To examine Australian General Practitioners' (GPs) confidence in initiating oral anticoagulants (OACs) for patients with atrial fibrillation (AF), and their practices for monitoring treatment adherence. Cross-sectional online survey. GPs practising in metropolitan, regional and rural/remote locations in Australia. 1765 Australian GPs recruited through professional GP networks. GPs' self-reported confidence initiating OACs; practices monitoring patient adherence and persistence; and perceived barriers to adherence. Demographic data including clinical experience and geographic location were collected. χ2 analyses were used to examine associations between the key outcome variables and GP location and clinical experience. Of 1765 respondents, 83.1% had practised for >10 years and 27.6% worked in regional or rural/remote areas. Overall, only 50.2% reported high confidence initiating OACs in patients with CHA2DS2-VA score ≥2 (a cumulative stroke risk score with a score of 1 for: congestive heart failure, hypertension, diabetes, vascular disease and age 65-74 years and 2 for: stroke/transient ischaemic attack, age ≥ 75 years). Unsurprisingly, confidence was higher among GPs with >10 years experience (51.5%) compared with 5-10 years (44.9%) and <5 years (43.2%) (p<0.01). Confidence was highest in rural/remote areas (73.2%) compared with regional (56.4%) and metropolitan areas (46.0%) (p<0.01). More GPs reported greater confidence initiating non-vitamin K antagonist oral anticoagulants (NOACs) (49.5%) than warfarin (6.2%) (p<0.01). Regional and rural/remote GPs, and those who had practised longer, were more likely to be confident with both NOACs and warfarin, while less experienced and metropolitan GPs showed stronger preference for NOACs. Only 76% reported monitoring adherence/persistence to OAC therapy. Reported barriers to patient adherence and persistence included low health literacy, medication concerns, cognitive impairment and lack of awareness of stroke risk. Only half of GPs reported high confidence initiating OAC treatment, and approximately a quarter do not routinely monitor medication adherence or persistence. Targeted strategies to improve confidence and align practices with guideline recommendations are required. Appropriate education should be developed targeting the specific issues underlying lack of confidence in initiating OAC and the practice of referring newly diagnosed patients to cardiology. Further research into implementing systems for monitoring and improving adherence and persistence would be worthwhile in the context of these findings.
people with type 2 diabetes mellitus (T2DM) are at increased risk of periodontal disease (POD), which gets complicated with diabetes. Good oral hygiene and regular dental check-ups are recommended to prevent oral health problems, including POD. This study aimed to assess the oral health knowledge and practices of people with T2DM in three health facilities of the Dschang Health District (West Region, Cameroon). we conducted a cross-sectional study over five months targeting people living with T2DM, followed up in three health facilities of the Dschang Health District, and who agreed to participate. Data were collected using a face-to-face questionnaire. The variables studied were sociodemographic and clinical characteristics, knowledge of the relationship between diabetes and POD, frequency of dental visits and oral hygiene practices. Knowledge and practices were considered good for a response score > 75% and poor for a score < 25%. Intermediate scores were considered average and insufficient. Bivariate and multivariate analyses were performed with a significance level (p <0.05). we recruited 217 (115 women) participants living with T2DM. The median age of participants was 62 (55-68.5) years. More than half (57.6%) had poorly controlled T2DM. Overall, two-thirds (66.8%) of participants had insufficient knowledge, while 12.4% only had good knowledge. More than a third of participants (39.6%) had poor practices and only 13.8% had good practices. The factors associated with good knowledge were secondary education (ORa = 2.819; 95% CI [1.001-7.943]; p=0.049) and retired status (ORa = 4.269; 95% CI [1.827-9.971]; p=0.001). Having a well-controlled T2DM was associated with good practices (ORa = 2.284; 95% CI [1.032-5.055]; p=0.042). most people living with T2DM have insufficient knowledge of oral health, poor oral health practices and fewer visits to the dentist. Secondary education and retired status were associated with good knowledge, while only well-controlled T2DM was associated with good practices. It is therefore vital to incorporate oral health education into their follow-up and education.
