Diabetes research and clinical practice最新文献

{"title":"Comparative effectiveness of telehealth-delivered family and standard models of diabetes self-management education and support for persons with type 2 diabetes mellitus","authors":"Jennifer A. Andersen ,&nbsp;Pearl A. McElfish ,&nbsp;James P. Selig ,&nbsp;Ji Li ,&nbsp;Brett Rowland ,&nbsp;Jonell Hudson ,&nbsp;Shashank Kraleti ,&nbsp;Joseph Henske ,&nbsp;Lindsay S. Mayberry","doi":"10.1016/j.diabres.2025.113063","DOIUrl":"10.1016/j.diabres.2025.113063","url":null,"abstract":"<div><h3>Aims</h3><div>Family members/support persons can shape the self-management decisions of persons with T2DM (PWDs), and their inclusion in DSMES may lead to improved outcomes. However, research on the effectiveness of family models of DSMES (Family-DSMES) is limited. We conducted a comparative effectiveness-implementation RCT of Family-DSMES and a standard model of DSMES (Standard-DSMES) delivered via telehealth.</div></div><div><h3>Methods</h3><div>550 diverse adult PWDs and their family members/support persons were recruited from eight primary care clinics in both rural and urban areas. Process data was collected to evaluate implementation characteristics. Biometric, behavioral, and psychosocial measures were collected from PWDs.</div></div><div><h3>Results</h3><div>Mean attendance was slightly higher for PWDs in Family-DSMES than Standard-DSMES (62 % vs. 57 %, <em>p</em> = 0.096). Engagement (<em>p</em> = 0.319) and class time (<em>p</em> = 0.145) were similar across arms. PWDs in both arms experienced a decrease in HbA1c at all time points (<em>p</em> &lt; 0.005). No statistically significant between-arm differences were found for biometric outcomes or behavioral outcomes including HbA1c. For diabetes-related helpful family involvement, the improvement in the Family-DSMES arm was significantly greater than in the Standard-DSMES arm (<em>p</em> = 0.024).</div></div><div><h3>Conclusions</h3><div>Results demonstrate the ability to engage rural and diverse PWDs in a telehealth intervention with high fidelity to achieve clinically and statistically significant improvements in HbA1c.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"232 ","pages":"Article 113063"},"PeriodicalIF":7.4,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809598","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}

{"title":"Regulatory roles of non-coding RNAs in ferroptosis during diabetic retinopathy","authors":"Qingjun Tian ,&nbsp;Chenxing Guo ,&nbsp;Fang Yuan ,&nbsp;Ying Shao ,&nbsp;Xing Liang ,&nbsp;Hetian Lei ,&nbsp;JingJing Wang ,&nbsp;Ronghua Feng ,&nbsp;Yajian Duan","doi":"10.1016/j.diabres.2025.113062","DOIUrl":"10.1016/j.diabres.2025.113062","url":null,"abstract":"<div><div>Diabetic retinopathy (DR) is one of the most common and severe microvascular complications of diabetes, characterized by both microvascular damage and neurodegeneration. Despite advances in clinical management, current treatment options remain limited and lack effective therapeutic targets. Recent evidence has revealed that ferroptosis—an iron-dependent form of programmed cell death—plays a crucial role in the onset and progression of DR. Ferroptosis exacerbates DR pathology by disrupting the homeostasis of retinal vascular and neuronal systems. Moreover, accumulating studies have demonstrated that non-coding RNAs (ncRNAs), including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), can modulate ferroptosis in DR through direct or indirect regulation of ferroptosis-related proteins and their downstream pathways. Elucidating the molecular mechanisms of ferroptosis regulators and the ncRNAs involved in this process may therefore uncover novel therapeutic strategies and intervention targets for DR. This review systematically summarizes recent advances in understanding the regulatory roles of ncRNAs in ferroptosis during DR progression and discusses future research directions in this emerging field.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113062"},"PeriodicalIF":7.4,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786737","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}

