Current Diabetes Reports最新文献

Purpose of review: To evaluate the evidence on the relationship between fatalism, self-efficacy, and clinical and behavioral diabetes outcomes among African American adults with type 2 diabetes and to recommend areas for future work.

Recent findings: Evidence suggests that psychosocial factors including fatalism and self-efficacy are essential for optimizing diabetes outcomes and may be important considerations for reducing health disparities in type 2 diabetes. A reproducible search using OVID Medline, PubMed, and EBSCOHost was conducted from database creation up to February 2025. Medical Subject Heading terms and key words representing fatalism, self-efficacy, and diabetes were used. Outcomes included: hemoglobin A1c, LDL, Blood Pressure, Self-Care, and Quality of Life. A total of 17 studies were identified, 5 examining fatalism and 12 examining self-efficacy. All 5 fatalism studies demonstrated that fatalism is statistically significantly related to self-care behaviors and HbA1c, however this relationship may be impacted by other psychosocial and social risk factors. Among the self-efficacy studies, 11 demonstrated statistically significant relationships between self-efficacy and one or more clinical and behavioral outcomes including HbA1c, diet, physical activity, medication adherence, blood glucose testing, and quality of life. All studies were cross-sectional analyses. Given the small number of studies focused on fatalism and the largely correlational results for self-efficacy, there is a need for more targeted research to understand contributors to and moderators of the influence of the factors on outcomes.

Background: While substantial literature exists on the intersection of overweight/obesity (OWO) and pregnancy, much of it focuses on specific aspects, making it difficult to maintain an overview of clinically relevant factors for optimal care of OWO women throughout pregnancy.

Objectives: To provide a comprehensive synthesis of the existing literature, covering the full spectrum of clinically relevant information needed to manage OWO women from preconception to birth.

Methods: For this narrative review a literature search was conducted on PubMed in January 2025. Eligible studies included full-text English articles with data from human subjects, with no restrictions on publication date.

Findings: The impact of OWO on pregnancy is multifaceted, encompassing four interrelated themes: physiological consequences, emerging risks, challenges in prenatal care, and intervention strategies. OWO women exhibit differences in metabolic and inflammatory pathways compared to normal-weight women, reflected in altered laboratory tests. When managing gestational diabetes and preeclampsia, obesity-related characteristics must be considered. Clinicians need to be alert of obesity-mediated fetal complications, including overgrowth, malformations, stillbirth, and preterm birth, while navigating challenges in ultrasound measurements. Interventions during the preconception and prenatal periods provide key opportunities to optimize maternal weight and reduce the risk of long-term disease development.

Conclusion: The review's insights enhance clinical practice and call on researchers and policymakers to prioritize strategies that offer early counseling for obese pregnant women. These initiatives aim to optimize outcomes for both mother and child and contribute to combating the global obesity crisis.

Purpose of review: Homebound older adults with type 2 diabetes (T2DM) have worse outcomes compared to older adults with diabetes who are not homebound. This systematic review aimed to summarize evidence on interventions aimed to improve outcomes in homebound older adults with T2DM. The PRISMA guidelines for reporting of systematic reviews were followed. PubMed, CINAHL, SCOPUS, and PsycINFO databases were searched. To be included, studies were published from database inception until November 6, 2023. Eligible studies included Participants who were older adults with a mean age of 60 or older; Interventions of any type; Comparators of any type; Outcomes of hemoglobin A1c (HbA1c), blood pressure, cholesterol, quality of life (QOL), healthcare utilization, depression, anxiety, psychological distress, or mortality; Study designs of clinical trials.

Recent findings: There were 2,280 articles identified by the search, with nine articles included in the final review. Eight studies were conducted in the United States and one in Japan. Seven used pre-post designs and two were randomized controlled trials. Sample sizes ranged from 11 to 8,318,291. Study participants had a mean age of 60-82 years. Interventions included telehealth, home-based health care with in-home primary care visits, nutrition counseling, and meal delivery programs. We found a paucity of studies tailored to homebound older adults with T2DM. Results suggest that interventions provided to homebound older adults with T2DM in the home, including home-based primary care, case management/care coordination, joint patient and caregiver/family education, and home telemonitoring integrated into electronic medical systems, hold promise for improving clinical outcomes.