Epigenetic age acceleration (EAA), a discrepancy between biological and chronological age based on DNA methylation patterns, has emerged as a critical marker for aging and metabolic health. Individuals with diabetes, particularly type 2 diabetes (T2D), exhibit notable EAA, linking the disease to accelerated biological ageing. This review explores the mechanisms underlying EAA in diabetes, including hyperglycaemia-induced oxidative stress, inflammation, and dysregulated epigenetic pathways. Additionally, we discuss the clinical implications of EAA, emphasizing its potential as a biomarker for diabetes-related complications and a predictor of cardiovascular disease, nephropathy, and premature mortality. Emerging therapeutic strategies targeting epigenetic mechanisms, such as dietary interventions, pharmacological agents, and lifestyle modifications, are also reviewed. Understanding the interplay between EAA and diabetes opens avenues for personalized medicine and innovative treatments aimed at mitigating the accelerated aging phenotype associated with diabetes.
Professional continuous glucose monitoring (proCGM) can improve glycemic control and support medication and lifestyle adjustments in people with diabetes. In 2022, the Care Transformation Collaborative of Rhode Island launched a quality improvement initiative to implement pharmacist-led proCGM services in primary care practices. This project aimed to determine the effects of a pharmacist-led proCGM service on glycemic control, overall and by practice site, compared to baseline hemoglobin A1C (A1C) level. A secondary aim was to assess care team members' views of the program impact on patients and the practice environment. A pre-post design was employed to assess reduction in A1C level 6 months following the implementation of pharmacist-led proCGM at six primary care sites. Pharmacists placed sensors, interpreted CGM data, and initiated diabetes medication changes. Eligible adult patients had either suboptimal glycemic control, discordant A1C and self-monitoring data, high hypoglycemia risk, or were referred by a provider. Changes in A1C were assessed 3-6 months after proCGM use. Care team surveys captured perceptions of the program's impact and sustainability. Among 396 patients, mean A1C decreased from 9.36% to 8.25% (p < 0.0001). A ≥ 1% point A1C reduction was achieved in 45.2% of patients. In multivariable analysis, baseline A1C was the strongest predictor of A1C improvement. Patients not using insulin and those who adopted personal CGM after the intervention were also more likely to improve. The majority of 51 care team members who completed the survey strongly agreed the service had positive impacts on patients and staff, and a majority believed the service could be sustainable. Pharmacist-led proCGM services were associated with meaningful short-term A1C reductions, especially in patients with high baseline A1C not using insulin. The model was well-received by care teams and may help expand access to effective diabetes management in primary care settings.
Type 1 diabetes (T1D) is a lifelong condition typically diagnosed in childhood. Clinical practice guidelines recommend comprehensive multidisciplinary team (MDT)-based care led by paediatric endocrinologists. However, experiences and opinions of health professionals about the implementation of T1D MDTs in Australia are currently unknown. To describe health service teams caring for children and youth with T1D in Australia and to identify opportunities for service improvements from providers' perspectives. Mixed-methods study co-designed with clinicians and consumers, including a survey of clinic leaders and semi-structured interviews. Survey questions covered modes of care delivery, team composition and outreach. Interview transcripts were thematically analysed using a hybrid inductive/deductive approach. Thirty-two T1D services leaders completed the survey; 16 were from major cities and 16 were from regional/rural areas across all Australian states and territories. The services provided care for ~51% of all <19-year-olds living with T1D. T1D services were multidisciplinary and commonly included dieticians (n = 29, 94%), nurse diabetes educators (n = 22, 71%) and general paediatricians (n = 21, 68%). Eight (29%) services had a dedicated psychologist. A quarter (25%) of regional/rural services had a paediatric endocrinologist compared with 100% of major city services (χ2 = 18.355; p < 0.001). All services offered telehealth consultations. Interviews revealed that services placed high value on having established cohesive teams skilled in T1D. Service leaders had concerns regarding workforce capacity and shortages, limited access to psychologists, inequitable access to insulin pumps and limited links with general practitioners. This mixed-methods study is the first Australia-wide exploration of T1D models of care that describes care provision from the clinicians' perspectives. A need exists to address current gaps to achieve the recommended MDT models of care for T1D. Understanding existing models of care will be essential to determine the future impacts of changes in policies, therapies and demands on paediatric T1D services.