{"title":"A phase 1b, randomized, open-label study of once-weekly insulin GZR4 in patients with type 2 diabetes mellitus","authors":"Xuhong Wang ,&nbsp;Ye Hu ,&nbsp;Chengyong Tang ,&nbsp;Chenghu Huang ,&nbsp;Fengxue Guo ,&nbsp;Wei Chen","doi":"10.1016/j.diabres.2025.113061","DOIUrl":"10.1016/j.diabres.2025.113061","url":null,"abstract":"<div><h3>Aims</h3><div>To investigate the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple ascending doses of GZR4 in patients with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>This randomized, active-controlled, phase 1b trial was conducted in adults with T2DM on stable daily basal insulin therapy. Eligible participants were randomized in 3:1 ratio within three cohorts to receive either a fixed once-weekly dose of GZR4 or once-daily insulin degludec (IDeg) subcutaneously for six weeks. Primary endpoints were incidence of adverse events (AEs), serious adverse events (SAEs), and hypoglycemia.</div></div><div><h3>Results</h3><div>The most commonly reported treatment-emergent AE across all treatment groups was hypoglycemia. No SAEs or severe hypoglycemia was observed. At steady state, the mean C_max of GZR4 was 289.0 ± 17.1 to 1,016.0 ± 262.4 ng/mL; mean AUC_{GZR4, 0-168h} ranged from 34,449.6 ± 2,055.7 to 137,064.2 ± 41,496.5 h.ng/mL. Mean change in FPG from baseline to week 6 was −1.77 ± 0.20 to −2.75 ± 0.71 mmol/L for GZR4 groups and −1.12 ± 0.36 mmol/L for IDeg group; corresponding change in HbA1c was −0.38 ± 0.64 % to −0.76 ± 0.14 % versus −0.13 ± 0.21 %.</div></div><div><h3>Conclusions</h3><div>GZR4 was safe and well tolerated in patients with diabetes in present trial with pharmacokinetic and pharmacodynamic profiles enabling once-weekly dosing.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113061"},"PeriodicalIF":7.4,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800415","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}

{"title":"Development and validation of prediction models for gestational diabetes mellitus in first-trimester pregnant women","authors":"Xiaohang Liu ,&nbsp;Fang Hu ,&nbsp;Ruohua Yan ,&nbsp;Ruixia Liu ,&nbsp;Shaofei Su ,&nbsp;Yaguang Peng ,&nbsp;Xiaoxia Peng ,&nbsp;Chenghong Yin","doi":"10.1016/j.diabres.2025.113048","DOIUrl":"10.1016/j.diabres.2025.113048","url":null,"abstract":"<div><h3>Aims</h3><div>Early intervention can reduce the risk of gestational diabetes mellitus (GDM) and related adverse pregnancy outcomes. Accordingly, this study aims to develop prediction models for GDM in early pregnant women.</div></div><div><h3>Methods</h3><div>Pregnant women enrolled at Beijing Obstetrics and Gynecology Hospital were included in the derivation and temporal datasets. Women with electronic data capture records from other subcenters were included in the external validation dataset. Logistic regression and eXtreme Gradient Boosting (XGBoost) models were used to predict the risk of GDM.</div></div><div><h3>Results</h3><div>A total of 20,435 pregnant women were included in the derivation dataset, with 1,997 pregnant women in the temporal validation dataset. Furthermore, 100 pregnant women were included in the external validation dataset. The logistic regression and XGBoost models demonstrated AUCs of 0.738 (95% CI: 0.707, 0.771) and 0.737 (95% CI: 0.706, 0.767) in temporal validation. For the external validation dataset, the AUCs were 0.674 (95% CI: 0.440, 0.879) and 0.737 (95% CI: 0.510, 0.929) for the logistic regression and XGBoost models, respectively.</div></div><div><h3>Conclusion</h3><div>Both the logistic regression and XGBoost models demonstrated satisfactory performance in the internal and temporal datasets. However, the XGBoost model showed more robust performance in the external validation dataset compared to the logistic regression model.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113048"},"PeriodicalIF":7.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780466","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}

