Diabetes care最新文献

{"title":"Subtypes of Type 2 Diabetes and Prediabetes: Mortality and Excess Life Lost in South Asians.","authors":"Ram Jagannathan, Dimple Kondal, Pradeep Tiwari, Mohan Deepa, Unjali P Gujral, Shivani A Patel, Sailesh Mohan, Ranjith Mohan Anjana, Lisa R Staimez, Ruby Gupta, Yara S Beyh, Ayodipupo S Oguntade, Howard H Chang, Mohammed K Ali, Arshed Quyyumi, Yan V Sun, Dorairaj Prabhakaran, Nikhil Tandon, Viswanathan Mohan, K M Venkat Narayan","doi":"10.2337/dc26-0043","DOIUrl":"https://doi.org/10.2337/dc26-0043","url":null,"abstract":"<p><strong>Objective: </strong>Current definitions of type 2 diabetes (T2D) and prediabetes do not capture their pathophysiological heterogeneity. We investigated data-driven subtypes of T2D and prediabetes and evaluated their associations with mortality.</p><p><strong>Research design and methods: </strong>We analyzed data from 14,036 South Asian participants from the CArdiometabolic Risk Reduction cohort using unsupervised k-means clustering based on five variables: age, BMI, HbA1c, insulin resistance, and β-cell dysfunction. For each subtype of T2D or prediabetes, we estimated Cox hazard ratios (HRs) for all-cause and cardiovascular disease (CVD) mortality and excess years of life lost compared with normal glucose tolerance.</p><p><strong>Results: </strong>Among 2,639 participants with T2D, three subtypes emerged: severe insulin-deficient diabetes (SIDD; 23.0%), mild insulin-deficient diabetes (MIDD; 54.5%), and severe insulin-resistant diabetes (SIRD; 22.5%). Among 4,992 participants with prediabetes, two subtypes were identified: insulin-deficient prediabetes (IDPD; 66.0%) and insulin-resistant prediabetes (IRPD; 34.0%). Over a median follow-up of 10.6 years, 1,076 deaths occurred (405 due to CVD). Compared with normal glucose tolerance, SIDD had the highest all-cause mortality (HR 3.34; 95% CI 2.39-4.68), followed by MIDD (1.39; 95% CI 1.05-1.84), and SIRD (1.67; 95% CI 1.15-2.41). Among prediabetes subtypes, IDPD was associated with increased all-cause (HR 1.32; 95% CI 1.03-1.68) and CVD mortality (HR 1.53; 95% CI 1.00-2.34), whereas IRPD was not. Excess years of life lost were greatest for SIDD (17.7 years), followed by MIDD (12.8 years) and SIRD (12.0 years).</p><p><strong>Conclusions: </strong>Insulin-deficient subtypes made up a high proportion of individuals with T2D and prediabetes and were associated with higher mortality hazards and excess years of life lost.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857965","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":"Accounting for Age-Related Increases in HbA1c More Accurately Quantifies Risk of Type 1 Diabetes Progression in Islet Autoantibody-Positive Adults.","authors":"Erin L Templeman, Nick Thomas, Susan Martin, Diane K Wherett, Maria J Redondo, Jennifer Sherr, Alessandra Petrelli, Laura M Jacobsen, Falastin Salami, Jacqueline Lonier, Carmella Evans-Molina, Jay Sosenko, Inês Barroso, Richard A Oram, Emily K Sims, Lauric A Ferrat","doi":"10.2337/dc26-0446","DOIUrl":"https://doi.org/10.2337/dc26-0446","url":null,"abstract":"<p><strong>Objective: </strong>HbA1c thresholds used to define dysglycemia in autoantibody-positive individuals at risk for type 1 diabetes do not account for age-related increases in HbA1c and may overestimate progression risk in adults. We evaluated whether age-adjusted HbA1c or a higher HbA1c threshold improves risk stratification across age-groups.</p><p><strong>Research design and methods: </strong>We analyzed 5,024 autoantibody-positive relatives (3,720 children and 1,304 adults) participating in the TrialNet Pathway to Prevention study. Age-related HbA1c effects were modeled using 6,273 adults from the population-based Exeter 10000 cohort. Progression risk was compared using the standard dysglycemia threshold (HbA1c ≥5.7% [39 mmol/mol]), age-adjusted HbA1c, and an alternative threshold of HbA1c ≥6.0% (42 mmol/mol).</p><p><strong>Results: </strong>Using HbA1c ≥5.7% (39 mmol/mol), children had higher 1-year progression risk than adults among single autoantibody-positive participants (38% [95% CI 28, 47] vs. 13% [7.2, 19]) and multiple autoantibody-positive participants (55% [49, 60] vs. 38% [27, 47]) (both P < 0.001). Age adjustment reduced these differences; progression risk was similar among single autoantibody-positive participants (38% [28, 47] vs. 27% [13, 39]; P = 0.32), with attenuated differences among multiple autoantibody-positive participants. An HbA1c threshold ≥6.0% (42 mmol/mol) yielded comparable progression risk between adults and children across autoantibody subgroups. In post hoc analyses, adults aged <30 years had progression risk similar to children (P = 0.1).