Pub Date : 2025-09-14DOI: 10.1016/s2213-8587(25)00262-1
Naveed Sattar, Michael E J Lean
No Abstract
没有抽象的
{"title":"Semaglutide 7·2 mg: another step towards tackling diseases mediated by obesity","authors":"Naveed Sattar, Michael E J Lean","doi":"10.1016/s2213-8587(25)00262-1","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00262-1","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"8 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-14DOI: 10.1016/s2213-8587(25)00226-8
Sean Wharton, Paula Freitas, Jøran Hjelmesæth, Maria Kabisch, Kristian Kandler, Ildiko Lingvay, Maria Quiroga, Julio Rosenstock, W Timothy Garvey
Background
Once-weekly subcutaneous semaglutide 2·4 mg is approved for weight management in people with obesity and related complications; however, some individuals do not reach their therapeutic goals with this dose. We aimed to test the efficacy and safety of a higher dose of semaglutide (7·2 mg) in people with obesity.
Methods
STEP UP was a phase 3b, randomised, double-blind, placebo-controlled and active-controlled trial conducted across 95 hospitals, specialist clinics, and medical centres in 11 countries in adults with BMI 30 kg/m2 or greater, without diabetes. Participants were randomly assigned (5:1:1) to receive once-weekly subcutaneous semaglutide 7·2 mg, 2·4 mg, or placebo, with a lifestyle intervention, for 72 weeks. Coprimary endpoints were percentage change in bodyweight and the proportion of participants with a bodyweight reduction of 5% or greater for semaglutide 7·2 mg versus placebo from baseline to week 72 (treatment policy estimand). Confirmatory secondary endpoints were percentage change in bodyweight with 7·2 mg versus 2·4 mg, change in waist circumference (cm), and proportion of participants with bodyweight reductions of 10% or greater, 15% or greater, 20% or greater, and 25% or greater versus placebo, and 20% or greater and 25% or greater versus 2·4 mg. Safety was assessed in all participants who received at least one dose of the trial product. This trial is registered with ClinicalTrials.gov (NCT05646706) and is now completed.
Findings
Between Jan 1, 2023, and Nov 26, 2024, 1407 participants were randomly assigned to semaglutide 7·2 mg (n=1005), semaglutide 2·4 mg (n=201), or placebo (n=201). 1037 (73·7%) of 1407 participants were female, the mean age was 47 (SD 12) years, mean bodyweight was 113·0 (24·1) kg, and mean BMI was 39·9 (7·1) kg/m2. The mean change in bodyweight was greater with semaglutide 7·2 mg versus 2·4 mg (–18·7% [SE 0·4] vs –15·6% [0·7]; estimated treatment difference [ETD] –3·1% [95% CI –4·7 to –1·6]; p<0·0001) and with semaglutide 7·2 mg versus placebo (–18·7% [0·4] vs –3·9% [0·6]; –14·8% [–16·2 to –13·4]; p<0·0001). Participants in the semaglutide 7·2 mg group were more likely than those in the placebo group to reach bodyweight reductions of 5% or greater (odds ratio 12·1 [95% CI 8·3 to 17·6]; p<0·0001), 10% or greater (14·5 [9·6 to 21·9]; p<0·0001), 15% or greater (20·3 [11·2 to 36·8]; p<0·0001), 20% or greater (27·3 [10·9 to 68·0]; p<0·0001), and 25% or greater (127·4 [36·8 to 441·
