Diabetes care最新文献

{"title":"Undiagnosed G6PD Deficiency in Black and Asian Individuals Is Prevalent and Contributes to Health Inequalities in Type 2 Diabetes Diagnosis and Complications.","authors":"Susan Martin, Miriam Samuel, Daniel Stow, Alys M Ridsdale, Ji Chen, Katherine G Young, Harry D Green, Andrew T Hattersley, Veline L'Esperance, Trevelyan J McKinley, Sarah Finer, Inês Barroso","doi":"10.2337/dc25-0556","DOIUrl":"https://doi.org/10.2337/dc25-0556","url":null,"abstract":"<p><strong>Objective: </strong>Glucose-6-phosphate dehydrogenase (G6PD) deficiency presents silently and is not routinely screened. It is associated with markedly lower HbA1c for the prevailing glucose levels. Since HbA1c is internationally recommended to diagnose and manage type 2 diabetes (T2D), we investigated the population-level impact of undiagnosed G6PD deficiency on T2D diagnosis and complications in the U.K.</p><p><strong>Research design and methods: </strong>We used whole-exome sequencing and electronic health record data from UK Biobank (n = 467,368) and Genes & Health (n = 43,011) cohorts.</p><p><strong>Results: </strong>In the U.K., we estimated that ∼1 in 7 Black and 1 in 63 Asian males carry G6PD deficiency alleles, compared with fewer than 1 in 10,000 White males. Despite this, less than 1 in 50 G6PD-deficient men are clinically recognized. Male G6PD carriers have considerably lower average HbA1c (0.9% [International Federation of Clinical Chemistry and Laboratory Medicine: 10.0 mmol/mol]) compared with noncarriers, while differences in average glucose were negligible. G6PD-deficient men had 1.37 (95% CI: 1.01, 1.86) higher odds of developing diabetes-related microvascular complications than noncarriers. Although risk factors were similar prior to diagnosis, male G6PD carriers diagnosed with T2D since 2011 were, on average, 4.1 years (95% CI: 0.6, 7.7) older at diagnosis compared with noncarriers. In addition, lower mean HbA1c values in G6PD carriers falsely underestimated their 10-year T2D risk.</p><p><strong>Conclusions: </strong>Undiagnosed G6PD deficiency has significant impact on T2D diagnosis with HbA1c and associates with increased risk of diabetes complications. This has major implications for global populations using HbA1c for diagnosis and monitoring, and could contribute significantly to inequalities in diabetes outcomes.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194134","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":"GLP-1 Receptor Agonist Indications and Prescriptions Among Adults Who Do and Do Not Smoke.","authors":"Eleanor L S Leavens, Michael J Arnold, Nicole L Nollen, Lisa Sanderson Cox, Kristy A Brown, Edward F Ellerbeck","doi":"10.2337/dca25-0090","DOIUrl":"10.2337/dca25-0090","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133135","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":"Differences in Prevalence and Incidence of Electrocardiogram Abnormalities and Cardiovascular Autonomic Neuropathy Among Randomized Glucose-Lowering Treatments in Early Type 2 Diabetes: The Glycemia Reduction Approaches in Diabetes (GRADE) Cohort.","authors":"Rodica Pop-Busui, Samuel P Rosin, Nicole M Butera, Heidi Krause-Steinrauf, Hiba Abou Assi, Rajesh K Garg, Silvio E Inzucchi, Aimee Katona, Janet B McGill, Sunder Mudaliar, David S Schade, Elizabeth R Seaquist, Margaret Tiktin, Elsayed Z Soliman, Jennifer B Green","doi":"10.2337/dc25-1087","DOIUrl":"https://doi.org/10.2337/dc25-1087","url":null,"abstract":"<p><strong>Objective: </strong>To describe the prevalence and incidence of electrocardiogram (ECG) abnormalities and ECG-derived cardiovascular autonomic neuropathy (CAN) in the GRADE cohort of adults with type 2 diabetes (T2D) <10 years.</p><p><strong>Research design and methods: </strong>Individuals with T2D taking metformin alone were randomly assigned to add insulin glargine, glimepiride, liraglutide, or sitagliptin. Resting ECGs were completed at the baseline, 2-year, and 4-year study visits and analyzed for minor and major abnormalities and CAN assessed with heart rate variability (HRV) in 4,769 participants. Incidence of new major, minor, and any ECG abnormalities and CAN by treatment group was analyzed using logistic repeated-measures models at years 2 and 4 adjusted for baseline risk factors.