Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are widely used in type 2 diabetes (T2D) management, but their efficacy and tolerance in Prader-Willi syndrome (PWS) remains unknown. Given the early onset of diabetes and treatment challenges, evaluating SGLT2is in this population is essential.
Research and methods
In this retrospective, multicenter study, 48 adults with PWS and T2D, among whom 24 patients receiving SGLT2is, were followed over 6 months. Glycemic and renal parameters were analyzed at baseline and 6 months.
Results
HbA1c was higher in the SGLT2i group and significantly improved (P < 0.05) while it remained stable in controls. The albumin-to-creatinine ratio also decreased significantly. No significant weight change was noted. Adverse events occurred in 37.5 % of treated patients, including acute kidney injury in 8.3 %.
Conclusions
SGLT2is improve glycemic control and renal markers in PWS with no weight loss. Close safety monitoring is warranted, particularly regarding renal function in PWS and more generally towards all complex obesity with neurodevelopmental disorders.
{"title":"Glycemic and renal effects of SGLT2 Inhibitors in Prader-Willi syndrome: Benefits and risks","authors":"Juliette Jacquot-Thierry , Sarah Chalopin , Héléna Mosbah , Émilie Montastier , Fabien Mourre , Blandine Gatta-Cherifi , Julien Bourry , Eléonore Guichard , Pauline Faucher , Christine Poitou , Chloé Amouyal","doi":"10.1016/j.diabet.2025.101704","DOIUrl":"10.1016/j.diabet.2025.101704","url":null,"abstract":"<div><h3>Objective</h3><div>Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are widely used in type 2 diabetes (T2D) management, but their efficacy and tolerance in Prader-Willi syndrome (PWS) remains unknown. Given the early onset of diabetes and treatment challenges, evaluating SGLT2is in this population is essential.</div></div><div><h3>Research and methods</h3><div>In this retrospective, multicenter study, 48 adults with PWS and T2D, among whom 24 patients receiving SGLT2is, were followed over 6 months. Glycemic and renal parameters were analyzed at baseline and 6 months.</div></div><div><h3>Results</h3><div>HbA1c was higher in the SGLT2i group and significantly improved (<em>P</em> < 0.05) while it remained stable in controls. The albumin-to-creatinine ratio also decreased significantly<strong>.</strong> No significant weight change was noted. Adverse events occurred in 37.5 % of treated patients, including acute kidney injury in 8.3 %.</div></div><div><h3>Conclusions</h3><div>SGLT2is improve glycemic control and renal markers in PWS with no weight loss. Close safety monitoring is warranted, particularly regarding renal function in PWS and more generally towards all complex obesity with neurodevelopmental disorders.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101704"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
- To investigate the incidences of death and lower limb amputation (LLA) among patients hospitalized with a first diabetic foot ulcer and to identify the associated risk factors.
Methods
- We leveraged medical records from 08/2017 to 10/2023 in the clinical data warehouse of the Greater Paris Hospitals. The primary outcome was the cumulative incidence of death estimated at 12 months. We used Kaplan-Meier and Aalen-Johansen estimators to assess the incidence of death and LLA (identified through ICD-10 codes). We used multivariate Cox regression and Fine and Gray models to estimate risk factors (clinical/biological data, medications, and comorbidities at baseline) for death and LLA, accounting for death as a competing event.
Results
- 3102 patients were included; the median age was 70.66 years and there were 67.64% males. The cumulative incidence of death at 12 months was 21.64% [95%CI 20.11;23.26]. Mortality risk was associated with older age, chronic cardiac, hepatic, or renal diseases, cancer history, and systemic inflammation, whereas being overweight was linked to lower mortality. The cumulative incidence of LLA at 12 months was 24.15% [22.54;25.79]. Risk factors for LLA included male sex, history of peripheral artery disease, emergency admission, and systemic inflammation markers, while dementia was associated with a lower risk.
Conclusion
- Cumulative incidences of all-cause mortality and LLA during the months following hospitalization with a first diabetic foot ulcer were alarmingly high. Mortality risk was primarily associated with patient comorbidities, while amputation risk was closely associated with systemic inflammation and history of peripheral artery disease.
