Hypertension is one of the most common comorbidities associated with diabetes. The standardized diagnosis and treatment of hypertension in diabetic patients, along with achieving blood pressure targets, is of great significance for reducing long-term complications, extending lifespan, and improving quality of life. Recent high-quality multicenter large-sample intervention studies have provided important evidence-based grounds for setting blood pressure targets in diabetic patients. Therefore, based on a comprehensive summary of important domestic and international research literature, and in combination with clinical practice experience, this management guideline is now formulated.
{"title":"Management Guidelines for Diabetic Patients With Hypertension","authors":"Weiqing Wang, Qin Wan, Suijun Wang, Guang Ning, Yufang Bi, Lianyong Liu, Yan Liu, Yu Liu, Xiaoying Li, Tingzhi Li, Xueyi Wu, Shengli Wu, Yubo Sha, Yifei Zhang, Rongyue Chen, Hongting Zheng, Dong Zhao, Ling Hu, Peng Duan, Xinguo Hou, Guoyue Yuan, Yu Xu, Shan Huang, Zhiqiang Kang, Qijuan Dong, Huanfeng Pan","doi":"10.1111/1753-0407.70093","DOIUrl":"https://doi.org/10.1111/1753-0407.70093","url":null,"abstract":"<p>Hypertension is one of the most common comorbidities associated with diabetes. The standardized diagnosis and treatment of hypertension in diabetic patients, along with achieving blood pressure targets, is of great significance for reducing long-term complications, extending lifespan, and improving quality of life. Recent high-quality multicenter large-sample intervention studies have provided important evidence-based grounds for setting blood pressure targets in diabetic patients. Therefore, based on a comprehensive summary of important domestic and international research literature, and in combination with clinical practice experience, this management guideline is now formulated.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetes represents a significant global health concern, with diabetic cardiomyopathy (DCM) emerging as a primary cause of mortality among individuals with diabetes. Despite the prevalence of DCM, advancements in therapeutic and preventative strategies remain constrained.
Methods
Recent studies were reviewed to provide a comprehensive summary of pathogenesis and clinical treatment of DCM, effect of ferroptosis, and potential value of ferroptosis inhibitors in DCM intervention.
Results
A growing body of research indicates that oxidative stress, inflammatory reactions, and other factors play a role in the onset and progression of DCM. Oxidative stress within cardiomyocytes is a primary mechanism implicated in the development of DCM, whereby heightened intracellular reactive oxygen species (ROS) facilitate cell death via ferroptosis. Ferroptosis inhibitors hold great promise as therapeutic agents.
Conclusions
This review provides an overview of the involvement of iron homeostasis regulation, oxidative stress, and ferroptosis in DCM, and the significance of ferroptosis in the prevention and treatment of DCM.
{"title":"Potential Significance of Targeting Ferroptosis for Intervention of Diabetic Cardiomyopathy","authors":"Qian Lei, Burton B. Yang, Juanjuan Lyu","doi":"10.1111/1753-0407.70116","DOIUrl":"https://doi.org/10.1111/1753-0407.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetes represents a significant global health concern, with diabetic cardiomyopathy (DCM) emerging as a primary cause of mortality among individuals with diabetes. Despite the prevalence of DCM, advancements in therapeutic and preventative strategies remain constrained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Recent studies were reviewed to provide a comprehensive summary of pathogenesis and clinical treatment of DCM, effect of ferroptosis, and potential value of ferroptosis inhibitors in DCM intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A growing body of research indicates that oxidative stress, inflammatory reactions, and other factors play a role in the onset and progression of DCM. Oxidative stress within cardiomyocytes is a primary mechanism implicated in the development of DCM, whereby heightened intracellular reactive oxygen species (ROS) facilitate cell death via ferroptosis. Ferroptosis inhibitors hold great promise as therapeutic agents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This review provides an overview of the involvement of iron homeostasis regulation, oxidative stress, and ferroptosis in DCM, and the significance of ferroptosis in the prevention and treatment of DCM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Obesity prevalence has increased over many decades, with one quarter of the adult population projected to be obese by 2035 [<span>1</span>]. The glucagon-like peptide 1 receptor agonists (GLP-1RA) and related agents are associated with effective and sustained weight loss and show evidence of reduction in a myriad of cardiovascular (CV) and renal outcomes [<span>2</span>], as well as improving metabolic, hepatic, respiratory, and musculoskeletal complications of obesity. An increasing concern, however, is whether concomitant reduction in skeletal muscle mass (SMM) with fat mass may have adverse consequences [<span>3</span>].