Canadian journal of diabetes最新文献

{"title":"Physiological Impacts of Type 1 Diabetes on Exercise Performance: A Systematic Review and Narrative Synthesis of the Literature.","authors":"Shania N Smee, Angela L Spence, Rhiannon Halse, Leo Ng, Vinutha B Shetty, Elizabeth A Davis, Raymond J Davey","doi":"10.1016/j.jcjd.2026.06.007","DOIUrl":"10.1016/j.jcjd.2026.06.007","url":null,"abstract":"<p><strong>Objective: </strong>Type 1 diabetes (T1D) may influence acute and adaptive responses to exercise training and performance. This systematic review aimed to summarize the evidence comparing exercise performance between individuals with and without T1D and to identify the physiological mechanisms underlying potential differences in exercise performance.</p><p><strong>Methods: </strong>Seven electronic databases were searched for studies comparing exercise performance and underlying physiological mechanisms in individuals with and without T1D. Exercise performance was categorized as aerobic, anaerobic, or skill based, and physiological mechanisms were grouped across cardiorespiratory, neuromuscular, and metabolic domains.</p><p><strong>Results: </strong>Of 6,563 studies, 28 met the inclusion criteria. Most (k=25) evaluated aerobic exercise performance with time-trial, time-to-exhaustion, and V̇O_2peak tests. Five evaluated anaerobic exercise performance with one-repetition maximum, maximum voluntary contraction, and supramaximal time-to-exhaustion tests. Of the aerobic studies, 88% reported lower aerobic performance in individuals with T1D compared with those without, potentially due to cardiovascular or circulatory mechanisms. Similarly, 60% of the anaerobic studies reported lower anaerobic performance in individuals with T1D compared with those without, potentially due to mitochondrial mechanisms and recovery. Certainty of evidence was assessed using the GRADE tool and was found to be very low.</p><p><strong>Conclusion: </strong>Current evidence suggests that aerobic exercise performance may be reduced in individuals with T1D. However, the evidence is weak, and these differences seem to be marginal. Suboptimal glycemic management and longer T1D duration may influence physiological responses to exercise and reduce performance capacity. Further research is required to support these conclusions and to determine the impact of T1D on anaerobic and skill-based exercise performance.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383283","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}

{"title":"Prandial Insulin Adjustments in the Context of Gastroparesis and Type 1 Diabetes: A Mixed-Methods Study.","authors":"Meryem K Talbo, Alexandra Katz, Amelie Roy-Fleming, Sarah Haag, Tricia M Peters, Rémi Rabasa-Lhoret, Jean-François Yale, Barbara Kelly, Jade Maria Moisan, Anne-Sophie Brazeau","doi":"10.1016/j.jcjd.2026.07.006","DOIUrl":"10.1016/j.jcjd.2026.07.006","url":null,"abstract":"<p><strong>Objective: </strong>Gastroparesis (impaired gastric motility) is a complication of type 1 diabetes that affects glycemic management. Yet, little research exists on prandial insulin adjustment strategies to manage this complex condition. This study combines the current literature with clinical and lived experiences to propose practical strategies for insulin adjustment for people with type 1 diabetes and gastroparesis.</p><p><strong>Methods: </strong>A mixed-methods approach was used. PubMed and Scopus were searched in February 2025, and Canadian clinicians and people with type 1 diabetes were surveyed using the Delphi method. Consensus was set at ≥80% agreement. Findings from both the review and the panel informed the proposed recommendations.</p><p><strong>Results: </strong>Of 2,750 studies retrieved, 7 met the inclusion criteria. Common themes included postprandial insulin dosing, dose reductions, and use of dual-wave or extended boluses with insulin pumps and automated insulin delivery (AID) systems. The expert panel included 42 clinicians and 6 people with type 1 diabetes and gastroparesis. The panel recommended splitting the insulin dose (25% to 70% with meal and the remaining dose after 2 to 4 h or as needed) for injection or non-automated insulin pump users. For AID users, recommendations included administering smaller insulin doses with the meal and allowing AID algorithms to manage postprandial glycemia. Participants emphasized individualized strategies based on symptoms, gastric motility, and glucose monitoring.</p><p><strong>Conclusions: </strong>This study provides expert-informed strategies grounded in literature for adjusting prandial insulin when gastroparesis is present. The findings highlight the growing evidence that AID systems can reduce the burden associated with gastroparesis and that continuous glucose monitoring can support timely dosing decisions.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815045","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}

