Edith E. Holloway, Laura Jenkins, Paul A. Agius, Sarah Manallack, Roslyn Le Gautier, Cathrine Mihalopoulos, Mary Lou Chatterton, Vincent L. Versace, Jennifer Halliday, Virginia Hagger, Shikha Gray, Kim Henshaw, Ben Harrap, Natasha Van Bruggen, Taryn Black, Glen Noonan, Carolyn Hines, Adrienne O’Neil, Timothy C. Skinner, Jane Speight, Christel Hendrieckx
OBJECTIVE To assess the effectiveness of Low Intensity mental health Support via a Telehealth Enabled Network (LISTEN), facilitated by diabetes health professionals, for reducing diabetes distress among adults with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS A two-arm, parallel group, pragmatic randomized controlled trial. Adults with diabetes distress (20-item Problem Areas in Diabetes [PAID] score ≥25, or ≥2 on three or more items) were recruited via the National Diabetes Services Scheme (NDSS) and randomized (1:1) via central randomization by computer to LISTEN (maximum four sessions of problem-solving therapy) or usual care (web-based resources about diabetes and emotional health). Participants completed self-report online surveys at baseline and at 8 and 26 weeks. The primary outcome was the change in diabetes distress (PAID) from baseline to 26 weeks. Secondary outcomes included psychological distress (10-item Kessler Psychological Distress Scale), general emotional well-being (World Health Organization 5-item Well-being Index) and coping self-efficacy at 8 and 26 weeks. Data were analyzed using intention-to-treat principles. RESULTS Participants (n = 429, 59% women, 40% men, 1% nonbinary; median age 54 [interquartile range 42.0–63.5]; 37% type 1 diabetes, 63% type 2 diabetes) were enrolled and randomized to the intervention (n = 216) or control group (n = 213). Over 26 weeks, there was a greater reduction in diabetes distress among the LISTEN group versus the control group (mean difference −7.2 [95% CI −11.6, −2.8]; P < 0.001; Cohen f2 = 0.03) and greater improvements in general emotional well-being and coping self-efficacy. No adverse events were reported. CONCLUSIONS LISTEN is an effective, low-intensity program, addressing the unmet needs of adults with type 1 and type 2 diabetes experiencing mild-to-moderate diabetes distress.
{"title":"Effectiveness of Low Intensity Mental Health Support via a Telehealth Enabled Network (LISTEN) for Adults With Diabetes Distress: A Parallel Group, Pragmatic Randomized Controlled Trial","authors":"Edith E. Holloway, Laura Jenkins, Paul A. Agius, Sarah Manallack, Roslyn Le Gautier, Cathrine Mihalopoulos, Mary Lou Chatterton, Vincent L. Versace, Jennifer Halliday, Virginia Hagger, Shikha Gray, Kim Henshaw, Ben Harrap, Natasha Van Bruggen, Taryn Black, Glen Noonan, Carolyn Hines, Adrienne O’Neil, Timothy C. Skinner, Jane Speight, Christel Hendrieckx","doi":"10.2337/dc24-2525","DOIUrl":"https://doi.org/10.2337/dc24-2525","url":null,"abstract":"OBJECTIVE To assess the effectiveness of Low Intensity mental health Support via a Telehealth Enabled Network (LISTEN), facilitated by diabetes health professionals, for reducing diabetes distress among adults with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS A two-arm, parallel group, pragmatic randomized controlled trial. Adults with diabetes distress (20-item Problem Areas in Diabetes [PAID] score ≥25, or ≥2 on three or more items) were recruited via the National Diabetes Services Scheme (NDSS) and randomized (1:1) via central randomization by computer to LISTEN (maximum four sessions of problem-solving therapy) or usual care (web-based resources about diabetes and emotional health). Participants completed self-report online surveys at baseline and at 8 and 26 weeks. The primary outcome was the change in diabetes distress (PAID) from baseline to 26 weeks. Secondary outcomes included psychological distress (10-item Kessler Psychological Distress Scale), general emotional well-being (World Health Organization 5-item Well-being Index) and coping self-efficacy at 8 and 26 weeks. Data were analyzed using intention-to-treat principles. RESULTS Participants (n = 429, 59% women, 40% men, 1% nonbinary; median age 54 [interquartile range 42.0–63.5]; 37% type 1 diabetes, 63% type 2 diabetes) were enrolled and randomized to the intervention (n = 216) or control group (n = 213). Over 26 weeks, there was a greater reduction in diabetes distress among the LISTEN group versus the control group (mean difference −7.2 [95% CI −11.6, −2.8]; P &lt; 0.001; Cohen f2 = 0.03) and greater improvements in general emotional well-being and coping self-efficacy. No adverse events were reported. CONCLUSIONS LISTEN is an effective, low-intensity program, addressing the unmet needs of adults with type 1 and type 2 diabetes experiencing mild-to-moderate diabetes distress.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"18 1","pages":"955-965"},"PeriodicalIF":16.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144104702","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}
BACKGROUND Significant clinical efficacy has been shown for semaglutide in managing type 2 diabetes (T2D); however, its cost-effectiveness remains uncertain. PURPOSE To systematically review existing evidence on cost-effectiveness of semaglutide versus other T2D medications. DATA SOURCES PubMed, Embase, and the Cost-Effectiveness Analysis Registry (by 11 June 2024). STUDY SELECTION A total of 45 articles (with 119 comparisons) from 2019 onward were included, representing Europe (n = 24), North America (n = 13), and Asia (all from China) (n = 8). DATA EXTRACTION Study characteristics and model characteristics/inputs/results were extracted. Lifetime costs and quality-adjusted life-years were evaluated. Proportions for cost-effectiveness outcomes (dominant, cost-effective, not cost-effective) were calculated. Subgroup analyses by region, sponsor type, comparator type, and model assumptions were performed. In sensitivity analysis a standard willingness-to-pay threshold was applied. DATA SYNTHESIS Of the articles included, 93.3% included adoption of a lifetime horizon and 84.4% a health care perspective and 68.9% were industry sponsored. For most studies reporting quality was high (86.7%). Overall, semaglutide was dominant/cost-effective in 73.9% of all comparisons. Notably, semaglutide was found to be dominant/cost-effective in all comparisons sponsored by Novo Nordisk versus in 50.0% of these funded by nonindustry sponsors and in none funded by other industry sponsors. Additionally, semaglutide was more cost-effective in high-income countries and in studies with adoption of a broader perspective, longer horizon, and lower discount rates. Results remained consistent with conversion with a common currency unit and willingness-to-pay threshold of US$50,000. LIMITATIONS Less detailed demographic information for more granular analyses. CONCLUSIONS Semaglutide is generally cost-effective compared with other glucose-lowering medications in evaluation against within-study willingness-to-pay thresholds; however, results varied by study sponsor type, region, and model assumptions, highlighting the need for transparent and context-sensitive economic evaluations.
