Colette J. Brown, Scott C. Roesch, Carlos E. Rosas, Jessica L. McCurley, Christina Cordero, Gabriela Trifan, Fernando Testai, Beibo Zhao, Jianwen Cai, Carmen R. Isasi, Linda C. Gallo
OBJECTIVE Social determinants of health (SDoHs) account for more than half of the variance in racial and ethnic disparities in health. However, few studies have examined how SDoHs may cluster in ways that affect health. We aimed to identify patterns of social adversity and their differential associations with both diabetes status at baseline and change in diabetes status across ∼12 years among Hispanic/Latino adults. RESEARCH DESIGN AND METHODS Participants were from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; N = 16,415; aged 18–74 years). Diabetes status (defined as normoglycemia, prediabetes, or diabetes per American Diabetes Association criteria) was measured by clinical assessment and self-reported medications at baseline (2008–2011) and two follow-up visits (2014–2017 and 2020–2024). SDoHs were assessed at baseline and as part of the HCHS/SOL Sociocultural Ancillary Study (2010–2012). RESULTS Latent class analyses of nine SDoHs (income, education, employment status, home ownership, language and social acculturation, chronic stressors, family cohesion, and social support) revealed four distinct patterns of social adversity: 1) low adversity, 2) social/educational strengths, 3) acculturated and underresourced, and 4) high adversity. Compared with the low-adversity group, the high-adversity group had the highest odds of worse diabetes status at baseline and had greater odds of worsening diabetes status over time. CONCLUSIONS SDoHs cluster in distinct ways that affect diabetes outcomes; social adversities must be addressed to mitigate diabetes burden among Hispanic/Latino adults.
目的：健康的社会决定因素（SDoHs）占种族和民族健康差异的一半以上。然而，很少有研究调查SDoHs如何以影响健康的方式聚集在一起。我们旨在确定西班牙裔/拉丁裔成年人的社会逆境模式及其与基线时糖尿病状况和糖尿病状况变化之间的差异关系。研究设计和方法参与者来自西班牙裔社区健康研究/拉丁裔研究（HCHS/SOL; N = 16,415；年龄18-74岁）。通过临床评估和基线（2008-2011年）和两次随访（2014-2017年和2020-2024年）的自我报告药物来测量糖尿病状态（定义为血糖正常、前驱糖尿病或美国糖尿病协会标准的糖尿病）。SDoHs在基线进行评估，并作为HCHS/SOL社会文化辅助研究（2010-2012）的一部分。结果对收入、受教育程度、就业状况、住房拥有率、语言和社会文化适应、慢性压力源、家庭凝聚力和社会支持等9个sdoh的潜在阶层分析显示，社会逆境有4种不同的模式：1)低逆境，2)社会/教育优势，3)文化适应和资源不足，4)高逆境。与低逆境组相比，高逆境组在基线时糖尿病恶化的几率最高，随着时间的推移，糖尿病恶化的几率也更高。结论：sdoh以不同的方式聚集影响糖尿病结局；必须解决社会逆境，以减轻西班牙裔/拉丁裔成年人的糖尿病负担。
{"title":"Profiles of Social Determinants of Health and Change in Diabetes Status Among U.S. Hispanic/Latino Adults: HCHS/SOL, 2008–2024","authors":"Colette J. Brown, Scott C. Roesch, Carlos E. Rosas, Jessica L. McCurley, Christina Cordero, Gabriela Trifan, Fernando Testai, Beibo Zhao, Jianwen Cai, Carmen R. Isasi, Linda C. Gallo","doi":"10.2337/dc25-2797","DOIUrl":"https://doi.org/10.2337/dc25-2797","url":null,"abstract":"OBJECTIVE Social determinants of health (SDoHs) account for more than half of the variance in racial and ethnic disparities in health. However, few studies have examined how SDoHs may cluster in ways that affect health. We aimed to identify patterns of social adversity and their differential associations with both diabetes status at baseline and change in diabetes status across ∼12 years among Hispanic/Latino adults. RESEARCH DESIGN AND METHODS Participants were from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; N = 16,415; aged 18–74 years). Diabetes status (defined as normoglycemia, prediabetes, or diabetes per American Diabetes Association criteria) was measured by clinical assessment and self-reported medications at baseline (2008–2011) and two follow-up visits (2014–2017 and 2020–2024). SDoHs were assessed at baseline and as part of the HCHS/SOL Sociocultural Ancillary Study (2010–2012). RESULTS Latent class analyses of nine SDoHs (income, education, employment status, home ownership, language and social acculturation, chronic stressors, family cohesion, and social support) revealed four distinct patterns of social adversity: 1) low adversity, 2) social/educational strengths, 3) acculturated and underresourced, and 4) high adversity. Compared with the low-adversity group, the high-adversity group had the highest odds of worse diabetes status at baseline and had greater odds of worsening diabetes status over time. CONCLUSIONS SDoHs cluster in distinct ways that affect diabetes outcomes; social adversities must be addressed to mitigate diabetes burden among Hispanic/Latino adults.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"20 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147506745","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}
Yeyi Zhu, Amanda L. Ngo, Lauren D. Liao, Rachel Harvill, Ben J. Marafino, Rana F. Chehab, Mara B. Greenberg, Assiamira Ferrara
OBJECTIVE Management of gestational diabetes mellitus (GDM) largely follows a uniform approach, despite growing recognition of GDM heterogeneity. We aimed to identify data-driven GDM clusters by using machine learning techniques and clinical data and to assess their associations with perinatal complications and postpartum diabetes risk. RESEARCH DESIGN AND METHODS In a population-based cohort study, 37,544 individuals with GDM were followed up through 12 years postpartum. In the discovery (70%) and validation (30%) sets, we applied dimension reduction and clustering methods using routinely available sociodemographic, behavioral, and clinical variables. Covariate-adjusted modified Poisson and Cox regression models were used to assess associations of GDM clusters with risk of perinatal complications and postpartum diabetes. RESULTS Four data-driven GDM phenotypic clusters were identified. Cluster 1 (C1) (65.6%), C2 (14.5%), C3 (12.0%), and C4 (7.8%) comprised the discovery set, with similar distributions in the validation set (C1–C4 66.7%, 14.0%, 12.0%, 7.4%, respectively). C2–C4 compared with C1 (late-diagnosed, lower-BMI, and postload hyperglycemia GDM) were associated with higher risks of perinatal complications and new-onset postpartum diabetes, especially C4 (early-diagnosed, comorbidity-related, and high–glucose challenge test GDM) (adjusted relative risks: severe maternal morbidity 1.43 [95% CI 1.19, 1.72] and neonatal intensive unit admission 1.53 [1.41, 1.66]; adjusted hazard ratio for diabetes 4.32 [95% CI 3.94, 4.73]). Within the largest cluster C1, three subclusters were identified, with differential risks of perinatal complications but not postpartum diabetes. CONCLUSIONS Our study identified distinct data-driven GDM phenotypic clusters with differential risks of perinatal complications and postpartum diabetes. These findings may inform personalized risk assessment and management strategies tailored to GDM phenotypic clusters to possibly reduce adverse health outcomes.