Therapeutic inertia (failure to initiate or intensify therapy when therapeutic goals are unmet) contributes to poor glycemic control and diabetes-related complications. We assessed the extent of therapeutic inertia, defined as a lack of new prescription orders for sodium-glucose cotransporter-2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA), among patients with type 2 diabetes and above-target hemoglobin A1c who had clinical indications for use, were not currently using these medications, and had no contraindications. We also examined whether prescribing patterns differed by race and ethnicity. We conducted a retrospective cohort analysis of 2018-2022 electronic health record data. Log-link Poisson generalized estimating equation models estimated relative risks (RR) and assessed predictors of therapeutic inertia and trends over time. Among 10 345 eligible patients (30 740 encounters), 56% were White, 37% Black, 3% Hispanic, 2% Asian, and 2% other races and ethnicities. The rate of new prescribing increased over time but remained low (SGLT2i: 0.9%-4.3%; GLP-1RA: 1.2%-5.2%). After adjusting for sociodemographic, clinical, and service factors, Black patients were less likely than White patients to receive new SGLT2i (RR 0.59, 95% CI 0.42 to 0.82) and GLP-1RA (RR 0.62, 95% CI 0.49 to 0.79) prescriptions; Hispanic patients were less likely to receive new GLP-1RA prescriptions (RR 0.48, 95% CI 0.25 to 0.92). Despite compelling indications, initiation of SGLT2i and GLP-1RA remained low overall and was significantly lower among Black and Hispanic patients, underscoring therapeutic inertia as a modifiable barrier to optimal diabetes care.
We conducted a systematic review and network meta-analysis to examine the overall and comparative cardiovascular outcomes of bexagliflozin, ertugliflozin, and sotagliflozin in type 2 diabetes patients. We included phase 3 or higher randomized controlled trials sourced from four databases: ClinicalTrials.gov, PubMed, Cochrane CENTRAL and Embase. A random-effects model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The primary endpoint was a composite of cardiovascular death or hospitalization for heart failure. The secondary endpoints were cardiovascular death, hospitalization for heart failure and all-cause mortality. Compared with placebo, bexagliflozin, ertugliflozin and sotagliflozin reduced composite cardiovascular death or hospitalization for heart failure (OR, 0.66 [95% CI 0.48-0.89]), hospitalization for heart failure (OR, 0.62 [0.55-0.70]) and acute coronary syndrome (OR, 0.35 [0.16-0.77]). No significant differences were observed among the three drugs for primary and secondary outcomes, although bexagliflozin (OR, 0.39 [0.16-0.94]) and sotagliflozin (OR, 0.41 [0.23-0.72]) had lower risks of myocardial infarction than did ertugliflozin. In conclusion, bexagliflozin, ertugliflozin, and sotagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure. Bexagliflozin and sotagliflozin may offer additional benefits in preventing the risk of myocardial infarction.
To examine temporal trends and risk factors for macrovascular complications in individuals with young-onset diabetes. Data from the Korean Health Insurance Review and Assessment Service (2008-2021) were analyzed for individuals diagnosed with diabetes before age 30 years. Age-standardized incidence and prevalence were estimated using Poisson regression. Time-dependent Cox models assessed risk factors, and segmented regression evaluated changes during the COVID-19 pandemic. We included 6,432 individuals with type 1 diabetes and 71,615 with type 2 diabetes. Between 2008 and 2021, the incidence of macrovascular complications declined from 72.1 to 35.5 per 10,000 persons in type 1 diabetes and from 169.5 to 71.4 in type 2 diabetes, whereas prevalence remained substantial. In type 1 diabetes, older age at diagnosis, low socioeconomic status, hypertension, dyslipidemia, and comorbidity burden increased risk; in type 2 diabetes, older age at diagnosis, low socioeconomic status, hypertension, mental and thyroid disorders, and comorbidity burden increased risk. During COVID-19, incidence increased only in type 2 diabetes. Despite declining incidence, macrovascular complications remain a substantial burden in young-onset diabetes, particularly in early adulthood and type 2 diabetes, highlighting the need for early cardiovascular risk management.