{"title":"Frailty, diabetic foot ulceration and mortality in people diagnosed with type 2 diabetes: Multistate analysis of primary care patients in the UK clinical practice research datalink","authors":"Liam Neal ,&nbsp;Tom Yates ,&nbsp;Sharmin Shabnam ,&nbsp;Matthew McCarthy ,&nbsp;Paddy C. Dempsey ,&nbsp;Melanie Davies ,&nbsp;Kamlesh Khunti ,&nbsp;Francesco Zaccardi","doi":"10.1016/j.diabres.2025.113058","DOIUrl":"10.1016/j.diabres.2025.113058","url":null,"abstract":"<div><h3>Aims</h3><div>Diabetic foot ulceration (DFU) is a serious complication of diabetes. Frailty is common in individuals with type 2 diabetes and has been associated with a higher mortality risk. We investigated the risk of DFU and mortality in relation to frailty in individuals with type 2 diabetes.</div></div><div><h3>Methods</h3><div>We identified DFU and mortality events between 2000 and 2021 in the Clinical Practice Research Datalink GOLD primary care records linked to hospital and mortality data. Frailty was categorised using the electronic frailty index. We employed parametric multistate modelling to describe the transitions across the states ‘Type 2 diabetes’, ‘DFU’ and ‘Mortality’.</div></div><div><h3>Results</h3><div>In 186,473 individuals with type 2 diabetes (median age, 62 years; 50.9 % women), 3,551 (1.9 %) developed DFU and 53,118 (28.5 %) died during a median follow-up of 8.8 years. Greater frailty was associated with higher rates of DFU and, especially, mortality. In women diagnosed at 60, the 10-year adjusted probability of DFU was 2.1 %, 1.9 %, 2.9 %, and 3.2 % for fit, mild, moderate, and severe frailty, respectively; corresponding estimates in men were 2.6 %, 2.7 %, 3.7 %, and 4.4 %.</div></div><div><h3>Conclusions</h3><div>Information on age and frailty at type 2 diabetes diagnosis is necessary to enhance risk stratification and guide personalised diagnostic and therapeutic strategies for DFU.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113058"},"PeriodicalIF":7.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773934","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}

{"title":"Effect of metformin on central arterial stiffness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis","authors":"Anditri Weningtyas ,&nbsp;Victor Alvianoes Guterez Hose ,&nbsp;Risa Ramadhiani ,&nbsp;Mohammad Saifur Rohman ,&nbsp;Dian Nugrahenny ,&nbsp;Achmad Rudijanto","doi":"10.1016/j.diabres.2025.113057","DOIUrl":"10.1016/j.diabres.2025.113057","url":null,"abstract":"<div><div>Type 2 diabetes mellitus (T2DM) is a global health problem linked to hyperglycemia and cardiovascular complications, including central arterial stiffness. Metformin, the first-line therapy for T2DM, has been suggested to provide vascular protection, although evidence on arterial stiffness is inconsistent. This study investigated the effect of metformin on central arterial stiffness through systematic searches of PubMed/MEDLINE, ScienceDirect, Cochrane, and Google Scholar. Three reviewers independently performed data extraction and quality assessment, and pooled analyses were conducted in RevMan 5.4.1 (PROSPERO 1135002). Results showed no significant difference in pulse wave velocity (PWV) between metformin (8.9–11.2 m/s) and comparison groups (8.0–11.8 m/s), with a pooled mean difference (MD) of 0.09 m/s (95 % CI –0.06 to 0.25; p = 0.23; I² = 0 %). However, metformin was associated with significantly higher central systolic blood pressure (cSBP) compared with controls (MD 3.30 mmHg, 95 % CI 0.60 to 6.00; p = 0.02; I² = 0 %). In conclusion, metformin does not significantly affect PWV but is linked to a modest increase in cSBP, highlighting the need for larger studies to clarify its vascular implications.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113057"},"PeriodicalIF":7.4,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767352","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}