Purpose of review: This review aims to highlight the evolution and multifaceted benefits of modern sulfonylureas (SUs) in managing Type 2 Diabetes Mellitus (T2DM). It discusses their enhanced glycemic control, pleiotropic advantages, usage with other antidiabetic agents, safety, and tolerability, supporting their persistent relevance and effectiveness in diabetes care.

Recent findings: Recent findings indicate that modern SUs, like glimepiride, offer significant cardioprotective and renoprotective benefits along with their primary role in glycemic control. Additionally, they have also shown their anti-inflammatory effects, lipid-lowering properties, testosterone-enhancing effects, and neuroprotective effects in recent years. These findings support the broader therapeutic advantages of modern SUs beyond glucose lowering. Hence, many guidelines now recommend modern SUs as an add-on therapy to metformin. Modern sulfonylureas remain a vital component in T2DM management strategy due to their efficacy, safety profile, and cost-effectiveness. Their pleiotropic benefits, like cardiovascular, renal, anti-inflammatory, neuroprotective effects, etc., make them a comprehensive therapeutic option. Considering their efficacy and safety profile, SUs are expected to remain vital components of antidiabetic therapy, providing valuable benefits in managing T2DM in the long run.

Purpose of review: This narrative review aims to explore the literature on advancements in diabetes management within long-term care facilities (LTCFs). Managing chronic diseases like diabetes in LTCFs is particularly challenging due to the dynamic nature of these environments and the significant changes they have undergone over the past decade. Various factors, including rising care costs and government regulations, influence the quality-of-care residents receive in these settings.

Recent findings: Many diabetes medications have not been extensively studied in LTCFs, and high-risk medications such as sulfonylureas and sliding scale insulin are still in use, potentially increasing the risk of morbidity and mortality among residents. Additionally, the adoption of diabetes technologies, such as continuous glucose monitors (CGMs) and insulin pumps, remains limited in LTCFs. Despite the high prevalence of diabetes, significant research gaps persist. Diabetes technologies have the potential to greatly improve diabetes management and outcomes for residents. However, more research is needed to evaluate their efficacy and safety in long-term care settings. Furthermore, there is a pressing need to address the gap in staff training on the use of these technologies. Closing these research gaps is essential for developing evidence-based guidelines and improving the quality of diabetes care in LTCFs.

Purpose of review: Neonatal and syndromic diabetes are rare but important conditions. These conditions often result in severe insulin deficiency or insulin resistance. In this review, we aim to discuss the clinical characteristics and genetics of neonatal and syndromic forms of diabetes.

Recent findings: Beyond the development of diabetes mellitus, many other organ systems are affected. Understanding the pathophysiology of these conditions have improved our collective understanding of the genetics and developmental biology related to glucose metabolism and beyond. This review will provide new information for researchers and provide a helpful resource for clinicians when evaluating a patient for neonatal and syndromic forms of diabetes.

Purposeof review: Prediabetes poses a significant risk of developing diabetes and it's complications. Africa faces specific challenges, hindering early recognition and management of prediabetes. We aimed to understand unique, ethnicity specific aspects of the burden, pathogenesis and management of prediabetes in Africa.

Recent findings: The rate of progression from prediabetes to diabetes is higher in African, compared to European populations. Prediabetes in Africans is driven mainly by hyperinsulinemia and reduced hepatic clearance causing obesity and insulin resistance, rather than impaired insulin sensitivity. High risk, difficult to reach individuals in lower socioeconomic strata, benefited from community versus facility-based screening. Intensive lifestyle changes with low calorie or low fat-high fiber diet provide longer lasting effect versus drug monotherapy. Using structured community-based screening, early detection of prediabetes is achievable, requiring dedicated stakeholder engagement. Further research into the etiology and sequencing of pathogenetic anomalies and preventive strategies in African populations is needed.

