Pub Date : 2026-02-01DOI: 10.1016/j.pcd.2025.11.006
Rachel D. Gordon , Jiqiang Wu , Jennifer Grasch , Neeharika Nandam , Patrick Schneider , Steven Gabbe , Mark B. Landon , Maged M. Costantine , Kartik K. Venkatesh , Elizabeth O. Buschur
We conducted a prospective observational cohort of pregnant individuals to compare continuous glucose monitoring trends between pregnant individuals with varying levels of glucose intolerance. We found that individuals who had an abnormal value on an oral glucose tolerance test had similar glucose trends to those with gestational diabetes mellitus
{"title":"Continuous glucose monitoring patterns among pregnant individuals with varying levels of glucose intolerance","authors":"Rachel D. Gordon , Jiqiang Wu , Jennifer Grasch , Neeharika Nandam , Patrick Schneider , Steven Gabbe , Mark B. Landon , Maged M. Costantine , Kartik K. Venkatesh , Elizabeth O. Buschur","doi":"10.1016/j.pcd.2025.11.006","DOIUrl":"10.1016/j.pcd.2025.11.006","url":null,"abstract":"<div><div>We conducted a prospective observational cohort of pregnant individuals to compare continuous glucose monitoring trends between pregnant individuals with varying levels of glucose intolerance. We found that individuals who had an abnormal value on an oral glucose tolerance test had similar glucose trends to those with gestational diabetes mellitus</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 133-136"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.pcd.2025.12.006
Jenna Meiman , Abigail Steinbrunner , Naleef Fareed , Joshua J. Joseph , Mark B. Landon , William A. Grobman , Kartik K. Venkatesh
We determined whether achieving glycemic control during pregnancy was associated with fewer postpartum depressive symptoms among individuals with pregestational diabetes. We found achievement of pregnancy glycemic targets was not associated with a lower risk of postpartum depressive symptoms in a population with a high frequency of pre-existing psychiatric morbidity.
{"title":"Achieving pregnancy glycemic targets and postpartum depressive symptoms among individuals with pregestational diabetes","authors":"Jenna Meiman , Abigail Steinbrunner , Naleef Fareed , Joshua J. Joseph , Mark B. Landon , William A. Grobman , Kartik K. Venkatesh","doi":"10.1016/j.pcd.2025.12.006","DOIUrl":"10.1016/j.pcd.2025.12.006","url":null,"abstract":"<div><div>We determined whether achieving glycemic control during pregnancy was associated with fewer postpartum depressive symptoms among individuals with pregestational diabetes. We found achievement of pregnancy glycemic targets was not associated with a lower risk of postpartum depressive symptoms in a population with a high frequency of pre-existing psychiatric morbidity.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 137-139"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.pcd.2025.11.012
Domingo Orozco-Beltran , Samuel Seidu , Jose Antonio Quesada
AIM
Glycated hemoglobin (HbA1c) is a key indicator of diabetes control. However, the risk of missing HbA1c values in clinical records is unknown. We aimed to analyze the relationship between missing HbA1c values and the occurrence of major cardiovascular events or death from all causes.
Methods
Retrospective cohort study based on a national database of primary care electronic medical records in Spain (BIFAP). We included people aged 30 years and older with an incident diagnosis of diabetes mellitus. Follow-up started on the date of diabetes diagnosis between 2005 and 2019, and ended on occurrence of composite endpoint (major cardiovascular events and/or death from all causes), or December 31st, 2019. The baseline exposure variable was HbA1c (< 7 %, 7 %–8 %, > 8 %, missing). Cox models were fitted.
Results
Our analysis included 303,199 people with diabetes, with an average age of 62.2 years and 44.7 % were women. The mean follow-up was 5.7 years, and 10.2 % of patients had missing HbA1c values. The cardiovascular risk was 1.18 (95 %CI: 1.14–1.22) in the HbA1c 7 %-8 % group, 1.41 (95 %CI: 1.36–1.46) in HbA1c > 8 %, and 2.95 (95 %CI: 2.89–3.05) in HbA1c missing, compared with HbA1c < 7 %.
Conclusions
In this large cohort of people with newly diagnosed diabetes, missing HbA1c values was associated with a significantly higher risk of major cardiovascular events or death, more than double the risk observed in people with the worst glycemic control. These findings underscore the clinical importance of routinely recording and monitoring HbA1c at diagnosis, not only as a marker of metabolic control but also as a potential prognostic indicator. The lack of HbA1c may act as an indicator of suboptimal clinical follow-up.