目的：尽管人们越来越认识到妊娠期糖尿病的异质性，但妊娠期糖尿病（GDM）的治疗在很大程度上遵循统一的方法。我们的目的是通过使用机器学习技术和临床数据来识别数据驱动的GDM集群，并评估它们与围产期并发症和产后糖尿病风险的关系。研究设计和方法在一项基于人群的队列研究中，对37,544名GDM患者进行了产后12年的随访。在发现集（70%）和验证集（30%）中，我们使用常规可用的社会人口学、行为和临床变量应用降维和聚类方法。采用协变量校正修正泊松和Cox回归模型来评估GDM集群与围产期并发症和产后糖尿病风险的关系。结果确定了四个数据驱动的GDM表型簇。聚类1 (C1)（65.6%）、C2（14.5%）、C3（12.0%）和C4（7.8%）组成了发现集，在验证集中分布相似（C1 - C4分别为66.7%、14.0%、12.0%和7.4%）。C2-C4与C1（晚期诊断、低bmi和负荷后高血糖GDM）相比，围产期并发症和产后新发糖尿病的风险更高，尤其是C4（早期诊断、合并症相关和高糖挑战试验GDM）（调整相对风险：重度产妇发病率1.43 [95% CI 1.19, 1.72]，新生儿重症监护病房入院1.53[1.41,1.66]；调整糖尿病风险比4.32 [95% CI 3.94, 4.73]）。在最大的簇C1中，确定了三个亚簇，围产儿并发症的风险不同，但没有产后糖尿病。结论：我们的研究确定了不同的数据驱动的GDM表型簇，具有围产期并发症和产后糖尿病的不同风险。这些发现可能为针对GDM表型集群的个性化风险评估和管理策略提供信息，从而可能减少不良健康结果。
{"title":"Data-Driven Phenotypic Clusters of Gestational Diabetes Mellitus and Associations With Risk of Perinatal Complications and Postpartum Diabetes","authors":"Yeyi Zhu, Amanda L. Ngo, Lauren D. Liao, Rachel Harvill, Ben J. Marafino, Rana F. Chehab, Mara B. Greenberg, Assiamira Ferrara","doi":"10.2337/dc25-2131","DOIUrl":"https://doi.org/10.2337/dc25-2131","url":null,"abstract":"OBJECTIVE Management of gestational diabetes mellitus (GDM) largely follows a uniform approach, despite growing recognition of GDM heterogeneity. We aimed to identify data-driven GDM clusters by using machine learning techniques and clinical data and to assess their associations with perinatal complications and postpartum diabetes risk. RESEARCH DESIGN AND METHODS In a population-based cohort study, 37,544 individuals with GDM were followed up through 12 years postpartum. In the discovery (70%) and validation (30%) sets, we applied dimension reduction and clustering methods using routinely available sociodemographic, behavioral, and clinical variables. Covariate-adjusted modified Poisson and Cox regression models were used to assess associations of GDM clusters with risk of perinatal complications and postpartum diabetes. RESULTS Four data-driven GDM phenotypic clusters were identified. Cluster 1 (C1) (65.6%), C2 (14.5%), C3 (12.0%), and C4 (7.8%) comprised the discovery set, with similar distributions in the validation set (C1–C4 66.7%, 14.0%, 12.0%, 7.4%, respectively). C2–C4 compared with C1 (late-diagnosed, lower-BMI, and postload hyperglycemia GDM) were associated with higher risks of perinatal complications and new-onset postpartum diabetes, especially C4 (early-diagnosed, comorbidity-related, and high–glucose challenge test GDM) (adjusted relative risks: severe maternal morbidity 1.43 [95% CI 1.19, 1.72] and neonatal intensive unit admission 1.53 [1.41, 1.66]; adjusted hazard ratio for diabetes 4.32 [95% CI 3.94, 4.73]). Within the largest cluster C1, three subclusters were identified, with differential risks of perinatal complications but not postpartum diabetes. CONCLUSIONS Our study identified distinct data-driven GDM phenotypic clusters with differential risks of perinatal complications and postpartum diabetes. These findings may inform personalized risk assessment and management strategies tailored to GDM phenotypic clusters to possibly reduce adverse health outcomes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"5 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470892","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}
Jantje Weiskorn, Marianne Becker, Clemens Kamrath, Johanna Hammersen, Susanne Bechtold-Dalla Pozza, Elke Müller-Roßberg, Martin Holder, Marie-Anne Burckhardt, Reinhard Walter Holl
OBJECTIVE We investigated the prevalence of elevated LDL cholesterol in youths with type 1 diabetes (T1D), contributing factors, the frequency of lipid-lowering medication (LLM), and the achievement of target values. RESEARCH DESIGN AND METHODS A cross-sectional analysis based on data from the Diabetes-Patienten-Verlaufsdokumentation registry (Diabetes Prospective Follow-up Registry) from 2013 to 2023. Inclusion criteria were T1D, age <18 years, and at least one documented LDL measurement. LDL cut offs of >2.6, >3.4, and >4.1 mmol/L were defined. Application of national and international treatment guidelines was examined. Descriptive analyses and linear and logistic regression models were implemented using SAS 9.4. RESULTS The study included 55,028 participants. Of these, 9.7% and 2.3% had LDL >3.4 mmol/L and >4.1 mmol/L, respectively. The parameters HbA1c (β = 1,142.7; P = 0.001), female sex (β = 861.5; P < 0.001), and BMI >70th percentile (β = 520.1; P < 0.001) had the strongest effect on LDL levels. Only 7.3% of the cohort with elevated LDL levels received LLM. The majority (92.7%) with LDL >3.4 mmol/L and 87.0% with LDL >4.1 mmol/L were not treated. Estimated odds ratios (95% CI) for the use of LLM were 19.13 (15.4–23.7) for LDL >4.1 mmol/L; 3.1 (1.82–5.41) for ages 12–18 years; 2.31 (1.9–2.1) for diabetes duration of 5–10 years; 1.8 (1.5–2.1) for BMI >70th percentile; 1.3 (1.0–1.6) for HbA1c >9%; and 1.18 (1.0–1.4) for female sex. However, only 15.7% of the treated patients (n = 707) reached the LDL target of <2.6 mmol/L, and LDL levels of 55% even remained at >3.4 mmol/L. CONCLUSIONS We found a high prevalence of LDL hypercholesterolemia. The use of LLM was low, despite treatment indication, and treatment targets were mostly not achieved either due to underdosing or nonadherence to LLM. These findings confirm that dyslipidemia remains an underestimated cardiovascular risk factor in pediatric diabetology.
