Diabetes care最新文献

{"title":"Serial Dried Blood Spot C-Peptide Sampling, but Not Urine C-Peptide-to-Creatinine Ratio, Detects Early Preservation of β-Cell Function in New-Onset Type 1 Diabetes: Experience From the USTEKID Trial.","authors":"Gareth J Dunseath, Wai-Yee Cheung, Stephen D Luzio, Kym Carter, Danijela Tatovic, Peter N Taylor, John W Gregory, Colin M Dayan","doi":"10.2337/dc25-2896","DOIUrl":"10.2337/dc25-2896","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether less invasive C-peptide tests, urine C-peptide-to-creatinine ratio (UCPCR) and dried blood spot (DBS), could replace the mixed-meal tolerance test (MMTT) in the context of an interventional clinical trial (Ustekinumab in Adolescents With Recent-Onset Type 1 Diabetes [USTEKID]).</p><p><strong>Research design and methods: </strong>C-peptide was assessed at screening and weeks 28 and 52 using a 2-h MMTT. UCPCR samples were taken after each MMTT. Fasting and 60-min postmeal DBS samples were collected weekly to week 28 and then monthly to week 52. UCPCR and glucose-adjusted DBS results were compared with MMTT results. Weekly DBS averages were calculated and differences between treatment groups assessed using a mixed linear model, bootstrap one-sample t tests, and autoregressive integrated moving averages. Six months of weekly DBS data were used to predict 12-month C-peptide levels.</p><p><strong>Results: </strong>Unlike MMTT C-peptide, UCPCR did not change in the first 6 months, before decreasing by 12 months. The DBS area under the curve from 0 to 60 min declined steadily over 12 months. The DBS C-peptide decline in the intervention group was significantly less than that in the control group by week 20 (P < 0.05). This was not apparent with UCPCR and did not become evident until 52 weeks with MMTT. The slope from 6 months of DBS could predict 12-month MMTT C-peptide in the control but not in the intervention group, consistent with the increasing impact of the intervention from 6 to 12 months indicated by the MMTT data.</p><p><strong>Conclusions: </strong>Frequently sampled glucose-adjusted DBS was more sensitive to early change than MMTT and could serve as a home-based marker of β-cell function, whereas UCPCR was not sensitive to change in the early period.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"1213-1220"},"PeriodicalIF":16.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936648","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":"Response to Comment on Wagner et al. Beyond Glucose-Rethinking Prediabetes for Precision Prevention.","authors":"Robert Wagner, Elizabeth Selvin, Martin Heni","doi":"10.2337/dci26-0052","DOIUrl":"10.2337/dci26-0052","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":"49 7","pages":"e125-e126"},"PeriodicalIF":16.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304496","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":"Comment on Huttasch et al. Increased Early Postprandial Glucagon Concentrations in Humans With Newly Diagnosed Type 2 Diabetes and Steatotic Liver Disease.","authors":"Yu-Tian Cao, Xi-Qiao Zhou","doi":"10.2337/dc26-0850","DOIUrl":"10.2337/dc26-0850","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":"49 7","pages":"e127-e128"},"PeriodicalIF":16.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304459","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":"Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes (PRISM): A Randomized Controlled Trial in Chinese Patients With Young-Onset Diabetes.","authors":"Andrea O Y Luk, Chun Kwan O, Baoqi Fan, Eric S H Lau, Yingnan Fan, Cadmon Lim, Juliana N M Lui, Kelly T C Wong, Sandra T F Tsoi, Emily W M Poon, Wai Yin Lai, Raymond Wan, Samuel Y S Wong, Maggie Haitan Wang, Eric K P Lee, Jane P Y Ho, Elaine Cheung, Elaine Chow, Risa Ozaki, Alice P S Kong, Ronald C W Ma, Juliana C N Chan","doi":"10.2337/dc26-0114","DOIUrl":"10.2337/dc26-0114","url":null,"abstract":"<p><strong>Objective: </strong>Young-onset type 2 diabetes (YOD) results from complex causes, calling for precision management.