{"title":"Routine HbA1c monitoring and cardiovascular outcomes in diabetes: Evidence from a large Spanish cohort","authors":"Domingo Orozco-Beltran , Samuel Seidu , Jose Antonio Quesada","doi":"10.1016/j.pcd.2025.11.012","DOIUrl":"10.1016/j.pcd.2025.11.012","url":null,"abstract":"<div><h3>AIM</h3><div>Glycated hemoglobin (HbA<sub>1c</sub>) is a key indicator of diabetes control. However, the risk of missing HbA<sub>1c</sub> values in clinical records is unknown. We aimed to analyze the relationship between missing HbA<sub>1c</sub> values and the occurrence of major cardiovascular events or death from all causes.</div></div><div><h3>Methods</h3><div>Retrospective cohort study based on a national database of primary care electronic medical records in Spain (BIFAP). We included people aged 30 years and older with an incident diagnosis of diabetes mellitus. Follow-up started on the date of diabetes diagnosis between 2005 and 2019, and ended on occurrence of composite endpoint (major cardiovascular events and/or death from all causes), or <em>December 31st</em>, 2019. The baseline exposure variable was HbA<sub>1c</sub> (< 7 %, 7 %–8 %, > 8 %, missing). Cox models were fitted.</div></div><div><h3>Results</h3><div>Our analysis included 303,199 people with diabetes, with an average age of 62.2 years and 44.7 % were women. The mean follow-up was 5.7 years, and 10.2 % of patients had missing HbA<sub>1c</sub> values. The cardiovascular risk was 1.18 (95 %CI: 1.14–1.22) in the HbA<sub>1c</sub> 7 %-8 % group, 1.41 (95 %CI: 1.36–1.46) in HbA<sub>1c</sub> > 8 %, and 2.95 (95 %CI: 2.89–3.05) in HbA<sub>1c</sub> missing, compared with HbA<sub>1c</sub> < 7 %.</div></div><div><h3>Conclusions</h3><div>In this large cohort of people with newly diagnosed diabetes, missing HbA1c values was associated with a significantly higher risk of major cardiovascular events or death, more than double the risk observed in people with the worst glycemic control. These findings underscore the clinical importance of routinely recording and monitoring HbA1c at diagnosis, not only as a marker of metabolic control but also as a potential prognostic indicator. The lack of HbA1c may act as an indicator of suboptimal clinical follow-up.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 13-20"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.pcd.2025.10.005
S. Carrod , M.B. Whyte , K. Bennett-Eastley , P. Grob , C. Steacy , M. Shabbir , M. Glover , J. Harris , K. Hart , H. Gage , M. Stedman , A. Heald , D. Cooke
Aims
To deliver and evaluate online, supported self-management interventions (BEATdiabetes) designed to promote lifestyle change and reduce psychological distress in type 2 diabetes (T2D).
Design & methods
A prospective service evaluation of BEATdiabetes, delivered within primary care in the National Health Service (NHS), 2019–2021. Primary outcome was absolute change in HbA1c and secondary outcomes were BMI, blood pressure (BP) and total cholesterol (TC) analysed using adjusted regression models. Pre- and post-analysis of the Diabetes Distress Scale (DDS) in the BEATdiabetes group only. The comparator population was The Salford Integrated Record (SIR, Salford, UK) diabetes cohort (no access to BEATdiabetes); matched by age, sex, ethnicity and BMI. Odds ratios (OR) evaluated achievement of clinical targets according to national guidelines.
Results
BEATdiabetes (n = 574) followed for median 217 days (interquartile range [IQR] 158–328); comparator group 241 days (IQR 187–328). BEATdiabetes had greater change in mean HbA1c (0.3 % DCCT; −3.3 mmol/mol; 95 % confidence interval [CI] −4.7 to −1.9 mmol/mol), BMI (-0.81 kg/m2; 95 % CI −1.07 to −0.54), systolic BP (-2.8 mmHg; 95 % CI −4.3 to −1.3; all P < 0.001), and diastolic BP (-1.3 mmHg; 95 % CI −2.3 to −0.3; P < 0.01). At baseline, n = 58 had DDS of ≥ 2 and n = 39 at follow-up (P = 0.023). BEATdiabetes had greater achievement target BP (OR 1.69 [95 % CI 1.28–2.24]), HbA1c (OR 1.79 [95 % CI 1.33–2.42]) and TC (OR 0.71 [95 % CI 0.50–0.99]). Estimated average cost per intervention was £ 149; 2021/2).
Conclusions
Combined online nutritional, psychological and behavioural intervention was more effective for weight and glycaemic reduction among adults with T2D, compared with usual care, with associated reduction in DDS.