{"title":"Hypercholesterolemia and Lipid-Lowering Therapy in Children and Adolescents With Type 1 Diabetes: Do We Implement Current Guidelines?","authors":"Jantje Weiskorn, Marianne Becker, Clemens Kamrath, Johanna Hammersen, Susanne Bechtold-Dalla Pozza, Elke Müller-Roßberg, Martin Holder, Marie-Anne Burckhardt, Reinhard Walter Holl","doi":"10.2337/dc25-2459","DOIUrl":"https://doi.org/10.2337/dc25-2459","url":null,"abstract":"OBJECTIVE We investigated the prevalence of elevated LDL cholesterol in youths with type 1 diabetes (T1D), contributing factors, the frequency of lipid-lowering medication (LLM), and the achievement of target values. RESEARCH DESIGN AND METHODS A cross-sectional analysis based on data from the Diabetes-Patienten-Verlaufsdokumentation registry (Diabetes Prospective Follow-up Registry) from 2013 to 2023. Inclusion criteria were T1D, age &lt;18 years, and at least one documented LDL measurement. LDL cut offs of &gt;2.6, &gt;3.4, and &gt;4.1 mmol/L were defined. Application of national and international treatment guidelines was examined. Descriptive analyses and linear and logistic regression models were implemented using SAS 9.4. RESULTS The study included 55,028 participants. Of these, 9.7% and 2.3% had LDL &gt;3.4 mmol/L and &gt;4.1 mmol/L, respectively. The parameters HbA1c (β = 1,142.7; P = 0.001), female sex (β = 861.5; P &lt; 0.001), and BMI &gt;70th percentile (β = 520.1; P &lt; 0.001) had the strongest effect on LDL levels. Only 7.3% of the cohort with elevated LDL levels received LLM. The majority (92.7%) with LDL &gt;3.4 mmol/L and 87.0% with LDL &gt;4.1 mmol/L were not treated. Estimated odds ratios (95% CI) for the use of LLM were 19.13 (15.4–23.7) for LDL &gt;4.1 mmol/L; 3.1 (1.82–5.41) for ages 12–18 years; 2.31 (1.9–2.1) for diabetes duration of 5–10 years; 1.8 (1.5–2.1) for BMI &gt;70th percentile; 1.3 (1.0–1.6) for HbA1c &gt;9%; and 1.18 (1.0–1.4) for female sex. However, only 15.7% of the treated patients (n = 707) reached the LDL target of &lt;2.6 mmol/L, and LDL levels of 55% even remained at &gt;3.4 mmol/L. CONCLUSIONS We found a high prevalence of LDL hypercholesterolemia. The use of LLM was low, despite treatment indication, and treatment targets were mostly not achieved either due to underdosing or nonadherence to LLM. These findings confirm that dyslipidemia remains an underestimated cardiovascular risk factor in pediatric diabetology.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"21 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470891","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}
Moritz V. Warmbrunn, Lin Yang, Raaj Kishore Biswas, Calen P. Ryan, Andrew Harper, Daniel W. Belsky, Giovanni Fiorito, Luigi Fontana
OBJECTIVE To investigate the long-term metabolic and hormonal consequences of sustained weight loss versus weight regain after 1 year of caloric restriction (CR), with attention to insulin resistance and type 2 diabetes risk. RESEARCH DESIGN AND METHODS In the 2-year Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy 2 (CALERIE-2) trial (n = 220), participants were randomized to 25% CR or control diet. The intervention targeted weight loss over the first 6–12 months, followed by a 12-month maintenance phase. To assess weight-regain consequences, participants were stratified by weight trajectory regardless of randomization, and group differences were balanced by propensity score weighting. Cardiometabolic and hormonal markers of available participants (n = 190), as well as a biomarker-based estimate of biological age, were compared across weight trajectory groups. RESULTS At 12 months, weight loss ranged from 5.0 to 5.8 kg between groups. Between months 12 and 24, most participants either maintained weight (n = 112) or continued to lose weight (n = 58), whereas a smaller group regained >5% of baseline weight (n = 20). This group had the largest initial caloric reductions. Weight regain reversed improvements in insulin area under the curve and the ratio of insulin-like growth factor 1 (IGF-1) to insulin-like growth factor-binding protein 1, and sustained weight loss maintained metabolic benefits and was associated with greater reductions in biological age. CONCLUSIONS Substantial weight loss followed by weight regain can attenuate or reverse CR-induced benefits on key regulators of the insulin–IGF-1 nutrient-sensing pathway and markers of biological aging. Sustained, moderate weight loss more effectively improves insulin resistance and maintains favorable hormonal profiles linked to type 2 diabetes risk and aging biology.
