Current Diabetes Reports最新文献

Purpose of review: Most youth with type 1 diabetes (T1D) do not meet the guidelines for physical activity engagement, thereby diminishing potential benefits to physical and mental health. This review synthesizes the recent literature on physical activity among youth with T1D and offers recommendations for future research.

Recent findings: Studies highlight challenges related to the use of inconsistent measurement tools, which prevent definitive conclusions about the mechanistic factors underlying low physical activity in youth. There has been limited research examining young children and youth newly diagnosed with T1D. Additionally, most interventions to promote physical activity in youth with T1D have involved structured and supervised exercise sessions, leaving a gap in knowledge regarding the potential impact of unstructured and unsupervised exercise interventions. To address these gaps, rigorous studies employing validated measures of physical activity in youth are needed. Interventions should incorporate developmentally appropriate behavioral science theories and emerging technologies in their design. Additional priorities include integrating diabetes technologies into clinical care, more real-world data to improve the accuracy of machine learning models for predicting dysglycemia, and advancing personalized mHealth interventions to promote physical activity in youth. While physical activity is an important area of pediatric diabetes research, gaps remain in our knowledge and intervention development. Physical activity consultations should be a part of routine diabetes care for youth. Research can inform these consultations by providing strategies to promote physical activity uptake and maintenance and by exploring ways to leverage new technologies to help youth with T1D exercise safely.

Purpose of review: The pharmacologic management of type 2 diabetes prioritises sodium-glucose cotransporter 2 (SGLT-2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists for their demonstrated cardiovascular benefits in individuals with atherosclerotic cardiovascular disease or multiple cardiovascular risk factors, chronic kidney disease, and heart failure. However, while current guidelines recommend these drug classes alone, combination therapy is not explicitly advocated. Herein we summarise the rationale and available evidence in support for combination therapy.

Recent findings: Evidence suggests that combining SGLT-2 inhibitors and GLP-1 receptor agonists improves metabolic outcomes, including HbA_1c, body weight, and blood pressure. More importantly, combination therapy can offer potential advantages for addressing residual cardiovascular risk, particularly in high-risk populations. Data from cardiovascular outcomes trials and real-world studies demonstrate consistent benefits of combination therapy across diverse subpopulations, including those with established atherosclerotic cardiovascular disease or chronic kidney disease. However, robust evidence remains limited for individuals at low cardiovascular risk, where therapy should primarily focus on metabolic goals. Of note, combination therapy faces significant barriers, including safety concerns in older or frail individuals, underutilisation in disadvantaged populations, while economic challenges may further hinder the accessibility of these therapies. Upfront combination therapy with both SGLT-2 inhibitors and GLP-1 receptor agonists could further reduce cardiovascular risk in people with type 2 diabetes, although it is crucial to pare down cost and disparities to access to maximise widespread benefits at population level.

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: 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: 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: 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.