Diabetes care最新文献

{"title":"Insulin Hypersecretion and Increased Ectopic Fat in South Asian American Adolescents and Young Adults Compared With White and African American Peers: The CHARISMA Study.","authors":"Talia A Hitt, Andrea Kelly, Darko Stefanovski, Babette S Zemel, Robert McCarter, Lisa Yanek, Ghazal Zandieh, Ipek Özdemir, Ihab R Kamel, Steve C N Hui, Peter Barker, Sheela N Magge","doi":"10.2337/dc25-2976","DOIUrl":"https://doi.org/10.2337/dc25-2976","url":null,"abstract":"<p><strong>Objective: </strong>South Asian individuals are at elevated diabetes risk attributed to insulin resistance, insulin deficiency, and ectopic fat. The CHARISMA study compared metabolic mechanisms in South Asian, White, and African American adolescents and young adults (AYAs) to investigate early diabetes risk in South Asian individuals.</p><p><strong>Research design and methods: </strong>AYAs aged 12-21 years with a BMI ≥23 kg/m2 or ≥80 percentile underwent MRI/MRS to quantify fat; OGTT with minimal modeling to calculate insulin sensitivity (Si), AUC insulin secretory rate (ISR), and disposition index (DI); DXA; and glucose-potentiated arginine stimulation test.</p><p><strong>Results: </strong>South Asian AYAs (n = 53, median [interquartile range] age 20.3 [18.9, 21.4] years) compared with White (n = 53, 19.1 [17.6, 20.8] years) and African American (n = 49, 18.8 [17.7, 20.5] years) AYAs (P = 0.02) of similar sex, pubertal stage, and BMI-Z had higher visceral fat on MRI (P < 0.001 vs. White; P = 0.009 vs. African American) and liver fat on MRS (P < 0.001 vs. both). South Asian AYAs had lower Si (P = 0.006) and higher dynamic AUC-ISR (P = 0.003) vs. White AYAs, higher total and static AUC-ISR vs. both White and African American AYAs (P < 0.001), and lower dynamic DI vs. African American AYAs (P = 0.039). South Asian AYAs had lower insulin clearance than White (P = 0.027) and African American (P = 0.007) AYAs. First-pass hepatic insulin extraction was lower in African American than South Asian (P < 0.0001) and White (P = 0.027) AYAs. Group differences in Si, dynamic AUC-ISR, and dynamic DI lost significance when visceral or liver fat was added to models, but higher total and static AUC-ISR in South Asian AYAs persisted.</p><p><strong>Conclusions: </strong>Compared with White and African American AYAs, South Asian AYAs have higher visceral and liver fat. These findings, along with lower Si and dynamic DI, suggest elevated metabolic risk in South Asian individuals, even at young ages. Higher total and static phase insulin secretion in South Asian AYAs may precede insulin deficiency, reported in adults.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730893","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":"Integrating Alcohol Use Into MASLD Care: A Practical Guide for Diabetes and Obesity Care Teams.","authors":"Anastasia-Stefania Alexopoulos, Kenneth Cusi","doi":"10.2337/dci26-0019","DOIUrl":"https://doi.org/10.2337/dci26-0019","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) affects the majority of individuals with diabetes and severe obesity, and is one of the most common indications for liver transplantation in the U.S. Emerging evidence underscores the synergistic and detrimental impact of alcohol and metabolic disease on liver and overall health. In 2023, the nomenclature for steatotic liver disease was revised to include a new subcategory known as MetALD (metabolic dysfunction- and alcohol-associated liver disease), which acknowledges alcohol use as a cofactor in liver injury alongside metabolic risk factors. This review offers key insights into the role of alcohol use as both a direct hepatotoxin and an indirect contributor to insulin resistance, dyslipidemia, and obesity. Notably, even light-to-moderate alcohol intake may hasten MASLD progression to cirrhosis and hepatocellular carcinoma, especially in individuals with existing metabolic disease, and can worsen cardiovascular disease risk. MetALD is associated with increased all-cause, cancer-related, and liver-related mortality in comparison with MASLD, reinforcing the importance of accurate alcohol assessment in managing diabetes and obesity. Diagnosis now requires stratifying alcohol use and integrating tools such as the Alcohol Use Disorders Identification Test (AUDIT) questionnaire and phosphatidylethanol testing. The caveats and use of these tools in clinical practice are discussed. Management strategies for MASLD focus on lifestyle changes, weight loss, and medications such as glucagon-like peptide 1 receptor agonists, with emerging evidence suggesting that these agents may also reduce alcohol consumption. However, treatment data on MetALD are limited. This review offers practical guidance for health care professionals on how to integrate alcohol use into existing, recommended MASLD care pathways.