Geremia B. Bolli, Philip D. Home, Francesca Porcellati, Matthew C. Riddle, Hertzel C. Gerstein, Paola Lucidi, Carmine G. Fanelli, David R. Owens
Insulin deficiency, often aggravated by insulin resistance, results in type 2 diabetes mellitus (T2DM). With the availability of glucagon-like peptide 1 receptor agonists and sodium–glucose cotransporter 2 inhibitors, basal insulin (BI) therapy is no longer the first-line option after lifestyle modification plus oral agents is insufficient. In contrast to BI, the newer medications require minor titration, lower hyperglycemia in a glucose-dependent manner, and reduce body weight. Importantly, the newer agents reduce cardiorenal events in the short term. Nonetheless, insulin therapy continues to play a key role in control of hyperglycemia and therefore long-term prevention of vascular complications. Its use is essential in many circumstances, including metabolic emergencies, new diabetes onset, latent autoimmune diabetes (LADA), pregnancy, and when other agents are less desirable due to comorbidities. BI is needed in the frequent condition of failure of other therapies to keep HbA1c to target and/or intolerance of them. There are several advantages to the combination of BI with the newer medications given their different but complementary mechanisms of action, primarily, the lower dose of each, improving adherence and outcomes while decreasing the side effects. Multiple choices for single or combination use can better meet the variety of clinical phenotypes in the heterogeneous T2DM population, using the tenets of precision medicine.
{"title":"The Modern Role of Basal Insulin in Advancing Therapy in People With Type 2 Diabetes","authors":"Geremia B. Bolli, Philip D. Home, Francesca Porcellati, Matthew C. Riddle, Hertzel C. Gerstein, Paola Lucidi, Carmine G. Fanelli, David R. Owens","doi":"10.2337/dci24-0104","DOIUrl":"https://doi.org/10.2337/dci24-0104","url":null,"abstract":"Insulin deficiency, often aggravated by insulin resistance, results in type 2 diabetes mellitus (T2DM). With the availability of glucagon-like peptide 1 receptor agonists and sodium–glucose cotransporter 2 inhibitors, basal insulin (BI) therapy is no longer the first-line option after lifestyle modification plus oral agents is insufficient. In contrast to BI, the newer medications require minor titration, lower hyperglycemia in a glucose-dependent manner, and reduce body weight. Importantly, the newer agents reduce cardiorenal events in the short term. Nonetheless, insulin therapy continues to play a key role in control of hyperglycemia and therefore long-term prevention of vascular complications. Its use is essential in many circumstances, including metabolic emergencies, new diabetes onset, latent autoimmune diabetes (LADA), pregnancy, and when other agents are less desirable due to comorbidities. BI is needed in the frequent condition of failure of other therapies to keep HbA1c to target and/or intolerance of them. There are several advantages to the combination of BI with the newer medications given their different but complementary mechanisms of action, primarily, the lower dose of each, improving adherence and outcomes while decreasing the side effects. Multiple choices for single or combination use can better meet the variety of clinical phenotypes in the heterogeneous T2DM population, using the tenets of precision medicine.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"20 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Norbert Freinkel Award recognizes contribution of research, clinical practice, and advocacy to improving pregnancy outcomes for women with diabetes. This award honors a man of outstanding achievements. Norbert was a forward-thinking investigator, a concise and precise writer, and a gifted clinical practitioner. His philosophy stated that a research question should be framed around an unsolved patient problem, a solution should be sought at several levels and across several disciplines, and the solution should be shared and applied to the problem. The Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network has followed this philosophy. Women now achieve better pregnancy preparation and have lower blood glucose and lower glycated hemoglobin with improved pregnancy outcomes. Screening and follow-up for gestational diabetes mellitus (GDM) is consistent. The trial on early metformin in addition to usual care in the reduction of GDM effects (A Randomized Placebo-Controlled Trial of the Effectiveness of Metformin in Addition to Usual Care in the Reduction of Gestational Diabetes Mellitus Effects [EMERGE]) provides evidence for metformin use in pregnancies complicated by GDM as an alternative to insulin. Learnings and evidence from ATLANTIC DIP have shaped national policy and guidelines and have contributed to global knowledge in this area. We continue to strive for excellence and equity of care and normalization of perinatal outcomes.
