Current Diabetes Reports最新文献

Purpose: Black men in the United States experience a disproportionate burden of cardiometabolic diseases, including type 2 diabetes (T2DM), hypertension, and cardiovascular disease (CVD). Despite these disparities, existing interventions often fail to address the shared risk factors, structural determinants, and implementation barriers that impact engagement and sustainability. This review applies implementation science frameworks to evaluate strategies for improving cardiometabolic interventions tailored to Black men.

Recent findings: Community-based interventions, culturally tailored health education programs, and peer-led models have demonstrated success in improving cardiometabolic outcomes for Black men. However, challenges such as medical mistrust, underrepresentation in research, and systemic barriers continue to limit their reach and sustainability. The Consolidated Framework for Implementation Research (CFIR) identifies multi-level barriers and facilitators, the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework assesses intervention impact, and the Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions (FRAME-IS) highlights equity-driven adaptations. Applying implementation science frameworks provides structured insights into optimizing interventions for Black men by addressing barriers across patient, provider, and system levels. Key facilitators include culturally relevant adaptations, an inclusive healthcare workforce, and trusted community partnerships. Future research should integrate equity-focused implementation strategies to improve adoption, engagement, and long-term sustainability of cardiometabolic interventions for Black men.

Purpose of review: Lower extremity amputations (LEAs) are among the most severe complications of diabetes, with approximately 1.5 million procedures performed globally each year. This review explores the impact of social and structural determinants of health on amputation rates in diabetic patients, highlighting disparities driven by systemic factors.

Recent findings: Structural determinants such as healthcare policies and economic systems intersect with social factors, including access to care, racial disparities, and socioeconomic status, influencing amputation risk. Black patients with diabetes face up to a fourfold increased risk of major amputation compared to non-Hispanic white patients. Lower socioeconomic status is also strongly linked to higher amputation rates. Geographic and environmental factors, like food deserts and limited access to specialized care, further exacerbate these disparities. Emerging prevention strategies, such as telemedicine and mobile health units, demonstrate promise in improving access to care. Addressing disparities in LEAs requires comprehensive policy changes and targeted interventions. Future directions include leveraging artificial intelligence and precision medicine alongside community-based programs to reduce amputation rates in high-risk diabetic populations.

Purpose of review: Early Gestational Diabetes Mellitus (eGDM) is an emerging public health issue in India, characterised by varying prevalence estimates, healthcare access disparities, and inconsistent screening practices. This scoping review aims to map the existing literature on eGDM screening in India, identify evidence gaps, and inform future research, policy formulation, and resource allocation.

Recent findings: The review, guided by the Arksey and O'Malley framework, includes studies published between 2000 and 2024 that highlight significant eGDM screening and management disparities across public and private healthcare settings, rural-urban locations, and socioeconomic groups. Several screening initiatives have been introduced, but challenges persist, including a lack of standardised diagnostic criteria, low healthcare provider awareness, limited accessibility of screening, and sociocultural barriers. Economic evaluations suggest that eGDM screening can be cost-effective, yet India-specific assessments remain scarce. The integration of eGDM screening within India's national healthcare programs, including NPCDCS, remains minimal. There is a significant gap in knowledge translation, with limited efforts in adapting research findings into policy and practice. Addressing these challenges requires robust policy and programmatic responses, including standardised diagnostic guidelines, improved healthcare provider training, equitable service access, and culturally sensitive community engagement. Strengthening research-to-policy pathways is critical to improving eGDM screening and outcomes across India.

Purpose of review: This review synthesizes current knowledge on islet autoantibodies (IAs) as predictive biomarkers for type 1 diabetes (T1D), focusing on their role in disease staging, autoantibody patterns, advancements in screening methodologies, and the implications of implementing population-wide screening initiatives.

Recent findings: Autoantibody profiling has refined T1D risk stratification, with progression rates influenced by IA characteristics including number, type, order of appearance, and affinity. While screening efforts initially targeted genetically at-risk groups, approximately 90% of new TID diagnoses occur in individuals without a family history, underscoring the need for broader population-based screening. The approval of teplizumab, a therapy shown to delay clinical T1D onset, represents a paradigm shift by providing an intervention following early identification through screening. Technological advancements have further optimized IA detection and therapeutic strategies. However, challenges such as cost-effectiveness, implementation logistics, and assay standardization remain. T1D is a chronic autoimmune disorder characterized by progressive pancreatic beta-cell destruction, leading to insulin deficiency. The natural history of T1D is typically marked by the appearance of IAs long before clinical symptoms emerge, providing a window for early detection and intervention. Identifying at-risk individuals during this asymptomatic phase can reduce disease severity at clinical onset and facilitate timely application of disease-modifying therapies like teplizumab. Emerging evidence emphasizes that IA characteristics collectively shape disease risk and progression. Advancements in screening technologies and therapies continue to support the integration of IA screening into clinical care, marking a significant step toward effective T1D prevention and management.

Purpose of review: Care guidelines recommend screening and intervention for diabetes distress (DD) as part of standard type 1 diabetes (T1D) care. The variability in how individuals with diabetes experience distress, alongside the range of treatment options, underscores the value of tailoring approaches for addressing diabetes distress. Our objective was to summarize contemporary clinical trials addressing DD directly in adults with T1D, focusing on evidence of heterogenous treatment effects.