{"title":"Incidence of death and amputation in patients with a first diabetic foot ulcer: results from the CODIA cohort","authors":"Julla Jean-Baptiste , Jolivet Théo , Estellat Candice , Varoquaux Gaël , Carlier Aurélie , Gautier Jean-François , Alberge Julie , Abouleka Yawa , Bergès Audrey , Liu Elise , Abecassis Judith , Tubach Florence , Potier Louis","doi":"10.1016/j.diabet.2025.101700","DOIUrl":"10.1016/j.diabet.2025.101700","url":null,"abstract":"<div><h3>Aim</h3><div><em>-</em> To investigate the incidences of death and lower limb amputation (LLA) among patients hospitalized with a first diabetic foot ulcer and to identify the associated risk factors.</div></div><div><h3>Methods</h3><div><em>-</em> We leveraged medical records from 08/2017 to 10/2023 in the clinical data warehouse of the Greater Paris Hospitals. The primary outcome was the cumulative incidence of death estimated at 12 months. We used Kaplan-Meier and Aalen-Johansen estimators to assess the incidence of death and LLA (identified through ICD-10 codes). We used multivariate Cox regression and Fine and Gray models to estimate risk factors (clinical/biological data, medications, and comorbidities at baseline) for death and LLA, accounting for death as a competing event.</div></div><div><h3>Results</h3><div><em>-</em> 3102 patients were included; the median age was 70.66 years and there were 67.64% males. The cumulative incidence of death at 12 months was 21.64% [95%CI 20.11;23.26]. Mortality risk was associated with older age, chronic cardiac, hepatic, or renal diseases, cancer history, and systemic inflammation, whereas being overweight was linked to lower mortality. The cumulative incidence of LLA at 12 months was 24.15% [22.54;25.79]. Risk factors for LLA included male sex, history of peripheral artery disease, emergency admission, and systemic inflammation markers, while dementia was associated with a lower risk.</div></div><div><h3>Conclusion</h3><div><em>-</em> Cumulative incidences of all-cause mortality and LLA during the months following hospitalization with a first diabetic foot ulcer were alarmingly high. Mortality risk was primarily associated with patient comorbidities, while amputation risk was closely associated with systemic inflammation and history of peripheral artery disease.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101700"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-05-16DOI: 10.1016/j.diabet.2025.101665
Robel Hussen Kabthymer , Tongzhi Wu , Sara Beigrezaei , Oscar H Franco , Allison M Hodge , Barbora de Courten
Aim
Globally, sugar intake from sugar-sweetened beverages (SSBs) exceeds the daily recommended limits for intake levels of free sugar. Artificially sweetened beverages (ASBs), widely used to replace SSBs, are increasingly linked to adverse health outcomes. Hence, we assessed the association of sweetened beverage intake (SSBs and ASBs) with the risk of type 2 diabetes (T2DM).
Methods
Data from the Melbourne Collaborative Cohort Study (MCCS) on 36,608 individuals aged 40 to 69 years were used. Self-reported data on diabetes were collected. The frequency of SSBs and ASBs consumption was categorized as: never or < 1 time/month; 1–3 per month; 1–6 times per week; ≥1 time / day. The association of sweetened beverage intake with the incidence of T2DM was assessed using modified Poisson regression, adjusted for lifestyle, obesity, socioeconomic, and other confounders.
Results
Intakes of SSBs and ASBs were associated with an increased risk of T2DM. A high intake (≥ 1 time/day) compared to a low intake (never or < 1 time / month) was associated with increased risk of T2DM for SSB intake (incidence risk ratio (IRR) = 1.23; 95 % CI: 1.05–1.45; P for trend = 0.006) and for ASB intake (IRR = 1.38; 95 % CI: 1.18–1.61; P for trend < 0.001). Further adjustment for body mass index (BMI) and waist-to hip ratio (WHR) eliminated the association for SSBs, but not ASBs intake.
Conclusions
Both sugar and artificially sweetened beverages were linked to an increased risk of T2DM. The findings highlight the need for public health measures to control the intake of sweetened beverages.
{"title":"The association of sweetened beverage intake with risk of type 2 diabetes in an Australian population: A longitudinal study","authors":"Robel Hussen Kabthymer , Tongzhi Wu , Sara Beigrezaei , Oscar H Franco , Allison M Hodge , Barbora de Courten","doi":"10.1016/j.diabet.2025.101665","DOIUrl":"10.1016/j.diabet.2025.101665","url":null,"abstract":"<div><h3>Aim</h3><div>Globally, sugar intake from sugar-sweetened beverages (SSBs) exceeds the daily recommended limits for intake levels of free sugar. Artificially sweetened beverages (ASBs), widely used to replace SSBs, are increasingly linked to adverse health outcomes. Hence, we assessed the association of sweetened beverage intake (SSBs and ASBs) with the risk of type 2 diabetes (T2DM).</div></div><div><h3>Methods</h3><div>Data from the Melbourne Collaborative Cohort Study (MCCS) on 36,608 individuals aged 40 to 69 years were used. Self-reported data on diabetes were collected. The frequency of SSBs and ASBs consumption was categorized as: never or < 1 time/month; 1–3 per month; 1–6 times per week; ≥1 time / day. The association of sweetened beverage intake with the incidence of T2DM was assessed using modified Poisson regression, adjusted for lifestyle, obesity, socioeconomic, and other confounders.</div></div><div><h3>Results</h3><div>Intakes of SSBs and ASBs were associated with an increased risk of T2DM. A high intake (≥ 1 time/day) compared to a low intake (never or < 1 time / month) was associated with increased risk of T2DM for SSB intake (incidence risk ratio (IRR) = 1.23; 95 % CI: 1.05–1.45; P for trend = 0.006) and for ASB intake (IRR = 1.38; 95 % CI: 1.18–1.61; P for trend < 0.001). Further adjustment for body mass index (BMI) and waist-to hip ratio (WHR) eliminated the association for SSBs, but not ASBs intake.</div></div><div><h3>Conclusions</h3><div>Both sugar and artificially sweetened beverages were linked to an increased risk of T2DM. The findings highlight the need for public health measures to control the intake of sweetened beverages.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101665"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We explored the association between epicardial adipose tissue (EAT) volume and diabetic retinopathy.