{"title":"ATLANTIC DIP, Changing the Landscape for Better Maternal and Infant Health: The 2024 Norbert Freinkel Award Lecture","authors":"Fidelma Dunne","doi":"10.2337/dci24-0047","DOIUrl":"https://doi.org/10.2337/dci24-0047","url":null,"abstract":"The Norbert Freinkel Award recognizes contribution of research, clinical practice, and advocacy to improving pregnancy outcomes for women with diabetes. This award honors a man of outstanding achievements. Norbert was a forward-thinking investigator, a concise and precise writer, and a gifted clinical practitioner. His philosophy stated that a research question should be framed around an unsolved patient problem, a solution should be sought at several levels and across several disciplines, and the solution should be shared and applied to the problem. The Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network has followed this philosophy. Women now achieve better pregnancy preparation and have lower blood glucose and lower glycated hemoglobin with improved pregnancy outcomes. Screening and follow-up for gestational diabetes mellitus (GDM) is consistent. The trial on early metformin in addition to usual care in the reduction of GDM effects (A Randomized Placebo-Controlled Trial of the Effectiveness of Metformin in Addition to Usual Care in the Reduction of Gestational Diabetes Mellitus Effects [EMERGE]) provides evidence for metformin use in pregnancies complicated by GDM as an alternative to insulin. Learnings and evidence from ATLANTIC DIP have shaped national policy and guidelines and have contributed to global knowledge in this area. We continue to strive for excellence and equity of care and normalization of perinatal outcomes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"53 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Linnea M. Wilson, Shoshana J. Herzig, Edward R. Marcantonio, Michael A. Steinman, Mara A. Schonberg, Brianna X. Wang, Ella Hileman-Kaplan, Timothy S. Anderson
BACKGROUND Inpatient hyperglycemia is common among adults, and management varies. PURPOSE To systematically identify guidelines on inpatient hyperglycemia management. DATA SOURCES MEDLINE, Guidelines International Network, and specialty society websites were searched from 1 January 2010 to 14 August 2024. STUDY SELECTION Clinical practice guidelines pertaining to blood glucose management in hospitalized adults were included. DATA EXTRACTION Two authors screened articles and extracted data, and three assessed guideline quality. Recommendations on inpatient monitoring, treatment targets, medications, and care transitions were collected. DATA SYNTHESIS Guidelines from 10 organizations met inclusion criteria, and 5 were assessed to be of high quality per the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument. All guidelines recommended monitoring blood glucose for patients with diabetes and nine for admission hyperglycemia. Eight guidelines recommended an upper blood glucose target of 180 mg/dL, five with a lower limit of 100 mg/dL and three of 140 mg/dL. Guidelines were in agreement on using capillary blood glucose monitoring, and three guidelines included discussion of continuous monitoring. Hyperglycemia treatment with basal-bolus insulin alone (n = 3) or with correction (n = 5) was most commonly recommended, while sliding scale insulin was advised against (n = 5). Guidance on use of oral diabetes medications was inconsistent. Five guidelines included discussion of transitioning to home medications. Recommendations for hypoglycemia management and diabetes management in older adults were largely limited to outpatient guidance. LIMITATIONS Non-English-language guidelines were excluded. CONCLUSIONS While there is consensus on inpatient blood glucose monitoring and use of basal-bolus insulin, there is disagreement on treatment targets and use of home medications and little guidance on how to transition treatment at discharge.
{"title":"Management of Diabetes and Hyperglycemia in the Hospital: A Systematic Review of Clinical Practice Guidelines","authors":"Linnea M. Wilson, Shoshana J. Herzig, Edward R. Marcantonio, Michael A. Steinman, Mara A. Schonberg, Brianna X. Wang, Ella Hileman-Kaplan, Timothy S. Anderson","doi":"10.2337/dc24-2510","DOIUrl":"https://doi.org/10.2337/dc24-2510","url":null,"abstract":"BACKGROUND Inpatient hyperglycemia is common among adults, and management varies. PURPOSE To systematically identify guidelines on inpatient hyperglycemia management. DATA SOURCES MEDLINE, Guidelines International Network, and specialty society websites were searched from 1 January 2010 to 14 August 2024. STUDY SELECTION Clinical practice guidelines pertaining to blood glucose management in hospitalized adults were included. DATA EXTRACTION Two authors screened articles and extracted data, and three assessed guideline quality. Recommendations on inpatient monitoring, treatment targets, medications, and care transitions were collected. DATA SYNTHESIS Guidelines from 10 organizations met inclusion criteria, and 5 were assessed to be of high quality per the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument. All