Diabetes care最新文献

{"title":"Understanding Patient Preferences Regarding Limb Salvage for Diabetic Foot Ulcers: A Discrete Choice Experiment.","authors":"Lyndsay M O'Hara, Alison D Lydecker, Gwen L Robinson, Nathan N O'Hara, Justin J Kim, Alyson J Littman, Brian M Schmidt, Odessa Addison, David J Margolis, Mary-Claire Roghmann","doi":"10.2337/dc25-0478","DOIUrl":"https://doi.org/10.2337/dc25-0478","url":null,"abstract":"<p><strong>Objective: </strong>Diabetic foot ulcers (DFUs) often lead to amputations. Limb salvage aims to preserve the lower extremity, but the complexity of care and uncertainty of healing can delay patients' return to normal activities. This study aimed to understand military veterans' preferences regarding limb salvage for DFUs, using a discrete choice experiment (DCE).</p><p><strong>Research design and methods: </strong>A DCE was conducted with 98 veterans with diabetes at the Baltimore Veterans Affairs Medical Center. Participants were presented with 10 choice sets involving different levels of postrecovery mobility, amputation levels, and future surgery risks. These attributes were developed through literature review and interviews. Data were analyzed using a multinomial logit model to estimate the utility of each attribute level and assess preference heterogeneity.</p><p><strong>Results: </strong>The study population was older (mean age 69 years), Black (61%), and male (94%). Half (53%) had a prior foot complication. Postrecovery mobility was the most important attribute (relative importance 53%), followed by amputation level (30%) and future surgery risk (18%). Veterans valued mobility highly, with significant utility differences between walking unaided and needing a wheelchair or scooter. They were willing to accept higher amputation levels to improve mobility.</p><p><strong>Conclusions: </strong>Postrecovery mobility is a critical factor for veterans with DFUs, outweighing concerns about amputation level and future surgical risks. It should be a focus of shared decision-making. The study is limited by its single-site setting and study population. Broader research is needed. Understanding patient preferences through DCE can inform more patient-centered approaches to DFU management, potentially improving outcomes and satisfaction.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556199","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":"A New Simulation Model to Estimate the Long-term Health and Cost Outcomes of Interventions for People With Type 1 Diabetes.","authors":"Carolina Barbosa, Thomas J Hoerger, Nicole A Mack, Georgiy V Bobashev, Simon Neuwahl, Rainer Hilscher, Trevor Orchard, Tina Costacou, Rachel G Miller, Ralph D'Agostino, Ping Zhang","doi":"10.2337/dc25-0124","DOIUrl":"https://doi.org/10.2337/dc25-0124","url":null,"abstract":"<p><strong>Objective: </strong>To develop a U.S.-based microsimulation model for assessing the cost-effectiveness of interventions to manage type 1 diabetes.</p><p><strong>Research design and methods: </strong>We developed risk equations for 14 diabetes-related complications and mortality, 12 risk factor progression equations, and one equation for utilities associated with 14 complications using data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) studies and the Epidemiology of Diabetes Complications (EDC) study. We integrated all equations into a simulation model. We conducted internal and external validation and demonstrated the utility of the model using a real-world example. Main model-generated outcomes included cumulative incidence of diabetes-related complications, life years, quality-adjusted life years, medical costs, and incremental cost-effectiveness ratios.</p><p><strong>Results: </strong>The model generates long-term clinical and economic outcomes from changes in risk factors of type 1 diabetes complications. Internal validation comparing modeled outcomes to observed data used to develop the model yielded good prediction accuracy, with mean absolute percentage error across all complications of 9% and correlation of cumulative failure rates above 0.9. External validation results were mixed, with occurrence of slight under- or overprediction across complications and studies. We illustrated the model with a case study estimating the effects of expanding the use of an insulin pump with continuous glucose monitoring to all people with type 1 diabetes.</p><p><strong>Conclusions: </strong>Our new comprehensive type 1 diabetes simulation model can generate valid and accurate results for assessing the long-term cost-effectiveness of interventions to manage type 1 diabetes in the U.S.