{"title":"Cost-effectiveness of Semaglutide Compared With Other Glucose-Lowering Medications in Treating Type 2 Diabetes: A Comprehensive Systematic Review and Meta-analysis","authors":"Ziyun Liu, Baoqi Zeng, Feng Sun, Qing Xia","doi":"10.2337/dc24-2241","DOIUrl":"https://doi.org/10.2337/dc24-2241","url":null,"abstract":"BACKGROUND Significant clinical efficacy has been shown for semaglutide in managing type 2 diabetes (T2D); however, its cost-effectiveness remains uncertain. PURPOSE To systematically review existing evidence on cost-effectiveness of semaglutide versus other T2D medications. DATA SOURCES PubMed, Embase, and the Cost-Effectiveness Analysis Registry (by 11 June 2024). STUDY SELECTION A total of 45 articles (with 119 comparisons) from 2019 onward were included, representing Europe (n = 24), North America (n = 13), and Asia (all from China) (n = 8). DATA EXTRACTION Study characteristics and model characteristics/inputs/results were extracted. Lifetime costs and quality-adjusted life-years were evaluated. Proportions for cost-effectiveness outcomes (dominant, cost-effective, not cost-effective) were calculated. Subgroup analyses by region, sponsor type, comparator type, and model assumptions were performed. In sensitivity analysis a standard willingness-to-pay threshold was applied. DATA SYNTHESIS Of the articles included, 93.3% included adoption of a lifetime horizon and 84.4% a health care perspective and 68.9% were industry sponsored. For most studies reporting quality was high (86.7%). Overall, semaglutide was dominant/cost-effective in 73.9% of all comparisons. Notably, semaglutide was found to be dominant/cost-effective in all comparisons sponsored by Novo Nordisk versus in 50.0% of these funded by nonindustry sponsors and in none funded by other industry sponsors. Additionally, semaglutide was more cost-effective in high-income countries and in studies with adoption of a broader perspective, longer horizon, and lower discount rates. Results remained consistent with conversion with a common currency unit and willingness-to-pay threshold of US$50,000. LIMITATIONS Less detailed demographic information for more granular analyses. CONCLUSIONS Semaglutide is generally cost-effective compared with other glucose-lowering medications in evaluation against within-study willingness-to-pay thresholds; however, results varied by study sponsor type, region, and model assumptions, highlighting the need for transparent and context-sensitive economic evaluations.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"129 1","pages":"1032-1041"},"PeriodicalIF":16.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144104696","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}
Venkatesh L. Murthy, Paolo Piaggi, Phillip Lin, Shilin Zhao, Lindsey K. Stolze, Andrew S. Perry, Robert L. Hanson, John Jeffrey Carr, James G. Terry, Leslie J. Baier, Clifton Bogardus, Clary Clish, Eric R. Gamazon, Jonathan Krakoff, Ravi V. Shah
OBJECTIVE To identify metabolic signatures of insulin action/secretion in Indigenous Americans (IAs) and their association with diabetes. RESEARCH DESIGN AND METHODS We defined circulating metabolomic signatures of insulin action/secretion in 446 IAs, including glucose disposal rate during low-dose insulin clamp (Mlow) and endogenous glucose production (EGP) during insulin infusion (suppression of hepatic glucose production). We then determined associations of these metabolic scores with glucose tolerance (in a separate set of ∼700 IAs) and diabetes/metabolic risk in ∼2,000 individuals (from Coronary Artery Risk Development in Young Adults [CARDIA] study). We used tissue-specific gene–metabolite mapping to pinpoint genetic pathways of type 2 diabetes (T2D) implicated by metabolomic signatures. RESULTS In young IAs (mean age 29 years; mean BMI 34.9 kg/m2) without diabetes, phenotype–metabolome associations across multiple insulin action phenotypes were linked to mechanisms of fatty acid and amino acid metabolism and inflammation (among others). Metabolite-based scores of insulin action were strongly related to incident diabetes in our discovery IA population (Mlow; 49 metabolites; standardized hazard ratio [HR] 0.49; 95% CI 0.35–0.69; P < 0.0001) and also associated with measures of insulin resistance in a distinct IA population (|ρ| ∼0.3–0.5 correlation) and in the CARDIA group (median age 33 years). At ∼20 years of follow-up in CARDIA, we observed a strong BMI- and glucose-independent association of the metabolite profile of Mlow (HR 0.65; 95% CI 0.56–0.74; P < 0.0001) and EGP suppression (HR 0.66; 95% CI 0.57–0.76; P < 0.0001) with incident diabetes, directionally opposed to BMI and glucose. Genes implicated by the metabolomic signatures were strongly linked to T2D. CONCLUSIONS Metabolic signatures of clamp-determined insulin action are strongly associated with incident diabetes, suggesting causal–functional pathways of T2D.