</p><p>While there is normally a decrease in SMM of 10%–15% from age 20 to 80 [<span>4</span>], excessive loss in muscle mass and the accompanying reduction in strength is associated with increased mortality, both overall and that due to a variety of separate conditions, whether measured based on bioelectrical impedance [<span>5</span>], self-reported walking limitation [<span>6</span>], or reduction in maximum handgrip strength [<span>7</span>]. In the National Health and Nutrition Examination Survey, 17%, 26%, and 31% of obese people aged 60–70, 70–80, and ≥ 80 had evidence of sarcopenia based on the appendicular lean mass-to-BMI ratio using dual-energy X-ray absorptiometry [<span>8</span>]. In further evidence of the prevalence of sarcopenic obesity, reduced handgrip strength and walking speed was present in 30%, 62%, and 89% of obese persons at ages 45–60, 61–80, and ≥ 80 in the Longitudinal Aging Study in India [<span>9</span>].</p><p>Across studies of dietary weight loss, GLP-1RA, and bariatric surgery, the relationship between the fraction of body weight lost and the fraction of lean body mass lost is linear, with somewhat limited data showing approximately 5% such loss for every 10% body weight reduction [<span>10</span>]. In a meta-analysis of 36 studies of bariatric surgery, the mean decrease in SMM averaged 7.8 kg at 12 months, with the first, second, third, and fourth quartiles of decrease in SMM 11.0, 9.1, 6.7 and 4.4 kg, respectively [<span>11</span>].</p><p>About one in eight adults say they have at some point taken a GLP-1RA, with about half of these currently taking the medications [<span>12</span>]. It is, then, important to ask whether this widely used treatment is associated with a reduction in SMM. These agents on average are associated with an improvement in physical function [<span>13</span>], and some have suggested that clinical trials have not shown GLP-1RA to be associated with “clinically relevant” skeletal muscle loss [<span>14</span>]. However, clinical trial populations differ in important ways from individuals in clinical treatment [<span>15-17</span>], the latter typically older with greater degrees of frailty and multiple comorbidities. The largest meta-analysis allowing insight into the effect of GLP-1RA on SMM involves 27 studies, with the change in fat-free mass as a percentage of the cha
{"title":"Monitoring Sarcopenia With Incretin Receptor Activator Treatment","authors":"Zachary T. Bloomgarden","doi":"10.1111/1753-0407.70117","DOIUrl":"https://doi.org/10.1111/1753-0407.70117","url":null,"abstract":"<p>Obesity prevalence has increased over many decades, with one quarter of the adult population projected to be obese by 2035 [<span>1</span>]. The glucagon-like peptide 1 receptor agonists (GLP-1RA) and related agents are associated with effective and sustained weight loss and show evidence of reduction in a myriad of cardiovascular (CV) and renal outcomes [<span>2</span>], as well as improving metabolic, hepatic, respiratory, and musculoskeletal complications of obesity. An increasing concern, however, is whether concomitant reduction in skeletal muscle mass (SMM) with fat mass may have adverse consequences [<span>3</span>].</p><p>While there is normally a decrease in SMM of 10%–15% from age 20 to 80 [<span>4</span>], excessive loss in muscle mass and the accompanying reduction in strength is associated with increased mortality, both overall and that due to a variety of separate conditions, whether measured based on bioelectrical impedance [<span>5</span>], self-reported walking limitation [<span>6</span>], or reduction in maximum handgrip strength [<span>7</span>]. In the National Health and Nutrition Examination Survey, 17%, 26%, and 31% of obese people aged 60–70, 70–80, and ≥ 80 had evidence of sarcopenia based on the appendicular lean mass-to-BMI ratio using dual-energy X-ray absorptiometry [<span>8</span>]. In further evidence of the prevalence of sarcopenic obesity, reduced handgrip strength and walking speed was present in 30%, 62%, and 89% of obese persons at ages 45–60, 61–80, and ≥ 80 in the Longitudinal Aging Study in India [<span>9</span>].</p><p>Across studies of dietary weight loss, GLP-1RA, and bariatric surgery, the relationship between the fraction of body weight lost and the fraction of lean body mass lost is linear, with somewhat limited data showing approximately 5% such loss for every 10% body weight reduction [<span>10</span>]. In a meta-analysis of 36 studies of bariatric surgery, the mean decrease in SMM averaged 7.8 kg at 12 months, with the first, second, third, and fourth quartiles of decrease in SMM 11.0, 9.1, 6.7 and 4.4 kg, respectively [<span>11</span>].</p><p>About one in eight adults say they have at some point taken a GLP-1RA, with about half of these currently taking the medications [<span>12</span>]. It is, then, important to ask whether this widely used treatment is associated with a reduction in SMM. These agents on average are associated with an improvement in physical function [<span>13</span>], and some have suggested that clinical trials have not shown GLP-1RA to be associated with “clinically relevant” skeletal muscle loss [<span>14</span>]. However, clinical trial populations differ in important ways from individuals in clinical treatment [<span>15-17</span>], the latter typically older with greater degrees of frailty and multiple comorbidities. The largest meta-analysis allowing insight into the effect of GLP-1RA on SMM involves 27 studies, with the change in fat-free mass as a percentage of the cha","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144308971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antibiotics in childhood are commonly used and have been linked to gut microbiome dysbiosis and metabolic disorders. However, direct evidence regarding the association between long-term or recurrent antibiotic use (LRAU) during early life and diabetes was scarce. We performed this study to investigate this association in two population-based studies.