Diabetes and cardiovascular disease profoundly affect rural Australians. The Care2U program was proposed to integrate rural community-based screening with general practice systems. Its innovative feature is a closed-loop communication model between outreach teams and general practitioners (GPs), enabling systematic tracking of diagnoses, management and outcomes for screening-detected medical conditions. This study explored the acceptability, feasibility and sustainability of the proposed model from healthcare providers' perspectives. A qualitative study was undertaken using a focus group. A total of 12 participants, including GPs, nurses, practice managers and health informatics professionals, took part in a 91-min discussion in April 2025. The proposed Care2U model, incorporating mobile outreach screening for diabetes and cardiovascular disease risk factors, was discussed. Transcripts were thematically analysed, with findings interpreted using the critical realism lens to account for structural, organisational and individual influences. Four overarching themes were identified: (i) strong perceived need and value of outreach services in underserved communities; (ii) strategies and challenges in identifying and engaging at-risk patients, particularly those without a regular GP; (iii) desired scope of screening, including both biomedical and lifestyle risk factors, with mixed views on feasibility of remote heart rhythm monitoring; and (iv) communication, workflow and medico-legal responsibilities in managing abnormal findings. Participants emphasised the need to integrate results directly into GP software and to establish clear responsibility for unaffiliated patients. The Care2U program was perceived as a valuable and feasible model to extend preventive care to rural communities. Its closed-loop communication system offers the potential to ensure continuity of care, strengthen GP-community integration and measure program impact. Addressing medico-legal, workflow, and sustainability challenges will be crucial for the implementation and scale-up of this initiative.
Posttraumatic stress disorder (PTSD) is associated with type 2 diabetes (T2D). However, no studies have determined if risk for adverse T2D outcomes vary among different PTSD comorbidity patterns. We identified 152,171 Veterans Health Administration (VHA) patients with de-identified medical records who had comorbid PTSD and T2D. All had adequate HbA1c control, not on insulin, and were free of microvascular and macrovascular complications at index. Latent class analyses (LCA) identified 3 comorbidity profiles characterized as depression + anxiety; high comorbidity; and low comorbidity. We then estimated the link between comorbidity classes and risk for adverse T2D outcomes and all-cause mortality. Most (64.4%) of the sample was ≥ 60 years of age, male (90.9%), and White race (69.1%). High comorbidity vs. low comorbidity and depression + anxiety vs. low comorbidity were associated with all-cause mortality (HR = 1.39; 95%CI:1.28-1.50 and HR = 1.18;95%CI:1.14-1.23, respectively). The depression + anxiety vs. the low comorbidity class, had slightly worse glycemic control (HR = 1.04; 95%CI:1.02-1.06) and microvascular complications (HR = 1.04; 95%CI:1.02-1.06). More psychiatric comorbidity in patients with PTSD is associated with worse glycemic control, increased risk for T2D micro- and macro- complications, and mortality. Research is needed to determine if treatment and improvement in patients with comorbid psychiatric disorders leads to improved T2D outcomes.
Diabetes mellitus leads to microvascular and macrovascular complications that significantly impact quality of life. Previous cross-sectional studies may overestimate complication impacts due to methodological limitations. We performed a longitudinal study to assess within-patient associations between diabetes complication severity and quality of life in type 1 and 2 diabetes, providing contemporary utility estimates for cost-effectiveness analyses. This longitudinal cohort study used Swiss diabetes registry data (2015-2022). Patients with type 1 and 2 diabetes completing ≥2 annual EQ-5D-3L questionnaires were included. We used the adapted Diabetes Complications Severity Index (aDCSI) to quantify complication severity. Associations were examined using mixed-effects regression models, adjusted for patient characteristics and survey time. Among 896 participants (422 type 1, 474 type 2), 83% had ≥1 complication at baseline. Type 1 patients reported better quality of life than type 2 (EQ-5D: 0.96 vs 0.88; VAS: 82.1 vs 75.5). Higher aDCSI scores were associated with reduced quality of life in both diabetes types. Women and insulin-treated patients reported lower scores. Only 4.9% developed complications. No quality of life decrement over time was observed. Diabetes complications reduce quality of life, with myocardial infarction (-0.05 EQ-5D utility) in type 2 and renal failure (-19 VAS points) in type 1, with decrements smaller than previous estimates.