guidelines recommended monitoring blood glucose for patients with diabetes and nine for admission hyperglycemia. Eight guidelines recommended an upper blood glucose target of 180 mg/dL, five with a lower limit of 100 mg/dL and three of 140 mg/dL. Guidelines were in agreement on using capillary blood glucose monitoring, and three guidelines included discussion of continuous monitoring. Hyperglycemia treatment with basal-bolus insulin alone (n = 3) or with correction (n = 5) was most commonly recommended, while sliding scale insulin was advised against (n = 5). Guidance on use of oral diabetes medications was inconsistent. Five guidelines included discussion of transitioning to home medications. Recommendations for hypoglycemia management and diabetes management in older adults were largely limited to outpatient guidance. LIMITATIONS Non-English-language guidelines were excluded. CONCLUSIONS While there is consensus on inpatient blood glucose monitoring and use of basal-bolus insulin, there is disagreement on treatment targets and use of home medications and little guidance on how to transition treatment at discharge.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"70 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danyang Wang, Jedidiah I. Morton, Agus Salim, Jonathan E. Shaw, Dianna J. Magliano
OBJECTIVE To explore the association between diabetes and anemia. RESEARCH DESIGN AND METHODS We included 9,026 and 389,616 participants from the U.S. National Health and Nutrition Examination Surveys and the UK Biobank study (UKB), respectively. Multivariable logistic regression was used to examine the cross-sectional association of diabetes with anemia, as defined by hemoglobin measurement. For the UKB follow-up, multivariable Cox proportional hazards regression was performed to estimate hazard ratios (HRs) and 95% CIs of incident anemia, as defined by hemoglobin levels or diagnosis records, in relation to diabetes. We further assessed the impact of inflammation, renal dysfunction, and medication use on this association in both populations. RESULTS Among White people aged 40–69 years in the U.S. and U.K., the adjusted odds of study participants with diagnosed diabetes also having anemia was two to four times higher than in those with normal glycemia. Over a median follow-up of 13.6 years in the UKB, 42,354 people developed anemia. The adjusted HRs for incident anemia comparing diagnosed diabetes with normal glycemia were 3.05 (95% CI 2.90–3.21) for iron deficiency anemia, 3.02 (95% CI 2.51–3.63) for anemia of chronic disease, and 4.88 (95% CI 4.23–5.63) for vitamin B12 deficiency anemia. Further adjustment for inflammation, renal dysfunction, and medication use partially attenuated these associations, but they remained strong and significant. CONCLUSIONS Diabetes was associated with several major types of anemia. Further studies are warranted to identify the mechanisms.
{"title":"Association Between Diabetes and Anemia: Evidence From NHANES and the UK Biobank","authors":"Danyang Wang, Jedidiah I. Morton, Agus Salim, Jonathan E. Shaw, Dianna J. Magliano","doi":"10.2337/dc24-2535","DOIUrl":"https://doi.org/10.2337/dc24-2535","url":null,"abstract":"OBJECTIVE To explore the association between diabetes and anemia. RESEARCH DESIGN AND METHODS We included 9,026 and 389,616 participants from the U.S. National Health and Nutrition Examination Surveys and the UK Biobank study (UKB), respectively. Multivariable logistic regression was used to examine the cross-sectional association of diabetes with anemia, as defined by hemoglobin measurement. For the UKB follow-up, multivariable Cox proportional hazards regression was performed to estimate hazard ratios (HRs) and 95% CIs of incident anemia, as defined by hemoglobin levels or diagnosis records, in relation to diabetes. We further assessed the impact of inflammation, renal dysfunction, and medication use on this association in both populations. RESULTS Among White people aged 40–69 years in the U.S. and U.K., the adjusted odds of study participants with diagnosed diabetes also having anemia was two to four times higher than in those with normal glycemia. Over a median follow-up of 13.6 years in the UKB, 42,354 people developed anemia. The adjusted HRs for incident anemia comparing diagnosed diabetes with normal glycemia were 3.05 (95% CI 2.90–3.21) for iron deficiency anemia, 3.02 (95% CI 2.51–3.63) for anemia of chronic disease, and 4.88 (95% CI 4.23–5.63) for vitamin B12 deficiency anemia. Further adjustment for inflammation, renal dysfunction, and medication use partially attenuated these associations, but they remained strong and significant. CONCLUSIONS Diabetes was associated with several major types of anemia. Further studies are warranted to identify the mechanisms.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"34 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesco Giorgino, Ildiko Lingvay, Luc F. Van Gaal, Palash Sharma, Ángel Rodríguez, Jacek Kiljański, Amelia Torcello-Gómez, Joshua A. Levine
