Pub Date : 2026-01-01DOI: 10.1016/j.diabres.2025.113076
Abu Saleh Md Moin , Radwan Darwish , Thozhukat Sathyapalan , Stephen L. Atkin , Alexandra E. Butler
Background
Extracellular matrix (ECM) remodeling by matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) contributes to vascular complications in type 2 diabetes (T2D), but the impact of acute insulin-induced hypoglycemia on this axis is unclear.
Objective
Assess whether hypoglycemia alters circulating MMP/TIMP levels in T2D versus controls.
Methods
In a prospective study, 46 adults (23 T2D; 23 matched controls) underwent stepwise insulin to glucose ≤2.2 mmol/L. Eleven MMPs and three TIMPs were measured at baseline, during hypoglycemia, and up to 24 h post-recovery.
Results
At baseline, T2D had higher MMP1, MMP7, MMP9, and TIMP1/3. During hypoglycemia, controls showed a transient MMP1 rise with post-recovery decline. In T2D, MMP8 increased from 1–24 h and exceeded controls at 1–4 h. MMP2 fell early then rebounded at 4 h. MMP3 rose at 4 h in both groups and persisted to 24 h in T2D. MMP9 remained elevated in T2D, decreasing only at 24 h. TIMP3 declined during recovery in controls but stayed elevated in T2D; TIMP1/2 were unchanged.
Conclusion
Acute hypoglycemia induces subtype-specific, time-dependent MMP–TIMP shifts. T2D shows amplified, prolonged responses—especially MMP8, MMP3, and MMP9—with insufficient TIMP buffering, suggesting a proteolytic milieu that may impair ECM integrity and vascular stability.
{"title":"Acute hypoglycemia attenuates serum matrix metalloproteinases and tissue inhibitors of metalloproteinases in type 2 diabetes","authors":"Abu Saleh Md Moin , Radwan Darwish , Thozhukat Sathyapalan , Stephen L. Atkin , Alexandra E. Butler","doi":"10.1016/j.diabres.2025.113076","DOIUrl":"10.1016/j.diabres.2025.113076","url":null,"abstract":"<div><h3>Background</h3><div>Extracellular matrix (ECM) remodeling by matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) contributes to vascular complications in type 2 diabetes (T2D), but the impact of acute insulin-induced hypoglycemia on this axis is unclear.</div></div><div><h3>Objective</h3><div>Assess whether hypoglycemia alters circulating MMP/TIMP levels in T2D versus controls.</div></div><div><h3>Methods</h3><div>In a prospective study, 46 adults (23 T2D; 23 matched controls) underwent stepwise insulin to glucose ≤2.2 mmol/L. Eleven MMPs and three TIMPs were measured at baseline, during hypoglycemia, and up to 24 h post-recovery.</div></div><div><h3>Results</h3><div>At baseline, T2D had higher MMP1, MMP7, MMP9, and TIMP1/3. During hypoglycemia, controls showed a transient MMP1 rise with post-recovery decline. In T2D, MMP8 increased from 1–24 h and exceeded controls at 1–4 h. MMP2 fell early then rebounded at 4 h. MMP3 rose at 4 h in both groups and persisted to 24 h in T2D. MMP9 remained elevated in T2D, decreasing only at 24 h. TIMP3 declined during recovery in controls but stayed elevated in T2D; TIMP1/2 were unchanged.</div></div><div><h3>Conclusion</h3><div>Acute hypoglycemia induces subtype-specific, time-dependent MMP–TIMP shifts. T2D shows amplified, prolonged responses—especially MMP8, MMP3, and MMP9—with insufficient TIMP buffering, suggesting a proteolytic milieu that may impair ECM integrity and vascular stability.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113076"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.diabres.2025.113077
Julie Wagner , Angela Bermúdez-Millán , Richard S. Feinn
Aims
To examine the association between health-related social needs (HRSNs) and indicators of self-rated health in adults with type 1 diabetes (T1D). Methods: Using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), we examined the association between HRSNs and 1) self-reported health (excellent to poor), 2) days of mental health not good, and, 3) days of physical health not good in the past 30 days. Data were from 476 adults with T1D in the U.S. Results: Participants were mostly white (75 %), male (54 %), and over 50 years old (52 %). Factor analysis of the 10 federal HRSN items produced three factors we named Psychosocial, Financial, and Employment. After controlling for age, sex, race/ethnicity, insurance, healthcare access, smoking, binge drinking, and comorbidities, higher Psychosocial HRSN score and Financial HRSN score were associated with lower self-reported health, more days of mental health not good, and more days of physical health not good. Employment HRSN was not associated with any measure of self-reported health. Conclusion: This is the first examination of HRSN and self-rated health in T1D. Screening for HRSNs should be integrated into diabetes care to identify and serve high-risk patients.
