BMJ Open Diabetes Research & Care最新文献

{"title":"Social determinants of health and recommended A1C monitoring among women with postpartum-onset diabetes: results from a retrospective cohort.","authors":"Natalie A Boychuk, Katharine J McCarthy, Shelley H Liu, Frances M Howell, Bohao Wu, Sandra S Albrecht, Hiu Tai Chan, Joseph Kennedy, Kacie Seil, Bahman Tabaei, Luciana Vieira, Victoria Mayer, Teresa Janevic","doi":"10.1136/bmjdrc-2025-005745","DOIUrl":"10.1136/bmjdrc-2025-005745","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes is increasingly prevalent in reproductive-aged women, but the association between social determinants of health (SDOH) and access to A1C monitoring after diagnosis are poorly understood. We explored SDOH and receipt of recommended follow-up A1C testing among postpartum women with diabetes.</p><p><strong>Research design and methods: </strong>A retrospective, population-based cohort of 5,590 women who delivered in New York City between 2009-2016 and experienced postpartum-onset diabetes. We explored associations between SDOH (race-ethnicity, nativity, insurance, nutrition program enrollment, education, and parity) and time to first follow-up test/rate of A1C testing using Cox proportional hazards and Poisson regression, respectively. We constructed models that were unadjusted, mutually adjusted, and further adjusted for clinical characteristics (body mass index, gestational diabetes mellitus, and age).</p><p><strong>Results: </strong>Few women received all biannual recommended follow-up tests over the study period (13.0%). Non-Hispanic Black women were more likely to receive their first follow-up test later (adjusted HR (aHR): 0.90, 95% CI 0.80 to 1.00) and had a lower rate of testing over 3 years (adjusted rate ratio (aRR): 0.92, 95% CI 0.84 to 0.99) compared with non-Hispanic White women. Women insured by Medicaid at delivery experienced a higher hazard of an earlier first follow-up A1C test (aHR: 1.14, 95% CI 1.06 to 1.22) and higher rates of testing (aRR: 1.09, 95% CI 1.03 to 1.15) than those with private or other insurance. Women with more children experienced lower rates of testing and a longer time to first A1C test compared with those with no prior children.</p><p><strong>Conclusions: </strong>Few women with postpartum-onset diabetes met A1C monitoring guidelines, suggesting a need to improve routine diabetes monitoring, particularly among Black women. The finding of an advantage in testing among people insured by Medicaid is promising. Additional research should explore mechanisms through which Medicaid insurance and other structural interventions may improve access to and engagement in routine diabetes care.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810945","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":"Tubed or tubeless insulin pumps? A retrospective real-world analysis of national French health data.","authors":"Helene Hanaire, Alexandre Vimont, Alice Bonin, Gabriel Guigand, Colin Hopley, Bogdan Catargi","doi":"10.1136/bmjdrc-2025-005860","DOIUrl":"10.1136/bmjdrc-2025-005860","url":null,"abstract":"<p><strong>Background: </strong>Tubeless insulin pumps, introduced in France in 2016, have been associated with higher user satisfaction than tubed pumps, primarily due to reduced interference with daily tasks. Whether this translates to greater treatment persistence remains uncertain. This study evaluates persistence among people with type 1 diabetes initiating tubed or tubeless pump therapy in France.</p><p><strong>Methods: </strong>This real-world, retrospective study used data from the French National Health Data System, a comprehensive medical claims database for the entire French population from 2016 to 2021. Treatment persistence was assessed using Kaplan-Meier curves and Cox models. Changes from one pump type to another were compared across calendar years using χ² tests.</p><p><strong>Results: </strong>Among 1 241 624 people with insulin claims, 233 874 had type 1 diabetes. Of these, 39% (n=90 362) initiated insulin therapy during the study period; 32% started and remained on multiple daily injections (excluded), and 68% initiated pump therapy. Among pump users (n=61 251), 51% used a tubed pump, 67% a tubeless pump, and 18% initiated both types sequentially. People initiating tubeless compared with tubed pumps had higher persistence rates (unadjusted HR 0.60, 95% CI 0.58 to 0.61) and a 40% lower risk of discontinuation (p<0.0001), consistent with the adjusted model (HR 0.59, 95% CI 0.57 to 0.61). Tubeless pumps were also associated with fewer changes from one therapy to another within 12 months. Treatment changes rose for tubed pump users after tubeless pumps entered the French market.