Diabetes care最新文献

{"title":"Longitudinal Determination of Diabetes Complications and Other Clinical Variables as Risk Factors for Diabetic Ketoacidosis in Type 1 Diabetes.","authors":"Priya Bapat, Dalton R Budhram, Abdulmohsen Bakhsh, Mohammad I Abuabat, Natasha J Verhoeff, Doug Mumford, Wajeeha Cheema, Cesar Falappa, Andrej Orszag, Akshay Jain, David Z I Cherney, Michael Fralick, Alanna Weisman, George Tomlinson, Leif Erik Lovblom, Bruce A Perkins","doi":"10.2337/dc24-2385","DOIUrl":"10.2337/dc24-2385","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to determine whether diabetes complications, such as kidney disease that may impair acid-base buffering capacity, independently predict the risk of subsequent diabetic ketoacidosis (DKA).</p><p><strong>Research design and methods: </strong>We accessed previously collected 34-year data from the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study through public data access. Multivariable Cox proportional hazards models with time-varying exposures and covariates were used to examine the associations of macrovascular disease and early and late stages of neuropathy, nephropathy, and retinopathy, with subsequent DKA occurrence as the outcome.</p><p><strong>Results: </strong>Of 1,441 participants, 297 experienced 488 DKA events over follow-up. Major adverse cardiovascular events [hazard ratio (HR) 3.16, 95% CI 1.57-6.35, P = 0.001] and late-stage neuropathy, which comprised serious foot ulcer or amputation (HR 1.59, 95% CI 1.04-2.45, P = 0.03) were independently associated with higher DKA risk. Higher risk was also associated with shorter diabetes duration (HR 0.76, 95% CI 0.64-0.91, P = 0.002), female sex (HR 2.04, 95% CI 1.56-2.67, P < 0.001), current insulin pump use (HR 3.04, 95% CI 2.29-4.02, P < 0.001), higher time-updated HbA1c (per additional 1%: HR 1.39, 95% CI 1.29-1.50, P < 0.001), and higher current insulin dose (per 1 additional unit/kg/day: HR 2.32, 95% CI 1.62-3.33, P < 0.001).</p><p><strong>Conclusions: </strong>A major cardiovascular event, foot ulcer, or amputation confers the greatest risk of future DKA independent of previously recognized risk factors, implying a need to target patients with these events for DKA prevention interventions, such as self-management skills for metabolic control, management of depression, and DKA education.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"614-622"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416559","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":"Value-Based Pricing and Its Implications for the Newly Announced Medicare Negotiated Price Under the Inflation Reduction Act.","authors":"Piaopiao Li, Mohammed K Ali, K M Venkat Narayan, Guillermo E Umpierrez, Vivian A Fonseca, Lizheng Shi, Hui Shao","doi":"10.2337/dc24-2403","DOIUrl":"10.2337/dc24-2403","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"e44-e46"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026241","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":"The Glycemic Impact of Protein Ingestion in People With Type 1 Diabetes.","authors":"Giang M Dao, Greg M Kowalski, Clinton R Bruce, David N O'Neal, Carmel E Smart, Dessi P Zaharieva, Declan T Hennessy, Sam Zhao, Dale J Morrison","doi":"10.2337/dci24-0096","DOIUrl":"10.2337/dci24-0096","url":null,"abstract":"<p><p>In individuals with type 1 diabetes, carbohydrate is commonly recognized as the primary macronutrient influencing postprandial glucose levels. Accumulating evidence indicates that protein ingestion also contributes to the increment in postprandial glucose levels, despite endocrine and metabolic responses different from those with carbohydrate ingestion. However, findings regarding protein ingestion's glycemic effect in people with type 1 diabetes are equivocal, with the magnitude of glycemic response seemingly dependent on the rate of absorption and composition of protein ingested. Therefore, the aim of this article is to outline the physiological mechanisms by which ingested protein influences blood glucose regulation in individuals with type 1 diabetes and provide clinical