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730930","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 and Vitiligo.","authors":"Jinghe Li, Xinyi Shao, Yi Ou, Zhaofu Tan, Tingqiao Chen, Genlong Bai, Jin Chen, Jun Shirakawa, Jingbo Zhang","doi":"10.2337/dc26-0488","DOIUrl":"https://doi.org/10.2337/dc26-0488","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719187","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":"Glycemic Outcomes of Endocrinology Consultation for Type 2 Diabetes by Visit Modality: A Retrospective Cohort Study.","authors":"Margaret Zupa, Jolie Wormwood, Shirley Qian, Varsha Vimalananda","doi":"10.2337/dc25-1134","DOIUrl":"10.2337/dc25-1134","url":null,"abstract":"<p><strong>Objective: </strong>This study examined the association of consult modality (i.e., electronic consultation [e-consult], synchronous telemedicine, or in person) with 6-month HbA1c improvement to <8% (64 mmol/mol) among adults with uncontrolled type 2 diabetes. The impact of factors that affect diabetes management complexity on this association was also explored.</p><p><strong>Research design and methods: </strong>This retrospective cohort study included adults with type 2 diabetes and HbA1c ≥ 8% seen for initial outpatient endocrinology consultation from 31 January 2021 to 1 April 2023 within the Veterans Health Administration. We used mixed-effects logistic regression to assess the association of consultation modality with 6-month HbA1c < 8%, adjusted for relevant patient-level variables.</p><p><strong>Results: </strong>In total, 21,847 patients were included: 93.1% were men; mean age was 64 years; 54.7% were White; 5,180 received e-consults; 4,377 participated in synchronous telemedicine; and 12,290 had in-person visits. Almost half (49.5%) achieved 6-month HbA1c <8%. Compared with in-person care, patients who received e-consults (adjusted odds ratio [aOR] 0.77; 95% CI 0.71-0.83) and synchronous telemedicine (aOR 0.86; 95% CI 0.80-0.93) were less likely to have 6-month HbA1c < 8%. In sensitivity analysis, audio-only telemedicine was associated with lower odds of 6-month HbA1c < 8% (aOR 0.78; 95% CI 0.71-0.86), whereas video-based telemedicine was not (aOR 0.98; 95% CI 0.88-1.09). There were no significant differences in the associations of patient-level characteristics with glycemic outcomes across care modalities.</p><p><strong>Conclusions: </strong>e-Consult and audio-only telemedicine for initial endocrinology consultations were associated with inferior 6-month glycemic outcomes compared with in-person care among adults with uncontrolled type 2 diabetes, and video telemedicine had similar glycemic outcomes. e-Consult and audio-only telemedicine care protocols may need to incorporate additional support for patients to achieve glycemic outcomes equivalent to in-person consultation.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701349","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":"Waist-to-Height Ratio Is Associated With the Risk of Coronary Artery Disease in Type 1 Diabetes: A 19-Year Cohort Study.","authors":"Erika Bezerra Parente, Fanny Jansson Sigfrids, Per-Henrik Groop, Lena M Thorn, Niina Sandholm, Valma Harjutsalo","doi":"10.2337/dc25-2811","DOIUrl":"https://doi.org/10.2337/dc25-2811","url":null,"abstract":"<p><p>Obesity, kidney disease, and coronary artery disease (CAD) are interconnected. Here, the relationship between central obesity and CAD across albuminuria categories in type 1 diabetes was investigated. Data on 4,349 individuals without prior CAD from the Finnish Diabetic Nephropathy Study were