Methods
We undertook a prospective analysis encompassing 147 010 participants from the UK Biobank. Cox proportional hazard regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of self-reported LRAU during early life on diabetes risk. We also conducted a case–control study within the Chinese population, in which 263 diabetes cases and 526 controls were matched for age and living location. Odds ratios (ORs) and 95% CI were was calculated using logistic regression models.
Results
We identified 4314 incident cases of type 2 diabetes over 1 840 944 person-years of follow-up in the UK Biobank. LRAU during early life was associated with a 26% higher risk of diabetes after accounting for putative risk factors (HR, 1.26; 95% CI, 1.16–1.37) in the UK biobank. We observed a more evident association between LRAU and an elevated risk of diabetes in the case–control study (OR, 3.32; 95% CI, 2.06–5.38). The primary finding was robust to several subgroup analyses and sensitivity analyses.
Conclusions
LRAU during early life may increase the risk of type 2 diabetes. Caution should be exercised when prescribing long-term or recurrent antibiotics to children and adolescents.
{"title":"Long-Term or Recurrent Antibiotic Use in Early Life and the Risk of Type 2 Diabetes: A Population-Based Prospective Cohort and a Case–Control Study","authors":"Zijun Li, Qiangsheng He, Xin He, Xin Xing, Songbo Fu, Xiaoping Sun, Mina Ma, Danni Wang, Ningning Mi, Jinyu Zhao, Jinqiu Yuan, Kehu Yang","doi":"10.1111/1753-0407.70113","DOIUrl":"https://doi.org/10.1111/1753-0407.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Antibiotics in childhood are commonly used and have been linked to gut microbiome dysbiosis and metabolic disorders. However, direct evidence regarding the association between long-term or recurrent antibiotic use (LRAU) during early life and diabetes was scarce. We performed this study to investigate this association in two population-based studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We undertook a prospective analysis encompassing 147 010 participants from the UK Biobank. Cox proportional hazard regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of self-reported LRAU during early life on diabetes risk. We also conducted a case–control study within the Chinese population, in which 263 diabetes cases and 526 controls were matched for age and living location. Odds ratios (ORs) and 95% CI were was calculated using logistic regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 4314 incident cases of type 2 diabetes over 1 840 944 person-years of follow-up in the UK Biobank. LRAU during early life was associated with a 26% higher risk of diabetes after accounting for putative risk factors (HR, 1.26; 95% CI, 1.16–1.37) in the UK biobank. We observed a more evident association between LRAU and an elevated risk of diabetes in the case–control study (OR, 3.32; 95% CI, 2.06–5.38). The primary finding was robust to several subgroup analyses and sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LRAU during early life may increase the risk of type 2 diabetes. Caution should be exercised when prescribing long-term or recurrent antibiotics to children and adolescents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katherine E. Wakelin, Rebecca K. Read, Ashely Y. Williams, Rachel R. Francois-Walcott, Nicola O'Donnell, Rose-Marie Satherley, Megan P. Harrington, Mary John, Christina J. Jones
Background
Research suggests that the wellbeing of caregivers of children with Type 1 Diabetes can influence child health outcomes. Therefore, the aim was to conduct a systematic review and meta-analysis to estimate the effect of psychological interventions for families of children with Type 1 Diabetes on caregiver and child functioning.
Methods
A systematic search of the literature identified 58 randomized controlled trials (RCTs) that met inclusion. Study quality was assessed using the Cochrane Risk-of-Bias Tool.
Results
Fifty-one trials had sufficient data to be included in the meta-analysis, analyzing nine variables (caregiver and child psychological distress, diabetes distress, family conflict and child quality of life (QoL), diabetes QoL and blood glucose) over three timepoints (post-intervention, short-term and long-term follow-up). Results from 10 (n = 550), three (n = 347) and 16 RCTs (n = 1631) respectively indicated that psychological interventions significantly reduced caregiver psychological distress post-intervention (SMD = −0.64, 95% CI = −1.15, −0.12), child psychological distress post-intervention (SMD = −0.34, 95% CI = −0.55, −0.31) and child blood glucose at short-term follow-up (SMD = −0.11, 95% CI = −0.21, −0.01), relative to controls.
Conclusions
Participants allocated to controls showed greater reductions in caregiver diabetes family conflict at short-and long-term follow−up than those assigned to psychological interventions. This was explained by significant baseline differences influencing a small number of studies. Studies were highly heterogenous regarding outcome measures, follow-ups, and interventions, with high concerns of bias often observed, reflecting the complexity of real−world clinical practice. Findings are promising. Appropriately powered RCTs with robust randomization are recommended to investigate the significance of effects, whilst considering dose response.