This systematic review examines the application of Artificial Intelligence-Generated Content (AIGC) in developing virtual patients (VPs) for diabetes management. Through structured analysis of current literature, the study demonstrates how AIGC methodologies address key clinical challenges: generative adversarial networks create synthetic continuous glucose monitoring trajectories to overcome data scarcity; reinforcement learning optimizes personalized insulin regimens through simulated treatment responses; and multimodal fusion techniques generate detailed models for diabetic complications. These approaches demonstrate technical feasibility in retrospective analyses and experimental settings for medical education and clinical decision support. However, their translation to clinical practice awaits rigorous prospective validation with diabetes-specific endpoints. However, validation remains primarily retrospective, with limited prospective trials reporting diabetes-specific endpoints like time-in-range and hypoglycemia metrics. Critical implementation barriers include data privacy concerns, model generalizability across diabetes subtypes, and clinical workflow integration. An empirical mapping of included studies onto a three-dimensional maturity framework reveals that while 92% of studies achieve technical validation, none demonstrate implementation maturity and only one has prospective evidence of clinical efficacy. Future progress hinges on interdisciplinary collaboration to develop robust validation frameworks aligned with regulatory standards and to proactively mitigate algorithmic biases, thereby bridging the gap between technical innovation and dependable clinical application.
Background/Objectives: Liver fat represents an early metabolic lesion in the development of diabetes and its cardiometabolic complications. Diets high in free sugars, particularly from sugar-sweetened beverages (SSBs), are associated with abdominal obesity and increased cardiometabolic risk, prompting global guidelines to limit SSBs as a major public health strategy. Low-fat cow's milk is promoted as the preferred caloric replacement strategy for SSBs due to its high nutritional value and cardiometabolic advantages. Fortified soymilk is a plant-based alternative with approved health claims for cholesterol and coronary heart disease risk reduction that offers an equivalent nutritional value to cow's milk. However, given concerns about its classification as an ultra-processed food (UPF), it is unclear whether soymilk offers comparable metabolic health benefits to milk as part of clinical and public health strategies to reduce SSB intake. The Soy Treatment Evaluation for Metabolic (STEM) health trial seeks to evaluate the impact of replacing SSBs with either 2% soymilk or 2% cow's milk on liver fat and other cardiometabolic risk factors in habitual adult consumers of SSBs with obesity. Methods: The STEM trial is a 24-week, pragmatic, 3-arm, parallel, randomized trial. We recruited adults with obesity (high BMI plus high waist circumference based on ethnic specific cut-offs) consuming ≥1 SSB/day. Participants were randomized to one of three groups based on their usual SSB intake at baseline (servings/day): continued SSB (355 mL can) intake; replacement with fortified, sweetened 2% soymilk (250 mL); or replacement with 2% cow's milk (250 mL). The primary outcome is the change in intrahepatocellular lipid (IHCL) measured by 1H-MRS at 24 weeks. Hierarchical testing will be done to reduce the familywise error rate. The superiority of cow's milk to SSBs will be assessed first to establish assay sensitivity. If superiority is established, then the non-inferiority of soymilk to cow's milk will be assessed using a pre-specified non-inferiority margin of 1.5% IHCL units (assessed by difference of means using a 90% confidence interval [CI]). Analyses will be conducted according to the intention-to-treat (ITT) principle using inverse probability weighting (IPW) for superiority testing and per-protocol analyses for non-inferiority testing, using ANCOVA adjusted for age, sex, metabolic dysfunction-associated steatotic liver disease (MASLD) status, medication use, intervention dose, and baseline levels. We hypothesize that soymilk will be non-inferior to cow's milk (Clinicaltrials.gov NCT05191160). Results: Recruitment began in November 2021. A total of 3050 individuals were screened. We randomized 186 participants (62 per group) between 19 April 2022 and 16 April 2024. Participants are 57% male; with a mean [SD] age of 39.9 [11.8] years; BMI of 34.6 [6.1] kg/m2, waist circumference of 112.6 [13.8] cm; IHCL of 10.0 [8.2] % with 64.1% meeting the criteria for MASLD; and SSBs intake of 2.3 [1.3] servings/day. Conclusions: Baseline characteristics were balanced across the study arms, with participants representing adults with a high-risk metabolic phenotype, and 64.1% meeting the criteria for MASLD. Findings will contribute to evidence on the cardiometabolic benefits of soymilk, informing clinical practice guidelines and public health policy.