implications on use of dietary protein in the context of glycemic management. Specifically, protein ingestion raises plasma amino acid levels, which directly or indirectly (via gut hormones) stimulates glucagon secretion. Together with the increase in gluconeogenic precursors and an absent endogenous insulin response in individuals with type 1 diabetes, this provides a synergistic physiological environment for increased endogenous glucose production and subsequently increasing circulating glucose levels for several hours. While there is a dearth of well-controlled studies in this area, we provide clinical implications and directions for future research regarding the potential for using ingestion of fast-absorbing protein (such as whey protein) as a tool to prevent and mitigate overnight- and exercise-induced hypoglycemia in people with type 1 diabetes.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"509-518"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416560","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":"In-Hospital Diabetes Management by a Diabetes Team and Insulin Titration Algorithms Based on Continuous Glucose Monitoring or Point-of-Care Glucose Testing in Patients With Type 2 Diabetes (DIATEC): A Randomized Controlled Trial.","authors":"Mikkel T Olsen, Carina K Klarskov, Signe H Jensen, Louise M Rasmussen, Birgitte Lindegaard, Jonas A Andersen, Hans Gottlieb, Suzanne Lunding, Ulrik Pedersen-Bjergaard, Katrine B Hansen, Peter L Kristensen","doi":"10.2337/dc24-2222","DOIUrl":"10.2337/dc24-2222","url":null,"abstract":"<p><strong>Objective: </strong>The Diabetes Team and CGM in Managing Hospitalized Patients With Diabetes (DIATEC) trial investigates the glycemic and clinical effects of inpatient continuous glucose monitoring (CGM)-guided insulin titration by diabetes teams.</p><p><strong>Research design and methods: </strong>This two-center trial randomized 166 non-intensive care unit patients with type 2 diabetes. Diabetes management was performed by regular staff, guided by diabetes teams using insulin titration algorithms based on either point-of-care glucose testing or CGM. The primary outcome was the difference in time in range (TIR) (3.9-10.0 mmol/L) between the two arms. Outcomes were assessed during hospitalization.</p><p><strong>Results: </strong>The CGM arm achieved a higher median (interquartile range [IQR]) TIR of 77.6% (24.4%) vs. 62.7% (31.5%) in the POC arm (P < 0.001). Median (IQR) time above range (TAR) >10.0 mmol/L was lower in the CGM arm at 21.1% (24.8%) vs. 36.5% (30.3%) in the POC arm (P = 0.001), and time below range (TBR) <3.9 mmol/L was reduced by CGM, with a relative difference to POC of 0.57 (95% CI 0.34-0.97; P = 0.042). Prolonged hypoglycemic events decreased (incidence rate ratio [IRR] 0.13; 95% CI 0.04-0.46; P = 0.001), and the mean (SD) coefficient of variation was lower in the CGM arm at 25.4% (6.3%) vs. 28.0% (8.2%) in the POC arm (P = 0.024). Mean (SD) total insulin doses were reduced in the CGM arm at 24.1 (13.9) vs. 29.3 (13.9) IU/day in the POC arm (P = 0.049). A composite of complications was lower in the CGM arm (IRR 0.76; 95% CI 0.59-0.98; P = 0.032).</p><p><strong>Conclusions: </strong>In-hospital CGM increased TIR by 15 percentage points, mainly by reducing TAR. CGM also lowered TBR, glycemic variability, prolonged hypoglycemic events, insulin usage, and in-hospital complications.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"569-578"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070352","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":"Understanding the Impact of Diabetic Peripheral Neuropathy and Neuropathic Pain on Quality of Life and Mental Health in 6,960 People With Diabetes.","authors":"Mette Krabsmark Borbjerg, Anne-Marie Wegeberg, Amar Nikontovic, Carsten Dahl Mørch, Lars Arendt-Nielsen, Niels Ejskjaer, Christina Brock, Peter Vestergaard, Johan Røikjer","doi":"10.2337/dc24-2287","DOIUrl":"10.2337/dc24-2287","url":null,"abstract":"<p><strong>Objective: </strong>Diabetic peripheral neuropathy (DPN) and neuropathic pain impacts quality of life (QoL) and mental health negatively. This cross-sectional survey study aimed to 1) elucidate the associations between painful and painless DPN and QoL, mental health, and socioeconomic factors, 2) assess the prevalence of sensory pain descriptors, and 3) evaluate the association between descriptors and the above factors.