{"title":"The Effectiveness of Psychological Interventions for Families of Children With Type 1 Diabetes on Caregiver and Child Functioning: A Systematic Review and Meta-Analysis","authors":"Katherine E. Wakelin, Rebecca K. Read, Ashely Y. Williams, Rachel R. Francois-Walcott, Nicola O'Donnell, Rose-Marie Satherley, Megan P. Harrington, Mary John, Christina J. Jones","doi":"10.1111/1753-0407.70112","DOIUrl":"https://doi.org/10.1111/1753-0407.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Research suggests that the wellbeing of caregivers of children with Type 1 Diabetes can influence child health outcomes. Therefore, the aim was to conduct a systematic review and meta-analysis to estimate the effect of psychological interventions for families of children with Type 1 Diabetes on caregiver and child functioning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of the literature identified 58 randomized controlled trials (RCTs) that met inclusion. Study quality was assessed using the Cochrane Risk-of-Bias Tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-one trials had sufficient data to be included in the meta-analysis, analyzing nine variables (caregiver and child psychological distress, diabetes distress, family conflict and child quality of life (QoL), diabetes QoL and blood glucose) over three timepoints (post-intervention, short-term and long-term follow-up). Results from 10 (<i>n</i> = 550), three (<i>n</i> = 347) and 16 RCTs (<i>n</i> = 1631) respectively indicated that psychological interventions significantly reduced caregiver psychological distress post-intervention (SMD = −0.64, 95% CI = −1.15, −0.12), child psychological distress post-intervention (SMD = −0.34, 95% CI = −0.55, −0.31) and child blood glucose at short-term follow-up (SMD = −0.11, 95% CI = −0.21, −0.01), relative to controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Participants allocated to controls showed greater reductions in caregiver diabetes family conflict at short-and long-term follow−up than those assigned to psychological interventions. This was explained by significant baseline differences influencing a small number of studies. Studies were highly heterogenous regarding outcome measures, follow-ups, and interventions, with high concerns of bias often observed, reflecting the complexity of real−world clinical practice. Findings are promising. Appropriately powered RCTs with robust randomization are recommended to investigate the significance of effects, whilst considering dose response.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity represents a critical global health challenge, marked by escalating prevalence and comorbidities such as cardiovascular disease, type 2 diabetes, chronic kidney disease, musculoskeletal disorders, and certain cancers [1]. The continuous development of antiobesity medications (AOMs), which demonstrate significant weight loss effects, presents new opportunities for the treatment of obesity [2]. On August 8, 2024, a search of the Informa Database identified a total of 2120 trials for AOMs, indicating that the research on AOMs is active and receiving significant attention.
Over the past 30 years, the number of clinical trials on AOMs has experienced significant fluctuations, peaking in 2023–2024 (Figure 1A). The number of clinical trials entering phases III–IV and phases I–II/III was comparable (48.5% vs. 50.9%), underscoring the development of novel AOMs derived from established therapies. Eventually, a total of 20 indications were identified in these trials, of which the top 10 were listed in Figure 1B. The majority of indications were Non-diabetic overweight or obesity (41.6%), followed closely by Diabetes-related overweight or obesity (41.0%). Among trials targeting non-diabetic overweight or obesity, only 35.6% reached phase III/IV, indicating this field is still in early-stage exploration. Figure 1C illustrates the distribution of clinical trials for AOMs based on their mechanisms of action and targets. Nutrient-stimulated hormone (NuSH) single receptor agonists dominate the landscape, accounting for 26.14% of trials, highlighting their significant research focus. Other AOMs, which target leptin, ghrelin, mitochondrial uncouplers, and growth differentiation factor 15 (GDF15), follow closely at 19.94%. In recent years, as the number of clinical trials on AOMs has steadily increased, the proportion of combined therapies has also risen, suggesting that this will be a future trend (Figure 1D). Recent advancements have been characterized by a surge in clinical trials targeting various mechanisms of action, as depicted in Figure 1E. Glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as a leading class, with Semaglutide and Liraglutide being the most extensively studied drugs classified as NuSH single receptor agonists. Meanwhile, peptides and molecular conjugates with dual-agonist and triple-agonist actions, such as Tirzepatide and Retatrutide, are currently under investigation and appear to have the strongest potential as anti-obesity medications [3]. Advances in incretin biology have driven the development of approved GLP-1 receptor agonists over recent decades. To date, the FDA has approved three NuSH-based AOMs: Liraglutide, Semaglutide, and Tirzepatide.
