Curtis Triplitt, Eugenio Cersosimo, Mariam Alatrach, John Adams, Andrea Hansis-Diarte, Gozde Baskoy, Amalia Gastaldelli, Alberto Chavez-Velazquez, Ralph A. DeFronzo
OBJECTIVE To examine the effects of sodium–glucose cotransporter 2 inhibitors (SGLT2is) alone or with glucagon-like peptide 1 receptor agonists (GLP-1RAs) on β-cell function (BCF) in type 2 diabetes. The hypothesis was that an SGLT2i combined with a GLP-1RA provides superior improvement in BCF than either agent alone. RESEARCH DESIGN AND METHODS Ninety patients underwent a 180-min oral glucose tolerance test (OGTT) 1) after one drug dose (acute study) (placebo [n = 15], dapagliflozin [n = 25], exenatide [n = 25], and dapagliflozin/exenatide [n = 25]), and 2) after 1 and 4 months of therapy. Corrected Matsuda index (cMI) for urinary glucose loss, insulin secretion, and BCF indices were calculated during OGTT. RESULTS In the acute study, mean ± SEM cMI in dapagliflozin (2.29 ± 0.33), exenatide (2.03 ± 0.12), and dapagliflozin/exenatide (2.36 ± 0.14) was higher (P < 0.05) than placebo (1.63 ± 0.36). After 1 and 4 months, cMI remained similarly elevated in exenatide and increased further (P < 0.001) in dapagliflozin and dapagliflozin/exenatide. In the acute study, insulin secretion in dapagliflozin was similar to placebo but higher (P < 0.001 vs. both) in exenatide and dapagliflozin/exenatide. After 1 and 4 months in exenatide and in dapagliflozin/ exenatide, insulin secretion remained higher (P < 0.01 vs. both) than dapagliflozin. BCF index in the acute study was 0.40 ± 0.04 in placebo, 62% higher (P < 0.05) in dapagliflozin (0.65 ± 0.10), threefold higher in exenatide (1.17 ± 0.22), and fourfold higher in dapagliflozin/exenatide (1.69 ± 0.12) (all P < 0.001 vs. placebo). At 1 and 4 months, BCF rose further in dapagliflozin and exenatide but did not increase further in dapagliflozin/exenatide. CONCLUSIONS Dapagliflozin and exenatide monotherapy cause sustained improvements in BCF and insulin sensitivity. Combination therapy with dapagliflozin plus exenatide markedly augmented both BCF and insulin sensitivity above that with either agent alone.
{"title":"Changes in β-Cell Function and Insulin Sensitivity During Treatment With Dapagliflozin Alone or in Combination With Exenatide in Type 2 Diabetes","authors":"Curtis Triplitt, Eugenio Cersosimo, Mariam Alatrach, John Adams, Andrea Hansis-Diarte, Gozde Baskoy, Amalia Gastaldelli, Alberto Chavez-Velazquez, Ralph A. DeFronzo","doi":"10.2337/dc25-0490","DOIUrl":"https://doi.org/10.2337/dc25-0490","url":null,"abstract":"OBJECTIVE To examine the effects of sodium–glucose cotransporter 2 inhibitors (SGLT2is) alone or with glucagon-like peptide 1 receptor agonists (GLP-1RAs) on β-cell function (BCF) in type 2 diabetes. The hypothesis was that an SGLT2i combined with a GLP-1RA provides superior improvement in BCF than either agent alone. RESEARCH DESIGN AND METHODS Ninety patients underwent a 180-min oral glucose tolerance test (OGTT) 1) after one drug dose (acute study) (placebo [n = 15], dapagliflozin [n = 25], exenatide [n = 25], and dapagliflozin/exenatide [n = 25]), and 2) after 1 and 4 months of therapy. Corrected Matsuda index (cMI) for urinary glucose loss, insulin secretion, and BCF indices were calculated during OGTT. RESULTS In the acute study, mean ± SEM cMI in dapagliflozin (2.29 ± 0.33), exenatide (2.03 ± 0.12), and dapagliflozin/exenatide (2.36 ± 0.14) was higher (P &lt; 0.05) than placebo (1.63 ± 0.36). After 1 and 4 months, cMI remained similarly elevated in exenatide and increased further (P &lt; 0.001) in dapagliflozin and dapagliflozin/exenatide. In the acute study, insulin secretion in dapagliflozin was similar to placebo but higher (P &lt; 0.001 vs. both) in exenatide and dapagliflozin/exenatide. After 1 and 4 months in exenatide and in dapagliflozin/ exenatide, insulin secretion remained higher (P &lt; 0.01 vs. both) than dapagliflozin. BCF index in the acute study was 0.40 ± 0.04 in placebo, 62% higher (P &lt; 0.05) in dapagliflozin (0.65 ± 0.10), threefold higher in exenatide (1.17 ± 0.22), and fourfold higher in dapagliflozin/exenatide (1.69 ± 0.12) (all P &lt; 0.001 vs. placebo). At 1 and 4 months, BCF rose further in dapagliflozin and exenatide but did not increase further in dapagliflozin/exenatide. CONCLUSIONS Dapagliflozin and exenatide monotherapy cause sustained improvements in BCF and insulin sensitivity. Combination therapy with dapagliflozin plus exenatide markedly augmented both BCF and insulin sensitivity above that with either agent alone.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"687 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586246","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}
Jaehyeong Cho, Selin Woo, Seung Ha Hwang, Soeun Kim, Hayeon Lee, Jiyoung Hwang, Jaewon Kim, Min Seo Kim, Lee Smith, Sooji Lee, Jinseok Lee, Hong-Hee Won, Sang Youl Rhee, Dong Keon Yon
OBJECTIVE To develop a multimodal model to predict chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM), given the limited research on this integrative approach. RESEARCH DESIGN AND METHODS We obtained multimodal data sets from Kyung Hee University Medical Center (n = 7,028; discovery cohort) for training and internal validation and UK Biobank (n = 1,544; validation cohort) for external validation. CKD was defined based on ICD-9 and ICD-10 codes and/or estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2. We ensembled various deep learning models and interpreted their predictions using explainable artificial intelligence (AI) methods, including shapley additive explanations (SHAP) and gradient-weighted class activation mapping (Grad-CAM). Subsequently, we investigated the potential association between the model probability and vascular complications. RESULTS The multimodal model, which ensembles visual geometry group 16 and deep neural network, presented high performance in predicting CKD, with area under the receiver operating characteristic curve of 0.880 (95% CI, 0.806–0.954) in the discovery cohort and 0.722 in the validation cohort. SHAP and Grad-CAM highlighted key predictors, including eGFR and optic disc, respectively. The model probability was associated with an increased risk of macrovascular complications (tertile 1 [T1]: adjusted hazard ratio, 1.42 [95% CI, 1.06–1.90]; T2: 1.59 [1.17–2.16]; T3: 1.64 [1.20–2.26]) and microvascular complications (T3: 1.30 [1.02–1.67]). CONCLUSIONS Our multimodal AI model integrates fundus images and clinical data from binational cohorts to predict the risk of new-onset CKD within 5 years and associated vascular complications in patients with T2DM.