</p><p><strong>Conclusions: </strong>Age-related variation in HbA1c influences dysglycemia classification in adults at risk for type 1 diabetes. Age-adjusted HbA1c or a higher HbA1c threshold (≥6.0% [42 mmol/mol]) in adults aged ≥30 years identifies individuals with progression risk comparable to children and may improve age-specific risk stratification in prevention settings.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847716","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":"Low-Dose Antithymocyte Globulin in Type 1 Diabetes: Real-World Exploratory Observation of C-Peptide by Modified Quantitative Response (mQR).","authors":"David Weber, Joshua Modeste, Sarah Peeling, Timothy P Foster, Brittany S Bruggeman, Laura M Jacobsen, Desmond A Schatz, Michael J Haller","doi":"10.2337/dc26-0223","DOIUrl":"https://doi.org/10.2337/dc26-0223","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the real-world feasibility and efficacy of low-dose antithymocyte globulin (ATG) by an exploratory modified quantitative response (mQR) of C-peptide in type 1 diabetes.</p><p><strong>Research design and methods: </strong>Individuals with stage 2 (n = 6) or stage 3 (n = 33) diabetes were treated clinically with low-dose ATG (2.5 mg/kg) and asked to obtain C-peptide via a commercial laboratory 90 min postconsumption of 6 mL/kg Boost. Thirty individuals (77%) completed 1 year of follow-up, with 22 (73% of those) providing pre-ATG and 1-year-post-ATG C-peptides. Area under the curve C-peptide was estimated from 90-min values to calculate mQR.</p><p><strong>Results: </strong>In the 22 evaluable patients, average mQR at 1 year was 0.072. Average HbA1c decreased from 7.1% (54 mmol/mol) to 6.0% (42 mmol/mol). There were 15 responders (+mQR) and 7 nonresponders (-mQR). There were no unexpected side effects.</p><p><strong>Conclusions: </strong>C-peptide mQR was feasible and produced expected responder frequencies following low-dose ATG in a clinical practice setting.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847689","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":"COVID-19 Vaccinations, SARS-CoV-2 Infections, and Type 1 Diabetes in Finnish Children.","authors":"Susanna Tall, Jenni Pettersson, Taina Härkönen, Suvi M Virtanen, Olli Vapalahti, Mikael Knip","doi":"10.2337/dc25-2913","DOIUrl":"https://doi.org/10.2337/dc25-2913","url":null,"abstract":"<p><strong>Objective: </strong>We assessed whether 1) severe acute respiratory syndrome coronavirus (SARS-CoV-2) vaccination is associated with the risk of type 1 diabetes and 2) SARS-CoV-2 vaccination or infection is associated with disease severity at type 1 diabetes diagnosis.</p><p><strong>Research design and methods: </strong>Every Finnish child aged 5-14 years diagnosed with type 1 diabetes (case subjects, n = 433) during a 16-month period (September 2021 to December 2022) were compared with three control subjects matched for age, sex, and municipality. Information on coronavirus disease 2019 (COVID-19) vaccinations was obtained from the National Vaccination Register. SARS-CoV-2 infections were identified based on circulating antibody titer in samples obtained soon after the diagnosis of type 1 diabetes.</p><p><strong>Results: </strong>COVID-19 vaccinations preceding type 1 diabetes diagnosis were not associated with risk of type 1 diabetes (hazard ratio 1.30, 95% CI 0.97-1.72, P = 0.076). Vaccinations were linked to less severe symptoms at the time of diagnosis. Children with protective HLA genotypes were more common among the vaccinated case subjects compared with unvaccinated case subjects. Vaccinations were inversely associated with insulin autoantibody positivity. There was no association between SARS-CoV-2 and type 1 diabetes symptoms or autoantibodies at the time of type 1 diabetes diagnosis.