Diabetes care最新文献

{"title":"The Heterogeneity of Type 1 Diabetes: Implications for Pathogenesis, Prevention, and Treatment-2024 Diabetes, Diabetes Care, and Diabetologia Expert Forum.","authors":"Carmella Evans-Molina, Yuval Dor, Åke Lernmark, Chantal Mathieu, Jeffrey R Millman, Raghavendra G Mirmira, Flemming Pociot, Maria J Redondo, Stephen S Rich, Sarah J Richardson, Michael R Rickels, R David Leslie","doi":"10.2337/dci25-0013","DOIUrl":"https://doi.org/10.2337/dci25-0013","url":null,"abstract":"<p><p>This article summarizes the current understanding of the heterogeneity of type 1 diabetes from a June 2024 international Expert Forum organized by the editors of Diabetes, Diabetes Care, and Diabetologia. The Forum reviewed key factors contributing to the development and progression of type 1 diabetes and outlined specific, high-priority research questions. Knowledge gaps were identified, and, notably, opportunities to harness disease heterogeneity to develop personalized therapies were outlined. Herein, we summarize our discussions and review the heterogeneity of genetic risk and immunologic and metabolic phenotypes that influence and characterize type 1 diabetes progression (presented as a palette of risk factors). We discuss how these age-related factors determine disease aggressiveness (along gradients) and describe how variable immunogenetic pathways aggregate (into networks) to affect β-cell and other pancreatic pathologies to cause clinical disease at different ages and with variable severity (described as disease-related thresholds). Heterogeneity of pathogenesis and clinical severity opens avenues to prevention and intervention, including the potential of disease-modifying immunotherapy and islet cell replacement. We conclude with a call for 1) continued research to identify more factors contributing to the disease, both overall and in specific subgroups; 2) investigations focusing on both individuals who surpass metabolic and immune thresholds and develop diabetes and those who remain disease free with the same level of immunogenetic risk; and 3) efforts to identify where the current type 1 diabetes staging system may fall short and determine how it can be improved to capture and leverage heterogeneity in prevention and intervention strategies.</p><p><p></p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746617","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":"Clinical and Demographic Characteristics Associated With Diabetes Remission in Six Integrated Health Care Systems: A Retrospective Cohort Study.","authors":"Barune Thapa, Julie A Schmittdiel, David Arterburn, Romain Neugebauer, Wendy Dyer, Patrick J O'Connor, Jaejin An, Andrea E Cassidy-Bushrow, Lisa K Gilliam, Stephanie A Hooker, Margaret B Nolan, Caryn E S Oshiro, Tainayah Thomas, Gregg Simonson, Sarah Krahe Dombrowski, Luis A Rodriguez","doi":"10.2337/dc25-0530","DOIUrl":"https://doi.org/10.2337/dc25-0530","url":null,"abstract":"<p><strong>Objective: </strong>To assess the real-world frequency and characteristics associated with type 2 diabetes remission in a large and diverse cohort of U.S. adults.</p><p><strong>Research design and methods: </strong>This retrospective cohort study used 2014-2023 electronic health record data from six major U.S. health care delivery systems. The cohort included 556,758 adults (≥18 years) with type 2 diabetes who had one or more HbA1c measurement in 2 years before study entry and evidence of glucose-lowering medication use. Pregnant women or adults who underwent bariatric surgery before or during the study were excluded. Type 2 diabetes remission was defined as HbA1c <6.5% persisting for ≥3 months after cessation of glucose-lowering medications. Multivariate logistic regression was used to identify characteristics associated with type 2 diabetes remission.</p><p><strong>Results: </strong>Over a 3-year follow-up, 2.9% (16,016 adults) achieved type 2 diabetes remission, although 36.9% of those who experienced remission relapsed. The strongest characteristics associated with remission were not receiving glucose-lowering medications at baseline versus three or more medications (odds ratio [OR] 15.9, 95% CI 12.1-21.0), baseline HbA1c <7% vs. ≥11% (OR 3.1, 2.9-3.3) and diabetes duration <1 year versus ≥4 years (OR 2.6, 2.5-2.7).