Diabetes care最新文献

{"title":"Effect of Fenofibrate on Progression of Diabetic Retinopathy in People With Type 1 Diabetes: Results From the LENS Trial.","authors":"Mohammed G Zayed, Robert Humphrey, Emily Sammons, David Preiss","doi":"10.2337/dc26-1470","DOIUrl":"https://doi.org/10.2337/dc26-1470","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139966","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":"Continuous Glucose Monitoring-Guided Insulin Optimization in Patients Receiving Nocturnal Parenteral Nutrition.","authors":"Laurianne Kerlogot, Vincent Rigalleau, Gauthier Pellet, Constance Chevrier, Coraline Baldé, Eva Wilsius, Marion Pidoux, Marion Jeamart, Florian Poullenot","doi":"10.2337/dc26-0936","DOIUrl":"https://doi.org/10.2337/dc26-0936","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether a continuous glucose monitoring (CGM) system (CGMS)-guided insulin optimization can improve glucose control and nutritional status in insulin-treated patients receiving long-term nocturnal parenteral nutrition (PN).</p><p><strong>Research design and methods: </strong>In this prospective single-center study, 12 insulin-treated adults with chronic intestinal failure undergoing nocturnal cyclic PN underwent 30-day CGM assessment before and after a diabetologist-led optimization of insulin therapy.</p><p><strong>Results: </strong>Glucose profiles improved after the intervention: less time >250 mg/dL (27% to 17%; -139 ± 113 min/day; P = 0.02), more time in range (44% to 59%; +206 ± 118 min/day; P = 0.002), and without more hypoglycemia. HbA1c decreased by -0.7% (-8 mmol/mol; P = 0.04), and glycosuria resolved in all affected patients (P = 0.03). Body weight increased by +5 kg (interquartile range 4-7.75; P = 0.006), as did serum albumin (+8 g/L; P = 0.006). Malnutrition resolved among 8 of 11 participants (P < 0.05).</p><p><strong>Conclusions: </strong>CGMS-guided insulin optimization was associated with improvements in glucose control and nutritional status.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140002","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 Care of Children With Type 1 Diabetes at School: Factors Related to the Choice of Care Location and Association With Glycemic Control.","authors":"Katsuyuki Matsui, Chihiro Nemoto, Koji Tagawa, Shizuyo Nagai, Kaori Fukawa, Hiroki Matsuura, Kentaro Shiga, Tatsuhiko Urakami, Tomoyuki Kawamura, Shigeyuki Ohtsu, Toru Kikuchi","doi":"10.2337/dc26-1452","DOIUrl":"https://doi.org/10.2337/dc26-1452","url":null,"abstract":"<p><strong>Objective: </strong>Type 1 diabetes (T1D) management in children requires a comprehensive approach tailored to developmental stages and school environments. This study investigated the locations of self-management behaviors at school, examining factors influencing location choice and their associations with glycemic control.</p><p><strong>Research design and methods: </strong>This multicenter, cross-sectional study analyzed 2018 registration data from 1,105 children with T1D attending schools or preschools in Japan. Associations among HbA1c, care behaviors, locations, treatment modalities, age, and sex were statistically evaluated.</p><p><strong>Results: </strong>The mean (SD) HbA1c was 8.01% (1.12%) (64.0 [12.2] mmol/mol). Care locations were the classroom (36.9%), designated rooms (52.6%), and the restroom (5.9%). HbA1c was significantly higher in the restroom group at 8.56% (0.98%) (70.1 [10.7] mmol/mol) than in the classroom group at 8.00% (1.20%) (63.9 [13.1] mmol/mol) and designated room group at 7.95% (1.08%) (63.4 [11.8] mmol/mol) (P < 0.001). Restroom use and omitting prelunch blood glucose monitoring were independently associated with higher HbA1c. Pump use, continuous glucose monitoring, and male sex predicted higher classroom use and lower restroom use. Joinpoint analysis showed that classroom use declined after age 6 (elementary school entry), whereas restroom use emerged from age 11 and spiked markedly at age 16 (20.8%), coinciding with high school entry, even among pump users.</p><p><strong>Conclusions: </strong>Care location choice shifts dynamically with age and school transitions, with restroom use being linked to poorer glycemic control. Supporting youth during school transitions requires targeted environmental adjustments and enhanced school-wide understanding to ensure safe and appropriate care locations.