BMI, waist circumference, and adiposity for characterization. Glycemic parameters and HOMA indices were compared between clusters, as well as subgroups.</p><p><strong>Results: </strong>Among 1382 girls, 809 (58.5%) were thin and 550 (39.8%) were pre-diabetic. We identified five clusters based on phenotypic characteristics: Cluster 1: young lean (YL), Cluster 2: old lean (OL), Cluster 3: low BMI-high waist, Cluster 4: normal BMI-low waist, and Cluster 5: obese. The cluster frequencies were 145 (26.4%), 131 (23.8%), 146 (26.5%), 74 (13.5%), and 54 (9.8%). Clusters YL and OL had the lowest fasting insulin concentrations, HOMA-IR, and HOMA-β but high HOMA-S and a compensatory β cell response for prevailing insulin insensitivity. Subgroup analysis further revealed a distinct lean pre-diabetic phenotype (n=314) with the lowest BMI (<18.5 kg/m²), no central obesity and adiposity, and the lowest fasting insulin concentration, HOMA-IR, and HOMA-β compared with remaining subgroups.</p><p><strong>Conclusions: </strong>We demonstrated the existence of a distinct lean pre-diabetic phenotype in adolescent girls whose characteristics seem to mirror those of adult type 5 diabetes, which has been recently recognized as a distinct entity. This suggests a need for precise strategies for primordial prevention.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective advantages, selective mismatches, chronic inflammation, obesity, and type 2 diabetes: a new hypothesis to explain the effects of natural selection on genetic variation at the ectodysplasin A receptor locus.","authors":"Dawn K Coletta, Leslea J Hlusko, G Richard Scott, Yann Klimentidis, Arielle Pastore, Sunny Palumbo, Nasrin Fatima, Lawrence J Mandarino","doi":"10.1136/bmjdrc-2026-005937","DOIUrl":"10.1136/bmjdrc-2026-005937","url":null,"abstract":"<p><p>Development of ectodermal tissues in humans is a complex process regulated by interacting signaling pathways. This review adopts an evolutionary medicine framework to examine how genetic variation in components of the ectodysplasin A (EDA) signaling pathway may have conferred human evolutionary fitness during the last ice age, but today may present an evolutionary mismatch, contributing to modern chronic diseases. A missense substitution at amino acid 370 in the human EDA receptor (EDAR) gene (EDARV370A), which is very common in East Asian, Native American, and Latino populations, produces pleiotropic effects in ectodermal tissues such as hair, teeth, mammary glands, and skin appendages. Several hypotheses have been offered to explain the high frequency of EDARV370A, proposing selective advantages related to thermal regulation, mother-infant vitamin D transmission, and/or tooth shape. However, new insight suggests that the selective advantage could have involved EDAR's systemic and epithelial immune effects rather than embryonic effects alone. We explore the possibility that inflammatory effects associated with EDARV370A were the target of selection approximately 20 000 years ago, but that this selective advantage could now represent an evolutionary mismatch in the context of abundant caloric supply, resulting in chronic inflammation and a higher risk of metabolic syndrome. Finally, we outline directions for future research.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproductive lifespan in relation to diabetes mellitus and metabolic syndrome in a nationally representative population.","authors":"AJin Cho, Yun Soo Hong, Hoon Kim","doi":"10.1136/bmjdrc-2026-005990","DOIUrl":"10.1136/bmjdrc-2026-005990","url":null,"abstract":"<p><strong>Aims: </strong>The association between reproductive lifespan (RLS) and diabetes and metabolic syndrome in menopausal women remains unclear. We investigated whether a short RLS is associated with diabetes and metabolic syndrome using nationally representative US data.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of menopausal women using data from the US National Health and Nutrition Examination Survey from 2007 to 2018. Weighted logistic regression models accounting for the complex survey design were used to estimate ORs and 95% CIs for diabetes and metabolic syndrome across quartiles of RLS.</p><p><strong>Results: </strong>A total of 868 postmenopausal women with a mean age of 54.1 years were included. The mean ages at menarche and menopause were 12.7 and 51.2 years, respectively. The mean RLS was 38.5 years and was categorized into quartiles (11-35, 36-39, 40-42 (reference group), and 43-50 years). Compared with the reference group, women in the second quartile had higher odds of diabetes (OR 2.23; 95% CI 1.05 to 4.73) after adjustment for age, demographic characteristics, behavioral factors, age at menarche, and family history of diabetes. In contrast, women in the shortest RLS quartile were not at increased odds of diabetes, and no significant linear trend was observed across RLS categories. No robust association was observed between RLS and metabolic syndrome. These findings were consistent in sensitivity analyses that additionally included women with surgical menopause and that further adjusted for dietary factors.