</p><p><strong>Conclusions: </strong>Higher persistence and lower therapy changes among tubeless pump users underscore its sustained benefit for diabetes management.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810933","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":"Elevated FIB-4 index as a risk marker within the KDIGO framework in patients with type 2 diabetes and hypertension.","authors":"Hongmei Fu, Chengzhi Xing, Hengye Wang, Xianwen Wei, Stefan Wirtz","doi":"10.1136/bmjdrc-2025-005880","DOIUrl":"10.1136/bmjdrc-2025-005880","url":null,"abstract":"<p><strong>Background and aims: </strong>The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guideline recommends risk stratification for chronic kidney disease (CKD) management; however, patients within the same KDIGO category may still experience heterogeneous outcomes. Hypertension and type 2 diabetes mellitus (T2DM) are predominant causes of CKD, and hepatic fibrosis is highly prevalent in this population, but not integrated into current KDIGO risk assessment. The Fibrosis-4 (FIB-4) index, a widely validated noninvasive marker of hepatic fibrosis, may capture residual risk not reflected by KDIGO stratification. This study aims to explore whether FIB-4 can identify residual risk beyond KDIGO stratification in patients with T2DM and hypertension.</p><p><strong>Methods: </strong>This cross-sectional study included 1208 patients with T2DM and hypertension. FIB-4 was dichotomized at 1.3 based on established guidelines. The primary outcome was KDIGO high/very high risk (categories 3-4). The secondary outcome was CKD, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m² and/or albumin-to-creatinine ratio ≥30 mg/g. Multivariable logistic regression, restricted cubic spline analysis, and stratified analyses were conducted.</p><p><strong>Results: </strong>Among 1208 patients (mean age 58.3 years; 60.1% male), 514 (42.5%) had FIB-4>1.3, 286 (23.7%) were classified as KDIGO 3-4, and 588 (48.7%) met criteria for CKD. After multivariable adjustment, FIB-4>1.3 was independently associated with both KDIGO 3-4 (OR 1.57, 95% CI 1.12 to 2.19, p=0.008) and CKD (OR 1.51, 95% CI 1.14 to 2.01, p=0.004). In stratified analyses, these associations persisted among patients achieving body mass index/low-density lipoprotein cholesterol targets, although statistical power was limited for KDIGO 3-4. Within KDIGO low-risk categories, elevated FIB-4 was associated with a significantly higher prevalence of vascular comorbidities (p value for trend<0.01 for all). Restricted cubic spline modeling demonstrated a non-linear relationship, with a threshold effect at approximately 1.3 (p value for non-linearity<0.001 for KDIGO 3-4; p=0.010 for CKD).</p><p><strong>Conclusions: </strong>Elevated FIB-4 is independently associated with KDIGO 3-4 and CKD, and identifies patients with higher vascular comorbidity burden even within KDIGO low-risk categories. FIB-4 may serve as a complementary risk stratification marker within the KDIGO framework for patients with T2DM and hypertension.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762439","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":"Cognitive skills in children and adolescents with type 1 diabetes: a scoping review and meta-analysis.","authors":"Dorsa Arman, Elijah Haynes, Mariana Brussoni, Anne M Gadermann, Tyrell Sideroff, Luc van Heerden, Jane Jun, Christine Voss","doi":"10.1136/bmjdrc-2025-005635","DOIUrl":"10.1136/bmjdrc-2025-005635","url":null,"abstract":"<p><p>Type 1 diabetes (T1D) complications may impair cognitive development, but evidence on cognitive skills in children and adolescents with T1D is inconsistent. This study aimed to document measures and outcomes used to assess cognitive skills in children with T1D and to examine the relationship between T1D and cognitive skills. A systematic literature search was conducted across five databases to identify studies that administered cognitive assessments to children and adolescents aged ≤19 years