The American Diabetes Association (ADA) publishes the “Standards of Care in Diabetes” (SOC) annually to offer clinicians, patients, and payers evidence-based guidelines for diabetes management. The 2025 SOC recommends that clinicians consider screening asymptomatic adults with diabetes for heart failure using natriuretic peptide levels, and that they screen asymptomatic adults with diabetes ≥65 years of age with any microvascular disease, foot complications, or end-organ damage from diabetes for peripheral artery disease (PAD) using ankle-brachial index (ABI) testing. This perspective evaluates those recommendations using established screening principles and the published literature. The recommendation to screen for heart failure using natriuretic peptide lacks robust evidence in several key areas. N-terminal pro-B-type natriuretic peptide, or NT-proBNP, itself performs poorly as a screening test in asymptomatic adults. Furthermore, there is ambiguity in treatment recommendations and insufficient evidence showing improved outcomes with sodium–glucose cotransporter 2 inhibitor treatment in adults with diabetes and stage B heart failure. Finally, the costs involved are high and may not be economically justifiable. Similarly, the recommendation to screen for PAD in asymptomatic adults with diabetes is not backed by rigorous scientific evidence. The evidence cited combines ABI screening with other effective screening tests and has limited generalizability. There is no guidance on how to interpret the results of ABI testing or how the information gained should be used to direct treatment. While the intent to improve health care through screening is commendable, these recommendations are inadequately supported by the principles of screening and the published literature. It is imperative that the ADA uses the greatest scientific rigor to prepare its SOC.
{"title":"Is Screening for Heart Failure and Peripheral Artery Disease Warranted in Asymptomatic Adults With Diabetes? A Perspective on the 2025 American Diabetes Association “Standards of Care in Diabetes”","authors":"William H. Herman, Shihchen Kuo","doi":"10.2337/dci24-0103","DOIUrl":"https://doi.org/10.2337/dci24-0103","url":null,"abstract":"The American Diabetes Association (ADA) publishes the “Standards of Care in Diabetes” (SOC) annually to offer clinicians, patients, and payers evidence-based guidelines for diabetes management. The 2025 SOC recommends that clinicians consider screening asymptomatic adults with diabetes for heart failure using natriuretic peptide levels, and that they screen asymptomatic adults with diabetes ≥65 years of age with any microvascular disease, foot complications, or end-organ damage from diabetes for peripheral artery disease (PAD) using ankle-brachial index (ABI) testing. This perspective evaluates those recommendations using established screening principles and the published literature. The recommendation to screen for heart failure using natriuretic peptide lacks robust evidence in several key areas. N-terminal pro-B-type natriuretic peptide, or NT-proBNP, itself performs poorly as a screening test in asymptomatic adults. Furthermore, there is ambiguity in treatment recommendations and insufficient evidence showing improved outcomes with sodium–glucose cotransporter 2 inhibitor treatment in adults with diabetes and stage B heart failure. Finally, the costs involved are high and may not be economically justifiable. Similarly, the recommendation to screen for PAD in asymptomatic adults with diabetes is not backed by rigorous scientific evidence. The evidence cited combines ABI screening with other effective screening tests and has limited generalizability. There is no guidance on how to interpret the results of ABI testing or how the information gained should be used to direct treatment. While the intent to improve health care through screening is commendable, these recommendations are inadequately supported by the principles of screening and the published literature. It is imperative that the ADA uses the greatest scientific rigor to prepare its SOC.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"7 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278335","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}
Natalie Rula Daya, Michael Fang, Jung-Im Shin, James S. Pankow, Pamela L. Lutsey, Arielle Valint, Justin B. Echouffo-Tcheugui, Scott Zeger, Elizabeth Selvin
OBJECTIVE To evaluate the concordance of glycated albumin, fructosamine, 1,5-anhydroglucitol (1,5-AG), and hemoglobin A1c (HbA1c) with continuous glucose monitor (CGM) metrics of hyperglycemia and glycemic control in a diverse population of adults with type 2 diabetes. RESEARCH DESIGN AND METHODS This was a pooled cross-sectional analysis of 552 adults, ages 30 to 97 years old, with diabetes. Participants wore a CGM for up to 2 weeks, and we evaluated the agreement between blood biomarkers (glycated albumin, fructosamine, and 1,5-AG) with CGM-defined metrics of hyperglycemia and glycemic control. RESULTS Of the 552 participants (mean age 74 years, 53% women, 36% Black), the median of mean CGM glucose was 132 mg/dL, and participants spent on average 84% of their time in range (70–180 mg/dL). CGM mean glucose was strongly related to HbA1c (r = 0.72), glycated albumin (r = 0.64), and fructosamine (r = 0.64) but weakly related to 1,5-AG (r = 0.46). Results were similar for time above range (>180 mg/dL). Glycated albumin and fructosamine performed similarly to HbA1c in the detection of target time in and above range (c-statistics ranged from 0.85 to 0.94). CONCLUSIONS Glycated albumin and fructosamine had similar associations with CGM-defined metrics of hyperglycemia compared with HbA1c. These three biomarkers performed similarly in the detection of time above range and in range. Our results provide evidence for the utility of glycated albumin and fructosamine as alternate measures of hyperglycemia.
