Diabetic Medicine[JOURNAL]
Sun
200 papers
Wolfram syndrome and diabetes mellitus in Aotearoa, New Zealand: Phenotype and response to GLP-1 receptor agonist therapy.
L'Amie A, Vincent AL, Jefferies CA … +5 more , Braatvedt G, Wiltshire E, Mouat F, Albert BB, Murphy R
Diabet Med · 2026 Jun · PMID 42324630 · Publisher ↗
AIM: To describe the clinical characteristics of patients with Wolfram syndrome (WFS) and diabetes mellitus (DM) in Aotearoa, New Zealand. Review of response to therapy in those treated with glucagon-like peptide-1 recep...
AIM: To describe the clinical characteristics of patients with Wolfram syndrome (WFS) and diabetes mellitus (DM) in Aotearoa, New Zealand. Review of response to therapy in those treated with glucagon-like peptide-1 receptor agonists (GLP1RA). METHODS: This retrospective cohort study describes 7 patients with WFS1 genetic variants (1 patient with WFS-like syndrome), and DM from 5 New Zealand families (age range 5-33 years, 4 females, 3 males). All are receiving insulin. In 5 patients receiving GLP1RA therapy, we described their pre- and post-treatment biometric parameters, glycaemic control and visual acuity. RESULTS: Genetic testing identified compound heterozygous variants in the WFS1 gene (inherited from each parent) in five patients. Another two were heterozygous carriers of a single WFS1 missense variant, one of which was associated with uniparental disomy. Among patients receiving GLP1RA therapy, reductions were seen in HbA1c (mean 11.6 mmol/mol) and total daily insulin dose (mean 0.25 units/kg/day). CONCLUSIONS: We report genotypic and phenotypic variability in association with clinical features, including age of onset and severity. GLP1RA therapy was associated with improvements in diabetic control. Longer-term follow-up is required to monitor for sustained benefit and for progression or improvement in other WFS clinical features.
Extracellular matrix proteins as risk markers for complications in type 1 diabetes.
Rygg MO, Møller AL, Curovic VR … +9 more , Rasmussen DGK, Theilade S, Tofte N, Winther SA, Genovese F, Karsdal MA, Kümler T, Hansen TW, Rossing P
Diabet Med · 2026 Jun · PMID 42322163 · Publisher ↗
AIMS: Kidney fibrosis, characterised by impaired extracellular matrix remodelling and excessive collagen deposition, is a hallmark of chronic kidney disease in diabetes. We investigated whether biomarkers reflecting coll...
AIMS: Kidney fibrosis, characterised by impaired extracellular matrix remodelling and excessive collagen deposition, is a hallmark of chronic kidney disease in diabetes. We investigated whether biomarkers reflecting collagen formation and degradation were associated with complications in type 1 diabetes. METHODS: In this observational cohort study, markers of collagen type III (PRO-C3), VII (PRO-C7) and XXVIII (PRO-C28) formation and collagen type III degradation (CTX-III) were measured in serum by ELISA. Associations between baseline biomarker levels and a composite kidney endpoint, all-cause mortality, albuminuria progression and cardiovascular events were tested using Cox proportional hazards models adjusted for traditional risk factors. Hazard ratios (HRs) are reported per 1-SD increase in log-transformed biomarker levels. RESULTS: Over a median follow-up of 6.3 (IQR: 5.9-6.7) years, 125 of 662 participants experienced the composite kidney endpoint, 58 participants died, 102 progressed in albuminuria and 94 developed a cardiovascular event. Higher baseline levels of PRO-C3 were associated with the development of the composite kidney endpoint (adjusted HR: 1.30, 95% CI 1.08-1.57, p < 0.01) and mortality (adjusted HR: 1.36, 95% CI 1.06-1.76, p = 0.016). No associations were found between PRO-C3 and albuminuria progression or cardiovascular events. PRO-C7, PRO-C28 and CTX-III were not associated with any of the endpoints. CONCLUSIONS: Higher baseline serum PRO-C3, a marker of collagen type III formation and fibrogenesis, was associated with an increased risk of developing the composite kidney endpoint and all-cause mortality in individuals with type 1 diabetes.