with T1D. Study characteristics, cognitive skills assessments and outcomes and comparisons to non-T1D peers where available were synthesized on an evidence map. Random-effects meta-analysis was used to assess differences in Wechsler Full Scale Intelligence Quotient (IQ) test scores between T1D and non-T1D groups. From 2464 studies, 129 were included. Five main cognitive categories were identified, with comparisons to non-T1D peers-where available-yielding mixed results: academic performance (n=37; n=7/22 worse T1D), executive function (n=101; n=31/48 worse T1D), intelligence (n=73; n=22/37 worse T1D), language (n=30; n=7/20 worse T1D) and memory and learning (n=84; n=31/48 worse T1D). Large-scale studies (n≥1000) did not find significant differences between groups for academic performance (n=0/6 worse T1D) and language (n=0/3 worse T1D). In the meta-analysis of 16 studies (n=1594), children with T1D had slightly lower IQ scores than peers without T1D (mean difference -3.49, 95% CI (-6.16 to -0.82); p=0.010). T1D appears to be associated with slightly lower cognitive outcomes in some areas. Further research is needed to understand the impact of these findings on daily functioning and to inform screening for at-risk children.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762363","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":"Feasibility of using OGTT 1-h PG as a diagnostic criterion for diabetes and pre-diabetes.","authors":"Lina Chen, Bingxian Bian, Hui Ran, Yixin Niu, Yanbo Li, Qing Su, Hongmei Zhang","doi":"10.1136/bmjdrc-2025-005689","DOIUrl":"10.1136/bmjdrc-2025-005689","url":null,"abstract":"<p><strong>Aims: </strong>To investigate whether oral glucose tolerance test (OGTT) 1-hour plasma glucose (1-h PG) concentration can be used as the criterion for diagnosing diabetes mellitus (DM) and pre-diabetes.</p><p><strong>Materials and methods: </strong>Data were collected from 1021 outpatients who completed a 5-point OGTT. The χ² test was used to compare the prevalence of diabetes and pre-diabetes based on OGTT 1-h and 2-h PG (2-hour PG) according to different criteria. Cohen's Kappa test and receiver operating characteristic curves (ROC curves) were used to evaluate the diagnostic value of OGTT 1-h PG for diabetes and pre-diabetes.</p><p><strong>Results: </strong>The prevalence rates of diabetes and pre-diabetes were 34.1% and 24.4% based on the American Diabetes Association (ADA) standard, 42.4% and 21.8% when OGTT 2-h PG was replaced with OGTT 1-h PG, and 44.4% and 20.8% when the OGTT 1-h PG was added to the ADA criteria. According to the WHO criteria, the prevalence rates of diabetes and pre-diabetes were 30.4% and 19.2%, 40.5% and 21.8% when OGTT 2-h PG was replaced with OGTT 1-h PG, and 43.9% and 22.2% when the OGTT 1-h PG was added to the WHO criteria. Substituting OGTT 1-h PG for OGTT 2-h PG in the ADA diagnostic strategy still retained good consistency for both diabetes (κ=0.7, 95% CI 70.1% to 78.4%) and pre-diabetes (κ=0.7, 95% CI 64.5% to 75.0%). For diabetes, the area under the curves (AUC) was 93.7% (95% CI 92.2% to 95.1%) for OGTT 1-h PG and 96.1% (95% CI 94.7% to 97.3%) for OGTT 2-h PG. For pre-diabetes, the AUC was 71.8% (95% CI 67.9% to 75.8%) for OGTT 1-h PG and 70.4% (95% CI 65.9% to 74.5%) for OGTT 2-h PG.</p><p><strong>Conclusions: </strong>The DM prevalence would be significantly higher if the OGTT 1-h PG was adopted as the diagnostic criterion. More prospective studies are needed to validate its clinical utility.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762390","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":"Sex differences in glycemic outcomes: a systematic review and meta-analysis of diabetes treatments.","authors":"Chengli Liu, Omer Mujahid, Aleix Beneyto, Iván Contreras, Josep Vehí","doi":"10.1136/bmjdrc-2025-005808","DOIUrl":"10.1136/bmjdrc-2025-005808","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Sex differences in glycemic outcomes following insulin therapy remain underexplored despite biological and psychosocial factors that may influence individual responses. This systematic review examines sex-specific differences in glycemic control to guide personalized diabetes care and promote health equity. We searched PubMed, Scopus, Cochrane Library, and Google Scholar (August 2014-December 2025) for randomized and observational studies