{"title":"Health-related social needs and self-Reported health among adults with type 1 diabetes in the 2022 Behavioral Risk Factor Surveillance System","authors":"Julie Wagner , Angela Bermúdez-Millán , Richard S. Feinn","doi":"10.1016/j.diabres.2025.113077","DOIUrl":"10.1016/j.diabres.2025.113077","url":null,"abstract":"<div><h3>Aims</h3><div>To examine the association between health-related social needs (HRSNs) and indicators of self-rated health in adults with type 1 diabetes (T1D). Methods: Using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), we examined the association between HRSNs and 1) self-reported health (excellent to poor), 2) days of mental health not good, and, 3) days of physical health not good in the past 30 days. Data were from 476 adults with T1D in the U.S. Results: Participants were mostly white (75 %), male (54 %), and over 50 years old (52 %). Factor analysis of the 10 federal HRSN items produced three factors we named Psychosocial, Financial, and Employment. After controlling for age, sex, race/ethnicity, insurance, healthcare access, smoking, binge drinking, and comorbidities, higher Psychosocial HRSN score and Financial HRSN score were associated with lower self-reported health, more days of mental health not good, and more days of physical health not good. Employment HRSN was not associated with any measure of self-reported health. Conclusion: This is the first examination of HRSN and self-rated health in T1D. Screening for HRSNs should be integrated into diabetes care to identify and serve high-risk patients.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113077"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.diabres.2025.113067
Merja K. Laine , Mervi Haapala , Kristiina Uusi-Rauva , Juhani Aakko , Markku Pentikäinen , Kirsi Mikkola , Nami Halonen , Kari Pulkki , Niina Säävuori , Per-Henrik Groop , Kaj Metsärinne
Aims
A significant number of individuals with diabetes have chronic kidney disease (CKD). Delays in diagnosis and management of CKD hinder treatment initiation and worsen outcomes. The adherence to monitoring and pharmacological treatments is poorly characterized worldwide.
Methods
We determined the prevalence, outcomes, treatment adherence, and healthcare resource utilization in individuals with type 1 (T1D) or type 2 (T2D) diabetes managed since 2008 in Finland. The management of CKD, glucose monitoring, and outcomes by SGLT-2 inhibitor (SGLT-2i) discontinuation were determined in large subpopulations.
Results
The prevalence of diabetes was 9.9 % in 2021. Despite having averaged 40–50 healthcare contacts per year, only one-third completed the recommended annual urine albumin-creatinine ratio (UACR) test. Factors positively associated with UACR test adherence included older age, male sex, T2D, higher HbA1c values, municipality, and calendar year. In T1D, 29 %, and in T2D, 75 % had HbA1c ≤ 53 mmol/mol. SGLT-2i was prescribed to 19 % of individuals with diabetes but one-third discontinued within a year, accompanied by a trend towards increased occurrence of kidney complications and heart failure.
Conclusions
Individuals with diabetes remain neglected for albuminuria screening, pharmacological management of complications, and also glycemic control in T1D, underlining an urgent need for improved awareness and risk management.