{"title":"Detecting Hyperglycemia Using Biomarkers Versus Continuous Glucose Monitoring","authors":"Natalie Rula Daya, Michael Fang, Jung-Im Shin, James S. Pankow, Pamela L. Lutsey, Arielle Valint, Justin B. Echouffo-Tcheugui, Scott Zeger, Elizabeth Selvin","doi":"10.2337/dc25-0595","DOIUrl":"https://doi.org/10.2337/dc25-0595","url":null,"abstract":"OBJECTIVE To evaluate the concordance of glycated albumin, fructosamine, 1,5-anhydroglucitol (1,5-AG), and hemoglobin A1c (HbA1c) with continuous glucose monitor (CGM) metrics of hyperglycemia and glycemic control in a diverse population of adults with type 2 diabetes. RESEARCH DESIGN AND METHODS This was a pooled cross-sectional analysis of 552 adults, ages 30 to 97 years old, with diabetes. Participants wore a CGM for up to 2 weeks, and we evaluated the agreement between blood biomarkers (glycated albumin, fructosamine, and 1,5-AG) with CGM-defined metrics of hyperglycemia and glycemic control. RESULTS Of the 552 participants (mean age 74 years, 53% women, 36% Black), the median of mean CGM glucose was 132 mg/dL, and participants spent on average 84% of their time in range (70–180 mg/dL). CGM mean glucose was strongly related to HbA1c (r = 0.72), glycated albumin (r = 0.64), and fructosamine (r = 0.64) but weakly related to 1,5-AG (r = 0.46). Results were similar for time above range (>180 mg/dL). Glycated albumin and fructosamine performed similarly to HbA1c in the detection of target time in and above range (c-statistics ranged from 0.85 to 0.94). CONCLUSIONS Glycated albumin and fructosamine had similar associations with CGM-defined metrics of hyperglycemia compared with HbA1c. These three biomarkers performed similarly in the detection of time above range and in range. Our results provide evidence for the utility of glycated albumin and fructosamine as alternate measures of hyperglycemia.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"36 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278339","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}
Caroline E. Sloan, Lindsay Zepel, Valerie A. Smith, David E. Arterburn, Aileen Baecker, Amy G. Clark, Aniket A. Kawatkar, Ryan M. Kane, Christopher R. Daigle, Karen J. Coleman, Matthew L. Maciejewski
OBJECTIVE Bariatric surgery lowers the risk of developing microvascular and macrovascular complications of type 2 diabetes, but it is unclear whether it also lowers long-term health expenditures in this population. RESEARCH DESIGN AND METHODS In a retrospective cohort study of 6,690 patients with obesity and type 2 diabetes who underwent bariatric surgery in 2012–2019 and 19,122 matched nonsurgical patients, we compared total, outpatient, inpatient, and medication expenditures 3 years presurgery and 5.5 years postsurgery, using generalized estimating equations. Expenditures were estimated in 6-month intervals. RESULTS Surgical and nonsurgical cohorts were well-matched, with 73% female, average BMI 44 kg/m2, mean age 50 years, and 32% on insulin. Estimated total expenditures were similar between surgical and nonsurgical patients up to 1 year presurgery. Total expenditures were significantly lower for surgical patients starting 1 year postsurgery and up to 5.5 years postsurgery compared with controls ($566 lower per 6-month interval at 5.5 years; 95% CI −$807, −$316). Expenditure differences were largely attributable to a 56% drop in medication expenditures for surgical patients, from $2,204 in the 6 months presurgery to $969 per 6-month interval at 5.5 years postsurgery. Surgical patients had a higher probability of inpatient admission throughout the postsurgical period (4.0–6.5% vs. 2.4–3.1% per 6-month interval). CONCLUSIONS Patients with type 2 diabetes undergoing bariatric surgery have significantly lower total postsurgical expenditures than matched controls, primarily because of substantial reductions in pharmacy expenditures. The long-term cost savings associated with bariatric surgery are likely to increase further, given the rapidly escalating costs of diabetes pharmacotherapy.
目的：减肥手术降低了2型糖尿病微血管和大血管并发症的发生风险，但目前尚不清楚它是否也降低了这一人群的长期健康支出。研究设计与方法在一项回顾性队列研究中，研究人员对2012-2019年接受减肥手术的6690名肥胖和2型糖尿病患者和19122名匹配的非手术患者进行了研究，使用广义估计方程比较了手术前3年和手术后5.5年的总费用、门诊费用、住院费用和药物费用。每隔6个月估计一次支出。结果：手术和非手术队列匹配良好，73%为女性，平均BMI为44 kg/m2，平均年龄为50岁，32%使用胰岛素。手术和非手术患者到手术前1年的估计总支出相似。与对照组相比，手术患者从术后1年开始至术后5.5年的总支出显著降低(5.5年时每6个月减少566美元；95% ci - 807美元，- 316美元)。支出差异主要是由于手术患者的药物支出下降了56%，从手术前6个月的2,204美元下降到手术后5.5年的每6个月969美元。手术患者在术后住院的概率更高（4.0-6.5% vs. 2.4-3.1% / 6个月间隔）。结论：接受减肥手术的2型糖尿病患者的术后总费用明显低于对照组，主要是因为药房费用的大幅减少。考虑到糖尿病药物治疗成本的迅速上升，与减肥手术相关的长期成本节约可能会进一步增加。
{"title":"Health Expenditures Decline After Bariatric Surgery for Patients With Type 2 Diabetes","authors":"Caroline E. Sloan, Lindsay Zepel, Valerie A. Smith, David E. Arterburn, Aileen Baecker, Amy G. Clark, Aniket A. Kawatkar, Ryan M. Kane, Christopher R. Daigle, Karen J. Coleman, Matthew L. Maciejewski","doi":"10.2337/dc25-0254","DOIUrl":"https://doi.org/10.2337/dc25-0254","url":null,"abstract":"OBJECTIVE Bariatric surgery lowers the risk of developing microvascular and macrovascular complications of type 2 diabetes, but it is unclear whether it also lowers long-term health expenditures in this population. RESEARCH DESIGN AND METHODS In a retrospective cohort study of 6,690 patients with obesity and type 2 diabetes who underwent bariatric surgery in 2012–2019 and 19,122 matched nonsurgical patients, we compared total, outpatient, inpatient, and medication expenditures 3 years presurgery and 5.5 years postsurgery, using generalized estimating equations. Expenditures were estimated in 6-month intervals. RESULTS Surgical and nonsurgical cohorts were well-matched, with 73% female, average BMI 44 kg/m2, mean age 50 years, and 32% on insulin. Estimated total expenditures were similar between surgical and nonsurgical patients up to 1 year presurgery. Total expenditures were significantly lower for surgical patients starting 1 year postsurgery and up to 5.5 years postsurgery compared with controls ($566 lower per 6-month interval at 5.5 years; 95% CI −$807, −$316). Expenditure differences were largely attributable to a 56% drop in medication expenditures for surgical patients, from $2,204 in the 6 months presurgery to $969 per 6-month interval at 5.5 years postsurgery. Surgical patients had a higher probability of inpatient admission throughout the postsurgical period (4.0–6.5% vs. 2.4–3.1% per 6-month interval). CONCLUSIONS Patients with type 2 diabetes undergoing bariatric surgery have significantly lower total postsurgical expenditures than matched controls, primarily because of substantial reductions in pharmacy expenditures. The long-term cost savings associated with bariatric surgery are likely to increase further, given the rapidly escalating costs of diabetes pharmacotherapy.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"221 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278344","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}