Methods
We used clinical data from a monocentric mixed retrospective and prospective observational study of 1093 individuals living with diabetes who had a computed tomography (CT) scan in order to calculate their coronary artery calcium (CAC) score. This scan was also used to compute EAT volume. For the present study, only persons whose diabetic retinopathy status was known (i.e., yes/no) were included.
Results
We included 1037 individuals living with diabetes (type 2 79.1 %, type 1 14.8 %, other types 6.2 %) for 14.6 ± 9.9 years. Mean body mass index was 29.4 ± 5.9 kg/m², HbA1c was 8.7 ± 2.2 %, 38.2 % had diabetic retinopathy, and EAT volume was 93 ± 40 cm3. Diabetic retinopathy was positively associated with North African ethnicity, type 1 diabetes, longer diabetes duration, higher HbA1c levels, and more hypertension and diabetes-related complications (nephropathy, neuropathy, macroangiopathy and a high CAC score). EAT volume was lower in patients with diabetic retinopathy than in those without (87 ± 37 vs 97 ± 42 cm3, P < 0.0001), independently of confounders (per 10cm3 increase: odds ratio 0.89 [95 % confidence interval 0.84;0.93], P < 0.0001).
Conclusion
We found an unexpected negative association between the volume of EAT—a proinflammatory tissue—and diabetic retinopathy prevalence. This finding warrants further mechanistic investigation.
前言：我们探讨了心外膜脂肪组织（EAT）体积与糖尿病视网膜病变之间的关系。方法：我们使用了一项来自1093例糖尿病患者的单中心混合回顾性和前瞻性观察研究的临床数据，这些糖尿病患者进行了计算机断层扫描（CT），以计算他们的冠状动脉钙（CAC）评分。该扫描也用于计算EAT体积。在本研究中，仅包括糖尿病视网膜病变状态已知的人（即，是/否）。结果：纳入1037例糖尿病患者（2型79.1%，1型14.8%，其他型6.2%），随访14.6±9.9年。平均体重指数为29.4±5.9 kg/m²，糖化血红蛋白为8.7±2.2%，糖尿病视网膜病变38.2%，EAT体积为93±40 cm3。糖尿病视网膜病变与北非种族、1型糖尿病、糖尿病病程较长、HbA1c水平较高、高血压和糖尿病相关并发症（肾病、神经病变、大血管病变和高CAC评分）呈正相关。糖尿病视网膜病变患者的EAT体积低于无糖尿病视网膜病变患者（87±37 vs 97±42 cm3, P < 0.0001），独立于混杂因素（每增加10cm3：优势比0.89[95%可信区间0.84;0.93],P < 0.0001）。结论：我们发现促炎组织eat的体积与糖尿病视网膜病变患病率之间存在意想不到的负相关。这一发现值得进一步的机理研究。
{"title":"Epicardial adipose tissue volume and diabetic retinopathy","authors":"Emmanuel Cosson , Sopio Tatulashvili , Marouane Boubaya , Amir Abdul Khalife , Imen Rezgani , Lucie Allard , Meriem Sal , Ines Barka , Mohamed Lamine Mariko , Mohamed Zerguine , Omar Nouhou Koutcha , Bénédicte Gaborit , Coralie Bloch-Queyrat , Pierre-Yves Brillet , Héloïse Torres-Villaros , Audrey Giocanti-Aurégan , Hélène Bihan","doi":"10.1016/j.diabet.2025.101706","DOIUrl":"10.1016/j.diabet.2025.101706","url":null,"abstract":"<div><h3>Introduction</h3><div>We explored the association between epicardial adipose tissue (EAT) volume and diabetic retinopathy.</div></div><div><h3>Methods</h3><div>We used clinical data from a monocentric mixed retrospective and prospective observational study of 1093 individuals living with diabetes who had a computed tomography (CT) scan in order to calculate their coronary artery calcium (CAC) score. This scan was also used to compute EAT volume. For the present study, only persons whose diabetic retinopathy status was known (i.e., yes/no) were included.