Diabetes care最新文献

Objective: We assessed the association between timing of moderate-to-vigorous physical activity (MVPA) with incident type 2 diabetes (T2D) and glycemic measures.

Research design and methods: Regression models were used to assess associations between accelerometer-derived MVPA timing and incident T2D in UK Biobank (UKB) (n = 84,528, prospective), prevalent diabetes, and glycemic measures in the National Health and Nutrition Examination Survey (NHANES) (n = 6,998, cross-sectional).

Results: In UKB, with early morning (0500-0959) MVPA as reference and before adjustment for total MVPA, "variable-timing" MVPA was associated with the lowest incident T2D risk; while after adjustment, afternoon-evening MVPA (1500-2400) showed the lowest incident T2D risk. In NHANES, afternoon/early evening MVPA was weakly associated with more favorable glycemic measures and lower diabetes prevalence after adjustment for total MVPA.

Conclusions: When keeping total MVPA volume constant, clustering MVPA in the afternoon-evening was associated with the strongest reduction in incident T2D risk, fewer prevalent diabetes, and more favorable glycemic measures.

Objective: To investigate the association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and nonarteritic ischemic optic neuropathy (NAION).

Research design and methods: The PubMed, Embase, and Cochrane Library databases were searched during August 2025. Odds ratios (ORs) and absolute risk for NAION values were pooled using random-effects Peto and inverse-variance models. Any ocular event was a secondary outcome.

Results: Fifteen longitudinal studies (n = 8 trials; n > 1.5 million patients) were included. GLP-1 RA use was associated with higher NAION risk (OR 1.70; 95% CI 1.23-2.36), consistent across randomized (2.36; 0.85-6.53) and nonrandomized studies (1.64; 1.15-2.35) (P = 0.51, for heterogeneity). Absolute NAION risk in the GLP-1 RA group was 0.09%, corresponding to a 0.037% risk difference (number needed to harm ∼ 2,700). There was no association with overall ocular events (OR 0.95; 95% CI 0.86-1.05).

Conclusions: GLP-1 RA use was associated with a modest increase in NAION risk but not overall ocular adverse events. Findings underscore the need for long-term postmarketing safety studies and should be interpreted against their well-established mortality and cardio-kidney-metabolic benefits.

Objective: To evaluate glycemic metrics and insulin delivery during real-world use of the MiniMed 780G (MM780G) system on days when users did not administer boluses.

Research design and methods: Global CareLink personal data of consenting MM780G users (N = 369,467) uploaded from 2 January 2020 to 31 March 2025 were analyzed. Among these individuals, 54,553 users experienced ≥10 days without any user-initiated boluses. Evaluated key metrics included time in range (TIR; 70-180 mg/dL), time below range (TBR; <70 mg/dL), time above range (>180 mg/dL), the glucose management indicator (GMI), and total insulin delivered. These were analyzed for the overall population who did not initiate boluses and for those who used and did not use recommended optimal settings (ROS; defined as a 100 mg/dL glucose target and a 2-h active insulin time). Subgroup analyses were conducted by age (≤15 or >15 years) and diabetes type (type 1 or 2).

Results: On days when boluses were missed, ROS users had a mean sensor glucose (SG) of 149.2 mg/dL, with mean TIR, TBR, and GMI of 76.3%, 0.8%, and 6.9%, respectively, whereas non-ROS users had a mean SG of 159.7 mg/dL with mean TIR, TBR, and GMI of 69.3%, 0.9%, and 7.1%, respectively. ROS use was associated with more individuals achieving consensus TIR, TBR, and GMI goals.

Conclusions: These data demonstrate effective glycemic control with the MM780G system on days when some users did not initiate boluses. A greater proportion of real-world users achieved glycemic goals when ROS were used.

Objective: To evaluate inhaled technosphere insulin (TI) in children with diabetes.

Research design and methods: A total of 230 youth 4-17 years old with type 1 (98%) or type 2 (2%) diabetes treated with multiple daily injections of insulin were randomly assigned 1:1 to TI or rapid-acting analog (RAA) insulin plus continuation of long-acting basal insulin and continuous glucose monitoring (CGM) for 26 weeks. The primary outcome was change in HbA1c, tested for noninferiority with margin of 0.4%.

Results: In intent-to-treat analysis, mean HbA1c (% ± SD) was 8.22 ± 0.87 at baseline and 8.41 ± 1.38 at 26 weeks with TI and 8.21 ± 0.96 and 8.21 ± 1.10, respectively, with RAA (adjusted difference = 0.18; 95% CI -0.07, 0.43; noninferiority P = 0.091). CGM-measured time in range 70-180 mg/dL was not significantly different between groups (adjusted difference -2.2%; 95% CI -7.0, 2.7; P = 0.38). Two severe hypoglycemic events occurred in the TI group and one in the RAA group. Change in forced expiration volume in 1 s from baseline to 26 weeks did not differ comparing TI and RAA (P = 0.53). The TI group reported greater treatment satisfaction (P = 0.004) and had less gain in weight and BMI percentile (P = 0.009) than did the RAA group.

Conclusions: The primary analysis did not meet the prespecified criteria for HbA1c noninferiority. However, TI use was safe over 26 weeks without affecting pulmonary function and was associated with greater treatment satisfaction and less weight gain compared with RAA, supporting TI as a treatment option for some pediatric patients with type 1 diabetes.