Dea H. Kofod, Nicholas Carlson, Thomas P. Almdal, Tobias Bomholt, Christian Torp-Pedersen, Kirsten Nørgaard, Jesper H. Svendsen, Bo Feldt-Rasmussen, Mads Hornum
OBJECTIVE The optimal glycemic target for individuals with severe chronic kidney disease (CKD) remains unclear. We investigated the association between HbA1c and complications in individuals with diabetes and severe CKD. RESEARCH DESIGN AND METHODS In a Danish nationwide registry-based cohort study, we included 27,113 individuals ≥18 years old with diabetes and severe CKD (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2) between 2010 and 2022. As reference groups, we included an age- and sex-matched cohort of 80,131 individuals with diabetes and mild-to-moderate CKD (eGFR 30–59 mL/min/1.73 m2) and 80,797 individuals with diabetes and no-to-mild CKD (eGFR ≥60 mL/min/1.73 m2). Multiple Cox regressions were used to estimate the standardized 1-year risk of major adverse cardiovascular events (MACE), microvascular complications, and hospitalizations due to hypoglycemia across strata of HbA1c levels. RESULTS For individuals with severe CKD, the risk of MACE significantly increased at HbA1c levels ≥7.2% (55 mmol/mol) (P < 0.01) and <5.8% (40 mmol/mol) (P < 0.001), compared with an HbA1c level of 6.3–6.6% (45–49 mmol/mol). The risk of microvascular complications significantly increased at HbA1c levels ≥7.2% (55 mmol/mol) (P < 0.001), and the risk of hospitalization due to hypoglycemia significantly increased at HbA1c levels ≥6.7% (50 mmol/mol) (P < 0.001). The association patterns between HbA1c and outcomes were similar in the severe CKD cohort compared with the matched cohorts with mild-to-moderate CKD and no-to-mild CKD. CONCLUSIONS Our data suggest an HbA1c range of 6.7–7.1% (50–54 mmol/mol) to be most favorable for reducing long-term complications in this high-risk population.
{"title":"The Association Between Hemoglobin A1c and Complications Among Individuals With Diabetes and Severe Chronic Kidney Disease","authors":"Dea H. Kofod, Nicholas Carlson, Thomas P. Almdal, Tobias Bomholt, Christian Torp-Pedersen, Kirsten Nørgaard, Jesper H. Svendsen, Bo Feldt-Rasmussen, Mads Hornum","doi":"10.2337/dc25-0339","DOIUrl":"https://doi.org/10.2337/dc25-0339","url":null,"abstract":"OBJECTIVE The optimal glycemic target for individuals with severe chronic kidney disease (CKD) remains unclear. We investigated the association between HbA1c and complications in individuals with diabetes and severe CKD. RESEARCH DESIGN AND METHODS In a Danish nationwide registry-based cohort study, we included 27,113 individuals ≥18 years old with diabetes and severe CKD (estimated glomerular filtration rate [eGFR] &lt;30 mL/min/1.73 m2) between 2010 and 2022. As reference groups, we included an age- and sex-matched cohort of 80,131 individuals with diabetes and mild-to-moderate CKD (eGFR 30–59 mL/min/1.73 m2) and 80,797 individuals with diabetes and no-to-mild CKD (eGFR ≥60 mL/min/1.73 m2). Multiple Cox regressions were used to estimate the standardized 1-year risk of major adverse cardiovascular events (MACE), microvascular complications, and hospitalizations due to hypoglycemia across strata of HbA1c levels. RESULTS For individuals with severe CKD, the risk of MACE significantly increased at HbA1c levels ≥7.2% (55 mmol/mol) (P &lt; 0.01) and &lt;5.8% (40 mmol/mol) (P &lt; 0.001), compared with an HbA1c level of 6.3–6.6% (45–49 mmol/mol). The risk of microvascular complications significantly increased at HbA1c levels ≥7.2% (55 mmol/mol) (P &lt; 0.001), and the risk of hospitalization due to hypoglycemia significantly increased at HbA1c levels ≥6.7% (50 mmol/mol) (P &lt; 0.001). The association patterns between HbA1c and outcomes were similar in the severe CKD cohort compared with the matched cohorts with mild-to-moderate CKD and no-to-mild CKD. CONCLUSIONS Our data suggest an HbA1c range of 6.7–7.1% (50–54 mmol/mol) to be most favorable for reducing long-term complications in this high-risk population.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"521 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237340","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}
Daniel R. Morales, Fan Bu, Benjamin Viernes, Scott L. DuVall, Michael E. Matheny, Katherine R. Simon, Thomas Falconer, Lauren R. Richter, Anna Ostropolets, Wallis C. Y. Lau, Kenneth K. C. Man, Shounak Chattopadhyay, Nestoras Mathioudakis, Evan Minty, Akihiko Nishimura, Feng Sun, Can Yin, Sarah L. Seager, Yi Chai, Jin J. Zhou, Yuan Lu, Carlen Reyes, Andrea Pistillo, Talita Duarte-Salles, Clair Blacketer, Martijn J. Schuemie, Patrick B. Ryan, Harlan M. Krumholz, George Hripcsak, Rohan Khera, Marc A. Suchard
OBJECTIVE To assess the association between glucagon-like peptide 1 receptor agonist (GLP-1RA) use and risk of incident thyroid tumors. RESEARCH DESIGN AND METHODS The retrospective, active-comparator new-user cohort study used international administrative claims and electronic health record databases. Participants included patients with type 2 diabetes mellitus (T2DM) with prior metformin therapy initiating a GLP-1RA versus new users of sodium–glucose cotransporter 2 inhibitors (SGLT2is), dipeptidyl peptidase 4 inhibitors (DPP-4is), and sulfonylureas (SUs). The outcome was incident thyroid tumor and thyroid malignancy. Propensity score matching and stratification were used to adjust for confounders with an intention-to-treat and on-treatment strategy. Cox regression was used to estimate hazard ratios (HRs) pooled using a random-effects meta-analysis. Unmeasured confounding was evaluated using negative outcomes, with calibration of the HR. RESULTS A total of 460,032 users of GLP-1RAs, 717,792 users of SGLT2is, 2,055,583 users of DPP-4is, and 1,119,868 users of SUs were included. Only U.S. cohorts passed study diagnostics. Thyroid tumor incidence ranged from 0.88 to 1.03 per 1,000 person-years in GLP-1RA cohorts. GLP-1RA exposure was not associated with an increased risk of thyroid tumors compared with SGLT2is, DPP-4is, or SUs (meta-analysis: GLP-1RA vs. SGLT2i HR range from 0.83 [95% CI 0.57–1.27] to 0.95 [0.85–1.06]; GLP-1RA vs. SU HR range from 0.95 [0.75–1.20] to 1.03 [0.87–1.23]; GLP-1RA vs. DPP-4i HR range from 0.78 [0.60–1.01] to 0.93 [0.83–1.04]). Analysis using thyroid malignancy and including a 1-year lag period produced similar conclusions. CONCLUSIONS In patients with T2DM initiating second-line treatments, we observed no increased risk of thyroid tumors with GLP-1RA exposure.