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556241","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":"Effect of SGLT2 Inhibition on Glucosuria During a Hyperglycemic Clamp in HNF1A-MODY (MODY3) and Type 2 Diabetes.","authors":"Henrik Maagensen, Johanne S Jensen, Stine O Høyerup, Anne C B Thuesen, Jesper Krogh, Jens J Holst, Henrik Vestergaard, Peter Rossing, Torben Hansen, Filip K Knop, Sofie Hædersdal, Tina Vilsbøll","doi":"10.2337/dc25-0737","DOIUrl":"https://doi.org/10.2337/dc25-0737","url":null,"abstract":"<p><strong>Objective: </strong>Pathogenic variants of HNF1A cause maturity-onset diabetes of the young type 3 (HNF1A-MODY; also known as MODY3). Individuals with HNF1A-MODY are primarily treated with sulfonylureas; however, little is known about the effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors in HNF1A-MODY. Interestingly, HNF1A-MODY is associated with increased glucosuria, which has been attributed to lower expression of SGLT2 as observed in HNF1A-knockout mice. We investigated the impact of acute SGLT2 inhibition on glucosuria in individuals with HNF1A-MODY or type 2 diabetes.</p><p><strong>Research design and methods: </strong>In a randomized, double-blind, crossover study, individuals with HNF1A-MODY or type 2 diabetes underwent two three-step hyperglycemic clamps targeted at 1-h periods of 10, 14, and 18 mmol/L glucose with and without acute SGLT2 inhibition (25 mg empagliflozin or placebo administrated 2 h before clamp procedures).</p><p><strong>Results: </strong>Eleven individuals with HNF1A-MODY (age [mean ± SD] 49 ± 15 years; glomerular filtration rate [GFR; mean ± SD] 113 ± 18 mL/min) and 10 individuals with type 2 diabetes (age 63 ± 7 years; GFR 103 ± 27 mL/min) were included. During the 3-h hyperglycemic clamp, SGLT2 inhibition increased urinary glucose excretion in both groups (HNF1A-MODY: 24.5 g [95% CI 20.6, 28.3]; type 2 diabetes: 23.5 g [95% CI 20.4, 26.5]). The effect of SGLT2 inhibition was not significantly different between the groups (1.0 g [95% CI -3.5, 5.6]; P = 0.6).</p><p><strong>Conclusions: </strong>The robust effect of SGLT2 inhibition on urinary glucose excretion in participants with HNF1A-MODY points to SGLT2 inhibition as a relevant glucose-lowering treatment strategy in individuals with HNF1A-MODY.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556198","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":"Association of Hospitalizations With Randomized Glycemia-Lowering Treatment in GRADE.","authors":"Daniel S Hsia, Naji Younes, Alokananda Ghosh, Erin J Kazemi, Heidi Krause-Steinrauf, John B Buse, Chelsea Baker, Janet Brown-Friday, Elsa Diaz, Jamie Diner, Erik J Groessl, Elizabeth A Legowski, Cary N Mariash, Andrea H Waltje, Deborah J Wexler, Catherine L Martin","doi":"10.2337/dc24-2839","DOIUrl":"10.2337/dc24-2839","url":null,"abstract":"<p><strong>Objective: </strong>To compare rates of and risk factors for hospitalizations among Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) participants taking metformin and randomly assigned to insulin glargine U-100, glimepiride, liraglutide, or sitagliptin.</p><p><strong>Research design and methods: </strong>Intention-to-treat (ITT) (N = 5,047) and on-assigned-treatment (AT) (N = 4,830) data sets were used. Baseline differences between those hospitalized versus those not hospitalized were assessed. Kaplan-Meier analysis was used to determine incidence for time to first hospitalization, and log-rank tests were used to determine treatment group differences. Time-to-event analyses were used to examine factors affecting subsequent hospitalization risk.</p><p><strong>Results: </strong>During GRADE, 1,636 participants (32.4%) were hospitalized at least once and 751 (14.9%) were hospitalized more than once. Hospitalized participants were older, less likely to be Hispanic, more likely to be White, and more likely to have a history of hypertension and had higher baseline BMI. There were no treatment group differences in incidence for time to first hospitalization in the ITT data set (P = 0.148), but a reduced hazard rate was observed for those taking liraglutide versus those taking glimepiride in the AT data set (hazard ratio 0.78 [95% CI 0.66, 0.92]; P = 0.022). Factors increasing the risk for subsequent hospitalizations included meeting the secondary outcome (HbA1c >7.5%, confirmed), each prior hospitalization, and change from assigned treatment (29%, 41%, and 56% increase in risk, respectively). Assignment to liraglutide versus glimepiride reduced this risk by 13%.</p><p><strong>Conclusions: </strong>Hospitalizations were common in GRADE, and rates were nearly identical across treatment groups. The small, but significant, reduction in risk for subsequent hospitalizations among participants assigned to liraglutide versus glimepiride may influence treatment decisions in populations similar to GRADE participants.