{"title":"The impact of an online self-management programme for type 2 diabetes. The BEATdiabetes prospective service evaluation","authors":"S. Carrod , M.B. Whyte , K. Bennett-Eastley , P. Grob , C. Steacy , M. Shabbir , M. Glover , J. Harris , K. Hart , H. Gage , M. Stedman , A. Heald , D. Cooke","doi":"10.1016/j.pcd.2025.10.005","DOIUrl":"10.1016/j.pcd.2025.10.005","url":null,"abstract":"<div><h3>Aims</h3><div>To deliver and evaluate online, supported self-management interventions (BEATdiabetes) designed to promote lifestyle change and reduce psychological distress in type 2 diabetes (T2D).</div></div><div><h3>Design & methods</h3><div>A prospective service evaluation of BEATdiabetes, delivered within primary care in the National Health Service (NHS), 2019–2021. Primary outcome was absolute change in HbA1c and secondary outcomes were BMI, blood pressure (BP) and total cholesterol (TC) analysed using adjusted regression models. Pre- and post-analysis of the Diabetes Distress Scale (DDS) in the BEATdiabetes group only. The comparator population was The Salford Integrated Record (SIR, Salford, UK) diabetes cohort (no access to BEATdiabetes); matched by age, sex, ethnicity and BMI. Odds ratios (OR) evaluated achievement of clinical targets according to national guidelines.</div></div><div><h3>Results</h3><div>BEATdiabetes (n = 574) followed for median 217 days (interquartile range [IQR] 158–328); comparator group 241 days (IQR 187–328). BEATdiabetes had greater change in mean HbA1c (0.3 % DCCT; −3.3 mmol/mol; 95 % confidence interval [CI] −4.7 to −1.9 mmol/mol), BMI (-0.81 kg/m<sup>2</sup>; 95 % CI −1.07 to −0.54), systolic BP (-2.8 mmHg; 95 % CI −4.3 to −1.3; all P < 0.001), and diastolic BP (-1.3 mmHg; 95 % CI −2.3 to −0.3; P < 0.01). At baseline, n = 58 had DDS of ≥ 2 and n = 39 at follow-up (P = 0.023). BEATdiabetes had greater achievement target BP (OR 1.69 [95 % CI 1.28–2.24]), HbA1c (OR 1.79 [95 % CI 1.33–2.42]) and TC (OR 0.71 [95 % CI 0.50–0.99]). Estimated average cost per intervention was £ 149; 2021/2).</div></div><div><h3>Conclusions</h3><div>Combined online nutritional, psychological and behavioural intervention was more effective for weight and glycaemic reduction among adults with T2D, compared with usual care, with associated reduction in DDS.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 21-29"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.pcd.2025.10.008
Min Kyoung Jang, Yun Kyung Cho, Jung Yoon Moon, Se Hee Min, Ju Hee Hwang, Chang Hee Jung
Mobile health (mHealth) interventions incorporating smartwatches and personalized coaching show promise in improving diabetes self-management. Although studies report modest glycemic benefits and behavioral improvements from app-based interventions, real-world data from East Asian populations remain limited.
Aims
To evaluate the effectiveness of a smartwatch-based, app-linked lifestyle intervention (iSMART-DM) in improving glycemic control and self-care behavior in patients with non-insulin-treated type 2 diabetes mellitus (T2DM).
Methods
In a 12-week, open-label randomized controlled trial, 80 adults with T2DM were randomized in a 2:1 ratio to an intervention group (n = 54; smartwatch + mobile app + structured education) or a control group (n = 26; structured education alone). The primary endpoint was the change in glycated hemoglobin (HbA1c). Secondary endpoints included fasting plasma glucose (FPG), HbA1c target attainment (<6.5 %), and changes in self-care behavior scores using the Summary of Diabetes Self-Care Activities Questionnaire (SDSCA-K). Satisfaction and adherence to the digital health intervention were also assessed.
Results
After 12 weeks, the mean HbA1c change was −0.14 % and −0.13 % in the intervention and control groups, respectively (p = 0.837). No significant differences were observed in FPG change or HbA1c target attainment. However, the intervention group showed significantly greater improvement in SDSCA-K scores (+9.7 points; 95 % CI 4.0–15.6; p = 0.001), particularly in diet and physical activity. User satisfaction with the mobile platform was high, with > 85 % reporting a positive effect on daily health management.