</p><p><strong>Research design and methods: </strong>Participants were grouped into people with (n = 1,601) and without (n = 5,359) DPN based on the Michigan Neuropathy Screening Instrument questionnaire. Participants with DPN were subsequently divided into people with (n = 1,085) and without (n = 516) concomitant neuropathic pain based on the modified Douleur Neuropathique en 4 Questions-interview.</p><p><strong>Results: </strong>The study showed diminished QoL (36-item Short Form Health Survey [SF-36]: 55.1 [interquartile range 36.7, 73.6], 82.2 [63.6, 90.9]) and poorer mental health (Hospital Anxiety and Depression Scale, subscale for anxiety [HADS-A]: 5.00 [2, 9], 2.00 [1, 5]; HADS-subscale for depression [HADS-D]: 4.00 [1, 8], 1.00 [0, 3]) in participants with DPN compared with participants without DPN. The addition of pain diminished QoL (SF-36: 50.7 [34.8, 69.8]) and mental health (HADS-A: 6 [3, 10], HADS-D: 4 [1, 8]) further. The most prevalent pain descriptor in participants with painful DPN were burning pain (73%), while the most prevalent sensory descriptor was pins-and-needles (93%). An interesting finding is the high prevalence of itch (44%). Weak associations with mental health and QoL were present for cold pain, electric pain, and itch.</p><p><strong>Conclusions: </strong>An increased focus on differences in QoL, mental health, and pain phenotypes is of importance to move the field forward toward more interdisciplinary, personalized treatment.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"588-595"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392769","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":"Repeated OGTT Versus Continuous Glucose Monitoring for Predicting Development of Stage 3 Type 1 Diabetes: A Longitudinal Analysis.","authors":"Aster K Desouter, Bart Keymeulen, Ursule Van de Velde, Annelien Van Dalem, Bruno Lapauw, Christophe De Block, Pieter Gillard, Nicole Seret, Eric V Balti, Elena R Van Vooren, Willem Staels, Sara Van Aken, Marieke den Brinker, Sylvia Depoorter, Joke Marlier, Hasan Kahya, Frans K Gorus","doi":"10.2337/dc24-2376","DOIUrl":"10.2337/dc24-2376","url":null,"abstract":"<p><strong>Objective: </strong>Evidence for using continuous glucose monitoring (CGM) as an alternative to oral glucose tolerance tests (OGTTs) in presymptomatic type 1 diabetes is primarily cross-sectional. We used longitudinal data to compare the diagnostic performance of repeated CGM, HbA1c, and OGTT metrics to predict progression to stage 3 type 1 diabetes.</p><p><strong>Research design and methods: </strong>Thirty-four multiple autoantibody-positive first-degree relatives (FDRs) (BMI SD score [SDS] <2) were followed in a multicenter study with semiannual 5-day CGM recordings, HbA1c, and OGTT for a median of 3.5 (interquartile range [IQR] 2.0-7.5) years. Longitudinal patterns were compared based on progression status. Prediction of rapid (<3 years) and overall progression to stage 3 was assessed using receiver operating characteristic (ROC) areas under the curve (AUCs), Kaplan-Meier method, baseline Cox proportional hazards models (concordance), and extended Cox proportional hazards models with time-varying covariates in multiple record data (n = 197 OGTTs and concomitant CGM recordings), adjusted for intraindividual correlations (corrected Akaike information criterion [AICc]).</p><p><strong>Results: </strong>After a median of 40 (IQR 20-91) months, 17 of 34 FDRs (baseline median age 16.6 years) developed stage 3 type 1 diabetes. CGM metrics increased close to onset, paralleling changes in OGTT, both with substantial intra- and interindividual variability. Cross-sectionally, the best OGTT and CGM metrics similarly predicted rapid (ROC AUC = 0.86-0.92) and overall progression (concordance = 0.73-0.78). In longitudinal models, OGTT-derived AUC glucose (AICc = 71) outperformed the best CGM metric (AICc = 75) and HbA1c (AICc = 80) (all P < 0.001). HbA1c complemented repeated CGM metrics (AICc = 68), though OGTT-based multivariable models remained superior (AICc = 59).