{"title":"Weight Regain Reverses Caloric Restriction–Induced Benefits on the Insulin–IGF-1 Nutrient-Sensing Pathway: Post Hoc Analysis From the CALERIE-2 Randomized Controlled Trial","authors":"Moritz V. Warmbrunn, Lin Yang, Raaj Kishore Biswas, Calen P. Ryan, Andrew Harper, Daniel W. Belsky, Giovanni Fiorito, Luigi Fontana","doi":"10.2337/dc25-1911","DOIUrl":"https://doi.org/10.2337/dc25-1911","url":null,"abstract":"OBJECTIVE To investigate the long-term metabolic and hormonal consequences of sustained weight loss versus weight regain after 1 year of caloric restriction (CR), with attention to insulin resistance and type 2 diabetes risk. RESEARCH DESIGN AND METHODS In the 2-year Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy 2 (CALERIE-2) trial (n = 220), participants were randomized to 25% CR or control diet. The intervention targeted weight loss over the first 6–12 months, followed by a 12-month maintenance phase. To assess weight-regain consequences, participants were stratified by weight trajectory regardless of randomization, and group differences were balanced by propensity score weighting. Cardiometabolic and hormonal markers of available participants (n = 190), as well as a biomarker-based estimate of biological age, were compared across weight trajectory groups. RESULTS At 12 months, weight loss ranged from 5.0 to 5.8 kg between groups. Between months 12 and 24, most participants either maintained weight (n = 112) or continued to lose weight (n = 58), whereas a smaller group regained &gt;5% of baseline weight (n = 20). This group had the largest initial caloric reductions. Weight regain reversed improvements in insulin area under the curve and the ratio of insulin-like growth factor 1 (IGF-1) to insulin-like growth factor-binding protein 1, and sustained weight loss maintained metabolic benefits and was associated with greater reductions in biological age. CONCLUSIONS Substantial weight loss followed by weight regain can attenuate or reverse CR-induced benefits on key regulators of the insulin–IGF-1 nutrient-sensing pathway and markers of biological aging. Sustained, moderate weight loss more effectively improves insulin resistance and maintains favorable hormonal profiles linked to type 2 diabetes risk and aging biology.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"11 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147465233","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}
Subin Jang, Yinzhao Wang, Sisi Ma, Daniel S. Hsia, Kristina Cossen, David Haynes, Megan O. Bensignor
OBJECTIVE To evaluate whether the Area Deprivation Index (ADI) contributes to predicting type 2 diabetes development in youth with prediabetes compared with a machine learning (ML) model built with other data elements. RESEARCH DESIGN AND METHODS Patient encounters (n = 665) from an electronic medical record were used to build supervised ML models to predict type 2 diabetes development within 1 year of prediabetes diagnosis. The ADI was constructed using patients’ census block data. Two models, trained on data with and without ADI, were built. The model selection resulted in logistic regressions with 1) HbA1c only and 2) HbA1c + ADI as the best models from each data set. RESULTS A total of 181 patient encounters (27.2%) developed type 2 diabetes. The area under the receiver operating characteristic curve of the HbA1c-only model was 0.68 and of the HbA1c + ADI model, 0.73. CONCLUSIONS The addition of ADI to the model resulted in the best performance in predicting youth-onset type 2 diabetes development.
{"title":"Improving the Algorithm: The Inclusion of a Socioeconomic Status Measure in Predicting Type 2 Diabetes Development in Youth With Prediabetes","authors":"Subin Jang, Yinzhao Wang, Sisi Ma, Daniel S. Hsia, Kristina Cossen, David Haynes, Megan O. Bensignor","doi":"10.2337/dc25-3060","DOIUrl":"https://doi.org/10.2337/dc25-3060","url":null,"abstract":"OBJECTIVE To evaluate whether the Area Deprivation Index (ADI) contributes to predicting type 2 diabetes development in youth with prediabetes compared with a machine learning (ML) model built with other data elements. RESEARCH DESIGN AND METHODS Patient encounters (n = 665) from an electronic medical record were used to build supervised ML models to predict type 2 diabetes development within 1 year of prediabetes diagnosis. The ADI was constructed using patients’ census block data. Two models, trained on data with and without ADI, were built. The model selection resulted in logistic regressions with 1) HbA1c only and 2) HbA1c + ADI as the best models from each data set. RESULTS A total of 181 patient encounters (27.2%) developed type 2 diabetes. The area under the receiver operating characteristic curve of the HbA1c-only model was 0.68 and of the HbA1c + ADI model, 0.73. CONCLUSIONS The addition of ADI to the model resulted in the best performance in predicting youth-onset type 2 diabetes development.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"20 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147462150","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}
OBJECTIVE mtDNA copy number (CN) reflects mitochondrial function, but prior studies have reported inconsistent associations with type 2 diabetes risk, ranging from inverse to positive or null findings. We hypothesized that mtDNA-CN is nonlinearly associated with incident type 2 diabetes. RESEARCH DESIGN AND METHODS We included 34,835 adults without diabetes from the Kunshan Aging Research With E-Health (KARE) cohort and 289,338 from the UK Biobank (UKB). Associations between blood mtDNA-CN and incident type 2 diabetes were evaluated using Cox proportional hazards and restricted cubic spline models stratified by age. RESULTS A U-shaped association was observed in the KARE cohort (P < 0.001), in which the hazard ratios (95% CIs) across increasing mtDNA-CN quartiles were 1.00 (reference), 0.94 (0.88–1.00), 0.85 (0.79–0.91), and 0.93 (0.87–1.00). In contrast, the UKB cohort exhibited a predominantly inverse linear trend. Age-stratified analyses revealed that this U-shaped association was particularly evident in younger participants (aged <65 years in KARE and <50 years in UKB), indicating elevated diabetes risk at both low and high mtDNA-CN levels. Additionally, mtDNA-CN declined with age in both cohorts, with an accelerated decrease beyond ∼65 years in KARE and ∼50 years in UKB. CONCLUSIONS Blood mtDNA-CN showed a U-shaped association with incident type 2 diabetes in younger individuals.