{"title":"Once-weekly semaglutide 7·2 mg in adults with obesity (STEP UP): a randomised, controlled, phase 3b trial","authors":"Sean Wharton, Paula Freitas, Jøran Hjelmesæth, Maria Kabisch, Kristian Kandler, Ildiko Lingvay, Maria Quiroga, Julio Rosenstock, W Timothy Garvey","doi":"10.1016/s2213-8587(25)00226-8","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00226-8","url":null,"abstract":"<h3>Background</h3>Once-weekly subcutaneous semaglutide 2·4 mg is approved for weight management in people with obesity and related complications; however, some individuals do not reach their therapeutic goals with this dose. We aimed to test the efficacy and safety of a higher dose of semaglutide (7·2 mg) in people with obesity.<h3>Methods</h3>STEP UP was a phase 3b, randomised, double-blind, placebo-controlled and active-controlled trial conducted across 95 hospitals, specialist clinics, and medical centres in 11 countries in adults with BMI 30 kg/m<sup>2</sup> or greater, without diabetes. Participants were randomly assigned (5:1:1) to receive once-weekly subcutaneous semaglutide 7·2 mg, 2·4 mg, or placebo, with a lifestyle intervention, for 72 weeks. Coprimary endpoints were percentage change in bodyweight and the proportion of participants with a bodyweight reduction of 5% or greater for semaglutide 7·2 mg versus placebo from baseline to week 72 (treatment policy estimand). Confirmatory secondary endpoints were percentage change in bodyweight with 7·2 mg versus 2·4 mg, change in waist circumference (cm), and proportion of participants with bodyweight reductions of 10% or greater, 15% or greater, 20% or greater, and 25% or greater versus placebo, and 20% or greater and 25% or greater versus 2·4 mg. Safety was assessed in all participants who received at least one dose of the trial product. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT05646706</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>) and is now completed.<h3>Findings</h3>Between Jan 1, 2023, and Nov 26, 2024, 1407 participants were randomly assigned to semaglutide 7·2 mg (n=1005), semaglutide 2·4 mg (n=201), or placebo (n=201). 1037 (73·7%) of 1407 participants were female, the mean age was 47 (SD 12) years, mean bodyweight was 113·0 (24·1) kg, and mean BMI was 39·9 (7·1) kg/m<sup>2</sup>. The mean change in bodyweight was greater with semaglutide 7·2 mg versus 2·4 mg (–18·7% [SE 0·4] <em>vs</em> –15·6% [0·7]; estimated treatment difference [ETD] –3·1% [95% CI –4·7 to –1·6]; p<0·0001) and with semaglutide 7·2 mg versus placebo (–18·7% [0·4] <em>vs</em> –3·9% [0·6]; –14·8% [–16·2 to –13·4]; p<0·0001). Participants in the semaglutide 7·2 mg group were more likely than those in the placebo group to reach bodyweight reductions of 5% or greater (odds ratio 12·1 [95% CI 8·3 to 17·6]; p<0·0001), 10% or greater (14·5 [9·6 to 21·9]; p<0·0001), 15% or greater (20·3 [11·2 to 36·8]; p<0·0001), 20% or greater (27·3 [10·9 to 68·0]; p<0·0001), and 25% or greater (127·4 [36·8 to 441·","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"42 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-14DOI: 10.1016/s2213-8587(25)00225-6
Ildiko Lingvay, Sara J Bergenheim, John B Buse, Paula Freitas, W Timothy Garvey, Nina M Harder-Lauridsen, Julio Rosenstock, Kushal Sahu, Sean Wharton
Background
Semaglutide 2·4 mg is approved for weight management in adults with obesity or overweight in the presence of at least one obesity-related complication; however, many people with obesity and type 2 diabetes do not reach their bodyweight reduction goals with this dose. We aimed to investigate the efficacy and safety of a new 7·2 mg maintenance dose of once-weekly subcutaneous semaglutide in people with obesity and type 2 diabetes.