{"title":"A Multimodal Predictive Model for Chronic Kidney Disease and Its Association With Vascular Complications in Patients With Type 2 Diabetes: Model Development and Validation Study in South Korea and the U.K.","authors":"Jaehyeong Cho, Selin Woo, Seung Ha Hwang, Soeun Kim, Hayeon Lee, Jiyoung Hwang, Jaewon Kim, Min Seo Kim, Lee Smith, Sooji Lee, Jinseok Lee, Hong-Hee Won, Sang Youl Rhee, Dong Keon Yon","doi":"10.2337/dc25-0355","DOIUrl":"https://doi.org/10.2337/dc25-0355","url":null,"abstract":"OBJECTIVE To develop a multimodal model to predict chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM), given the limited research on this integrative approach. RESEARCH DESIGN AND METHODS We obtained multimodal data sets from Kyung Hee University Medical Center (n = 7,028; discovery cohort) for training and internal validation and UK Biobank (n = 1,544; validation cohort) for external validation. CKD was defined based on ICD-9 and ICD-10 codes and/or estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2. We ensembled various deep learning models and interpreted their predictions using explainable artificial intelligence (AI) methods, including shapley additive explanations (SHAP) and gradient-weighted class activation mapping (Grad-CAM). Subsequently, we investigated the potential association between the model probability and vascular complications. RESULTS The multimodal model, which ensembles visual geometry group 16 and deep neural network, presented high performance in predicting CKD, with area under the receiver operating characteristic curve of 0.880 (95% CI, 0.806–0.954) in the discovery cohort and 0.722 in the validation cohort. SHAP and Grad-CAM highlighted key predictors, including eGFR and optic disc, respectively. The model probability was associated with an increased risk of macrovascular complications (tertile 1 [T1]: adjusted hazard ratio, 1.42 [95% CI, 1.06–1.90]; T2: 1.59 [1.17–2.16]; T3: 1.64 [1.20–2.26]) and microvascular complications (T3: 1.30 [1.02–1.67]). CONCLUSIONS Our multimodal AI model integrates fundus images and clinical data from binational cohorts to predict the risk of new-onset CKD within 5 years and associated vascular complications in patients with T2DM.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"49 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533067","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}
Adrian Matias Bacong, Veronica Njuguna, Jeanne Darbinian, Luis A. Rodriguez, Erica P. Gunderson, Louise C. Greenspan, Nitya Rajeshuni, Latha Palaniappan, Joan C. Lo
OBJECTIVE To compare prediabetes prevalence among disaggregated U.S. Asian and Pacific Islander (Asian/PI) adolescents with non-Hispanic White (NHW) adolescents with overweight or obesity in a primary care population. RESEARCH DESIGN AND METHODS This retrospective, cross-sectional study used Kaiser Permanente Northern California health record data. The cohort comprised 20,540 NHW and 16,508 Asian/PI adolescents aged 10–17 years with overweight (BMI 85th to <95th percentile) or obesity (BMI ≥95th percentile) at a pediatric visit (2012–2019) and HbA1c measured within 1 year. Those with HbA1c ≥6.5%, a diabetes diagnosis, or diabetes pharmacotherapy were excluded. Prediabetes was classified as HbA1c 5.7–6.4%. Adjusted prevalence ratios (aPRs) with 95% CIs for prediabetes were examined for Filipino, Chinese, South Asian, Vietnamese, and Native Hawaiian/Pacific Islander (NHPI) compared with NHW using modified Poisson regression, adjusting for age, sex, BMI, neighborhood deprivation index, and visit year. RESULTS Asian/PI adolescents with overweight or obesity had a higher prediabetes prevalence (26.9%) than NHW adolescents (11.9%) (P < 0.001), with variation among Asian subgroups of 31.0% for South Asian, 32.0% for NHPI, 28.2% for Filipino, 25.9% for Chinese, and 18.4% for Vietnamese adolescents. In multivariable analyses, the aPRs for prediabetes (vs. NHW) were 2.80 (95% CI, 2.57–3.05) for South Asian, 2.44 (2.23–2.67) for NHPI, 2.18 (2.06–2.32) for Filipino, 2.18 (1.99–2.39) for Chinese, and 1.68 (1.38–2.04) for Vietnamese adolescents. These findings were similar by sex, and patterns were similar within overweight or obesity subgroups. CONCLUSIONS Asian/PI adolescents with overweight or obesity have considerably higher prediabetes prevalence than NHW adolescents, independent of BMI. Findings varied by ethnicity. Prediabetes screening is essential for the high-risk population of Asian/PI adolescents with overweight or obesity.