involving adults of both sexes on insulin. Twenty-four studies were included, with certainty of evidence assessed using GRADE. In type 1 diabetes, women showed no significant difference in achieving HbA1c &lt;7% (RR 1.05, 95% CI 0.91 to 1.22; very low certainty) and toward higher time-in-range (SMD 0.78, -0.01 to 1.57; moderate certainty). In type 2 diabetes, men were more likely to achieve HbA1c targets (RR 0.86, 95% CI 0.72 to 1.03; low certainty), while women required higher weight-adjusted insulin doses (SMD 0.55, 0.23 to 0.86; very low certainty). Hypoglycemia risk showed opposing trends in inpatient (RR 0.78, 95% CI 0.33 to 1.83; very low certainty) versus outpatient settings (RR 1.08, 95% CI 0.61 to 1.89; low certainty) with substantial heterogeneity (I2&gt;70%). These findings suggest that sex-related differences in glycemic outcomes vary by diabetes type and treatment context. Given the low certainty and heterogeneity of current evidence, results should be interpreted as hypothesis-generating. This review supports the consideration of biological sex within a broader, individualized diabetes management framework and highlights the need for future sex-stratified analyses with rigorous control of lifestyle and physiological factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Sex differences in glycemic outcomes following the same insulin therapy in diabetes remain underexplored. Numerous factors, encompassing both biological and psychosocial aspects, could potentially influence individual responses to insulin therapy. This systematic review examines sex-specific differences in glycemic control to guide personalized diabetes care and promote health equity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed, Scopus, Cochrane Library, and Google Scholar were searched (August 1, 2014-December 31, 2025) for randomized and observational studies. Eligible studies included adults of both sexes on insulin reporting sex-specific data for predefined outcomes. Data on glycated hemoglobin (HbA1c), blood glucose metrics, hypoglycemia, and insulin dose were extracted. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-four studies were included. In type 1 diabetes, women showed no significant difference in achieving HbA1c &lt;7% (risk ratio (RR) 1.05, 95% CI 0.91 to 1.22; very low certainty) and toward higher time-in-range (standardized mean difference (SMD) 0.78, -0.01 to 1.57; moderate certainty). In type 2 diabetes, men were more likely to ac","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762424","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":"Differences in association between gestational weight gain and perinatal outcomes according to pre-pregnancy body mass index categories and gestational diabetes mellitus status: findings from a large Japanese cohort.","authors":"Kei Fujikawa Shingu, Mitsuyoshi Takahara, Masako Waguri, Jun Takeda, Naoto Katakami, Iichiro Shimomura, Atsuo Itakura, Takashi Sugiyama, Naho Morisaki","doi":"10.1136/bmjdrc-2025-005709","DOIUrl":"10.1136/bmjdrc-2025-005709","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to examine the impact of gestational weight gain (GWG) on perinatal outcomes based on body mass index (BMI) category and gestational diabetes mellitus (GDM) status.</p><p><strong>Research design and methods: </strong>This retrospective study included 53 183 Japanese women with GDM and 734 028 with normal glucose tolerance (NGT). We assessed interaction effects of BMI categories (underweight <18.5, normal 18.5-24.9, overweight 25.0-29.9, obese ≥30.0 kg/m²) and GDM status on GWG and perinatal outcomes, including birth weight, hypertensive disorders of pregnancy, preterm delivery, mode of delivery, and a composite outcome, using generalized linear models with a logit link function.</p><p><strong>Results: </strong>BMI category and GDM status had significant interaction effects on the association between GWG and all outcomes (all p<0.05, using the likelihood ratio test). Notably, the impact of increased GWG on the risk of having large-for-gestational-age newborns was greater in women with GDM than in those with NGT, a trend that was most pronounced in the obese group. For GWG, from 5-6 kg to 15-16 kg, the predicted probability of large-for-gestational-age newborns increased by 10.0% (from 4.9% to 14.9%) for NGT compared with 15.6% (from 6.3% to 21.8%) for GDM in the normal BMI group, and by 14.4% (from 17.6% to 32.0%) and 23.1% (from 23.5% to 46.6%), respectively, in the obese group.