</p><p><strong>Conclusions: </strong>In longitudinal models, repeated CGM and HbA1c were nearly as effective as OGTT in predicting stage 3 type 1 diabetes and may be more convenient for long-term clinical monitoring.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"528-536"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191628","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":"An Atypical Presentation of Cytokine Release Syndrome With Signs of Arthritis During Treatment With Teplizumab in a Pediatric Patient.","authors":"Courtney J Duckworth, Raymond J Kreienkamp, Evan C Rieger, Thinh H Nguyen, Jason L Gaglia, Belinda S Lennerz","doi":"10.2337/dc24-2322","DOIUrl":"10.2337/dc24-2322","url":null,"abstract":"","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"e49-e50"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026238","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":"Arterial Stiffness Is Related to Diabetes-Associated Microvascular Complications: The SEARCH for Diabetes in Youth Study.","authors":"Ryan P Brady, Elaine M Urbina, Zhiqian Gao, Dana Dabelea, Eva Lustigova, Santica Marcovina, Amy K Mottl, Catherine Pihoker, Kristi Reynolds, LeAnne Sancrainte, Lawrence M Dolan, Amy S Shah","doi":"10.2337/dc24-2320","DOIUrl":"10.2337/dc24-2320","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relationship between arterial stiffness, an early marker of macrovascular cardiovascular disease, and microvascular complications in adolescents and young adults with youth-onset diabetes.</p><p><strong>Research design and methods: </strong>This study included 1,226 individuals (median age at initial visit 18 years; 58% female; 53% non-Hispanic White, 22% non-Hispanic Black, and 20% Hispanic) with youth-onset type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth Study. Arterial stiffness measures included pulse wave velocity for carotid femoral, carotid radial, femoral foot, and augmentation index (AIx). Microvascular complications included microalbuminuria, peripheral neuropathy, and retinopathy. Participants were followed up once at ∼5 years.</p><p><strong>Results: </strong>Cross-sectionally, in type 1 diabetes, AIx was associated with higher odds of having any one microvascular complication (odds ratio [OR] 1.35; 95% CI 1.04-1.76), microalbuminuria (OR 2.76; 95% CI 1.78-4.39), neuropathy (OR 1.63; 95% CI 1.07-2.50), and retinopathy (OR 1.37; 95% CI 1.06-1.79). In type 2 diabetes, AIx was associated with higher odds of microalbuminuria (OR 2.05; 95% CI 1.04-4.33; all P < 0.05). In longitudinal analysis, in type 1 diabetes, a change in AIx was associated with the development of any one microvascular complication (OR 1.45; 95% CI 1.15-1.82), microalbuminuria (OR 5.42; 95% CI 1.98-14.80), neuropathy (OR 2.03; 95% CI 1.22-3.40), and retinopathy (OR 1.48; 95% CI 1.15-1.90). In type 2 diabetes, a change in AIx was associated with the development of microalbuminuria (OR 21.98; 95% CI 1.30-372.88; all P < 0.05).</p><p><strong>Conclusions: </strong>Arterial stiffness is related to and predicts microvascular complications in youth-onset type 1 and type 2 diabetes.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"639-647"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416482","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":"Association Between Self-Monitored Blood Glucose and Continuous Glucose Monitoring in Youth With Type 1 Diabetes and Medicaid Insurance.","authors":"Janice Chan, Nicholas Jackson, Arianna Gonzalez Rebollar, Cynthia Santana, Giselle Perez de la Garza, Tannaz Moin, Jennifer K Yee, Estelle Everett","doi":"10.2337/dc24-2224","DOIUrl":"10.2337/dc24-2224","url":null,"abstract":"<p><strong>Objective: </strong>Youth with type 1 diabetes (T1D) and Medicaid must demonstrate they have self-monitored their blood glucose level at least four times daily to receive continuous glucose monitors (CGMs). New California Medicaid policies eliminated this requirement and, thus, CGM access has increased. This study examines whether infrequent baseline self-monitored blood glucose (SMBG) checks result in suboptimal outcomes or nonadherence with CGM use.