Automated insulin delivery (AID) systems are increasingly used in type 1 diabetes (T1D) management, yet large-scale real-world evidence in pediatric populations remains limited. This study assessed the impact of AID therapy on glycemic outcomes in children and adolescents with T1D using data from the international SWEET registry. We performed an observational comparative study using two treatment periods (12 months before and after AID initiation). Data were obtained from the SWEET database, with 53 centers across 29 countries contributing eligible cases. Participants were children and adolescents (≤18 years) with T1D who initiated AID therapy between 2014 and 2022. Primary endpoints included HbA1c, mean sensor glucose, and percentages of time spent in predefined glycemic ranges. A total of 2,170 participants were included. AID therapy was associated with significant improvements in glycemic control. Time in the target range (70-180 mg/dL) and tight target range (70-140 mg/dL) increased, while mean sensor glucose and glucose variability decreased. Time below range (<70 mg/dL) was reduced. HbA1c improved without a significant change in total daily insulin dose. In this large multinational real-world cohort, AID therapy significantly improved glycemic outcomes and reduced hypoglycemia in children and adolescents with T1D. These findings support the effectiveness of AID systems across diverse clinical settings and underscore their value in pediatric diabetes care.
Type 1 diabetes (T1D) is associated with an increased risk of Alzheimer's disease and related dementias (AD/ADRD), although mechanisms remain unclear. This study examined the relationships between blood-based biomarkers of ADRD, diabetes-related factors, and glycemia in adults with T1D. This study analyzed 114 adults from the Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes (GluCog) Study with available plasma samples. Regression models assessed relationships between biomarkers (Aβ42/Aβ40 ratio, GFAP, NfL, pTau181, pTau217), diabetes characteristics, and continuous glucose monitoring metrics (up to 20 days), adjusting for demographics and kidney disease. False discovery rate (FDR) correction was applied. Lower Aβ42/Aβ40 ratios were associated with older age of T1D diagnosis and higher NfL concentrations with higher mean glucose, lower glucose time in range, more time spent with glucose above 180 and 250 mg/dL, higher HbA1c, neuropathy, and diabetic ketoacidosis. These remained significant after additional adjustment for kidney disease, although residual confounding by renal function cannot be excluded. Higher NfL was linked with multiple measures of hyperglycemia and other diabetes-related complications, consistent with neuronal injury rather than suggesting an ADRD-specific process. Longitudinal studies are needed to clarify the mechanisms between NfL and glycemia in T1D.
To establish the incidence of developing diabetes mellitus (DM) post hospitalisation with influenza. Retrospective cohort study. Electronic healthcare records from Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics in England. 13 710 adults with a first episode of hospitalised influenza as the primary cause for admission between 1 July 2004 and 1 March 2021 based on ICD-10 codes without pre-existing DM were included. A randomly selected group (a) from CPRD records matched for age, sex and General Practitioner (GP) practice and (b) an unmatched group of hospitalised sepsis patients were used as comparator groups. Patients were followed from 1 day after discharge till either DM diagnosis, death or end of GP record. HRs for incidence of DM were calculated using adjusted Cox regression models. Incidence of DM was 12.5 per 1000 person years. Adjusted HRs (aHR) for developing DM after hospitalised influenza compared with matched controls was 1.54 (95% CI 1.39 to 1.70, p<0.001) and to hospitalised sepsis comparators 1.14 (95% CI 1.03 to 1.26, p=0.013). The greatest risk for developing DM in hospitalised influenza patients was within 90 days of discharge (aHR 2.71 (95% CI 1.94 to 3.77, p<0.001)) compared with matched controls. Risk factors for DM after influenza hospitalisation included being male, pre-existing DM risk, obesity and critical care admission during acute illness. Patients' post hospitalisation with influenza had a greater incidence of DM when compared with both matched controls and patients following hospitalisation with sepsis.
Early-life nutritional deprivation from famine may increase lifelong vulnerability to Type 2 Diabetes Mellitus (T2DM). This Systematic Review and Meta-Analysis evaluated studies published over the past three decades to assess and appraise the association between famine exposure across developmental stages and T2DM risk. PubMed, Embase, Web of Science, and the Cochrane Library identified observational studies published between 1995 and 2025. Studies reporting risk estimates or data enabling calculation of risk ratios (RRs) were included, followed by pooled estimates were generated. Methodological quality was assessed using the Newcastle-Ottawa Scale. Subgroup analyses, meta-regression and sensitivity analyses were conducted to explore heterogeneity. Of 6311 identified articles, 40 met the inclusion criteria. Overall, famine exposure was associated with 43 % higher risk of T2DM (95 % CI: 1.30-1.56; I2 = 96.7 %). The pooled risk increased to 47 % in studies published between 2016 and 2025. Longer famine duration (RR = 1.79) and females (RR = 1.52) showed comparatively higher risk. Higher famine severity and exposures during the fetal stage indicated greater susceptibility. Thus, famine exposure is consistently associated with increased risk of T2DM, particularly with prolonged or severe exposure and among women. Nutritional deprivation during key developmental periods may have lasting metabolic effects.
