Canadian journal of diabetes最新文献

Introduction: To determine the prevalence of Polycystic Ovary Syndrome (PCOS) among pregnancies affected by type 2 diabetes (T2D) and explore its relationship with maternal and neonatal outcomes.

Methods: Pregnancies affected by T2D from the Calgary Diabetes in Pregnancy program from 2008-2020 were chart reviewed for presence of PCOS, using logistic regression to examine associations between PCOS and maternal and neonatal outcomes.

Results: The prevalence of PCOS in pregnancies affected by T2D was 134/897 (14.9%). Compared with pregnancies affected by T2D alone, pregnancies affected by PCOS and T2D had higher odds of nulliparity (OR 2.09, 95% CI 1.44, 3.02), pre-pregnancy weight ≥91kg (OR 1.79, 95% CI 1.23, 2.60), preconception care (OR 2.79, 95% CI 1.77, 4.40), and metformin use (OR 2.01, 95% CI 1.37, 2.93). They had lower odds of maternal age ≥35 years (OR 0.68, 95% CI 0.46, 0.99), singleton pregnancy (OR 0.29, 95% CI 0.11, 0.75), and insulin use (OR 0.60, 95% CI 0.39, 0.93). There were no statistically significant differences between groups for neonatal outcomes.

Conclusions: The prevalence of PCOS among our cohort of pregnant women with T2D was lower than the reported prevalence of PCOS among women with T2D, perhaps reflecting the subfertility PCOS can confer. This may also explain the association with PCOS and nulliparity. People with PCOS were also more likely to receive preconception care and metformin.

Background: Individuals with type 1 diabetes require careful perioperative management to minimize risks and optimize outcomes. Automated insulin delivery systems (AID) have demonstrated efficacy in improving glycemic control in outpatient settings. However, the safety and effectiveness of use during surgery remains unclear.

Objective: We aimed to synthesize the existing literature evaluating the perioperative use of AID systems in individuals with type 1 diabetes undergoing surgical procedures.

Methods: A comprehensive search of PubMed, Ovid/MEDLINE, and CINAHL was conducted through May 20, 2025. Eligible studies included adults or children with type 1 diabetes undergoing surgery using AID systems with reported glycemic outcomes. Data were extracted from cohort studies, case reports, and expert guidance documents. Screening and data extraction were performed in Covidence by three independent reviewers.

Results: Sixteen studies were included: two observational cohorts, nine case reports/series, two reviews, one retrospective study, one randomized controlled trial and one expert guidance document. Across all studies, continuation of AID systems perioperatively was associated with high time-in-range, minimal hypoglycemia, and no severe adverse events such as diabetic ketoacidosis. Technical concerns included continuous glucose monitoring signal interference from medications or surgical equipment. Expert guidance emphasized individualized planning, intraoperative monitoring, and device-specific considerations.

Conclusions: Preliminary evidence suggests that perioperative continuation of AID systems is safe and feasible in select individuals with type 1 diabetes. However, despite promising glycemic outcomes, current literature is limited to small-scale, mostly observational data. Larger prospective studies are needed to validate safety, inform standardized protocols, and support widespread clinical adoption.

Aims: Self-management is a key component of optimal management of diabetes. Patients with coexistent diabetes and kidney failure requiring dialysis therapy have an additional health burden which complicates self-management practices. Limited studies have explored barriers and facilitators using qualitative methodology for patients in the context of kidney failure on dialysis. The objective of this study was to understand barriers and facilitators to diabetes self- management among patients with kidney failure requiring dialysis therapy.

Methods: An interpretive descriptive methodology was used to address the study objective. We conducted semi-structured interviews with fourteen participants.

Findings: Fourteen participants (seven male and seven female) aged 45 to 84 years participated in semi-structured interviews. Analysis of 14 interviews found perceived barriers to diabetes self-management that covered five themes: Lesser stability and comfort, shortage of financial resources, physical limitations, healthcare access and navigation, and medical complexity. Facilitators were grouped into three themes: Greater health literacy and empowerment, supportive social environment, motivation and optimism.

Conclusions: Findings from this study highlight the importance of further research in this domain to mitigate barriers and leverage facilitators, as well as to guide resource allocation to improve diabetes care and self-management education and support among dialysis patients with diabetes.

Background: Hyperinsulinemia is implicated in obesity, type 2 diabetes (T2D) and heart disease (cardiometabolic disease, CMD). Our previous sex-combined Mendelian randomization (MR) study suggested that increased insulin response 30 minutes after oral glucose ingestion, adjusted for glycemia (corrected insulin response, CIR) might modestly increase body mass index (BMI) but protect against T2D and dyslipidemia.

