Current Diabetes Reports最新文献

Purpose of review: This literature review highlights the behavioral and biological mechanisms that link racial discrimination to type 2 diabetes (T2D) risk, self-management, and related complications in the Black population in the United States. Next steps are discussed and include recommendations for disease mitigation.

Recent findings: Black Americans are exposed to high levels of stress, with many stressors rooted in racial discrimination, a psychosocial factor that inhibits positive behavior change and disrupts bodily systems and functioning. T2D is a largely preventable disease, yet Black Americans experience known structural and systemic barriers (i.e., structural racism) that profoundly impact diabetes onset and progression. While causal mechanisms that link racial discrimination and T2D have become a more recent focus of study, a dearth of research on racial discrimination-related stress, and the role it plays in the onset and self-management of T2D, remains. Identifying the structural and contextual factors, specifically racial discrimination, that influence diabetes risk and self-management among Black adults is important in closing the gap in health disparities. Findings on coping strategies adopted across the African diaspora are also warranted as policy makers, researchers, and clinicians work together to create an actionable path forward.

Purpose of review: The co-occurrence of diabetes and mental illnesses such as bipolar disorder (BD), obsessive-compulsive disorder (OCD), and schizophrenia creates significant barriers for both people with diabetes (PWD) and their healthcare teams. This literature review provides an analysis of the relationship between diabetes and mental illnesses through exploring epidemiology, shared risk factors, and clinical implications. The aim is to enhance the understanding of these complex comorbidities to guide and improve future research and clinical practice.

Recent findings: Recent research suggests a strong link between mental illness, metabolic syndrome, and diabetes. Studies show that BD has a robust relationship with metabolic disease and the antipsychotic medications used in treatment for many mental illnesses are strongly associated with weight gain and metabolic disease. However, there is limited research exploring the bidirectional relationship that diabetes has with BD, schizophrenia, and OCD. While research exists on the link between diabetes and mental conditions such as depression and anxiety, little research has examined schizophrenia, OCD and BD. The findings noted in this review suggest gaps in treatment options, healthcare services, and social support. While this paper provides a foundation for future progress, advancement in this field will require a collaborative effort from researchers, healthcare professionals, and community outreach programs to effectively close the gaps in care noted in these patient populations.

Purpose of review: Text-messaging interventions effectively prevent and manage numerous health conditions. This scoping review evaluates recent literature on text-messaging interventions focused on diabetes prevention, highlighting their development, associated outcomes, reach, and potential sustainability.

Recent findings: A total of 28 studies met eligibility criteria and were included in this review. Text-messaging was often used as a primary intervention method, focusing on promoting weight loss through physical activity and dietary changes. Studies also explored hybrid approaches integrating text-messaging with in-person sessions or other digital platforms. Intervention development involved multi-phase content creation, often leveraging established diabetes prevention curricula. Studies generally reported high feasibility and acceptability, although effectiveness was mixed. Cost-effectiveness comparisons favored text-messaging over traditional in-person programs. Implementation strategies aligned interventions with existing healthcare workflows, facilitating scalability and integration into routine care practices. Text-messaging interventions demonstrate considerable promise but require further refinement to ensure their effectiveness, particularly in enhancing participant engagement to ensure effectiveness and sustainability. Future research should focus on refining intervention content, integrating interactive features, and expanding cost-effectiveness evaluations to support broader implementation in real-world settings.

Purpose of review: This article aims to review the recent literature assessing the relationship between obesity and colorectal carcinogenesis, the effect of obesity on the treatment of colorectal cancer (CRC), tools available to help augment the increased risk, and outcomes for patients who are affected by both obesity and colorectal cancer.

Recent findings: The biochemical mechanisms contributing to CRC carcinogenesis are not well understood but are suspected to be related to adipose tissue leading to a pro-inflammatory state and changes in the gut microbiome. Individuals with obesity are at higher risk for CRC development, worse oncologic outcomes, and increased rates of post-operative complications. Bariatric surgery decreases CRC risk but results with GLP-1 agonists are heterogeneous. Prehabilitation is the only weight loss method that has been demonstrated to decrease risks of post-operative morbidity in this population. Obesity augments CRC risk and outcomes. There are persistent knowledge gaps in etiology and epidemiology for the increased CRC risk in obese patients and more research is required to identify the therapeutic advantage of weight loss on CRC risk.

Purpose of review: The purpose of this review is to assess the effects of glucagon-like peptide-1 (GLP-1) agonists, sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) on type 2 diabetes mellitus (T2DM) remission. This review explores the efficacy, safety, and durability of these surgical and medical modalities of diabetes management.

Recent findings: Studies have shown that GLP-1 agonists achieve higher rates of T2DM remission compared to standard glucose-lowering medications and lifestyle changes. In addition to weight loss, bariatric surgery has been found to be highly effective in treating and inducing remission of T2DM. Studies suggest that post-surgical patients see enhanced glycemic control. Both surgical interventions and GLP1 agonists are effective in achieving T2DM remission. Long-term follow-up and randomized controlled trials comparing bariatric surgery and GLP-1 agonists are necessary to evaluate their relative effectiveness in T2DM control. Further research is also needed to assess the combined effects of these treatment modalities.

Purpose of review: Individuals with diabetes face increased risk of atherosclerotic cardiovascular disease (ASCVD), in part due to hyperlipidemia. Even after LDL cholesterol-lowering, residual ASCVD risk persists, part of which may be attributed to elevated remnant cholesterol. We describe the impact of elevated remnant cholesterol on ASCVD risk in diabetes.