</div></div><div><h3>Results</h3><div>We included 1037 individuals living with diabetes (type 2 79.1 %, type 1 14.8 %, other types 6.2 %) for 14.6 ± 9.9 years. Mean body mass index was 29.4 ± 5.9 kg/m², HbA1c was 8.7 ± 2.2 %, 38.2 % had diabetic retinopathy, and EAT volume was 93 ± 40 cm<sup>3</sup>. Diabetic retinopathy was positively associated with North African ethnicity, type 1 diabetes, longer diabetes duration, higher HbA1c levels, and more hypertension and diabetes-related complications (nephropathy, neuropathy, macroangiopathy and a high CAC score). EAT volume was lower in patients with diabetic retinopathy than in those without (87 ± 37 vs 97 ± 42 cm<sup>3</sup>, <em>P</em> < 0.0001), independently of confounders (per 10cm<sup>3</sup> increase: odds ratio 0.89 [95 % confidence interval 0.84;0.93], <em>P</em> < 0.0001).</div></div><div><h3>Conclusion</h3><div>We found an unexpected negative association between the volume of EAT—a proinflammatory tissue—and diabetic retinopathy prevalence. This finding warrants further mechanistic investigation.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101706"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-08-18DOI: 10.1016/j.diabet.2025.101697
Nathanaël Bassas Letissier , Nassir Mirfendereski , Marie-Laure Laroche , Jean- Luc Faillie , Marc Paccalin , Pierre-Jean Saulnier , Marion Allouchery , Helena Mosbah
Background
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been widely used in the management of type 2 diabetes, with proven cardiovascular and renal benefits. However, their use has been associated with a risk of diabetic ketoacidosis (DKA).
Aim
This study aims to describe the characteristics of DKA cases associated with SGLT2i use in patients aged 65 and over, based on data from the French pharmacovigilance database.
Methods
A retrospective analysis was conducted on all cases of DKA reported with SGLT2i in patients aged 65 years and older. Cases were retrieved from 2020 onward; 55 were analyzed. Patient characteristics, drug exposure, adverse drug reaction (ADR) reports, hospitalization details, and precipitating factors were examined.
Results
Median patient age was 74.0 years (IQR: 69.0; 77.5), with a predominance of males (63.4 %). The median Charlson comorbidity index was 8.0 (IQR: 6.0; 10.0), and polypharmacy was common, with a median of nine drugs per patient. Infections (36.4 %), dehydration (20.0 %), and fasting (18.2 %) were the main precipitating factors. All cases required hospitalization, with 36.4 % admitted to an intensive care unit (ICU). Among ICU patients, 35.0 % required orotracheal intubation and/or vasopressor therapy. One case (1.8 %) resulted in death. Factors significantly associated with ICU admission included younger age (71.3 vs. 75.4 years, P = 0.009), lower pH at admission (P = 0.003), and infection as a precipitating factor (P = 0.007).
Conclusion
This study highlights the clinical characteristics and risk factors of SGLT2i-associated DKA in older adults. Infections and severe acidosis were key predictors of ICU admission. The findings underscore the importance of careful patient selection and monitoring to mitigate DKA risk in older patients receiving SGLT2i therapy.