{"title":"A U-Shaped Association Between Blood mtDNA Copy Number and Risk of Type 2 Diabetes","authors":"Xinhao Huang, Zijian Tian, Ying Pan, Jia Zhang, Benrui Wu, Shiteng Gao, Yao Cheng, Qi Hu, Jinxiang Ma, Qi Pan, Jian Shao, Kaixin Zhou","doi":"10.2337/dc25-2198","DOIUrl":"https://doi.org/10.2337/dc25-2198","url":null,"abstract":"OBJECTIVE mtDNA copy number (CN) reflects mitochondrial function, but prior studies have reported inconsistent associations with type 2 diabetes risk, ranging from inverse to positive or null findings. We hypothesized that mtDNA-CN is nonlinearly associated with incident type 2 diabetes. RESEARCH DESIGN AND METHODS We included 34,835 adults without diabetes from the Kunshan Aging Research With E-Health (KARE) cohort and 289,338 from the UK Biobank (UKB). Associations between blood mtDNA-CN and incident type 2 diabetes were evaluated using Cox proportional hazards and restricted cubic spline models stratified by age. RESULTS A U-shaped association was observed in the KARE cohort (P &lt; 0.001), in which the hazard ratios (95% CIs) across increasing mtDNA-CN quartiles were 1.00 (reference), 0.94 (0.88–1.00), 0.85 (0.79–0.91), and 0.93 (0.87–1.00). In contrast, the UKB cohort exhibited a predominantly inverse linear trend. Age-stratified analyses revealed that this U-shaped association was particularly evident in younger participants (aged &lt;65 years in KARE and &lt;50 years in UKB), indicating elevated diabetes risk at both low and high mtDNA-CN levels. Additionally, mtDNA-CN declined with age in both cohorts, with an accelerated decrease beyond ∼65 years in KARE and ∼50 years in UKB. CONCLUSIONS Blood mtDNA-CN showed a U-shaped association with incident type 2 diabetes in younger individuals.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"13 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147462178","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}
Leila R. Zelnick, Subbulaxmi Trikudanathan, Yoshio N. Hall, Ernest Ayers, Lisa Anderson, Nathaniel Ashford, Evelin Jones, Andrea C. Rivas-Nieto, Simon Hsu, Kuanysh Kabytaev, Zhuo Wang, Andrew N. Hoofnagle, Irl B. Hirsch, Ian H. de Boer
OBJECTIVE Accurate assessment of glycemia in patients treated with maintenance dialysis is imperative and hampered by known biases of glycated hemoglobin (HbA1c) in kidney failure (KF). This study evaluated the accuracy, variability, and covariate bias of three glycemic biomarkers compared with glycemia measured by continuous glucose monitor (CGM) among people with and without diabetes treated with maintenance dialysis. RESEARCH DESIGN AND METHODS In a prospective community-based cohort study, 251 participants treated with maintenance dialysis wore a Dexcom G6 Pro CGM for 10 days. We compared correlations of HbA1c, glycated albumin (GA), and fructosamine with CGM-derived mean glycemia and examined sources of bias. RESULTS Participants (43% women; 63% with diabetes) had a median of 9.3 (interquartile range 8.5–9.4) valid days of CGM data. Mean (SD) HbA1c, GA, fructosamine, and mean CGM glucose were 6.2% (1.4%), 19.6% (6.3%), 351 (99) µmol/L, and 170 (63) mg/dL, respectively. HbA1c, GA, and fructosamine all strongly correlated with mean CGM blood glucose, with HbA1c and GA more correlated than fructosamine (overall, r = 0.85, r = 0.87, and r = 0.70, respectively; in diabetes, r = 0.84, r = 0.84, and r = 0.64, respectively). Compared with mean CGM glucose, HbA1c was significantly biased by erythropoiesis-stimulating agent dose, BMI, hemoglobin, and serum albumin; GA and fructosamine were biased by dialysis modality and vintage, residual kidney function, and BMI. CONCLUSIONS HbA1c and GA were strongly correlated with mean CGM blood glucose, but all biomarkers had substantial bias by relevant clinical characteristics. HbA1c and GA may be useful assessments of average glycemia in patients treated with maintenance dialysis, if bias can be adequately addressed.