Recent findings: Preclinical, observational, and Mendelian randomization studies robustly suggest that elevated remnant cholesterol causally increases risk of ASCVD, suggesting remnant cholesterol could be a treatment target. However, the results of recent clinical trials of omega-3 fatty acids and fibrates, which lower levels of remnant cholesterol in individuals with diabetes, are conflicting in terms of ASCVD prevention. This is likely partly due to neutral effects of these drugs on the total level of apolipoprotein B(apoB)-containing lipoproteins. Elevated remnant cholesterol remains a likely cause of ASCVD in diabetes. Remnant cholesterol-lowering therapies should also lower apoB levels to reduce risk of ASCVD.

Purpose of review: Type 2 diabetes (T2D) management is complex and requires daily personal involvement and self-management skills to maintain optimal glycemic levels and improve health outcomes. Engagement in self-management behaviors in the early years of diagnosis can be challenging due to prevailing psychosocial factors present during this critical transition period, coupled with a lack of information, support, and skills. Technology-based diabetes self-management interventions can improve access to needed education and support, and their effectiveness in the general T2D population is well documented. This scoping review synthesized evidence on the use of technology for promoting diabetes self-management behaviors and related outcomes among individuals newly diagnosed with T2D (within the first 12 months since diagnosis).

Recent findings: Twenty-five studies were included. Technology-based diabetes self-management interventions tailored to those newly diagnosed with T2D have grown exponentially in the past five years. Existing evidence, though limited, showed that technologies such as websites, mobile apps, and continuous glucose monitoring combined with other communication features, can facilitate patient education, patient-provider communication, and health data monitoring. However, these technologies less commonly involved social support functions. These technologies have the potential to improve diabetes knowledge and positively impact clinical, behavioral, and psychological outcomes. However, small sample sizes, use of non-experimental designs, and the absence of formative research and theoretical foundations limit the strength of existing studies. Technology-based self-management interventions for those newly diagnosed with T2D show promise in improving T2D-related outcomes. Future studies should include larger sample sizes, adopt rigorous study designs, and integrate formative work to enhance relevance, adoption, and impact.

Purpose of review: To provide an update on diabetes management during labour and delivery in women with type 1 diabetes with focus on appropriate insulin administration, carbohydrate supply and use of diabetes technology to support safe delivery and neonatal well-being.

Recent findings: During active labour and elective cesarean section capillary blood glucose monitoring or continuous glucose monitoring at least hourly is recommended. Infusion with isotonic (5%) glucose can be given with adjustable infusion rate to address maternal carbohydrate requirements and to prevent maternal hypoglycemia. Subcutaneous insulin administration with multiple injections or insulin pump therapy is considered at least as safe and efficient as intravenous administration to obtain tight glycemic targets. Automated insulin delivery via insulin pump can be continued during labour and delivery. Diabetes management during labour and delivery involves intensive glucose monitoring, adequate insulin administration and carbohydrate administration to support safe delivery and neonatal well-being.

Purpose of review: This review explores the role of the endocannabinoid system (ECS) in regulating energy balance, food intake, and metabolism, with a focus on how ECS dysregulation contributes to obesity. The goal is to provide insights into the mechanisms underlying obesity and its associated metabolic disorders.

Recent findings: Recent research indicates that the ECS significantly influences food intake, fat storage, insulin sensitivity, and inflammation, all of which are central to the development and progression of obesity. New research areas include the interaction between the ECS and gut microbiota, circadian rhythms of the ECS, and the impact of genetic and epigenetic factors on ECS function. Interest in the therapeutic potential of targeting the ECS has grown, with earlier treatments like CB1 receptor antagonists showing mixed results in efficacy and safety. Evidence from both animal and human studies highlight the impact of elevated levels of the endocannabinoids anandamide and 2-AG on food intake, insulin resistance, visceral fat accumulation, and metabolic disturbances associated with obesity. The review explores the interaction between the ECS and other physiological systems, including gut-brain communication, circadian rhythms, as well as leptin and ghrelin signaling. Additionally, genetic and epigenetic factors influencing ECS function are examined, emphasizing their contribution to obesity susceptibility. While therapeutic approaches targeting the ECS, particularly CB1 receptor antagonism, have shown potential in managing obesity, the review acknowledges the challenges posed by central nervous system side effects in earlier treatments like rimonabant. However, recent advancements in peripherally restricted CB1 antagonists offer renewed hope for safer and more effective obesity treatments. The review concludes by addressing future research directions and therapeutic strategies to combat this global health challenge.

Purpose of review: Provide a concise update on metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), as well as a practical approach to screening and initial evaluation.

Recent findings: Nomenclature changes have placed a greater focus on cardiometabolic risk factors in the definition of MASLD. Screening for MASLD is by stepwise noninvasive serum and imaging tests which can identify patients at risk for advanced fibrosis and liver-related complications. MASLD has been increasing in prevalence and disease burden but is underrecognized in primary care and endocrinology clinics. Multiple society guidelines, synthesized here, provide a framework for the initial approach in the diagnosis and evaluation of MASLD. Recent advances in pharmacologic treatment underline the importance of screening for patients who are at risk for advanced fibrosis as they are most likely to benefit from new drug classes, such as the liver-directed thyroid receptor agonist resmiterom.