OBJECTIVE To evaluate late (week 40 or 42; hereafter, week 40/42) metabolic outcomes by early glycemic response (<20% or ≥20% fasting serum glucose [FSG] reduction at week 4) or weight response (<5% or ≥5% weight reduction at week 8), respectively, in tirzepatide-treated participants with type 2 diabetes in the SURPASS trials. RESEARCH DESIGN AND METHODS This post hoc analysis used pooled data across trials. Baseline characteristics, change from baseline to week 40/42 for efficacy parameters, and gastrointestinal (GI) adverse events (AEs) were described and analyzed by early response in terms of FSG (SURPASS-1 to -4; n = 3,676) or weight (SURPASS-1 to -5; n = 4,121) in the efficacy and safety analysis set, respectively. RESULTS Early responders in FSG (50%) were younger, with higher glycemic parameters and lower weight at baseline. Early responders in weight (31%) had lower glycemic parameters and weight at baseline, and a greater percentage were women and White. Early versus nonearly responders in FSG or weight achieved better HbA1c (−2.6% vs. −2.0% or −2.5% vs. −2.2%, respectively) and weight (−11% vs. −10% or −15% vs. −8%, respectively) responses at week 40/42 and greater improvements in blood pressure and lipids profile. Nonearly responders also had clinically meaningful HbA1c and weight reductions with all tirzepatide doses. The incidence of GI AEs (generally mild to moderate events) decreased over time and was, in general, comparable between early and nonearly responders. CONCLUSIONS Both early glucose and weight responses with tirzepatide were associated with better longer-term metabolic outcomes. Early response may be a good clinical indicator that could help inform treatment individualization to achieve therapeutic goals.
{"title":"Early Fasting Serum Glucose or Weight Reduction With Tirzepatide and Metabolic Outcomes in People With Type 2 Diabetes: A Post Hoc Analysis of the SURPASS Trials","authors":"Francesco Giorgino, Ildiko Lingvay, Luc F. Van Gaal, Palash Sharma, Ángel Rodríguez, Jacek Kiljański, Amelia Torcello-Gómez, Joshua A. Levine","doi":"10.2337/dc24-2790","DOIUrl":"https://doi.org/10.2337/dc24-2790","url":null,"abstract":"OBJECTIVE To evaluate late (week 40 or 42; hereafter, week 40/42) metabolic outcomes by early glycemic response (&lt;20% or ≥20% fasting serum glucose [FSG] reduction at week 4) or weight response (&lt;5% or ≥5% weight reduction at week 8), respectively, in tirzepatide-treated participants with type 2 diabetes in the SURPASS trials. RESEARCH DESIGN AND METHODS This post hoc analysis used pooled data across trials. Baseline characteristics, change from baseline to week 40/42 for efficacy parameters, and gastrointestinal (GI) adverse events (AEs) were described and analyzed by early response in terms of FSG (SURPASS-1 to -4; n = 3,676) or weight (SURPASS-1 to -5; n = 4,121) in the efficacy and safety analysis set, respectively. RESULTS Early responders in FSG (50%) were younger, with higher glycemic parameters and lower weight at baseline. Early responders in weight (31%) had lower glycemic parameters and weight at baseline, and a greater percentage were women and White. Early versus nonearly responders in FSG or weight achieved better HbA1c (−2.6% vs. −2.0% or −2.5% vs. −2.2%, respectively) and weight (−11% vs. −10% or −15% vs. −8%, respectively) responses at week 40/42 and greater improvements in blood pressure and lipids profile. Nonearly responders also had clinically meaningful HbA1c and weight reductions with all tirzepatide doses. The incidence of GI AEs (generally mild to moderate events) decreased over time and was, in general, comparable between early and nonearly responders. CONCLUSIONS Both early glucose and weight responses with tirzepatide were associated with better longer-term metabolic outcomes. Early response may be a good clinical indicator that could help inform treatment individualization to achieve therapeutic goals.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"14 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tiffany Tian, Cindy N. Ho, Alessandra T. Ayers, Rachel E. Aaron, David C. Klonoff, David T. Ahn, David Kerr, Anne L. Peters, Athena Philis-Tsimikas, Viral N. Shah, Emily G. Herndon, Yijiong Yang, Chengdong Li, Jing Wang
OBJECTIVE Diabetes devices, including continuous glucose monitors (CGMs) and insulin pumps, may significantly affect environmental sustainability and long-term resilience. RESEARCH DESIGN AND METHODS This observational study enrolled 49 adults with diabetes using CGMs, insulin pumps, or multiple daily injections (MDIs; three or more per day). Participants completed daily surveys detailing the types and amounts of diabetes-related waste discarded. RESULTS Of the 49 participants, 11 used MDIs and 38 used insulin pumps. Most were female (63%), were White (80%), had a bachelor’s degree (90%), lived in suburban/urban areas (86%), and were aged <65 years (78%). Average monthly waste was 2.7 lbs for pumps and 3.1 lbs for MDIs. Diabetes-related products contributed nearly 2% of household waste. CONCLUSIONS This study highlights the importance of improving recycling methods and reducing waste from diabetes devices.