</p><p><strong>Research design and methods: </strong>The Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes (PRISM) study was a single-center, two-arm, 3-year randomized controlled trial in which Chinese individuals aged 18 to 50 years with non-type 1 diabetes diagnosed at age ≤40 years were randomly assigned to intervention (Joint Asia Diabetes Evaluation [JADE]-PRISM) or usual clinic-based care (JADE only). The intervention included technologically guided assessment and use of biogenetic markers (autoantibodies, C-peptide, and common and rare genetic variants) to classify diabetes for 1-year intensified, algorithm-based treatment followed by two annual reviews by an endocrinologist-led multidisciplinary team. The primary end point was a composite of incident or progression of all diabetes-related complications. Secondary end points included attainment of three or more treatment targets (HbA1c <6.2%, blood pressure <120/75 mmHg, LDL cholesterol <1.2 mmol/L, triglycerides <1.2 mmol/L, and waist circumference <80 [women] or <85 cm [men]), proxies of β-cell function, and patient-reported outcome measures (PROMs).</p><p><strong>Results: </strong>During 2020 to 2021, 884 participants (mean [SD] age 40.7 [6.5] years; mean [SD] age at diagnosis 32.5 [6.8] years; autoantibody positivity [n = 46]; monogenic diabetes [n = 23]; C-peptide <200 pmol/L [n = 82]; central obesity [n = 699]; dyslipidemia [n = 669]; hypertension [n = 588]; albuminuria [n = 313]; insulin treated [n = 250]) were randomly assigned to the JADE-PRISM (n = 441) or JADE-only group (n = 443). During the 3-year study, the primary end point developed in 116 participants (26.3%) in the JADE-PRISM group versus 125 (28.2%) in the JADE-only group (odds ratio 0.908 [95% CI 0.675-1.221]). In the JADE-PRISM group, 104 participants (23.8%) versus 54 in the JADE-only group (12.2%; P < 0.001) reached three or more treatment targets, with improved proxies of β-cell function and reduced emotional distress.</p><p><strong>Conclusions: </strong>A 3-year technology-enhanced, multicomponent program improved cardiometabolic status, proxies of β-cell function, and PROMs in individuals with YOD but did not reduce complications.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"1202-1212"},"PeriodicalIF":16.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936618","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":"Reduced Prevalence of Impaired Awareness of Hypoglycemia Over Two Decades in Population-Based Samples of Youth With Type 1 Diabetes.","authors":"Peter W J Delaney, Eadaoin Hayes, Remya Rajan, Grant J Smith, Elizabeth A Davis, Timothy W Jones, Mary B Abraham","doi":"10.2337/dc26-0044","DOIUrl":"10.2337/dc26-0044","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the change in prevalence of impaired awareness of hypoglycemia (IAH) and severe hypoglycemia (SH) across three cohorts (2002, 2015, and 2024) in youth with type 1 diabetes.</p><p><strong>Research design and methods: </strong>Youth (12-18 years old) completed a Modified Clarke questionnaire to assess IAH. Prevalence of IAH and recent SH was compared across cohorts. Continuous glucose monitoring (CGM)-derived metrics were compared between those with and without IAH in 2024.</p><p><strong>Results: </strong>IAH prevalence was 15.9% compared with 33.1% in 2002 (P < 0.001) and 21.4% in 2015 (P = 0.051). The 2024 SH rate was 0.92 per 100 patient-years, 3.5-fold lower (95% CI 1.2, 12.5) than in 2015 and 30-fold lower (12.7, 98.9) than in 2002 despite HbA1c reduction across cohorts (P < 0.001). Hypoglycemia exposure did not differ between IAH and non-IAH when analyzing CGM metrics (P > 0.05).</p><p><strong>Conclusions: </strong>IAH and SH have declined substantially over two decades, reflecting improved diabetes care. However, ongoing IAH signifies the need for routine screening.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"1280-1284"},"PeriodicalIF":16.