目的了解美洲原住民（IAs）胰岛素作用/分泌的代谢特征及其与糖尿病的关系。研究设计和方法我们定义了446例IAs中胰岛素作用/分泌的循环代谢组学特征，包括低剂量胰岛素钳夹（Mlow）期间的葡萄糖处置率和胰岛素输注期间的内源性葡萄糖生成（EGP）（抑制肝脏葡萄糖生成）。然后，我们确定了这些代谢评分与葡萄糖耐量（在一组单独的~ 700 IAs中）和糖尿病/代谢风险（来自年轻人冠状动脉风险发展[CARDIA]研究）之间的关联。我们使用组织特异性基因代谢物定位来查明与代谢组学特征有关的2型糖尿病（T2D）的遗传途径。结果年轻IAs患者(平均年龄29岁；平均BMI 34.9 kg/m2)，没有糖尿病，多种胰岛素作用表型的表型-代谢组学关联与脂肪酸和氨基酸代谢和炎症（等）的机制有关。在我们发现的IA人群中，基于代谢产物的胰岛素作用评分与糖尿病发病率密切相关(Mlow；49个代谢物;标准化风险比[HR] 0.49；95% ci 0.35-0.69；P, lt;0.0001)，也与不同IA人群（|ρ| ~ 0.3-0.5相关）和CARDIA组（中位年龄33岁）的胰岛素抵抗测量值相关。在CARDIA患者随访约20年时，我们观察到Mlow代谢物谱与BMI和葡萄糖有很强的相关性(HR 0.65；95% ci 0.56-0.74；P, lt;0.0001)和EGP抑制(HR 0.66；95% ci 0.57-0.76；P, lt;0.0001)发生糖尿病，与BMI和葡萄糖方向相反。与代谢组学特征相关的基因与T2D密切相关。结论钳形胰岛素作用的代谢特征与糖尿病的发生密切相关，提示T2D的因果功能通路。
{"title":"Human Physiologic Responses to Insulin in Indigenous Americans Identify a Metabolic Susceptibility Profile Linked to Diabetes","authors":"Venkatesh L. Murthy, Paolo Piaggi, Phillip Lin, Shilin Zhao, Lindsey K. Stolze, Andrew S. Perry, Robert L. Hanson, John Jeffrey Carr, James G. Terry, Leslie J. Baier, Clifton Bogardus, Clary Clish, Eric R. Gamazon, Jonathan Krakoff, Ravi V. Shah","doi":"10.2337/dc25-0151","DOIUrl":"https://doi.org/10.2337/dc25-0151","url":null,"abstract":"OBJECTIVE To identify metabolic signatures of insulin action/secretion in Indigenous Americans (IAs) and their association with diabetes. RESEARCH DESIGN AND METHODS We defined circulating metabolomic signatures of insulin action/secretion in 446 IAs, including glucose disposal rate during low-dose insulin clamp (Mlow) and endogenous glucose production (EGP) during insulin infusion (suppression of hepatic glucose production). We then determined associations of these metabolic scores with glucose tolerance (in a separate set of ∼700 IAs) and diabetes/metabolic risk in ∼2,000 individuals (from Coronary Artery Risk Development in Young Adults [CARDIA] study). We used tissue-specific gene–metabolite mapping to pinpoint genetic pathways of type 2 diabetes (T2D) implicated by metabolomic signatures. RESULTS In young IAs (mean age 29 years; mean BMI 34.9 kg/m2) without diabetes, phenotype–metabolome associations across multiple insulin action phenotypes were linked to mechanisms of fatty acid and amino acid metabolism and inflammation (among others). Metabolite-based scores of insulin action were strongly related to incident diabetes in our discovery IA population (Mlow; 49 metabolites; standardized hazard ratio [HR] 0.49; 95% CI 0.35–0.69; P &lt; 0.0001) and also associated with measures of insulin resistance in a distinct IA population (|ρ| ∼0.3–0.5 correlation) and in the CARDIA group (median age 33 years). At ∼20 years of follow-up in CARDIA, we observed a strong BMI- and glucose-independent association of the metabolite profile of Mlow (HR 0.65; 95% CI 0.56–0.74; P &lt; 0.0001) and EGP suppression (HR 0.66; 95% CI 0.57–0.76; P &lt; 0.0001) with incident diabetes, directionally opposed to BMI and glucose. Genes implicated by the metabolomic signatures were strongly linked to T2D. CONCLUSIONS Metabolic signatures of clamp-determined insulin action are strongly associated with incident diabetes, suggesting causal–functional pathways of T2D.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"55 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144104708","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}
Alessandro Mantovani, Riccardo Morandin, Maria Giovanna Lando, Veronica Fiorio, Grazia Pennisi, Salvatore Petta, Norbert Stefan, Herbert Tilg, Christopher D. Byrne, Giovanni Targher
BACKGROUND There is uncertainty regarding effect of sodium–glucose cotransporter 2 (SGLT2) inhibitors on the risk of major adverse liver-related outcomes (MALOs). PURPOSE We performed a meta-analysis of observational cohort studies to quantify the magnitude of the association between SGLT2 inhibitor use and risk of developing MALOs for people with type 2 diabetes mellitus (T2DM). DATA SOURCES We systematically reviewed three large electronic databases from inception to January 2025. STUDY SELECTION We included active-comparator, new-user cohort studies with comparison of SGLT2 inhibitors versus other glucose-lowering medications in patients with T2DM. DATA EXTRACTION The primary outcome was incidence rate of MALOs defined as a composite of hepatic decompensation events, hepatocellular carcinoma, liver transplantation, or liver-related deaths. Secondary outcomes included each of the above as individual events. Meta-analysis was performed with random-effects models. DATA SYNTHESIS We identified eight cohort studies with aggregate data on 626,104 patients with T2DM (397,806 SGLT2 inhibitor new users and 228,298 new users of other glucose-lowering agents). During a median of 2.7 years, SGLT2 inhibitor use was associated with significantly lower risk of MALOs (random-effects hazard ratio 0.83, 95% CI 0.72–0.95; I2 = 83.1%) and liver-related deaths (0.64, 0.50–0.82; I2 = 0%). The significant risk reduction in MALOs was observed in comparisons of SGLT2 inhibitors with dipeptidyl peptidase 4 inhibitors, metformin, or pioglitazone but not glucagon-like peptide 1 receptor agonists. Sensitivity analyses did not modify these results. A funnel plot did not show significant publication bias. LIMITATIONS Observational design of the cohort studies and high level of heterogeneity are the main limitations. CONCLUSIONS SGLT2 inhibitor use was associated with lower risk of MALOs for patients with T2DM.