目的探讨胰高血糖素样肽1受体激动剂（GLP-1RA）的使用与甲状腺肿瘤发生风险的关系。研究设计和方法回顾性、主动比较新用户队列研究使用国际行政索赔和电子健康记录数据库。参与者包括先前接受二甲双胍治疗的2型糖尿病（T2DM）患者，开始GLP-1RA与新使用钠-葡萄糖共转运蛋白2抑制剂（SGLT2is），二肽基肽酶4抑制剂（DPP-4is）和磺脲类药物（SUs）的患者。结果为甲状腺肿瘤和甲状腺恶性。倾向评分匹配和分层用于调整混杂因素的意向治疗和治疗策略。采用Cox回归估计随机效应荟萃分析汇总的风险比（hr）。使用阴性结果评估未测量的混杂，并校准HR。结果共纳入GLP-1RAs患者460,032人，SGLT2is患者717,792人，DPP-4is患者2,0055,583人，SUs患者1,119,868人。只有美国的队列通过了研究诊断。在GLP-1RA队列中，甲状腺肿瘤发病率为每1000人年0.88 - 1.03。与SGLT2is、DPP-4is或SUs相比，GLP-1RA暴露与甲状腺肿瘤风险增加无关(荟萃分析：GLP-1RA与SGLT2i的危险度范围为0.83 [95% CI 0.57-1.27]至0.95 [0.85-1.06]；GLP-1RA与SU的HR范围为0.95[0.75-1.20]至1.03 [0.87-1.23]；GLP-1RA与DPP-4i的HR范围为0.78[0.60-1.01]至0.93[0.83-1.04])。对甲状腺恶性肿瘤的分析，包括1年的滞后期，得出了类似的结论。结论：在接受二线治疗的T2DM患者中，我们观察到GLP-1RA暴露没有增加甲状腺肿瘤的风险。
{"title":"Risk of Thyroid Tumors With GLP-1 Receptor Agonists: A Retrospective Cohort Study","authors":"Daniel R. Morales, Fan Bu, Benjamin Viernes, Scott L. DuVall, Michael E. Matheny, Katherine R. Simon, Thomas Falconer, Lauren R. Richter, Anna Ostropolets, Wallis C. Y. Lau, Kenneth K. C. Man, Shounak Chattopadhyay, Nestoras Mathioudakis, Evan Minty, Akihiko Nishimura, Feng Sun, Can Yin, Sarah L. Seager, Yi Chai, Jin J. Zhou, Yuan Lu, Carlen Reyes, Andrea Pistillo, Talita Duarte-Salles, Clair Blacketer, Martijn J. Schuemie, Patrick B. Ryan, Harlan M. Krumholz, George Hripcsak, Rohan Khera, Marc A. Suchard","doi":"10.2337/dc25-0154","DOIUrl":"https://doi.org/10.2337/dc25-0154","url":null,"abstract":"OBJECTIVE To assess the association between glucagon-like peptide 1 receptor agonist (GLP-1RA) use and risk of incident thyroid tumors. RESEARCH DESIGN AND METHODS The retrospective, active-comparator new-user cohort study used international administrative claims and electronic health record databases. Participants included patients with type 2 diabetes mellitus (T2DM) with prior metformin therapy initiating a GLP-1RA versus new users of sodium–glucose cotransporter 2 inhibitors (SGLT2is), dipeptidyl peptidase 4 inhibitors (DPP-4is), and sulfonylureas (SUs). The outcome was incident thyroid tumor and thyroid malignancy. Propensity score matching and stratification were used to adjust for confounders with an intention-to-treat and on-treatment strategy. Cox regression was used to estimate hazard ratios (HRs) pooled using a random-effects meta-analysis. Unmeasured confounding was evaluated using negative outcomes, with calibration of the HR. RESULTS A total of 460,032 users of GLP-1RAs, 717,792 users of SGLT2is, 2,055,583 users of DPP-4is, and 1,119,868 users of SUs were included. Only U.S. cohorts passed study diagnostics. Thyroid tumor incidence ranged from 0.88 to 1.03 per 1,000 person-years in GLP-1RA cohorts. GLP-1RA exposure was not associated with an increased risk of thyroid tumors compared with SGLT2is, DPP-4is, or SUs (meta-analysis: GLP-1RA vs. SGLT2i HR range from 0.83 [95% CI 0.57–1.27] to 0.95 [0.85–1.06]; GLP-1RA vs. SU HR range from 0.95 [0.75–1.20] to 1.03 [0.87–1.23]; GLP-1RA vs. DPP-4i HR range from 0.78 [0.60–1.01] to 0.93 [0.83–1.04]). Analysis using thyroid malignancy and including a 1-year lag period produced similar conclusions. CONCLUSIONS In patients with T2DM initiating second-line treatments, we observed no increased risk of thyroid tumors with GLP-1RA exposure.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"56 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth Nethery, Jennifer A. Hutcheon, Julie Lee, Patricia A. Janssen, Laura Schummers
OBJECTIVE To evaluate changes in gestational diabetes mellitus (GDM) treatment and newborn birth weight after a 2010 change in GDM screening recommendations from a two-step (50-g glucose challenge test + 3-h, 100-g oral glucose tolerance test [OGTT] with Carpenter-Coustan criteria) to a mix of one-step and two-step (2-h, 75-g OGTT with International Association for Diabetes in Pregnancy Study Group criteria). RESEARCH DESIGN AND METHODS We estimated effects of the screening change on the incidence of lifestyle or medication treatment, infant birth weight >90th percentile or <10th percentile for gestational age (large and small for gestational age), and endocrinologist visits using interrupted time series analysis in all 463,881 individuals with singleton pregnancies (>28 gestational weeks) from British Columbia, Canada, between 2004 and 2019. RESULTS After the screening change, lifestyle-treated GDM increased immediately (level change 1.85 [95% CI 1.19–2.51]), corresponding to a 1.85% increase in incidence. Medication-treated GDM increased gradually (trend change 0.23 [95% CI 0.09–0.37] per year), but there was no change in medication-treated GDM using a shorter (3-year) postpolicy period (level change −0.31 [95% CI −0.9 to 0.29]; trend change 0.03 [95% CI −0.36 to 0.43]). We detected no change in infant birth weight outcomes and endocrinology visits. CONCLUSIONS Changing the screening approach substantially increased diagnoses of lifestyle-treated GDM but did not impact medication-treated GDM or infant birth weight.