Additionally, further management of obesity necessitates personalized therapies and multimodal strategies, as long-term maintenance of weight loss is challenging for most people. Combination therapies, like the integration
肥胖是一项重大的全球健康挑战，其特点是心血管疾病、2型糖尿病、慢性肾脏疾病、肌肉骨骼疾病和某些癌症等患病率和合并症不断上升。抗肥胖药物（AOMs）的不断发展，显示出显著的减肥效果，为肥胖的治疗提供了新的机会。2024年8月8日，通过对Informa数据库的检索，发现AOMs的试验总数为2120个，表明AOMs的研究非常活跃，受到了极大的关注。在过去30年中，AOMs的临床试验数量经历了显著波动，在2023-2024年达到峰值（图1A）。进入III - iv期和I-II /III期的临床试验数量相当（48.5% vs 50.9%），强调了源自既定疗法的新型AOMs的发展。最终，这些试验共确定了20个适应症，其中排名前10位的见图1B。大多数适应症为非糖尿病性超重或肥胖（41.6%），其次为糖尿病相关超重或肥胖（41.0%）。在针对非糖尿病性超重或肥胖的试验中，只有35.6%达到III/IV期，表明该领域仍处于早期探索阶段。图1C显示了基于AOMs作用机制和靶点的临床试验分布。营养刺激激素（NuSH）单受体激动剂占主导地位，占试验的26.14%，突出了其重要的研究重点。其他靶向瘦素、胃饥饿素、线粒体解偶联剂和生长分化因子15 （GDF15）的AOMs紧随其后，占19.94%。近年来，随着AOMs临床试验数量的稳步增加，联合治疗的比例也在上升，这将是未来的趋势（图1D）。最近的进展特点是针对各种作用机制的临床试验激增，如图1E所示。胰高血糖素样肽-1 （GLP-1）受体激动剂已成为一类领先的药物，其中Semaglutide和Liraglutide是被分类为NuSH单受体激动剂的研究最广泛的药物。与此同时，具有双激动剂和三激动剂作用的多肽和分子偶联物，如替西帕肽和利特鲁肽，目前正在研究中，似乎具有最大的抗肥胖药物潜力b[3]。近几十年来，肠促胰岛素生物学的进步推动了批准的GLP-1受体激动剂的发展。迄今为止，FDA已经批准了三种基于nush的AOMs：利拉鲁肽、Semaglutide和替西帕肽。此外，肥胖的进一步管理需要个性化治疗和多模式策略，因为长期维持体重减轻对大多数人来说是具有挑战性的。联合治疗，如AOMs或减肥手术的整合，以及生活方式的改变，代表了未来治疗发展的方向。与此同时，针对非糖尿病超重或肥胖患者的研究也得到了关注，这反映了公众对肥胖的兴趣日益浓厚，以及新型AOMs的不断发展。总之，随着新型AOMs的开发和临床经验的增加，肥胖治疗将变得更加有效，帮助患者提高生活质量，减轻肥胖相关合并症的负担。刘丹录：概念化、数据整理、形式分析、调查、方法论、撰写原稿。陈毅：监督、审定、撰稿编辑、项目管理、资金获取。根据国际医学期刊编辑委员会（ICMJE）的最新指南，所有作者都对所报道的研究的构思、设计、执行或解释做出了重大贡献。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。
{"title":"A New Era in Obesity Treatment: The Evolution of Antiobesity Medications (AOMs) Based on Clinical Trials","authors":"Danlu Liu, Yi Chen","doi":"10.1111/1753-0407.70115","DOIUrl":"https://doi.org/10.1111/1753-0407.70115","url":null,"abstract":"<p>Obesity represents a critical global health challenge, marked by escalating prevalence and comorbidities such as cardiovascular disease, type 2 diabetes, chronic kidney disease, musculoskeletal disorders, and certain cancers [<span>1</span>]. The continuous development of antiobesity medications (AOMs), which demonstrate significant weight loss effects, presents new opportunities for the treatment of obesity [<span>2</span>]. On August 8, 2024, a search of the Informa Database identified a total of 2120 trials for AOMs, indicating that the research on AOMs is active and receiving significant attention.</p><p>Over the past 30 years, the number of clinical trials on AOMs has experienced significant fluctuations, peaking in 2023–2024 (Figure 1A). The number of clinical trials entering phases III–IV and phases I–II/III was comparable (48.5% vs. 50.9%), underscoring the development of novel AOMs derived from established therapies. Eventually, a total of 20 indications were identified in these trials, of which the top 10 were listed in Figure 1B. The majority of indications were Non-diabetic overweight or obesity (41.6%), followed closely by Diabetes-related overweight or obesity (41.0%). Among trials targeting non-diabetic overweight or obesity, only 35.6% reached phase III/IV, indicating this field is still in early-stage exploration. Figure 1C illustrates the distribution of clinical trials for AOMs based on their mechanisms of action and targets. Nutrient-stimulated hormone (NuSH) single receptor agonists dominate the landscape, accounting for 26.14% of trials, highlighting their significant research focus. Other AOMs, which target leptin, ghrelin, mitochondrial uncouplers, and growth differentiation factor 15 (GDF15), follow closely at 19.94%. In recent years, as the number of clinical trials on AOMs has steadily increased, the proportion of combined therapies has also risen, suggesting that this will be a future trend (Figure 1D). Recent advancements have been characterized by a surge in clinical trials targeting various mechanisms of action, as depicted in Figure 1E. Glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as a leading class, with Semaglutide and Liraglutide being the most extensively studied drugs classified as NuSH single receptor agonists. Meanwhile, peptides and molecular conjugates with dual-agonist and triple-agonist actions, such as Tirzepatide and Retatrutide, are currently under investigation and appear to have the strongest potential as anti-obesity medications [<span>3</span>]. Advances in incretin biology have driven the development of approved GLP-1 receptor agonists over recent decades. To date, the FDA has approved three NuSH-based AOMs: Liraglutide, Semaglutide, and Tirzepatide.</p><p>Additionally, further management of obesity necessitates personalized therapies and multimodal strategies, as long-term maintenance of weight loss is challenging for most people. Combination therapies, like the integration ","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emerging evidence suggests the presence of distinct endotypes of Type 1 diabetes mellitus (T1DM): T1DE1 in individuals diagnosed at age < 7 years in contrast to T1DE2 in those diagnosed at ≥ 13 years of age. We aimed to comprehensively explore the phenotypic heterogeneity of T1DM with respect to the age-related endotypes.