Conclusions
Although short-term glycemic control showed no significant difference, the smartwatch-based mobile intervention significantly enhanced self-care behaviors in patients with T2DM. These findings highlight the behavioral benefits of wearable-integrated mHealth platforms and support their broader application in lifestyle modification strategies
结合智能手表和个性化指导的移动健康（mHealth）干预措施有望改善糖尿病自我管理。尽管研究报告了基于应用程序的干预措施对血糖和行为的适度改善，但来自东亚人群的真实数据仍然有限。目的：评估基于智能手表、与应用程序相关的生活方式干预（iSMART-DM）在改善非胰岛素治疗的2型糖尿病（T2DM）患者血糖控制和自我护理行为方面的有效性。方法：在一项为期12周的开放标签随机对照试验中，80名成年T2DM患者按2:1的比例随机分为干预组（n = 54；智能手表+移动应用+结构化教育）和对照组（n = 26；仅进行结构化教育）。主要终点是糖化血红蛋白（HbA1c）的变化。次要终点包括空腹血糖（FPG）、HbA1c达标情况(结果：12周后，干预组和对照组的平均HbA1c变化分别为-0.14 %和-0.13 % （p = 0.837）。在FPG变化或HbA1c目标达成方面未观察到显著差异。然而，干预组在SDSCA-K评分（+9.7分；95 % CI 4.0-15.6; p = 0.001），特别是在饮食和体育活动方面，表现出更大的改善。用户对移动平台的满意度很高，> 85% %报告了对日常健康管理的积极影响。结论：虽然短期血糖控制无显著差异，但基于智能手表的移动干预可显著增强T2DM患者的自我护理行为。这些发现强调了可穿戴集成移动健康平台的行为益处，并支持其在生活方式改变策略中的更广泛应用。
{"title":"Impact of smart watch mobile application on the risk treatment of type 2 diabetes mellitus (iSMART-DM)","authors":"Min Kyoung Jang, Yun Kyung Cho, Jung Yoon Moon, Se Hee Min, Ju Hee Hwang, Chang Hee Jung","doi":"10.1016/j.pcd.2025.10.008","DOIUrl":"10.1016/j.pcd.2025.10.008","url":null,"abstract":"<div><div>Mobile health (mHealth) interventions incorporating smartwatches and personalized coaching show promise in improving diabetes self-management. Although studies report modest glycemic benefits and behavioral improvements from app-based interventions, real-world data from East Asian populations remain limited.</div></div><div><h3>Aims</h3><div>To evaluate the effectiveness of a smartwatch-based, app-linked lifestyle intervention (iSMART-DM) in improving glycemic control and self-care behavior in patients with non-insulin-treated type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>In a 12-week, open-label randomized controlled trial, 80 adults with T2DM were randomized in a 2:1 ratio to an intervention group (n = 54; smartwatch + mobile app + structured education) or a control group (n = 26; structured education alone). The primary endpoint was the change in glycated hemoglobin (HbA1c). Secondary endpoints included fasting plasma glucose (FPG), HbA1c target attainment (<6.5 %), and changes in self-care behavior scores using the Summary of Diabetes Self-Care Activities Questionnaire (SDSCA-K). Satisfaction and adherence to the digital health intervention were also assessed.</div></div><div><h3>Results</h3><div>After 12 weeks, the mean HbA1c change was −0.14 % and −0.13 % in the intervention and control groups, respectively (p = 0.837). No significant differences were observed in FPG change or HbA1c target attainment. However, the intervention group showed significantly greater improvement in SDSCA-K scores (+9.7 points; 95 % CI 4.0–15.6; p = 0.001), particularly in diet and physical activity. User satisfaction with the mobile platform was high, with > 85 % reporting a positive effect on daily health management.</div></div><div><h3>Conclusions</h3><div>Although short-term glycemic control showed no significant difference, the smartwatch-based mobile intervention significantly enhanced self-care behaviors in patients with T2DM. These findings highlight the behavioral benefits of wearable-integrated mHealth platforms and support their broader application in lifestyle modification strategies</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 47-52"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.pcd.2025.12.004
Erik Somersalo , Cedric Korpijaakko , Mia D. Eriksson , Miira M. Klemetti , Hannu Kautiainen , Johan G. Eriksson , Merja K. Laine
Aims
Fetal and neonatal complications are common in pregnancies affected by maternal type 1 diabetes. The aim of this study is to investigate whether type 1 diabetes during pregnancy is reflected in offspring long-term mortality during a follow-up of up to 30 years.