analyzed. Central obesity was defined as waist-to-height ratio (WHtR) ≥0.5. Outcomes included acute myocardial infarction, coronary revascularizations, and CAD-related death. Associations were assessed with Cox regression adjusted for baseline covariates. Over a median 19-year follow-up, 664 CAD events (15.3%) occurred. The 10- and 20-year cumulative CAD incidences were 11.6% and 25.3%, respectively, in those with central obesity versus 4.4% and 9.9% without, respectively. In multivariable analysis, the hazard ratio for CAD per 0.1-unit WHtR increase was 1.21 (95% CI, 1.06-1.38); P = 0.006) overall and 1.26 (95% CI, 1.02-1.56; P = 0.03) among those without albuminuria. In conclusion, WHtR is associated with increased CAD risk in type 1 diabetes, particularly among those without albuminuria.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694218","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":"Bivalent RSV Prefusion F Protein-Based Vaccine Effectiveness in Individuals With and Without Diabetes: A Prespecified Analysis of the DAN-RSV Trial.","authors":"Manan Pareek, Mats C Højbjerg Lassen, Niklas Dyrby Johansen, Sine H Christensen, Negar Aliabadi, Kristoffer G Skaarup, Daniel Modin, Brian L Claggett, Maj Beldring Henningsen, Carsten S Larsen, Lykke Larsen, Lothar Wiese, Michael Dalager-Pedersen, Matias G Lindholm, Anne Marie R Jensen, Maria Dons, Katrine F Bernholm, Filip S Davidovski, Lisa S Duus, Camilla I Ottosen, Anne B Nielsen, Julie H Borchsenius, Caroline Espersen, Güldas Köse, Frederik H Fussing, Lars Køber, Scott D Solomon, Jens Ulrik Stæhr Jensen, Cyril Jean-Marie Martel, Bradford D Gessner, Claudia Schwarz, Mette Skovdal, Pingping Zhang, Elizabeth Begier, Tor Biering-Sørensen","doi":"10.2337/dca26-0020","DOIUrl":"https://doi.org/10.2337/dca26-0020","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694278","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 Potential of GIP in Type 2 Diabetes and Obesity.","authors":"Michael Nauck, Fiona Gribble, Frank Reimann, David A D'Alessio, Jonathan E Campbell","doi":"10.2337/dci25-0141","DOIUrl":"https://doi.org/10.2337/dci25-0141","url":null,"abstract":"<p><p>Incretin-based pharmacology has revolutionized the medical treatment of type 2 diabetes and obesity. The most effective drug to date is tirzepatide, a dual incretin receptor agonist that engages both the glucagon-like peptide-1 receptor (GLP-1R) and the glucose-dependent insulinotropic polypeptide receptor (GIPR). While the relative contributions of GIPR and GLP-1R actions to the clinical effects of tirzepatide have not been established, the potency of this agent has reignited interest in the clinical potential of GIPR agonism. Here, we discuss incretin biology as it relates to metabolic pharmacology and contextualize the mechanisms by which GIPR activity could contribute to the development of new and effective drugs. We explore current and future applications of GIPR agonists and antagonists, to underscore the potential that this signaling system could add to treatment of type 2 diabetes and obesity.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679651","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":"Nonmedical Factors That Influence Diabetes Complications and Multilevel Strategies to Reduce Disparities and Improve Outcomes in the U.S.","authors":"Emily Rose N San Diego, Benjamin Aceves, Linda C Gallo, Jessica L McCurley, Athena Philis-Tsimikas","doi":"10.2337/dci25-0091","DOIUrl":"https://doi.org/10.2337/dci25-0091","url":null,"abstract":"<p><p></p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679601","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":"Hepatic Events Prevention by Antihyperglycemic Therapies and Intervention Comparisons in Type 2 Diabetes: The HEPATIC-T2DM Network Meta-analysis.","authors":"Pedro Robson Costa Passos, Rodrigo Motta, Valbert Oliveira Costa Filho, Mariana Macambira Noronha, Roberto Cavalcante Venâncio, Guilherme Grossi Lopes Cançado, Amanda Adler, Jeremy F Cobbold, Jeremy W Tomlinson","doi":"10.2337/dc26-0336","DOIUrl":"https://doi.org/10.2337/dc26-0336","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) amplifies liver disease burden, yet the comparative hepatic effects of antidiabetic drugs remain poorly defined.