{"title":"Disease management, outcomes, and healthcare resource utilization in real-life clinical practice of diabetes and diabetic kidney disease in Finland","authors":"Merja K. Laine , Mervi Haapala , Kristiina Uusi-Rauva , Juhani Aakko , Markku Pentikäinen , Kirsi Mikkola , Nami Halonen , Kari Pulkki , Niina Säävuori , Per-Henrik Groop , Kaj Metsärinne","doi":"10.1016/j.diabres.2025.113067","DOIUrl":"10.1016/j.diabres.2025.113067","url":null,"abstract":"<div><h3>Aims</h3><div>A significant number of individuals with diabetes have chronic kidney disease (CKD). Delays in diagnosis and management of CKD hinder treatment initiation and worsen outcomes. The adherence to monitoring and pharmacological treatments is poorly characterized worldwide.</div></div><div><h3>Methods</h3><div>We determined the prevalence, outcomes, treatment adherence, and healthcare resource utilization in individuals with type 1 (T1D) or type 2 (T2D) diabetes managed since 2008 in Finland. The management of CKD, glucose monitoring, and outcomes by SGLT-2 inhibitor (SGLT-2i) discontinuation were determined in large subpopulations.</div></div><div><h3>Results</h3><div>The prevalence of diabetes was 9.9 % in 2021. Despite having averaged 40–50 healthcare contacts per year, only one-third completed the recommended annual urine albumin-creatinine ratio (UACR) test. Factors positively associated with UACR test adherence included older age, male sex, T2D, higher HbA<sub>1c</sub> values, municipality, and calendar year. In T1D, 29 %, and in T2D, 75 % had HbA<sub>1c</sub> ≤ 53 mmol/mol. SGLT-2i was prescribed to 19 % of individuals with diabetes but one-third discontinued within a year, accompanied by a trend towards increased occurrence of kidney complications and heart failure.</div></div><div><h3>Conclusions</h3><div>Individuals with diabetes remain neglected for albuminuria screening, pharmacological management of complications, and also glycemic control in T1D, underlining an urgent need for improved awareness and risk management.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113067"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145818148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.diabres.2025.113075
David B. Olawade , Rita Chikeru Owhonda , John Oluwatosin Alabi , Eghosasere Egbon , Raphael Igbarumah Ayo Daniel , Oluwakemi Jumoke Bello
Traditional diabetes management employs reactive strategies with therapeutic adjustments after adverse glycaemic events rather than proactive prevention, resulting in suboptimal control and increased complications. Digital twin (DT) technology creates virtual replicas through computational modelling and real time data integration as a transformative approach. However, questions remain regarding clinical validation, implementation feasibility, and generalisability. This review examines current applications, challenges, and future potential of digital twin technology in diabetes prediction and management. PubMed, Scopus, Web of Science, and IEEE Xplore databases were searched for peer reviewed articles (2015–2024) on DT applications in diabetes care, predictive modelling, and therapeutic optimisation. Critical synthesis compared methodological approaches, performance metrics, and implementation challenges. DT demonstrate variable but promising potential through glucose prediction, personalised insulin dosing, dietary optimisation, and complication risk assessment, integrating continuous glucose monitoring, wearable sensors, and machine learning algorithms. Evidence quality varies substantially, with most studies representing proof-of-concept or pilot implementations. Implementation faces data privacy concerns, validation requirements, and integration complexities. Critical gaps exist in long-term effectiveness, algorithmic bias mitigation, and generalisability to underserved populations. DT technology represents an evolving paradigm towards precision diabetes care. However, rigorous clinical validation, addressing equity concerns, and establishing sustainable implementation frameworks remain essential for widespread adoption.
传统的糖尿病管理采用反应性策略，在不良血糖事件发生后进行治疗调整，而不是主动预防，导致控制不佳和并发症增加。数字孪生（DT）技术通过计算建模和实时数据集成创建虚拟副本，作为一种变革性方法。然而，关于临床验证、实施可行性和普遍性的问题仍然存在。本文综述了数字孪生技术在糖尿病预测和管理中的应用现状、挑战和未来潜力。检索PubMed、Scopus、Web of Science和IEEE Xplore数据库，检索同行评审的关于DT在糖尿病护理、预测建模和治疗优化中的应用的文章（2015-2024）。关键综合比较了方法方法、性能指标和实现挑战。DT通过血糖预测、个性化胰岛素剂量、饮食优化、并发症风险评估、集成连续血糖监测、可穿戴传感器和机器学习算法，展示了可变但有前景的潜力。证据质量差异很大，大多数研究代表概念验证或试点实施。实现面临数据隐私问题、验证需求和集成复杂性。在长期有效性、减少算法偏差和向服务不足人群推广方面存在重大差距。DT技术代表了一种不断发展的糖尿病精准护理模式。然而，严格的临床验证、解决公平问题和建立可持续的实施框架对于广泛采用仍然至关重要。
{"title":"Digital twin paradigm in diabetes prediction and management","authors":"David B. Olawade , Rita Chikeru Owhonda , John Oluwatosin Alabi , Eghosasere Egbon , Raphael Igbarumah Ayo Daniel , Oluwakemi Jumoke Bello","doi":"10.1016/j.diabres.2025.113075","DOIUrl":"10.1016/j.diabres.2025.113075","url":null,"abstract":"<div><div>Traditional diabetes management employs reactive strategies with therapeutic adjustments after adverse glycaemic events rather than proactive prevention, resulting in suboptimal control and increased complications. Digital twin (DT) technology creates virtual replicas through computational modelling and real time data integration as a transformative approach. However, questions remain regarding clinical validation, implementation feasibility, and generalisability. This review examines current applications, challenges, and future potential of digital twin technology in diabetes prediction and management. PubMed, Scopus, Web of Science, and IEEE Xplore databases were searched for peer reviewed articles (2015–2024) on DT applications in diabetes care, predictive modelling, and therapeutic optimisation. Critical synthesis compared methodological approaches, performance metrics, and implementation challenges. DT demonstrate variable but promising potential through glucose prediction, personalised insulin dosing, dietary optimisation, and complication risk assessment, integrating continuous glucose monitoring, wearable sensors, and machine learning algorithms. Evidence quality varies substantially, with most studies representing proof-of-concept or pilot implementations. Implementation faces data privacy concerns, validation requirements, and integration complexities. Critical gaps exist in long-term effectiveness, algorithmic bias mitigation, and generalisability to underserved populations. DT technology represents an evolving paradigm towards precision diabetes care. However, rigorous clinical validation, addressing equity concerns, and establishing sustainable implementation frameworks remain essential for widespread adoption.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113075"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart failure (HF) affects up to 40 % of patients with type 2 diabetes mellitus (T2DM), imposing significant clinical and economic burdens. N-terminal pro-B-type natriuretic peptide (NT-proBNP) effectively assesses HF risk, but its economic value in China is unclear.