背景：钠-葡萄糖共转运蛋白2 （SGLT2）抑制剂对主要肝脏相关不良结局（MALOs）风险的影响尚不确定。我们对观察性队列研究进行了荟萃分析，以量化2型糖尿病（T2DM）患者使用SGLT2抑制剂与发生malo风险之间的关联程度。我们系统地回顾了三个大型电子数据库从成立到2025年1月。研究选择我们纳入了主动比较者，新用户队列研究，比较了SGLT2抑制剂与其他降糖药物在T2DM患者中的应用。主要终点是MALOs的发生率，定义为肝失代偿事件、肝细胞癌、肝移植或肝脏相关死亡的复合。次要结局包括上述每个单独事件。采用随机效应模型进行meta分析。我们确定了8项队列研究，汇总了626104例T2DM患者的数据（397,806例SGLT2抑制剂新使用者和228,298例其他降糖药新使用者）。在中位2.7年期间，SGLT2抑制剂的使用与MALOs的风险显著降低相关(随机效应风险比0.83,95% CI 0.72-0.95；I2 = 83.1%)和肝脏相关死亡(0.64,0.50-0.82；I2 = 0%)。在比较SGLT2抑制剂与二肽基肽酶4抑制剂、二甲双胍或吡格列酮时，观察到MALOs的显著风险降低，但胰高血糖素样肽1受体激动剂没有。敏感性分析没有改变这些结果。漏斗图未显示显著的发表偏倚。队列研究的观察设计和高水平的异质性是主要的局限性。结论：使用SGLT2抑制剂可降低T2DM患者发生malo的风险。
{"title":"Sodium–Glucose Cotransporter 2 Inhibitor Use and Risk of Liver-Related Events in Patients With Type 2 Diabetes: A Meta-analysis of Observational Cohort Studies","authors":"Alessandro Mantovani, Riccardo Morandin, Maria Giovanna Lando, Veronica Fiorio, Grazia Pennisi, Salvatore Petta, Norbert Stefan, Herbert Tilg, Christopher D. Byrne, Giovanni Targher","doi":"10.2337/dc25-0282","DOIUrl":"https://doi.org/10.2337/dc25-0282","url":null,"abstract":"BACKGROUND There is uncertainty regarding effect of sodium–glucose cotransporter 2 (SGLT2) inhibitors on the risk of major adverse liver-related outcomes (MALOs). PURPOSE We performed a meta-analysis of observational cohort studies to quantify the magnitude of the association between SGLT2 inhibitor use and risk of developing MALOs for people with type 2 diabetes mellitus (T2DM). DATA SOURCES We systematically reviewed three large electronic databases from inception to January 2025. STUDY SELECTION We included active-comparator, new-user cohort studies with comparison of SGLT2 inhibitors versus other glucose-lowering medications in patients with T2DM. DATA EXTRACTION The primary outcome was incidence rate of MALOs defined as a composite of hepatic decompensation events, hepatocellular carcinoma, liver transplantation, or liver-related deaths. Secondary outcomes included each of the above as individual events. Meta-analysis was performed with random-effects models. DATA SYNTHESIS We identified eight cohort studies with aggregate data on 626,104 patients with T2DM (397,806 SGLT2 inhibitor new users and 228,298 new users of other glucose-lowering agents). During a median of 2.7 years, SGLT2 inhibitor use was associated with significantly lower risk of MALOs (random-effects hazard ratio 0.83, 95% CI 0.72–0.95; I2 = 83.1%) and liver-related deaths (0.64, 0.50–0.82; I2 = 0%). The significant risk reduction in MALOs was observed in comparisons of SGLT2 inhibitors with dipeptidyl peptidase 4 inhibitors, metformin, or pioglitazone but not glucagon-like peptide 1 receptor agonists. Sensitivity analyses did not modify these results. A funnel plot did not show significant publication bias. LIMITATIONS Observational design of the cohort studies and high level of heterogeneity are the main limitations. CONCLUSIONS SGLT2 inhibitor use was associated with lower risk of MALOs for patients with T2DM.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"70 1","pages":"1042-1052"},"PeriodicalIF":16.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144104681","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}
Muhammad Abdul-Ghani, Mohamed Abu-Farha, Tamam Abdul-Ghani, Alberto Chavez-Velazquez, Auora Merovci, Ralph A. DeFronzo, Fahad Alajmi, Michael Stern, Fahd Al-Mulla
OBJECTIVE To examine the ability of the 1-h plasma glucose (PG) concentration during the oral glucose tolerance test (OGTT) to predict the risk of progression to prediabetes in individuals with normal glucose tolerance (NGT). RESEARCH DESIGN AND METHODS A total of 1,557 participants from the San Antonio Heart Study who were free of type 2 diabetes at baseline, had a baseline OGTT, and had a repeat OGTT after 7.5 years of follow-up were evaluated. The ability of 1-h PG concentration to predict the development of prediabetes, based on American Diabetes Association criteria, was evaluated. RESULTS Approximately one-quarter of participants with NGT (24.7%) progressed to prediabetes at 7.5 years (22.5% with 1-h PG <155 mg/dL and 42.5% with 1-h PG >155 mg/dL). The 1-h PG was the strongest predictor of developing prediabetes, and a 1-h cut point of 120 mg/dL had 61% sensitivity and 67% specificity in identifying individuals with NGT at high risk of developing prediabetes. Participants with a 1-h PG of 120–155 mg/dL and who experienced a deterioration in glucose tolerance (progression to prediabetes) at follow-up were characterized by severe insulin resistance and metabolic abnormalities characteristic of the insulin resistance syndrome. Therefore, we suggest the term pre-prediabetes for this group to emphasize their high future risk of deteriorating glucose tolerance. CONCLUSIONS An increase in 1-h PG concentration precedes the development of prediabetes and identifies individuals with a 1-h PG of 120–155 mg/dL who are at increased risk of developing prediabetes. Therefore, we suggest the term pre-prediabetes for this group with an elevated risk of deteriorating glucose tolerance.