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129628","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 Multicenter 13-Week Evaluation of the twiist Automated Insulin Delivery in Insulin-Treated Type 2 Diabetes: The twiist-T2D Pivotal Trial.","authors":"Carol J Levy, Lauren Kanapka, Timothy E Graham, Davida F Kruger, Yogish C Kudva, Thomas Blevins, Viral N Shah, Anders L Carlson, David R Liljenquist, Kathleen Dungan, David Huffman, Kristin Castorino, Whitney Ceretti, Lori M Laffel, Elena Toschi, John Chip H Reed, Georgia Davis, Jamie Diner, Nicole Ehrhardt, Irl B Hirsch, Yu Kuei Lin, Malek El Muayed, Ruth S Weinstock, Devin Steenkamp, Erik Kramer, Lakshmi G Singh, Elias K Spanakis, Liana K Billings, Rodolfo J Galindo, Jacqueline Lonier, Rodica Pop-Busui, Athena Philis-Tsimikas, David T Ahn, Melissa S Putman, Jorge L Jo Kamimoto, Joanna Mitri, Ken Snow, Thomas J Mouse, Stephanie Stoway, Ryan Bailey, Roy W Beck","doi":"10.2337/dc26-1270","DOIUrl":"https://doi.org/10.2337/dc26-1270","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy, safety, and user satisfaction of the twiist automated insulin delivery (AID) system in adults with type 2 diabetes.</p><p><strong>Research design and methods: </strong>In a single-arm, multicenter trial, 307 adults with insulin-treated type 2 diabetes, 19-85 years old, initiated use of the twiist AID system for 13 weeks after collection of baseline continuous glucose monitoring (CGM) data. The primary outcome was change in HbA1c from baseline to 13 weeks.</p><p><strong>Results: </strong>Mean HbA1c decreased by 0.7% (95% CI -0.9 to -0.6) from 8.1% ± 1.5% at baseline to 7.4% ± 0.9% after using twiist for 13 weeks (P < 0.001 for both noninferiority and superiority). The treatment effect was greatest in participants with baseline HbA1c ≥9.0%. A substantial HbA1c reduction was observed when AID was added to prestudy use of a glucagon-like peptide 1 receptor agonist or sodium-glucose cotransporter 2 inhibitor drug, which was continued during the trial. Mean CGM-measured time-in-range 70-180 mg/dL increased from 57% ± 26% to 73% ± 17% (mean change 16% [95% CI 14-18]; P < 0.001). All other multiplicity-controlled CGM outcomes reflective of hyperglycemia showed significant improvement from baseline. The frequency of CGM-measured hypoglycemia was low at baseline and remained low during follow-up. Diabetic ketoacidosis occurred in one participant; no severe hypoglycemia events occurred. Using twiist, participant satisfaction was higher than with their prestudy insulin delivery method (P < 0.001) and sleep quality improved (P < 0.001).</p><p><strong>Conclusions: </strong>In this single-arm, 13-week trial in adults with insulin-treated type 2 diabetes, AID with the twiist system was safe and associated with substantially improved glycemia.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129543","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":"Estimating the True MACE Benefits From Tirzepatide in SURPASS-CVOT Using an Imputed Placebo Analysis of REWIND.","authors":"Naveed Sattar, Hertzel C Gerstein, David D'Alessio, Deepak L Bhatt, John B Buse, Stefano Del Prato, Steven E Kahn, A Michael Lincoff, Darren K McGuire, Michael A Nauck, Steven E Nissen, Bernard Zinman, Sophia Zoungas, Amy Bartee, Debra Miller, Hiroshi Nishiyama, Yongming Qu, Govinda Weerakkody, Russell J Wiese, Imre Pavo, Stephen J Nicholls","doi":"10.2337/dc26-0298","DOIUrl":"10.2337/dc26-0298","url":null,"abstract":"<p><strong>Objective: </strong>In prespecified analyses, the treatment effect for major adverse cardiovascular event (MACE) of tirzepatide compared with imputed placebo was estimated using SURPASS-Cardiovascular Outcomes Trial (SURPASS-CVOT) and Researching Cardiovascular Events With a Weekly Incretin in Diabetes (REWIND) trial data.</p><p><strong>Research design and methods: </strong>The indirect comparison with placebo was conducted for primary (MACE-3) and secondary outcomes of SURPASS-CVOT. The analysis included data from REWIND participants who would have been eligible for SURPASS-CVOT and all participants from SURPASS-CVOT. Propensity score estimation was used to adjust for differences in participant characteristics between studies. The indirect analysis of the treatment effect was derived by multiplying the hazard ratio (HR) for MACE-3 between tirzepatide and dulaglutide in SURPASS-CVOT by the HR for dulaglutide versus placebo in REWIND. Sensitivity analyses were performed using unadjusted analyses, including both the selected REWIND and the entire REWIND populations, and adjusted analysis in the entire REWIND population. Post hoc sensitivity analyses used data from a recent glucagon-like peptide 1 receptor agonist (GLP-1RA) meta-analysis that included REWIND.