目的评估2010年GDM筛查建议从两步（50 g葡萄糖刺激试验+ 3-h， 100 g口服葡萄糖耐量试验[OGTT]与Carpenter-Coustan标准）改为一步和两步混合（2小时，75 g OGTT与国际妊娠糖尿病协会研究组标准）后，妊娠糖尿病（GDM）治疗和新生儿体重的变化。研究设计和方法我们使用中断时间序列分析，对2004年至2019年加拿大不列颠哥伦比亚省所有463,881例单胎妊娠（28胎周）患者的生活方式或药物治疗发生率、婴儿出生体重第90百分位或第10百分位（胎龄大或小）以及内分泌学家就诊情况进行了筛查变化的影响。结果：筛查改变后，生活方式治疗的GDM立即增加（水平变化1.85 [95% CI 1.19-2.51]），相应的发病率增加1.85%。药物治疗的GDM逐渐增加（趋势变化为每年0.23 [95% CI 0.09-0.37]），但在较短（3年）的政策后期间，药物治疗的GDM没有变化(水平变化为- 0.31 [95% CI - 0.9至0.29]；趋势变化0.03 [95% CI - 0.36 ~ 0.43])。我们没有发现婴儿出生体重结局和内分泌学就诊的变化。结论：改变筛查方法大大增加了生活方式治疗的GDM的诊断率，但对药物治疗的GDM或婴儿出生体重没有影响。
{"title":"Effects of a Province-Wide Change in Gestational Diabetes Mellitus Screening Policy on Treatment and Newborn Birth Weight","authors":"Elizabeth Nethery, Jennifer A. Hutcheon, Julie Lee, Patricia A. Janssen, Laura Schummers","doi":"10.2337/dc25-0480","DOIUrl":"https://doi.org/10.2337/dc25-0480","url":null,"abstract":"OBJECTIVE To evaluate changes in gestational diabetes mellitus (GDM) treatment and newborn birth weight after a 2010 change in GDM screening recommendations from a two-step (50-g glucose challenge test + 3-h, 100-g oral glucose tolerance test [OGTT] with Carpenter-Coustan criteria) to a mix of one-step and two-step (2-h, 75-g OGTT with International Association for Diabetes in Pregnancy Study Group criteria). RESEARCH DESIGN AND METHODS We estimated effects of the screening change on the incidence of lifestyle or medication treatment, infant birth weight &gt;90th percentile or &lt;10th percentile for gestational age (large and small for gestational age), and endocrinologist visits using interrupted time series analysis in all 463,881 individuals with singleton pregnancies (&gt;28 gestational weeks) from British Columbia, Canada, between 2004 and 2019. RESULTS After the screening change, lifestyle-treated GDM increased immediately (level change 1.85 [95% CI 1.19–2.51]), corresponding to a 1.85% increase in incidence. Medication-treated GDM increased gradually (trend change 0.23 [95% CI 0.09–0.37] per year), but there was no change in medication-treated GDM using a shorter (3-year) postpolicy period (level change −0.31 [95% CI −0.9 to 0.29]; trend change 0.03 [95% CI −0.36 to 0.43]). We detected no change in infant birth weight outcomes and endocrinology visits. CONCLUSIONS Changing the screening approach substantially increased diagnoses of lifestyle-treated GDM but did not impact medication-treated GDM or infant birth weight.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"11 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218875","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}
Wajd Alkabbani, Sara J. Cromer, Dae Hyun Kim, Julie M. Paik, Katsiaryna Bykov, Medha Munshi, Deborah J. Wexler, Elisabetta Patorno
OBJECTIVE To assess time trends of and examine which sociodemographic and clinical characteristics are associated with continuous glucose monitoring (CGM) initiation in insulin-treated older adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Using data from Medicare Fee-for-Service (2013–2020) and Optum’s deidentified Clinformatics Data Mart Database (Clinformatics) (2013–2022), we identified patients aged ≥65 years with T2D receiving insulin therapy who initiated CGM annually. Initiation of a CGM device was defined based on Current Procedural Terminology codes and National Drug Codes. Then, we 1:4 matched new users of CGM to patients unexposed to CGM, using risk set sampling. Index date was the date of CGM initiation or, for control participants, the closest physician visit within ±7 days. We used logistic regression to assess demographic and clinical characteristics associated with CGM initiation. RESULTS The annual CGM initiation rate rose from 107 to 5,249/100,000 in Medicare (2013–2020) and from 796 to 9,195/100,000 in Clinformatics (2013–2022). Compared with White patients, Hispanic (odds ratio, 96% CI: 0.44, 0.42–0.48 in Medicare and 0.81, 0.78–0.85 in Clinformatics) and Black (0.71, 0.69–0.73 in Medicare and 0.89, 0.85–0.92 in Clinformatics) individuals were less likely to receive CGM. Older age and residing in low socioeconomic status areas were associated with lower CGM uptake, while history of hypoglycemia and lower frailty scores increased CGM initiation likelihood. CONCLUSIONS CGM initiation has increased over time but remains <10% among insulin-treated older adults with T2D. Substantial racial, ethnic, and socioeconomic disparities were observed.