{"title":"Quantifying Environmental Waste From Diabetes Devices in the U.S.","authors":"Tiffany Tian, Cindy N. Ho, Alessandra T. Ayers, Rachel E. Aaron, David C. Klonoff, David T. Ahn, David Kerr, Anne L. Peters, Athena Philis-Tsimikas, Viral N. Shah, Emily G. Herndon, Yijiong Yang, Chengdong Li, Jing Wang","doi":"10.2337/dc24-2522","DOIUrl":"https://doi.org/10.2337/dc24-2522","url":null,"abstract":"OBJECTIVE Diabetes devices, including continuous glucose monitors (CGMs) and insulin pumps, may significantly affect environmental sustainability and long-term resilience. RESEARCH DESIGN AND METHODS This observational study enrolled 49 adults with diabetes using CGMs, insulin pumps, or multiple daily injections (MDIs; three or more per day). Participants completed daily surveys detailing the types and amounts of diabetes-related waste discarded. RESULTS Of the 49 participants, 11 used MDIs and 38 used insulin pumps. Most were female (63%), were White (80%), had a bachelor’s degree (90%), lived in suburban/urban areas (86%), and were aged &lt;65 years (78%). Average monthly waste was 2.7 lbs for pumps and 3.1 lbs for MDIs. Diabetes-related products contributed nearly 2% of household waste. CONCLUSIONS This study highlights the importance of improving recycling methods and reducing waste from diabetes devices.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"20 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rasimcan Meral, Merve Celik Guler, Diarratou Kaba, Jeevitha Prativadi, Eric D. Frontera, Maria Cristina Foss-Freitas, Noura Nachawi, David T. Broome, Marissa Lightbourne, Rebecca J. Brown, Simeon I. Taylor, Elif A. Oral
OBJECTIVE Lipodystrophy encompasses a group of rare disorders associated with severe metabolic disease. These disorders are defined by abnormal fat distribution, with near-total (generalized lipodystrophy [GL]) or partial (partial lipodystrophy [PL]; e.g. familial partial lipodystrophy [FPLD]) absence of adipocyte mass, leading to a decreased ability to store lipids safely. Excess lipids are more likely to be stored in nonadipose tissues, which leads to the metabolic manifestations. We have recently shown that glucagon-like peptide-1 agonists are associated with metabolic improvements in FPLD. Here, we hypothesize that tirzepatide, a dual incretin, may also lead to metabolic improvement in patients with lipodystrophy. RESEARCH DESIGN AND METHODS An observational cohort of patients with lipodystrophy who received tirzepatide clinically were tracked in the context of ongoing natural history studies. RESULTS Seventeen patients received tirzepatide, 14 who had FPLD (aged 30–74 years; n = 12 female and 2 male). After a median 8.7 months of follow-up, the following were significantly reduced: BMI (median difference, −1.7; range, −5.9 to 0.9 kg/m2; P = 0.008), HbA1c (median difference, −1.1%; range −6.3% to −0.1%; P < 0.001), triglycerides (median difference, −65 mg/dL [−0.73 mmol/L]; range, −3,820 to 43 mg/dL [−43.2 to 0.49 mmol/L]; P = 0.003), and total daily insulin requirements (median difference, −109; range, −315 to 0 units/day; P = 0.002). Three additional patients with rarer forms of lipodystrophy, also with robust response to tirzepatide, are also discussed (atypical PL, n = 1; acquired GL; n = 2; aged 35–64 years; all female). Side effects were limited to benign gastrointestinal symptoms. CONCLUSIONS Tirzepatide may be an effective treatment for patients with lipodystrophy.