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"1288-1294"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153094","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":"Physical Activity Is Associated With Improved Glycemic Outcomes in Newly Diagnosed Youth With Type 1 Diabetes: 4T Exercise Program.","authors":"Dessi P Zaharieva, Victor Ritter, Franziska K Bishop, Manisha Desai, Ananta Addala, Priya Prahalad, Michael C Riddell, David M Maahs","doi":"10.2337/dc25-0765","DOIUrl":"https://doi.org/10.2337/dc25-0765","url":null,"abstract":"<p><strong>Objective: </strong>The Teamwork, Targets, Technology, and Tight Range (4T) Exercise Program evaluated physical activity patterns across the first year of type 1 diabetes diagnosis and whether physical activity was associated with changes in glucose outcomes in the 24 h following physical activity.</p><p><strong>Research design and methods: </strong>The 4T Exercise Program started newly diagnosed youth with type 1 diabetes on a continuous glucose monitoring (CGM) system and physical activity tracker around 1 month postdiagnosis. A subset of youth opted to participate in up to four quarterly structured exercise education sessions to increase their knowledge around safe physical activity.</p><p><strong>Results: </strong>Ninety-eight youth with type 1 diabetes (median [interquartile range (IQR)] age of 13 [12-15] years, 45% female, 44% non-Hispanic White) completed the study. Compared with sedentary days, days with ≥10 min of vigorous intensity physical activity were associated with an increase in time in range (TIR) of 2.3% (1.4-3.2%; P < 0.001), a decrease in time above range (TAR) of 3.1% (2.2-4.0%; P < 0.001), and an increase in time below range (TBR) of 0.8% (0.6-0.9%; P < 0.001) in the 24 h following physical activity. From 1-3 months to 10-12 months postdiagnosis, the median (IQR) step count increased by 1,134 (445-1,519) steps per day (P < 0.001), while daily moderate-to-vigorous physical activity increased by 11 (2-23) min per day (P < 0.001).</p><p><strong>Conclusions: </strong>In the 24 h following physical activity as compared with sedentary days, TIR improved, TAR was lower, and TBR remained within clinical target recommendations. For youth with new-onset type 1 diabetes, each structured exercise education session was associated with a further 0.79% increase in TIR.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546630","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":"Differential Effect of GLP-1 Receptor Agonists and SGLT2 Inhibitors on Lower-Extremity Amputation Outcomes in Type 2 Diabetes: A Nationwide Retrospective Cohort Study.","authors":"Alexander T Hong, Ivan Y Luu, Forest Lin, Laura Shin, Chiu-Hsieh Hsu, Chia-Ding Shih, David G Armstrong, Tze-Woei Tan","doi":"10.2337/dc25-0292","DOIUrl":"https://doi.org/10.2337/dc25-0292","url":null,"abstract":"<p><strong>Objective: </strong>To compare the risk of lower-extremity amputations (LEAs) between new users of glucagon-like peptide 1 receptor agonists (GLP-1RAs) versus sodium-glucose cotransporter 2 inhibitors (SGLT2is).</p><p><strong>Research design and methods: </strong>This retrospective cohort study used TriNetX, a federated electronic health records network, including adults with type 2 diabetes who initiated GLP-1RAs or SGLT2is between May 2013 and March 2025. Propensity score matching (1:1) was used to balance demographics, comorbidities, medications, and laboratory values. Major (above-ankle) amputation-free survival was evaluated using Kaplan-Meier curves, while risks of major and minor LEAs, diabetic foot ulcers (DFUs), and mortality were estimated using hazard ratios (HRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>The matched cohorts included 180,740 GLP-1RA and 180,740 SGLT2i recipients. At 3 years, the GLP-1RA cohort was associated with greater major amputation-free survival (99.69% vs. 99.64%, P = 0.001) compared with the SGLT2i cohort. Additionally, GLP-1RA treatment was associated with a lower risk of major LEAs (HR 0.77 [95% CI 0.66, 0.90]), minor LEAs (HR 0.73 [95% CI 0.63, 0.84]), DFUs (HR 0.92 [95% CI 0.87, 0.96]), and mortality (HR 0.66 [95% CI 0.63, 0.69]). Risk reduction for major LEA remained significant in individuals with peripheral artery disease (HR 0.68 [95% CI 0.56, 0.82]) and DFUs (HR 0.70 [95% CI 0.58, 0.84]).</p><p><strong>Conclusions: </strong>GLP-1RA treatment was associated with greater major amputation-free survival compared with SGLT2i in people with type 2 diabetes, particularly in high-risk subgroups. Prospective studies are needed to confirm findings and inform selection of glucose-lowering therapies for people at risk for diabetes-related amputations.