{"title":"Accuracy, Variability, and Bias of Glycemic Biomarkers in Patients Treated With Maintenance Dialysis","authors":"Leila R. Zelnick, Subbulaxmi Trikudanathan, Yoshio N. Hall, Ernest Ayers, Lisa Anderson, Nathaniel Ashford, Evelin Jones, Andrea C. Rivas-Nieto, Simon Hsu, Kuanysh Kabytaev, Zhuo Wang, Andrew N. Hoofnagle, Irl B. Hirsch, Ian H. de Boer","doi":"10.2337/dc25-2952","DOIUrl":"https://doi.org/10.2337/dc25-2952","url":null,"abstract":"OBJECTIVE Accurate assessment of glycemia in patients treated with maintenance dialysis is imperative and hampered by known biases of glycated hemoglobin (HbA1c) in kidney failure (KF). This study evaluated the accuracy, variability, and covariate bias of three glycemic biomarkers compared with glycemia measured by continuous glucose monitor (CGM) among people with and without diabetes treated with maintenance dialysis. RESEARCH DESIGN AND METHODS In a prospective community-based cohort study, 251 participants treated with maintenance dialysis wore a Dexcom G6 Pro CGM for 10 days. We compared correlations of HbA1c, glycated albumin (GA), and fructosamine with CGM-derived mean glycemia and examined sources of bias. RESULTS Participants (43% women; 63% with diabetes) had a median of 9.3 (interquartile range 8.5–9.4) valid days of CGM data. Mean (SD) HbA1c, GA, fructosamine, and mean CGM glucose were 6.2% (1.4%), 19.6% (6.3%), 351 (99) µmol/L, and 170 (63) mg/dL, respectively. HbA1c, GA, and fructosamine all strongly correlated with mean CGM blood glucose, with HbA1c and GA more correlated than fructosamine (overall, r = 0.85, r = 0.87, and r = 0.70, respectively; in diabetes, r = 0.84, r = 0.84, and r = 0.64, respectively). Compared with mean CGM glucose, HbA1c was significantly biased by erythropoiesis-stimulating agent dose, BMI, hemoglobin, and serum albumin; GA and fructosamine were biased by dialysis modality and vintage, residual kidney function, and BMI. CONCLUSIONS HbA1c and GA were strongly correlated with mean CGM blood glucose, but all biomarkers had substantial bias by relevant clinical characteristics. HbA1c and GA may be useful assessments of average glycemia in patients treated with maintenance dialysis, if bias can be adequately addressed.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"80 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383341","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}
John W. Ostrominski, Janinne Ortega-Montiel, Deborah J. Wexler, Brendan M. Everett, Sara J. Cromer, Caroline F. Byrne, Robert J. Glynn, Julie M. Paik, Elisabetta Patorno
OBJECTIVE To evaluate the comparative effectiveness of dulaglutide or semaglutide versus tirzepatide on cardiovascular outcomes in adults with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). RESEARCH DESIGN AND METHODS Two target trial emulations included commercially insured adults (June 2022–December 2024) with T2D and ASCVD who initiated subcutaneous tirzepatide, dulaglutide, or semaglutide. The primary outcome was modified major adverse cardiovascular events (MACE), defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause death. First, new users of tirzepatide and dulaglutide were propensity score (PS) matched one to one. Second, new users of tirzepatide and semaglutide were PS matched one to one. Incidence rates (IRs) per 1,000 person-years and hazard ratios (HRs) were estimated. RESULTS After PS matching, 9,233 pairs of tirzepatide or dulaglutide initiators and 25,266 pairs of tirzepatide or semaglutide initiators were identified. Tirzepatide initiators experienced a lower rate of modified MACE versus dulaglutide initiators (IR 31.3 vs. 39.4, respectively; HR 0.80 [95% CI 0.65–0.99]), which seemed to be driven by lower all-cause mortality among tirzepatide versus dulaglutide initiators (HR 0.60 [95% CI 0.43–0.83]). In post hoc analyses, tirzepatide was associated with lower rates of pneumonia-related hospitalization when compared with dulaglutide. Rates of modified MACE were similar among tirzepatide and semaglutide initiators (IR 23.7 vs. 23.2, respectively; HR 1.03 [95% CI 0.90–1.17]). CONCLUSIONS Among adults with T2D and ASCVD in routine care, tirzepatide was associated with a lower risk of modified MACE when compared with dulaglutide, driven by reduction in all-cause mortality. Risks of modified MACE seemed similar with tirzepatide and semaglutide.
目的评价杜拉鲁肽或西马鲁肽与替西帕肽对成人2型糖尿病（T2D）和动脉粥样硬化性心血管疾病（ASCVD）心血管结局的比较效果。研究设计和方法两项目标试验模拟包括商业保险的患有T2D和ASCVD的成年人（2022年6月至2024年12月），他们开始皮下注射替西帕肽、杜拉鲁肽或西马鲁肽。主要终点是修正的主要不良心血管事件（MACE），定义为非致死性心肌梗死、非致死性卒中和全因死亡的组合。首先，对替西帕肽和杜拉鲁肽的新使用者进行倾向评分（PS）一对一匹配。其次，替西帕肽和西马鲁肽的新使用者进行了一对一的PS匹配。估计每1000人年的发病率（IRs）和危险比（hr）。结果经PS匹配，共鉴定出9233对替西帕肽或半马鲁肽引发剂和25266对替西帕肽或半马鲁肽引发剂。与杜拉鲁肽启动剂相比，替西肽启动剂的改良MACE发生率较低（IR分别为31.3 vs 39.4; HR 0.80 [95% CI 0.65-0.99]），这似乎是由于替西肽启动剂与杜拉鲁肽启动剂的全因死亡率较低（HR 0.60 [95% CI 0.43-0.83]）。在事后分析中，与杜拉鲁肽相比，替西帕肽与肺炎相关住院率较低相关。替西帕肽和西马鲁肽引发剂的MACE修饰率相似（IR分别为23.7比23.2；HR为1.03 [95% CI 0.90-1.17]）。结论：在常规治疗的T2D和ASCVD患者中，与dulaglutide相比，替西帕肽与改良MACE的风险较低相关，这是由于全因死亡率降低所致。改良MACE的风险与替西帕肽和西马鲁肽相似。