Methods
This study evaluated the cost-effectiveness of three HF risk assessment strategies in patients with T2DM: NT-proBNP-guided assessment (using a cut-off of ≥125 pg/mL), usual care in China, and Systematic COronary Risk Evaluation (SCORE). A decision tree and Markov model with 1-year cycles simulated lifetime direct medical costs (given in United States dollars [US$]) and health outcomes in patients with T2DM aged ≥40 years from a Chinese healthcare perspective. High-risk patients received SGLT2 inhibitors plus standard of care.
Results
Compared with usual care, the NT-proBNP-guided strategy was cost-saving, reducing costs by US$1002.73 while increasing QALYs by 0.055 per patient. It was also less costly and more effective than the SCORE strategy. Probabilistic sensitivity analysis confirmed the robustness of this finding, demonstrating a 96.9 % probability of the NT-proBNP strategy being cost-saving versus usual care.
Conclusions
NT-proBNP is a dominant and robust cost-saving strategy for HF risk assessment in patients with T2DM in China, reducing both HF cases and associated healthcare costs.
{"title":"Economic evaluation of NT-proBNP for heart failure risk assessment in patients with type 2 diabetes in China","authors":"Miao Yu , Zhiwei Leng , Xinguo Hou , Junping Wen , Chaogui Tang , Powei Wu , Jianwei Xuan","doi":"10.1016/j.diabres.2025.113068","DOIUrl":"10.1016/j.diabres.2025.113068","url":null,"abstract":"<div><h3>Aims</h3><div>Heart failure (HF) affects up to 40 % of patients with type 2 diabetes mellitus (T2DM), imposing significant clinical and economic burdens. N-terminal pro-B-type natriuretic peptide (NT-proBNP) effectively assesses HF risk, but its economic value in China is unclear.</div></div><div><h3>Methods</h3><div>This study evaluated the cost-effectiveness of three HF risk assessment strategies in patients with T2DM: NT-proBNP-guided assessment (using a cut-off of ≥125 pg/mL), usual care in China, and Systematic COronary Risk Evaluation (SCORE). A decision tree and Markov model with 1-year cycles simulated lifetime direct medical costs (given in United States dollars [US$]) and health outcomes in patients with T2DM aged ≥40 years from a Chinese healthcare perspective. High-risk patients received SGLT2 inhibitors plus standard of care.</div></div><div><h3>Results</h3><div>Compared with usual care, the NT-proBNP-guided strategy was cost-saving, reducing costs by US$1002.73 while increasing QALYs by 0.055 per patient. It was also less costly and more effective than the SCORE strategy. Probabilistic sensitivity analysis confirmed the robustness of this finding, demonstrating a 96.9 % probability of the NT-proBNP strategy being cost-saving versus usual care.</div></div><div><h3>Conclusions</h3><div>NT-proBNP is a dominant and robust cost-saving strategy for HF risk assessment in patients with T2DM in China, reducing both HF cases and associated healthcare costs.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113068"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Early detection of impaired glucose tolerance (IGT) is critical for preventing overt diabetes and cardiovascular disease. Few studies have evaluated the predictors of the transition from normal glucose tolerance (NGT) to glucose intolerance (GI; IGT or type 2 diabetes, and/or impaired fasting glucose). We conducted a 5-year prospective study of individuals with NGT to evaluate the predictors of GI development.