</p><p><strong>Conclusions: </strong>Type 2 diabetes remission was low among adults without bariatric surgery. The strongest associated characteristics were fewer diabetes medications, lower baseline HbA1c, and shorter diabetes duration. These findings highlight actionable factors to identify patients who may benefit most from targeted interventions. Future research should evaluate the long-term durability and health impacts of remission.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746602","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":"Real-Time Continuous Glucose Monitoring in Pregnancies With Gestational Diabetes: A Randomized Controlled Trial.","authors":"Amy M Valent, Michaela Rickert, Christian Huerta Pagan, Lucy Ward, Emily Dunn, Monica Rincon","doi":"10.2337/dc25-0115","DOIUrl":"https://doi.org/10.2337/dc25-0115","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy of real-time continuous glucose monitoring (CGM; intervention) with capillary blood glucose (CBG) monitoring (control) alone to achieve greater percent glucose time in range (%TIR) among pregnant individuals diagnosed gestational diabetes mellitus (GDM).</p><p><strong>Research design and methods: </strong>This was an open-label, single-center, randomized controlled trial of pregnant individuals with GDM and ≥20 weeks' gestation. Subjects were randomly assigned (2:1) to use real-time CGM plus adjunctive CBG versus CBG alone for glucose monitoring. The intervention group was instructed on the continuous use of the Dexcom G6 CGM system from enrollment to admission for delivery. The control group used CBG monitoring four times per day underwent blinded CGM approximately every 20 days throughout the study period. The primary outcome was the CGM %TIR defined as 60-140 mg/dL (3.3-7.8 mmol/L) from study enrollment until hospital admission for delivery.</p><p><strong>Results: </strong>A total of 111 participants were enrolled between February 2021 and June 2023 (n = 74 in intervention group; n = 37 in control group) with no statistical differences in demographic characteristics between the groups. The CGM group had significantly higher %TIR ±SD (93 ± 6 min vs. 88 ± 14 min at 60-140 mg/dL; P = 0.027). Among key secondary CGM metric outcomes, the intervention group had significantly higher daytime TIR with lower 24-h and daytime mean glucose and percent time >140 mg/dL compared with the control group.</p><p><strong>Conclusions: </strong>We demonstrated a significantly higher %TIR using real-time CGM compared with CBG glucose monitoring among pregnant people with GDM. Studies are needed to determine if achieving lower CGM glucose levels can improve perinatal and neonatal outcomes.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746616","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":"Effects of Semaglutide With or Without Concomitant Mineralocorticoid Receptor Antagonist Use in Participants With Type 2 Diabetes and Chronic Kidney Disease: A FLOW Trial Prespecified Secondary Analysis.","authors":"Peter Rossing, George Bakris, Vlado Perkovic, Richard Pratley, Katherine R Tuttle, Kenneth W Mahaffey, Thomas Idorn, Nicolas Belmar, Heidrun Bosch-Traberg, Søren Rasmussen, Robert S Busch, Ronald E Schmieder, Pieter Gillard, Johannes F E Mann","doi":"10.2337/dc25-0472","DOIUrl":"https://doi.org/10.2337/dc25-0472","url":null,"abstract":"<p><strong>Objective: </strong>In the Evaluate Renal Function With Semaglutide Once Weekly (FLOW) trial, semaglutide reduced the risk of major kidney and cardiovascular (CV) outcomes and all-cause mortality in people with type 2 diabetes (T2D) and chronic kidney disease (CKD). This prespecified analysis assessed the effects of semaglutide on kidney, CV, and mortality outcomes by baseline mineralocorticoid receptor antagonist (MRA) use.</p><p><strong>Research design and methods: </strong>Participants were randomized to once-weekly subcutaneous semaglutide 1.0 mg or placebo. The primary kidney outcome was a composite of time to first persistent ≥50% eGFR reduction from baseline, kidney failure, or death from kidney/CV causes. Baseline MRA was predominantly spironolactone; finerenone was only available after recruitment ended.