{"title":"High Prevalence of Prediabetes Among Asian and Pacific Islander Adolescents With Overweight or Obesity in a Primary Care Population","authors":"Adrian Matias Bacong, Veronica Njuguna, Jeanne Darbinian, Luis A. Rodriguez, Erica P. Gunderson, Louise C. Greenspan, Nitya Rajeshuni, Latha Palaniappan, Joan C. Lo","doi":"10.2337/dc25-0343","DOIUrl":"https://doi.org/10.2337/dc25-0343","url":null,"abstract":"OBJECTIVE To compare prediabetes prevalence among disaggregated U.S. Asian and Pacific Islander (Asian/PI) adolescents with non-Hispanic White (NHW) adolescents with overweight or obesity in a primary care population. RESEARCH DESIGN AND METHODS This retrospective, cross-sectional study used Kaiser Permanente Northern California health record data. The cohort comprised 20,540 NHW and 16,508 Asian/PI adolescents aged 10–17 years with overweight (BMI 85th to &lt;95th percentile) or obesity (BMI ≥95th percentile) at a pediatric visit (2012–2019) and HbA1c measured within 1 year. Those with HbA1c ≥6.5%, a diabetes diagnosis, or diabetes pharmacotherapy were excluded. Prediabetes was classified as HbA1c 5.7–6.4%. Adjusted prevalence ratios (aPRs) with 95% CIs for prediabetes were examined for Filipino, Chinese, South Asian, Vietnamese, and Native Hawaiian/Pacific Islander (NHPI) compared with NHW using modified Poisson regression, adjusting for age, sex, BMI, neighborhood deprivation index, and visit year. RESULTS Asian/PI adolescents with overweight or obesity had a higher prediabetes prevalence (26.9%) than NHW adolescents (11.9%) (P &lt; 0.001), with variation among Asian subgroups of 31.0% for South Asian, 32.0% for NHPI, 28.2% for Filipino, 25.9% for Chinese, and 18.4% for Vietnamese adolescents. In multivariable analyses, the aPRs for prediabetes (vs. NHW) were 2.80 (95% CI, 2.57–3.05) for South Asian, 2.44 (2.23–2.67) for NHPI, 2.18 (2.06–2.32) for Filipino, 2.18 (1.99–2.39) for Chinese, and 1.68 (1.38–2.04) for Vietnamese adolescents. These findings were similar by sex, and patterns were similar within overweight or obesity subgroups. CONCLUSIONS Asian/PI adolescents with overweight or obesity have considerably higher prediabetes prevalence than NHW adolescents, independent of BMI. Findings varied by ethnicity. Prediabetes screening is essential for the high-risk population of Asian/PI adolescents with overweight or obesity.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"635 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520353","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}
Lin Li, Ruyi Li, Zixin Qiu, Kai Zhu, Rui Li, Shiyu Zhao, Jiajing Che, Tianyu Guo, Kun Xu, Tingting Geng, Yunfei Liao, An Pan, Gang Liu
OBJECTIVE To identify baseline multiomic and phenotypic predictors and develop prediction models for weight and body composition loss and regain in the Low-Carbohydrate Diet and Time-Restricted Eating (LEAN-TIME) trial. RESEARCH DESIGN AND METHODS A post hoc analysis was conducted of the LEAN-TIME feeding trial using data from 88 adults with overweight/obesity completing a 12-week calorie-restricted weight-loss phase and 79 completing a 28-week weight-regain phase. Baseline dietary, metabolic, fecal metabolome, and gut microbiome data were candidate predictors of changes in weight, body fat mass (BFM), and soft lean mass (SLM). Multivariable regression and the least absolute shrinkage and selection operator model were used to identify predictors and develop weighted-sum prediction models. RESULTS Multiomic and phenotypic models significantly outperformed phenotype-only models (P < 0.05), demonstrating strong predictive performance during both phases. During weight loss, the multiomic and phenotypic model yielded R2 values of 0.49, 0.61, and 0.54 for changes in weight, BFM, and SLM, respectively, with corresponding root mean square errors (RMSEs) of 1.59, 1.41, and 0.98 kg. For binary classification of clinically meaningful weight loss (≥5%), the model achieved an area under the curve of 0.95 (sensitivity 94.12%; specificity 86.79%). During weight regain, R2 values reached 0.72, 0.73, and 0.66 for weight, BFM, and SLM (RMSEs 1.40, 1.62, and 0.73 kg), respectively. Several key baseline predictors, primarily gut microbes and fecal metabolites, such as N-acetyl-l-aspartic acid, Ruminococcus callidus, and Bifidobacterium adolescentis, were shared for weight and body composition changes during both phases. CONCLUSIONS Baseline multiomic and phenotypic data effectively predict weight and body composition loss and regain, offering insights for personalized weight management.