{"title":"An expert narrative review on the brain-kidney axis in diabetic kidney disease: Mechanisms and therapeutic insights","authors":"Zongrui Zhang ,&nbsp;Rangzi Yi ,&nbsp;Shihong Xiong ,&nbsp;Yushu Zhang ,&nbsp;Xuebin Cao ,&nbsp;Wenqi Zhen ,&nbsp;Yang Yang ,&nbsp;Na Gong","doi":"10.1016/j.diabres.2025.113055","DOIUrl":"10.1016/j.diabres.2025.113055","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease. Conventional research focuses on renal-intrinsic pathophysiology, yet emerging evidence reveals bidirectional neuroimmune communication along the brain-kidney axis critically modulates DKD progression. Emerging evidence reveals that bidirectional neuroimmune communication along the brain-kidney axis critically modulates DKD progression through inflammatory, cholinergic, and metabolic pathways⁵, yet the clinical translational potential remains incompletely defined.</div></div><div><h3>Objective</h3><div>To comprehensively evaluate the neuroimmune regulatory mechanisms of the brain-kidney axis in DKD, identify key therapeutic targets (TNF-α/NF-κB pathway, α7nAChR, SGLT inhibitors, GLP-1 receptor agonists), and assess their efficacy and central nervous system safety profiles.</div></div><div><h3>Methods</h3><div>We performed a comprehensive literature search of PubMed, Cochrane Library, Web of Science, and Embase from inception to November 2025, supplemented by hand-searching reference lists. Studies investigating neuroimmune mechanisms, therapeutic interventions, or multimodal imaging biomarkers related to the brain-kidney axis in DKD were critically appraised and narratively synthesized using a thematic analysis approach. Evidence quality was evaluated using GRADE criteria.</div></div><div><h3>Results</h3><div>We identified three core pathways: TNF-α/NF-κB-mediated neuroinflammation amplification (primarily preclinical evidence), α7nAChR-driven cholinergic anti-inflammatory responses (very low-quality evidence), and SGLT-dependent metabolic modulation. High-quality randomized controlled trials demonstrate that SGLT2 inhibitors reduce hard renal endpoints by 30–40%, while GLP-1 receptor agonists improve renal outcomes but raise concerns regarding autonomic dysfunction and neuropathy. Multimodal imaging reveals correlative brain-kidney functional connectivity alterations, supporting axis involvement in DKD pathogenesis; however, the proposed ’brain-kidney connectivity score’ remains an exploratory concept that requires validation through standardized multimodal registration and algorithm development.</div></div><div><h3>Conclusion</h3><div>The brain-kidney axis provides a novel framework for DKD pathophysiology. While high-quality evidence supports SGLT2 inhibitors and GLP-1 receptor agonists for renoprotection, central nervous system safety monitoring remains critical. Future research must validate dynamic multimodal imaging tools and develop personalized combination therapeutic strategies to optimize clinical translation.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"233 ","pages":"Article 113055"},"PeriodicalIF":7.4,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767409","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}

{"title":"Utility of continuous glucose monitoring in people with type 2 diabetes on insulin-based regimens in clinical practice: A case series and expert opinion.","authors":"Soo Lim, Rimei Nishimura, Jothydev Kesavadev, Alice Pik Shan Kong, Margaret J McGill, Horng-Yih Ou, Chun-Kwan O, Chun-Chuan Lee, Xiaomei Zhang, Linong Ji, Chih-Yuan Wang","doi":"10.1016/j.diabres.2025.113054","DOIUrl":"https://doi.org/10.1016/j.diabres.2025.113054","url":null,"abstract":"<p><p>In individuals with type 2 diabetes (T2D) on insulin, continuous glucose monitoring (CGM) provides feedback on intra- and inter-day glycaemic variations that helps tailor the insulin regimen and lifestyle choices, without the pain of multiple finger pricks. However, practical guidance on the use of CGM in this cohort is limited in Asia. In this case series-based review and expert opinion paper, we aim to provide expert guidance, through a case-based approach, on the use of CGM in people with T2D on insulin therapy, primarily in three profiles: (1) individuals with no comorbidities; (2) those with comorbid cardiovascular risk factors; and (3) elderly individuals with T2D on insulin. Five anonymised demonstrative real-world cases, including ambulatory glucose profiles, have been presented. The benefits of CGM in T2D management in each profile as well as supporting literature are discussed and ten key clinical practice points are proposed to aid in optimising the use of CGM for achieving glycaemic targets, adjusting insulin therapy, motivating adherence to lifestyle intervention, reducing the risk of, or minimising the duration of, hypoglycaemia, and improving the overall quality of life and well-being in this population.</p>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":" ","pages":"113054"},"PeriodicalIF":7.4,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755538","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}