</p><p><strong>Results: </strong>Effects were analyzed by baseline MRA use (n = 257 [136 in the semaglutide group and 121 in the placebo group]) and nonuse (n = 3,276 [1,631 in the semaglutide group and 1,645 in the placebo group]). Semaglutide reduced the risk of the primary kidney outcome by 49% (59 events; hazard ratio [HR] 0.51 [95% CI 0.30, 0.86]) and 21% (682 events; HR 0.79 [95% CI 0.68, 0.92]; P-interaction = 0.12) versus placebo in MRA and non-MRA subgroups, respectively. There was no heterogeneity, favoring the effects of semaglutide on major adverse CV events (MACE) and all-cause mortality in both MRA subgroups (P-interaction > 0.7). Albuminuria at 104 weeks was reduced from baseline with semaglutide by 15% (95% CI -41, 31) in MRA users and 33% (26, 39) in nonusers versus placebo (P-interaction = 0.22). Estimated glomerular filtration rate decline was similarly reduced with semaglutide (P-interaction = 0.71). The safety profile of semaglutide was comparable between subgroups.</p><p><strong>Conclusions: </strong>In participants with T2D and CKD, consistent benefits of semaglutide on major kidney outcomes, MACE, and all-cause mortality were observed regardless of baseline MRA use.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746614","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":"Extinguishing the Fire: Treating Pediatric Type 2 Diabetes by Targeting Obesity Treatment.","authors":"Megan O Bensignor, Daniel S Hsia, Michelle A Van Name, Ania M Jastreboff, Justin R Ryder","doi":"10.2337/dci25-0031","DOIUrl":"https://doi.org/10.2337/dci25-0031","url":null,"abstract":"<p><p>Childhood obesity affects nearly one in five children in the U.S. and is a key driver in youth-onset type 2 diabetes (T2D) development and progression. Effective obesity treatment may lead to T2D remission and can greatly improve dysglycemia and insulin sensitivity. The main objective of this article is to describe the growing evidence in support of targeting obesity to treat T2D in youth. There is growing evidence and guidance that for adults with T2D medical and surgical treatments for obesity should be prioritized. Yet, for youth with T2D, there has been limited movement to prioritize treating obesity, despite its role in diabetes pathophysiology. In adults, addition of obesity medications and bariatric surgery to the diabetes treatment regimen results in substantial weight reduction, improvement in dysglycemia, and decreased use of diabetes agents. In youth, there is limited, yet mounting evidence of these same benefits. U.S. Food and Drug Administration-approved obesity medications are effective and well tolerated in youth with obesity and an important therapeutic tool for youth with T2D and obesity. For several medications clinically significant weight reduction has been demonstrated, with improvement in insulin resistance and dysglycemia. In youth with T2D significant weight reduction has been demonstrated with bariatric surgery, with significant 3- and 10-year diabetes remission rates. Further studies in pediatric patients with T2D and obesity are needed to determine the long-term impacts of obesity therapies and bariatric surgery on progression and outcomes of youth-onset T2D.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746615","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":"Evaluation of a Prediction-Based Bedtime Intervention in Reducing Nocturnal Low Glucose in Adults With Type 1 Diabetes: The DailyDose Bedtime Smart Snack Crossover Study.","authors":"Clara Mosquera-Lopez, Valentina Roquemen-Echeverri, Peter G Jacobs, Katrina Ramsey, Joseph Pinsonault, Jae Eom, Hantao Ling, Daisy Chen, Deborah Branigan, Jessica R Castle, Korey K Hood, Melanie B Gillingham, Diana Aby-Daniel, Leah M Wilson","doi":"10.2337/dc25-0407","DOIUrl":"https://doi.org/10.2337/dc25-0407","url":null,"abstract":"<p><strong>Objective: </strong>Nocturnal hypoglycemia is challenging for individuals with type 1 diabetes, particularly those who are physically active or using multiple daily injections (MDIs). We hypothesized that adding bedtime decision support to usual care with continuous glucose monitoring (CGM)-augmented MDI therapy could reduce nocturnal hypoglycemia.</p><p><strong>Research design and methods: </strong>We developed the DailyDose Smart Snack (DDSS) app, which features CGM and physical activity logging and delivers personalized bedtime snack recommendations to help prevent nocturnal hypoglycemia. Recommendations are based on the probability and timing of low-glucose events forecasted by an evidential neural network. We conducted a randomized crossover trial comparing DDSS with CGM-augmented MDI for 4 weeks each under free-living conditions to evaluate the feasibility and effect of DDSS in reducing nocturnal hypoglycemia.