{"title":"Prediction of Weight Loss and Regain Based on Multiomic and Phenotypic Features: Results From a Calorie-Restricted Feeding Trial","authors":"Lin Li, Ruyi Li, Zixin Qiu, Kai Zhu, Rui Li, Shiyu Zhao, Jiajing Che, Tianyu Guo, Kun Xu, Tingting Geng, Yunfei Liao, An Pan, Gang Liu","doi":"10.2337/dc25-0728","DOIUrl":"https://doi.org/10.2337/dc25-0728","url":null,"abstract":"OBJECTIVE To identify baseline multiomic and phenotypic predictors and develop prediction models for weight and body composition loss and regain in the Low-Carbohydrate Diet and Time-Restricted Eating (LEAN-TIME) trial. RESEARCH DESIGN AND METHODS A post hoc analysis was conducted of the LEAN-TIME feeding trial using data from 88 adults with overweight/obesity completing a 12-week calorie-restricted weight-loss phase and 79 completing a 28-week weight-regain phase. Baseline dietary, metabolic, fecal metabolome, and gut microbiome data were candidate predictors of changes in weight, body fat mass (BFM), and soft lean mass (SLM). Multivariable regression and the least absolute shrinkage and selection operator model were used to identify predictors and develop weighted-sum prediction models. RESULTS Multiomic and phenotypic models significantly outperformed phenotype-only models (P &lt; 0.05), demonstrating strong predictive performance during both phases. During weight loss, the multiomic and phenotypic model yielded R2 values of 0.49, 0.61, and 0.54 for changes in weight, BFM, and SLM, respectively, with corresponding root mean square errors (RMSEs) of 1.59, 1.41, and 0.98 kg. For binary classification of clinically meaningful weight loss (≥5%), the model achieved an area under the curve of 0.95 (sensitivity 94.12%; specificity 86.79%). During weight regain, R2 values reached 0.72, 0.73, and 0.66 for weight, BFM, and SLM (RMSEs 1.40, 1.62, and 0.73 kg), respectively. Several key baseline predictors, primarily gut microbes and fecal metabolites, such as N-acetyl-l-aspartic acid, Ruminococcus callidus, and Bifidobacterium adolescentis, were shared for weight and body composition changes during both phases. CONCLUSIONS Baseline multiomic and phenotypic data effectively predict weight and body composition loss and regain, offering insights for personalized weight management.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"27 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520334","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}
Chris Ho Ching Yeung, Alison K. Wright, Daniel P. Windred, Angus C. Burns, Andrew J.K. Phillips, Sean W. Cain, Martin K. Rutter, Qian Xiao
OBJECTIVE Circadian rhythms play a key role in metabolic health. Rest–activity rhythms, which are in part driven by circadian rhythms, may be associated with diabetes risk. There is a need for large prospective studies to comprehensively examine different rest–activity metrics to determine their relative strength in predicting risk of incident type 2 diabetes. RESEARCH DESIGN AND METHODS In actigraphy data from 83,887 UK Biobank participants, we applied both parametric and nonparametric algorithms to derive 13 different metrics characterizing different aspects of rest–activity rhythm. Diabetes cases were identified using both self-reported data and health records. We used Cox proportional hazards models to assess associations between rest–activity parameters and type 2 diabetes risk and random forest models to determine the relative importance of these parameters in risk prediction. RESULTS We found that multiple rest–activity characteristics were predictive of a higher risk of incident diabetes, including lower pseudo-F statistic (hazard ratio [HR] of quintile 1 ([Q1] vs. Q5 1.27; 95% CI 1.09–1.46; Ptrend < 0.001), lower amplitude (HRQ1 vs. Q5 2.56; 95% CI 2.21–2.97; Ptrend < 0.001), lower midline estimating statistic of rhythm (HRQ1 vs. Q5 2.59; 95% CI 2.24–3.00; Ptrend < 0.001), lower relative amplitude (HRQ1 vs. Q5 4.64; 95% CI 3.74–5.76; Ptrend < 0.001), lower M10 (HRQ1 vs. Q5 3.82; 95% CI 3.20–4.55; Ptrend < 0.001), higher L5 (HRQ5 vs. Q1 1.88; 95% CI 1.62–2.19; Ptrend < 0.001), and later L5 start time (HRQ5 vs. Q1 1.20; 95% CI 1.04–1.38; Ptrend = 0.004). Random forest models ranked most of the rest–activity metrics as top predictors of diabetes incidence, when compared with traditional diabetes risk factors. The findings were consistent across subgroups of age, sex, BMI, and shift work status. CONCLUSIONS Rest–activity rhythm characteristics measured from actigraphy data may serve as digital biomarkers for predicting type 2 diabetes risk.