Methods: Given the sex differences in fat distribution, we undertook sex-stratified MR to assess potential causal effect of CIR on adiposity and CMD using summary statistics from the largest genome wide association studies in European ancestries. A Bonferroni adjusted p-value of ≤0.003 was considered significant and ≤0.05 nominally significant.

Result: Inverse variance weighted MR (IVWMR) suggests that increased CIR may increase leg fat percentage in females (females: β = 0.311 ± 0.10, P = 0.002, males: β = 0.253 ± 0.12, P = 0.035), reduce triglyceride (males: β = -0.046 ± 0.015, P = 0.002; females: β = -0.077 ± 0.023, P = 9.17 x 10^-4) and protect against type 2 diabetes (males: OR 0.471, 95% CI 0.327-0.676, P=4.64 x 10^-5; females: OR 0.511, 95% CI 0.372-0.701, P=3.31 x 10^-5). After Bonferroni correction, we did not find evidence that increased CIR modulates body mass index, waist-hip ratio, HDL-cholesterol or coronary artery disease in either sex. Reverse IVWMR indicates T2D reduces CIR only in males (OR 0.613-0.927, P=5.47 x 10^-3).

Conclusion: Increased CIR might have beneficial effects on T2D and lipids in both sexes with no evidence for deleterious effects on adiposity and CMD.

Background: Older adults living with both type 2 diabetes mellitus (T2DM) and frailty show greater physical function impairment than those with either condition alone. Females experience disproportionately worse outcomes, including reduced physical function, higher glycated hemoglobin (HbA1c), and greater frailty. Yet, little is known about sex effects on physical function after elastic-band training with diabetes education.

Objective: This study investigated how sex influence's physical function following a 16-week elastic-band resistance training combined with T2DM education in older adults living with T2DM and frailty.

Methods: Participants (n=182) included in the Band-Frail program were 1) aged ≥ 65 years, 2) living with T2DM or with an HbA1c ≥ 6.5%, and 3) were at least pre-frail based on the Fried's Frailty Scale. The intervention was a 16-week elastic band resistance training twice a week and T2DM education once a week. The primary outcome was physical function (Short Physical Performance Battery (SPPB): Score=0-12), with secondary outcomes of HbA1c, and Frailty score (1-5).

Results: Intention to Treat (ITT) revealed a significant change for physical function (Coef=0.83; 95% CI, 0.28% to 1.37%; P=0.004), HbA1c (Coef=-0.28; 95% CI, -0.53 to -0.03; P=0.03), and frailty (Coef=-0.49; 95% CI, -0.73% to -0.24%; P<0.01). A significant Time×Sex interaction (Coef=0.70; 95% CI, 0.07% to 1.33%; P=0.028) was observed for physical function, demonstrating females improving 0.70-points greater than males following the 16-week intervention.

Conclusion: Biological sex impacts the change in physical function following a 16-week elastic bands resistance training program and T2DM education in older adults living with T2DM and frailty.

Background: Virtual care adoption in pediatric type 1 diabetes (T1D) accelerated during COVID-19, yet little is known about pediatric healthcare professionals' (HCP) perspectives. To identify how HCPs navigate and are impacted by pediatric diabetes virtual care, we explored their experiences with virtual care in British Columbia (BC).

Methods: The study team purposively recruited HCPs from across the province. Semi-structured interviews were conducted with 32 pediatric HCPs across BC (September 2023-September 2024). Data were analyzed using inductive thematic analysis informed by the BC Health Quality Matrix.

Results: HCPs valued virtual visits for flexibility, safety, accessibility, and efficiency. However, challenges included rapport loss, inability to perform physical assessments, and concerns related to inequities in technology access. Virtual care impacted HCPs' well-being in complex ways, with some reporting benefits but others facing challenges.

Conclusion: Pediatric HCPs view virtual care as both beneficial and challenging, recognizing it as a valuable supplement, not a replacement, for in-person visits. As our understanding of these tensions deepens, addressing care gaps and implementing informed strategies will be essential for sustainable, high-quality virtual diabetes care and broader system integration.

Background: Diabetes mellitus (DM) can negatively affect sexual health through vascular, neurologic, hormonal, and psychosocial pathways. Despite the high burden of diabetes-related sexual problems, patients' needs are often overlooked in primary care due to stigma and communication barriers. Understanding determinants of sexual quality of life and patient perspectives may support better integration of sexual-health care into diabetes management.

Objective: To assess sexual quality of life (SQoL) among adults with DM and examine its associations with sociodemographic and clinical factors, as well as attitudes, and expectations regarding sexual-health discussions in primary care.