</p><p><strong>Results: </strong>At baseline, participants were a mean age of 57.2 ± 10.0 years, 36.3% were women, mean diabetes duration was 4.3 ± 2.8 years, and mean HbA1c was 7.5 ± 0.5%. Participants with ECG abnormalities at baseline (57.1%) and ECG-derived CAN (52.8%) were older and had more severe cardiovascular risk factors. The incidence of minor and major ECG abnormalities was similar among all treatment groups. However, at year 4, major ECG abnormalities were fewer in the liraglutide versus nonliraglutide groups (9% vs. 13%; P = 0.03). The incidence of CAN did not differ between the liraglutide and nonliraglutide groups across visits (P = 0.42); however, one measure of HRV (SD of normal-to-normal R-R intervals) was higher at year 2 in the liraglutide versus nonliraglutide groups (P = 0.02).</p><p><strong>Conclusions: </strong>ECG abnormalities, including those reflecting CAN, are common in individuals with T2D <10 years and more so in those with certain cardiovascular risk factors. The development of major ECG abnormalities may be lower with liraglutide.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133097","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":"Type 2 Diabetes Remission: A Systematic Review and Meta-analysis of Nonsurgical Randomized Controlled Trials.","authors":"Diana T Sherifali, Megan E Racey, Michelle K Greenway, Paige E Alliston, Muhammad U Ali, Hertzel C Gerstein","doi":"10.2337/dc25-0562","DOIUrl":"https://doi.org/10.2337/dc25-0562","url":null,"abstract":"<p><strong>Background: </strong>Evidence that type 2 diabetes can be reversed has been limited by the understanding and implementation of these interventions.</p><p><strong>Purpose: </strong>We assessed the effect of nonsurgical randomized controlled trials (RCTs) on type 2 diabetes remission and characterized core components.</p><p><strong>Data sources: </strong>We reviewed articles from MEDLINE and Embase (inception to April 2025).</p><p><strong>Study selection: </strong>RCTs of multimodal pharmacological or nonpharmacological type 2 diabetes remission interventions for adults with type 2 diabetes were included.</p><p><strong>Data extraction: </strong>Study characteristics and outcomes for clinical/population health, patient-reported, and adverse event were extracted.</p><p><strong>Data synthesis: </strong>We performed a random-effects multilevel meta-analysis of studies, grouped based on type of intervention and by length of follow-up. A total of 18 studies were included in this review from 11 different countries. There was a higher likelihood of achieving type 2 diabetes remission through multimodal interventions (risk ratio [RR] 1.75 [95% CI 1.49-2.04]) and for nonpharmacological interventions (RR 5.80 [95% CI 4.28-7.87]), compared with the control group. Other significant outcomes for intervention groups compared with control groups included change in A1C, weight loss, and quality of life and improvements in adverse events of hypoglycemia.</p><p><strong>Limitations: </strong>There was heterogeneity in our small pool of included studies (diversity of nonpharmacological components), stringent intervention protocols, narrow participant selection criteria, and lack of consistent diabetes remission definitions.</p><p><strong>Conclusions: </strong>With specific protocols, a variety of tailored approaches can induce type 2 diabetes remission for patients with newly diagnosed type 2 diabetes who are able to subscribe to strict protocols. Consideration of long-term sustainability and effectiveness is needed in future research, along with patient preferences.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126766","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":"Effectiveness of an Incentives-Enhanced Stepped Care Intervention Program in Diabetes Prevention in a Multiethnic Asian Prediabetes Cohort: Results From the Pre-DICTED Randomized Controlled Trial.","authors":"Yong Mong Bee, Neha Awasthi, Mihir Gandhi, Amanda Yun Rui Lam, Selly Julianty, Gilbert Choon Seng Tan, Emily Tse Lin Ho, Su-Yen Goh, Gavin Siew Wei Tan, Eugene Jin Wen Shum, Yu Qi Lee, Mary Foong Fong Chong, Tazeen H Jafar, Rob M van Dam, Yee Leong Teoh, Julian Thumboo, Eric Andrew Finkelstein","doi":"10.2337/dc25-1555","DOIUrl":"https://doi.org/10.2337/dc25-1555","url":null,"abstract":"<p><strong>Objective: </strong>Diabetes prevention in real-world settings is affected by the challenge of intervention adherence and difficulty in sustaining behavior change. This study evaluated the effectiveness of a stepped care prevention program, enhanced with financial incentives, in reducing the risk of diabetes conversion in a multiethnic prediabetes cohort in Singapore.