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487556","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":"Inadequately Controlled Type 2 Diabetes and Hypercortisolism: Improved Glycemia With Mifepristone Treatment.","authors":"Ralph A DeFronzo, Vivian Fonseca, Vanita R Aroda, Richard J Auchus, Timothy Bailey, Irina Bancos, Robert S Busch, John B Buse, Elena A Christofides, Bradley Eilerman, James W Findling, Yehuda Handelsman, Steven E Kahn, Harold J Miller, Jonathan G Ownby, John C Parker, Athena Philis-Tsimikas, Richard Pratley, Julio Rosenstock, Michael H Shanik, Lance A Sloan, Guillermo Umpierrez, Samir Shambharkar, Iulia Cristina Tudor, Tina K Schlafly, Daniel Einhorn","doi":"10.2337/dc25-1055","DOIUrl":"https://doi.org/10.2337/dc25-1055","url":null,"abstract":"<p><strong>Objective: </strong>In many individuals, type 2 diabetes (T2D) remains poorly controlled despite taking multiple glucose-lowering therapies. Several studies have demonstrated that endogenous hypercortisolism is prevalent among these individuals. We tested whether cortisol-directed therapy improves their glycemic control.</p><p><strong>Research design and methods: </strong>In this prospective, multicenter, double-blind study, 136 individuals with T2D (hemoglobin A1c [HbA1c] 7.5%-11.5% [58-102 mmol/mol] on multiple medications) and hypercortisolism (by dexamethasone suppression test) were randomized 2:1 to the glucocorticoid receptor antagonist mifepristone (300-900 mg once daily; n = 91) or placebo (n = 45) for 24 weeks, with stratification by presence/absence of an adrenal imaging abnormality. The primary end point was the change in HbA1c. Secondary end points included changes in glucose-lowering medications, weight, and waist circumference and safety.</p><p><strong>Results: </strong>Mean baseline HbA1c in the study cohort was 8.55% (69.9 mmol/mol). At 24 weeks, the least squares mean (LSM) difference from placebo in HbA1c was -1.32% (95% CI -1.81 to -0.83; P < 0.001). Participants receiving mifepristone experienced reductions in body weight and waist circumference (placebo-adjusted LSM differences of -5.12 kg [95% CI -8.20 to -2.03] and -5.1 cm [-8.23 to -1.99], respectively). Of participants on mifepristone, 46% discontinued therapy, compared with 18% on placebo. Adverse events with mifepristone (>10% of participants) included hypokalemia, fatigue, nausea, vomiting, headache, peripheral edema, diarrhea, and dizziness, consistent with mifepristone's known tolerability profile. Increases in blood pressure also occurred.</p><p><strong>Conclusions: </strong>In individuals with inadequately controlled T2D and hypercortisolism, cortisol-directed medical therapy with mifepristone reduced HbA1c, with a manageable tolerability profile.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478306","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":"Sociodemographic, Clinical, and Psychosocial Predictors of Short- and Long-term Study Retention in Diabetes Prevention Program (DPP) Outcomes Study (DPPOS).","authors":"Ashley H Tjaden, Barbara H Braffett, Nicole M Butera, Maria Rosario Araneta, Owen Carmichael, Erik J Groessl, Helen P Hazuda, Mary A Hoskin, Uzoma Ibebuogu, Michelle F Magee, Marjorie Mau, Tamara Stich, Diana Soliman, Amisha Wallia, Marinella Temprosa, Sherita H Golden","doi":"10.2337/dc25-0520","DOIUrl":"10.2337/dc25-0520","url":null,"abstract":"<p><strong>Objective: </strong>Success of longitudinal studies depends on retention of participants. We examined characteristics as predictors of retention among participants with prediabetes and type 2 diabetes (T2D) in the Diabetes Prevention Program (DPP) and the follow-up DPP Outcomes Study.</p><p><strong>Research design and methods: </strong>A total of 3,234 adults at high risk of T2D joined the DPP (1996-1999, mean age 51 ± 10 years). They were randomized to lifestyle, metformin, or placebo intervention, and then followed through 2020. Logistic regression models estimated the association between baseline sociodemographic, clinical and psychosocial characteristics (life events, family functioning, social support), and short-term retention (∼3 years). Cox proportional hazards models, censoring at death, estimated the association between baseline and time-varying characteristics and time to dropout over the entire 20 years of follow-up.</p><p><strong>Results: </strong>Among surviving participants (n = 3,218), 93% were retained after 3 years, and 75% of those surviving remained engaged over 20 years. Younger age was associated with dropout during DPP and over 20 years of follow-up. Female sex, non-White race/ethnicity, employment, and lack of baseline depressive symptoms were associated with better long-term retention. Over time, better health state (SF-36) (hazard ratio [HR]: 0.89 per 0.1 point; 95% CI: 0.83-0.95) was associated with retention. Greater BMI (HR: 1.06 per 5 kg/m2; 95% CI: 1.00-1.12), more recent life events (HR: 1.08; 95% CI: 1.02-1.14), and depressive symptoms (HR: 1.11 per 5 points; 95% CI: 1.05-1.18) were associated with reduced retention. Among adults 45-59 years of age at baseline, development of T2D was associated with better retention (HR: 0.75; 95% CI: 0.58-0.97).