</p><p><strong>Conclusions: </strong>The impact of GWG on perinatal outcomes differed according to the BMI category and GDM status. These findings support the need to take into account both factors when developing GWG recommendations to minimize the risk of adverse perinatal outcomes.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762403","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":"Low uptake and disparities in therapeutic inertia of cardiorenal protective diabetes medications for patients with type 2 diabetes and above-target hemoglobin A1c.","authors":"Jashalynn German, Wei Angel Huang, Amanda Brucker, Khayla Daniel, David Halpern, Nrupen Bhavsar, Eugenia McPeek Hinz, Richard Shannon, Michael Pignone, Matthew J Crowley, Bryan C Batch, Benjamin A Goldstein, Susan Elizabeth Spratt","doi":"10.1136/bmjdrc-2025-005546","DOIUrl":"10.1136/bmjdrc-2025-005546","url":null,"abstract":"<p><strong>Introduction: </strong>Therapeutic inertia (failure to initiate or intensify therapy when therapeutic goals are unmet) contributes to poor glycemic control and diabetes-related complications. We assessed the extent of therapeutic inertia, defined as a lack of new prescription orders for sodium-glucose cotransporter-2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA), among patients with type 2 diabetes and above-target hemoglobin A1c who had clinical indications for use, were not currently using these medications, and had no contraindications. We also examined whether prescribing patterns differed by race and ethnicity.</p><p><strong>Research design and methods: </strong>We conducted a retrospective cohort analysis of 2018-2022 electronic health record data. Log-link Poisson generalized estimating equation models estimated relative risks (RR) and assessed predictors of therapeutic inertia and trends over time.</p><p><strong>Results: </strong>Among 10 345 eligible patients (30 740 encounters), 56% were White, 37% Black, 3% Hispanic, 2% Asian, and 2% other races and ethnicities. The rate of new prescribing increased over time but remained low (SGLT2i: 0.9%-4.3%; GLP-1RA: 1.2%-5.2%). After adjusting for sociodemographic, clinical, and service factors, Black patients were less likely than White patients to receive new SGLT2i (RR 0.59, 95% CI 0.42 to 0.82) and GLP-1RA (RR 0.62, 95% CI 0.49 to 0.79) prescriptions; Hispanic patients were less likely to receive new GLP-1RA prescriptions (RR 0.48, 95% CI 0.25 to 0.92).</p><p><strong>Conclusion: </strong>Despite compelling indications, initiation of SGLT2i and GLP-1RA remained low overall and was significantly lower among Black and Hispanic patients, underscoring therapeutic inertia as a modifiable barrier to optimal diabetes care.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762397","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":"Safety and efficacy of switching from dulaglutide to tirzepatide across clinically relevant baseline characteristics in participants with T2D: subgroup analysis of SURPASS-SWITCH.","authors":"Rafael Violante-Ortiz, Ludger Rose, Palash Sharma, Elisa Gomez Valderas, K Karthik Chivukula, Anita Ym Kwan","doi":"10.1136/bmjdrc-2025-005711","DOIUrl":"10.1136/bmjdrc-2025-005711","url":null,"abstract":"<p><strong>Introduction: </strong>In SURPASS-SWITCH, switching from dulaglutide to tirzepatide resulted in greater improvements in glycemic control and body weight in adults with type 2 diabetes (T2D). This study aimed to investigate the efficacy and safety of switching from weekly dulaglutide to weekly tirzepatide in adults with T2D in prespecified baseline subgroups from SURPASS-SWITCH.</p><p><strong>Research design and methods: </strong>This phase IV, randomized, open-label, active-controlled, parallel-group, multicenter, multinational trial included adults with hemoglobin A1c (HbA1c) ≥7.0% to ≤9.5%, on a stable dose of dulaglutide for at least 6 months, on a stable dose of 0-3 oral antihyperglycemic medications for at least 3 months, with stable body weight, and body mass index (BMI) ≥25 kg/m² at screening. Participants were randomly assigned 1:1 to continue with and escalate to dulaglutide 4.5 mg or maximum tolerated dose (MTD) or switch to tirzepatide with escalation to 15 mg or MTD. Changes from baseline in HbA1c and body weight at week 40 in baseline subgroups of age (<65, ≥65 years), HbA1c (≤8.5%, >8.5%), duration of T2D (≤5, >5 to ≤10, >10 years), baseline dulaglutide dose (0.75 mg, 1.5 mg), duration of dulaglutide dose (<1, ≥1 year), BMI (<27, ≥27; <30, ≥30 to <35, ≥35 kg/m²), and ethnicity (Hispanic or Latino, non-Hispanic or non-Latino), and sex (female, male) were determined.