目的：昼夜节律在代谢健康中发挥关键作用。部分由昼夜节律驱动的休息-活动节律可能与糖尿病风险有关。有必要进行大规模的前瞻性研究，以全面检查不同的休息-活动指标，以确定它们在预测2型糖尿病发生风险方面的相对强度。研究设计和方法在83,887名英国生物银行参与者的活动记录数据中，我们应用参数和非参数算法推导出表征休息-活动节律不同方面的13种不同指标。通过自我报告数据和健康记录确定糖尿病病例。我们使用Cox比例风险模型来评估休息-活动参数与2型糖尿病风险之间的关系，并使用随机森林模型来确定这些参数在风险预测中的相对重要性。结果我们发现，多种休息-活动特征可预测较高的糖尿病发生风险，包括五分位数1 （[Q1] vs. Q5）的伪f统计量（风险比[HR]）较低([Q1] vs. Q5 = 1.27；95% ci 1.09-1.46；Ptrend, lt;0.001)，振幅较低(HRQ1 vs. Q5 2.56；95% ci 2.21-2.97；Ptrend, lt;0.001)，心律中线下估计统计量(HRQ1 vs. Q5 2.59；95% ci 2.24-3.00；Ptrend, lt;0.001)，相对振幅较低(HRQ1 vs. Q5 4.64；95% ci 3.74-5.76；Ptrend, lt;0.001)， M10较低(HRQ1 vs. Q5 3.82；95% ci 3.20-4.55；Ptrend, lt;0.001)， L5较高(HRQ5 vs Q1 1.88；95% ci 1.62-2.19；Ptrend, lt;0.001)， L5开始时间较晚(HRQ5 vs. Q1 1.20；95% ci 1.04-1.38；p趋势= 0.004)。与传统的糖尿病风险因素相比，随机森林模型将大多数休息-活动指标列为糖尿病发病率的主要预测因素。这些发现在不同年龄、性别、BMI和轮班工作状态的亚组中是一致的。结论：从活动记录仪数据中测量的休息-活动节律特征可作为预测2型糖尿病风险的数字生物标志物。
{"title":"Impaired Rest–Activity Rhythm Characteristics Predict Higher Risk of Incident Type 2 Diabetes in UK Biobank Participants","authors":"Chris Ho Ching Yeung, Alison K. Wright, Daniel P. Windred, Angus C. Burns, Andrew J.K. Phillips, Sean W. Cain, Martin K. Rutter, Qian Xiao","doi":"10.2337/dc25-0309","DOIUrl":"https://doi.org/10.2337/dc25-0309","url":null,"abstract":"OBJECTIVE Circadian rhythms play a key role in metabolic health. Rest–activity rhythms, which are in part driven by circadian rhythms, may be associated with diabetes risk. There is a need for large prospective studies to comprehensively examine different rest–activity metrics to determine their relative strength in predicting risk of incident type 2 diabetes. RESEARCH DESIGN AND METHODS In actigraphy data from 83,887 UK Biobank participants, we applied both parametric and nonparametric algorithms to derive 13 different metrics characterizing different aspects of rest–activity rhythm. Diabetes cases were identified using both self-reported data and health records. We used Cox proportional hazards models to assess associations between rest–activity parameters and type 2 diabetes risk and random forest models to determine the relative importance of these parameters in risk prediction. RESULTS We found that multiple rest–activity characteristics were predictive of a higher risk of incident diabetes, including lower pseudo-F statistic (hazard ratio [HR] of quintile 1 ([Q1] vs. Q5 1.27; 95% CI 1.09–1.46; Ptrend &lt; 0.001), lower amplitude (HRQ1 vs. Q5 2.56; 95% CI 2.21–2.97; Ptrend &lt; 0.001), lower midline estimating statistic of rhythm (HRQ1 vs. Q5 2.59; 95% CI 2.24–3.00; Ptrend &lt; 0.001), lower relative amplitude (HRQ1 vs. Q5 4.64; 95% CI 3.74–5.76; Ptrend &lt; 0.001), lower M10 (HRQ1 vs. Q5 3.82; 95% CI 3.20–4.55; Ptrend &lt; 0.001), higher L5 (HRQ5 vs. Q1 1.88; 95% CI 1.62–2.19; Ptrend &lt; 0.001), and later L5 start time (HRQ5 vs. Q1 1.20; 95% CI 1.04–1.38; Ptrend = 0.004). Random forest models ranked most of the rest–activity metrics as top predictors of diabetes incidence, when compared with traditional diabetes risk factors. The findings were consistent across subgroups of age, sex, BMI, and shift work status. CONCLUSIONS Rest–activity rhythm characteristics measured from actigraphy data may serve as digital biomarkers for predicting type 2 diabetes risk.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"31 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500380","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}
Kevin Yau, Joel G. Ray, Nivethika Jeyakumar, Bin Luo, Sheikh Abdullah, Eric McArthur, Stephanie N. Dixon, Sara Wing, Kristin K. Clemens, Fabio Castrillon-Ramirez, Jacob A. Udell, Alejandro Meraz-Munoz, Ann Young, Ziv Harel, Jeffrey Perl, Vikas S. Sridhar, Huajing Ni, Tae Won Yi, Lawrence A. Leiter, Amit X. Garg, David Z.I. Cherney, Ron Wald
OBJECTIVE The aim of this study was to evaluate the effect of glucagon-like peptide 1 receptor agonist (GLP-1RA) versus dipeptidyl peptidase 4 inhibitor (DPP4i) initiation on emergency department (ED) visits and all-cause hospitalizations across the spectrum of kidney disease. RESEARCH DESIGN AND METHODS This was a retrospective population-based observational cohort study in adults with an estimated glomerular filtration rate <90 mL/min/1.73 m2 using inverse probability of treatment weighting. The Prentice-Williams-Peterson (PWP) gap time model was used for the primary analysis. RESULTS The cohort included 24,576 new users of a GLP-1RA and 23,600 DPP4i new users. GLP1RA initiation was associated with a lower risk of all-cause ED encounters or hospitalizations (hazard ratio [HR] 0.90; 95% CI 0.87–0.94; P < 0.0001). This finding was consistent in confirmatory analyses using the Andersen-Gill model and the PWP calendar time model. CONCLUSIONS GLP-1RA initiation was associated with a reduction in all-cause ED visits and hospitalizations compared with new use of a DPP4i.