Methods
A 75-g oral glucose tolerance test was performed to diagnose GI. We enrolled 1,008 Japanese individuals with NGT who completed a 5-year follow-up. Using logistic regression analyses, we explored the predictive factors for GI development and assessed the single-nucleotide polymorphisms of type 2 diabetes susceptibility.
Results
We identified the 1-h plasma glucose (1-h PG) level and age interaction as predictors of GI development. In the stratified analysis, the sex-and body mass index-adjusted odds ratios for GI development in individuals with 1-h PG ≥ 8.3 mmol/L and age ≥ 57 years was 12.9 (95 % CI: 5.7–29.2) compared to the reference. Genetic risk was associated with the aggravation of 1-h PG levels.
Conclusions
The combination of 1-h PG and age serves as a potential predictor of GI development in individuals with NGT.
{"title":"Simultaneous assessment of one-hour plasma glucose levels and age as a potential predictor of glucose intolerance development in individuals with normal glucose tolerance","authors":"Misaki Takakado , Yasuharu Tabara , Shota Inoue , Toshimi Hadate , Ryoichi Kawamura , Koutatsu Maruyama , Isao Saito , Jun Ohashi , Haruhiko Osawa , Yasunori Takata","doi":"10.1016/j.diabres.2025.113079","DOIUrl":"10.1016/j.diabres.2025.113079","url":null,"abstract":"<div><h3>Aims</h3><div>Early detection of impaired glucose tolerance (IGT) is critical for preventing overt diabetes and cardiovascular disease. Few studies have evaluated the predictors of the transition from normal glucose tolerance (NGT) to glucose intolerance (GI; IGT or type 2 diabetes, and/or impaired fasting glucose). We conducted a 5-year prospective study of individuals with NGT to evaluate the predictors of GI development.</div></div><div><h3>Methods</h3><div>A 75-g oral glucose tolerance test was performed to diagnose GI. We enrolled 1,008 Japanese individuals with NGT who completed a 5-year follow-up. Using logistic regression analyses, we explored the predictive factors for GI development and assessed the single-nucleotide polymorphisms of type 2 diabetes susceptibility.</div></div><div><h3>Results</h3><div>We identified the 1-h plasma glucose (1-h PG) level and age interaction as predictors of GI development. In the stratified analysis, the sex-and body mass index-adjusted odds ratios for GI development in individuals with 1-h PG ≥ 8.3 mmol/L and age ≥ 57 years was 12.9 (95 % CI: 5.7–29.2) compared to the reference. Genetic risk was associated with the aggravation of 1-h PG levels.</div></div><div><h3>Conclusions</h3><div>The combination of 1-h PG and age serves as a potential predictor of GI development in individuals with NGT.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"232 ","pages":"Article 113079"},"PeriodicalIF":7.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-30DOI: 10.1016/j.diabres.2025.113078
Nithya Kadiyala , Janet Allen , Rama Lakshman , Charlotte K. Boughton , Malgorzata E. Wilinska , Ajay Thankamony , Sara Hartnell , Hood Thabit , Ruben H. Willemsen , Pratik Shah , Julia Ware , Roman Hovorka
Aims
The aim of this qualitative study was to explore the impact of using the CamAPS HX fully closed-loop system, which does not require carbohydrate counting, meal announcements or pre-meal bolusing, on the daily lives of adolescents with type 1 diabetes and HbA1c above the recommended target (≥ 7.5 % [58 mmol/mol]).
Methods
Twelve adolescents took part in virtual semi-structured interviews. Data was analyzed thematically using an inductive-deductive approach. Study participants also completed quality of life questionnaires.
Results
All interviewees reported reduced effort in managing diabetes, as they no longer needed to count carbohydrates or bolus, and worried less about their glucose levels. This led to improved quality of life, with a greater sense of freedom and normalcy, particularly around meals. A few also noted benefits in physical activity, sleep, work and social life. Interviewees expressed dissatisfaction with the algorithm’s slow response to postprandial glucose spikes, and the need for a tethered pump. Questionnaires showed no significant differences in hypoglycaemia fear or diabetes distress between study periods but reflected a positive experience with the closed-loop system.
Conclusions
In adolescents with type 1 diabetes, fully closed-loop insulin delivery reduced the daily burden of self-management, leading to improved quality of life.