</p><p><strong>Conclusions: </strong>There was no significant association between SARS-CoV-2 vaccination and risk of type 1 diabetes. Neither COVID-19 vaccinations nor SARS-CoV-2 infections explain the more severe symptoms at type 1 diabetes diagnosis observed in Finnish children after the beginning of the COVID-19 pandemic. Parents who vaccinate their children are more likely to seek medical care. This may result in less severe symptoms in their children at diagnosis of diabetes.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847698","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":"High-Amplitude and Prolonged Glucose Excursions as a Key Determinant of Discordance Between Glucose Management Indicator and Glycated Hemoglobin in Type 1 Diabetes.","authors":"Soojin Park, So Hyun Cho, Seohyun Kim, Sang Ho Park, Ji Yoon Kim, Rosa Oh, Myunghwa Jang, You-Bin Lee, Gyuri Kim, Kyu Yeon Hur, Jae Hyeon Kim, Sang-Man Jin","doi":"10.2337/dc25-2820","DOIUrl":"https://doi.org/10.2337/dc25-2820","url":null,"abstract":"<p><strong>Objective: </strong>Discordance between the glucose management indicator (GMI) and hemoglobin A1c (HbA1c) is frequently observed in diabetes, yet its physiological basis remains unclear. This study investigated how specific glucose excursion patterns captured by continuous glucose monitoring (CGM) contribute to this discordance in individuals with type 1 diabetes.</p><p><strong>Research design and methods: </strong>Ninety-day CGM traces from 611 adults with type 1 diabetes were paired with HbA1c results obtained within ±15 days. Glucose excursions were quantified using the glucose rate increase detector (GRID) algorithm with varied peak glucose and time-to-peak thresholds. Discordance was defined using GMI-to-HbA1c and updated GMI (uGMI)-to-HbA1c ratios, and associations with GRID-derived excursion metrics were evaluated alongside conventional CGM-derived variability metrics.</p><p><strong>Results: </strong>Excursions with peak glucose ≥250 mg/dL and time to peak ≥90 min were significantly associated with higher uGMI-to-HbA1c ratios after adjustment for age, sex, eGFR, and HbA1c group, with consistent findings across CGM devices (sensor type 1: β = 0.174, 95% CI 0.147-0.201; sensor type 2: β = 0.102, 95% CI 0.068-0.136; both P < 0.001) and alternative GMI formulations. In restricted cubic spline analyses, adjustment for GRID-derived excursion metrics differentially reshaped the associations of HbA1c, GMI, and uGMI with albuminuria and elevated triglyceride-glucose (TyG) index in an outcome- and context-dependent manner, preferentially enhancing the informativeness of GMI and uGMI-but not HbA1c.</p><p><strong>Conclusions: </strong>Frequent high and prolonged glucose excursions were consistently associated with GMI-HbA1c discordance across devices, HbA1c strata, and analytic conditions. GRID-derived excursion metrics modify the relationship between GMI/uGMI and glycemia-associated risk.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824883","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":"Everyone or Just Some? Cost-Effectiveness of General Population Versus Targeted Screening Strategies for Type 1 Diabetes in Canada.","authors":"Shweta Mital, Desmond A Schatz, Michael J Haller, Diane K Wherrett, Hai V Nguyen","doi":"10.2337/dc25-2248","DOIUrl":"10.2337/dc25-2248","url":null,"abstract":"<p><strong>Objective: </strong>Timely screening for type 1 diabetes can prevent life-threatening diabetic ketoacidosis and offers the opportunity to delay disease onset with emerging disease-modifying therapies. Yet, population-wide screening is costly, raising questions on whether its benefits justify the costs and the optimal age and frequency of screening. This study examined the cost-effectiveness of general population versus targeted autoantibody screening at alternative ages and frequencies.</p><p><strong>Research design and methods: </strong>Using a hybrid decision tree-Markov model, this study compared six strategies defined by different populations screened (i.e., general population vs. only groups at high genetic risk or those with a family history), and frequency and age of screening (once at age 4 vs. twice, at ages 2 and 6) versus no screening. Costs were estimated from the Canadian health system perspective, and effectiveness was measured as the number of at-risk children detected.