Methods
This register-based follow-up study included 1762 offspring of women with type 1 diabetes (cases) and 8810 offspring of women without diabetes (controls). Time and causes of death between 1988 and 2018 were obtained from Statistics Finland. Clinical characteristics at birth of study participants and their mothers were obtained from the Finnish Medical Birth Register.
Results
Cases had an 1,67 times higher mortality than controls during the 30-year follow-up period (crude HR 1.67 [95 % CI: 1.01–2.77]), with a median follow-up of 21 years (IQR 15–28). Cases possessed an adverse risk-profile at the neonatal stage. Endocrine, nutritional and metabolic diseases (IRR 5.02/100 000 person years [95 % CI 1.01–24.88]), and diseases of the nervous system (IRR 5.03/100 000 person years [95 % CI 1.16–21.82]) were overrepresented as the cause of death in this group.
Conclusions
These findings suggest that maternal type 1 diabetes during pregnancy is associated with higher mortality during a 30-year follow-up.
目的：胎儿和新生儿并发症是常见的妊娠受母体1型糖尿病。本研究的目的是在长达30年的随访期间调查怀孕期间的1型糖尿病是否反映在后代的长期死亡率中。方法：本研究纳入1762例1型糖尿病女性的后代（病例）和8810例非糖尿病女性的后代（对照组）。1988年至2018年期间的死亡时间和原因来自芬兰统计局。研究参与者及其母亲出生时的临床特征从芬兰医学出生登记处获得。结果：30年随访期间，病例死亡率是对照组的1.67倍（粗危险度1.67[95 % CI: 1.01-2.77]），中位随访时间为21年（IQR 15-28）。病例在新生儿阶段具有不利的风险概况。内分泌、营养和代谢性疾病（IRR 5.02/10万人年[95 % CI 1.01-24.88]）和神经系统疾病（IRR 5.03/10万人年[95 % CI 1.16-21.82]）是本组死亡的主要原因。结论：这些发现表明，在30年的随访中，怀孕期间的母亲1型糖尿病与较高的死亡率相关。
{"title":"Mortality in offspring of women with type 1 diabetes during pregnancy","authors":"Erik Somersalo , Cedric Korpijaakko , Mia D. Eriksson , Miira M. Klemetti , Hannu Kautiainen , Johan G. Eriksson , Merja K. Laine","doi":"10.1016/j.pcd.2025.12.004","DOIUrl":"10.1016/j.pcd.2025.12.004","url":null,"abstract":"<div><h3>Aims</h3><div>Fetal and neonatal complications are common in pregnancies affected by maternal type 1 diabetes. The aim of this study is to investigate whether type 1 diabetes during pregnancy is reflected in offspring long-term mortality during a follow-up of up to 30 years.</div></div><div><h3>Methods</h3><div>This register-based follow-up study included 1762 offspring of women with type 1 diabetes (cases) and 8810 offspring of women without diabetes (controls). Time and causes of death between 1988 and 2018 were obtained from Statistics Finland. Clinical characteristics at birth of study participants and their mothers were obtained from the Finnish Medical Birth Register.</div></div><div><h3>Results</h3><div>Cases had an 1,67 times higher mortality than controls during the 30-year follow-up period (crude HR 1.67 [95 % CI: 1.01–2.77]), with a median follow-up of 21 years (IQR 15–28). Cases possessed an adverse risk-profile at the neonatal stage. Endocrine, nutritional and metabolic diseases (IRR 5.02/100 000 person years [95 % CI 1.01–24.88]), and diseases of the nervous system (IRR 5.03/100 000 person years [95 % CI 1.16–21.82]) were overrepresented as the cause of death in this group.</div></div><div><h3>Conclusions</h3><div>These findings suggest that maternal type 1 diabetes during pregnancy is associated with higher mortality during a 30-year follow-up.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 127-132"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.pcd.2025.11.011
Yun-Kai Yeh , Fu-Shun Yen , James Cheng-Chung Wei , Yi-Ting Tsai , Heng-Jun Lin , Ying-Hsiu Shih , Chih-Cheng Hsu , Chii-Min Hwu
Aims
This retrospective cohort study aimed to investigate the impact of pay-for-performance programs (P4P) on hospitalization rates in individuals with type 1 diabetes mellitus (T1D).
Methods
Using propensity score matching, we recruited 625 pairs of individuals with T1D with and without P4P care from the National Health Insurance Research Database of Taiwan between January 1, 2006, and December 31, 2018. The study used a multivariable Cox regression model to compare the risks of hospitalization for various reasons in individuals with T1D with and without P4P care.