{"title":"Ketoacidosis associated with type 2 sodium-glucose cotransporter inhibitors (SGLT2i) in patients aged 65 and older: Evidence from the French national pharmacovigilance database","authors":"Nathanaël Bassas Letissier , Nassir Mirfendereski , Marie-Laure Laroche , Jean- Luc Faillie , Marc Paccalin , Pierre-Jean Saulnier , Marion Allouchery , Helena Mosbah","doi":"10.1016/j.diabet.2025.101697","DOIUrl":"10.1016/j.diabet.2025.101697","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been widely used in the management of type 2 diabetes, with proven cardiovascular and renal benefits. However, their use has been associated with a risk of diabetic ketoacidosis (DKA).</div></div><div><h3>Aim</h3><div>This study aims to describe the characteristics of DKA cases associated with SGLT2i use in patients aged 65 and over, based on data from the French pharmacovigilance database.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on all cases of DKA reported with SGLT2i in patients aged 65 years and older. Cases were retrieved from 2020 onward; 55 were analyzed. Patient characteristics, drug exposure, adverse drug reaction (ADR) reports, hospitalization details, and precipitating factors were examined.</div></div><div><h3>Results</h3><div>Median patient age was 74.0 years (IQR: 69.0; 77.5), with a predominance of males (63.4 %). The median Charlson comorbidity index was 8.0 (IQR: 6.0; 10.0), and polypharmacy was common, with a median of nine drugs per patient. Infections (36.4 %), dehydration (20.0 %), and fasting (18.2 %) were the main precipitating factors. All cases required hospitalization, with 36.4 % admitted to an intensive care unit (ICU). Among ICU patients, 35.0 % required orotracheal intubation and/or vasopressor therapy. One case (1.8 %) resulted in death. Factors significantly associated with ICU admission included younger age (71.3 vs. 75.4 years, <em>P</em> = 0.009), lower pH at admission (<em>P</em> = 0.003), and infection as a precipitating factor (<em>P</em> = 0.007).</div></div><div><h3>Conclusion</h3><div>This study highlights the clinical characteristics and risk factors of SGLT2i-associated DKA in older adults. Infections and severe acidosis were key predictors of ICU admission. The findings underscore the importance of careful patient selection and monitoring to mitigate DKA risk in older patients receiving SGLT2i therapy.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101697"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-07-26DOI: 10.1016/j.diabet.2025.101692
Chaiho Jeong , Bongseong Kim , Dae Jong Oh , Tae-Seo Sohn , Kyungdo Han , Hyuk-Sang Kwon
Background
Patients with type 2 diabetes (T2D) are at greater risk of suicide due to stresses associated with disease management. Smoking adds to this burden. However, its association with suicide mortality in this population remains unclear. This study aimed to evaluate the relationship between smoking and suicide mortality in this high-risk group.
Methods
This cohort study utilized the Korean National Health Insurance Service (NHIS) database. A total of 2,524,769 participants aged ≥ 20 years with T2D who underwent national health examinations in 2015–2016 were included. Participants were followed until suicide death or the end of the study period.
Results
Over 5.8 years mean follow-up, 5,578 individuals died by suicide. Risk of suicide mortality was significantly higher—adjusted hazard ratio [95 % confidence interval]—in current smokers compared to never-smokers: 1.55 [1.44;1.67]. A dose–response pattern was observed among current smokers: 1.41 [1.22;1.63] for light smokers (<10 cigarettes/day) and 1.66 [1.52;1.81] for heavy smokers (≥20/day). In ex-smokers, only those with a smoking history of ≥ 30 years exhibited an elevated risk: 1.12 [1.02;1.24]. The association was particularly strong in women: 2.97 [2.39;3.69]; and individuals aged <65 years: 1.76 [1.61;1.92].
Conclusions
Current smoking was significantly associated with increased suicide mortality in patients with T2D, particularly among heavy smokers, women and those younger than 65 years. Long-term smoking history was also associated with elevated risk among ex-smokers.
{"title":"Association between smoking status and suicide mortality in patients with type 2 diabetes: A nationwide population-based cohort study","authors":"Chaiho Jeong , Bongseong Kim , Dae Jong Oh , Tae-Seo Sohn , Kyungdo Han , Hyuk-Sang Kwon","doi":"10.1016/j.diabet.2025.101692","DOIUrl":"10.1016/j.diabet.2025.101692","url":null,"abstract":"<div><h3>Background</h3><div>Patients with type 2 diabetes (T2D) are at greater risk of suicide due to stresses associated with disease management. Smoking adds to this burden. However, its association with suicide mortality in this population remains unclear. This study aimed to evaluate the relationship between smoking and suicide mortality in this high-risk group.</div></div><div><h3>Methods</h3><div>This cohort study utilized the Korean National Health Insurance Service (NHIS) database. A total of 2,524,769 participants aged ≥ 20 years with T2D who underwent national health examinations in 2015–2016 were included. Participants were followed until suicide death or the end of the study period.</div></div><div><h3>Results</h3><div>Over 5.8 years mean follow-up, 5,578 individuals died by suicide. Risk of suicide mortality was significantly higher—adjusted hazard ratio [95 % confidence interval]—in current smokers compared to never-smokers: 1.55 [1.44;1.67]. A dose–response pattern was observed among current smokers: 1.41 [1.22;1.63] for light smokers (<10 cigarettes/day) and 1.66 [1.52;1.81] for heavy smokers (≥20/day). In ex-smokers, only those with a smoking history of ≥ 30 years exhibited an elevated risk: 1.12 [1.02;1.24]. The association was particularly strong in women: 2.97 [2.39;3.69]; and individuals aged <65 years: 1.76 [1.61;1.92].</div></div><div><h3>Conclusions</h3><div>Current smoking was significantly associated with increased suicide mortality in patients with T2D, particularly among heavy smokers, women and those younger than 65 years. Long-term smoking history was also associated with elevated risk among ex-smokers.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101692"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-09-12DOI: 10.1016/j.diabet.2025.101703
Beatriz Barquiel , Daniel Álvarez , Óscar Moreno Domínguez , Elena García-Pérez de Sevilla , Natalia Hillman , Ricardo Romero , Ruth Gaspar , Montserrat Arévalo , Noemí González-Perez de Villar
Aims
Diabetic retinopathy (DR) is a complication of chronic hyperglycemia in people living with type 1 diabetes (PLWT1D). The use of automated insulin delivery (AID) systems may modify this course. In this prospective observational study, we evaluated whether the MiniMed 780G AID system was associated with remission or improvement in the severity of DR.