{"title":"Overall Uptake and Racial, Ethnic, and Socioeconomic Disparities in the Use of Continuous Glucose Monitoring Devices Among Insulin-Treated Older Adults With Type 2 Diabetes","authors":"Wajd Alkabbani, Sara J. Cromer, Dae Hyun Kim, Julie M. Paik, Katsiaryna Bykov, Medha Munshi, Deborah J. Wexler, Elisabetta Patorno","doi":"10.2337/dca25-0006","DOIUrl":"https://doi.org/10.2337/dca25-0006","url":null,"abstract":"OBJECTIVE To assess time trends of and examine which sociodemographic and clinical characteristics are associated with continuous glucose monitoring (CGM) initiation in insulin-treated older adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Using data from Medicare Fee-for-Service (2013–2020) and Optum’s deidentified Clinformatics Data Mart Database (Clinformatics) (2013–2022), we identified patients aged ≥65 years with T2D receiving insulin therapy who initiated CGM annually. Initiation of a CGM device was defined based on Current Procedural Terminology codes and National Drug Codes. Then, we 1:4 matched new users of CGM to patients unexposed to CGM, using risk set sampling. Index date was the date of CGM initiation or, for control participants, the closest physician visit within ±7 days. We used logistic regression to assess demographic and clinical characteristics associated with CGM initiation. RESULTS The annual CGM initiation rate rose from 107 to 5,249/100,000 in Medicare (2013–2020) and from 796 to 9,195/100,000 in Clinformatics (2013–2022). Compared with White patients, Hispanic (odds ratio, 96% CI: 0.44, 0.42–0.48 in Medicare and 0.81, 0.78–0.85 in Clinformatics) and Black (0.71, 0.69–0.73 in Medicare and 0.89, 0.85–0.92 in Clinformatics) individuals were less likely to receive CGM. Older age and residing in low socioeconomic status areas were associated with lower CGM uptake, while history of hypoglycemia and lower frailty scores increased CGM initiation likelihood. CONCLUSIONS CGM initiation has increased over time but remains &lt;10% among insulin-treated older adults with T2D. Substantial racial, ethnic, and socioeconomic disparities were observed.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"28 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183785","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 To compare the effectiveness of sodium–glucose cotransporter 2 inhibitors (SGLT2is) versus metformin in preventing delirium among patients with type 2 diabetes (T2D), using real-world data. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study using the TriNetX global health research network, including 857,171 adults with T2D who initiated either an SGLT2i (n = 88,012) or metformin (n = 769,159) from 2005 to 2025. Propensity score matching (1:1) was used to balance covariates between groups. The primary outcome was incident delirium; secondary outcomes included all-cause mortality. Absolute risk reduction (ARR), adjusted hazard ratios (aHRs), and Kaplan-Meier survival analyses were used to assess outcomes. RESULTS After matching, SGLT2i use was associated with a significantly lower risk of delirium compared with metformin (ARR 5.03%, 3.97% vs. 9.0%; aHR 0.91 [95% CI 0.87, 0.95], P < 0.001). All-cause mortality was also lower in the SGLT2i group (ARR 9.23%, aHR 0.85 [95% CI 0.87, 0.88], P < 0.001). The most pronounced benefits were seen in adults aged ≥80 years (aHR 0.83, P < 0.0001), males, and high-risk subgroups using insulin or sedatives. CONCLUSIONS This first head-to-head, real-world study suggests that SGLT2is may offer superior protection against delirium compared with metformin in patients with T2D, especially in high-risk populations. These findings support the inclusion of cognitive outcomes in diabetes treatment decisions and suggest a potential shift in first-line therapy strategies.