Barriers and enablers to physical activity in type 1 diabetes: A mixed-methods study of adults and parent-reported child perspectives in the UK.
Cockcroft EJ, Bright C, Nathan H … +4 more , Farrow D, Russon C, Pulsford RM, Andrews RC
Diabet Med · 2026 Jun · PMID 42321600 · Publisher ↗
AIMS: To identify and compare barriers and enablers influencing physical activity in adults and parent-proxy responses for children with type 1 diabetes in the UK. METHODS: A cross sectional survey was distributed via Br...
AIMS: To identify and compare barriers and enablers influencing physical activity in adults and parent-proxy responses for children with type 1 diabetes in the UK. METHODS: A cross sectional survey was distributed via BreakthroughT1D (formerly JDRF) networks between December 2022 and January 2023. The survey included closed and open-ended questions on physical activity behaviours and influencing factors. Responses were collected from adults with type 1 diabetes and parent-proxy responses for children with type 1 diabetes. Quantitative data were analysed using descriptive statistics and two-proportion z-tests. Free-text responses were analysed thematically. Barriers and enablers were synthesised using the COM-B model and socioecological framework to identify behavioural determinants and intervention targets. RESULTS: 311 responses were analysed (182 adults; 129 parent proxies for children). Stigma and negative comments were reported by nearly three-quarters of both groups. Adults more frequently reported clinical and motivational barriers: fear of hypoglycaemia (53%) and lack of motivation (39%). Adults reported significantly less healthcare provider support for physical activity (24%) compared with parent-proxy responses for children (57%). Parent-proxy responses for children more frequently reported external barriers, including lack of education among coaches (31%). CONCLUSION: This is one of the first UK-based studies to comprehensively compare barriers and enablers across age groups. Stigma in physical activity and sports settings emerges as a major, under-recognised barrier requiring urgent attention. Multilevel interventions are required, targeting individual knowledge and motivation alongside systemic changes. These should include mandatory diabetes education for coaches and teachers, policy enforcement to address discrimination and enhanced healthcare provider support for physical activity.
Comparative predictive accuracy of machine learning versus traditional statistical methods for diabetes-related complications: A systematic review and analysis.
Ghafoor B, Zaccardi F, Khunti K … +1 more , Shabnam S
Diabet Med · 2026 Jun · PMID 42316875 · Publisher ↗
AIMS: To compare the predictive accuracy of machine learning models versus traditional statistical models for predicting and detecting long-term complications among individuals with diabetes (PROSPERO: CRD420250629747)....
AIMS: To compare the predictive accuracy of machine learning models versus traditional statistical models for predicting and detecting long-term complications among individuals with diabetes (PROSPERO: CRD420250629747). METHODS: We systematically searched MEDLINE, PubMed, Cochrane and Scopus (2014-2025) for studies developing or validating prediction models in people with diabetes. Excluding case-control studies, we identified 36 eligible studies (280 model comparisons) from 18,237 records. We extracted study design, model details and performance metrics (primarily C-statistics). Risk of bias was assessed using PROBAST. RESULTS: Across 280 comparisons, ensemble machine learning methods frequently outperformed logistic regression. Random forest models achieved higher discrimination in 63% (43/68) of comparisons, while extreme gradient boosting showed improvement in 58% (14/24). Support vector machines improved performance in only 44% (24/55). Generally, predictive accuracy gains were modest. Methodological quality was concerning as external validation was reported in only 8% (3/36) of studies, calibration in 13% (5/36), and 59% of studies demonstrated a high risk of bias. CONCLUSIONS: Machine learning models, particularly ensemble methods, offer modest discrimination improvements over traditional statistics for predicting diabetes-related complications. However, widespread methodological limitations, specifically the lack of external validation, inconsistent calibration reporting and high bias, substantially limit our confidence and clinical readiness. Rigorous external validation and transparent reporting are needed before routine implementation.
Women living with diabetes: Overlooked and under-recognised, the psychosocial impact.
Forde R, Forbes A, Adams D … +10 more , Esmer AC, Davidsen E, de Wit M, Hadjiconstantinou M, Hashim R, Munda A, Nefs G, Pedrosa HC, Sabidi A, Parsons J
Diabet Med · 2026 Jun · PMID 42316786 · Publisher ↗
AIM: Diabetes intersects with women's reproductive and sexual health across the life course; however, the psychosocial implications of key reproductive transitions remain under-recognised in research and clinical practic...
