Journal of Diabetes Research最新文献

Aims: This study was aimed at evaluating the effectiveness of traditional Chinese exercises (TCEs) in improving both physical and psychological health in individuals with prediabetes.

Methods: Randomized controlled trials were systematically searched in the Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and the Chinese Biomedical Literature Database (CBM) up to August 28, 2025. Data from 22 trials involving 1854 participants were analyzed using Stata 15.0. The risk of bias was assessed with the Cochrane RoB 2.0 tool.

Results: TCEs significantly improved fasting blood glucose (FBG), insulin resistance, glycated hemoglobin (HbA1c), 2-h postprandial blood glucose (2hPG), and several psychological outcomes compared with controls. Subgroup analyses showed consistent improvements in FBG at 3, 6, and 12 months, although the effect size and heterogeneity varied across time points. HbA1c and 2hPG improved at 3 and 6 months, while fasting insulin changes were significant only at 3 months. Baduanjin and Qigong were most effective for metabolic outcomes, whereas evidence for Taiji was limited and inconclusive, though some studies suggested potential benefits for HbA1c. Psychological benefits were observed across all exercise types.

Conclusion: TCEs may enhance metabolic regulation and psychological well-being in individuals with prediabetes, potentially reducing the risk of progression to Type 2 diabetes. However, due to high heterogeneity and small sample sizes for some outcomes, these findings should be interpreted with caution. Large, well-designed multicenter trials are warranted to confirm these effects.

Background: Diabetes mellitus (DM) and cardiovascular disease (CVD) are interconnected conditions that significantly contribute to global mortality, yet their bidirectional relationship and combined mortality impact remain underexplored.

Methods: Utilizing data from the NHANES 2005-2018 cohort (N = 24,934), we categorized participants aged ≥ 35 years into four groups: nondiabetic/non-pre-existing CVD, diabetic/non-pre-existing CVD, nondiabetic/pre-existing CVD, and diabetic/pre-existing CVD. Propensity score matching (PSM) and causal mediation analysis were employed to assess independent and synergistic mortality risks.

Results: Over a mean follow-up of 7.37 years, diabetic/pre-existing CVD participants exhibited the highest mortality rates (61.37 all-cause and 23.88 cardiovascular deaths per 1000 person-years). Diabetes alone increased all-cause mortality by 34% (HR = 1.34, 95% CI = 1.22-1.47) and cardiovascular mortality by 32% (HR = 1.32, 1.10-1.58), while pre-existing CVD alone increased risks by 72% (HR = 1.72, 1.56-1.89) and 142% (HR = 2.42, 2.05-2.87), respectively. Comorbid diabetes/pre-existing CVD synergistically elevated all-cause mortality by 142% (HR = 2.42, 2.19-2.68) and cardiovascular mortality by 237% (HR = 3.37, 2.83-4.02). Although no statistically significant multiplicative interaction was observed, additive interaction metrics between diabetes and pre-existing CVD on mortality risks revealed a stronger synergistic effect on cardiovascular mortality (RERI = 0.64-1.17, AP = 12.01%-23.82%) than on all-cause mortality (RERI = 0.39-0.75, AP = 9.26%-18.73%). Mediation analysis demonstrated bidirectional effects: Diabetes mediated 6.82% of all-cause and 4.17% of cardiovascular mortality in pre-existing CVD patients, while pre-existing CVD mediated 5.47% and 7.87% in diabetic individuals.

Conclusions: Diabetes and pre-existing CVD independently and synergistically increase mortality risks, with additive interactions particularly pronounced for cardiovascular mortality. The bidirectional mediation effects highlight the need for integrated management strategies to mitigate the compounded mortality burden.

Background: Diabetic neuropathy (DN) and nephropathy (DKD) are prevalent microvascular complications in Type 2 diabetes mellitus (T2DM), often evolving silently. Detecting early nephropathy remains a clinical challenge, especially in patients with preserved renal function.

Objective: The objective was to determine whether the Toronto Clinical Scoring System (TCS) for diabetic neuropathy can predict early nephropathy (albuminuria) in people with well-controlled T2DM who have a normal eGFR.