{"title":"Lived experience of fully closed-loop insulin delivery in adolescents with type 1 diabetes and HbA1c above target","authors":"Nithya Kadiyala , Janet Allen , Rama Lakshman , Charlotte K. Boughton , Malgorzata E. Wilinska , Ajay Thankamony , Sara Hartnell , Hood Thabit , Ruben H. Willemsen , Pratik Shah , Julia Ware , Roman Hovorka","doi":"10.1016/j.diabres.2025.113078","DOIUrl":"10.1016/j.diabres.2025.113078","url":null,"abstract":"<div><h3>Aims</h3><div>The aim of this qualitative study was to explore the impact of using the CamAPS HX fully closed-loop system, which does not require carbohydrate counting, meal announcements or pre-meal bolusing, on the daily lives of adolescents with type 1 diabetes and HbA1c above the recommended target (≥<!--> <!-->7.5 % [58 mmol/mol]).</div></div><div><h3>Methods</h3><div>Twelve adolescents took part in virtual semi-structured interviews. Data was analyzed thematically using an inductive-deductive approach. Study participants also completed quality of life questionnaires.</div></div><div><h3>Results</h3><div>All interviewees reported reduced effort in managing diabetes, as they no longer needed to count carbohydrates or bolus, and worried less about their glucose levels. This led to improved quality of life, with a greater sense of freedom and normalcy, particularly around meals. A few also noted benefits in physical activity, sleep, work and social life. Interviewees expressed dissatisfaction with the algorithm’s slow response to postprandial glucose spikes, and the need for a tethered pump. Questionnaires showed no significant differences in hypoglycaemia fear or diabetes distress between study periods but reflected a positive experience with the closed-loop system.</div></div><div><h3>Conclusions</h3><div>In adolescents with type 1 diabetes, fully closed-loop insulin delivery reduced the daily burden of self-management, leading to improved quality of life.</div><div>Clinical trial registration: NCT05653050.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"232 ","pages":"Article 113078"},"PeriodicalIF":7.4,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This 15-year cohort study assessed whether peri-renal fat volume index (PRFVI) and renal sinus fat volume index (RSFVI) predict diabetic kidney disease (DKD) better than general or abdominal obesity measures in Japanese adults with type 2 diabetes (T2D).
Methods
Researchers studied 190 DKD-free individuals, measured their abdominal and renal fat via computed tomography, and categorized them into tertiles based on five adiposity indices: body mass index (BMI), visceral fat area (VFA), subcutaneous fat area (SFA), PRFVI, and RSFVI.
Results
Participants averaged 58 years old; 52.6 % were male with a median diabetes duration of 5 years and a BMI of 25.4 kg/m2. PRFVI correlated with BMI, whereas RSFVI correlated with aging. Over a median 8.5-year follow-up, 53.7 % of patients developed DKD. Notably, higher RSFVI tertiles were significantly associated with DKD risk (hazard ratio 1.96, 95 % confidence interval 1.14–3.39, P = 0.016), and RSFVI had the best predictive value for DKD among all indices (AUC = 0.769). Both renal fat indices showed stronger associations with DKD development than traditional obesity measures.
Conclusions
The findings demonstrate that renal fat measure, particularly RSFVI, provides incremental predictive value independent of conventional DKD risk variables, suggesting that local renal fat may be a target for early DKD detection and intervention in people with T2D.