{"title":"One-Hour Plasma Glucose Predicts the Progression From Normal Glucose Tolerance to Prediabetes","authors":"Muhammad Abdul-Ghani, Mohamed Abu-Farha, Tamam Abdul-Ghani, Alberto Chavez-Velazquez, Auora Merovci, Ralph A. DeFronzo, Fahad Alajmi, Michael Stern, Fahd Al-Mulla","doi":"10.2337/dc24-2832","DOIUrl":"https://doi.org/10.2337/dc24-2832","url":null,"abstract":"OBJECTIVE To examine the ability of the 1-h plasma glucose (PG) concentration during the oral glucose tolerance test (OGTT) to predict the risk of progression to prediabetes in individuals with normal glucose tolerance (NGT). RESEARCH DESIGN AND METHODS A total of 1,557 participants from the San Antonio Heart Study who were free of type 2 diabetes at baseline, had a baseline OGTT, and had a repeat OGTT after 7.5 years of follow-up were evaluated. The ability of 1-h PG concentration to predict the development of prediabetes, based on American Diabetes Association criteria, was evaluated. RESULTS Approximately one-quarter of participants with NGT (24.7%) progressed to prediabetes at 7.5 years (22.5% with 1-h PG &lt;155 mg/dL and 42.5% with 1-h PG &gt;155 mg/dL). The 1-h PG was the strongest predictor of developing prediabetes, and a 1-h cut point of 120 mg/dL had 61% sensitivity and 67% specificity in identifying individuals with NGT at high risk of developing prediabetes. Participants with a 1-h PG of 120–155 mg/dL and who experienced a deterioration in glucose tolerance (progression to prediabetes) at follow-up were characterized by severe insulin resistance and metabolic abnormalities characteristic of the insulin resistance syndrome. Therefore, we suggest the term pre-prediabetes for this group to emphasize their high future risk of deteriorating glucose tolerance. CONCLUSIONS An increase in 1-h PG concentration precedes the development of prediabetes and identifies individuals with a 1-h PG of 120–155 mg/dL who are at increased risk of developing prediabetes. Therefore, we suggest the term pre-prediabetes for this group with an elevated risk of deteriorating glucose tolerance.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"3 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144067118","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}
Yanyan Chen, Jinping Wang, Xinxin Feng, Xin Qian, Siyao He, Qier An, Xiang Yin, Xuan Wang, Yali An, Qiuhong Gong, Shuhan Zhou, Hui Li, Xiuwei Zhai, Xiaoping Chen, Guangwei Li
OBJECTIVE To examine the incidence of stroke in Chinese adults with newly diagnosed type 2 diabetes (NDD), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT) over a 34-year follow-up period. RESEARCH DESIGN AND METHODS This cohort study included participants with NDD, IGT, and NGT initially identified in 1986 in the Da Qing Diabetes Prevention Study who were followed up for 34 years. Patients with IGT were randomized into a 6-year lifestyle intervention or control group. The stroke incidence and hazard ratios (HRs) were determined across the three glucose-level groups. RESULTS Over 34 years, the cumulative stroke incidence in the NDD, IGT nonintervention, and IGT intervention groups were 65.4%, 62.8%, and 49.8%, respectively. The annual incidence in the NDD group was significantly higher than that in the NGT group (24.3 vs. 18.5 per 1,000 person-years), after adjusting for age and sex. After adjusting for risk factors, the risk of stroke was significantly higher in the NDD (HR 1.80, 95% CI 1.46–2.21, P < 0.001), IGT nonintervention (HR 1.52, 95% CI 1.11–2.07, P = 0.008), and IGT intervention (HR 1.33, 95% CI 1.17–1.63, P = 0.01) groups than in the NGT group. A reduced stroke risk was observed in the overall IGT intervention group compared with the NDD group (HR 0.77, 95% CI 0.64–0.94, P = 0.009), especially in women (HR 0.64, 95% CI 0.47–0.88, P = 0.006). CONCLUSIONS Over 34 years, ∼50% of Chinese adults with NDD and IGT experienced stroke. Further efforts in diabetes management and intervention are required.
目的通过34年的随访，研究中国成人新诊断的2型糖尿病（NDD）、糖耐量受损（IGT）和糖耐量正常（NGT）患者脑卒中的发生率。研究设计和方法本队列研究纳入了1986年在大庆糖尿病预防研究中首次发现的NDD、IGT和NGT患者，随访34年。IGT患者被随机分为6年生活方式干预组和对照组。测定三个血糖水平组的脑卒中发生率和危险比（hr）。结果34年间，NDD组、IGT不干预组和IGT干预组脑卒中累计发生率分别为65.4%、62.8%和49.8%。在调整了年龄和性别后，NDD组的年发病率显著高于NGT组（24.3 vs 18.5 / 1000人年）。在调整了危险因素后，NDD组的卒中风险明显更高(HR 1.80, 95% CI 1.46-2.21, P <；IGT非干预组（HR 1.52, 95% CI 1.11-2.07, P = 0.008）和IGT干预组（HR 1.33, 95% CI 1.17-1.63, P = 0.01）的死亡率均高于NGT组。与NDD组相比，整体IGT干预组卒中风险降低（HR 0.77, 95% CI 0.64 - 0.94, P = 0.009），尤其是女性（HR 0.64, 95% CI 0.47-0.88, P = 0.006）。结论：在34年的时间里，约50%的中国成人NDD和IGT患者经历过卒中。需要在糖尿病管理和干预方面作出进一步努力。
{"title":"Stroke Incidence Evolution in People With Newly Diagnosed Diabetes and Impaired Glucose Tolerance: A 34-Year Follow-up of the Da Qing Diabetes Study","authors":"Yanyan Chen, Jinping Wang, Xinxin Feng, Xin Qian, Siyao He, Qier An, Xiang Yin, Xuan Wang, Yali An, Qiuhong Gong, Shuhan Zhou, Hui Li, Xiuwei Zhai, Xiaoping Chen, Guangwei Li","doi":"10.2337/dc24-2675","DOIUrl":"https://doi.org/10.2337/dc24-2675","url":null,"abstract":"OBJECTIVE To examine the incidence of stroke in Chinese adults with newly diagnosed type 2 diabetes (NDD), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT) over a 34-year follow-up period. RESEARCH DESIGN AND METHODS This cohort study included participants with NDD, IGT, and NGT initially identified in 1986 in the Da Qing Diabetes Prevention Study who were followed up for 34 years. Patients with IGT were randomized into a 6-year lifestyle intervention or control group. The stroke incidence and hazard ratios (HRs) were determined across the three glucose-level groups. RESULTS Over 34 years, the cumulative stroke incidence in the NDD, IGT nonintervention, and IGT intervention groups were 65.4%, 62.8%, and 49.8%, respectively. The annual incidence in the NDD group was significantly higher than that in the NGT group (24.3 vs. 18.5 per 1,000 person-years), after adjusting for age and sex. After adjusting for risk factors, the risk of stroke was significantly higher in the NDD (HR 1.80, 95% CI 1.46–2.21, P &lt; 0.001), IGT nonintervention (HR 1.52, 95% CI 1.11–2.07, P = 0.008), and IGT intervention (HR 1.33, 95% CI 1.17–1.63, P = 0.01) groups than in the NGT group. A reduced stroke risk was observed in the overall IGT intervention group compared with the NDD group (HR 0.77, 95% CI 0.64–0.94, P = 0.009), especially in women (HR 0.64, 95% CI 0.47–0.88, P = 0.006). CONCLUSIONS Over 34 years, ∼50% of Chinese adults with NDD and IGT experienced stroke. Further efforts in diabetes management and intervention are required.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"96 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066518","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}