Methods: We conducted a cross-sectional study with 122 T2DM patients (HbA1c < 7%, eGFR > 90) to look for peripheral neuropathy using TCS and nephropathy using the urinary albumin-to-creatinine ratio (UACR). Patients were classified based on the presence of albuminuria (UACR ≥ 30 mg/g). Statistical analyses included t-tests, chi-square tests, Spearman correlation, and logistic regression.

Results: Patients with diabetic nephropathy or neuropathy were significantly older and exhibited higher systolic blood pressure and albuminuria. A clear stepwise increase in albuminuria was observed with rising neuropathy severity, with nephropathy prevalence ranging from 42% in patients without neuropathy to 72% in those with severe neuropathy. A significant positive correlation between TCS and UACR (ρ = 0.29, p = 0.0012) supports a progressive link between nerve and kidney involvement.

Conclusion: Clinical diabetic neuropathy is significantly associated with early nephropathy in well-controlled T2DM patients. Routine neuropathy assessment may serve as a simple, cost-effective predictor of subclinical renal damage. Future prospective studies should investigate whether early intervention in patients with neuropathy can attenuate or delay renal injury and whether this predictive link holds true across diverse ethnic and age groups.

Background: Disparities in outcomes and technology use in children with Type 1 diabetes (T1D) from underresourced backgrounds are well documented. The feasibility of initiating automated insulin delivery (AID) soon after diagnosis of T1D is less certain in this population. This pilot study assessed the feasibility and acceptability of providing access to the Tandem Control-IQ AID system to children with public insurance soon after T1D diagnosis.

Methods: Publicly insured children aged 6-21 years of age within 3 months of T1D diagnosis were eligible for the study. Participants were randomized 2:1 to AID or usual care for 6 months. Continuous glucose monitoring data were collected at baseline, 3 months, and 6 months. Caregivers and youth completed closing surveys and participated in focus group interviews to assess safety and user experience.

Results: Nineteen youth were enrolled, with thirteen in the intervention and six in the control group. The mean age was 11.5 ± 2.3 years, 47% were female, and 89% were from underrepresented racial or ethnic groups. A larger proportion of the AID group compared to the control group achieved the American Diabetes Association benchmark of > 70% time in range (50% vs. 0% of participants at 3 months; 37% vs. 0% of participants at 6 months; not statistically significant). All caregivers and 69% of youth in the AID group reported satisfaction, and 85% of youth continued using AID 6 months after the completion of the study. Focus groups showed favorable experiences with AID use.

Conclusion: Early initiation of AID is feasible and acceptable in youth with recently diagnosed T1D from underresourced populations who historically experience lower technology adoption and less optimal glycemic outcomes. Diabetes clinicians should consider providing tailored support and dedicated resources to families early in diagnosis with T1D to promote AID initiation and continued use.

Objective: Continuous glucose monitors (CGMs) enhance diabetes management, but disparities exist, particularly among underserved populations in federally qualified health centers (FQHCs). In 2022, a California Medicaid policy change expanded CGM coverage, providing an opportunity to better evaluate barriers to CGM use within primary care in an FQHC.

Methods: We used 2022-2023 electronic health record (EHR) data to identify adults with diabetes managed on insulin within a nurse practitioner-led diabetes program in primary care. Patients were categorized as current, former, or never CGM users. We used summary statistics, chi-squared, and Bartlett's tests to assess unadjusted group differences and multivariate logistic regression to identify factors associated with former or never use. All patients were invited to complete a survey on CGM facilitators and barriers.

Results: Among 275 eligible patients, 109 (40%) were current CGM users, 31 (11%) former users, and 135 (49%) never users. Discussions on CGM occurred in 45% of never users, who were more likely to have non-Medicaid insurance, fewer than five clinic visits (OR 3.69, 95% CI: 1.94-6.99), and a lower baseline A1C (OR 0.67, 95% CI: 0.52-0.86). No demographic or clinical factors were associated with former CGM use. Among survey respondents (n = 124), the desire to reduce finger-pricks motivated CGM use, while device burden and inconvenience contributed to discontinuation or refusal.

Conclusions: Medicaid policy expansion reduced major structural barriers to CGM use, yet some patient-related barriers persisted. Team-based care models integrating health educators and advanced practice providers can successfully support CGM access and sustained use in underserved populations.

