Current Diabetes Reports最新文献

Purpose of review: To synthesize the components of diabetes prevention programs (DPPs) after gestational diabetes mellitus (GDM) and how they relate to factors that influence implementation. We conducted a scoping review of the literature using MEDLINE, Embase, PsychINFO, and Emcare. We provided a narrative description of intervention components based on the Template for Intervention Description and Replication (TIDieR) and the study results based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Recent findings: Seventeen included studies described DPPs after GDM. Recruitment typically began during pregnancy, while interventions started postpartum, with higher reach and participation rates for studies that recruited during pregnancy. The included DPPs used face-to-face delivery, virtual delivery, or a combination. Many programs were individual, but a few had a group component. Program duration varied from one month to three years. The available data highlighted the need to increase engagement, particularly for minority groups, and utilize flexibility and tailoring of program components and delivery to optimize retention, impact and sustainability. Significant barriers to the successful implementation of DPPs after GDM exist; the reporting of intervention components and implementation outcomes in the existing studies is variable. Validated frameworks, including RE-AIM, should be integrated into intervention development, implementation and evaluation.

Purpose of review: Summarize recent literature on: understanding of and emotional reactions to type 1 diabetes (T1D) risk; willingness to be screened; behavioral responses to T1D-risk screening results; and provider attitudes/concerns about general population screening.

Recent findings: Difficulty understanding what it means to be at increased risk for T1D is common; anxiety about increased risk may occur, particularly in multiple islet autoantibody positive (IA+) individuals. Many are hesitant to be screened or to be medically monitored if at increased risk. Those at risk may engage in behaviors to try to prevent T1D. Providers are often cautious about general population screening, with concerns about associated anxiety paramount. Understanding the psychosocial implications of T1D-risk screening is critical to its success. Interventions are needed to improve understanding of the purpose, procedures and consequences of screening, what it means to be at risk, and ways to cope with associated anxiety. The psychosocial impact of a Stage 1 or Stage 2 T1D diagnosis needs clarification and the availability of drugs to delay disease onset is likely to have a significant impact on the decision to be screened and monitored if at-risk for T1D. The impact of screening on children as well as their role in screening/medical monitoring decision-making needs to be addressed.

Purpose of review: Obesity is a chronic illness highly comorbid with mental health conditions, particularly depression. Among the factors involved in this association, inflammation is a consistently identified link. This review explores the emerging role of the gut microbiota as a modulator of inflammation and its potential involvement in the pathophysiological processes linking obesity and depression.

Recent findings: Chronic low-grade inflammation is observed in both obesity and depressive disorders. Alterations in gut microbiota are increasingly implicated in inflammatory mechanisms, including increased intestinal permeability, immune activation, and short-chain fatty acid (SCFA) production, influencing leukocyte function and cytokine production. Additionally, both obesity and depression are associated with altered microbial composition. The gut microbiome contributes to chronic inflammation relevant to the pathophysiology of both obesity and depression. Accumulating evidence highlights the need for further research into how gut microbiota influences inflammatory mechanisms observed in both obesity and depression.

Purpose of review: Adiponectin, a hormone secreted by adipocytes, plays a crucial role in maintaining metabolic balance and supporting cardiovascular health. Although it is known for its protective effects, such as improving insulin sensitivity, reducing inflammation, and maintaining endothelial function, there are paradoxical associations between high adiponectin levels and increased cardiovascular mortality-referred to as the "adiponectin paradox"-which complicates its clinical interpretation. This review explores the cardioprotective effects of adiponectin in both type 1 and type 2 diabetes, focusing on its potential to regulate glucose metabolism and prevent cardiovascular complications.

Recent findings: By reviewing key studies, the article evaluates adiponectin's diverse roles and compares its effects on cardiovascular outcomes across diabetes subtypes, especially in diabetic cardiomyopathy, with an emphasis on congestive heart failure. The findings underscore the importance of further research into therapeutic strategies aimed at modulating adiponectin levels, particularly for individuals with diabetes and congestive heart failure. Understanding the dual nature of adiponectin's effects is critical for developing target interventions to improve cardiovascular outcomes in diabetic populations.

Purpose of review: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in patients living with type 1 diabetes (T1D). Dyslipidemia is a frequent risk factor in this population. Although statin therapy has demonstrated cardiovascular (CV) benefits in diabetes overall, specific evidence in T1D remains limited. This systematic review aims to evaluate the impact of statins on clinical and surrogate atherosclerosis-related outcomes in patients with T1D without established ASCVD.

Recent findings: Statin use was associated with a significant reduction in the risk of major adverse cardiovascular events (MACE), with a pooled hazard ratio (HR) of 0.77 (95% CI: 0.70-0.84; low certainty), and a mean low-density lipoprotein cholesterol (LDL-C) reduction of 30.3 mg/dL (95% CI: -47.02 to -13.58; moderate certainty). Reductions in ApoB and non-HDL cholesterol were also reported. We conducted a systematic review following PRISMA guidelines. Searches were performed in PubMed, EMBASE, and Epistemonikos from inception to June 2025 using terms related to T1D, statins, and primary prevention. Eleven studies were included-nine randomized controlled trials (RCTs) and two cohort studies. Six (four RCTs and two cohorts) were eligible for meta-analysis of two primary outcomes; the remaining were summarized narratively. Statin use in T1D patients without ASCVD was associated with improved lipid profiles and reduced MACE. These findings support considering statins as a preventive strategy in this population, although prospective studies with hard outcomes are needed to better identify patients most likely to benefit.