目的：本研究的目的是评估胰高血糖素样肽1受体激动剂（GLP-1RA）与二肽基肽酶4抑制剂（DPP4i）启动对急诊科（ED）就诊和全因肾病住院的影响。研究设计和方法：这是一项基于人群的回顾性观察队列研究，研究对象为肾小球滤过率为90 mL/min/1.73 m2的成人，采用治疗加权逆概率法。采用Prentice-Williams-Peterson （PWP）间隙时间模型进行初步分析。该队列包括24,576名GLP-1RA新用户和23,600名DPP4i新用户。GLP1RA起始与全因ED遭遇或住院的风险较低相关(风险比[HR] 0.90；95% ci 0.87-0.94；P, lt;0.0001)。这一发现在使用Andersen-Gill模型和PWP日历时间模型的验证分析中是一致的。结论：与新使用DPP4i相比，GLP-1RA启动与全因ED就诊和住院次数减少有关。
{"title":"Glucagon-Like Peptide 1 Receptor Agonists and the Risk of Emergency Department Visits and Hospitalization in Patients With Chronic Kidney Disease","authors":"Kevin Yau, Joel G. Ray, Nivethika Jeyakumar, Bin Luo, Sheikh Abdullah, Eric McArthur, Stephanie N. Dixon, Sara Wing, Kristin K. Clemens, Fabio Castrillon-Ramirez, Jacob A. Udell, Alejandro Meraz-Munoz, Ann Young, Ziv Harel, Jeffrey Perl, Vikas S. Sridhar, Huajing Ni, Tae Won Yi, Lawrence A. Leiter, Amit X. Garg, David Z.I. Cherney, Ron Wald","doi":"10.2337/dc24-2811","DOIUrl":"https://doi.org/10.2337/dc24-2811","url":null,"abstract":"OBJECTIVE The aim of this study was to evaluate the effect of glucagon-like peptide 1 receptor agonist (GLP-1RA) versus dipeptidyl peptidase 4 inhibitor (DPP4i) initiation on emergency department (ED) visits and all-cause hospitalizations across the spectrum of kidney disease. RESEARCH DESIGN AND METHODS This was a retrospective population-based observational cohort study in adults with an estimated glomerular filtration rate &lt;90 mL/min/1.73 m2 using inverse probability of treatment weighting. The Prentice-Williams-Peterson (PWP) gap time model was used for the primary analysis. RESULTS The cohort included 24,576 new users of a GLP-1RA and 23,600 DPP4i new users. GLP1RA initiation was associated with a lower risk of all-cause ED encounters or hospitalizations (hazard ratio [HR] 0.90; 95% CI 0.87–0.94; P &lt; 0.0001). This finding was consistent in confirmatory analyses using the Andersen-Gill model and the PWP calendar time model. CONCLUSIONS GLP-1RA initiation was associated with a reduction in all-cause ED visits and hospitalizations compared with new use of a DPP4i.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"22 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500442","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}
Jeffrey S. Gonzalez, Claire J. Hoogendoorn, Raymond Hernandez, Stefan Schneider, Fayel Mustafiz, Megha Siddhanta, Elizabeth A. Pyatak
OBJECTIVE In an observational study, we paired ecological momentary assessment (EMA) and continuous glucose monitoring (CGM) to examine lagged effects of glycemic regulation on diabetes-related distress (DD), and vice versa, among adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Participants (N = 182; median ± SD age 40 ± 14 years; 54% women; 41% Latino; 29% White and 15% Black) wore a blinded CGM device for 14 days and completed five to six EMA surveys per day. We tested expected associations between momentary DD ratings and relevant patient-reported outcomes on validated questionnaires. Using multilevel cross-lagged modeling, we evaluated within-person lagged effects of CGM metrics (mean glucose mean; percentage of time in range [TIR; i.e., 70–180 mg/dL] and percentages of time 181–250, >250, and <70 mg/dL; and coefficient of variation [CV]) over 3-h periods on DD rated 0–100 at the end of that interval and 3 h later. We also examined lagged effects of DD on subsequent CGM metrics. RESULTS Momentary DD ratings were significantly associated with results of questionnaires for DD, well-being, functional and mental health, and quality of life. Higher mean glucose, less TIR, greater percentage of time 181–250 and >250 mg/dL, and higher CV over 3 h each predicted greater DD at the end of that interval; higher 3-h mean glucose also predicted more DD 3 h later (P < 0.05). Greater DD unexpectedly predicted a lower percentage of time in hypoglycemia over the next 3 h (P < 0.05) but predicted no other CGM metrics. CONCLUSIONS Findings support the validity of EMA of DD in adults with T1D and suggest glucose dysregulation is linked to subsequent increased DD over the short term, not vice versa. These findings have implications for interventions targeting DD.