Methods
This cross-sectional study was conducted in China and involved 1204 children newly diagnosed with T1DM who were admitted to the pediatric department of a tertiary hospital from January 1, 2010 to December 31, 2023. The patients were divided into three age groups: < 7 years (T1DE1), 7–12 years, and ≥ 13 years (T1DE2). A comparison was made among the age groups regarding demographic characteristics, glucose metabolism, β-cell autoimmunity, and metabolic decompensation.
Results
Patients under 7 years exhibited a shorter symptom duration before diagnosis, along with the lowest fasting and postprandial C-peptide and C-peptide to glucose ratio levels and the highest postprandial glucose levels. They also showed the highest insulin autoantibody positivity rate and creatine kinase-MB levels. In contrast, patients aged 13 and older had the highest HbA1c levels and glutamate decarboxylase antibody positivity rate. In addition, this group showed the highest prevalence of TPOAb and TgAb positivity, as well as the largest proportion of abnormal liver function cases.
Conclusions
The study illustrates age-specific phenotypic heterogeneity in pediatric T1DM, indicating the presence of distinct endotypes. Further investigation of these endotypes may offer more evidence for the precise treatment of T1DM.
{"title":"Phenotypic Spectrum at Diagnosis of Age-Related Endotypes of Type 1 Diabetes Mellitus: A Cross-Sectional Study in China","authors":"Qiaoli Zhou, Xueqin Zheng, Chenguang Ma, Wei Gu","doi":"10.1111/1753-0407.70111","DOIUrl":"https://doi.org/10.1111/1753-0407.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Emerging evidence suggests the presence of distinct endotypes of Type 1 diabetes mellitus (T1DM): T1DE1 in individuals diagnosed at age < 7 years in contrast to T1DE2 in those diagnosed at ≥ 13 years of age. We aimed to comprehensively explore the phenotypic heterogeneity of T1DM with respect to the age-related endotypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study was conducted in China and involved 1204 children newly diagnosed with T1DM who were admitted to the pediatric department of a tertiary hospital from January 1, 2010 to December 31, 2023. The patients were divided into three age groups: < 7 years (T1DE1), 7–12 years, and ≥ 13 years (T1DE2). A comparison was made among the age groups regarding demographic characteristics, glucose metabolism, β-cell autoimmunity, and metabolic decompensation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients under 7 years exhibited a shorter symptom duration before diagnosis, along with the lowest fasting and postprandial C-peptide and C-peptide to glucose ratio levels and the highest postprandial glucose levels. They also showed the highest insulin autoantibody positivity rate and creatine kinase-MB levels. In contrast, patients aged 13 and older had the highest HbA1c levels and glutamate decarboxylase antibody positivity rate. In addition, this group showed the highest prevalence of TPOAb and TgAb positivity, as well as the largest proportion of abnormal liver function cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study illustrates age-specific phenotypic heterogeneity in pediatric T1DM, indicating the presence of distinct endotypes. Further investigation of these endotypes may offer more evidence for the precise treatment of T1DM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144264421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mingxin Bai, Donge Yan, Ruixue Feng, Xingwu Ran, Dawei Chen, Chun Wang, Lihong Chen, Shuang Lin, Sen He, Yan Liu, Murong Wu, Zhiyi Lei, Yun Gao
Background
Previous studies have shown that vitamin D deficiency was associated with both cardiac autonomic dysfunction and the development of diabetic foot (DF). However, the impact of vitamin D levels on heart rate variability (HRV) in individuals with DF, a high-risk group, remains unclear. We explored the association between vitamin D status and HRV in individuals with DF.
Methods
A total of 458 individuals with DF were assessed for vitamin D levels by 25-hydroxyvitamin D (25(OH)D) and evaluated for cardiovascular autonomic function using both time and frequency domains of the HRV measures. Multivariate regression analysis and restricted cubic spline regression were employed to examine the associations.