</p><p><strong>Research design and methods: </strong>The Pre-Diabetes Interventions and Continued Tracking to Ease Out Diabetes (Pre-DICTED) trial was a randomized controlled trial involving 751 overweight or obese individuals with impaired glucose tolerance, impaired fasting glucose, or both. Participants were assigned to standard care (control arm) or a stepped care intervention program, starting with lifestyle interventions for 6 months before adding metformin for participants who remained at high risk of diabetes conversion based on study visit assessments. Intervention arm participants also received financial incentives for attending lifestyle sessions and for achieving ≥5% weight loss. The primary end point was the proportion of participants developing diabetes at 3 years in the modified intention-to-treat population.</p><p><strong>Results: </strong>After 3 years, 34.8% of participants in the intervention arm developed diabetes compared with 47.3% in the control arm (adjusted risk difference -10.93%; 95% CI -18.04 to -3.81; P = 0.003). The adjusted relative risk was 0.74 (95% CI 0.62-0.88; P < 0.001). In the intervention arm, 26.4% of participants received metformin, and 45.1% received cash incentives. Adverse events were more common in the intervention arm, mainly because of metformin-related gastrointestinal symptoms.</p><p><strong>Conclusions: </strong>A stepped care diabetes prevention program, enhanced with financial incentives, effectively reduced diabetes conversion in a multiethnic Asian prediabetes cohort.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088588","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":"Dementia Risk in People With Type 1 Diabetes and Associated Risk Factors: A Nationwide, Register-Based Cohort Study.","authors":"Milena Jancev, Björn Eliasson, Hertzel C Gerstein, Katarina Eeg-Olofsson, Tali Cukierman-Yaffe, Geert Jan Biessels, J Hans DeVries, Frank L J Visseren, Naveed Sattar, Thomas T van Sloten","doi":"10.2337/dc25-0773","DOIUrl":"https://doi.org/10.2337/dc25-0773","url":null,"abstract":"<p><strong>Objective: </strong>Life expectancy of individuals with type 1 diabetes has increased, extending exposure to age-related conditions including dementia. Although earlier studies have linked type 1 diabetes with higher dementia risk, the relationships with dementia subtypes and associated risk factors are incompletely understood.</p><p><strong>Research design and methods: </strong>In this cohort study, 43,440 individuals with type 1 diabetes from the Swedish National Diabetes Register and 217,109 age-, sex-, and county-matched controls from the Swedish Total Population Register were included. Cox regression was used to study the relation between type 1 diabetes and risk of all-cause dementia and dementia subtypes (Alzheimer disease, vascular dementia, and non-Alzheimer-nonvascular dementia). We also examined the relationship between various risk factors and risk of all-cause dementia in type 1 diabetes.</p><p><strong>Results: </strong>After a median follow-up time of 14.3 (7.9-20.0) years, dementia was recorded in 530 (1.2%) individuals with type 1 diabetes and 1,867 (0.9%) age-, sex-, and county-matched controls (mean baseline age 33.0 [14.0] years). Compared with controls, individuals with type 1 diabetes had a higher risk of all-cause dementia (hazard ratio [HR] 2.02 [95% CI 1.83-2.23], Alzheimer disease (HR 1.38 [95% CI 1.13-1.69]), vascular dementia (HR 3.73 [95% CI 3.07-4.52]) and non-Alzheimer-nonvascular dementia (HR 1.87 [95% CI 1.63-2.15]). Risk factors related to dementia risk in type 1 diabetes beyond age were lower education level, being single, higher systolic blood pressure, higher HbA1c, history of stroke or transient ischemic attack, history of cardiovascular disease, and longer diabetes duration.