{"title":"Diabetes-Related Distress and Glycemic Dysregulation in Everyday Life With Type 1 Diabetes: Which Comes First?","authors":"Jeffrey S. Gonzalez, Claire J. Hoogendoorn, Raymond Hernandez, Stefan Schneider, Fayel Mustafiz, Megha Siddhanta, Elizabeth A. Pyatak","doi":"10.2337/dc25-0559","DOIUrl":"https://doi.org/10.2337/dc25-0559","url":null,"abstract":"OBJECTIVE In an observational study, we paired ecological momentary assessment (EMA) and continuous glucose monitoring (CGM) to examine lagged effects of glycemic regulation on diabetes-related distress (DD), and vice versa, among adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Participants (N = 182; median ± SD age 40 ± 14 years; 54% women; 41% Latino; 29% White and 15% Black) wore a blinded CGM device for 14 days and completed five to six EMA surveys per day. We tested expected associations between momentary DD ratings and relevant patient-reported outcomes on validated questionnaires. Using multilevel cross-lagged modeling, we evaluated within-person lagged effects of CGM metrics (mean glucose mean; percentage of time in range [TIR; i.e., 70–180 mg/dL] and percentages of time 181–250, &gt;250, and &lt;70 mg/dL; and coefficient of variation [CV]) over 3-h periods on DD rated 0–100 at the end of that interval and 3 h later. We also examined lagged effects of DD on subsequent CGM metrics. RESULTS Momentary DD ratings were significantly associated with results of questionnaires for DD, well-being, functional and mental health, and quality of life. Higher mean glucose, less TIR, greater percentage of time 181–250 and &gt;250 mg/dL, and higher CV over 3 h each predicted greater DD at the end of that interval; higher 3-h mean glucose also predicted more DD 3 h later (P &lt; 0.05). Greater DD unexpectedly predicted a lower percentage of time in hypoglycemia over the next 3 h (P &lt; 0.05) but predicted no other CGM metrics. CONCLUSIONS Findings support the validity of EMA of DD in adults with T1D and suggest glucose dysregulation is linked to subsequent increased DD over the short term, not vice versa. These findings have implications for interventions targeting DD.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"17 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144479185","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}
Barbara H. Braffett, Tore Julsrud Berg, Malin Zimmerman, Kasper Olesen, Søren Gregersen, Michael R. Krogsgaard, Lars B. Dahlin, Kirsten Nørgaard
Upper-limb complications (ULCs) in diabetes, affecting joints, tendons, muscles, connective tissue, nerves, and skin, are underrecognized but prevalent conditions in type 1 and type 2 diabetes. Advances in diabetes care have extended life expectancy, leading to an aging population with diabetes with increased susceptibility to long-term complications beyond traditional vascular issues. Despite some data on ULCs epidemiology, understanding of their pathogenesis, prevention, and impact on quality of life remains limited, and treatments are often based on clinical experience rather than robust evidence. ULCs, including frozen shoulder, trigger finger, carpal tunnel syndrome, ulnar nerve entrapment, Dupuytren disease with contracture, and limited joint mobility, occur two to three times more frequently in diabetes, with higher rates in individuals aged>50 years and those with longer diabetes duration. Chronic hyperglycemia, glycation of collagen, and low-grade inflammation are hypothesized contributors. Modifiable risk factors include poor glycemic control, smoking, and obesity. Individuals with diabetes face slower symptom resolution, higher recurrence rates, and a greater likelihood of bilateral or multiple conditions. Awareness among clinicians and patients is critical, with emphasis on routine screening and proactive management. Early diagnosis, patient education, and targeted interventions can mitigate long-term complications and improve quality of life. Future guidelines should integrate ULC monitoring into routine diabetes care and prioritize clinical trials to establish evidence-based management strategies. Addressing ULCs comprehensively will enhance outcomes for individuals with diabetes, ensuring better functional health and reduced societal burden.
{"title":"Upper-Limb Complications in Diabetes: A Narrative Review","authors":"Barbara H. Braffett, Tore Julsrud Berg, Malin Zimmerman, Kasper Olesen, Søren Gregersen, Michael R. Krogsgaard, Lars B. Dahlin, Kirsten Nørgaard","doi":"10.2337/dci25-0012","DOIUrl":"https://doi.org/10.2337/dci25-0012","url":null,"abstract":"Upper-limb complications (ULCs) in diabetes, affecting joints, tendons, muscles, connective tissue, nerves, and skin, are underrecognized but prevalent conditions in type 1 and type 2 diabetes. Advances in diabetes care have extended life expectancy, leading to an aging population with diabetes with increased susceptibility to long-term complications beyond traditional vascular issues. Despite some data on ULCs epidemiology, understanding of their pathogenesis, prevention, and impact on quality of life remains limited, and treatments are often based on clinical experience rather than robust evidence. ULCs, including frozen shoulder, trigger finger, carpal tunnel syndrome, ulnar nerve entrapment, Dupuytren disease with contracture, and limited joint mobility, occur two to three times more frequently in diabetes, with higher rates in individuals aged&gt;50 years and those with longer diabetes duration. Chronic hyperglycemia, glycation of collagen, and low-grade inflammation are hypothesized contributors. Modifiable risk factors include poor glycemic control, smoking, and obesity. Individuals with diabetes face slower symptom resolution, higher recurrence rates, and a greater likelihood of bilateral or multiple conditions. Awareness among clinicians and patients is critical, with emphasis on routine screening and proactive management. Early diagnosis, patient education, and targeted interventions can mitigate long-term complications and improve quality of life. Future guidelines should integrate ULC monitoring into routine diabetes care and prioritize clinical trials to establish evidence-based management strategies. Addressing ULCs comprehensively will enhance outcomes for individuals with diabetes, ensuring better functional health and reduced societal burden.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"16 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370511","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}
Yu Mi Kang, Robert P. Giugliano, Xinhui Ran, Prakash Deedwania, Gaetano M. De Ferrari, Jyothis T. George, Ioanna Gouni-Berthold, Gabriel Paiva da Silva Lima, Yehuda Handelsman, Basil S. Lewis, E. Magnus Ohman, Huei Wang, J. Antonio G. López, Maria Laura Monsalvo, Marc S. Sabatine, Lawrence A. Leiter
OBJECTIVE To evaluate the clinical efficacy of intensive LDL cholesterol (LDL-C) lowering in type 1 diabetes mellitus (T1DM). RESEARCH DESIGN AND METHODS Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) randomized participants with atherosclerotic cardiovascular disease (ASCVD) on statins to evolocumab or placebo (median follow-up 2.2 years). The primary end point (PEP) was cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. RESULTS Of 27,564 participants, 10,834 (39.3%) had type 2 diabetes mellitus (T2DM), and 197 (0.7%) had T1DM. In the placebo arm, there was a stepwise increase in the 2.5-year PEP Kaplan-Meier rate from 11.0% to 15.2% to 20.4% in participants with no diabetes, T2DM, and T1DM, respectively (P < 0.0001). Hazard ratios for PEP with evolocumab were 0.87 (95% CI 0.79–0.96), 0.84 (0.75–0.93), and 0.66 (0.32–1.38) in the no diabetes, T2DM, and T1DM groups, and absolute risk reduction was 1.3%, 2.5%, and 7.3%, respectively. CONCLUSIONS Intensive LDL-C lowering may provide substantial clinical benefit in individuals with T1DM and ASCVD. Additional randomized controlled cardiovascular outcomes trials are needed in this population.