Results
Vitamin D levels were positively associated with HRV indices in people with DF, including standard deviation of the normal sinus interval (SDNN), standard deviation of the 5-min average RR intervals (SDANN), low-frequency power (LF), high-frequency power (HF), and the LF/HF ratio (all p < 0.05). The associations between serum 25(OH)D and cardiac autonomic dysfunction were nonlinear. When 25(OH)D levels were < 50 nmol/L, the odds ratio (OR) for predicted cardiac autonomic dysfunction per SD increase in 25(OH)D was 0.56 (95% CI, 0.44–0.72). However, no significant effect was observed when 25(OH)D levels exceeded 50 nmol/L.
Conclusions
This study demonstrates that lower 25(OH)D levels are associated with reduced HRV in individuals with DF. Specifically, when 25(OH)D levels fall below 50 nmol/L, the risk of cardiac autonomic dysfunction in people with DF significantly increases.
{"title":"Nonlinear Association Between Serum 25-Hydroxyvitamin D and Cardiac Autonomic Dysfunction in Diabetic Foot: A Threshold Effect on Heart Rate Variability","authors":"Mingxin Bai, Donge Yan, Ruixue Feng, Xingwu Ran, Dawei Chen, Chun Wang, Lihong Chen, Shuang Lin, Sen He, Yan Liu, Murong Wu, Zhiyi Lei, Yun Gao","doi":"10.1111/1753-0407.70109","DOIUrl":"https://doi.org/10.1111/1753-0407.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous studies have shown that vitamin D deficiency was associated with both cardiac autonomic dysfunction and the development of diabetic foot (DF). However, the impact of vitamin D levels on heart rate variability (HRV) in individuals with DF, a high-risk group, remains unclear. We explored the association between vitamin D status and HRV in individuals with DF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 458 individuals with DF were assessed for vitamin D levels by 25-hydroxyvitamin D (25(OH)D) and evaluated for cardiovascular autonomic function using both time and frequency domains of the HRV measures. Multivariate regression analysis and restricted cubic spline regression were employed to examine the associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Vitamin D levels were positively associated with HRV indices in people with DF, including standard deviation of the normal sinus interval (SDNN), standard deviation of the 5-min average RR intervals (SDANN), low-frequency power (LF), high-frequency power (HF), and the LF/HF ratio (all <i>p</i> < 0.05). The associations between serum 25(OH)D and cardiac autonomic dysfunction were nonlinear. When 25(OH)D levels were < 50 nmol/L, the odds ratio (OR) for predicted cardiac autonomic dysfunction per SD increase in 25(OH)D was 0.56 (95% CI, 0.44–0.72). However, no significant effect was observed when 25(OH)D levels exceeded 50 nmol/L.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrates that lower 25(OH)D levels are associated with reduced HRV in individuals with DF. Specifically, when 25(OH)D levels fall below 50 nmol/L, the risk of cardiac autonomic dysfunction in people with DF significantly increases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sohail Aziz, Sabariah Noor Harun, Siti Maisharah Sheikh Ghadzi
Background
Estimated glomerular filtration rate (eGFR) is a key clinical marker for assessing kidney complications in type 2 diabetes mellitus (T2DM). This study aimed to develop and validate a disease progression model of eGFR in Malaysian T2DM patients, with and without diabetic nephropathy (DN).
Methods
Retrospective data from 251 patients (3241 observations) were analyzed using NONMEM software. Baseline eGFR was assessed without covariates, and both linear and non-linear models were tested. Model selection was based on the likelihood ratio test (5% significance level), objective function value (OFV), visual predictive check (VPC), relative standard error, and scientific plausibility. External validation was performed using data from 109 patients.
Results
A linear model best described disease progression, with a baseline eGFR of 84.6 mL/min/1.73 m2 and a decline rate of −0.0041 mL/min/1.73 m2/year. Cardiovascular disease (CVD) reduced eGFR by 1.05 mL/min/1.73 m2/year, while fasting blood sugar (FBS) above 7.4 mmol/L correlated with an additional decline of 0.043 mL/min/1.73 m2/year. Angiotensin receptor blockers (ARBs) improved eGFR by 0.4 mL/min/1.73 m2/year, whereas statins and metformin contributed improvements of 0.34 and 0.32 mL/min/1.73 m2/year, respectively. External validation confirmed model consistency with observed data.
Conclusion
Glycaemic control and CVD significantly impact eGFR decline. ARBs, statins, and metformin help preserve kidney function. Effective glycaemic management is crucial in slowing kidney deterioration, especially in T2DM patients at risk for DN.