Celia L. Kohler, Tim Vigers, Laura Pyle, Kristen Miller, Edith T. Zemanick, Antoinette Moran, Scott D. Sagel, Christine L. Chan
OBJECTIVE A number of disease-modifying therapies have been introduced for people with cystic fibrosis (CF) over the past two decades. The cumulative effects of this changing landscape on CF–related diabetes (CFRD) are unclear. We examined trends in CFRD epidemiology over time using data from the U.S. Cystic Fibrosis Foundation Patient Registry (CFFPR). RESEARCH DESIGN AND METHODS CFFPR data from 2003 to 2018 were queried to determine annual screening, incidence, and prevalence rates of CFRD. Individuals with incident CFRD were compared with individuals without CFRD. Survival analyses were performed to estimate the cumulative hazard of CFRD given predictors of interest over the 15 years of study. Data were also grouped into three time periods (2003–2008, 2009–2013, and 2014–2018) to investigate whether the hazard of developing CFRD varied over time. RESULTS CFRD screening rates increased from 2003 to 2018, particularly in 10- to 18-year-olds. Although screening rates increased in adults, overall rates remained low. In 10- to 18-year-olds, the incidence of CFRD was stable over time, while incident cases in adults steadily decreased, approaching incident rates in adolescents. Despite this, the prevalence of CFRD has gradually increased in adults, likely reflecting increased longevity. Age, female sex, Black race, severe mutation class, liver disease, poorer lung function, pancreatic insufficiency, enteric feeds, and low and high BMI were all risk factors associated with CFRD. CONCLUSIONS Findings support the need for the development of tailored CFRD screening algorithms and increased subspecialists to care for a growing population of adults with CF and CF-associated comorbidities.
{"title":"Trends in Cystic Fibrosis–Related Diabetes Epidemiology Between 2003 and 2018 From the U.S. Cystic Fibrosis Foundation Patient Registry","authors":"Celia L. Kohler, Tim Vigers, Laura Pyle, Kristen Miller, Edith T. Zemanick, Antoinette Moran, Scott D. Sagel, Christine L. Chan","doi":"10.2337/dc25-0044","DOIUrl":"https://doi.org/10.2337/dc25-0044","url":null,"abstract":"OBJECTIVE A number of disease-modifying therapies have been introduced for people with cystic fibrosis (CF) over the past two decades. The cumulative effects of this changing landscape on CF–related diabetes (CFRD) are unclear. We examined trends in CFRD epidemiology over time using data from the U.S. Cystic Fibrosis Foundation Patient Registry (CFFPR). RESEARCH DESIGN AND METHODS CFFPR data from 2003 to 2018 were queried to determine annual screening, incidence, and prevalence rates of CFRD. Individuals with incident CFRD were compared with individuals without CFRD. Survival analyses were performed to estimate the cumulative hazard of CFRD given predictors of interest over the 15 years of study. Data were also grouped into three time periods (2003–2008, 2009–2013, and 2014–2018) to investigate whether the hazard of developing CFRD varied over time. RESULTS CFRD screening rates increased from 2003 to 2018, particularly in 10- to 18-year-olds. Although screening rates increased in adults, overall rates remained low. In 10- to 18-year-olds, the incidence of CFRD was stable over time, while incident cases in adults steadily decreased, approaching incident rates in adolescents. Despite this, the prevalence of CFRD has gradually increased in adults, likely reflecting increased longevity. Age, female sex, Black race, severe mutation class, liver disease, poorer lung function, pancreatic insufficiency, enteric feeds, and low and high BMI were all risk factors associated with CFRD. CONCLUSIONS Findings support the need for the development of tailored CFRD screening algorithms and increased subspecialists to care for a growing population of adults with CF and CF-associated comorbidities.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"29 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066520","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}
Hongbo Yang, Kai Luo, Brandilyn A. Peters, Yi Wang, Yanbo Zhang, Martha Daviglus, Amber Pirzada, Christina Cordero, Bing Yu, Robert D. Burk, Robert Kaplan, Qibin Qi
OBJECTIVE To examine associations of serum imidazole propionate (ImP), histidine, and their ratio with incident type 2 diabetes (T2D) and related dietary and gut microbial factors in U.S. Hispanic/Latino people. RESEARCH DESIGN AND METHODS In the Hispanic Community Health Study/Study of Latinos, we evaluated serum ImP, histidine, and ImP-to-histidine ratio at baseline (2008–2011) and their cross-sectional associations with dietary intake and prospective associations with incident T2D over ∼12 years (n = 4,632). In a subsample with gut microbiota data during a follow-up visit (2016–2018), we examined gut microbial species associated with serum ImP and their potential interactions with dietary intake. RESULTS Serum ImP and ImP-to-histidine ratio were positively associated with incident T2D (hazard ratio [95% CI] = 1.17 [1.00–1.36] and 1.33 [1.14–1.55], respectively, comparing highest and lowest tertiles), whereas histidine was inversely associated with incident T2D (hazard ratio = 0.75 [95% CI 0.64–0.86]). A higher amount of fiber intake was associated with lower serum ImP level and ImP-to-histidine ratio, whereas histidine intake was not associated with serum ImP level in the overall sample. Fifty-three bacterial species, including 19 putative ImP producers, were associated with serum ImP. Histidine intake was positively associated with serum ImP and ImP-to-histidine ratio only in participants with a high ImP-associated gut microbiota score (P = 0.03 and 0.02, respectively, for interaction). The associations of fiber intake with serum ImP and ImP-to-histidine ratio were partly mediated by ImP-associated gut microbiota (proportion mediated = 31.4% and 19.8%, respectively). CONCLUSIONS This study suggested an unfavorable relationship between histidine metabolism toward ImP production, potentially regulated by dietary intake and gut microbiota, and risk of T2D in U.S. Hispanics/Latino people.