Methods
The study included PLWT1D with DR treated either with the AID system or with multiple daily insulin injections (MDI) combined with intermittent glucose monitoring. The follow-up period was two years. DR was graded annually, and HbA1c levels were recorded. Glucose monitoring parameters were also assessed to evaluate the impact of glucose ranges and variability on retinopathy. Group comparisons were performed using univariate and multivariate statistical analyses.
Results
DR remission occurred in 15/30 (50 %) participants treated with the AID system, compared with 0/30 (0 %) in the MDI group (P < 0.001). Improvement in DR stage was observed in 15/30 (50 %) participants in the AID group, compared with 2/30 (6.7 %) in the MDI group (P < 0.001). These outcomes were associated with lower HbA1c, reduced time above range (TAR), and a lower coefficient of variation (CV) in the remission group.
Conclusion
Remission or improvement of DR was observed in patients with type 1 diabetes treated with an AID system.
{"title":"Diabetic retinopathy remission in patients using an automated insulin delivery system: A prospective controlled study","authors":"Beatriz Barquiel , Daniel Álvarez , Óscar Moreno Domínguez , Elena García-Pérez de Sevilla , Natalia Hillman , Ricardo Romero , Ruth Gaspar , Montserrat Arévalo , Noemí González-Perez de Villar","doi":"10.1016/j.diabet.2025.101703","DOIUrl":"10.1016/j.diabet.2025.101703","url":null,"abstract":"<div><h3>Aims</h3><div>Diabetic retinopathy (DR) is a complication of chronic hyperglycemia in people living with type 1 diabetes (PLWT1D). The use of automated insulin delivery (AID) systems may modify this course. In this prospective observational study, we evaluated whether the MiniMed 780G AID system was associated with remission or improvement in the severity of DR.</div></div><div><h3>Methods</h3><div>The study included PLWT1D with DR treated either with the AID system or with multiple daily insulin injections (MDI) combined with intermittent glucose monitoring. The follow-up period was two years. DR was graded annually, and HbA1c levels were recorded. Glucose monitoring parameters were also assessed to evaluate the impact of glucose ranges and variability on retinopathy. Group comparisons were performed using univariate and multivariate statistical analyses.</div></div><div><h3>Results</h3><div>DR remission occurred in 15/30 (50 %) participants treated with the AID system, compared with 0/30 (0 %) in the MDI group (<em>P</em> < 0.001). Improvement in DR stage was observed in 15/30 (50 %) participants in the AID group, compared with 2/30 (6.7 %) in the MDI group (<em>P</em> < 0.001). These outcomes were associated with lower HbA1c, reduced time above range (TAR), and a lower coefficient of variation (CV) in the remission group.</div></div><div><h3>Conclusion</h3><div>Remission or improvement of DR was observed in patients with type 1 diabetes treated with an AID system.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101703"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-06-20DOI: 10.1016/j.diabet.2025.101667
Cassandra A.A. Locatelli , Meryem K. Talbo , Virginie Messier , Caroline Grou , Maha Lebbar , Erin E. Mulvihill , Anne-Sophie Brazeau , Rémi Rabasa-Lhoret
Aim
People living with type 1 diabetes (T1D) are at elevated risk of additional autoimmune diseases (ADs) than the general population. We aimed to describe the association between additional ADs and T1D-related physical and mental burden in adults.
Methods
This was a cross-sectional analysis using data from the BEhaviors, Therapies, TEchnologies, and hypoglycemic Risk in T1D (BETTER) registry. Using patient reported-outcomes and validated questionnaires, we compared prevalence of vascular complications, hypoglycemia, and mental health issues between those with T1D alone (AD-) and T1D with additional AD (AD+).