Methods: This analytical cross-sectional study included 326 sexually active adults with DM recruited from primary care clinics in Izmir, Türkiye. Data were collected through interviewer-administered questionnaires that captured demographic/clinical characteristics, SQoL (SQoL-F/SQoL-M), and patients' attitudes and expectations regarding sexual-health communication. Statistical analyses included group comparisons, correlations, and multiple linear regression.

Results: Older age and longer diabetes duration were independently associated with lower SQoL scores. More favorable attitudes toward discussing sexual health were linked to being male, younger, and more educated. Preference for clinician-initiated communication was greater among women, more educated individuals, and those with longer disease duration. SQoL correlated moderately with attitude scores but not expectation scores.

Conclusions: Sexual well-being in diabetes is shaped by age, disease course, and communication-related beliefs. Routine, proactive inquiry by family physicians-supported by culturally sensitive communication-may reduce barriers and improve sexual health outcomes in diabetes care.

Aims: To evaluate efficacy, durability, and safety of early combination therapy compared with stepwise escalation in newly diagnosed type 2 diabetes.

Methods: We searched PubMed, Cochrane CENTRAL, and Embase through November 2025 for trials comparing early combination therapy with stepwise escalation in treatment-naïve patients. Outcomes included A1C reduction, time to treatment failure, beta cell function, hypoglycemia, weight change, cardiovascular risk markers, and hepatic outcomes. The random-effects meta-analysis used the inverse variance method.

Results: Eleven studies (24,364 participants) were included. Early combination therapy achieved greater A1C reduction versus stepwise escalation (mean difference -0.49%, 95% CI: -0.53 to -0.45, p<0.001) and nearly doubled time to treatment failure (61.9 versus 36.1 months, HR 0.51, p<0.0001). Beta cell function was preserved for 3.5 years with early combination therapy, compared to a progressive decline with stepwise therapy. Early combination therapy demonstrated a 7.5-fold lower incidence of hypoglycemia, favorable effects on weight (5.3 kg difference), reduced carotid atherosclerosis progression, improved blood pressure and lipid profiles, and reduced hepatic fat accumulation.

Conclusions: Early combination therapy is superior to stepwise escalation in glycemic control, durability, beta-cell preservation, safety, and cardiovascular risk reduction, thereby supporting disease modification rather than merely symptomatic control.

Diabetic retinopathy (DR) is a leading cause of vision loss among working-age adults and one of the most frequent complications of diabetes mellitus. Current therapies, including laser photocoagulation and intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents, are effective only in advanced disease and remain invasive and palliative. The multifactorial pathogenesis of DR involves hyperglycemia-driven oxidative stress, chronic inflammation, dyslipidemia, and disruption of the blood-retinal barrier. Peroxisome proliferator-activated receptors (PPARs) have emerged as key regulators of metabolic and inflammatory signalling in the retina. PPAR-alpha agonists, such as fenofibrate and pemafibrate, exert antioxidant, anti-inflammatory, and vasoprotective effects, whereas PPAR-gamma agonists (e.g. pioglitazone) improve insulin sensitivity and attenuate oxidative damage, albeit with safety concerns such as fluid retention. Dual PPARα/γ agonists, including saroglitazar, provide synergistic benefits by reducing leukostasis, neovascularization, and inflammatory signalling, whereas PPAR-β/δ is gaining attention for its role in retinal energy metabolism. In parallel, non-PPAR targets, such as the advanced glycation end product-receptor for advanced glycation end product (AGE-RAGE) axis, VEGF signalling, aldose reductase, and adenosine monophosphate-activated protein kinase pathways, represent complementary mechanisms. Natural compounds (e.g. curcumin, resveratrol), statins, and metabolic modulators have demonstrated promising preclinical efficacy. Targeting both PPAR and non-PPAR pathways may enable preventive and multimodal management of DR. Future efforts should prioritize early-stage interventions, combination strategies, and innovative ocular drug-delivery systems to overcome current therapeutic limitations and shift from reactive to preventive care.

Background: Non-adherence to diabetes treatment leads to persistent hyperglycemia, a key driver of non-healing diabetic foot ulcers (DFUs). Continuous glucose monitoring (CGM) and telemedicine have independently improved glycemic control, HbA1c, and time in range. This study reviews the various components of telemedicine and CGM to gain insight that can contribute to future directions for enhancing DFU interventions.

Method: a scoping review was conducted in PubMed, Embase, CINAHL, and Scopus.

Results: 16 studies were included. Aggregated, three main implication areas, one with subdivisions were identified: 1) Components in a remote treatment package, a) The telemedicine term, b) The specialized healthcare professional, c) Monitoring health data, and d) Supervision and feedback on monitored data, 2) Improved glycemic control with remote treatment, and 3) Future directions for DFU interventions.

Conclusion: Selected components of telemedicine and CGM may be utilized in future DFU interventions but needs to be tested in a future feasibility study.