Results
Individuals with T1D receiving pay-for-performance (P4P) care demonstrated a significantly lower risk of all-cause hospitalization (adjusted hazard ratio [aHR] 0.63, 95 % confidence interval [CI] 0.54–0.73). This reduction was particularly notable for hospitalizations related to glucose management or metabolic disorders, infectious diseases, pneumonia, circulatory and respiratory system diseases, and mental health, compared with those not receiving P4P care. However, no significant differences were observed in hospitalization risks for hyperglycemic crisis, severe hypoglycemia, or injury between individuals with and without P4P care.
Conclusions
This nationwide cohort study found that P4P participation was associated with a lower risk of hospitalization in individuals with type 1 diabetes.
{"title":"The impact of pay-for-performance programs on hospitalization risks in subjects with type 1 diabetes mellitus: A nationwide cohort study","authors":"Yun-Kai Yeh , Fu-Shun Yen , James Cheng-Chung Wei , Yi-Ting Tsai , Heng-Jun Lin , Ying-Hsiu Shih , Chih-Cheng Hsu , Chii-Min Hwu","doi":"10.1016/j.pcd.2025.11.011","DOIUrl":"10.1016/j.pcd.2025.11.011","url":null,"abstract":"<div><h3>Aims</h3><div>This retrospective cohort study aimed to investigate the impact of pay-for-performance programs (P4P) on hospitalization rates in individuals with type 1 diabetes mellitus (T1D).</div></div><div><h3>Methods</h3><div>Using propensity score matching, we recruited 625 pairs of individuals with T1D with and without P4P care from the National Health Insurance Research Database of Taiwan between January 1, 2006, and December 31, 2018. The study used a multivariable Cox regression model to compare the risks of hospitalization for various reasons in individuals with T1D with and without P4P care.</div></div><div><h3>Results</h3><div>Individuals with T1D receiving pay-for-performance (P4P) care demonstrated a significantly lower risk of all-cause hospitalization (adjusted hazard ratio [aHR] 0.63, 95 % confidence interval [CI] 0.54–0.73). This reduction was particularly notable for hospitalizations related to glucose management or metabolic disorders, infectious diseases, pneumonia, circulatory and respiratory system diseases, and mental health, compared with those not receiving P4P care. However, no significant differences were observed in hospitalization risks for hyperglycemic crisis, severe hypoglycemia, or injury between individuals with and without P4P care.</div></div><div><h3>Conclusions</h3><div>This nationwide cohort study found that P4P participation was associated with a lower risk of hospitalization in individuals with type 1 diabetes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 68-73"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.pcd.2025.11.004
Sammra Maqsood , Saiqa Amjad , Faiyaz Ahmed , Md Faruque Ahmad
Background
A new feeding strategy called time-restricted eating (TRE) is being developed with the goal to remedy obesity and type 2 diabetes by aligning food consumption with the body's endogenous circadian rhythms. These rhythms regulate metabolic function on a daily 24-hour basis by exerting a significant impact on energy balance, lipid metabolism, and glucose homeostasis.
Methods
These databases were searched in an exhaustive manner: Scopus, Web of Science, Google Scholar, PubMed, Saudi Digital Library, and the Cochrane Library; the search was widened until January 2025. Essential search terms were: dieting on time constraint, metabolic health, the circadian rhythm, obesity, and diabetes.
Results
To optimize metabolic health, TRE takes advantage of circadian rhythms by restricting daily calorie consumption to a specified time window. TRE has been shown in clinical trials to enhance weight loss, insulin sensitivity, and glucose metabolism. Clinical evidence indicates that TRE can alter the disease trajectory of obese patients as well as patients with type 2 diabetes. The psychological and behavioral determinants of compliance with this intervention are also addressed in this review.
Conclusion
For the control of metabolic disease, TRE holds promise. For more insight into the therapeutic benefit of TRE, future studies should investigate its possible combination with individualized nutritional regimens and its long-term impact on metabolic and psychological health.