Purpose of review: This review explores the effects of obesity and weight loss on bone and musculoskeletal health.

Recent findings: Obesity is associated with lower bone turnover, higher bone mineral density (BMD) and reduced risk of hip and wrist fractures, although ankle and lower leg fractures may be more frequent. In contrast, weight loss increases bone turnover, especially bone resorption, reduces BMD, especially at cortical sites, and increases fracture risk, especially at the hip and wrist. Skeletal adverse events depend on the magnitude of weight loss and are more prominent following bariatric surgery. Changes in mechanical loading, loss of muscle mass, hormonal alterations, and nutrient/vitamin deficiencies are implicated. Emerging anti-obesity medications may have a positive effect on bone and partially compensate the negative impact of weight loss. Regular exercise, vitamin D supplementation, adequate calcium and protein intake can mitigate these effects. Identification of the effects of excess body weight and the benefit-to-risk balance of weight loss interventions on bone health may help improve clinical management of invididuals with obesity and related metabolic disorders.

Purpose of review: This review mapped evidence on community-based screening interventions for early detection of prediabetes and type 2 diabetes (T2D), and identified barriers and strategies for developing and implementing such interventions in community settings for diverse populations.

Recent findings: Using the Arskey & O'Malley and Levac frameworks, we conducted a scoping review that identified 33 studies across 13 countries that developed and tested a community-based T2D screening intervention, utilizing risk assessment and Point-of-Care (POC) glucose testing. Screenings occurred in settings such as pharmacies (21%), faith-based centers (6%), and mobile vans (6%), with most studies from the United States (42%), Australia (16%), and Canada (9%). Post-screening, 89% of interventions offered referrals to primary care, while few connected participants to community programming. Barriers and strategies were mapped to the socioecological model to guide future development and implementation of early detection interventions in community settings. This review identified key factors for successful community-based T2D screening interventions, including adequate resources (i.e., funding and personnel), community engagement efforts, and accessible, feasible screening of T2D in community settings. POC testing proved valuable for early detection through immediate glucose results that would prompt potential interventions. However, challenges remain in ensuring long-term sustainability and feasibility of such approaches, as many interventions encountered high attrition rates due to challenges with referral pathways to health care and community programs, structural inequities, and lack of sustainable follow-up processes. Future research should focus on evaluating the cost-effectiveness and sustainable integration of these community-based T2D screening approaches into health systems for broader impact.

Purpose of review: This narrative review synthesizes current evidence on the role of various sleep parameters-including sleep duration, sleep quality, sleep timing, social jetlag, and chronotype-in energy intake, macronutrient consumption, diet quality, and meal timing. We aim to evaluate whether existing evidence supports a causal impact of sleep on eating behavior and discuss the clinical implications of these findings for diabetes care and management.

Recent findings: The impact of short sleep duration on eating behavior is the most widely studied and supported by experimental evidence suggesting that reduced sleep duration increases energy intake and promotes poorer diet quality. Later sleep timing is also associated with increased energy intake and poorer diet quality, and may interact with short sleep duration in influencing eating behavior. Chronotype, social jetlag, and sleep quality have also been linked to eating behavior; however, findings in these areas have been predominantly observational and cross-sectional, and may be confounded by co-occurring influences from other sleep parameters. Given the strength of the evidence for the role of sleep duration in eating behavior, future studies should evaluate the feasibility and efficacy of sleep extension interventions for controlling energy intake and improving diet quality in patients with type 2 diabetes. Further research should also clarify and distinguish the independent and interacting influences of multiple sleep parameters on eating behavior, as well as the potential effects of eating behavior on sleep.

Purpose of review: This review explores the role of GLP-1 receptor agonists (GLP-1 RAs) in addressing metabolic dysfunction and neurodegeneration in Parkinson's disease (PD), focusing on body weight regulation and neuroprotection.

Recent findings: GLP-1 RAs modulate insulin signaling, reduce neuroinflammation and oxidative stress, and improve mitochondrial functional mechanisms linked to neuroprotection. Clinical trials show modest but sustained improvements in motor symptoms and suggest benefits in cognition, mood, and apathy. While GLP-1 RAs induce weight loss in diabetes, their metabolic impact in normoglycaemic PD patients appears limited. However, individuals with obesity or insulin resistance may experience enhanced clinical and cognitive outcomes. GLP-1 RAs offer a multifaceted therapeutic strategy in PD, targeting both central neurodegenerative processes and peripheral metabolic dysfunction. Their potential for disease modification and symptom relief, particularly in specific phenotypes, supports their further exploration as part of a personalized treatment approach.