Diabetes, Obesity & Metabolism最新文献

Aims: To assess characteristics associated with earlier (≤2 years since diagnosis) versus later (>2 years) insulin pump initiation among new type 1 diabetes applicants to the publicly funded insulin pump program in Ontario, and whether timing of pump initiation is associated with cumulative glycaemic exposure.

Materials and methods: A retrospective population-based cohort study was conducted using administrative healthcare databases in Ontario, Canada. All pump program applicants prior to 31 March 2021 were included. An adjusted log-binomial regression model using generalized estimating equations assessed associations between patient- and physician-level characteristics and earlier versus later pump initiation. A linear regression model examined differences in cumulative HbA1c over time between earlier versus later pump initiators.

Results: Among 4899 individuals, 62.6% were earlier pump initiators. Greater social disadvantage was associated with lower likelihood of earlier pump initiation [adjusted relative risk (RR) 0.81 (95% confidence interval {CI} 0.75-0.88)] for most versus least disadvantaged quintile. Compared to paediatrician care, endocrinologist [RR 0.85 (95% CI 0.79, 0.91)], general internist [0.73 (0.64-0.83)], and family physician care [0.28 (0.21-0.37)] were associated with less earlier pump initiation. Older age at diagnosis and physician training prior to publicly funded pump therapy were associated with less earlier pump initiation. Earlier pump initiators had a significantly lower annual rate of increase in cumulative HbA1c compared with later initiators (-0.33% per year; 95% CI -0.45 to -0.20; p < 0.001), although cumulative HbA1c at 10 years did not differ significantly between groups (mean difference -1.50; p = 0.112).

Conclusions: Social disadvantage and physician characteristics are associated with less earlier pump initiation, which may have negative long-term effects on glycaemic management. Barriers to earlier pump initiation should be removed to promote equitable access and optimize glycaemic outcomes.

Aim: Heart failure with preserved ejection fraction (HFpEF) presents a therapeutic challenge, characterised by a paucity of validated treatments. Emerging data suggest that targeting adiposity is central to HFpEF pathogenesis. We conducted an updated network meta-analysis to compare the efficacy of emerging and established HFpEF therapies.

Materials and methods: We systematically searched PubMed, Embase and Cochrane Library from inception to April 2025 for randomised controlled trials enrolling patients with HFpEF and evaluating pharmacotherapies, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, mineralocorticoid receptor antagonists (MRAs), digoxin, angiotensin receptor-neprilysin inhibitor, sodium-glucose transporter 2 inhibitors (SGLT2is), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), nitrates and nitrites. The primary outcome was a composite of cardiovascular death and heart failure (HF) hospitalisation. The secondary outcomes included cardiovascular death, all-cause mortality, worsening HF events, change in the 6-min walk test (6MWT) distance, Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) and N-terminal pro-B-type natriuretic peptide levels. A frequentist random-effects NMA was conducted.

Results: Thirty-nine trials with 78 treatment arms and 48 235 patients were enrolled. Compared with placebo, GLP-1 RAs (HR: 0.73, 95% CI 0.61-0.88) and SGLT2is (HR: 0.79, 95% CI 0.70-0.90; P-score: 0.807) significantly reduced the risk of cardiovascular death and HF hospitalisation. GLP-1 RAs showed the highest probability of ranking first (P-score: 0.871). GLP-1 RAs elicited the greatest improvement in functional outcomes, including the 6MWT (mean difference: +17.60 m, 95% CI 8.53-26.67) and KCCQ-CSS (mean difference: +7.38 points, 95% CI 5.51-9.26). No statistically significant differences in cardiovascular death or all-cause mortality were observed among the treatments.

Conclusions: In patients with HFpEF, GLP-1RA, SGLT2i and MRA significantly reduced the risk of cardiovascular death and HF hospitalisation, while GLP-1RA additionally improved the functional and quality-of-life outcomes. GLP-1RA and SGLT2i significantly reduced HF morbidity, and GLP-1RA uniquely improved functional status, positioning adiposity modulation as a central therapeutic target in HFpEF.

Aims/hypothesis: Gestational diabetes and abnormal 100-g oral glucose tolerance test (OGTT) results in pregnancy are associated with type 2 diabetes, but their relationship with cardiovascular disease (CVD) is less clear. We evaluated the risk of CVD according to the number of abnormal OGTT values during pregnancy.

Methods: This retrospective cohort study used data from a major Israeli healthcare provider. Pregnant individuals aged 20-50 years without a prior diagnosis of type 2 diabetes and CVD who had a complete 100-g OGTT during their last pregnancy between January 2000 and December 2022 were included. The primary outcome was the development of a composite of CVD by September 2024. Risk was assessed using Cox proportional hazards models based on the number of abnormal OGTT values.

Results: The study included 103 389 individuals with a mean age of 34 ± 5.2 years. Overall, the median follow-up was 6.8 years (IQR, 3.4-12.9), totalling 886 955 person-years. A composite of CVD developed in 641 individuals (a cumulative incidence of 0.62%). When compared to individuals with all OGTT values normal, individuals with one to three abnormal values had an adjusted hazard ratio (HR) of 1.2 (95% CI: 1.02-1.4) for CVD, reaching 2.41 (95% CI 1.44-4.05) in those with four abnormal OGTT values.