AIM: Diabetes intersects with women's reproductive and sexual health across the life course; however, the psychosocial implications of key reproductive transitions remain under-recognised in research and clinical practice. This review synthesised evidence on the psychosocial impacts of diabetes during menstruation, pregnancy, the menopausal transition and sexual functioning, with the aim of identifying critical gaps in research and care. METHODS: A narrative review was conducted, informed by a semi-structured literature search. FINDINGS: Women living with diabetes experience substantial psychosocial burdens that extend beyond glycaemic management across all reproductive stages. During menstruation, hormonal fluctuations contribute to glycaemic variability, increased self-management demands and emotional distress, often without adequate clinical guidance. Pregnancy in women with type 1, type 2, and gestational diabetes is associated with heightened anxiety, diabetes distress, stigma and guilt, yet psychosocial needs remain largely unaddressed in routine care. The menopausal transition represents a further period of vulnerability, characterised by worsening glycaemic variability, increased psychological morbidity and elevated cardiovascular risk. Sexual dysfunction is highly prevalent across the lifespan in women with diabetes and is strongly associated with depression, anxiety and body image concerns. CONCLUSION: Overall, the evidence highlights a persistent disconnect between the psychosocial needs of women and the predominantly biomedical focus of current diabetes care models. Addressing this gap requires a person-centred approach that integrates psychosocial and women-specific health considerations into diabetes research, education and clinical practice. Strengthening this evidence base is essential to improving long-term health outcomes for women living with diabetes.
A 4-week community-implemented diabetes prevention program is associated with improved metabolic outcomes at 12 months after participation.
Bourne JE, Cranston K, Dineen T … +8 more , MacPherson M, Locke S, Santos A, Grieve N, Colyer A, Falkenhain K, Yildirim AN, Jung ME
Diabet Med · 2026 Jun · PMID 42310924 · Publisher ↗
AIMS: Small Steps for Big Changes (SSBC) is a 4-week, evidence-based diabetes prevention program delivered by non-medical personnel in community settings. This study explored changes in type 2 diabetes risk factors and h...
AIMS: Small Steps for Big Changes (SSBC) is a 4-week, evidence-based diabetes prevention program delivered by non-medical personnel in community settings. This study explored changes in type 2 diabetes risk factors and health behaviours over 12 months following SSBC program completion. METHODS: A single-arm pragmatic trial with repeated measures was conducted in three urban locations in Canada and was delivered virtually during COVID-19. Participants were adults at risk of developing type 2 diabetes (HbA1c 39-46 mmol/mol[5.7-6.4%]). SSBC consists of 6 one-hour sessions involving behavioural counselling and exercise. The primary outcome was HbA1c at 12-month post-program. Secondary outcomes included weight, waist circumference, functional exercise capacity, diet and physical activity behaviour at 12-month post-program. RESULTS: Three hundred and eighty-nine individuals at risk of developing type 2 diabetes were enrolled (mean age = 58.8(8.7) years, 61% White, 68% women), with a 93% session attendance rate. Of 389 enrolled, 172 completed 12-month assessments, of whom 117 had HbA1c at baseline and the 12-month follow-up. At 12 months, participants had significant reductions in HbA1c (-1.91 mmol/mol; -0.19% [95% CI: -2.57, -1.36 mmol/mol; -0.25, -0.13%]), weight (-3.03 [-4.15, -1.93] kg), waist circumference (-4.07 [-5.27, -2.91] cm) and improved distance walked on the six-minute walk test (37.55 [28.58, 46.75] m). Favourable changes in diet and physical activity were also sustained at 12-month post-program. CONCLUSIONS: SSBC participation was associated with improvements in key diabetes risk factors at 12-month post-program. These findings suggest that brief, community-based, lay-led programs may have potential for supporting diabetes prevention.
Real-world performance of point-of-care metre, blood gas and laboratory glucose methods in Australian and American hospital inpatient cohorts.