{"title":"Disease Progression Modeling of Estimated Glomerular Filtration Rate (eGFR): A Pharmacometrics Approach","authors":"Sohail Aziz, Sabariah Noor Harun, Siti Maisharah Sheikh Ghadzi","doi":"10.1111/1753-0407.70104","DOIUrl":"https://doi.org/10.1111/1753-0407.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Estimated glomerular filtration rate (eGFR) is a key clinical marker for assessing kidney complications in type 2 diabetes mellitus (T2DM). This study aimed to develop and validate a disease progression model of eGFR in Malaysian T2DM patients, with and without diabetic nephropathy (DN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective data from 251 patients (3241 observations) were analyzed using NONMEM software. Baseline eGFR was assessed without covariates, and both linear and non-linear models were tested. Model selection was based on the likelihood ratio test (5% significance level), objective function value (OFV), visual predictive check (VPC), relative standard error, and scientific plausibility. External validation was performed using data from 109 patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A linear model best described disease progression, with a baseline eGFR of 84.6 mL/min/1.73 m<sup>2</sup> and a decline rate of −0.0041 mL/min/1.73 m<sup>2</sup>/year. Cardiovascular disease (CVD) reduced eGFR by 1.05 mL/min/1.73 m<sup>2</sup>/year, while fasting blood sugar (FBS) above 7.4 mmol/L correlated with an additional decline of 0.043 mL/min/1.73 m<sup>2</sup>/year. Angiotensin receptor blockers (ARBs) improved eGFR by 0.4 mL/min/1.73 m<sup>2</sup>/year, whereas statins and metformin contributed improvements of 0.34 and 0.32 mL/min/1.73 m<sup>2</sup>/year, respectively. External validation confirmed model consistency with observed data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Glycaemic control and CVD significantly impact eGFR decline. ARBs, statins, and metformin help preserve kidney function. Effective glycaemic management is crucial in slowing kidney deterioration, especially in T2DM patients at risk for DN.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
William Hou, Katherine R. Tuttle, Weining Shen, Andrew Reikes, Jonathan H. Watanabe
Aims
In patients with new onset type 2 diabetes, this study aimed to analyze glucose-lowering medication use patterns between 2014 and 2022.
Materials and Methods
This retrospective study included adults with incident type 2 diabetes in the University of California Health System between 2014 and 2022. We determined medications used within 1 year of diagnosis and evaluated statistical evidence of use pattern changes via Mann–Kendall trend tests. Four categories of high-risk patients requiring cardio-kidney-metabolic protection were also evaluated in stratified analyses based on 2024 ADA guidelines.
Results
Of 40 150 patients with incident type 2 diabetes, 38.5% initiated glucose-lowering medication within 1 year. Metformin remained the most used medication from 2014 to 2022. From 2014 to 2022, usage of GLP-1 receptor agonists and SGLT-2 inhibitors increased exponentially. GLP-1 receptor agonist use increased from below 2.5%–21%. While SGLT-2 inhibitor use increased from less than 2.5%–14%. This growth coincided with a decline in sulfonylurea usage. Among high-risk, insulin was most prevalent in those with heart failure or chronic kidney disease. However, usage of insulin declined overall in all groups. Utilization of SGLT-2 inhibitors was particularly high in patients with prior heart failure.
Conclusions
In adults with new onset type 2 diabetes, GLP-1 receptor agonist and SGLT-2 inhibitor utilization has markedly increased, coordinating with evolving guidelines that emphasize cardiovascular and chronic kidney disease management. However, overall adoption rates of these medications remain low based on indicated populations. Sulfonylurea use declined while metformin remains the most frequently initiated treatment.
{"title":"Trends in Pharmacological Treatment of Patients With New Onset Type 2 Diabetes: Usage Patterns in an Evolving Guideline Landscape","authors":"William Hou, Katherine R. Tuttle, Weining Shen, Andrew Reikes, Jonathan H. Watanabe","doi":"10.1111/1753-0407.70108","DOIUrl":"https://doi.org/10.1111/1753-0407.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>In patients with new onset type 2 diabetes, this study aimed to analyze glucose-lowering medication use patterns between 2014 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This retrospective study included adults with incident type 2 diabetes in the University of California Health System between 2014 and 2022. We determined medications used within 1 year of diagnosis and evaluated statistical evidence of use pattern changes via Mann–Kendall trend tests. Four categories of high-risk patients requiring cardio-kidney-metabolic protection were also evaluated in stratified analyses based on 2024 ADA guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 40 150 patients with incident type 2 diabetes, 38.5% initiated glucose-lowering medication within 1 year. Metformin remained the most used medication from 2014 to 2022. From 2014 to 2022, usage of GLP-1 receptor agonists and SGLT-2 inhibitors increased exponentially. GLP-1 receptor agonist use increased from below 2.5%–21%. While SGLT-2 inhibitor use increased from less than 2.5%–14%. This growth coincided with a decline in sulfonylurea usage. Among high-risk, insulin was most prevalent in those with heart failure or chronic kidney disease. However, usage of insulin declined overall in all groups. Utilization of SGLT-2 inhibitors was particularly high in patients with prior heart failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In adults with new onset type 2 diabetes, GLP-1 receptor agonist and SGLT-2 inhibitor utilization has markedly increased, coordinating with evolving guidelines that emphasize cardiovascular and chronic kidney disease management. However, overall adoption rates of these medications remain low based on indicated populations. Sulfonylurea use declined while metformin remains the most frequently initiated treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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