{"title":"Metabolic Improvements With Tirzepatide in Lipodystrophy: A Novel Option?","authors":"Rasimcan Meral, Merve Celik Guler, Diarratou Kaba, Jeevitha Prativadi, Eric D. Frontera, Maria Cristina Foss-Freitas, Noura Nachawi, David T. Broome, Marissa Lightbourne, Rebecca J. Brown, Simeon I. Taylor, Elif A. Oral","doi":"10.2337/dc24-2408","DOIUrl":"https://doi.org/10.2337/dc24-2408","url":null,"abstract":"OBJECTIVE Lipodystrophy encompasses a group of rare disorders associated with severe metabolic disease. These disorders are defined by abnormal fat distribution, with near-total (generalized lipodystrophy [GL]) or partial (partial lipodystrophy [PL]; e.g. familial partial lipodystrophy [FPLD]) absence of adipocyte mass, leading to a decreased ability to store lipids safely. Excess lipids are more likely to be stored in nonadipose tissues, which leads to the metabolic manifestations. We have recently shown that glucagon-like peptide-1 agonists are associated with metabolic improvements in FPLD. Here, we hypothesize that tirzepatide, a dual incretin, may also lead to metabolic improvement in patients with lipodystrophy. RESEARCH DESIGN AND METHODS An observational cohort of patients with lipodystrophy who received tirzepatide clinically were tracked in the context of ongoing natural history studies. RESULTS Seventeen patients received tirzepatide, 14 who had FPLD (aged 30–74 years; n = 12 female and 2 male). After a median 8.7 months of follow-up, the following were significantly reduced: BMI (median difference, −1.7; range, −5.9 to 0.9 kg/m2; P = 0.008), HbA1c (median difference, −1.1%; range −6.3% to −0.1%; P &lt; 0.001), triglycerides (median difference, −65 mg/dL [−0.73 mmol/L]; range, −3,820 to 43 mg/dL [−43.2 to 0.49 mmol/L]; P = 0.003), and total daily insulin requirements (median difference, −109; range, −315 to 0 units/day; P = 0.002). Three additional patients with rarer forms of lipodystrophy, also with robust response to tirzepatide, are also discussed (atypical PL, n = 1; acquired GL; n = 2; aged 35–64 years; all female). Side effects were limited to benign gastrointestinal symptoms. CONCLUSIONS Tirzepatide may be an effective treatment for patients with lipodystrophy.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"44 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ravi Retnakaran, Chang Ye, Caroline K. Kramer, Anthony J. Hanley, Philip W. Connelly, Mathew Sermer, Bernard Zinman
OBJECTIVE The International Diabetes Federation recently endorsed a 1-h oral glucose tolerance test (OGTT) as more convenient than the conventional 2-h OGTT. In practice, women with hyperglycemia in pregnancy are advised to undergo a 2-h OGTT within 6 months after delivery, but this test is often not completed, partly owing to its inconvenience for busy mothers. Recognizing the potential advantage of the 1-h OGTT in this setting, we sought to compare 1-h and 2-h OGTT glucose measurements at 3 months postpartum as predictors of dysglycemia (prediabetes/diabetes) over the first 5 years postpartum. RESEARCH DESIGN AND METHODS A total of 369 women across a range of glucose tolerance in pregnancy (from normoglycemia to gestational diabetes [GDM]) underwent multisample 2-h 75-g OGTTs at 3 months, 1 year, 3 years, and 5 years postpartum. Glucose measurements from the 3-month OGTT were ranked as predictors of dysglycemia (both criteria) by change in concordance index (CCI) of Cox proportional hazard regression models. RESULTS At the 3-month OGTT, 1-h glucose identified all but 10 of 70 women concurrently diagnosed with dysglycemia by 2-h glucose, while diagnosing an additional 96 women. The cumulative incidence of dysglycemia progressively increased over 5 years by tertile of 1-h glucose on the 3-month OGTT (P < 0.0001). On regression analyses, the strongest predictor of dysglycemia was 1-h glucose (change in CCI: 16.1%), followed by 2-h glucose (14.9%). In women with GDM, 1-h glucose again emerged as strongest predictor of dysglycemia (13.0%), followed by 2-h glucose (12.8%). CONCLUSIONS The 1-h OGTT may offer a strategy for increasing rates of postpartum reclassification following hyperglycemia in pregnancy.