{"title":"Diet, Gut Microbiota, and Histidine Metabolism Toward Imidazole Propionate Production in Relation to Type 2 Diabetes","authors":"Hongbo Yang, Kai Luo, Brandilyn A. Peters, Yi Wang, Yanbo Zhang, Martha Daviglus, Amber Pirzada, Christina Cordero, Bing Yu, Robert D. Burk, Robert Kaplan, Qibin Qi","doi":"10.2337/dc24-2816","DOIUrl":"https://doi.org/10.2337/dc24-2816","url":null,"abstract":"OBJECTIVE To examine associations of serum imidazole propionate (ImP), histidine, and their ratio with incident type 2 diabetes (T2D) and related dietary and gut microbial factors in U.S. Hispanic/Latino people. RESEARCH DESIGN AND METHODS In the Hispanic Community Health Study/Study of Latinos, we evaluated serum ImP, histidine, and ImP-to-histidine ratio at baseline (2008–2011) and their cross-sectional associations with dietary intake and prospective associations with incident T2D over ∼12 years (n = 4,632). In a subsample with gut microbiota data during a follow-up visit (2016–2018), we examined gut microbial species associated with serum ImP and their potential interactions with dietary intake. RESULTS Serum ImP and ImP-to-histidine ratio were positively associated with incident T2D (hazard ratio [95% CI] = 1.17 [1.00–1.36] and 1.33 [1.14–1.55], respectively, comparing highest and lowest tertiles), whereas histidine was inversely associated with incident T2D (hazard ratio = 0.75 [95% CI 0.64–0.86]). A higher amount of fiber intake was associated with lower serum ImP level and ImP-to-histidine ratio, whereas histidine intake was not associated with serum ImP level in the overall sample. Fifty-three bacterial species, including 19 putative ImP producers, were associated with serum ImP. Histidine intake was positively associated with serum ImP and ImP-to-histidine ratio only in participants with a high ImP-associated gut microbiota score (P = 0.03 and 0.02, respectively, for interaction). The associations of fiber intake with serum ImP and ImP-to-histidine ratio were partly mediated by ImP-associated gut microbiota (proportion mediated = 31.4% and 19.8%, respectively). CONCLUSIONS This study suggested an unfavorable relationship between histidine metabolism toward ImP production, potentially regulated by dietary intake and gut microbiota, and risk of T2D in U.S. Hispanics/Latino people.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"35 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930755","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}
Andrew O. Agbaje, Justin P. Zachariah, Alan R. Barker, Craig A. Williams, Dimitris Vlachopoulos, Christoph Saner, Tomi-Pekka Tuomainen
OBJECTIVE Insulin resistance (IR) and dysglycemia can induce cardiac remodeling in adulthood, but little evidence exists with respect to cardiac remodeling in youth with and without evidence of new-onset glucose metabolic alterations. This study investigated whether changes in metabolic status from adolescence to young adulthood are associated with the risk of progressive cardiac remodeling and examined potential mechanistic pathways. RESEARCH DESIGN AND METHODS From the Avon Longitudinal Study of Parents and Children (ALSPAC), U.K. cohort, 1,595 adolescents, mean (SD) age 17.7 (0.4) years, who had data on fasting plasma glucose and insulin levels, and echocardiography left ventricular (LV) mass indexed for height raised to the power of 2.7 (LVMI2.7) and in whom these factors repeatedly were measured at a clinic visit when they were aged 24 years were included. HOMA-IR was computed, hyperglycemia was defined as glucose concentration of ≥5.6 mmol/L and ≥6.1 mmol/L, and LV hypertrophy was defined as LVMI2.7 ≥51g/m2.7. RESULTS The prevalence of LV hypertrophy increased from 2.4% at baseline to 7.1% at follow-up. Each unit increase of glucose (β = 0.37 g/m2.7 [95% CI 0.23–0.52]; P < 0.001) and HOMA-IR (1.10 g/m2.7 [0.63–1.57]; P < 0.001) was independently associated with increased LVMI2.7 over 7 years. Persistent hyperglycemia of 5.6 mmol/L and 6.1 mmol/L was associated with higher odds (odds ratio [OR] 1.46 [95% CI 1.35–1.47], P < 0.001; and 3.10 [95% CI 1.19–8.08], P = 0.021, respectively) of worsening LV hypertrophy over 7 years. Increased fat mass (62% mediation) significantly mediated the association of increased HOMA-IR with increased LVMI2.7. CONCLUSIONS Persistent adolescent hyperglycemia and worsening IR were associated with the risk of worsening structural and functional cardiac damage, and these were largely explained by increased fat mass.