</p><p><strong>Results: </strong>Twenty participants completed the study (mean ± SD age 39 ± 15 years; 10 women; HbA1c 7.1% ± 1.0% [54 ± 11 mmol/mol]). There was no difference between arms in the proportion of nights with low-glucose events <70 mg/dL lasting 10+ min (control 26.0% ± 14.1% vs. DDSS 23.6% ± 15.6%; odds ratio [OR] 0.83; P = 0.207) or in overnight CGM metrics. A post hoc analysis showed that the proportion of nights with low-glucose events <54 mg/dL lasting 10+ min was significantly reduced in the DDSS arm by 3.5% (11.9% ± 12.9% vs. 8.3% ± 8.8%; OR 0.64; P = 0.040).</p><p><strong>Conclusions: </strong>DDSS did not significantly reduce the proportion of nights with low-glucose events <70 mg/dL lasting 10+ min but reduced nocturnal low glucose <54 mg/dL without compromising other glycemic metrics.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700729","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":"SCORE2-Diabetes Predicts the Risk of Heart Failure and Atrial Fibrillation in Individuals With Newly Diagnosed Type 2 Diabetes.","authors":"Stelios Karayiannides, Natalia Widén, Georgios Tsatsaris, Neda Rajamand-Ekberg, Sergiu-Bogdan Catrina","doi":"10.2337/dc25-0933","DOIUrl":"https://doi.org/10.2337/dc25-0933","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692816","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":"Diabetes in Pregnancy and School-Age Developmental Outcomes for Offspring: A Statewide Retrospective Cohort Study.","authors":"Hannah G Gordon, Richard J Hiscock, Alexis Shub, Jessica A Atkinson, Susan P Walker, Anna Forsythe, Amber L Kennedy, Parinaz Mehdipour, Stephen Tong, Roxanne M Hastie, Anthea C Lindquist","doi":"10.2337/dc25-0678","DOIUrl":"https://doi.org/10.2337/dc25-0678","url":null,"abstract":"<p><strong>Objective: </strong>The impact of diabetes in pregnancy on offspring neurodevelopment is unclear. We investigate whether exposure to diabetes in utero is associated with developmental vulnerability or educational delay during primary school.</p><p><strong>Research design and methods: </strong>We used population-level pregnancy and birth data from 2009 to 2021 from Victoria, Australia, linked with standardized national assessments. Adjusting for a range of maternal and childhood covariates, we investigated whether diabetes in pregnancy was associated with an altered risk of developmental vulnerability compared with no diabetes in the first year of fulltime school (ages 4-6 years), defined as below the tenth centile in two or more domains in the Australian Early Development Census (AEDC), and altered educational outcomes in grade 3 (ages 7-8 years), defined as the adjusted mean difference in overall z score in the National Assessment Program - Literacy and Numeracy test (NAPLAN).</p><p><strong>Results: </strong>Our study comprised 177,898 children who had linked birth and AEDC data, and 115,231 with linked birth and NAPLAN data, including, respectively, 16,363 (9.2%) and 7,532 (6.5%) exposed to diabetes in pregnancy. Following adjusted analysis, diabetes in pregnancy was not associated with an altered risk of overall developmental vulnerability compared with no diabetes (adjusted relative risk 1.02 [95% CI 0.98, 1.07]). Diabetes was associated with a marginally higher overall NAPLAN z score, but below the prespecified threshold for clinical significance (adjusted mean difference 0.04 [95% CI 0.01, 0.07]).</p><p><strong>Conclusions: </strong>Diabetes in pregnancy was not associated with overall developmental vulnerability or a clinically meaningful difference in educational outcomes. This should provide reassurance for patients and their treating clinicians.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683840","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":"Use of the Omnipod 5 Automated Insulin Delivery System Activity Feature Reduces Insulin Delivery and Attenuates the Drop in Glycemia Associated With Exercise in a Randomized Controlled Trial.","authors":"Lauren V Turner, Jennifer L Sherr, Dessi P Zaharieva, Jesica Baran, Irl B Hirsch, Bruce W Bode, Sue A Brown, Suzan Bzdick, Mei Mei Church, David W Hansen, Ryan Kingman, Lori M Laffel, Viral N Shah, Sheri Stone, Todd E Vienneau, Lauren M Huyett, Bonnie Dumais, Trang T Ly, Michael C Riddel","doi":"10.2337/dc25-0141","DOIUrl":"https://doi.org/10.2337/dc25-0141","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy of enabling Activity feature 60 (AF-60) or 30 min (AF-30) before prolonged exercise versus the automated mode (Auto) in adults and adolescents with type 1 diabetes wearing the Omnipod 5 System.