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950525","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":"Automated Insulin Delivery: Great Strides in the Past, Great Needs for the Future.","authors":"Rachel Seese, Charlotte Katie Boughton, Roman Hovorka","doi":"10.2337/dci26-0051","DOIUrl":"https://doi.org/10.2337/dci26-0051","url":null,"abstract":"<p><p>Advances in diabetes technologies are transforming the management of type 1 diabetes. In this review, we reflect on the successful translation from bench to bedside of hybrid automated insulin delivery (AID) systems, including development of the core components as well as commercialization, and then we focus on progress toward next-generation fully automated systems. With the availability of greater choice, we review the factors that influence users and health care professionals when selecting an AID system while recognizing the challenges of comparing AID systems. We discuss the importance of the diabetes technology ecosystem in ensuring equity of access and effective implementation. We contrast the different potential approaches to fully automated systems that could reduce burden, including the use of ultrarapid insulins, adjunctive therapies, integration of signals from additional wearables, and dual-hormone systems. Finally, we review emerging evidence for the use of AID in more vulnerable people with type 1 diabetes, in adults with type 2 diabetes, in people with cystic fibrosis-related diabetes, and in the inpatient setting.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310819","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":"Exercise-Induced Immune Modulation in Type 1 Diabetes: From Mechanisms to Clinical Perspectives.","authors":"Daniel A Cook, David Perna-Barrull, Marta Murillo, Marta Vives-Pi","doi":"10.2337/dci26-0044","DOIUrl":"https://doi.org/10.2337/dci26-0044","url":null,"abstract":"<p><p>Type 1 diabetes is a chronic autoimmune disease driven by immune-mediated destruction of pancreatic β-cells. While technological advances in insulin delivery and glucose monitoring have improved glycemic management, they do not address the underlying autoimmune process. Identifying low-risk adjunct strategies that can modulate immune dysfunction therefore remains a clinical and translational priority. Physical exercise is a cornerstone of type 1 diabetes management for its metabolic benefits, yet its potential role as an immunomodulatory intervention has received comparatively little attention. This review critically examines current evidence on exercise-induced immune modulation in type 1 diabetes. We first summarize the effects of exercise on innate and adaptive immunity, including changes in immune-cell phenotypes, cytokine and chemokine profiles, and muscle-derived mediators. We then synthesize preclinical data from rodent models and human β-cell systems showing that exercise reduces islet inflammation, limits immune-cell infiltration, protects β-cells from cytokine-induced injury, and induces anti-inflammatory exerkines such as meteorin-like protein and irisin. Finally, we review available clinical evidence in individuals with type 1 diabetes, including observational and interventional studies linking higher levels of physical activity to longer partial remission, reduced progression of islet autoimmunity, and anti-inflammatory immune signatures. Overall, although direct clinical evidence remains limited, converging preclinical and early human data support a biologically plausible immunoregulatory role for exercise in type 1 diabetes. We discuss therapeutic perspectives where structured exercise may act as a low-risk cotherapy, particularly early after diagnosis or in combination with emerging immunotherapies, and highlight key priorities for future clinical trials.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240837","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":"Pathophysiology and Treatment of Type 1 Diabetes in Older Adults.","authors":"Alessandra Petrelli, Nicholas J Thomas, Suzy V Hope, Loredana Bucciarelli, Paolo Fiorina","doi":"10.2337/dci25-0143","DOIUrl":"https://doi.org/10.2337/dci25-0143","url":null,"abstract":"<p><p>This article highlights how age and type 1 diabetes interact to shape clinical onset and treatment, emphasizing the need for tailored strategies in classifying and managing type 1 diabetes across the lifespan, particularly in later life. This article represents an expert perspective based on selected literature. In considering type 1 diabetes in adults, distinction is needed between incident cases, where biological age influences underlying pathophysiology, and prevalent cases, capturing both adult-onset type 1 diabetes and long-standing childhood-onset type 1 diabetes in individuals reaching older age. Type 