目的：比较钠-葡萄糖共转运蛋白2抑制剂（SGLT2is）与二甲双胍预防2型糖尿病（T2D）患者谵妄的有效性。研究设计和方法我们使用TriNetX全球健康研究网络进行了一项回顾性队列研究，包括857,171名T2D成人患者，他们在2005年至2025年期间接受了sglt2d治疗（n = 88,012）或二甲双胍治疗（n = 769,159）。倾向评分匹配（1:1）用于平衡组间协变量。主要结局为偶发性谵妄；次要结局包括全因死亡率。绝对风险降低（ARR）、校正风险比（aHRs）和Kaplan-Meier生存分析用于评估结果。结果匹配后，与二甲双胍相比，使用SGLT2i与谵妄风险显著降低相关(ARR 5.03%, 3.97% vs. 9.0%；aHR 0.91 [95% CI 0.87, 0.95], P <；0.001)。SGLT2i组的全因死亡率也较低(ARR 9.23%, aHR 0.85 [95% CI 0.87, 0.88], P &；0.001)。在≥80岁的成年人中获益最明显(aHR 0.83, P <；0.0001)，男性和使用胰岛素或镇静剂的高危亚组。结论：这项首次面对面的真实世界研究表明，与二甲双胍相比，SGLT2is可能对T2D患者的谵妄提供更好的保护，特别是在高危人群中。这些发现支持将认知结果纳入糖尿病治疗决策，并提示一线治疗策略的潜在转变。
{"title":"SGLT2i Versus Metformin for Delirium Prevention in Type 2 Diabetes: A Real-World, Head- to-Head Comparative Study","authors":"Mingyang Sun, Xiaoling Wang, Zhongyuan Lu, Yitian Yang, Shuang Lv, Mengrong Miao, Wan-Ming Chen, Szu-Yuan Wu, Jiaqiang Zhang","doi":"10.2337/dc25-0433","DOIUrl":"https://doi.org/10.2337/dc25-0433","url":null,"abstract":"OBJECTIVE To compare the effectiveness of sodium–glucose cotransporter 2 inhibitors (SGLT2is) versus metformin in preventing delirium among patients with type 2 diabetes (T2D), using real-world data. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study using the TriNetX global health research network, including 857,171 adults with T2D who initiated either an SGLT2i (n = 88,012) or metformin (n = 769,159) from 2005 to 2025. Propensity score matching (1:1) was used to balance covariates between groups. The primary outcome was incident delirium; secondary outcomes included all-cause mortality. Absolute risk reduction (ARR), adjusted hazard ratios (aHRs), and Kaplan-Meier survival analyses were used to assess outcomes. RESULTS After matching, SGLT2i use was associated with a significantly lower risk of delirium compared with metformin (ARR 5.03%, 3.97% vs. 9.0%; aHR 0.91 [95% CI 0.87, 0.95], P &lt; 0.001). All-cause mortality was also lower in the SGLT2i group (ARR 9.23%, aHR 0.85 [95% CI 0.87, 0.88], P &lt; 0.001). The most pronounced benefits were seen in adults aged ≥80 years (aHR 0.83, P &lt; 0.0001), males, and high-risk subgroups using insulin or sedatives. CONCLUSIONS This first head-to-head, real-world study suggests that SGLT2is may offer superior protection against delirium compared with metformin in patients with T2D, especially in high-risk populations. These findings support the inclusion of cognitive outcomes in diabetes treatment decisions and suggest a potential shift in first-line therapy strategies.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"58 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164936","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}
Michelle So, Sara Vogrin, Michaela Waibel, Thomas W.H. Kay, John M. Wentworth
OBJECTIVE Baricitinib preserves β-cell function in people with recently diagnosed type 1 diabetes. We aimed to determine whether simple routine clinical measures could be used to assess β-cell preservation and predict treatment response. RESEARCH DESIGNS AND METHOD Measures of β-cell function derived from clinical and biochemical measures were calculated using data from the BAricitinib in Newly DIagnosed Type 1 diabetes (BANDIT) randomized trial of baricitinib in recent-onset type 1 diabetes. Measures that reported and predicted treatment efficacy were determined using linear regression and receiver operator characteristic analysis, respectively. Therapeutic predictors were validated using data from trials of rituximab, abatacept, and antithymocyte globulin. RESULTS Quantitative response score (QRS), fasting C-peptide, and model-estimated C-peptide (CPest) most reliably differentiated placebo-treated from baricitinib-treated participants at 24 and 48 weeks. The Beta2 score, derived from fasting glucose, C-peptide, HbA1c, and insulin dose at 12 weeks, was optimal for predicting QRS >0 following 1 year of treatment with baricitinib and the other immunotherapies (areas under receiver operator curve 0.864 and 0.765, respectively). A 6.2% decrease in the Beta2 score at week 12 predicted significant improvement in HbA1c (−0.6% or −6 mmol/mol) and insulin use (−0.26 units/kg/day) in combined data from the rituximab, abatacept, and antithymocyte globulin trials. CONCLUSIONS QRS, fasting C-peptide, and CPest could be used as more efficient, less burdensome primary outcome measures for future immunotherapy trials. The ability of the Beta2 score to predict treatment responses could facilitate adaptive trial designs and help guide treatment decisions in the clinic.
{"title":"β-Cell Function Derived From Routine Clinical Measures Reports and Predicts Treatment Response to Immunotherapy in Recent-Onset Type 1 Diabetes","authors":"Michelle So, Sara Vogrin, Michaela Waibel, Thomas W.H. Kay, John M. Wentworth","doi":"10.2337/dc25-0565","DOIUrl":"https://doi.org/10.2337/dc25-0565","url":null,"abstract":"OBJECTIVE Baricitinib preserves β-cell function in people with recently diagnosed type 1 diabetes. We aimed to determine whether simple routine clinical measures could be used to assess β-cell preservation and predict treatment response. RESEARCH DESIGNS AND METHOD Measures of β-cell function derived from clinical and biochemical measures were calculated using data from the BAricitinib in Newly DIagnosed Type 1 diabetes (BANDIT) randomized trial of baricitinib in recent-onset type 1 diabetes. Measures that reported and predicted treatment efficacy were determined using linear regression and receiver operator characteristic analysis, respectively. Therapeutic predictors were validated using data from trials of rituximab, abatacept, and antithymocyte globulin. RESULTS Quantitative response score (QRS), fasting C-peptide, and model-estimated C-peptide (CPest) most reliably differentiated placebo-treated from baricitinib-treated participants at 24 and 48 weeks. The Beta2 score, derived from fasting glucose, C-peptide, HbA1c, and insulin dose at 12 weeks, was optimal for predicting QRS &gt;0 following 1 year of treatment with baricitinib and the other immunotherapies (areas under receiver operator curve 0.864 and 0.765, respectively). A 6.2% decrease in the Beta2 score at week 12 predicted significant improvement in HbA1c (−0.6% or −6 mmol/mol) and insulin use (−0.26 units/kg/day) in combined data from the rituximab, abatacept, and antithymocyte globulin trials. CONCLUSIONS QRS, fasting C-peptide, and CPest could be used as more efficient, less burdensome primary outcome measures for future immunotherapy trials. The ability of the Beta2 score to predict treatment responses could facilitate adaptive trial designs and help guide treatment decisions in the clinic.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"98 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153488","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}