</p><p><strong>Research design and methods: </strong>In this three-way crossover study, 38 participants (age 30 ± 15 years; BMI 24.7 ± 4.1 kg/m2; HbA1c 7.5% ± 0.9% [58 ± 11 mmol/mol]) from the extension phase of the pivotal trial of the Omnipod 5 System completed a 70-min treadmill session at 64-76% maximum heart rate in a postabsorptive state under each of the three conditions. Auto was resumed after exercise, and glycemia and insulin delivery metrics were examined in the 4-h postexercise period.</p><p><strong>Results: </strong>The percentage of participants who developed hypoglycemia during exercise did not differ significantly between Auto (42%) and AF-60 (29%; P = 0.34) or AF-30 (24%; P = 0.14). However, AF-60 and AF-30 reduced insulin delivery compared with Auto in the hour before (P < 0.001) and during exercise (P < 0.001). There was also a favorable attenuation in glucose drop during exercise when comparing Auto (-57 ± -35 mg/dL) with AF-60 (-44 ± -33 mg/dL; P = 0.02) and AF-30 (-36 ± -34 mg/dL; P = 0.01). In the postexercise period, glycemia and insulin delivery were comparable.</p><p><strong>Conclusions: </strong>Enabling the Activity feature either 60 or 30 min before exercise reduced insulin delivery and attenuated glucose drops relative to Auto, but hypoglycemia incidence was not different across the three conditions. These findings support the use of the Omnipod 5 System for exercise but highlight the importance of using additional strategies, such as earlier use of Activity feature and/or carbohydrate intake to further reduce hypoglycemia risk.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664127","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":"Transition of BMI Status From Childhood to Adulthood and Cardiovascular-Kidney-Metabolic Syndrome in Midlife: A 36-Year Cohort Study.","authors":"Yang Wang, Yang Yang, Jing Chen, Ming-Fei Du, Yue Sun, Dan Wang, Hao Jia, Gui-Lin Hu, Zi-Yue Man, Teng Zhang, Sheng-Hao Zuo, Chao Chu, Ming-Ke Chang, Ze-Jiaxin Niu, Ying Xiong, Hao Li, Shi Yao, Lei Chen, Jie Ren, Yu-Ming Kang, Zu-Yi Yuan, Duo-Lao Wang, Gregory Y H Lip, Zheng Liu, Jian-Jun Mu","doi":"10.2337/dca25-0027","DOIUrl":"https://doi.org/10.2337/dca25-0027","url":null,"abstract":"<p><strong>Objective: </strong>We investigated the associations between BMI transitions from childhood to adulthood and cardiovascular-kidney-metabolic (CKM) syndrome and its components in midlife.</p><p><strong>Research design and methods: </strong>Using data from the Hanzhong Adolescent Hypertension Study, 1,997 participants aged 6-18 years were followed for 36 years into midlife (mean age 48.12 years). Participants were categorized into four groups based on BMI transitions from childhood to midlife: control, incident, persistent, and resolution. CKM stages ranged from early (stages 0-1), to intermediate (stage 2), to advanced (stages 3-4), defined by cardiovascular disease, chronic kidney disease, and metabolic disorders. Multivariable regression models were used to assess associations between BMI transitions and CKM outcomes.</p><p><strong>Results: </strong>Individuals transitioning from normal childhood BMI to overweight in adulthood had higher risks of intermediate (odds ratio [OR] 5.19 [95% CI 3.15-8.53]) and advanced CKM stages (OR 6.70 [95% CI 3.96-11.33]) compared with those with persistently normal BMI. These risks were attenuated if elevated childhood BMI resolved by adulthood. For specific CKM components, individuals with normal childhood BMI but overweight in adulthood showed higher risks of left ventricular diastolic dysfunction, subclinical kidney damage, albuminuria, and metabolic abnormalities compared with those with persistently normal BMI. These risks were reduced if high childhood BMI normalized by adulthood.</p><p><strong>Conclusions: </strong>Transitioning from normal childhood BMI to overweight in adulthood is associated with increased risks of higher CKM stages in midlife. However, individuals whose high childhood BMI resolved by adulthood exhibit similar risk to those with persistently normal BMI.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651645","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}