Current Diabetes Reports最新文献

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.

Purpose of review: Euglycemic diabetic ketoacidosis (euDKA) has been described since the 1970s, however the incidence appears to be increasing in association with the increased use of sodium-glucose cotransporter 2 inhibitor (SGLT2i) medications. Traditional hospital-based DKA protocols in which an insulin infusion is adjusted based on glucose levels are not effective in euDKA due to the presence of euglycemia which limits the capacity for insulin administration. This review was completed to review the data on euDKA and introduce a protocol for targeted management of this condition.

Recent findings: Data comparing euDKA outcomes to traditional hyperglycemia DKA demonstrate longer hospital length of stay and mean time to anion gap closure in euDKA based on current DKA management standards. Furthermore, the increase in prescribing SGLT2i medications thereby increases the risk of euDKA. At present, there are no reported protocols specific for euDKA and it is not directly addressed in the most recent guidelines issued by Endocrinology specialty societies. We created a protocol within our hospital intensive care unit to standardize treatment of euDKA using fixed insulin infusion and titration of dextrose-containing fluids. The protocol has been approved by our hospital regulatory committees and is currently being utilized in intensive care units. Future studies should review ongoing safety and efficacy of protocol use in various hospital settings.

Purpose of review: The goal of this review is to address the challenges in diagnosing and managing lipodystrophy syndromes.

Recent findings: Clinical and metabolic assessments, along with genetic analyses, are essential for tailoring medical care and providing appropriate genetic counseling. Efforts are underway to develop more objective diagnostic tools using imaging techniques or novel biomarkers. Leptin therapy has been a significant breakthrough for generalized lipodystrophy treatment; however, more effective treatments are still needed for partial and acquired forms. While gene editing and transcript modification strategies are being explored for specific forms of lipodystrophy, reducing the burden on adipocytes by lowering caloric intake remains a fundamental approach across all forms of the condition. As supporting data emerge, agents that reduce caloric intake may become integral to treatment algorithms. This review offers practical guidance for clinicians managing patients with lipodystrophy, highlighting advances in diagnosis, treatment, and ongoing challenges in clinical care.

Purpose of the review: Identity is a fundamental, but understudied, aspect of the diabetes experience. Diabetes imposes many life changes, which likely impact self-perception. The current review explores the concept of identity with diabetes, implications for health, and processes to facilitate a positive identity.

Recent findings: Identity with diabetes has been explored as a dimension, process, and outcome. Research suggests the degree to which people integrate diabetes into identity is associated with diabetes self-management behaviors and psychosocial functioning, but glycemic outcomes are inconsistent. There is potential to support positive incorporation of diabetes into identity by targeting the physical, behavioral, emotional, and social implications of diabetes on the self. The current literature on diabetes identity is limited and varies in its conceptualization but consistently supports the need to positively integrate diabetes into identity to support health and well-being. Future research and practice should consider diabetes identity in order to understand and enhance the experiences of people with diabetes.

Purpose of review: Health care professionals (HCPs), including physicians, nurse practitioners, nurses, diabetes educators, and dietitians, play a crucial role in recognizing and addressing behavioral and psychosocial concerns as part of comprehensive diabetes care. This review examines HCP-delivered behavioral interventions for youth with type 1 diabetes (T1D), highlighting their structure, outcomes, and opportunities for improvement.

Recent findings: Effective interventions were intensive, personalized, and family-centered, often incorporating motivational interviewing to address individual needs. In contrast, interventions with limited impact faced challenges such as low participation and difficulties maintaining intervention fidelity. HCP-delivered behavioral interventions show promise in improving both glycemic and psychosocial outcomes, yet barriers remain. Enhancing HCP training, intervention personalization, clinical integration, fidelity strategies, sustainability, accessibility, and interdisciplinary collaboration can strengthen future interventions. Refining these approaches will help optimize diabetes care, improve quality of life, and ensure more equitable access to behavioral support for youth with T1D and their families.

Purpose of review: In this review, we explore the under-recognized burden of fractures in diabetes, focusing on resource-constrained healthcare systems. We examine the epidemiology, assessment methodologies, and management approaches to osteoporosis in diabetes and discuss strategies to improve skeletal health outcomes.

Recent findings: Public healthcare strategies for fracture risk reduction in diabetes include educating healthcare providers, empowering patients, and integrating fracture liaison services for secondary prevention. Community-based awareness programs, digital health solutions, and screening tools such as FRAX® (with diabetes-specific adjustments) facilitate early identification and management. Policies supporting insurance coverage and cost-effective management strategies are likewise crucial. Diabetes-related bone fragility, characterized by altered bone quality and increased fracture risk despite relatively preserved bone density, creates a significant yet underrecognized health burden. Fracture prevention in diabetes is both a clinical necessity and an economic imperative. In this expanding cohort, multidisciplinary, policy-supported strategies can reduce morbidity, mortality, and costs associated with fragility fractures.

Purpose of review: Diabetes mellitus (DM) is a growing global health concern, and diabetic cardiomyopathy (DCM) affects up to 12% of individuals with diabetes, leading to myocardial hypertrophy, ventricular remodeling, and contractile dysfunction, ultimately progressing to heart failure (HF). This review explores the role of microRNAs (miRNAs) in DCM development and their potential as diagnostic and therapeutic biomarkers.

Recent findings: MicroRNAs, short single-stranded non-coding RNAs, are key regulators of various pathophysiological processes in DCM. By modulating gene expression, they influence critical signaling pathways involved in inflammation, apoptosis, pyroptosis, oxidative stress, and fibrosis, all of which contribute to DCM progression. Emerging research suggests that miRNAs could serve as early-stage biomarkers for asymptomatic DCM and may offer novel therapeutic targets. This systematic review compiles current findings from both animal and human studies on the role of miRNAs in DCM. It highlights their potential in the early diagnosis and treatment of DCM, underscoring the need for further research to translate these insights into clinical applications.