</p><p><strong>Conclusions: </strong>The risk of all-cause dementia and dementia subtypes is higher in individuals with type 1 diabetes compared with matched controls.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088605","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":"Response to Comment on Wang et al. Transition of BMI Status From Childhood to Adulthood and Cardiovascular-Kidney-Metabolic Syndrome in Midlife: A 36-Year Cohort Study. Diabetes Care 2025;48:XXXX-XXXX.","authors":"Yang Wang, Zheng Liu","doi":"10.2337/dci25-0102","DOIUrl":"https://doi.org/10.2337/dci25-0102","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088635","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":"Delays in Access to Innovative Diabetes Therapies: A Persistent Inequity in Latin America.","authors":"Catalina Alvarez, Valeria Hirschler, Luis Eduardo Calliari, Margarita Barrientos, Ethel Codner","doi":"10.2337/dc25-2005","DOIUrl":"https://doi.org/10.2337/dc25-2005","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076897","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":"Risk Factors and Consequences of Lapses in Proliferative Diabetic Retinopathy Care in a National Cohort.","authors":"Serina S Applebaum, Yanhong Deng, Julia J Fu, Michael Kane, Kristen H Nwanyanwu","doi":"10.2337/dc25-1202","DOIUrl":"https://doi.org/10.2337/dc25-1202","url":null,"abstract":"<p><strong>Objective: </strong>To identify prevalence, risk factors, and visual outcomes associated with occurrence and duration of lapses in proliferative diabetic retinopathy (PDR) care.</p><p><strong>Research design and methods: </strong>This was a retrospective national cohort study (2008-2023) of adults with PDR and ≥6 months of follow-up who were participating in the Sight Outcomes Research Collaborative. We used multivariable regressions to assess factors associated with lapse occurrence and duration, and compared post-lapse visual acuity by lapse duration.</p><p><strong>Results: </strong>Among 15,211 individuals, 71.8% experienced a lapse in care; 14.2% of the lapses lasted >24 months. Lapses were more common among non-Hispanic Black, younger, and individuals with disability, and less common in those with poor vision or prior PDR treatment. Older age and PDR treatment predicted shorter lapses, and residence in distressed areas predicted longer lapses. Visual acuity worsened after lapses, with greater declines after longer lapses.</p><p><strong>Conclusions: </strong>Prolonged lapses in PDR care are common, disproportionately affect vulnerable groups, and are associated with persistent vision loss.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076883","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":"Adults With Type 2 Diabetes Benefit From Automated Insulin Delivery Irrespective of C-Peptide Level.","authors":"Irl B Hirsch, Yogish C Kudva, David T Ahn, Thomas Blevins, Michael R Rickels, Dan Raghinaru, John W Lum, Craig Kollman, Jordan E Pinsker, Roy W Beck","doi":"10.2337/dc25-1125","DOIUrl":"https://doi.org/10.2337/dc25-1125","url":null,"abstract":"<p><strong>Objective: </strong>The Centers for Medicare & Medicaid Services (CMS) requires a low C-peptide level for insulin pump coverage unless the individual is β-cell autoantibody positive, which precludes coverage of automated insulin delivery (AID) systems for many people with type 2 diabetes.</p><p><strong>Research design and methods: </strong>In the Randomized Trial Evaluating the Efficacy and Safety of Control-IQ+ Technology in Adults With Type 2 Diabetes Using Basal-Bolus Insulin Therapy study evaluating the t:slim X2 insulin pump with Control-IQ+ technology, adults with insulin-treated type 2 diabetes were categorized into high C-peptide (n = 195) and low C-peptide (n = 59) groups based on CMS criteria.</p><p><strong>Results: </strong>In the AID group, mean HbA1c decreased from baseline by 0.8%, which was significantly greater than in the control group with both high (P < 0.001) and low (P = 0.02) C-peptide levels. Results were similar in participants ≥65 years old.</p><p><strong>Conclusions: </strong>The benefit of AID is present with high and low C-peptide levels. Thus, requiring a low C-peptide level as a prerequisite for AID therapy is not warranted.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071488","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}