</p><p><strong>Purpose: </strong>To compare associations between antidiabetic drug classes and major adverse liver outcomes (MALOs) in adults with T2DM.</p><p><strong>Data sources: </strong>PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched from December 1946 through 23 August 2025.</p><p><strong>Study selection: </strong>Studies enrolling adults with T2DM that evaluated associations between antidiabetic drug classes with regard to MALOs were included.</p><p><strong>Data extraction: </strong>Data were extracted on study characteristics, drug exposures, and MALOs.</p><p><strong>Data synthesis: </strong>A three-level Bayesian network meta-analysis with study- and database-level random effects was performed. Outcomes are reported as hazard ratios (HRs) and ranked using the surface under the cumulative ranking curve. Forty-six observational studies (N = 7,124,845) were included. Thiazolidinediones were least associated with hepatocellular carcinoma incidence and significantly lower than DPP-4 inhibitors (HR 0.50), GLP-1RAs (HR 0.72), insulin (HR 0.20), and sulfonylureas (HR 0.69). For decompensation (composite), GLP-1RAs were associated with the lowest hazard compared with all other classes (HRs 0.16-0.91; all significant). SGLT2 inhibitors were least associated with cirrhosis (HR 0.66 vs. DPP-4 inhibitors; HR 0.66 vs. GLP-1RAs). GLP-1RAs were least associated with variceal bleeding and hepatic encephalopathy, whereas SGLT2 inhibitors were least associated with liver-related mortality.</p><p><strong>Limitations: </strong>All included studies were observational, precluding causal inference.</p><p><strong>Conclusions: </strong>Liver-specific risk reduction is not uniform across antihyperglycemic drug classes. Randomized trials are needed to determine whether these associations reflect true drug effects.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679617","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":"Addressing Health-Related Social Needs in Diabetes Care: Increasing Our Stride Toward Health Equity?","authors":"Matthew J O'Brien, Taynara Formagini","doi":"10.2337/dci25-0090","DOIUrl":"https://doi.org/10.2337/dci25-0090","url":null,"abstract":"<p><p>Diabetes-related disparities among U.S. racial and ethnic minority groups persist, despite decades of research on their causes and interventions in an attempt to reduce them. Research demonstrates a strong relationship between diabetes disparities and social determinants of health, the conditions where people are born, live, work, play, worship, and age. While these upstream factors strongly shape health outcomes, they are largely influenced by policy and community-level interventions with limited influence by clinicians or health systems. By contrast, health-related social needs (HRSN) are downstream consequences of adverse social and structural conditions that directly affect individuals and families. These immediate, actionable needs, such as food, housing, and transportation, can be addressed within health care settings. HRSN disproportionately affect racial and ethnic minority communities, with higher prevalence of diabetes, worse outcomes, and greater acute care use. These observations highlight the importance of addressing HRSN in diabetes care given the potential to improve outcomes and achieve diabetes equity. This narrative review summarizes current evidence on identifying and addressing HRSN in health care settings. Recently, significant progress has been made integrating medical and social care for adults with diabetes and HRSN. Specific examples of these efforts with reporting of diabetes outcomes are reviewed here. However, existing research has not yet demonstrated that HRSN interventions consistently reduce diabetes disparities. Additional infrastructure is needed to scale and sustain interventions, enhancing their feasibility, effectiveness, and long-term impact. We conclude with recommendations for research and practice to optimize social care integration for adults with diabetes and achieve diabetes equity.</p><p><p></p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679644","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}