</p><p><strong>Conclusions: </strong>Twenty-year retention of a racially and geographically diverse cohort with prediabetes is possible. Retention was associated with age, psychosocial factors, T2D development, and BMI.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337363","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":"Nonglycemic and Glycemic Risk Factors for Painful Neuropathic Symptoms and for Distal Symmetrical Polyneuropathy (DSPN) in the Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study.","authors":"William H Herman, Adam Ciarleglio, Brian C Callaghan, Sharon L Edelstein, Ronald Goldberg, Neil H White, James W Albers","doi":"10.2337/dc25-0596","DOIUrl":"https://doi.org/10.2337/dc25-0596","url":null,"abstract":"<p><strong>Objective: </strong>The clinical presentation, symptoms, and signs of neuropathy vary substantially. We determined whether painful neuropathic symptoms and distal symmetrical polyneuropathy (DSPN) were associated with different risk factors in a longitudinal study of Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study (DPP/DPPOS) participants.</p><p><strong>Research design and methods: </strong>We assessed neuropathy in 1,779 DPP/DPPOS participants ∼21 years after DPP randomization. Symptoms were assessed using the Michigan Neuropathy Screening Instrument (MNSI) questionnaire and signs using pinprick, vibration, and monofilament testing. We defined four mutually exclusive neuropathy phenotypes: 1) no symptoms or signs of DSPN, 2) neuropathic pain without signs, 3) other neurologic symptoms without pain or signs, and 4) DSPN (MNSI questionnaire score ≥4 or any signs). We used multinomial logistic regression models to compare nonglycemic and glycemic risk factors among participants to better understand risk factors associated with painful neuropathic symptoms and DSPN.</p><p><strong>Results: </strong>Among the participants, 501 (28%) had no symptoms or signs, 144 (8%) had painful neuropathic symptoms without signs, and 473 (27%) had DSPN. Compared with participants with neither symptoms nor signs, those with painful neuropathic symptoms were more likely to be women, to have greater weight, and lower estimated glomerular filtration rate. Painful symptoms were not associated with glycemia. In contrast, DSPN, when compared with painful symptoms, was associated with older age, White race, and glycemic exposure.</p><p><strong>Conclusions: </strong>In this cohort, risk factors for painful neuropathic symptoms and DSPN differed. Improved recognition of painful neuropathic symptoms and better consensus on diagnostic criteria may facilitate research into their causes, prevention, and treatment.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328102","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":"Role of Adipose Tissue Compartments for Cardiovascular Risk in Diabetes Endotypes.","authors":"Oana-Patricia Zaharia, Yuliya Kupriyanova, Pavel Bobrov, Christian Binsch, Birgit Knebel, Tim Mori, Iryna Yurchenko, Dania Marel Mendez Cardenas, Theresa Kössler, Nina Trinks, Martin Schön, Kálmán B Bódis, Robert Wagner, Vera Schrauwen-Hinderling, Michael Roden","doi":"10.2337/dc24-2023","DOIUrl":"https://doi.org/10.2337/dc24-2023","url":null,"abstract":"<p><strong>Objective: </strong>The severe insulin-resistant diabetes (SIRD) endotype is associated with metabolic dysfunction-associated steatotic liver disease and higher cardiovascular risk. We investigated whether skeletal muscle or adipose tissue lipids are elevated in SIRD.</p><p><strong>Research design and methods: </strong>Participants (N = 420) of the German Diabetes Study (GDS) were assigned to diabetes clusters using a validated algorithm. 1H-magnetic resonance methods were used to quantify intramyocellular lipids (IMCLs), intrahepatic lipids (IHLs), and visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volumes.</p><p><strong>Results: </strong>Aside from elevated IHLs (P < 0.01), SIRD showed higher VAT and SAT than other endotypes after adjustment for BMI (all P < 0.05) but not for multiple comparisons. All endotypes featured comparable IMCLs. VAT volume and IHLs correlated with cardiovascular risk scores (Framingham r = 0.661 and 0.548, respectively, P < 0.05). Polygenic risk scores for VAT were associated with higher cardiovascular risk.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319010","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}