Aims: People with diabetes experience a significantly higher prevalence of mental health issues, particularly depression. This adversely affects their diabetes management and overall health. This scoping review aims to develop a conceptual framework for understanding the connection between depression and diabetes outcomes globally, specifically focusing on intermediary factors that may influence this relationship.

Methods: PubMed, EMBASE, PsycINFO, and Global Index Medicus were searched using relevant keywords on May 17, 2024. The inclusion criteria encompassed peer-reviewed studies involving adults diagnosed with Type 2 diabetes that assessed depression and analysed its impact on diabetes outcomes through various pathways.

Results: The review identified 30 studies examining the association between depression and diabetes outcomes. Results indicate that while depression is linked to poorer diabetes outcomes like glycaemic control and complications of diabetes, the mechanisms are complex and often mediated by factors such as self-efficacy, social support, and diabetes-related distress. Notably, self-efficacy emerged as a critical mediator in the relationship between depression and self-management behaviours, which are known to be associated with diabetes outcomes. Furthermore, social support was identified as a protective factor that can reduce the adverse effects of depression on glycaemic control.

Conclusions: Addressing mental health concerns in diabetes care is essential for improving patient outcomes. This review underscores the need for integrated interventions that consider psychosocial factors to enhance self-management and glycaemic control among individuals with Type 2 diabetes. Future research should focus on exploring these relationships in diverse populations to inform tailored strategies for effective diabetes management.

Aims: This research explores the impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) on key risk factors associated with kidney and cardiovascular diseases in Indigenous (Aboriginal and/or Torres Strait Islander) and non-Indigenous adults living with Type 2 diabetes, receiving care at a regional health facility in North Queensland, Australia.

Methods: This retrospective study included patients who attended the diabetes clinic at a regional hospital between January 2016 and January 2020. Data was extracted from electronic medical records. Basic demographic characteristics along with blood pressure, body weight, BMI, urine albumin creatinine ratio (UACR), serum creatinine, estimated glomerular filtration rate (eGFR), HbA1c, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels were retrieved from initial presentation, 6 months, and 12 months post. Data was analyzed using IBM SPSS 28 with appropriate statistical tests applied.

Results: The study involved a total of 164 patients. GLP-1RA use resulted in a significant reduction of HbA1c between 0 and 6 months (8.7%-7.9%, p < 0.01) and 0 and 12 months (8.7%-8.1%, p < 0.01). Significant reduction in weight between 0 and 6 months (115.9-114.0 kg, p < 0.001), 6 and 12 months (114.0-112.5 kg, p = 0.004), and 0 and 12 months (115.9-112.5 kg, p < 0.001) was also seen. However, there were no statistically significant differences in all measures of lipid profile and no significant changes in UACR and eGFR.

Conclusions: This study affirms the effectiveness of GLP-1RAs as a glycemic control agent with an additional benefit of weight reduction across a 12-month period in adult T2DM patients. No effect on other cardiovascular parameters apart from weight or renal risk factors was observed. Further investigation into the influence of GLP-1RAs on these would be beneficial.

Background: Patient utilization of diabetes technology differs based on sociodemographic and other factors. Underserved patients have reported that providers decline to prescribe continuous glucose monitors (CGMs) and insulin pumps. This qualitative study elucidated provider perspectives regarding facilitators and barriers to the prescription and patient use of diabetes technology.

Methods: Sixteen diabetes care providers (75.0% MD, 18.8% APRN, 6.3% PharmD, and 50.0% adult endocrinology) at academic health centers, a Veterans Affairs Medical Center, and a safety net hospital in the southeastern United States were surveyed and interviewed from January to May 2024. Survey data were analyzed using descriptive statistics; a thematic analysis was used for interview transcripts with an adapted version of the social-ecological model (SEM) as the coding framework.