{"title":"Feasibility of a Progressive High-Intensity Interval Training Model of Exercise for Patients With Type 2 Diabetes Mellitus Enrolled in Cardiac Rehabilitation.","authors":"Lisa M Cotie, Laura Banks, Lillian Pinto da Silva, Carolina G Carvalho, Paul Oh, Tracey J F Colella","doi":"10.1016/j.jcjd.2026.08.004","DOIUrl":"10.1016/j.jcjd.2026.08.004","url":null,"abstract":"<p><strong>Objective: </strong>A link exists between type 2 diabetes mellitus (T2DM) and developing cardiovascular disease. Lifestyle interventions targeting T2DM and cardiovascular disease are required. Cardiac rehabilitation offers a multidisciplinary approach for management. High-intensity interval training (HIIT) may provide equivalent benefits compared to moderate-intensity continuous exercise in improving cardiorespiratory fitness and glycemic control. HIIT should be considered when prescribing exercise for patients living with T2DM; however, further feasibility research is required. The objective of this study was to determine the feasibility of progressive HIIT in patients living with T2DM.</p><p><strong>Methods: </strong>Patients in a 24-week cardiac rehabilitation program provided research consent at 12 weeks. Feasibility was assessed using intervention adherence, dropout rate and reason, patient satisfaction, and safety. Patients completed the HIIT protocol 3 times per week, at 80% to 95% heart rate reserve. Patients started at Stage 1 (10×30-s high intensity:30-s recovery) and progressed to Stages 2 to 4 every 3 weeks according to patient desire and achievement of target work rate without adverse events. Possible progressions included Stage 2 (10×1-min high intensity:1-min recovery), Stage 3 (6×2-min high intensity:2-min recovery), and Stage 4 (4×4-min high intensity:3-min recovery).</p><p><strong>Results: </strong>Twenty-two participants consented to participation, and 17 (60.2±12.4 years) completed the program (23% dropout rate). Adherence to on-site HIIT sessions was 79%, and to at-home unsupervised sessions was 70%. Five patients (4 females) remained at Stage 1; 4 (2 females) progressed to Stage 2; 7 (2 females) progressed to Stage 3; and 1 (male) progressed to Stage 4. Satisfaction surveys revealed that patients enjoyed HIIT as much as moderate-intensity continuous exercise (p=0.29). No HIIT-related adverse events were reported.</p><p><strong>Conclusions: </strong>Progressive HIIT is feasible, enjoyable, and safe among patients living with T2DM.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803136","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}

{"title":"Professor Vera Bril (1948-2026): Scientist, Mentor, and Close Friend to the Canadian Diabetes Community.","authors":"Bruce A Perkins, Carolina Barnett-Tapia, Juan Francisco Idiaquez, Catherine Zahn, Hans Katzberg","doi":"10.1016/j.jcjd.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.jcjd.2026.08.005","url":null,"abstract":"","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803195","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}

{"title":"Trends and Disparities in Mortality Due to Coexisting Diabetes Mellitus and Chronic Obstructive Pulmonary Disease Among Adults in the United States (1999 to 2023): Insights From the CDC WONDER Database.","authors":"Zhitong Li, Yajing Bai, Wenxia Ren, Linlin Gao, Ruixue Duan, Yuxiang Zhao, Anqi Zhao, Wenjing Wang, Yexin Ji, Shiwei Liu, Xiansheng Liu","doi":"10.1016/j.jcjd.2026.07.004","DOIUrl":"10.1016/j.jcjd.2026.07.004","url":null,"abstract":"<p><strong>Objective: </strong>Diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) are major health concerns in the United States, and both contribute significantly to mortality. However, trends in mortality due to their co-occurrence from 1999 to 2023 remain underexplored. We therefore examined these trends and associated demographic and geographic disparities.</p><p><strong>Methods: </strong>This study used data from the CDC WONDER database, focusing on death certificates with both DM and COPD listed as causes. We analyzed deaths among individuals aged 35 years and older, categorized by demographic (age, sex, race/ethnicity) and geographic factors. Crude mortality rates and age-adjusted mortality rates (AAMRs) were calculated. Joinpoint regression analysis was used to assess mortality trends, with the annual percent change and average annual percent change determining rate shifts across time periods.</p><p><strong>Results: </strong>From 1999 to 2023, the AAMR for DM and COPD increased 1.5 times, peaking in 2021 before declining by 2023. Significant increases in mortality were observed across sexes, with males consistently having higher rates. Racial disparities were evident, with non-Hispanic Black and American Indian populations experiencing higher AAMRs. Age group analysis revealed a sharp rise in mortality among older adults, particularly those aged 65 years and older. Geographically, rural areas exhibited higher AAMRs than metropolitan regions, with the South having the highest mortality rates.</p><p><strong>Conclusions: </strong>The mortality burden from coexisting DM and COPD has significantly increased in the past 2 decades, particularly among older adults and certain racial/ethnic groups. These findings highlight the need for targeted public health interventions and health-care strategies to address these disparities.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803193","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}