{"title":"One-Hour Oral Glucose Tolerance Test for the Postpartum Reclassification of Women With Hyperglycemia in Pregnancy","authors":"Ravi Retnakaran, Chang Ye, Caroline K. Kramer, Anthony J. Hanley, Philip W. Connelly, Mathew Sermer, Bernard Zinman","doi":"10.2337/dc24-1848","DOIUrl":"https://doi.org/10.2337/dc24-1848","url":null,"abstract":"OBJECTIVE The International Diabetes Federation recently endorsed a 1-h oral glucose tolerance test (OGTT) as more convenient than the conventional 2-h OGTT. In practice, women with hyperglycemia in pregnancy are advised to undergo a 2-h OGTT within 6 months after delivery, but this test is often not completed, partly owing to its inconvenience for busy mothers. Recognizing the potential advantage of the 1-h OGTT in this setting, we sought to compare 1-h and 2-h OGTT glucose measurements at 3 months postpartum as predictors of dysglycemia (prediabetes/diabetes) over the first 5 years postpartum. RESEARCH DESIGN AND METHODS A total of 369 women across a range of glucose tolerance in pregnancy (from normoglycemia to gestational diabetes [GDM]) underwent multisample 2-h 75-g OGTTs at 3 months, 1 year, 3 years, and 5 years postpartum. Glucose measurements from the 3-month OGTT were ranked as predictors of dysglycemia (both criteria) by change in concordance index (CCI) of Cox proportional hazard regression models. RESULTS At the 3-month OGTT, 1-h glucose identified all but 10 of 70 women concurrently diagnosed with dysglycemia by 2-h glucose, while diagnosing an additional 96 women. The cumulative incidence of dysglycemia progressively increased over 5 years by tertile of 1-h glucose on the 3-month OGTT (P &lt; 0.0001). On regression analyses, the strongest predictor of dysglycemia was 1-h glucose (change in CCI: 16.1%), followed by 2-h glucose (14.9%). In women with GDM, 1-h glucose again emerged as strongest predictor of dysglycemia (13.0%), followed by 2-h glucose (12.8%). CONCLUSIONS The 1-h OGTT may offer a strategy for increasing rates of postpartum reclassification following hyperglycemia in pregnancy.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"35 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adi Vinograd, Tsahi T. Lerman, Orit Pinhas-Hamiel, Aya Bardugo, Cole D. Bendor, Estela Derazne, Josef Coresh, Ofir Vinograd, Miri Lutski, Inbar Zucker, Michal Bromberg, Tamar Fishman, Gabriel Chodick, Hertzel C. Gerstein, Tali Cukierman-Yaffe, Asaf Vivante, Adi Leiba, Arnon Afek, Amir Tirosh, Boris Fishman, Gilad Twig
OBJECTIVE We assess diabetes risk in adulthood among adolescents with isolated glucosuria. RESEARCH DESIGN AND METHODS Included were adolescents (16–19 years) examined before military service between 1993 and 2015. Data were linked with the Israeli National Diabetes Registry. Glucosuria was confirmed following normal renal function and glucose tolerance tests. Cox models were applied. RESULTS The study included 1,611,467 adolescents, of whom 755 (0.05%) had glucosuria. The latter group had a higher proportion of males (75% vs. 57%) and a lower proportion of BMI ≥ 85th percentile (10.4% vs. 16.3%) compared with nonglucosuric (all P < 0.001). During follow-up, 10,328 diabetes cases were recorded with an incidence rate of 87.5 and 43.3 per 100,000 person-years for those with versus without glucosuria, respectively. Individuals with glucosuria had an adjusted hazard ratio of 2.17 (95% CI, 1.17–4.04) for diabetes. CONCLUSIONS Glucosuria in adolescents is associated with an increased risk of early-onset diabetes.
{"title":"Isolated Glucosuria in Adolescence and Early-Onset Diabetes: A Nationwide Cohort Study of 1.6 Million Adolescents","authors":"Adi Vinograd, Tsahi T. Lerman, Orit Pinhas-Hamiel, Aya Bardugo, Cole D. Bendor, Estela Derazne, Josef Coresh, Ofir Vinograd, Miri Lutski, Inbar Zucker, Michal Bromberg, Tamar Fishman, Gabriel Chodick, Hertzel C. Gerstein, Tali Cukierman-Yaffe, Asaf Vivante, Adi Leiba, Arnon Afek, Amir Tirosh, Boris Fishman, Gilad Twig","doi":"10.2337/dc24-2402","DOIUrl":"https://doi.org/10.2337/dc24-2402","url":null,"abstract":"OBJECTIVE We assess diabetes risk in adulthood among adolescents with isolated glucosuria. RESEARCH DESIGN AND METHODS Included were adolescents (16–19 years) examined before military service between 1993 and 2015. Data were linked with the Israeli National Diabetes Registry. Glucosuria was confirmed following normal renal function and glucose tolerance tests. Cox models were applied. RESULTS The study included 1,611,467 adolescents, of whom 755 (0.05%) had glucosuria. The latter group had a higher proportion of males (75% vs. 57%) and a lower proportion of BMI ≥ 85th