</p><p><strong>Results: </strong>Analyses included 2,055 of 9,901 participants from REWIND and all 13,165 participants from SURPASS-CVOT. In indirect treatment effect comparisons, tirzepatide versus placebo was associated with lower MACE-3 (HR 0.72; 95% CI 0.55, 0.94), death from CV cause or heart failure events (HR 0.70; 95% CI 0.51, 0.96), and all-cause death (HR 0.61; 95% CI 0.45, 0.82). Sensitivity analyses, including nonadjusted or the entire REWIND cohort data or meta-analysis data for GLP-1RAs, were generally consistent.</p><p><strong>Conclusions: </strong>In this indirect prespecified exploratory comparison, tirzepatide compared with imputed placebo was associated with reduced CV outcomes and all-cause mortality in participants with type 2 diabetes and established atherosclerotic CV disease.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"1771-1778"},"PeriodicalIF":16.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13594787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625308","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":"Diagnostic Tools to Establish the Presence of Peripheral Arterial Disease in People With Diabetes (DMPAD): A Multicenter Comparative Diagnostic Accuracy Study.","authors":"Pasha Normahani, Laura Burgess, Catriona Graham, John Norrie, David Mark Epstein, Neghal Kandiyil, Athanasios Saratzis, Francine Heatley, Sasha Smith, Kamlesh Khunti, David Wingfield, Monica Branca Morim, Trusha Coward, Tim Hartshorne, Simon Ashwell, Joseph Shalhoub, Elizabeth Pigott, Usman Jaffer, Alun H Davies","doi":"10.2337/dc25-1693","DOIUrl":"10.2337/dc25-1693","url":null,"abstract":"<p><strong>Objective: </strong>Accurate diagnosis of peripheral arterial disease (PAD) in people with diabetes is critical, but the accuracy of common bedside tests remains uncertain. This study evaluated the diagnostic accuracy of five bedside tests-ankle brachial pressure index (ABPI), exercise ABPI, toe brachial pressure index (TBPI), visual Doppler, and audible Doppler. Results were compared against the reference standard of computed tomography angiography (CTA) or magnetic resonance angiography (MRA).</p><p><strong>Research design and methods: </strong>A prospective multicenter diagnostic accuracy study was conducted across 16 sites in the U.K. Participants aged ≥18 years, with a history of diabetes (symptomatic and asymptomatic), without contraindications to CTA or MRA, PAD status known on imaging, or a known history of PAD intervention, were eligible to partake. Patients were recruited from both primary and secondary care. Radiologists, blinded to index test results, used the ANGIO scoring system, with ≥50% stenosis defining PAD. The primary outcome was test sensitivity.</p><p><strong>Results: </strong>From April 2022 to November 2023, 604 participants were enrolled; 536 completed the study with valid reference imaging. PAD was identified in 37% of participants. Sensitivity was low across all bedside tests: audible Doppler (36%, 95% CI 27-45), visual Doppler (42%, 95% CI 33-51), TBPI (55%, 95% CI 46-64), ABPI (41%, 95% CI 32-50), and exercise ABPI (41%, 95% CI 31-51).</p><p><strong>Conclusions: </strong>In people with diabetes, visual Doppler, audible Doppler, ABPI, TBPI, and exercise ABPI demonstrated poor diagnostic performance for PAD and should not be considered as accurate diagnostic tools in this population.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"1795-1802"},"PeriodicalIF":16.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13594800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623281","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":"suPAR Identifies Treatment-Resistant Inflammatory Risk Beyond hs-CRP in Type 2 Diabetes With Coronary Artery Disease: An Ancillary Analysis of BARI 2D.","authors":"Anis Ismail, Yiyuan Huang, Bahjat Ghazzal, Christina Hutten, Theresa Farhat, Ramya Elangovan, Bobby Bobby, Pennelope Kunkle, Alexi Vasbinder, Mousumi Banerjee, Arshed Quyyumi, Richard E Pratley, Maria M Brooks, Rodica Pop-Busui, Salim S Hayek","doi":"10.2337/dc26-0899","DOIUrl":"10.2337/dc26-0899","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether soluble urokinase plasminogen activator receptor (suPAR) is modified by randomized diabetes and revascularization strategies in patients with type 2 diabetes and coronary artery disease and whether combined suPAR and hs-CRP classification refines residual cardiovascular risk stratification.