</p><p><strong>Results: </strong>Compared with family history-based screening at ages 2 and 6, general population screening at age 4 cost $404,534 more but detected 35 more cases (per 10,000 children) for an incremental cost-effectiveness ratio of $11,383/case detected. General population screening at ages 2 and 6 cost an additional $462,679 and detected 18 more cases (per 10,000 children) at an incremental cost of $25,923/case detected. Screening targeted at only infants at high genetic risk involved higher costs and detected fewer cases than general population screening.</p><p><strong>Conclusions: </strong>General population screening detects more at-risk children than targeted approaches but also incurs higher costs. The incremental cost per case detected is comparable to that reported for other pediatric screening initiatives.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"792-799"},"PeriodicalIF":16.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shrunken Pore Syndrome and Risk of Cardiovascular Disease and All-Cause Mortality in Individuals With Type 1 Diabetes With and Without Albuminuria.","authors":"Valma Harjutsalo, Lena M Thorn, Niina Sandholm, Per-Henrik Groop","doi":"10.2337/dc25-2987","DOIUrl":"10.2337/dc25-2987","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between \"shrunken pore syndrome\" (SPS), defined as a large discrepancy between estimated glomerular filtration rates based on cystatin C (eGFRcys) and creatinine (eGFRcr), and coronary artery disease (CAD), stroke, peripheral artery disease (PAD), heart failure (HF), and all-cause mortality in individuals with T1D with and without albuminuria.</p><p><strong>Research design and methods: </strong>The study comprised 3,769 individuals with and without albuminuria from the Finnish Diabetic Nephropathy Study (FinnDiane) who had both serum creatinine (Scr) and serum cystatin C (SCysC) data available.</p><p><strong>Results: </strong>SPS (eGFRcys/eGFRcr ratio cutoff 0.7) was not associated with CAD or stroke. In those with SPS but without albuminuria, the hazard ratios (HRs) for HF, PAD, and all-cause mortality were 3.07 (95% CI 1.47-6.38), 3.64 (95% CI 1.75-7.57), and 3.08 (95% CI 1.86-5.11). The associations between the eGFRcys/eGFRcr ratio as a continuous variable, as well as eGFRcys alone and HF, PAD, and all-cause mortality were significant in those without albuminuria. In individuals with albuminuria, SPS was only associated with HF (HR 1.54; 95% CI 1.02-2.33), whereas the eGFRcys/eGFRcr ratio as a continuous variable was not associated with any of the outcomes. On the contrary, both eGFRcys and eGFRcr were independently associated with all studied outcomes in those with albuminuria.</p><p><strong>Conclusions: </strong>Findings highlight the clinical potential of identifying individuals at increased risk of HF, PAD, and all-cause mortality at an early stage among those with T1D without albuminuria by evaluating both eGFRcys and eGFRcr and their discrepancy.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"874-881"},"PeriodicalIF":16.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476784","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":"Per- and Polyfluoroalkyl Substances During Pregnancy and Gestational Diabetes: The Environmental Influences on Child Health Outcomes (ECHO) Cohort.","authors":"Anne P Starling, Mohamad Burjak, Adaeze W Nzegwu, Xiaoshuang Xun, John L Adgate, Emily S Barrett, Deborah H Bennett, Leda Chatzi, Elena Colicino, Dana Dabelea, Anne L Dunlop, Stephanie M Eick, Shohreh F Farzan, Assiamira Ferrara, Abby F Fleisch, Sarah D Geiger, Monique M Hedderson, Linda G Kahn, Margaret R Karagas, Rachel S Kelly, Donghai Liang, Pi-I Lin, Thomas G O'Connor, Amy M Padula, Alicia K Peterson, Megan E Romano, Sheela Sathyanarayana, Yeyi Zhu, Damaskini Valvi","doi":"10.2337/dc25-1340","DOIUrl":"10.2337/dc25-1340","url":null,"abstract":"<p><strong>Objective: </strong>Exposure to per- and polyfluoroalkyl substances (PFAS) may increase the risk of gestational diabetes mellitus (GDM), with adverse consequences for pregnant women and their offspring. However, epidemiologic studies have shown inconsistent results. We addressed this question in a large, pooled sample of U.S. women.