</p><p><strong>Conclusion: </strong>A relatively short RLS may be associated with higher odds of diabetes, although this association did not follow a clear dose-response pattern. These findings suggest that reduced lifetime estrogen exposure may contribute to cardiometabolic risk. Given the cross-sectional design, longitudinal studies are needed to support these findings.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body composition displays expected and unexpected contributions to blood pressure and glycemia in young South African women.","authors":"Ravi Retnakaran, Junwei Shen, Rayjean J Hung, Stephen J Lye, Shane A Norris","doi":"10.1136/bmjdrc-2026-006131","DOIUrl":"10.1136/bmjdrc-2026-006131","url":null,"abstract":"<p><strong>Introduction: </strong>Sub-Saharan Africa is undergoing rapid demographic, sociocultural, and economic transitions that are contributing to rising rates of overweight/obesity, which in turn may drive cardiometabolic sequelae such as diabetes and hypertension. However, the extent to which excess adiposity may contribute to the prevalence of such sequelae in sub-Saharan Africa remains uncertain. We thus sought to systematically evaluate body composition by dual-energy X-ray absorptiometry (DEXA) and its associations with glycemia and blood pressure (BP) in young women in Soweto, South Africa.</p><p><strong>Research design and methods: </strong>This study was performed in 7735 women (median age of 22.4 years) undergoing assessment for a clinical trial. Whole-body DEXA scan yielded 12 measures of body composition (reflecting whole-body fat, central adiposity, peripheral adiposity, and lean mass/soft tissue) that were assessed as predictors of A1c, systolic BP, and diastolic BP, respectively.</p><p><strong>Results: </strong>The study population had high rates of overweight/obesity (49.6%), pre-diabetes/diabetes (10.9%), and hypertension (11.9%). While specific adiposity measures (fat mass (FM), visceral adipose tissue, subcutaneous adipose tissue (SAT), android fat) were significantly associated with A1c, these associations were exceedingly modest, with these measures additionally explaining only 0.14% to 0.37% of the variance in A1c. In contrast, all 12 body composition measures showed significant associations with systolic BP and diastolic BP. Indices of lean mass/soft tissue (lean mass index, lean mass, fat-free soft tissue mass) explained 5.8% to 6.3% of the variance in systolic BP, while measures of adiposity (android fat, SAT, FM) reconciled 4.6% to 4.8% of the variance in diastolic BP, reflecting much stronger associations with BP than with A1c.</p><p><strong>Conclusion: </strong>In this young adult population with high rates of overweight/obesity and pre-diabetes/diabetes, DEXA-derived adiposity exhibits modest associations with glycemia, underscoring the atypical nature of diabetes in sub-Saharan Africa.</p><p><strong>Trial registration number: </strong>PACTR201903750173871.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of stress hyperglycemia ratio in patients undergoing percutaneous coronary intervention: a dose-response meta-analysis.","authors":"Jinyu He, Qianxiang Wang, Junhua He, Chunyu Zhang, Haojie Xue, Jing Wang, Yi Zhong, Jian Feng, Li Deng","doi":"10.1136/bmjdrc-2025-005656","DOIUrl":"10.1136/bmjdrc-2025-005656","url":null,"abstract":"<p><strong>Background: </strong>Stress hyperglycemia is common during percutaneous coronary intervention (PCI) and is associated with worse outcomes. The stress hyperglycemia ratio (SHR), which standardizes acute glucose levels to chronic glycemic status, may provide superior prognostic information compared with admission glucose alone.</p><p><strong>Objective: </strong>To systematically evaluate the association between SHR and clinical outcomes in PCI patients and to quantify the exposure-response relationship.</p><p><strong>Data sources: </strong>PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov were searched from inception to August 5, 2025.</p><p><strong>Study selection: </strong>Observational studies reporting SHR prior to PCI and subsequent clinical outcomes were included.</p><p><strong>Data extraction: </strong>Two investigators independently extracted study characteristics, SHR definitions, and adjusted effect estimates. Risk of bias was assessed using ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions), and certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation framework.</p><p><strong>Data synthesis: </strong>Thirteen studies comprising 41 096 PCI patients were included. Elevated SHR was associated with increased risks of all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), cardiovascular mortality, recurrent myocardial infarction, and stroke, but not with repeat revascularization. Sensitivity analyses yielded consistent results. The dose-response analysis suggested an approximately linear dose-response pattern between SHR and MACCE.</p><p><strong>Limitations: </strong>Most studies were observational, SHR definitions varied, and residual confounding cannot be excluded. The limited number of studies restricted the interpretability of dose-response analyses.