Microalbuminuria, common in diabetes, lacks clarity as a predictor of diabetes onset. This study examines its association with incident type 2 diabetes (T2DM) and clinical implications. This prospective cohort analysis utilized data from 411,389 UK Biobank participants with baseline urine albumin-to-creatinine ratio (UACR) measurements. Cox proportional hazards regression models, supplemented by restricted cubic spline analyses, were implemented to longitudinally evaluate the association between UACR levels and incident T2DM risk. Over an average follow-up duration of 13.8 years (range: 13.1-14.6 years), 15,942 new cases of diabetes were identified. After adjusting for potential confounders, the hazard ratios for incident T2DM were 1.31 (95% CI: 1.17-1.45) for UACR between 3-30 mg/mmol and 2.20 (95% CI: 1.58-3.06) for UACR > 30 mg/mmol, when compared to a reference UACR of <3 mg/mmol. These results remained stable across multiple sensitivity analyses, including those addressing potential confounding factors such as body mass index, insulin resistance, uric acid levels, and estimated glomerular filtration rate using the creatinine-cystatin C equation (eGFRcr-cys). This large-scale cohort study demonstrates that microalbuminuria serves as a clinical predictor of elevated risk for incident T2DM in adults. Routine UACR screening in high-risk populations may enhance early detection and intervention.
This study aimed to assess, compare, and rank the effects of different behavioral interventions on key cardiovascular risk factors in adults with type 2 diabetes. We searched PubMed, Scopus, and Web of Science up to March 2025. A random-effects network meta-analysis with a Frequentist framework was conducted to estimate mean differences (MDs) and 95% confidence intervals (CIs). The certainty of evidence was rated using the GRADE approach. Standard behavioral therapy (SBT) improved short-term glycemic control, reducing HbA1c by 0.24% (95% CI: -0.41, -0.06) at 0-3 months with moderate-certainty evidence. Multicomponent interventions, particularly those combining cognitive behavioral therapy (CBT), SBT, and motivational interviewing (MI), showed the largest and most sustained effects, achieving a 1.84% HbA1c reduction (95% CI: -2.04, -1.63) at 12-36 months compared with SBT alone. SBT also reduced systolic blood pressure and increased HDL cholesterol. Ranking analyses indicated that SBT + mindfulness-based interventions, ACT/DBT-based approaches, and CBT + SBT + MI were most effective for HbA1c reduction. For fasting blood glucose, CBT combined with SBT or MI showed the highest effectiveness, while SBT plus control ranked well at 6-12 months. Overall, multicomponent behavioral strategies appear most effective for sustained HbA1c improvement, although stronger evidence is needed for fasting glucose and adiposity outcomes.
To evaluate glycemic control, weight management, and patient-reported outcomes (PROs) in adults with type 2 diabetes mellitus who transitioned to oral semaglutide (OS) after inadequate glycemic control on dipeptidyl peptidase-4 inhibitors (DPP-4i). This 40-week, observational, prospective study included three visits: baseline (V1, OS initiation), intermediate visits (V2.X), and final visit (V3, week 40 ± 4). The primary endpoint was change in glycated haemoglobin (HbA1c) from V1 to V3. Secondary endpoints included changes in body weight (BW), PROs - assessed by the Diabetes Distress Scale (DDS) and the Dutch Eating Behaviour Questionnaire (DEBQ) - and anthropometric/clinical parameters. 281 patients were enrolled (mean age 67.5 ± 12.0 years; 55.9% male). In the in-study set (all patients initiating OS, regardless of discontinuation), mean HbA1c decreased by - 0.7 ± 0.05% (p < 0.0001), and mean BW decreased by - 3.6 ± 0.22  kg (p < 0.0001) from V1 to V3. Scores on the DDS domains and the DEBQ (emotional and external eating domains) decreased, indicating reduced diabetes-related distress and improved eating behaviours. Adverse events were reported by 23.1% of patients, with no hypoglycaemic episodes observed. OS was safe and effective in improving glycemic control, reducing BW, and alleviating diabetes-related distress and unhealthy eating behaviors in patients with type 2 diabetes mellitus switched from DPP-4i.