</p><p><strong>Research design and methods: </strong>This retrospective study included youth with T1D and Medicaid who started CGM after January 2019, when newer models no longer needed calibration, at two large health care systems. Patients were stratified by data on baseline SMBG frequency (<4 vs. ≥4 checks daily) collected at the clinic visit prior to starting CGM. Differences between SMBG groups in CGM adherence and HbA1c over time were assessed by a mixed-effects linear regression model and fixed-effect interaction term. Patients were surveyed to explore individual impact of CGM on diabetes management.</p><p><strong>Results: </strong>We followed 78 youth for 6 months. CGM adherence was similar between SMBG frequency groups at 3 months (68.7% vs. 68.4%; P = 0.97) and sustained at 6 months. HbA1c values improved in both groups at 3 months, with a larger improvement in those with SMBG <4 daily checks (1.3% vs. 0.4%), and sustained at 6 months. Patient surveys (n = 35) reported high engagement with CGM and increased insulin boluses after initiation.</p><p><strong>Conclusions: </strong>Patients using CGM demonstrated improvement in HbA1c regardless of prior SMBG. Increased engagement with CGM likely promoted increased insulin boluses. Therefore, restriction of CGM to those with SMBG ≥4 daily checks is an unnecessary barrier, excluding those who could potentially benefit the most.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"632-638"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416554","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":"Sex-Specific Blood Pressure Trajectories and Cardiovascular Disease in Type 1 Diabetes: 32-Year Follow-up of the Pittsburgh Epidemiology of Diabetes Complications Cohort.","authors":"Rachel G Miller, Trevor J Orchard, Tina Costacou","doi":"10.2337/dc24-2258","DOIUrl":"10.2337/dc24-2258","url":null,"abstract":"<p><strong>Objective: </strong>We examined sex differences in longitudinal blood pressure (BP) and 32-year cardiovascular disease (CVD) incidence in the Pittsburgh Epidemiology of Diabetes Complications type 1 diabetes cohort.</p><p><strong>Research design and methods: </strong>BP was measured up to nine (median six) times between 1986-1988 baseline and 2016-2018; n = 300 women and 304 men without CVD at baseline were followed until December 2020 for incidence of total CVD, major adverse cardiovascular events (MACE) (CVD death, myocardial infarction [MI], or stroke), and hard coronary artery disease (hCAD) (CAD death, MI, or coronary revascularization/blockage ≥ 50%). We estimated associations between time to event and longitudinal systolic BP (SBP) and diastolic BP (DBP) by sex using joint models adjusted for time-varying longitudinal antihypertensive (AH) medication use, HbA1c, and overt nephropathy, baseline age, and other CVD risk factors.</p><p><strong>Results: </strong>Longitudinal SBP was 5.8 mmHg lower (P < 0.0001) and DBP 6.2 mmHg lower (P < 0.0001) in women versus men. Women had -0.3 mmHg/year faster DBP decline (P < 0.0001) despite similar AH rates by sex. Incidence of CVD was similar by sex. Each 5-mmHg increment in longitudinal SBP (hazard ratio [HR] = 1.23; 95% CI 1.04, 1.45) and DBP (HR = 1.56; 95% CI 1.20, 2.04) was associated with MACE in men only; DBP (HR = 1.28; 95% CI 1.05, 1.56) was associated with hCAD in women only.</p><p><strong>Conclusions: </strong>BP was lower in women than men, and the strength of its association with the initial manifestation of CVD differed by sex. Further research into sex-specific BP mechanisms is needed to improve CVD risk reduction in people living with type 1 diabetes.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"605-613"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392768","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}