Recent findings: We reviewed five studies testing diverse intervention strategies, including emotional support, telehealth, digital health platforms, and patient-centered communication. All studies were effective in reducing DD. Four studies examined the variation in treatment effects or outcomes in relation to observable participant characteristics and demonstrated heterogeneity both in the factors associated with changes in DD and factors associated with the differential impact of specific interventions. This review uncovered preliminary evidence of heterogeneous treatment effects across a range of DD-focused interventions. Gaining a deeper, more comprehensive understanding of the individuals or subgroups for whom evidence-based DD strategies are particularly effective versus less effective is needed to advance data-driven personalized treatment for DD. Future studies should prioritize diversity in enrolled individuals and advanced analytic approaches that can empirically match individuals with elevated DD to their optimal treatment approach.

Purpose of review: To highlight various preventive and therapeutic strategies via health care delivery system to minimize sight-threatening diabetic retinopathy.

Recent findings: Diabetic retinopathy (DR) is a common and specific microvascular complication of diabetes and is a common cause of blindness among economic age groups or the working population of the country. Clinically, DR can be graded as non-sight-threatening diabetic retinopathy (NSTDR), including mild and moderate non-proliferative abnormalities and sight-threatening diabetic retinopathy (STDR), which comprises of severe non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), or clinically significant macular edema (CSME). In STDR, the disease progresses to the proliferative phase which is characterized by the formation of new blood vessels and macular edema owing to the accumulation of fluid within the retina, producing severe and often irreversible vision loss. With the influx of artificial intelligence in the medical arena, there is a continuous rise in the demand for the development of automated analysis software for the analysis of retinal images in people with diabetes. Nowadays, Smartphone-based retinal imaging has emerged as one of the most cost-effective ways of screening for DR in the community, which even non-ophthalmologists can do. Understanding the factors associated with STDR can help to develop primary and secondary prevention strategies. Spreading awareness regarding STDR at the community level is crucial. All diabetic patients need regular and repetitive follow-ups with the ophthalmologist for screening and timely treatment of DR, particularly STDR. Preservation of sight in STDR can be achieved through effective screening, timely laser treatment, intraocular injection of steroids and anti-vascular endothelial growth-factor agents and intraocular surgery.

Purpose of review: The "obesity paradox" describes the counterintuitive observation that overweight and mildly obese individuals with cardiovascular disease (CVD) may have better outcomes than those with normal weight. This paradox is particularly intriguing in patients with type-2 diabetes (T2D), where obesity is a well-established risk factor for cardiometabolic complications.

Recent findings: Evidence from some epidemiological studies suggested an obesity paradox in mortality risk among patients with T2D. However, confounding factors may influence this association, including reverse causality, differences in risk factor profiles, and adipose tissue distribution. Recent research also questions the reliance on body mass index as an accurate measure of metabolic health, emphasizing the role of alternative anthropometric indices. This review critically evaluates the evidence for the obesity paradox in T2D, explores potential mechanistic explanations, and discusses clinical implications. Understanding the complex interaction between diabetes and obesity in CVD risk is essential for refining obesity management strategies in individuals with T2D and CVD.

Purpose of review: To assess the current literature on iron intake in relation to obesity and its comorbidities. Specifically, to evaluate the potential mechanisms and the strength of the evidence linking heme iron intake to these conditions, highlight methodological challenges in assessing iron intake, and identify gaps that warrant further investigation.

Recent findings: Studies were mostly prospective cohorts. Across studies, total, heme and non-heme iron intakes were associated with both increased and decreased risk in relation to outcomes, which may be due to differences in the population being investigated and methods used to estimate the heme iron content of foods. The evidence concerning total, heme and non-heme dietary iron is inconclusive when evaluating its associations with obesity and comorbidities. Well-designed clinical trials are needed to better inform nutrition guidelines. Additionally, quantification of total, heme and non-heme iron in foods is essential to improve dietary assessments and strengthen research on their potential impact on health.

Purpose of review: The rates of diabetes in pregnancy (type 1, type 2, and gestational diabetes) are increasing. Diabetes in pregnancy is associated with increased risk for maternal and neonatal complications. Certain groups are disproportionately affected by these complications and this paper reviews the data about disparities in diabetes in pregnancy and explores the social determinants of health (SDoH) underlying these disparities.

Recent findings: Rates of diagnosis of gestational diabetes and pregestational diabetes are higher in racial and ethnic minority groups and people with socioeconomic disadvantage. There is higher all cause maternal mortality for Black people compared to White people. Emerging data suggests higher risk for adverse pregnancy outcomes for Black, American Indian, and Hispanic/Latina subjects with diabetes compared to White subjects. Individuals living in neighborhoods with higher poverty and less educational attainment also have higher rates of pregnancy and neonatal complications with diabetes. Diabetes in pregnancy is a complex condition which requires specialty care that can be time-consuming and costly. Individuals with disadvantages in income and employment, food security, social protection and support, and access to affordable and quality health services may be particularly susceptible to adverse outcomes of diabetes in pregnancy. Providers can reduce disparities by recognizing individuals with vulnerabilities in SDoH and tailoring treatment to social context. Equitable access to diabetes technology and postpartum care can also reduce disparities in outcomes.

Purpose of review: This systematic examination quantifies financial toxicity- the economic burden and related financial distress experienced by patients due to medical costs- in diabetes management globally, analyzing prevalence, mechanisms, and interventions across diverse healthcare systems and geographic contexts.

Recent findings: Data indicates 30-60% of diabetes patients experience financial toxicity, with household expenditures ranging from 5 to 40% of income on disease management, and demographic disparities evident. Current intervention strategies demonstrate limited efficacy, particularly in resource-constrained settings, while policy approaches show mixed results across economic contexts. Financial toxicity operates through four identified pathways: direct expenses, indirect costs (productivity/caregiver burden), insurance coverage limitations, and structural access barriers. Research priorities include developing validated measurement instruments for diabetes financial toxicity, implementing contextually appropriate interventions, and establishing causative relationships between financial burden and clinical outcomes through longitudinal studies.