Methods
STEP UP T2D was a randomised, phase 3b, double-blind controlled, three-arm, parallel-group trial conducted at 68 hospitals, specialist clinics, and medical centres in Bulgaria, Canada, Hungary, Poland, Portugal, Slovakia, South Africa, and the USA. Adults aged 18 years or older (BMI ≥30·0 kg/m2, HbA1c 7·0–10·0% [53–86 mmol/mol]) were randomly assigned (3:1:1) to receive once-weekly subcutaneous semaglutide 7·2 mg, 2·4 mg, or placebo, alongside a lifestyle intervention, for 72 weeks. Coprimary endpoints were the percentage change in bodyweight and the proportion of participants reaching a bodyweight reduction of 5% or greater with semaglutide 7·2 mg versus placebo. Confirmatory secondary endpoints were the proportion of participants reaching a bodyweight reduction of 10% or greater, 15% or greater, and 20% or greater, and changes in waist circumference (cm) and HbA1c (%) with semaglutide 7·2 mg versus placebo. Efficacy was assessed in all randomly assigned participants, and safety was assessed in all randomly assigned participants who received at least one dose of the trial product. This trial is registered with ClinicalTrials.gov (NCT05649137) and is now closed and completed.
Findings
Between Jan 4 and May 4, 2023, 512 participants were randomly assigned to receive semaglutide 7·2 mg (n=307), semaglutide 2·4 mg (n=103), or placebo (n=102). 265 (51·8%) of 512 participants were female, the mean age was 56 (SD 10) years, mean bodyweight was 110·1 (22·9) kg, mean BMI was 38·6 (7·1) kg/m2, and mean HbA1c was 8·1% (0·9). Compared with placebo, semaglutide 7·2 mg led to greater reductions in mean bodyweight (−13·2% vs −3·9%; estimated treatment difference [ETD] −9·3% [95% CI −11·0 to −7·7]; p<0·0001); more participants reaching bodyweight reductions of 5% or greater (odds ratio 10·0 [95% CI 6·0 to 16·9]; p<0·0001), 10% or greater (11·3 [5·9 to 21·4]; p<0·0001), 15% or greater (8·1 [3·7 to 17·7]; p<0·0001), and 20% or greater (12·3 [3·0 to 51·0]; p=0·0006); and reduced waist
{"title":"Once-weekly semaglutide 7·2 mg in adults with obesity and type 2 diabetes (STEP UP T2D): a randomised, controlled, phase 3b trial","authors":"Ildiko Lingvay, Sara J Bergenheim, John B Buse, Paula Freitas, W Timothy Garvey, Nina M Harder-Lauridsen, Julio Rosenstock, Kushal Sahu, Sean Wharton","doi":"10.1016/s2213-8587(25)00225-6","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00225-6","url":null,"abstract":"<h3>Background</h3>Semaglutide 2·4 mg is approved for weight management in adults with obesity or overweight in the presence of at least one obesity-related complication; however, many people with obesity and type 2 diabetes do not reach their bodyweight reduction goals with this dose. We aimed to investigate the efficacy and safety of a new 7·2 mg maintenance dose of once-weekly subcutaneous semaglutide in people with obesity and type 2 diabetes.<h3>Methods</h3>STEP UP T2D was a randomised, phase 3b, double-blind controlled, three-arm, parallel-group trial conducted at 68 hospitals, specialist clinics, and medical centres in Bulgaria, Canada, Hungary, Poland, Portugal, Slovakia, South Africa, and the USA. Adults aged 18 years or older (BMI ≥30·0 kg/m<sup>2</sup>, HbA<sub>1c</sub> 7·0–10·0% [53–86 mmol/mol]) were randomly assigned (3:1:1) to receive once-weekly subcutaneous semaglutide 7·2 mg, 2·4 mg, or placebo, alongside a lifestyle intervention, for 72 weeks. Coprimary endpoints were the percentage change in bodyweight and the proportion of participants reaching a bodyweight reduction of 5% or greater with semaglutide 7·2 mg versus placebo. Confirmatory secondary endpoints were the proportion of participants reaching a bodyweight reduction of 10% or greater, 15% or greater, and 20% or greater, and changes in waist circumference (cm) and HbA<sub>1c</sub> (%) with semaglutide 7·2 mg versus placebo. Efficacy was assessed in all randomly assigned participants, and safety was assessed in all randomly assigned participants who received at least one dose of the trial product. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT05649137</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>) and is now closed and completed.<h3>Findings</h3>Between Jan 4 and May 4, 2023, 512 participants were randomly assigned to receive semaglutide 7·2 mg (n=307), semaglutide 2·4 mg (n=103), or placebo (n=102). 265 (51·8%) of 512 participants were female, the mean age was 56 (SD 10) years, mean bodyweight was 110·1 (22·9) kg, mean BMI was 38·6 (7·1) kg/m<sup>2</sup>, and mean HbA<sub>1c</sub> was 8·1% (0·9). Compared with placebo, semaglutide 7·2 mg led to greater reductions in mean bodyweight (−13·2% <em>vs</em> −3·9%; estimated treatment difference [ETD] −9·3% [95% CI −11·0 to −7·7]; p<0·0001); more participants reaching bodyweight reductions of 5% or greater (odds ratio 10·0 [95% CI 6·0 to 16·9]; p<0·0001), 10% or greater (11·3 [5·9 to 21·4]; p<0·0001), 15% or greater (8·1 [3·7 to 17·7]; p<0·0001), and 20% or greater (12·3 [3·0 to 51·0]; p=0·0006); and reduced waist ","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"17 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-12DOI: 10.1016/s2213-8587(25)00256-6
Ram Jagannathan, Lisa R Staimez, K M Venkat Narayan
No Abstract
没有抽象的
{"title":"Type 2 diabetes subtypes classification: a global reckoning with heterogeneity","authors":"Ram Jagannathan, Lisa R Staimez, K M Venkat Narayan","doi":"10.1016/s2213-8587(25)00256-6","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00256-6","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"33 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-28DOI: 10.1016/s2213-8587(25)00264-5
No Abstract
没有抽象的
{"title":"What is the hidden cost of expensive drugs?","authors":"","doi":"10.1016/s2213-8587(25)00264-5","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00264-5","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"21 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-25DOI: 10.1016/s2213-8587(25)00227-x
Maria Fleseriu, Elena V Varlamov, Amit Akirov, Fabienne Langlois, Stephan Petersenn, Shlomo Melmed
Hyperprolactinaemia can result from physiological causes, pharmacological agents, or pathological conditions such as prolactin-secreting pituitary adenomas and other pituitary stalk-compressing masses. Sporadic prolactinomas are the most common functioning pituitary adenomas, with a female predominance during reproductive years. In men, these adenomas are usually larger and more aggressive. Prolactinomas are characterised by positive immunostaining for prolactin, pituitary-specific positive transcription factor 1, and oestrogen receptor α. Dopamine agonists, particularly cabergoline, are typically used as primary therapy. Treatment with up to 2·0 mg per week of cabergoline for at least 6 months normalises prolactin concentrations, achieves adenoma shrinkage of at least 30%, and restores gonadal function in most patients. Transsphenoidal surgery is increasingly used as primary therapy for small prolactinomas given a high chance of remission; transsphenoidal surgery is also indicated for patients with dopamine agonist intolerance or resistance. Radiotherapy is reserved for treatment-refractory prolactinomas. Multidisciplinary management and an individualised approach are key to maximising therapeutic responsiveness and optimising outcomes. In this Review, we assess evidence relating to pathogenesis, diagnosis, and management of prolactinomas, and highlight opportunities for future research.