</p><p><strong>Conclusions: </strong>Elevated SHR was associated with an increased risk of adverse outcomes after PCI. The dose-response analysis suggested an approximately linear dose-response pattern between SHR and MACCE. However, these findings should be interpreted cautiously given the observational nature of the evidence and the limited number of studies for certain analyses.</p><p><strong>Prospero registration number: </strong>CRD420251045853.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early loss and progressive deterioration of glucagon responses to hypoglycemia in children with type 1 diabetes.","authors":"Antoine Harvengt, Maude Beckers, Ilektra Iakovidou, Anaïs Maure, Zain Syed, Laure Boutsen, Dominique Beckers, Philippe A Lysy","doi":"10.1136/bmjdrc-2026-005959","DOIUrl":"10.1136/bmjdrc-2026-005959","url":null,"abstract":"<p><strong>Introduction: </strong>Impaired glucagon counterregulation is a major contributor to hypoglycemia risk in type 1 diabetes (T1D). While well described in adults, the timing, trajectory, and determinants of glucagon dysfunction in children remain poorly defined. Our objective was to characterize the evolution of glucagon secretion during insulin-induced hypoglycemia in children with newly diagnosed T1D and to identify biomarkers of counterregulatory failure.</p><p><strong>Research design and methods: </strong>GLUcagon REsponse to hypoglycemia in children and adolescents with new-onset type 1 DIAbetes (GLUREDIA) - Work Package (WP) 1 is a prospective, multicenter longitudinal study including 22 children and adolescents (aged 2-17 years) with newly diagnosed T1D and eight healthy first-degree relatives. Participants underwent standardized insulin-induced hypoglycemia tests (IIHTs). In patients with T1D, IIHTs were performed at diagnosis and at 6, 12, and 18 months. Plasma glucagon and counterregulatory hormones were measured at baseline and during hypoglycemia. Continuous glucose monitoring (CGM) metrics and circulating biomarkers were analyzed using longitudinal mixed models and regression analyses.</p><p><strong>Results: </strong>In healthy participants, IIHT elicited a robust physiological increase in glucagon during hypoglycemia (p<0.001). In contrast, children with T1D showed no significant glucagon response despite deeper hypoglycemia. Longitudinally, glucagon responsiveness was absent at diagnosis, transiently improved at 6 months (p=0.04), absent at 12 months, and paradoxically suppressed at 18 months (p=0.02). Basal glucagon levels remained stable over time. Glucagon responses correlated positively with CGM time-in-range (70-180 mg/dL) and negatively with glycemic variability and hypoglycemia frequency. A CGM-based logistic model integrating these metrics predicted impaired glucagon responses with good discrimination (area under the curve 0.79). Circulating glucose-dependent insulinotropic polypeptide, glucagon-like peptide-1, tumor necrosis factor-α, and interferon-γ correlated positively with glucagon secretion, whereas partial remission status did not.</p><p><strong>Conclusions: </strong>Glucagon counterregulation is profoundly impaired early in pediatric T1D and deteriorates dynamically within the first 18 months after diagnosis. Glycemic instability and recurrent hypoglycemia are key determinants of α-cell dysfunction. CGM-derived metrics may serve as non-invasive surrogates of impaired counterregulation and support early risk stratification for hypoglycemia in children with T1D.</p><p><strong>Trial registration number: </strong>NCT06770621.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-like peptide-1 receptor agonists for primary cardiovascular disease prevention in type 2 diabetes, a systematic review.","authors":"Guillaume Grenet, Raha Eskandari, Joyce Ko, Stephen P Adams, Douglas M Salzwedel, Balraj S Heran, Anshula Ambasta, Ken Bassett, Wade Thompson","doi":"10.1136/bmjdrc-2026-006225","DOIUrl":"10.1136/bmjdrc-2026-006225","url":null,"abstract":"<p><p>We aimed to estimate the cardiovascular (CV) benefit of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes (T2D) without a history of CV disease (CVD) (primary CVD prevention). We searched MEDLINE and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) and Epistemonikos for systematic reviews (up to July 4, 2025). We included RCTs of patients with T2D comparing a GLP-1 RA to placebo using a CV or renal primary outcome. 11 drug manufacturer-funded trials (77 419 participants) were included. We used version 1 of the Cochrane risk of bias tool. Our primary analysis was the pooled estimate of the treatment effect in primary CVD prevention. Outcomes of interest were major adverse cardiovascular events (MACE, primary outcome), all-cause mortality, CV mortality, myocardial infarction, stroke, and serious adverse events (secondary outcomes). Only 26% of participants were primary CVD prevention patients. The pooled estimates of treatment effect for primary CVD prevention were not significant for the primary outcome, MACE (pooled HR 0.88, 95% CI 0.74 to 1.05, based on eight trials, n=16 672), and all secondary outcomes. The certainty of the evidence was rated as low due to trials' risk of bias and imprecision. Our review was limited to subgroup analyses of aggregated data from studies not powered for primary prevention alone. Current evidence is insufficient to establish CV benefits of GLP-1 RAs in T2D without a history of CVD, and dedicated primary prevention trials are needed.