目的胰岛素抵抗（IR）和血糖异常可诱导成年期心脏重构，但很少有证据表明有或没有新发糖代谢改变的青年期心脏重构。本研究调查了从青春期到青年期的代谢状态变化是否与进行性心脏重构的风险相关，并研究了潜在的机制途径。研究设计和方法来自英国雅芳父母与儿童纵向研究（ALSPAC）， 1595名青少年，平均（SD）年龄17.7（0.4）岁，他们有空腹血糖和胰岛素水平的数据，超声心动图左心室（LV）质量指数升高到2.7 (LVMI2.7)，这些因素在他们24岁时在诊所就诊时反复测量。计算HOMA-IR，葡萄糖浓度≥5.6 mmol/L和≥6.1 mmol/L定义为高血糖，LVMI2.7≥51g/m2.7定义为左室肥大。结果左室肥厚的发生率从基线时的2.4%上升到随访时的7.1%。葡萄糖每单位增加(β = 0.37 g/m2.7 [95% CI 0.23-0.52]；P, lt;0.001)和HOMA-IR (1.10 g/m2.7 [0.63-1.57]；P, lt;0.001)与7年内LVMI2.7升高独立相关。5.6 mmol/L和6.1 mmol/L的持续高血糖与较高的比值相关(比值比[OR] 1.46 [95% CI 1.35-1.47], P &；0.001;和3.10 [95% CI 1.19-8.08], P = 0.021，分别)在7年内左室肥厚加重。脂肪量增加（62%介导）显著介导HOMA-IR升高与LVMI2.7升高的关联。结论：青少年持续高血糖和IR恶化与心脏结构和功能损伤恶化的风险相关，这在很大程度上可以用脂肪量增加来解释。
{"title":"Persistent Hyperglycemia and Insulin Resistance With the Risk of Worsening Cardiac Damage in Adolescents: A 7-Year Longitudinal Study of the ALSPAC Birth Cohort","authors":"Andrew O. Agbaje, Justin P. Zachariah, Alan R. Barker, Craig A. Williams, Dimitris Vlachopoulos, Christoph Saner, Tomi-Pekka Tuomainen","doi":"10.2337/dc24-2459","DOIUrl":"https://doi.org/10.2337/dc24-2459","url":null,"abstract":"OBJECTIVE Insulin resistance (IR) and dysglycemia can induce cardiac remodeling in adulthood, but little evidence exists with respect to cardiac remodeling in youth with and without evidence of new-onset glucose metabolic alterations. This study investigated whether changes in metabolic status from adolescence to young adulthood are associated with the risk of progressive cardiac remodeling and examined potential mechanistic pathways. RESEARCH DESIGN AND METHODS From the Avon Longitudinal Study of Parents and Children (ALSPAC), U.K. cohort, 1,595 adolescents, mean (SD) age 17.7 (0.4) years, who had data on fasting plasma glucose and insulin levels, and echocardiography left ventricular (LV) mass indexed for height raised to the power of 2.7 (LVMI2.7) and in whom these factors repeatedly were measured at a clinic visit when they were aged 24 years were included. HOMA-IR was computed, hyperglycemia was defined as glucose concentration of ≥5.6 mmol/L and ≥6.1 mmol/L, and LV hypertrophy was defined as LVMI2.7 ≥51g/m2.7. RESULTS The prevalence of LV hypertrophy increased from 2.4% at baseline to 7.1% at follow-up. Each unit increase of glucose (β = 0.37 g/m2.7 [95% CI 0.23–0.52]; P &lt; 0.001) and HOMA-IR (1.10 g/m2.7 [0.63–1.57]; P &lt; 0.001) was independently associated with increased LVMI2.7 over 7 years. Persistent hyperglycemia of 5.6 mmol/L and 6.1 mmol/L was associated with higher odds (odds ratio [OR] 1.46 [95% CI 1.35–1.47], P &lt; 0.001; and 3.10 [95% CI 1.19–8.08], P = 0.021, respectively) of worsening LV hypertrophy over 7 years. Increased fat mass (62% mediation) significantly mediated the association of increased HOMA-IR with increased LVMI2.7. CONCLUSIONS Persistent adolescent hyperglycemia and worsening IR were associated with the risk of worsening structural and functional cardiac damage, and these were largely explained by increased fat mass.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"41 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920099","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}
Justin B. Echouffo-Tcheugui, Rosette J. Chakkalakal, Mohammed K. Ali
Prediabetes is an intermediate stage between normal glycemia and diabetes and is highly prevalent, especially in adults, but is also increasingly common in young individuals. Randomized clinical trials have demonstrated that lifestyle modification is cost-effective in preventing diabetes. Implementation studies showed the feasibility of delivering real-world structured lifestyle modification programs adapted from the U.S. Diabetes Prevention Program trial. However, the current approach to diabetes prevention in the U.S. has been largely inadequate thus far, as evidenced by the stagnant numbers of people with prediabetes and the growing number of those with diabetes. The many gaps in the implementation of the National Diabetes Prevention Program (NDPP) can be characterized as due to macro-level barriers (failures of pay-for-performance reimbursement, an undersupply of lifestyle change programs), micro-level barriers (low and disparate reach, low referral and retention rates in the program), variable fidelity in implementation, and limitations of a one-size-fits-all intervention. All of these issues point to a need for reexamining strategies for diabetes prevention in the U.S., which is yet to show benefits or value at the population level. This article details how prediabetes is currently suboptimally addressed in clinical practice and communities in the U.S. and articulates why there is an urgent need to rethink our approach to addressing prediabetes, possibly through integration of synergistic individual- and societal-levels approaches.
{"title":"Is the Current Lifestyle Modification Approach to Diabetes Prevention in the U.S. a Success?","authors":"Justin B. Echouffo-Tcheugui, Rosette J. Chakkalakal, Mohammed K. Ali","doi":"10.2337/dci24-0040","DOIUrl":"https://doi.org/10.2337/dci24-0040","url":null,"abstract":"Prediabetes is an intermediate stage between normal glycemia and diabetes and is highly prevalent, especially in adults, but is also increasingly common in young individuals. Randomized clinical trials have demonstrated that lifestyle modification is cost-effective in preventing diabetes. Implementation studies showed the feasibility of delivering real-world structured lifestyle modification programs adapted from the U.S. Diabetes Prevention Program trial. However, the current approach to diabetes prevention in the U.S. has been largely inadequate thus far, as evidenced by the stagnant numbers of people with prediabetes and the growing number of those with diabetes. The many gaps in the implementation of the National Diabetes Prevention Program (NDPP) can be characterized as due to macro-level barriers (failures of pay-for-performance reimbursement, an undersupply of lifestyle change programs), micro-level barriers (low and disparate reach, low referral and retention rates in the program), variable fidelity in implementation, and limitations of a one-size-fits-all intervention. All of these issues point to a need for reexamining strategies for diabetes prevention in the U.S., which is yet to show benefits or value at the population level. This article details how prediabetes is currently suboptimally addressed in clinical practice and communities in the U.S. and articulates why there is an urgent need to rethink our approach to addressing prediabetes, possibly through integration of synergistic individual- and societal-levels approaches.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"12 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920104","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：