Cooper JAL, Barmanray RD, Fazio TN … +3 more , Capurro D, Fourlanos S, Chiang C
Diabet Med · 2026 Jun · PMID 42310492 · Publisher ↗
AIMS: Point-of-care ('POC') glucose metres are ubiquitous in hospitals, with results guiding clinical glucose management. Inpatient accuracy can diverge from controlled evaluations and may alter decision making. We there...
AIMS: Point-of-care ('POC') glucose metres are ubiquitous in hospitals, with results guiding clinical glucose management. Inpatient accuracy can diverge from controlled evaluations and may alter decision making. We therefore aim to characterise real-world inpatient glucose metre performance against gold standard methods. METHODS: We assess POC metre, blood gas and laboratory glucose measures across two large, retrospective, adult, inpatient cohorts (Australian quaternary centre and US MIMIC-IV dataset). Glucose 'pairs' were defined as measurements by different modalities occurring within 15 min, with sensitivity analysis within 5 min. Agreement was evaluated using robust regression, mean absolute relative difference, and error-grid analyses. Stratified analyses assessed the effect of haemoglobin and pO. RESULTS: Blood gas closely paralleled laboratory glucose, supporting its use as a practical comparator. POC glucose metres in both datasets exhibited systematic bias: positive at lower glucose and negative at higher glucose, with greatest variability at extremes. Narrowing the pairing window modestly improved overall error in the Australian dataset but still did not meet ISO or FDA numerical targets. For both datasets, on Parkes/Consensus Error Grids, >98% of pairs fell within low-risk zones (A/B). On the DTS grid, zone-A percentages were 90.7% in the Australian cohort and 75.7% in MIMIC-IV. Low haemoglobin amplified negative bias at higher glucose, while pO strata showed no consistent impact. CONCLUSIONS: In routine inpatient care, POC glucose metres show systematic bias, amplified by anaemia. Our results support local validation of glucose metre performance and identification of high-risk results to prompt confirmatory testing.
Glycaemic penalty index as an independent predictor of healthcare-associated infection in surgical inpatients: A nested cohort study from the STOIC-D surgery trial.
Blomson G, Barmanray RD, Kyi M … +5 more , Colman PG, Worth LJ, Le MV, Sun E, Fourlanos S
Diabet Med · 2026 Jun · PMID 42304655 · Publisher ↗
AIMS: To evaluate the utility of the Glycemic Penalty Index (GPI), a validated tool for assessing risk of adversity associated with inpatient dysglycaemia in surgical intensive care patients, in predicting adverse clinic...
AIMS: To evaluate the utility of the Glycemic Penalty Index (GPI), a validated tool for assessing risk of adversity associated with inpatient dysglycaemia in surgical intensive care patients, in predicting adverse clinical outcomes among surgical inpatients at a quaternary Australian hospital. METHODS: This nested cohort study analysed data from the control arm of the Specialist Treatment of Inpatients: Caring for Diabetes in Surgery (STOIC-D Surgery) randomised controlled trial. The GPI was calculated using blood glucose values to derive patient-day weighted mean GPI (PDWMGPI). Univariable and multivariable analyses assessed associations between GPI and the outcomes of healthcare-associated infection (HAI) and acute kidney injury. RESULTS: 691 surgical inpatients with diabetes receiving standard care were included. On multivariable analysis, increasing PDWMGPI was independently associated with healthcare-associated infection (odds ratio 1.02 per one-unit increase, 95% CI 1.01-1.04, p = 0.008). CONCLUSION: The association between PDWMGPI and HAI suggests that linearised summary glycaemic measures may support clinicians in identifying patients at increased risk of adverse inpatient outcomes related to glycaemic patterns when interpreted alongside clinical factors. The simplicity of GPI as a single score may assist risk stratification and prioritisation of specialist diabetes input in surgical inpatient settings.
Unaddressed dimensions of low-calorie diet for T2D remission in Nepal: Enhancing global applicability.
Gao S, Geng Y
Diabet Med · 2026 Jun · PMID 42290086 · Publisher ↗
Abstract loading — click title to view on PubMed.
Clinic visit no-shows and last-minute cancellations are common among teens and emerging adults with type 1 diabetes.