Ye Yuan, Carmen R. Isasi, Tala Al-Rousan, Arnab K. Ghosh, Pricila H. Mullachery, Priya Palta, Nour Makarem
OBJECTIVE To investigate associations of concurrent hypertension and type 2 diabetes (T2D) with mortality in U.S. adults and elucidate differences by sex, race, and ethnicity. RESEARCH DESIGN AND METHODS The study population included 48,727 adults from the 1999–2018 National Health and Nutrition Examination Surveys. Participants were categorized into four mutually exclusive categories: 1) no hypertension and no T2D, 2) hypertension only, 3) T2D only, and 4) coexisting hypertension and T2D. Outcomes were all-cause and cardiovascular mortality defined using ICD-10 codes. Kaplan-Meier curves and multivariable Cox proportional hazards models were used to evaluate associations of hypertension and T2D status with mortality risk. RESULTS The burden of concurrent hypertension and T2D doubled between 1999 and 2018 from 6 to 12%. Overall, 50.5% of participants did not have T2D or hypertension, 38.4% had hypertension only, 2.4% had T2D only, and 8.7% had both. During a 9.2-year median follow-up, 7,734 deaths occurred. Concurrent hypertension and T2D versus no hypertension or T2D predicted higher all-cause (hazard ratio 2.46 [95% CI 2.45, 2.47]) and cardiovascular mortality risk (2.97 [2.94, 3.00]), with stronger associations in females versus males (P for interaction < 0.01). Compared with having hypertension or T2D only, concurrent hypertension and T2D predicted up to 66% and more than twofold higher all-cause and cardiovascular mortality risk, respectively, and associations varied by sex and race and ethnicity (P for interaction < 0.01), depending on the reference group (T2D only or hypertension only). Concurrent prediabetes and elevated blood pressure predicted up to 19% higher mortality risk compared with having neither or either condition. CONCLUSIONS Concurrent hypertension and T2D predict high mortality risk, underscoring the critical need for contextual interventions that extend healthspan in the U.S.
目的：研究美国成人并发高血压和2型糖尿病（T2D）与死亡率的关系，并阐明性别、种族和民族的差异。研究设计和方法研究人群包括1999-2018年全国健康和营养检查调查的48,727名成年人。参与者被分为四个相互排斥的类别：1)无高血压和无T2D， 2)只有高血压，3)只有T2D， 4)高血压和T2D共存。结果是使用ICD-10代码定义的全因死亡率和心血管死亡率。Kaplan-Meier曲线和多变量Cox比例风险模型用于评估高血压和T2D状态与死亡风险的关系。结果1999年至2018年间，高血压和T2D并发的负担翻了一番，从6%增加到12%。总体而言，50.5%的参与者没有T2D或高血压，38.4%的参与者只有高血压，2.4%的参与者只有T2D， 8.7%的参与者两者都有。在9.2年的中位随访期间，发生了7734例死亡。合并高血压和T2D与不合并高血压或T2D相比预测更高的全因风险（风险比2.46 [95% CI 2.45, 2.47]）和心血管死亡风险（风险比2.97[2.94,3.00]），且女性与男性的相关性更强(P为相互作用&；lt；0.01)。与仅患有高血压或T2D相比，并发高血压和T2D分别预测高达66%和两倍以上的全因和心血管死亡风险，且相关性因性别、种族和民族而异(P为相互作用&；lt；0.01)，取决于参照组（仅T2D或仅高血压）。与没有或没有糖尿病前期和血压升高的人相比，同时患有糖尿病前期和血压升高的人死亡风险高出19%。结论：并发高血压和T2D预测高死亡风险，强调了在美国对延长健康寿命的相关干预措施的迫切需要
{"title":"Associations of Concurrent Hypertension and Type 2 Diabetes With Mortality Outcomes: A Prospective Study of U.S. Adults","authors":"Ye Yuan, Carmen R. Isasi, Tala Al-Rousan, Arnab K. Ghosh, Pricila H. Mullachery, Priya Palta, Nour Makarem","doi":"10.2337/dca24-0118","DOIUrl":"https://doi.org/10.2337/dca24-0118","url":null,"abstract":"OBJECTIVE To investigate associations of concurrent hypertension and type 2 diabetes (T2D) with mortality in U.S. adults and elucidate differences by sex, race, and ethnicity. RESEARCH DESIGN AND METHODS The study population included 48,727 adults from the 1999–2018 National Health and Nutrition Examination Surveys. Participants were categorized into four mutually exclusive categories: 1) no hypertension and no T2D, 2) hypertension only, 3) T2D only, and 4) coexisting hypertension and T2D. Outcomes were all-cause and cardiovascular mortality defined using ICD-10 codes. Kaplan-Meier curves and multivariable Cox proportional hazards models were used to evaluate associations of hypertension and T2D status with mortality risk. RESULTS The burden of concurrent hypertension and T2D doubled between 1999 and 2018 from 6 to 12%. Overall, 50.5% of participants did not have T2D or hypertension, 38.4% had hypertension only, 2.4% had T2D only, and 8.7% had both. During a 9.2-year median follow-up, 7,734 deaths occurred. Concurrent hypertension and T2D versus no hypertension or T2D predicted higher all-cause (hazard ratio 2.46 [95% CI 2.45, 2.47]) and cardiovascular mortality risk (2.97 [2.94, 3.00]), with stronger associations in females versus males (P for interaction &lt; 0.01). Compared with having hypertension or T2D only, concurrent hypertension and T2D predicted up to 66% and more than twofold higher all-cause and cardiovascular mortality risk, respectively, and associations varied by sex and race and ethnicity (P for interaction &lt; 0.01), depending on the reference group (T2D only or hypertension only). Concurrent prediabetes and elevated blood pressure predicted up to 19% higher mortality risk compared with having neither or either condition. CONCLUSIONS Concurrent hypertension and T2D predict high mortality risk, underscoring the critical need for contextual interventions that extend healthspan in the U.S.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"1 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113908","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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