{"title":"Prolactin-secreting adenomas: pathogenesis, diagnosis, and management","authors":"Maria Fleseriu, Elena V Varlamov, Amit Akirov, Fabienne Langlois, Stephan Petersenn, Shlomo Melmed","doi":"10.1016/s2213-8587(25)00227-x","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00227-x","url":null,"abstract":"Hyperprolactinaemia can result from physiological causes, pharmacological agents, or pathological conditions such as prolactin-secreting pituitary adenomas and other pituitary stalk-compressing masses. Sporadic prolactinomas are the most common functioning pituitary adenomas, with a female predominance during reproductive years. In men, these adenomas are usually larger and more aggressive. Prolactinomas are characterised by positive immunostaining for prolactin, pituitary-specific positive transcription factor 1, and oestrogen receptor α. Dopamine agonists, particularly cabergoline, are typically used as primary therapy. Treatment with up to 2·0 mg per week of cabergoline for at least 6 months normalises prolactin concentrations, achieves adenoma shrinkage of at least 30%, and restores gonadal function in most patients. Transsphenoidal surgery is increasingly used as primary therapy for small prolactinomas given a high chance of remission; transsphenoidal surgery is also indicated for patients with dopamine agonist intolerance or resistance. Radiotherapy is reserved for treatment-refractory prolactinomas. Multidisciplinary management and an individualised approach are key to maximising therapeutic responsiveness and optimising outcomes. In this Review, we assess evidence relating to pathogenesis, diagnosis, and management of prolactinomas, and highlight opportunities for future research.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"178 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-25DOI: 10.1016/s2213-8587(25)00200-1
Anna Solini
No Abstract
没有抽象的
{"title":"Cardiovascular risk in type 1 versus type 2 diabetes","authors":"Anna Solini","doi":"10.1016/s2213-8587(25)00200-1","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00200-1","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"8 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-25DOI: 10.1016/s2213-8587(25)00165-2
Vagia Patsoukaki, Lars Lind, Erik Lampa, Sadiq Radhi, Katarina Eeg-Olofsson, Björn Eliasson, Jan W Eriksson
Background
Despite improvements in diabetes care and risk factor management, the residual risk for cardiovascular disease and premature death remains substantially elevated in people both with type 1 and type 2 diabetes. This study aimed to compare the risk of cardiovascular disease and mortality, as well as the contibution of underlying risk factors, between type 1 and type 2 diabetes.
Methods
In this nationwide, population-based cohort study, all living people with diabetes aged 18–84 years reported in the Swedish National Diabetes Register (NDR) by Jan 1, 2016, were followed-up over a period of 5 years until Dec 31, 2020. Data from the National Patient Register, including all inpatient and outpatient hospital visits, were used to compare the incidence of major cardiovascular disease events (myocardial infarction, heart failure onset or exacerbation, stroke, and cardiovascular death) and all-cause death, also in different age groups. Baseline data were collected from NDR and other national registers. Cox regression analyses, adjusted for age and sex, as well as for multiple cardiovascular risk factors were performed. In addition, the type 1 diabetes and type 2 diabetes cohorts were compared with matched control groups with no diabetes.
Findings
404 026 adults with type 1 diabetes (38 351 [9·5%]) or type 2 diabetes (365 675 [90·5%]) were included. Individuals with type 2 diabetes had a higher risk than individuals with type 1 diabetes for the composite endpoint of any cardiovascular disease event (HR 1·23, 95% CI 1·07–1·41) at ages younger than 50 years but a lower risk at ages older than 60 years (0·87, 0·82–0·92). A similar pattern was observed for myocardial infarction (0·67, 0·61–0·73) and all-cause mortality (0·89, 0·84–0·95) in ages older than 60 years. However, the risk for stroke was overall lower in type 2 diabetes (0·91, 0·84–0·98, all ages combined), whereas for heart failure it was higher at ages younger than 50 years (1·60, 1·15–2·21). Among people with previous cardiovascular disease, those with type 2 diabetes overall had a lower risk versus type 1 diabetes for all cardiovascular disease (0·76, 0·70–0·81), for myocardial infarction (0·62, 0·56–0·70), cardiovascular mortality (0·68, 0·61–0·75) and all-cause mortality (0·71, 0·66–0·77). In analyses adjusting for multiple cardiovascular risk factors, the whole cohort with type 2 diabetes had a greater risk for incident cardiovascular disease and mortality compared with type 1 diabetes. However, when diabetes duration was excluded from the model, type 1 diabetes was associated with higher risk. Compared with matched controls, both diabetes types were associated with greater risk for the studied outcomes, but this was most marked for type 1 diabetes.