{"title":"Global Prevalence and Risk Factors of Obstructive Sleep Apnea in People With Diabetes: A Systematic Review and Meta-Regression.","authors":"Panbo Sun, Meiling He, Wei Su","doi":"10.1016/j.jcjd.2026.07.005","DOIUrl":"10.1016/j.jcjd.2026.07.005","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the global prevalence of objectively confirmed obstructive sleep apnea (OSA) and the questionnaire-defined high-risk proportion among adults with type 2 diabetes mellitus (T2DM) and to explore sources of heterogeneity.</p><p><strong>Methods: </strong>PubMed, Web of Science, Scopus, and Cochrane Library were searched up to July 2025. Studies reporting polysomnography (PSG)/portable monitoring-confirmed OSA prevalence or validated questionnaire-based screening results in adults with T2DM were included. Random-effects meta-analyses and meta-regression were performed.</p><p><strong>Results: </strong>A total of 23 studies were included. The pooled prevalence of PSG/portable monitoring-confirmed OSA was 37% (95% confidence interval [CI]: 27% to 49%), and the pooled questionnaire-defined high-risk proportion was 42% (95% CI: 31% to 53%). Both estimates revealed substantial heterogeneity (I²≈99%). Regional estimates varied, but several regions had limited evidence; the North American estimate of 86% was based on a single study and should not be considered representative. By diagnostic modality, the PSG-confirmed prevalence was 54%, whereas the STOP-BANG and Berlin Questionnaire screen-positive proportions were 29% and 20%, respectively. Meta-regression suggested that publication year and diagnostic method contributed to the heterogeneity. Obesity, hypertension, and male sex were consistently associated with a higher reported OSA prevalence, although causal inference is limited by the predominance of cross-sectional designs.</p><p><strong>Conclusion: </strong>OSA is common among adults with T2DM, but estimates vary substantially by diagnostic method, region, and study population. Screening selected higher risk adults with T2DM and confirming the diagnosis with objective testing may be reasonable; however, given the marked heterogeneity, publication bias signals, and sparse regional data, these findings should be interpreted as evidence informed and hypothesis generating rather than practice changing.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803153","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}

{"title":"Health-Care Providers' Perspectives on Information, Care, and Support for Women With Gestational Diabetes Mellitus: Insights From a Qualitative Study.","authors":"Mette Juel Rothmann, Amaal Muuse, Pernille Christiansen, Charlotte Overgaard, Christina Anne Vinter, Dorte Møller Jensen, Jori Aalders","doi":"10.1016/j.jcjd.2026.07.007","DOIUrl":"10.1016/j.jcjd.2026.07.007","url":null,"abstract":"<p><strong>Objective: </strong>To explore healthcare professionals' (HCPs) experiences of providing gestational diabetes mellitus (GDM) care, education, and support, and their perceptions of how well women's and families' needs are addressed.</p><p><strong>Method: </strong>A qualitative exploratory study was conducted using semi-structured interviews with 10 HCPs from obstetric and diabetes outpatient clinics in Southern Denmark. Data were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Four themes were identified: (1) benefits and limitations of a fixed GDM care system; (2) the influence of risk information, motivation, and partner support; (3) challenges related to culture, language, and health literacy; and (4) psychological and social aspects of GDM, including shock and stigma.</p><p><strong>Discussion: </strong>HCPs valued the universal multidisciplinary care model but described challenges in addressing individual and complex psychosocial needs.</p><p><strong>Conclusions: </strong>While current GDM care supports high-quality treatment and prevention of complications, greater flexibility and patient-centred approaches are needed, particularly for vulnerable groups within universal healthcare settings.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765925","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}