</p><p><strong>Research design and methods: </strong>Participants (n = 5,229) from 16 cohorts had singleton pregnancies. PFAS were quantified in a single plasma or serum sample during pregnancy (1999-2021); six PFAS detected in ≥60% of participants were analyzed. The primary outcome was GDM diagnosis based on self-report or medical record documentation. The secondary outcome, among 1,213 participants, was fasting glucose. We estimated associations between each PFAS and GDM using generalized estimating equations models with Poisson distribution and robust variance, and estimated associations between each PFAS and fasting glucose using generalized estimating equations models for linear regression. Effect modification by prepregnancy BMI or race and ethnicity was evaluated via interaction terms and stratification. We quantified the combined effect of the PFAS mixture using quantile-based g-computation.</p><p><strong>Results: </strong>Associations between individual PFAS and GDM were null or weakly inverse; the association with the six-PFAS mixture was negative (prevalence ratio [95% CI] per quartile increase: 0.75 [0.58, 0.96]). Certain PFAS were more strongly negatively associated with GDM among participants with BMI <25 kg/m2. Associations between PFAS and fasting glucose were largely null, although both positive and negative associations were observed in specific race and ethnicity strata.</p><p><strong>Conclusions: </strong>In a large, pooled sample of U.S. pregnant women, greater concentrations of PFAS were not associated with higher prevalence of GDM.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"852-860"},"PeriodicalIF":16.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of High-Dose Oral Insulin in Children With Stage 1 Type 1 Diabetes: The Fr1da Insulin Intervention Randomized Controlled Trial.","authors":"Anette-Gabriele Ziegler, Ali Albeer, Stefanie Arnolds, Robin Assfalg, Melanie Bunk, Carolin Daniel, Anna Hofelich, Stefanie Jacobsen, Kerstin Kick, Jan Knoop, Mirjam Kohls, Olga Kordonouri, Claudia Matzke, Markus Pfirrmann, Claudia Ramminger, Katharina Sarcletti, Marlon Scholz, Katharina Schütte-Borkovec, Isabelle Serr, Marc Weigelt, Andreas Weiss, Christiane Winkler, Ezio Bonifacio, Peter Achenbach","doi":"10.2337/dc25-2818","DOIUrl":"10.2337/dc25-2818","url":null,"abstract":"<p><strong>Objective: </strong>Oral administration of an antigen can induce immunological tolerance. Insulin is an autoantigen in childhood type 1 diabetes (T1D). We tested the effect of treatment with high-dose oral insulin on disease progression and immune response to insulin in children with stage 1 T1D.</p><p><strong>Research design and methods: </strong>We conducted a phase 2 randomized placebo-controlled double-blind trial in children with stage 1 T1D who received daily oral insulin (7.5 mg/day for 3 months and 67.5 mg/day for 9 months; n = 110) or placebo (n = 110) for 12 months. The coprimary outcomes were 1) time from baseline to dysglycemia or clinical diabetes and 2) increased immune response to insulin within 12 months of treatment (assessed in the first 90 participants).</p><p><strong>Results: </strong>Of 220 participants (112 girls; median age 4.8 years; interquartile range 3.6, 6.2), 179 completed the trial. Dysglycemia or diabetes developed in 87 participants (46 receiving oral insulin and 41 receiving placebo; hazard ratio 1.07; 95% CI 0.66-1.73; P = 0.74). The 5-year progression rate was 40% (95% CI 30-51%) in each group. A modest treatment interaction was found with the INS rs689 genotype (P = 0.03). Increased immune response to insulin was observed in 11 (25%) of 44 participants in the oral insulin group and 13 (31%) of 42 in the placebo group (P = 0.63). Oral insulin was well tolerated. No significant study-related adverse events occurred.</p><p><strong>Conclusions: </strong>In children with stage 1 T1D, 1 year of high-dose oral insulin did not alter progression to dysglycemia or diabetes or immune response to insulin.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"746-754"},"PeriodicalIF":16.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Merging T1D and T2D Management: Shared Strategies for Common Goals-Building on Early Lessons From GLP-1 Trials in T1D.","authors":"Richard M Bergenstal, Holly J Willis, Anders L Carlson","doi":"10.2337/dci26-0010","DOIUrl":"10.2337/dci26-0010","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":"49 5","pages":"706-708"},"PeriodicalIF":16.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}