Results: On the survey, providers estimated that 80% (IQR 58.0%-86.0%) of their patients who met American Diabetes Association criteria for CGMs and 50% (IQR 48.0%-63.0%) for insulin pumps regularly used them. System factors (e.g., lack of insurance, high device costs, and insurance bureaucracy) were perceived by providers (62.5%-93.8%) as patients' top barriers to use. Across the interviews (n = 362 codes), providers' top prescribing barriers were also system-level (65.7%), including working with insurance, durable medical equipment (DME) companies, and pharmacies (15.7%), checking eligibility requirements (11.0%), and electronic health record (EHR) limitations (9.7%). Interpersonal prescribing barriers (7.5%) were tied to patients having low health literacy (3.6%) and communication with non-English-speaking patients (1.7%). Individual prescribing barriers (26.0%) included patients expressing concerns about device adhesives/appearance (5.5%) and patients having limited knowledge/interest (3.0%). Facilitators across SEM levels included simplified eligibility criteria, EHR order sets, shared decision-making, and proactive insurance/DME companies.

Conclusions: These findings indicate the need for multilevel solutions to improve the prescription and use of diabetes technology. Future research and clinical practice should aim to enhance EHR functionality and system integration, improve patient-provider communication, and streamline insurance criteria and processes.

Aims: The aim of this study is to evaluate the real-world prescribing patterns of SGLT2 inhibitors and GLP-1 receptor agonists (GLP-1RA) in patients with newly diagnosed Type 2 diabetes (T2DM), particularly among those with high cardiovascular risks or chronic kidney disease, and to identify demographic, clinical, and system-level factors associated with receiving these medications.

Materials and methods: This cross-sectional study analyzed electronic medical records (EMRs) of patients with newly diagnosed T2DM from 60 primary care clinics in West Michigan between April 2021 and January 2023. We assessed the documented prescription rates of SGLT2 inhibitors and GLP-1RAs within 3 months of diagnosis based on EMRs, particularly in high-risk subgroups.

Results: Overall, 19.9% of n = 5783 patients with newly diagnosed T2DM had either an SGLT2 inhibitor or GLP-1RA prescribed. Prescription rates for these agents were 20.0% for patients with chronic ischemic heart disease and 19.3% for those with impaired kidney function. In adjusted analyses, higher BMI (aOR 2.92 for BMI > 40 kg/m², 95% CI 1.58-5.42, ref BMI < 24 kg/m²), hyperlipidemia (aOR 1.89, 95% CI 1.28-2.79), chronic ischemic heart disease (aOR 1.55, 95% CI 1.11-2.18), and higher HbA1c (aOR 1.32 per 1% increase, 95% CI 1.22-1.42) were associated with higher odds of receiving prescription of these medications.

Conclusions: Despite guideline recommendations, SGLT2 inhibitors and GLP-1RAs are prescribed to only a minority of patients with newly diagnosed T2DM, even among those with clear indications. Efforts to improve guideline-adherent care in primary care settings are needed.

Background and aims: In this study, we investigated whether high-intensity interval training (HIIT) and mixed probiotic consumption, either autonomously or synergistically, could regulate the expression of calcium-binding protein-1 (SMOC-1), insulin resistance (IR), and blood glucose (BG) in male rats with induced diabetes.

Methods: Thirty healthy male Wistar rats, aged about 8 weeks, were randomly divided into five groups of six rats each, including control group (C, 1G), diabetic control group (CD, 2G), probiotic supplement group (Pro, 3G), HIIT group (Ex, 4G), and HIIT and probiotic supplement group (Pro + Ex, 5G). Each strain of the mixed probiotic supplement, containing Lactobacillus rhamnosus GG (PTCC1637), Lactobacillus reuteri, and Lactococcus casei enriched with L-cysteine HCl, was administered at a concentration of 10¹⁰ colony-forming units (CFU) per milliliter to Groups 3G and 5G. Groups 4G and 5G underwent HIIT to evaluate the effect of supplementation and HIIT on SMOC-1, IR, and BG.

Results: Mixed probiotics and HIIT did not affect SMOC-1 expression in liver muscle (η ² = 0.00, p = 0.965, F _{(1, 15)} = 0.002); however, they synergistically lowered IR (η ² = 0.23, p = 0.048, F _{(1, 15)} = 4.65) and BG (η ² = 0.32, p = 0.013, F _{(1, 15)} = 7.79).

Conclusion: We found no significant effect of mixed probiotic supplementation or its combination with HIIT on SMOC-1. Notably, the HIIT and mixed probiotics reduced IR and BG. Future studies can help assess the accurate synergistic effects of HIIT and mixed probiotics.