{"title":"All-Trans Retinoic Acid in Rodent Models of Autoimmune Diabetes: Clinical Potential of Targeted Drug Delivery.","authors":"Benjamin Green, Dominick L Auci","doi":"10.1016/j.jcjd.2026.08.001","DOIUrl":"10.1016/j.jcjd.2026.08.001","url":null,"abstract":"<p><p>Type 1 diabetes (T1D) is a chronic disease characterized by the relentless autoimmune destruction of insulin-producing pancreatic beta cells (β cells). Approximately 9.5 million people worldwide live with T1D; 1.9 million are under 20 years old. There is no cure and there are few effective treatments, making novel therapies desperately needed. All-trans retinoic acid (ATRA) has demonstrated promise in preventing and even ameliorating T1D, particularly in various rodent T1D models. The benefits are thought to be mediated by influences on T cells, particularly regulatory (Treg) and autoreactive effector T cells. Intriguingly, ATRA may also directly contribute to the differentiation and maintenance of pancreatic β cells. This mini review will focus on experiences with ATRA in rodent models of T1D, including measures of efficacy, Treg expansion, reduction of autoreactive effector T-cell activity and oxidative stress, and, perhaps most promisingly, preservation and stimulation of pancreatic β cells. We will then discuss the clinical potential of ATRA in T1D, including targeted drug delivery strategies to deliver ATRA locally to the relevant immune microenvironment, limiting its systemic exposure, reducing toxic side effects, and enhancing efficacy.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759643","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}

{"title":"Weight Loss and Body Image Are Not Synonymous: Divergent Effects of Glucagon-Like Peptide-1 Receptor Agonist Therapy and Behavioural Intervention in a Young Adult With Type 1 Diabetes-A Case Report.","authors":"Nicole Patience, Marilyn D Ritholz, Molly Savory, Haley Brabant, Elena Toschi","doi":"10.1016/j.jcjd.2026.08.002","DOIUrl":"10.1016/j.jcjd.2026.08.002","url":null,"abstract":"","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761997","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}

{"title":"The Association Between Reversion of Prediabetes to Normoglycemia and Incident Cardiovascular Disease and Mortality: A Systematic Review and Meta-Analysis.","authors":"Naseem Eisa, Omar Barood","doi":"10.1016/j.jcjd.2026.08.003","DOIUrl":"10.1016/j.jcjd.2026.08.003","url":null,"abstract":"<p><strong>Objective: </strong>Prediabetes affects ∼470 million adults worldwide and is an established risk factor for cardiovascular disease. Whether reversion from prediabetes to normoglycemia reduces the risk of cardiovascular disease remains uncertain. We conducted a systematic review and meta-analysis to quantify this association with major cardiovascular events, cardiovascular mortality, and all-cause mortality.</p><p><strong>Methods: </strong>We searched PubMed, Embase, CENTRAL, Web of Science, and Scopus to February 2026 for cohort studies and post hoc analyses of randomized trials comparing cardiovascular outcomes in adults who reverted from prediabetes to normoglycemia vs those with persistent prediabetes. Hazard ratios were pooled using a DerSimonian-Laird random-effects model, with Hartung-Knapp-Sidik-Jonkman sensitivity analysis. Heterogeneity was assessed using I². Publication bias was evaluated using Egger's test.</p><p><strong>Results: </strong>Seven studies (71,143 participants; follow-up 2 to 30 years) were included. Reversion to normoglycemia was associated with significantly lower composite cardiovascular events (HR 0.72, 95% CI 0.57 to 0.90; p=0.004; I²=76.1%) and cardiovascular mortality (HR 0.69, 95% CI 0.51 to 0.95; p=0.023; I²=65.5%). No significant association was found for all-cause mortality (HR 0.95, 95% CI 0.88 to 1.02; p=0.169). The 95% prediction interval for the primary outcome ranged from 0.37 to 1.39. Leave-one-out sensitivity analysis confirmed the stability of the results. Egger's test revealed no publication bias (p=0.36).</p><p><strong>Conclusions: </strong>Reversion from prediabetes to normoglycemia is associated with significant reductions in cardiovascular events and cardiovascular mortality, supporting early identification and management of prediabetes as a cardiovascular prevention strategy. The observational nature of the evidence and the wide prediction interval warrant cautious interpretation.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765912","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}