背景：一种名为限时饮食（TRE）的新喂养策略正在开发中，其目标是通过使食物摄入与人体内源性昼夜节律相一致来治疗肥胖和2型糖尿病。这些节律通过对能量平衡、脂质代谢和葡萄糖稳态产生重大影响，每天24小时调节代谢功能。方法：全面检索Scopus、Web of Science、谷歌Scholar、PubMed、Saudi Digital Library和Cochrane Library；搜索范围扩大到2025年1月。基本搜索词是：限时节食、代谢健康、昼夜节律、肥胖和糖尿病。结果：为了优化代谢健康，TRE利用昼夜节律将每日卡路里消耗限制在特定的时间窗内。在临床试验中，TRE已被证明可以促进减肥、胰岛素敏感性和葡萄糖代谢。临床证据表明，TRE可以改变肥胖患者和2型糖尿病患者的疾病轨迹。依从性的心理和行为决定因素也在这篇综述中讨论。结论：对代谢性疾病的控制有一定的应用前景。为了更深入地了解TRE的治疗益处，未来的研究应探讨其与个性化营养方案的可能组合及其对代谢和心理健康的长期影响。
{"title":"Time-restricted eating and circadian rhythms: A new frontier in diabetes and obesity management","authors":"Sammra Maqsood , Saiqa Amjad , Faiyaz Ahmed , Md Faruque Ahmad","doi":"10.1016/j.pcd.2025.11.004","DOIUrl":"10.1016/j.pcd.2025.11.004","url":null,"abstract":"<div><h3>Background</h3><div>A new feeding strategy called time-restricted eating (TRE) is being developed with the goal to remedy obesity and type 2 diabetes by aligning food consumption with the body's endogenous circadian rhythms. These rhythms regulate metabolic function on a daily 24-hour basis by exerting a significant impact on energy balance, lipid metabolism, and glucose homeostasis.</div></div><div><h3>Methods</h3><div>These databases were searched in an exhaustive manner: Scopus, Web of Science, Google Scholar, PubMed, Saudi Digital Library, and the Cochrane Library; the search was widened until January 2025. Essential search terms were: dieting on time constraint, metabolic health, the circadian rhythm, obesity, and diabetes.</div></div><div><h3>Results</h3><div>To optimize metabolic health, TRE takes advantage of circadian rhythms by restricting daily calorie consumption to a specified time window. TRE has been shown in clinical trials to enhance weight loss, insulin sensitivity, and glucose metabolism. Clinical evidence indicates that TRE can alter the disease trajectory of obese patients as well as patients with type 2 diabetes. The psychological and behavioral determinants of compliance with this intervention are also addressed in this review.</div></div><div><h3>Conclusion</h3><div>For the control of metabolic disease, TRE holds promise. For more insight into the therapeutic benefit of TRE, future studies should investigate its possible combination with individualized nutritional regimens and its long-term impact on metabolic and psychological health.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 1-12"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.pcd.2025.12.001
Longjian Liu , Nathalie S. May , Yuwei Hou , Jingyi Shi , Edward J. Gracely , Arthur L. Frank , Howard J. Eisen
Aim
Research on the epidemiology of diabetes mellitus (DM) has identified a geographically distinct region in the United States (U.S.) known as the diabetes belt (DM Belt), which represents a significant public health concern. This study aimed to examine the factors contributing to the increased risk of DM in the DM Belt compared to the non-DM Belt.
Methods
Data were analyzed from 398,243 adults aged ≥ 18 years who participated in the 2019 Behavior Risk Factor Surveillance System. DM status was based on participants’ self-reported physician-diagnosed DM. The DM Belt was defined at the state level according to the U.S. Center for Disease Control and Prevention’s classification. Logistic regression (LR) was used to estimate odds ratios for DM and assess the excess DM risk in the DM Belt versus the non-DM Belt. Random Forest (RF) and stepwise LR were employed to identify and rank key contributors to the excess DM risk.
Results
Residents of the DM Belt had a significantly higher prevalence of DM than those in the non-DM Belt (age-sex-adjusted rate: 12.5 % versus 10.5 %, p < 0.001). Low socioeconomic status (SES), physical inactivity, and hypertension were identified as the top three factors explaining the excess DM risk in the DM Belt.
Conclusions
These findings underscore the importance of an integrated approach to improving SES, promoting healthy behaviors, managing chronic conditions for reducing DM risk. Addressing these factors can help mitigate health disparities in DM risk across the U.S.