</p><p><strong>Research design and methods: </strong>In this ancillary analysis of Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D), we measured plasma suPAR and hs-CRP at baseline (n = 2,277) and 1 year (landmark cohort, n = 1,978). The primary outcome was all-cause death, nonfatal myocardial infarction, or nonfatal stroke. Associations were assessed using sequentially adjusted Cox models.</p><p><strong>Results: </strong>Over 1 year, suPAR was not reduced by diabetes (insulin sensitizing vs. insulin provision) or cardiac (revascularization vs. medical therapy) treatment strategies (median 2.96-3.15 ng/mL; all-treatment arm P ≥ 0.75), while hs-CRP declined substantially (median 2.07-1.30 mg/L). suPAR independently predicted the composite outcome (adjusted hazard ratio [HR] 1.40 per SD; 95% CI 1.27-1.55), unattenuated after hs-CRP adjustment. In an exploratory analysis, suPAR modified the diabetes treatment effect (P-interaction = 0.005), with insulin provision associated with worse outcomes in the highest suPAR tertile (HR 1.33; 95% CI 1.03-1.72). Baseline suPAR predicted risk in participants whose hs-CRP normalized (HR 1.45; 95% CI 1.04-2.03). Joint classification revealed a threefold gradient in event rates (7.1% to 21.6%), with elevated suPAR conferring excess risk even after hs-CRP normalization.</p><p><strong>Conclusions: </strong>Over 1 year, suPAR was unmodified by diabetes or revascularization strategies in BARI 2D despite intensive guideline-directed medical optimization, in contrast to hs-CRP, which declined substantially. Combined suPAR and hs-CRP classification produced a graded risk hierarchy that hs-CRP normalization alone did not resolve.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"1868-1876"},"PeriodicalIF":16.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13594799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714937","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":"Early Pregnancy Glycemic Testing for Prediction of Gestational Diabetes Mellitus and Large-for-Gestational-Age Birth Weight.","authors":"","doi":"10.2337/dc26-0302","DOIUrl":"10.2337/dc26-0302","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated whether early pregnancy oral glucose tolerance testing (OGTT) or continuous glucose monitoring (CGM) improves gestational diabetes mellitus (GDM) or large-for-gestational-age (LGA) birth prediction over clinical factors alone.</p><p><strong>Research design and methods: </strong>In the Glycemic Observation and Metabolic Outcomes in Mothers and Offspring (GO MOMs) study, a prospective observational study at nine U.S. sites (2021-2025), participants with singleton gestation and without preexisting diabetes underwent blinded 75-g OGTT and CGM at 10-14 weeks' gestation. Predictive models for GDM at 24-28 weeks and LGA were developed using these data and clinical factors (maternal age, BMI, GDM or macrosomia history). New glycemic criteria maximized the area under the receiver operating characteristic curve in training data from four sites and were validated in five. Models incorporating OGTT or CGM criteria versus clinical factors alone compared positive predictive value (PPV) at a prespecified negative predictive value (NPV) at a reported 8.3% national GDM prevalence and 10% for LGA.</p><p><strong>Results: </strong>Of 2,178 participants, 93.3% who were pregnant at 24-28 weeks completed OGTTs (15.4% GDM), and 98.1% with live births had data to determine LGA (11.2% LGA). At NPV ≥96% and 8.3% GDM prevalence, PPV for GDM was 12.2% (95% CI 11.0-13.3%) for clinical factors alone, 26.5% (23.1-30.3%) for OGTT plus clinical factors, and 19.8% (17.2-22.5%) for CGM plus clinical factors. For LGA, neither glycemic model improved PPV. Validation confirmed findings.</p><p><strong>Conclusions: </strong>In a U.S.-representative population, adding 10- to 14-week OGTT or CGM criteria to clinical factors improved GDM but not LGA prediction. Future studies should determine whether predicting GDM in the first trimester facilitates interventions that improve GDM-related pregnancy outcomes.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"1779-1789"},"PeriodicalIF":16.