Results
Among 3222 participants (66.2 % female, 42.7 ± 15.0 years), 36.3 % reported ≥ 1 AD+. The AD+ group was older (+4.4 years) and more female (+17.7 %) than the AD- group. The AD+ group had similar HbA1c (P = 0.20) but was more likely to report level 2 hypoglycemia in the past month (OR: 1.27 [95 %Cl 1.06–1.52]) and level 3 hypoglycemia since diagnosis (1.22 [1.05–1.42]). The AD+ group reported more cardiovascular disease (1.40 [1.03 to 1.90]), nephropathy (1.49 [1.19–1.86]), neuropathy (1.38 [1.13–1.69]), retinopathy (1.48 [1.22–1.78]), higher depression scores (p = 0.015), and anxiety/depression medication use (1.31 [1.10–1.56]). Number of AD+ was positively associated with depression scores (1 AD+ P = 0.055, 2+ AD+ p = 0.027), level 3 hypoglycemia since diagnosis (1 AD+ p = 0.037, 2+ AD+ P = 0.025), and number of chronic complications (1 AD+ P < 0.001, 2+ AD+ P < 0.001).
Conclusion
For people with T1D, living with additional ADs is associated with higher levels of physical and mental diabetes complications, warranting regular screening in this population.
目的：1型糖尿病（T1D）患者患其他自身免疫性疾病（ADs）的风险高于一般人群。我们的目的是描述额外的ad与成人t1d相关的身体和精神负担之间的关系。方法：这是一项横断面分析，使用来自T1D患者的行为、治疗、技术和低血糖风险（BETTER）登记的数据。使用患者报告的结果和有效的问卷，我们比较了单独T1D （AD-）和T1D合并AD （AD+）患者血管并发症、低血糖和精神健康问题的患病率。结果：在3222名参与者中（66.2%为女性，42.7±15.0岁），36.3%报告≥1 AD+。AD+组比AD-组年龄大（+4.4岁），女性患者多（+ 17.7%）。AD+组HbA1c相似（P = 0.20），但在过去一个月内报告2级低血糖（OR: 1.27 [95% Cl 1.06-1.52]）和诊断后报告3级低血糖（OR: 1.22[1.05-1.42]）的可能性更大。AD+组出现更多心血管疾病（1.40[1.03 ~ 1.90]）、肾病（1.49[1.19 ~ 1.86]）、神经病变（1.38[1.13 ~ 1.69]）、视网膜病变（1.48[1.22 ~ 1.78]）、抑郁评分（p = 0.015）和焦虑/抑郁药物使用（1.31[1.10 ~ 1.56]）。AD+次数与抑郁评分（1 AD+ P = 0.055, 2+ AD+ P = 0.027）、诊断以来3级低血糖（1 AD+ P = 0.037, 2+ AD+ P = 0.025）、慢性并发症次数（1 AD+ P < 0.001, 2+ AD+ P < 0.001）呈正相关。结论：对于T1D患者，患有额外ad的患者与更高水平的身体和精神糖尿病并发症相关，需要对该人群进行定期筛查。
{"title":"In adults living with type 1 diabetes, additional autoimmune diseases are associated with more chronic complications and depression. A BETTER registry analysis","authors":"Cassandra A.A. Locatelli , Meryem K. Talbo , Virginie Messier , Caroline Grou , Maha Lebbar , Erin E. Mulvihill , Anne-Sophie Brazeau , Rémi Rabasa-Lhoret","doi":"10.1016/j.diabet.2025.101667","DOIUrl":"10.1016/j.diabet.2025.101667","url":null,"abstract":"<div><h3>Aim</h3><div>People living with type 1 diabetes (T1D) are at elevated risk of additional autoimmune diseases (ADs) than the general population. We aimed to describe the association between additional ADs and T1D-related physical and mental burden in adults.</div></div><div><h3>Methods</h3><div>This was a cross-sectional analysis using data from the BEhaviors, Therapies, TEchnologies, and hypoglycemic Risk in T1D (BETTER) registry. Using patient reported-outcomes and validated questionnaires, we compared prevalence of vascular complications, hypoglycemia, and mental health issues between those with T1D alone (AD-) and T1D with additional AD (AD+).</div></div><div><h3>Results</h3><div>Among 3222 participants (66.2 % female, 42.7 ± 15.0 years), 36.3 % reported ≥ 1 AD+. The AD+ group was older (+4.4 years) and more female (+17.7 %) than the AD- group. The AD+ group had similar HbA1c (<em>P</em> = 0.20) but was more likely to report level 2 hypoglycemia in the past month (OR: 1.27 [95 %Cl 1.06–1.52]) and level 3 hypoglycemia since diagnosis (1.22 [1.05–1.42]). The AD+ group reported more cardiovascular disease (1.40 [1.03 to 1.90]), nephropathy (1.49 [1.19–1.86]), neuropathy (1.38 [1.13–1.69]), retinopathy (1.48 [1.22–1.78]), higher depression scores (<em>p</em> = 0.015), and anxiety/depression medication use (1.31 [1.10–1.56]). Number of AD+ was positively associated with depression scores (1 AD+ <em>P</em> = 0.055, 2+ AD+ <em>p</em> = 0.027), level 3 hypoglycemia since diagnosis (1 AD+ <em>p</em> = 0.037, 2+ AD+ <em>P</em> = 0.025), and number of chronic complications (1 AD+ <em>P</em> < 0.001, 2+ AD+ <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>For people with T1D, living with additional ADs is associated with higher levels of physical and mental diabetes complications, warranting regular screening in this population.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101667"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess the prevalence of pancreatic lesions in patients hospitalized for newly diagnosed or uncontrolled diabetes mellitus and identify potential predictive factors for pancreatic pathology.