目的：这项为期15年的队列研究评估了日本成人2型糖尿病（T2D）患者肾周脂肪体积指数（PRFVI）和肾窦脂肪体积指数（RSFVI）是否比一般或腹部肥胖指标更能预测糖尿病肾病（DKD）。方法：研究人员对190例无dkd患者进行了研究，通过计算机断层扫描测量了他们的腹部和肾脏脂肪，并根据BMI、内脏脂肪面积（VFA）、皮下脂肪面积（SFA）、PRFVI和RSFVI这5个肥胖指数将他们分类。结果：参与者平均58岁 ；52.6% 为男性，中位糖尿病病程为5 年，BMI为25.4 kg/m2。PRFVI与BMI相关，而RSFVI与年龄相关。在中位8.5年的随访中，53.7 %的患者发生了DKD。值得注意的是，较高的RSFVI分位数与DKD风险显著相关（风险比1.96,95 % CI 1.14-3.39, P = 0.016），在所有指标中，RSFVI对DKD的预测价值最好（AUC = 0.769）。两项肾脏脂肪指标均显示与DKD发展的相关性强于传统的肥胖指标。结论：研究结果表明，PRFVI，特别是RSFVI，提供了独立于传统DKD风险变量的增量预测价值，提示局部肾脂肪可能是T2D患者早期DKD检测和干预的目标。
{"title":"Peri-renal and renal sinus fat accumulation and diabetic kidney disease in type 2 diabetes: A Japanese cohort study","authors":"Hayato Tanabe , Teruyuki Kono , Haruka Saito , Gulinu Maimaituxun , Kenichi Tanaka , Junichiro J. Kazama , Michio Shimabukuro","doi":"10.1016/j.diabres.2025.113074","DOIUrl":"10.1016/j.diabres.2025.113074","url":null,"abstract":"<div><h3>Aims</h3><div>This 15-year cohort study assessed whether <em>peri</em>-renal fat volume index (PRFVI) and renal sinus fat volume index (RSFVI) predict diabetic kidney disease (DKD) better than general or abdominal obesity measures in Japanese adults with type 2 diabetes (T2D).</div></div><div><h3>Methods</h3><div>Researchers studied 190 DKD-free individuals, measured their abdominal and renal fat via computed tomography, and categorized them into tertiles based on five adiposity indices: body mass index (BMI), visceral fat area (VFA), subcutaneous fat area (SFA), PRFVI, and RSFVI.</div></div><div><h3>Results</h3><div>Participants averaged 58 years old; 52.6 % were male with a median diabetes duration of 5 years and a BMI of 25.4 kg/m<sup>2</sup>. PRFVI correlated with BMI, whereas RSFVI correlated with aging. Over a median 8.5-year follow-up, 53.7 % of patients developed DKD. Notably, higher RSFVI tertiles were significantly associated with DKD risk (hazard ratio 1.96, 95 % confidence interval 1.14–3.39, P = 0.016), and RSFVI had the best predictive value for DKD among all indices (AUC = 0.769). Both renal fat indices showed stronger associations with DKD development than traditional obesity measures.</div></div><div><h3>Conclusions</h3><div>The findings demonstrate that renal fat measure, particularly RSFVI, provides incremental predictive value independent of conventional DKD risk variables, suggesting that local renal fat may be a target for early DKD detection and intervention in people with T2D.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"232 ","pages":"Article 113074"},"PeriodicalIF":7.4,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To elucidate the overall protective effects of tirzepatide against atherosclerosis-related events, including cardiovascular and lower-extremity events.
Methods
We conducted a retrospective cohort study using the TriNetX global health research network to identify patients with type 2 diabetes (T2D) who initiated tirzepatide or sitagliptin between January 2022 and December 2023. The primary outcome was major adverse cardiovascular and limb events (MACLE), defined as the composite of major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, and stroke) and major adverse limb events (MALE: all-cause death and major lower extremity amputation). Propensity score matching was applied.
Results
After matching, 31,751 patients per group were analyzed. At 1 year, the incidence of MACLE was lower with tirzepatide compared to that with sitagliptin (4.3 % vs. 6.1 %; hazard ratio (HR), 0.70; 95 % confidence interval (CI), 0.66–0.76; p < 0.001). Tirzepatide was also associated with a reduced risk of MACE (HR, 0.71; 95 % CI, 0.66–0.76), MALE (HR, 0.39; 95 % CI, 0.34–0.46), and major lower extremity amputation (HR, 0.61; 95 % CI, 0.44–0.84). Consistent benefits were observed across major subgroups.
Conclusions
Tirzepatide was associated with a significantly lower risk of cardiovascular and limb events compared to sitagliptin in patients with T2D.