Conclusions: A history of abnormal 100-gram OGTT results during pregnancy, and specifically having four abnormal values, is associated with an elevated risk of CVD. These results underscore the need for early post-partum identification and prevention strategies in this high-risk population.

Aim: To synthesise evidence from RCTs investigating the effectiveness of nutrition interventions on depression, anxiety, stress, and/or diabetes distress outcomes in adults living with diabetes.

Methods: Six online databases were searched using key words between 2000 and February 2024. Included studies were conducted in adult populations (≥18 years), with Type 1 (T1D) or Type 2 Diabetes (T2D), investigating impacts of nutrition interventions on mental health outcomes. Random effects meta-analyses were undertaken for mental health outcomes.

Results: Thirty publications met inclusion criteria, all included adults with T2D, with one including both T1D and T2D. The most common interventions were nutrition supplements (n = 17, 57%) and altering macronutrient intakes (n = 5, 17%). Most studies reported on depression (n = 26) and anxiety (n = 14) outcomes, with fewer examining stress (n = 7) or diabetes-related distress (n = 8). Meta-analyses indicated nutrition supplementation when compared to control improved scores for depression (Beck Depression Inventory (BDI): WMD = -3.13; 95% CI: -5.09, -1.17) and anxiety (Beck Anxiety Inventory: WMD = -1.30; 95% CI: -2.08, -0.52) but not for stress. Meta-analyses confirmed that altering macronutrient composition significantly lowered diabetes-related distress (Problem Areas in Diabetes (PAID): WMD = -4.20; 95% CI: -8.18, -0.22).

Conclusion: This review provides evidence that nutrition interventions, particularly supplement use or altered macronutrient composition, improve depression and anxiety for those with T2D. Future research should evaluate the impact of whole dietary patterns on mental health in adults with diabetes, especially T1D, to inform effective food-based nutrition advice, rather than focusing on individual supplements.

Aims: Management of insulin therapy in elderly individuals with type 2 diabetes (T2D) residing in nursing homes is often challenging due to comorbidities, cognitive impairment and limited access to specialist care. Continuous glucose monitoring (CGM) and telemedicine may help optimise glycaemic control in this vulnerable population.

Materials and methods: In order to assess the efficacy and safety of a CGM and telemedicine-based management of insulin therapy in nursing home residents with T2D, a 12-week, randomised, controlled and open-label trial has been designed. Eighty-five patients on stable basal-bolus insulin therapy were assigned to either telemedicine-assisted insulin titration based on CGM data (intervention group) or standard care with capillary blood glucose monitoring (control group). The primary endpoint was the change in time in range (TIR, 70-180 mg/dL), with secondary outcomes including time below range (TBR), time above range (TAR), haemoglobin A1c (HbA1c), insulin dose and safety endpoints.

Results: TIR increased significantly in the intervention, but not in the control group, with a significant difference between study groups (p = 0.010). TBR showed a reduction in the intervention arm and an increase in the control arm with a significant difference between groups (p = 0.007). HbA1c and mean insulin daily units significantly also decreased in the intervention group, with significant differences between groups (p = 0.028 and p = 0.002, respectively). No safety issues potentially related to the intervention were identified during the study.

Conclusion: In conclusion, remote insulin dose adjustment based on interstitial glucose monitoring ameliorates glucose control in nursing home residents with T2D on basal-bolus insulin therapy.

Background: Parkinson's disease (PD) is an increasingly prevalent neurodegenerative condition, particularly among individuals with type 2 diabetes mellitus (T2DM). While prior studies have suggested that GLP-1 receptor agonists (GLP-1RAs) and metformin may confer neuroprotective effects, most were limited by small sample sizes, short follow-up, uncontrolled designs, or lacked direct comparisons between therapies-making their findings inconclusive for clinical decision-making.

Methods: Using the TriNetX Global Collaborative Network, we identified 92 485 patients with T2DM initiating GLP-1RA therapy and matched them 1:1 to new metformin users using propensity score matching. Patients with prior antidiabetic therapy, PD, or dementia were excluded. Incident PD was the primary outcome; all-cause mortality served as a secondary endpoint. Adjusted hazard ratios (aHRs) were estimated using Cox models. Competing risk and time-stratified (≤5, 5-10, >10 years) analyses were conducted. Positive and negative outcome/exposure controls were employed to validate internal consistency.

Results: The overall PD risk was comparable between GLP-1RA and metformin groups (aHR, 0.91; 95% CI, 0.79-1.05). However, between years 5 and 10, GLP-1RA use was associated with a significantly lower PD risk (aHR, 0.56; 95% CI, 0.34-0.93). Mortality risk did not differ significantly. Validation analyses confirmed the specificity of the findings.

Conclusions: By addressing key limitations of earlier studies through a large-scale, active-comparator, new-user design, this study provides novel evidence of a delayed neuroprotective effect of GLP-1RAs. These findings support incorporating neurologic outcomes into long-term diabetes management and may inform therapy selection in high-risk populations.