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13594796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201696","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":"Insulin Dose-Adjusted Hemoglobin A1c Has Suboptimal Performance for Identifying C-Peptide-Defined Partial Remission: The SEARCH for Diabetes in Youth Study.","authors":"Michael L Ferm, Xiaofan Huang, Charles G Minard, Daniel J DeSalvo, Amy S Shah, Catherine Pihoker, Anna C Bellatorre, Maria J Redondo","doi":"10.2337/dc26-1313","DOIUrl":"https://doi.org/10.2337/dc26-1313","url":null,"abstract":"<p><strong>Objective: </strong>Insulin dose-adjusted hemoglobin A1c (IDAA1c = HbA1c [%] + [4 × total daily dose in units/kg/day]) ≤9 is widely used to define partial remission in pediatric type 1 diabetes and as an eligibility criterion or outcome in disease-modifying therapy trials. However, it has not been validated in U.S. youth. Because higher BMI increases insulin resistance and insulin requirements, we hypothesized that IDAA1c would perform suboptimally in participants with overweight or obesity.</p><p><strong>Research design and methods: </strong>We analyzed data from 422 SEARCH for Diabetes in Youth study participants with mixed-meal tolerance test (MMTT)-stimulated C-peptide within 12 months of diagnosis. Partial remission was defined using MMTT-stimulated area under the curve (AUC) mean C-peptide. Participant characteristics were compared by BMI category (<85th percentile [normal or underweight] and ≥85th percentile [overweight or obese]) using Wilcoxon rank sum and Fisher exact tests. Sensitivity, specificity, and receiver operating characteristic (ROC) AUC of IDAA1c ≤9 for identifying partial remission were evaluated.</p><p><strong>Results: </strong>Participants with normal or underweight versus participants with overweight or obesity had lower IDAA1c (8.95 vs. 9.28, P = 0.043) despite lower stimulated C-peptide (1.25 vs. 1.88 ng/mL, P < 0.001). Overall, IDAA1c ≤9 had 61% sensitivity and 79% specificity for predicting C-peptide ≥0.91 ng/mL with an ROC AUC of 0.77. Among participants with overweight or obesity, sensitivity was 45% and specificity 81%. A Youden index-derived cutoff of IDAA1c ≤11.6 improved sensitivity to 93%, with specificity of 54% in participants with overweight or obesity.</p><p><strong>Conclusions: </strong>IDAA1c ≤9 demonstrated suboptimal accuracy as a screening test for partial remission, especially underestimating β-cell function in youth with overweight or obesity. BMI-specific cutoffs improved sensitivity but reduced specificity.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077166","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":"Increased Risk of Obstructive Sleep Apnea and Poor Sleep Quality Among Older Adults With Type 1 Diabetes: The DCCT/EDIC Study.","authors":"Catherine L Martin, Matthew Bott, William H Herman, Barbara H Braffett, Victoria R Trapani, Ionut Bebu, Harsha Karanchi, Jean M Lawrence, Jennifer Sherr, Gayle M Lorenzi, Pearl G Lee, David M Nathan, Ronald D Chervin, Rose A Gubitosi-Klug","doi":"10.2337/dc26-1678","DOIUrl":"https://doi.org/10.2337/dc26-1678","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the prevalence of sleep problems and their risk factors among older adults with type 1 diabetes.</p><p><strong>Research design and methods: </strong>Participants with type 1 diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study completed validated questionnaires to assess sleep-related problems, including risk of obstructive sleep apnea (OSA) (intermediate/high risk: STOP-Bang ≥3), poor sleep quality (Pittsburgh Sleep Quality Index >5), and mild or greater levels of excessive daytime sleepiness (Epworth Sleepiness Scale >10). Logistic regression models assessed the odds of each sleep problem by demographic and clinical variables, glycemia, and diabetes complications.</p><p><strong>Results: </strong>In 963 participants (52% male, mean [SD] age 64 [7] years) with type 1 diabetes (mean [SD] duration 43 [5] years), diagnosed OSA and current positive airway pressure device use were reported by 29% and 19% of participants, respectively. Increased OSA risk was present in 64%, poor sleep quality in 43%, and daytime sleepiness in 10% of participants. Each 1% absolute increase (11 mmol/mol) in current or mean HbA1c was associated with 15% to 20% higher odds of any sleep problem. In models adjusted for age, sex, BMI, and mean HbA1c, cardiovascular autonomic neuropathy was associated with higher odds of intermediate/high OSA risk, and albuminuria and severe hypoglycemia were associated with higher odds of poor sleep quality.</p><p><strong>Conclusions: </strong>OSA risk and poor sleep quality were common among DCCT/EDIC participants. Sleep assessments for older individuals with long-standing type 1 diabetes and research to identify mechanisms to explain the observed associations are warranted.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083459","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}