{"title":"Comparative Effectiveness of Tirzepatide Versus Dulaglutide or Semaglutide on Major Cardiovascular Events in Type 2 Diabetes and Cardiovascular Disease: Insights From Two Target-Trial Emulations","authors":"John W. Ostrominski, Janinne Ortega-Montiel, Deborah J. Wexler, Brendan M. Everett, Sara J. Cromer, Caroline F. Byrne, Robert J. Glynn, Julie M. Paik, Elisabetta Patorno","doi":"10.2337/dc25-3063","DOIUrl":"https://doi.org/10.2337/dc25-3063","url":null,"abstract":"OBJECTIVE To evaluate the comparative effectiveness of dulaglutide or semaglutide versus tirzepatide on cardiovascular outcomes in adults with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). RESEARCH DESIGN AND METHODS Two target trial emulations included commercially insured adults (June 2022–December 2024) with T2D and ASCVD who initiated subcutaneous tirzepatide, dulaglutide, or semaglutide. The primary outcome was modified major adverse cardiovascular events (MACE), defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause death. First, new users of tirzepatide and dulaglutide were propensity score (PS) matched one to one. Second, new users of tirzepatide and semaglutide were PS matched one to one. Incidence rates (IRs) per 1,000 person-years and hazard ratios (HRs) were estimated. RESULTS After PS matching, 9,233 pairs of tirzepatide or dulaglutide initiators and 25,266 pairs of tirzepatide or semaglutide initiators were identified. Tirzepatide initiators experienced a lower rate of modified MACE versus dulaglutide initiators (IR 31.3 vs. 39.4, respectively; HR 0.80 [95% CI 0.65–0.99]), which seemed to be driven by lower all-cause mortality among tirzepatide versus dulaglutide initiators (HR 0.60 [95% CI 0.43–0.83]). In post hoc analyses, tirzepatide was associated with lower rates of pneumonia-related hospitalization when compared with dulaglutide. Rates of modified MACE were similar among tirzepatide and semaglutide initiators (IR 23.7 vs. 23.2, respectively; HR 1.03 [95% CI 0.90–1.17]). CONCLUSIONS Among adults with T2D and ASCVD in routine care, tirzepatide was associated with a lower risk of modified MACE when compared with dulaglutide, driven by reduction in all-cause mortality. Risks of modified MACE seemed similar with tirzepatide and semaglutide.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"100 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350728","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}
Ashok A. Ganeshalingam, Nicolai Uhrenholt, Sidse Arnfred, Peter Gæde, Andreas K. Pedersen, Niels Bilenberg, Jan Frystyk
OBJECTIVE To examine the effects of semaglutide on insulin sensitivity, insulin resistance, and β-cell function and explore whether these changes were mediated by weight loss in overweight or obese individuals with schizophrenia and prediabetes receiving second-generation antipsychotics. RESEARCH DESIGN AND METHODS In this 30-week, double-blind trial, 154 participants were randomized to semaglutide (n = 77) or placebo (n = 77); 141 (91.5%) completed the study. Baseline and end-of-study assessments included fasting glucose, insulin, C-peptide, HOMA2 of β-cell function, HOMA2 of insulin sensitivity, HOMA of insulin resistance, and body weight. RESULTS Participants (56% women, mean age 38.3 years) provided complete insulin data in 131 cases. Compared with placebo, semaglutide significantly reduced fasting glucose (−0.87 mmol/L [95% CI −1.15, −0.59]; P < 0.001), improved insulin sensitivity (8.60 [5.82, 13.65]; P = 0.001), and lowered insulin resistance (−0.69 [−1.00, −0.20]; P = 0.006). Mean weight loss was 9.2 kg and mediated improvements in insulin sensitivity (estimate 7.82; P = 0.01) and insulin resistance (estimate −0.75; P = 0.01). Nonsignificant trends were observed toward reduced fasting insulin (−52.3 pmol/L; P = 0.11) and C-peptide (−182.9 pmol/L; P = 0.096), with a modest, nonsignificant increase in β-cell function (8.10; P = 0.19). CONCLUSIONS Semaglutide significantly improved insulin sensitivity, reduced insulin resistance, lowered fasting glucose, and promoted substantial weight loss in patients with antipsychotic-induced metabolic disturbances. Weight loss partly mediated the metabolic improvements, while β-cell function remained largely unchanged. These findings support semaglutide as a potential strategy for mitigating metabolic dysfunction in this high-risk population.
{"title":"Semaglutide Effects on Insulin Sensitivity and β-Cell Function in Patients With Schizophrenia, Prediabetes, and Obesity Treated With Second-Generation Antipsychotics: Findings From the HISTORI Trial, a 30-Week Randomized, Placebo-Controlled Trial With Semaglutide 1.0 mg Weekly","authors":"Ashok A. Ganeshalingam, Nicolai Uhrenholt, Sidse Arnfred, Peter Gæde, Andreas K. Pedersen, Niels Bilenberg, Jan Frystyk","doi":"10.2337/dc25-2041","DOIUrl":"https://doi.org/10.2337/dc25-2041","url":null,"abstract":"OBJECTIVE To examine the effects of semaglutide on insulin sensitivity, insulin resistance, and β-cell function and explore whether these changes were mediated by weight loss in overweight or obese individuals with schizophrenia and prediabetes receiving second-generation antipsychotics. RESEARCH DESIGN AND METHODS In this 30-week, double-blind trial, 154 participants were randomized to semaglutide (n = 77) or placebo (n = 77); 141 (91.5%) completed the study. Baseline and end-of-study assessments included fasting glucose, insulin, C-peptide, HOMA2 of β-cell function, HOMA2 of insulin sensitivity, HOMA of insulin resistance, and body weight. RESULTS Participants (56% women, mean age 38.3 years) provided complete insulin data in 131 cases. Compared with placebo, semaglutide significantly reduced fasting glucose (−0.87 mmol/L [95% CI −1.15, −0.59]; P &lt; 0.001), improved insulin sensitivity (8.60 [5.82, 13.65]; P = 0.001), and lowered insulin resistance (−0.69 [−1.00, −0.20]; P = 0.006). Mean weight loss was 9.2 kg and mediated improvements in insulin sensitivity (estimate 7.82; P = 0.01) and insulin resistance (estimate −0.75; P = 0.01). Nonsignificant trends were observed toward reduced fasting insulin (−52.3 pmol/L; P = 0.11) and C-peptide (−182.9 pmol/L; P = 0.096), with a modest, nonsignificant increase in β-cell function (8.10; P = 0.19). CONCLUSIONS Semaglutide significantly improved insulin sensitivity, reduced insulin resistance, lowered fasting glucose, and promoted substantial weight loss in patients with antipsychotic-induced metabolic disturbances. Weight loss partly mediated the metabolic improvements, while β-cell function remained largely unchanged. These findings support semaglutide as a potential strategy for mitigating metabolic dysfunction in this high-risk population.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"227 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350690","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}