目的评价强化降LDL- c治疗1型糖尿病（T1DM）的临床疗效。研究设计和方法：在高风险受试者（FOURIER）中进一步进行PCSK9抑制的心血管结局研究，将接受他汀类药物治疗的动脉粥样硬化性心血管疾病（ASCVD）患者随机分为evolocumab或安慰剂（中位随访时间为2.2年）。主要终点（PEP）是心血管死亡、心肌梗死、中风、不稳定型心绞痛住院或冠状动脉血运重建术。结果在27,564名参与者中，10,834名（39.3%）患有2型糖尿病（T2DM）， 197名（0.7%）患有T1DM。在安慰剂组中，无糖尿病、2型糖尿病和1型糖尿病患者的2.5年PEP Kaplan-Meier率分别从11.0%逐步增加到15.2%和20.4% (P <；0.0001)。在无糖尿病、T2DM和T1DM组，PEP与evolocumab的风险比分别为0.87 （95% CI 0.79-0.96）、0.84（0.75-0.93）和0.66(0.32-1.38)，绝对风险降低分别为1.3%、2.5%和7.3%。结论：强化LDL-C降低可能为T1DM和ASCVD患者提供实质性的临床益处。需要在这一人群中进行额外的随机对照心血管结局试验。
{"title":"Cardiovascular Outcomes and Efficacy of the PCSK9 Inhibitor Evolocumab in Individuals With Type 1 Diabetes: Insights From the FOURIER Trial","authors":"Yu Mi Kang, Robert P. Giugliano, Xinhui Ran, Prakash Deedwania, Gaetano M. De Ferrari, Jyothis T. George, Ioanna Gouni-Berthold, Gabriel Paiva da Silva Lima, Yehuda Handelsman, Basil S. Lewis, E. Magnus Ohman, Huei Wang, J. Antonio G. López, Maria Laura Monsalvo, Marc S. Sabatine, Lawrence A. Leiter","doi":"10.2337/dc25-0942","DOIUrl":"https://doi.org/10.2337/dc25-0942","url":null,"abstract":"OBJECTIVE To evaluate the clinical efficacy of intensive LDL cholesterol (LDL-C) lowering in type 1 diabetes mellitus (T1DM). RESEARCH DESIGN AND METHODS Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) randomized participants with atherosclerotic cardiovascular disease (ASCVD) on statins to evolocumab or placebo (median follow-up 2.2 years). The primary end point (PEP) was cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. RESULTS Of 27,564 participants, 10,834 (39.3%) had type 2 diabetes mellitus (T2DM), and 197 (0.7%) had T1DM. In the placebo arm, there was a stepwise increase in the 2.5-year PEP Kaplan-Meier rate from 11.0% to 15.2% to 20.4% in participants with no diabetes, T2DM, and T1DM, respectively (P &lt; 0.0001). Hazard ratios for PEP with evolocumab were 0.87 (95% CI 0.79–0.96), 0.84 (0.75–0.93), and 0.66 (0.32–1.38) in the no diabetes, T2DM, and T1DM groups, and absolute risk reduction was 1.3%, 2.5%, and 7.3%, respectively. CONCLUSIONS Intensive LDL-C lowering may provide substantial clinical benefit in individuals with T1DM and ASCVD. Additional randomized controlled cardiovascular outcomes trials are needed in this population.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"9 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144341055","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}
Mariana P. Socal, Namratha R. Kandula, Pineal I. Bareamichael, Jeromie Ballreich, Ilina Odouard, So-Yeon Kang, Joy O. Acha, Kelly E. Anderson, Michael DiStefano, Fernando Gerchman, Joseph F. Levy
Unaffordability of pharmaceutical treatments remains as a critical barrier to diabetes care in the U.S. Through a synthesis of recent evidence on affordability of diabetes drugs, with particular attention to emergent reforms, this call for action focuses on structural solutions to improve the affordability of pharmaceutical treatments for diabetes in the U.S. that providers should be aware of and consider supporting. Incentivizing competition in biosimilars and generics markets, increasing transparency, reforming pricing models that influence drug coverage, and expanding federal negotiation of drug prices, among other actions, can help make prescription drugs more affordable for patients, reduce budgetary impacts on payors, and increase access, ultimately helping to improve the health of all Americans living with diabetes.
{"title":"Improving Affordability of Pharmaceutical Treatments for Diabetes: A Call for Action","authors":"Mariana P. Socal, Namratha R. Kandula, Pineal I. Bareamichael, Jeromie Ballreich, Ilina Odouard, So-Yeon Kang, Joy O. Acha, Kelly E. Anderson, Michael DiStefano, Fernando Gerchman, Joseph F. Levy","doi":"10.2337/dci25-0002","DOIUrl":"https://doi.org/10.2337/dci25-0002","url":null,"abstract":"Unaffordability of pharmaceutical treatments remains as a critical barrier to diabetes care in the U.S. Through a synthesis of recent evidence on affordability of diabetes drugs, with particular attention to emergent reforms, this call for action focuses on structural solutions to improve the affordability of pharmaceutical treatments for diabetes in the U.S. that providers should be aware of and consider supporting. Incentivizing competition in biosimilars and generics markets, increasing transparency, reforming pricing models that influence drug coverage, and expanding federal negotiation of drug prices, among other actions, can help make prescription drugs more affordable for patients, reduce budgetary impacts on payors, and increase access, ultimately helping to improve the health of all Americans living with diabetes.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"632 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337509","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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