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiometabolic factors and risk of dementia in people with type 2 diabetes in England: a large retrospective cohort study.","authors":"Heidi Tm Lai, Kiara Chang, Mansour Ta Sharabiani, Jonathan Valabhji, Edward W Gregg, Lefkos T Middleton, Azeem Majeed, Jonathan Pearson-Stuttard, Christopher J Millett, Alex Bottle, Eszter P Vamos","doi":"10.1136/bmjdrc-2025-005743","DOIUrl":"10.1136/bmjdrc-2025-005743","url":null,"abstract":"<p><strong>Introduction: </strong>People with type 2 diabetes (T2D) have a higher dementia risk. Cardiometabolic factors may influence dementia development, but long-term links among people with T2D remain unclear. Prior studies show mixed findings and have not considered how the time before dementia diagnosis at which cardiometabolic factors are measured affects their association with dementia risk.</p><p><strong>Methods: </strong>We examined the associations between eight routinely measured cardiometabolic factors (including blood pressure, lipid, and glycemic markers) and the risk of dementia in 249 958 adults with T2D from the Clinical Practice Research Datalink (1999-2018). Multivariable Cox proportional hazards regression was applied with age as the timescale and stratified by follow-up time at 5, 5-10, and ≥10 years before dementia diagnosis. Cardiometabolic factors were analyzed continuously and categorically using clinically relevant cut-offs.</p><p><strong>Results: </strong>22 492 incident dementia cases were observed (1 257 998 person-years of follow-up). Higher systolic blood pressure was associated with a lower dementia risk, particularly when measured closer to the time of dementia diagnosis. Higher diastolic blood pressure (DBP) (90 vs 80 mm Hg) was associated with a 21% greater risk of dementia (95% CI 15% to 27%). Dementia risk was 32% (27%-36%) lower for those with a body mass index (BMI) ≥30 (vs <25 kg/m²) when measured within 5 years of dementia diagnosis, but 15% (7%-23%) and 43% (31%-56%) higher if measured 5-10 and ≥10 years before diagnosis, respectively. Higher levels of glycemic measures were consistently associated with a greater dementia risk. Findings for total cholesterol and low-density lipoprotein were largely null.</p><p><strong>Conclusions: </strong>Higher DBP, BMI, and glycemic measures measured over 10 years before dementia diagnosis were linked to a greater dementia risk among adults with T2D. Associations varied depending on when cardiometabolic factors were measured relative to dementia diagnosis, demonstrating the importance of distinguishing potential long-term risk factors from short-term markers of dementia development.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of the twiist Automated Insulin Delivery System: first study with twiist.","authors":"Adriana Ruiz, Ann Mcdonough, Ken Snow, Bruce Bode, Joanna Mitri","doi":"10.1136/bmjdrc-2026-006307","DOIUrl":"10.1136/bmjdrc-2026-006307","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized controlled trials and real-world studies have demonstrated that automated insulin delivery (AID) systems enhance glycemic control and mitigate hypoglycemia risk in individuals with type 1 diabetes. This study evaluated the safety, effectiveness, and usability of the twiist AID System on glycemic outcomes in adults with type 1 diabetes.</p><p><strong>Research design and methods: </strong>This 8-week, prospective, single-center, single-arm study included 20 adults with type 1 diabetes. The primary outcome measures were the percent of time spent in established continuous glucose monitoring (CGM) glycemic target ranges at 8 weeks. The primary efficacy outcome was percent time in range (%TIR; 70-180 mg/dL) at 8 weeks. Secondary outcomes were the change in glucose pre-occlusion detection; the effects of total daily insulin delivery (TDD) on glucose pre- and post-occlusion detection; the effect of Max basal ratio on %TIR; the effect of users' correction range on %TIR; and change in glycated haemoglobin (HbA1c). Changes in TDD and body weight were also assessed.</p><p><strong>Results: </strong>19 participants completed the study. At 8 weeks, the mean %TIR was 70.3±15.5%. Participants achieved or maintained glycemic targets for all CGM metrics except time above >250 mg/dL. A total of 67 occlusion events occurred in 15 participants. These events were detected within 30 min of rising glucose. Higher max basal ratio settings were associated with higher %TIR. The %TIR for participants with a correction range <100 mg/dL was 79.2±13.4% vs 67.2±15.0% for those with a correction range >100 mg/dL. HbA1c levels decreased (-0.4%±0.5%) in participants with baseline HbA1c >7%. A slight increase in TDD (1.3±16.2 U) and a decrease in body weight (-0.09±2.9 kg) were observed. No serious adverse events were reported.</p><p><strong>Conclusions: </strong>Eight-week use of twiist enabled participants to achieve or maintain established glycemic targets and suggests the system's ability to detect occlusions before clinically significant glucose rise regardless of TDD. Larger and longer term studies are needed.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}