Methods
We conducted a retrospective, single-center observational study at Brest University Hospital between February 2016 and February 2022. Adult patients hospitalized for newly diagnosed diabetes or uncontrolled diabetes mellitus who underwent a computed tomography (CT) scan within six months of admission were included. Patients with type 1 diabetes, prior pancreatectomy, or a known history of pancreatic adenocarcinoma were excluded. Clinical, biological, and imaging data were analyzed.
Results
Among 412 patients analyzed, 53 (12.9 %) presented pancreatic abnormalities (PA), including 11 cases (2.7 %) of malignant pancreatic lesion. Predictive factors for PA (P < 0.05) included (odds ratio [95 % confidence interval]): age ≥ 65 years (2.00 [1.52;5.27]); body mass index ≤ 26.4 kg/m2 (2.65 [1.1;4.98]); LDL/HDL ratio ≤ 3.0 (4.75 [2.03;11.10]); and presence of at least one clinical warning sign (alcoholic use, steatorrhea, abdominal pain) (2.29 [1.21;4.33]). Using all four criteria together, 68 of 412 CT scans would have been avoided, with no missed cases.
Conclusions
The prevalence of pancreatic lesions in patients hospitalized for diabetes-related glycemic imbalance was significant although malignancy remained low. Age ≥ 65 years, low body mass index, and altered lipid profile may help identify patients requiring pancreatic imaging. Future prospective studies should refine these criteria to develop screening strategies for early pancreatic cancer detection in high-risk selected diabetic populations.
{"title":"Prevalence and predictive factors of computed tomography-detected pancreatopathy in a cohort of adult patients hospitalized for newly diagnosed or uncontrolled non-auto-immune diabetes","authors":"Noëmie Lemétayer , Lucille Quénéhervé , Jean-Romain Risson , Charlotte Nachtergaele , Geneviève Crouzeix , Emmanuel Sonnet , Nathalie Roudaut , Véronique Kerlan , Vianney Deméocq , Philippe Thuillier","doi":"10.1016/j.diabet.2025.101699","DOIUrl":"10.1016/j.diabet.2025.101699","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the prevalence of pancreatic lesions in patients hospitalized for newly diagnosed or uncontrolled diabetes mellitus and identify potential predictive factors for pancreatic pathology.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-center observational study at Brest University Hospital between February 2016 and February 2022. Adult patients hospitalized for newly diagnosed diabetes or uncontrolled diabetes mellitus who underwent a computed tomography (CT) scan within six months of admission were included. Patients with type 1 diabetes, prior pancreatectomy, or a known history of pancreatic adenocarcinoma were excluded. Clinical, biological, and imaging data were analyzed.</div></div><div><h3>Results</h3><div>Among 412 patients analyzed, 53 (12.9 %) presented pancreatic abnormalities (PA), including 11 cases (2.7 %) of malignant pancreatic lesion. Predictive factors for PA (<em>P</em> < 0.05) included (odds ratio [95 % confidence interval]): age ≥ 65 years (2.00 [1.52;5.27]); body mass index ≤ 26.4 kg/m<sup>2</sup> (2.65 [1.1;4.98]); LDL/HDL ratio ≤ 3.0 (4.75 [2.03;11.10]); and presence of at least one clinical warning sign (alcoholic use, steatorrhea, abdominal pain) (2.29 [1.21;4.33]). Using all four criteria together, 68 of 412 CT scans would have been avoided, with no missed cases.</div></div><div><h3>Conclusions</h3><div>The prevalence of pancreatic lesions in patients hospitalized for diabetes-related glycemic imbalance was significant although malignancy remained low. Age ≥ 65 years, low body mass index, and altered lipid profile may help identify patients requiring pancreatic imaging. Future prospective studies should refine these criteria to develop screening strategies for early pancreatic cancer detection in high-risk selected diabetic populations.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 6","pages":"Article 101699"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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