</p><p><strong>Results: </strong>Reductions in HbA1c and body weight at week 40 were significant and consistently greater with tirzepatide across all prespecified baseline subgroups. HbA1c reduction was greater in the subgroups with higher baseline HbA1c and low baseline BMI. Weight reduction was greater for participants in the non-Hispanic or non-Latino subgroup. The safety profile was similar across subgroups. Nausea and diarrhea were usually the most frequently reported treatment-emergent adverse events in each subgroup.</p><p><strong>Conclusions: </strong>In this subgroup analysis of SURPASS-SWITCH, switching to tirzepatide from dulaglutide was generally well-tolerated and associated with significant and consistent improvements in HbA1c and weight reductions versus dulaglutide across all baseline subgroups evaluated. These results indicate that switching to tirzepatide may provide a clinical option across a range of baseline characteristics when treatment goals are not being met with dulaglutide.</p><p><strong>Trial registration number: </strong>NCT05564039.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580465","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":"African immigrants with type 2 diabetes present with three physiologic subtypes: implications for screening, diagnosis and treatment.","authors":"Eliza A Huefner, Kauthrah Ntabadde, Grace G Smith, Simon Pierre Bigirimana, Christopher W DuBose, Arthur Sherman, Anne E Sumner","doi":"10.1136/bmjdrc-2025-005504","DOIUrl":"10.1136/bmjdrc-2025-005504","url":null,"abstract":"<p><strong>Introduction: </strong>As type 2 diabetes (T2D) prevalence increases in the USA and Africa, factors from both regions affect African immigrants.</p><p><strong>Objective: </strong>T2D in African immigrants was characterized by examining: (a) insulin deficiency and insulin resistance; (b) phenotypic presentation; (c) sociodemographic factors.</p><p><strong>Methods: </strong>In 633 African immigrants (male: 62%, age 39±11, (mean±SD), range 20-70 years), body mass index (BMI): 27.8±4.6, range 18.8-46.2 kg/m²), weight gain information was collected, BMI and waist circumference (WC) measured and OGTT performed. Insulin resistance was defined by the lowest quartile of the Matsuda Index (≤2.80); insulin secretion by the Insulin Secretion Index (ISI). Insulin deficiency was defined as less than the maximum ISI in participants with T2D without IR (0.430). WC thresholds defined central obesity (men: WC ≥94 cm; women ≥80 cm).</p><p><strong>Results: </strong>Normal glucose tolerance, pre-diabetes and T2D occurred in 61%, 32% and 7%, respectively. Three subtypes of T2D were identified: insulin-deficient-T2D (ID-T2D) in 45%, insulin-resistant-T2D (IR-T2D) in 30%, insulin-deficient+insulin-resistant (ID+IR-T2D) in 25%. ID+IR-T2D had the highest glucose concentrations (all p<0.05), whereas insulins were highest in IR-T2D (all p<0.01). Phenotypic differences by T2D subtype were identified. In the ID-T2D group, 20% of participants had a healthy weight and central obesity occurred in 55%. In the IR-T2D and ID+IR-T2D groups, 100% had central obesity and a BMI in either the overweight or obese categories. Sociodemographic factors specifically, weight gain, sedentary lifestyle and percent married, increased across glucose tolerance category (p values <0.01) but did not differ by T2D subtype (p≥0.3).</p><p><strong>Conclusions: </strong>Spanning the BMI spectrum from normal to obese, African immigrants have three subtypes of T2D. Weight gain was greatest in immigrants who developed T2D but did not differ by subtype. As life in America promotes weight gain, sharing information about the consequences of weight gain with all Americans, both native and foreign-born, is key to T2D prevention and treatment.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"14 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479881","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}