Objective: We evaluated the prognostic and clinical utility of kidneyintelX.dkd, a biomarker-based risk score, in patients with type 2 diabetes and a broad range of chronic kidney disease (CKD) by assessing its association with kidney outcomes at baseline and longitudinally, comparing it with the established Kidney Disease Improving Global Outcomes (KDIGO) risk classification, and examining its responsiveness to canagliflozin.

Research design and methods: We measured tumor necrosis factor receptor-1 (TNFR-1), TNFR-2, and kidney injury molecule-1 (KIM-1) in banked plasma samples at baseline and year 1 and calculated kidneyintelX.dkd scores of participants with CKD G1-G3b from two large randomized controlled trials (Canagliflozin Cardiovascular Assessment Study [CANVAS] and Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation [CREDENCE]). We assessed concordance between KDIGO and kidneyintelX.dkd risk levels, evaluated associations of baseline and 1-year changes in kidneyintelX.dkd with kidney outcomes, and examined treatment effects of canagliflozin versus placebo.

Results: Mean kidneyintelX.dkd scores increased across higher KDIGO risk categories, but individual-level differences revealed improved risk reclassification. The kidneyintelX.dkd score was independently associated with kidney outcomes and more strongly predictive than KDIGO classification. At 1 year, canagliflozin significantly lowered kidneyintelX.dkd score versus placebo, and longitudinal reductions by 1 year were associated with lower subsequent risk of kidney outcomes, independent of changes in estimated glomerular filtration rate or urinary albumin-to-creatinine ratio. Absolute risk reductions with canagliflozin were largest among those at high kidneyintelX.dkd risk.

Conclusions: The kidneyintelX.dkd score adds prognostic value beyond clinical classification, reflects canagliflozin treatment response, and helps identify individuals most likely to benefit from therapy. These findings support a role for the kidneyintelX.dkd score in personalized risk assessment and monitoring in type 2 diabetes and CKD in prospective studies and clinical practice.

Objective: Type 1 and 2 diabetes have been variably associated with reduced forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), but mechanisms remain unclear. This study examined the role of glucose and insulin metabolism for pulmonary function across diabetes (sub)types and normal glucose tolerance as the control (CON) in the German Diabetes Study (GDS) and assessed causality by Mendelian randomization (MR) analyses in independent cohorts.

Research design and methods: In GDS, 426 spirometry measurements of participants with type 1 diabetes, 482 of participants with type 2 diabetes, and 244 of CON were cross-sectionally analyzed after phenotyping, including Botnia clamps for insulin sensitivity (M value), secretion, and clearance. Associations between metabolic measures and lung function were assessed using generalized linear models, adjusting for confounders. MR analysis used data from the MAGIC (Meta-Analyses of Glucose and Insulin-Related Traits Consortium) consortium (HOMA-insulin resistance [IR], n = 37,037) and the UK Household Longitudinal Study (pulmonary function, n = 321,047).

Results: In GDS, higher M value (all β > 0.18, P < 0.0001) and insulin clearance (all β = 0.05, P < 0.050) were associated with higher FEV1 and FVC. Compared with type 1 diabetes and CON, type 2 diabetes had lower FEV1 and FVC, which associated with M value (all β > 0.17, P < 0.050). FEV1 was associated with daily insulin doses in type 1 diabetes (β = -0.21, P = 0.0006). FEV1 was associated with type 2 diabetes (β = -0.19, P = 0.0052), severe insulin resistant (β =-0.27, P = 0.039), and mild age-related diabetes (β = -0.23, P = 0.0033). MR supported a causal association between HOMA-IR and lower FEV1 (β = -0.13, P = 0.0018).

Conclusions: Lower FEV1 and FVC in diabetes are linked to insulin resistance, impaired clearance, and higher insulin doses, all of which result in higher insulinemia and likely represent underlying pathogenic mechanisms.

Objective: Hypoglycemia exposure lowers the glycemic threshold for symptom recognition, contributing to impaired awareness of hypoglycemia (IAH). Interoceptive awareness, the ability to sense and interpret internal bodily sensations, is associated with a lower risk of IAH. We tested the hypothesis that interoceptive awareness moderates the association between hypoglycemia exposure and glycemic threshold for autonomic symptom recognition.

Research design and methods: Adults with type 1 diabetes completed validated surveys assessing interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness, Version 2 [MAIA-2]) and the glycemic threshold for autonomic symptom recognition (Hypoglycemia Awareness Questionnaire Symptom Level subscale) and provided 30-day continuous glucose monitoring data. We used proportional odds logistic regression to examine whether the MAIA-2 Attention Regulation scale score (measuring the ability to sustain and control attention to bodily sensations) moderated the association between hypoglycemia exposure (percent time [%-time] <60 mg/dL) and symptom level, adjusting for covariates.

Results: Among 717 participants (94% White, 52% female, mean [SD] age 44 [15] years; diabetes duration 25 [15] years; 17% with IAH), 30-day hypoglycemia exposure (%-time <60 mg/dL) was 0.8 (1.4%) (11.5 [20.2] min/day). Higher hypoglycemia exposure was associated with lower symptom levels (odds ratio [OR] 0.45; 95% CI 0.31, 0.66; P < 0.001). Interoceptive awareness alone was not associated with symptom level (OR 0.93; 95% CI 0.78, 1.12), but higher interoceptive awareness attenuated the association between hypoglycemia exposure and symptom level (OR 1.14; 95% CI 1.01, 1.27; P < 0.05).

Conclusions: Interoceptive awareness moderated the association between hypoglycemia exposure and glycemic threshold for symptom recognition. Research is needed to examine whether interventions can improve interoceptive awareness and, thereby, restore awareness of hypoglycemia.