percentile (10.4% vs. 16.3%) compared with nonglucosuric (all P &lt; 0.001). During follow-up, 10,328 diabetes cases were recorded with an incidence rate of 87.5 and 43.3 per 100,000 person-years for those with versus without glucosuria, respectively. Individuals with glucosuria had an adjusted hazard ratio of 2.17 (95% CI, 1.17–4.04) for diabetes. CONCLUSIONS Glucosuria in adolescents is associated with an increased risk of early-onset diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"27 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143507121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth A. Mann, Saketh Rompicherla, Brian Miyazaki, Nicole Rioles, Holly Hardison, Lauren Golden, Jennifer Sarhis, Halis K. Akturk, Joyce Lee, Daniel J. DeSalvo, Patricia Gomez, Osagie Ebekozien, Priya Prahalad
OBJECTIVE Early initiation of continuous glucose monitor (CGM) after type 1 diabetes (T1D) diagnosis has been associated with lower hemoglobin A1C (HbA1c) in single-institution studies. This multicenter study evaluated the association between the timing of CGM initiation and HbA1c at 3 years postdiagnosis. RESEARCH DESIGN AND METHODS Data were obtained from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) electronic health record database from 25 pediatric centers and included children and adolescents ≤18 years old diagnosed with T1D in 2019 and 2020. CGM initiation and glycemic outcomes were followed for 3 years after diagnosis. Locally estimated scatterplot smoothing plots evaluated the relationship between timing of CGM initiation and HbA1c over time, and logistic regression models were used to adjust for potential confounders. RESULTS There were 4,164 people included in this analysis, mean age was 12.6 (SD 3.5) years, and 37% had public health insurance. Of the 93% (n = 3,877) who initiated CGM within 3 years of T1D diagnosis, 21% did so at 0–3 months, 14% at 3–6 months, 14% at 6–12 months, and 51% after 12 months. Median HbA1c at 3 years postdiagnosis was lower for the 0–3 and 3–6 months groups compared with the 6–12 months and non-CGM user groups (7.9%, 7.9%, 8.4%, and 9.5%, respectively). Adjusted odds of HbA1c >9% were lowest for the 0–3 months group followed by the 3–6 months group. CONCLUSIONS In summary, early initiation of CGM within the first 6 months of diagnosis is associated with improved HbA1c outcomes at 3 years postdiagnosis.
{"title":"Early Continuous Glucose Monitor Use in Children and Adolescents With Type 1 Diabetes: Rates of Initiation and Impact on Glycemic Outcomes","authors":"Elizabeth A. Mann, Saketh Rompicherla, Brian Miyazaki, Nicole Rioles, Holly Hardison, Lauren Golden, Jennifer Sarhis, Halis K. Akturk, Joyce Lee, Daniel J. DeSalvo, Patricia Gomez, Osagie Ebekozien, Priya Prahalad","doi":"10.2337/dc25-0076","DOIUrl":"https://doi.org/10.2337/dc25-0076","url":null,"abstract":"OBJECTIVE Early initiation of continuous glucose monitor (CGM) after type 1 diabetes (T1D) diagnosis has been associated with lower hemoglobin A1C (HbA1c) in single-institution studies. This multicenter study evaluated the association between the timing of CGM initiation and HbA1c at 3 years postdiagnosis. RESEARCH DESIGN AND METHODS Data were obtained from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) electronic health record database from 25 pediatric centers and included children and adolescents ≤18 years old diagnosed with T1D in 2019 and 2020. CGM initiation and glycemic outcomes were followed for 3 years after diagnosis. Locally estimated scatterplot smoothing plots evaluated the relationship between timing of CGM initiation and HbA1c over time, and logistic regression models were used to adjust for potential confounders. RESULTS There were 4,164 people included in this analysis, mean age was 12.6 (SD 3.5) years, and 37% had public health insurance. Of the 93% (n = 3,877) who initiated CGM within 3 years of T1D diagnosis, 21% did so at 0–3 months, 14% at 3–6 months, 14% at 6–12 months, and 51% after 12 months. Median HbA1c at 3 years postdiagnosis was lower for the 0–3 and 3–6 months groups compared with the 6–12 months and non-CGM user groups (7.9%, 7.9%, 8.4%, and 9.5%, respectively). Adjusted odds of HbA1c &gt;9% were lowest for the 0–3 months group followed by the 3–6 months group. CONCLUSIONS In summary, early initiation of CGM within the first 6 months of diagnosis is associated with improved HbA1c outcomes at 3 years postdiagnosis.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"69 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143507120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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