{"title":"Kidney function decline mediates the adverse effects of arterial stiffness on all-cause and cardiovascular disease mortality in Cardiovascular-Kidney-Metabolic syndrome population: A cohort study","authors":"Song Liu ,&nbsp;Qizhang Man ,&nbsp;Shuan Wang ,&nbsp;Yifeng Huang ,&nbsp;Jinfeng Wen ,&nbsp;Ying Yang ,&nbsp;Hao Xie ,&nbsp;Lei Fan","doi":"10.1016/j.diabres.2025.113051","DOIUrl":"10.1016/j.diabres.2025.113051","url":null,"abstract":"<div><h3>Aids</h3><div>Cardiovascular-Kidney-Metabolic (CKM) syndrome links metabolic, renal, and cardiovascular disorders. The prognostic value and mechanisms of estimated pulse wave velocity (ePWV) in CKM syndrome remain unclear.</div></div><div><h3>Methods</h3><div>We analyzed 34,004 CKM syndrome patients from NHANES 1999–2018. Cox regression, restricted cubic splines, and mediation analyses examined ePWV-mortality associations and renal function’s mediating role.</div></div><div><h3>Results</h3><div>Over 104 months median follow-up, 4,141 all-cause and 1,261 cardiovascular deaths occurred. In fully adjusted model, each unit ePWV increase associated with 32 % higher all-cause mortality (HR: 1.32, 95 % CI: 1.29–1.35) and 34 % higher CVD mortality (HR: 1.34, 95 % CI: 1.28–1.40). The association showed L-shaped patterns in non-advanced CKM cases and linear relationships in advanced stages. Kidney function decline mediated 24 % of all-cause and 26 % of CVD mortality risk.</div><div>Conclusions.</div><div>Elevated ePWV predicts increased mortality in CKM syndrome patients, with kidney function decline as a significant mediating pathway. These findings highlight the importance of arterial stiffness assessment and renal protection in CKM management.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113051"},"PeriodicalIF":7.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741535","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}

{"title":"Deinsulinisation in type 2 Diabetes: Evidence-based strategies for safe treatment simplification “Approaches to reducing insulin in type 2 diabetes”","authors":"Carlo B Giorda ,&nbsp;Valentina Anelli ,&nbsp;Umberto Goglia ,&nbsp;Stefano De Riu ,&nbsp;Giuseppina Russo ,&nbsp;Marco Gallo ,&nbsp;Salvatore De Cosmo ,&nbsp;Gerardo Corigliano ,&nbsp;Michele Roberto Modestino","doi":"10.1016/j.diabres.2025.113056","DOIUrl":"10.1016/j.diabres.2025.113056","url":null,"abstract":"<div><div>Insulin remains a cornerstone in managing advanced type 2 diabetes (T2D), but long-term use poses challenges, including hypoglycemia, weight gain, and treatment burden. The advent of GLP-1 receptor agonists (GLP-1 RAs) and SGLT2 inhibitors (SGLT2i) has enabled the concept of deinsulinisation: reducing or withdrawing insulin in favor of safer, simpler therapies. This narrative review examines current evidence on deinsulinisation strategies, focusing on four key factors: age, HbA1c levels, BMI, and prior insulin regimen. Data from trials, observational studies, and guidelines suggest insulin withdrawal can be safe and effective, particularly in older adults, those with low daily insulin doses, and patients with stable glycemic control. Newer fixed-ratio combinations and once-weekly GLP-1 RAs support improved adherence, fewer hypoglycemic events, and weight loss. Predictors of success include lower insulin requirements, lower HbA1c levels, and shorter diabetes duration, though high-quality evidence is limited. Continuous glucose monitoring (CGM) and structured deprescribing protocols are key to minimizing clinical inertia and avoiding overtreatment. Deinsulinisation aligns with ADA/EASD guidance, especially for frail or elderly patients, emphasizing safety and quality of life. While individualized and closely monitored approaches are essential, deinsulinisation represents a paradigm shift toward more personalized, risk-balance, and patient-centered T2D care.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"231 ","pages":"Article 113056"},"PeriodicalIF":7.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751680","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}