Purpose of review: Type 2 diabetes (T2D) disproportionately impacts minority populations. The National Institute on Minority Health and Health Disparities (NIMHD) developed a research framework to encourage health disparities research that considers a multi-level, multi-domain perspective. The purpose of this review was to describe evidence on the levels and domains that influence T2D disparities among minority populations and use this information to adapt the NIMHD Research Framework for T2D.

Recent findings: Screening identified 108 articles published between 2017 and 2023 covering 74,354,597 participants. Articles were classified under the following domains, Biological (18), Behavioral (22), Physical/Built Environment (19), Sociocultural Environment (42), and Health Care System (31). Article levels of influence included Individual (73), Interpersonal (18), Community (36), and Societal (10). Findings were used to adapt the NIMHD Research Framework with an eye towards advancing T2D-related health equity. The results of this review confirm the complex nature of T2D-related disparities and support the notion that drivers operate within and between multiple levels and multiple domains to influence T2D-related outcomes across the lifespan.

Purpose of review: This review highlights the impact of weight loss on metabolic dysfunction associated steatotic liver disease (MASLD), formally known as nonalcoholic fatty liver disease (NAFLD), and its progressive form of metabolic dysfunction associated steatohepatitis (MASH), formally known as nonalcoholic steatohepatitis (NASH). The effects of weight loss, as achieved through lifestyle modification, pharmacotherapy, bariatric surgery or endobariatric procedures on MASLD/MASH and hepatic fibrosis are discussed.

Recent findings: Although foundational in the treatment of MASLD/MASH, weight loss through life-style modification is challenging for most patients to achieve and sustain long-term. In patients with MASLD/MASH, a multidisciplinary approach may facilitate success with lifestyle modification, individualized consideration of pharmacotherapies and/or surgical approaches that have potential to lend an improvement in MASLD/MASH. Effective and sustained weight loss improves hepatic steatosis, steatohepatitis and potentially hepatic fibrosis. Improvement in hepatic fibrosis can improve patient-related outcomes associated with complications of advanced hepatic fibrosis or cirrhosis in patients with MASLD/MASH. Identifying risk factors that influence MASLD/MASH and early implementation of therapeutic weight loss strategies may improve chronic liver injury and decrease risk for adverse clinical outcomes related to progressive hepatic fibrosis attributable to MASLD/MASH.

Purpose of review: To review the genetics of type 1 diabetes (T1D) and T1D genetic risk scores, focusing on their development, research and clinical applications, and future directions.

Recent findings: More than 90 genetic loci have been linked to T1D risk, with approximately half of the genetic risk attributable to the human leukocyte antigen (HLA) locus, along with non-HLA loci that have smaller effects to disease risk. The practical use of T1D genetic risk scores simplifies the complex genetic information, within the HLA and non-HLA regions, by combining the additive effect and interactions of single nucleotide polymorphisms (SNPs) associated with risk. Genetic risk scores have proven to be useful in various aspects, including classifying diabetes (e.g., distinguishing between T1D vs. neonatal, type 2 or other diabetes types), predicting the risk of developing T1D, assessing the prognosis of the clinical course (e.g., determining the risk of developing insulin dependence and glycemic control), and research into the heterogeneity of diabetes (e.g., atypical diabetes). However, there are gaps in our current knowledge including the specific sets of genes that regulate transition between preclinical stages of T1D, response to disease modifying therapies, and other outcomes of interest such as persistence of beta cell function. Several T1D genetic risk scores have been developed and shown to be valuable in various contexts, from classification of diabetes to providing insights into its etiology and predicting T1D risk across different stages of T1D. Further research is needed to develop and validate T1D genetic risk scores that are effective across all populations and ancestries. Finally, barriers such as cost, and training of medical professionals have to be addressed before the use of genetic risk scores can be incorporated into routine clinical practice.