{"title":"The U.S. diabetes belt and factors explaining the excess risk: Multifactorial modeling and machine learning analysis","authors":"Longjian Liu , Nathalie S. May , Yuwei Hou , Jingyi Shi , Edward J. Gracely , Arthur L. Frank , Howard J. Eisen","doi":"10.1016/j.pcd.2025.12.001","DOIUrl":"10.1016/j.pcd.2025.12.001","url":null,"abstract":"<div><h3>Aim</h3><div>Research on the epidemiology of diabetes mellitus (DM) has identified a geographically distinct region in the United States (U.S.) known as the diabetes belt (DM Belt), which represents a significant public health concern. This study aimed to examine the factors contributing to the increased risk of DM in the DM Belt compared to the non-DM Belt.</div></div><div><h3>Methods</h3><div>Data were analyzed from 398,243 adults aged ≥ 18 years who participated in the 2019 Behavior Risk Factor Surveillance System. DM status was based on participants’ self-reported physician-diagnosed DM. The DM Belt was defined at the state level according to the U.S. Center for Disease Control and Prevention’s classification. Logistic regression (LR) was used to estimate odds ratios for DM and assess the excess DM risk in the DM Belt versus the non-DM Belt. Random Forest (RF) and stepwise LR were employed to identify and rank key contributors to the excess DM risk.</div></div><div><h3>Results</h3><div>Residents of the DM Belt had a significantly higher prevalence of DM than those in the non-DM Belt (age-sex-adjusted rate: 12.5 % versus 10.5 %, p < 0.001). Low socioeconomic status (SES), physical inactivity, and hypertension were identified as the top three factors explaining the excess DM risk in the DM Belt.</div></div><div><h3>Conclusions</h3><div>These findings underscore the importance of an integrated approach to improving SES, promoting healthy behaviors, managing chronic conditions for reducing DM risk. Addressing these factors can help mitigate health disparities in DM risk across the U.S.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 99-105"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity is a significant public health issue, influenced by dietary, environmental, socioeconomic, and behavioral factors. Identifying these predictors is crucial for effective prevention strategies and policies. Cohort datasets provide a valuable resource for understanding long-term health trends and risk factors, offering robust insights into obesity determinants. This study aims to identify obesity predictors using cohort data from western Iran.
Methods
This study used the main phase and first follow-up data from the RaNCD cohort study, including 2064 participants with an obesity incidence of 18 %. We used a hybrid feature selection approach combining filter and wrapper methods using Linear Regression (LR) and Decision Tree (DT) algorithms. Training, testing, and evaluation were performed in Jupyter Notebook using Python 3.12.
Results
Fifty-seven variables were identified as significant predictors of BMI. Among them, anthropometric measures such as weight (r = 0.688) and waist circumference (r = 0.686) showed the strongest positive associations, while physical activity (MET, r = –0.151) had the strongest negative correlation. Anthropometric, demographic, and laboratory measures yielded the most accurate BMI predictions, whereas dietary and lifestyle factors contributed less, likely due to limited variability in self-reported data.
Conclusion
According to the results, anthropometric, demographic, and lab tests variables were three common predictors for obesity. Integrating these with basic clinical and laboratory data could improve early detection of metabolic risk in primary care screening programs. Public health programs should emphasize culturally tailored approaches to physical activity and dietary behavior to address obesity at the community level.
{"title":"Quantitative analysis of obesity predictors: Evidence from the Ravansar non-communicable disease (RaNCD) cohort study","authors":"Sharareh Rostam Niakan Kalhori , Farid Najafi , Seyed Mohammad Ayyoubzadeh , Fatemeh Sadat Mirebrahimzadeh , Soroush Heydari","doi":"10.1016/j.pcd.2025.10.007","DOIUrl":"10.1016/j.pcd.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a significant public health issue, influenced by dietary, environmental, socioeconomic, and behavioral factors. Identifying these predictors is crucial for effective prevention strategies and policies. Cohort datasets provide a valuable resource for understanding long-term health trends and risk factors, offering robust insights into obesity determinants. This study aims to identify obesity predictors using cohort data from western Iran.</div></div><div><h3>Methods</h3><div>This study used the main phase and first follow-up data from the RaNCD cohort study, including 2064 participants with an obesity incidence of 18 %. We used a hybrid feature selection approach combining filter and wrapper methods using Linear Regression (LR) and Decision Tree (DT) algorithms. Training, testing, and evaluation were performed in Jupyter Notebook using Python 3.12.</div></div><div><h3>Results</h3><div>Fifty-seven variables were identified as significant predictors of BMI. Among them, anthropometric measures such as weight (r = 0.688) and waist circumference (r = 0.686) showed the strongest positive associations, while physical activity (MET, r = –0.151) had the strongest negative correlation. Anthropometric, demographic, and laboratory measures yielded the most accurate BMI predictions, whereas dietary and lifestyle factors contributed less, likely due to limited variability in self-reported data.</div></div><div><h3>Conclusion</h3><div>According to the results, anthropometric, demographic, and lab tests variables were three common predictors for obesity. Integrating these with basic clinical and laboratory data could improve early detection of metabolic risk in primary care screening programs. Public health programs should emphasize culturally tailored approaches to physical activity and dietary behavior to address obesity at the community level.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"20 1","pages":"Pages 74-79"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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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