Rana F. Chehab, Mara B. Greenberg, Catherine Lee, Amanda L. Ngo, Juanran Feng, Yeyi Zhu, Assiamira Ferrara
OBJECTIVE Children exposed to gestational diabetes mellitus (GDM) face an increased risk of obesity. We examined whether offspring obesity risk varied by maternal glycemic management trajectories during pregnancy compared with offspring unexposed to GDM. RESEARCH DESIGN AND METHODS This population-based prospective cohort included individuals who delivered at Kaiser Permanente Northern California (2011–2017) and their offspring with BMI measured at ages 2–10 through 2022. Glycemic management trajectories (optimal ≥80% of glucose values meeting American Diabetes Association targets) were identified from GDM diagnosis to delivery. Associations with offspring BMI and obesity risk were estimated using adjusted generalized estimating equations. RESULTS Among 206,464 pregnant individuals, 14,870 (7.2%) had GDM; among whom four glycemic management trajectories were identified: stably optimal (T1), rapidly improving to optimal (T2), slowly improving to near optimal (T3), and slowly improving to suboptimal (T4). Associations showed a dose-response pattern across T1–T4. By age 10, offspring in T1 had BMI (β = 0.27 [95% CI −0.13, 0.66]) and obesity risk (risk ratios 1.07 [0.91, 1.26]) similar to those unexposed to GDM. In contrast, offspring in T2, T3, and T4 had progressively higher BMI (1.00 [0.55, 1.46], 1.22 [0.67, 1.76], and 2.15 [1.48, 2.49]) and obesity risk (1.37 [1.18, 1.59], 1.53 [1.29, 1.81], and 1.62 [1.33, 1.98]). Associations were attenuated but persisted after adjustment for prepregnancy BMI. CONCLUSIONS Early and sustained glycemic management after GDM diagnosis was associated with lower childhood obesity risk comparable to that in offspring unexposed to GDM. These findings suggest an opportunity for prenatal risk stratification and prevention for children at higher obesity risk.
目的：暴露于妊娠期糖尿病（GDM）的儿童面临肥胖的风险增加。我们研究了与未暴露于GDM的后代相比，怀孕期间母亲血糖管理轨迹是否会改变后代肥胖风险。研究设计和方法：这项以人群为基础的前瞻性队列研究包括2011-2017年在北加州凯撒医疗机构分娩的患者及其后代，其BMI在2-10岁至2022年期间测量。从GDM诊断到分娩，血糖管理轨迹（最佳≥80%的血糖值符合美国糖尿病协会的目标）被确定。使用调整后的广义估计方程估计后代BMI和肥胖风险之间的关系。结果206464例孕妇中，14870例（7.2%）发生GDM；其中确定了四种血糖管理轨迹：稳定最佳（T1），快速改善至最佳（T2），缓慢改善至接近最佳（T3），缓慢改善至次优（T4）。关联显示T1-T4间的剂量-反应模式。到10岁时，T1组的后代BMI （β = 0.27 [95% CI - 0.13, 0.66]）和肥胖风险（风险比1.07[0.91,1.26]）与未暴露于GDM的后代相似。相比之下，T2、T3和T4的后代BMI（1.00[0.55, 1.46]、1.22[0.67,1.76]和2.15[1.48,2.49]）和肥胖风险（1.37[1.18,1.59]、1.53[1.29,1.81]和1.62[1.33,1.98]）逐渐升高。这种关联减弱，但在调整孕前BMI后仍然存在。结论：与未暴露于GDM的后代相比，GDM诊断后早期和持续血糖管理与较低的儿童肥胖风险相关。这些发现为产前风险分层和预防高肥胖风险儿童提供了机会。
{"title":"Gestational Diabetes, Glycemic Management Trajectories, and Offspring Growth Patterns and Obesity Risk","authors":"Rana F. Chehab, Mara B. Greenberg, Catherine Lee, Amanda L. Ngo, Juanran Feng, Yeyi Zhu, Assiamira Ferrara","doi":"10.2337/dc25-1643","DOIUrl":"https://doi.org/10.2337/dc25-1643","url":null,"abstract":"OBJECTIVE Children exposed to gestational diabetes mellitus (GDM) face an increased risk of obesity. We examined whether offspring obesity risk varied by maternal glycemic management trajectories during pregnancy compared with offspring unexposed to GDM. RESEARCH DESIGN AND METHODS This population-based prospective cohort included individuals who delivered at Kaiser Permanente Northern California (2011–2017) and their offspring with BMI measured at ages 2–10 through 2022. Glycemic management trajectories (optimal ≥80% of glucose values meeting American Diabetes Association targets) were identified from GDM diagnosis to delivery. Associations with offspring BMI and obesity risk were estimated using adjusted generalized estimating equations. RESULTS Among 206,464 pregnant individuals, 14,870 (7.2%) had GDM; among whom four glycemic management trajectories were identified: stably optimal (T1), rapidly improving to optimal (T2), slowly improving to near optimal (T3), and slowly improving to suboptimal (T4). Associations showed a dose-response pattern across T1–T4. By age 10, offspring in T1 had BMI (β = 0.27 [95% CI −0.13, 0.66]) and obesity risk (risk ratios 1.07 [0.91, 1.26]) similar to those unexposed to GDM. In contrast, offspring in T2, T3, and T4 had progressively higher BMI (1.00 [0.55, 1.46], 1.22 [0.67, 1.76], and 2.15 [1.48, 2.49]) and obesity risk (1.37 [1.18, 1.59], 1.53 [1.29, 1.81], and 1.62 [1.33, 1.98]). Associations were attenuated but persisted after adjustment for prepregnancy BMI. CONCLUSIONS Early and sustained glycemic management after GDM diagnosis was associated with lower childhood obesity risk comparable to that in offspring unexposed to GDM. These findings suggest an opportunity for prenatal risk stratification and prevention for children at higher obesity risk.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"61 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350696","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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