Interpretation
In this study, type 1 diabetes was associated with higher overall risk for cardiovascular disease events and all-cause mortality than type 2 diabetes, particularly at ages older than 60 years for
{"title":"Risk differences and underlying factors of cardiovascular events and mortality in patients with type 2 diabetes versus type 1 diabetes: a longitudinal cohort study of Swedish nationwide register data","authors":"Vagia Patsoukaki, Lars Lind, Erik Lampa, Sadiq Radhi, Katarina Eeg-Olofsson, Björn Eliasson, Jan W Eriksson","doi":"10.1016/s2213-8587(25)00165-2","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00165-2","url":null,"abstract":"<h3>Background</h3>Despite improvements in diabetes care and risk factor management, the residual risk for cardiovascular disease and premature death remains substantially elevated in people both with type 1 and type 2 diabetes. This study aimed to compare the risk of cardiovascular disease and mortality, as well as the contibution of underlying risk factors, between type 1 and type 2 diabetes.<h3>Methods</h3>In this nationwide, population-based cohort study, all living people with diabetes aged 18–84 years reported in the Swedish National Diabetes Register (NDR) by Jan 1, 2016, were followed-up over a period of 5 years until Dec 31, 2020. Data from the National Patient Register, including all inpatient and outpatient hospital visits, were used to compare the incidence of major cardiovascular disease events (myocardial infarction, heart failure onset or exacerbation, stroke, and cardiovascular death) and all-cause death, also in different age groups. Baseline data were collected from NDR and other national registers. Cox regression analyses, adjusted for age and sex, as well as for multiple cardiovascular risk factors were performed. In addition, the type 1 diabetes and type 2 diabetes cohorts were compared with matched control groups with no diabetes.<h3>Findings</h3>404 026 adults with type 1 diabetes (38 351 [9·5%]) or type 2 diabetes (365 675 [90·5%]) were included. Individuals with type 2 diabetes had a higher risk than individuals with type 1 diabetes for the composite endpoint of any cardiovascular disease event (HR 1·23, 95% CI 1·07–1·41) at ages younger than 50 years but a lower risk at ages older than 60 years (0·87, 0·82–0·92). A similar pattern was observed for myocardial infarction (0·67, 0·61–0·73) and all-cause mortality (0·89, 0·84–0·95) in ages older than 60 years. However, the risk for stroke was overall lower in type 2 diabetes (0·91, 0·84–0·98, all ages combined), whereas for heart failure it was higher at ages younger than 50 years (1·60, 1·15–2·21). Among people with previous cardiovascular disease, those with type 2 diabetes overall had a lower risk versus type 1 diabetes for all cardiovascular disease (0·76, 0·70–0·81), for myocardial infarction (0·62, 0·56–0·70), cardiovascular mortality (0·68, 0·61–0·75) and all-cause mortality (0·71, 0·66–0·77). In analyses adjusting for multiple cardiovascular risk factors, the whole cohort with type 2 diabetes had a greater risk for incident cardiovascular disease and mortality compared with type 1 diabetes. However, when diabetes duration was excluded from the model, type 1 diabetes was associated with higher risk. Compared with matched controls, both diabetes types were associated with greater risk for the studied outcomes, but this was most marked for type 1 diabetes.<h3>Interpretation</h3>In this study, type 1 diabetes was associated with higher overall risk for cardiovascular disease events and all-cause mortality than type 2 diabetes, particularly at ages older than 60 years for","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"9 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-22DOI: 10.1016/s2213-8587(25)00254-2
Naveed Sattar
No Abstract
没有抽象的
{"title":"Rethinking obesity through the lens of genetics, environment and differential life circumstances","authors":"Naveed Sattar","doi":"10.1016/s2213-8587(25)00254-2","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00254-2","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"18 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144901698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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