目的：阐明替西肽对动脉粥样硬化相关事件的总体保护作用，包括心血管和下肢事件。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，以确定在2022年1月至2023年12月期间开始使用替西帕肽或西格列汀的2型糖尿病（T2D）患者。主要终点为主要心血管和肢体不良事件（MACLE），定义为主要心血管不良事件（MACE：全因死亡、心肌梗死和卒中）和主要肢体不良事件（MALE：全因死亡和主要下肢截肢）的组合。采用倾向评分匹配。结果：配对后，每组共分析31751例患者。在1 年时，替西帕肽的MACLE发生率低于西格列汀(4.3 % vs 6.1 %；风险比（HR） 0.70；95 %置信区间（CI）， 0.66-0.76；p 结论：与西格列汀相比，替西帕肽与T2D患者心血管和肢体事件的风险显著降低相关。
{"title":"Major adverse cardiovascular and limb events caused by tirzepatide in patients with type 2 diabetes at high cardiovascular risk: A comparison with sitagliptin","authors":"Yoshihiro Iwasaki , Takenobu Shimada , Takefumi Kishimori , Takao Kato , Jumpei Koike , Takehiro Matsumoto , Takafumi Yagi , Masaharu Okada","doi":"10.1016/j.diabres.2025.113072","DOIUrl":"10.1016/j.diabres.2025.113072","url":null,"abstract":"<div><h3>Aims</h3><div>To elucidate the overall protective effects of tirzepatide against atherosclerosis-related events, including cardiovascular and lower-extremity events.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX global health research network to identify patients with type 2 diabetes (T2D) who initiated tirzepatide or sitagliptin between January 2022 and December 2023. The primary outcome was major adverse cardiovascular and limb events (MACLE), defined as the composite of major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, and stroke) and major adverse limb events (MALE: all-cause death and major lower extremity amputation). Propensity score matching was applied.</div></div><div><h3>Results</h3><div>After matching, 31,751 patients per group were analyzed. At 1 year, the incidence of MACLE was lower with tirzepatide compared to that with sitagliptin (4.3 % vs. 6.1 %; hazard ratio (HR), 0.70; 95 % confidence interval (CI), 0.66–0.76; p < 0.001). Tirzepatide was also associated with a reduced risk of MACE (HR, 0.71; 95 % CI, 0.66–0.76), MALE (HR, 0.39; 95 % CI, 0.34–0.46), and major lower extremity amputation (HR, 0.61; 95 % CI, 0.44–0.84). Consistent benefits were observed across major subgroups.</div></div><div><h3>Conclusions</h3><div>Tirzepatide was associated with a significantly lower risk of cardiovascular and limb events compared to sitagliptin in patients with T2D.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113072"},"PeriodicalIF":7.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-22DOI: 10.1016/j.diabres.2025.113059
Hongmei Li, Xu Li, Fangjiu Liu
Background: Metformin reduces mortality in type 2 diabetes mellitus (T2DM), but its underlying pathways remain incompletely understood. We hypothesize that serum albumin could potentially mediate the effects of metformin on mortality. Methods: Participants were drawn from the National Health and Nutrition Examination Survey (NHANES) across ten cycles for this retrospective longitudinal analysis. We employed mediation analysis to assess the impact of metformin on all-cause mortality risk mediated by albumin (ALB). Results: In our longitudinal study, all-cause mortality was 40.97 %. Multivariate logistic regression analysis identified a significant correlation between metformin and the likelihood of all-cause mortality (HR = 0.8, 95 %CI = 0.71–0.90, P < 0.001). Mediation analysis indicated that the relationship between metformin and all-cause mortality risk was partially mediated by ALB, accounting for 13.32 % of the association (P < 0.0001). Conclusion: ALB mediates the association between metformin use and lower all-cause mortality in older Americans with T2DM and hypertension, underscoring the mortality-reducing importance of nutritional status.
{"title":"Metformin and all-cause mortality in older adults with type 2 diabetes mellitus and hypertension: NHANES 1999–2018 evidence for albumin as a mediator","authors":"Hongmei Li, Xu Li, Fangjiu Liu","doi":"10.1016/j.diabres.2025.113059","DOIUrl":"10.1016/j.diabres.2025.113059","url":null,"abstract":"<div><div><strong>Background:</strong> Metformin reduces mortality in type 2 diabetes mellitus (T2DM), but its underlying pathways remain incompletely understood. We hypothesize that serum albumin could potentially mediate the effects of metformin on mortality. <strong>Methods:</strong> Participants were drawn from the National Health and Nutrition Examination Survey (NHANES) across ten cycles for this retrospective longitudinal analysis. We employed mediation analysis to assess the impact of metformin on all-cause mortality risk mediated by albumin (ALB). <strong>Results:</strong> In our longitudinal study, all-cause mortality was 40.97 %. Multivariate logistic regression analysis identified a significant correlation between metformin and the likelihood of all-cause mortality (HR = 0.8, 95 %CI = 0.71–0.90, P < 0.001). Mediation analysis indicated that the relationship between metformin and all-cause mortality risk was partially mediated by ALB, accounting for 13.32 % of the association (P < 0.0001). <strong>Conclusion:</strong> ALB mediates the association between metformin use and lower all-cause mortality in older Americans with T2DM and hypertension, underscoring the mortality-reducing importance of nutritional status.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113059"},"PeriodicalIF":7.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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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