1 diabetes diagnosed after age 30 years presents diagnostic and management challenges. Diagnosis remains difficult due to high prevalence of type 2 diabetes and frequent misclassification. When adult-onset type 1 diabetes is rigorously defined, key clinical features, including progression from dysglycemia and early β-cell decline, more resemble those in younger individuals. Differences across ages are best interpreted as an age-related phenotype arising from the biological context in which autoimmunity occurs, immune remodeling, insulin resistance, and pancreatic changes, rather than distinct pathogenic mechanisms. While incidence of adult-onset type 1 diabetes is largely static, prevalence is increasing, especially among those ages ≥65 years, largely due to improved outcomes with declining mortality and disability-adjusted life-years. While type 1 diabetes management should not intrinsically alter with age, older adults face elevated risks of comorbidities, including frailty and cognitive and visual impairment, which can complicate management and impact glucose levels, particularly hypoglycemia risk; individualized glycemic targets are needed with a focus on safety and quality of life. Moving forward integrating adults into pre-type 1 diabetes screening and prevention efforts will be essential to refine prediction, reduce misclassification, and guide disease-modifying interventions.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159741","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":"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":"1095-1099"},"PeriodicalIF":16.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13191379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694218","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":"Dose-Response Associations of Intermittent Lifestyle Physical Activity Micropatterns and Incident Type 2 Diabetes.","authors":"Kar Hau Chong, Matthew N Ahmadi, Raaj K Biswas, Monique E Francois, Nicholas A Koemel, Angelo Sabag, Martin J Gibala, Shelley E Keating, Jonathan Little, Cecilie Thøgersen-Ntoumani, Emmanuel Stamatakis","doi":"10.2337/dc25-3018","DOIUrl":"10.2337/dc25-3018","url":null,"abstract":"<p><strong>Objective: </strong>To examine dose-response associations of vigorous intermittent lifestyle physical activity (VILPA; bouts ≤1 min) and its moderate- to vigorous-intensity equivalent (MV-ILPA; bouts ≤3 min) with incident type 2 diabetes.</p><p><strong>Research design and methods: </strong>Prospective data from UK Biobank accelerometry substudy participants who reported no leisure-time exercise and had no type 2 diabetes at baseline were analyzed. Daily duration and frequency of VILPA and MV-ILPA were derived from wrist-worn accelerometers. Incident type 2 diabetes was ascertained through linked primary care, hospital, and death records. Dose-response associations were examined using multivariable-adjusted Fine-Gray subdistribution hazard models accounting for competing risks.</p><p><strong>Results: </strong>Among 22,706 participants (mean age 62.3 years; 56.4% female), 665 developed type 2 diabetes over an average follow-up of 7.9 years. Daily durations of VILPA and MV-ILPA showed inverse, nonlinear L-shaped associations with incident type 2 diabetes. Median durations of 3.9 min/day of VILPA and 25.3 min/day of MV-ILPA were associated with 36% and 46% lower risks of type 2 diabetes, respectively, compared with no VILPA or 3.9 min/day of MV-ILPA. Daily VILPA frequency showed a near-linear inverse association, with 10.4 bouts/day (median) corresponding to a hazard ratio (HR) of 0.64 (95% CI 0.51-0.81) compared with 0 bouts/day. Daily MV-ILPA frequency showed a U-shaped pattern, with risk reductions plateauing at approximately 56 bouts/day (HR 0.54; 95% CI 0.39-0.76).</p><p><strong>Conclusions: </strong>Among adults who do not engage in leisure-time exercise, accruing brief, intermittent bouts of moderate- to vigorous-intensity physical activity during day-to-day routines may be a promising strategy for prevention of type 2 diabetes.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"1086-1094"},"PeriodicalIF":16.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792943","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}