Patterson AI, Ruggles H, Dewalt DA … +1 more , Vitale RJ
Diabet Med · 2026 Jun · PMID 42286432 · Full text
AIMS: This study aimed to compare demographic and clinical information of teens and emerging adults with type 1 diabetes (T1D) by endocrinology visit completion status (no-showed, cancelled last minute [within 8 days], a...
AIMS: This study aimed to compare demographic and clinical information of teens and emerging adults with type 1 diabetes (T1D) by endocrinology visit completion status (no-showed, cancelled last minute [within 8 days], attended). METHODS: Three endocrinology clinic schedules (two paediatric, one adult) were reviewed weekly over a 6-month period to identify people with T1D (≥1 year) ages 15-35. A1c, demographics and use of emergency department (ED)/inpatient care over the last year were recorded. We compared these factors by visit completion status using ANOVA, chi-squared and Fisher's exact tests. RESULTS: Of 529 individuals, 9% no-showed and 21% cancelled their visit last minute. Among those who cancelled, private insurance was more common than public (60% vs. 38%, respectively), which differed from those who no-showed (40% vs. 53%, p < 0.001). A1c was higher in people who no-showed (79 mmol/mol, 9.4%) than cancelled (67 mmol/mol, 8.2%) or completed visits (62 mmol/mol, 7.8%, p < 0.001). Those who no-showed were more likely to have 2+ ED visits/hospitalizations in the last year compared with those who cancelled or attended (21% vs. 11% vs. 6%, respectively; p = 0.013). CONCLUSIONS: Among 15-35-year-olds with T1D, no-shows and last-minute cancellations were common. Those who cancelled last minute had higher A1cs and greater ED/hospital use than those who completed visits, although these were not as high as in those who no-showed. Mechanisms to identify and ensure appropriate follow-up among individuals with last-minute cancellations should be explored.
Experiences of receiving and delivering a novel complex intervention for type 1 diabetes and disordered eating: Process evaluation of the Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY).
Zaremba N, Harrison A, Brown J … +9 more , Pillay D, Konstantara E, Treasure J, Hopkins D, Prins J, de Galan B, Ismail K, Nefs G, Stadler M
Diabet Med · 2026 Jun · PMID 42277630 · Publisher ↗
AIM: The Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY) intervention is a novel cognitive behaviour therapy (CBT) intervention for individuals with type 1 diabetes and disordered eatin...
AIM: The Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY) intervention is a novel cognitive behaviour therapy (CBT) intervention for individuals with type 1 diabetes and disordered eating (T1DE). The aim of this mixed-method process evaluation is to assess the acceptability, appropriateness and feasibility of STEADY, and explore experiences of both participants and healthcare professionals during therapy delivery. METHODS: Participants who received STEADY (n = 13) and healthcare professionals delivering STEADY therapy (n = 3) completed person-reported outcome measures (PROMs) to assess the acceptability (AIM), appropriateness (IAM) and feasibility (FIM) of STEADY and took part in semi-structured interviews to explore experiences, therapeutic processes and implementation considerations. Interviews were analysed using thematic analysis. RESULTS: PROM scores indicated high ratings across participants (AIM = 18.36 ± 2.01; IAM = 18.18 ± 2.64; FIM = 18.00 ± 2.32) and healthcare professionals (AIM = 17.67 ± 2.08; IAM = 17.33 ± 2.31; FIM = 17.67 ± 2.08), suggesting high likelihood of implementation success. Thematic analysis showed significant overlap in participant and therapist experiences. Key themes included integrated T1DE-specific CBT delivery, specialist knowledge of T1DE and a strong therapeutic alliance. Both groups emphasised the need for tailored delivery, therapist expertise in T1DE and structural adaptations to standard CBT models. Participant's experiences also included a clear path of therapeutic growth and expectations of therapy. Therapists' experiences included considerations for clinical safeguarding and organisational factors impacting wider implementation. CONCLUSIONS: Our findings demonstrate that STEADY is acceptable, appropriate and feasible for individuals with mild to moderate severity T1DE. The substantial alignment between participant and therapist perspectives offers clear directions for refining the intervention and support implementation in a full-scale RCT.
A qualitative enquiry into the lived experiences of women with type 1 diabetes using closed-loop insulin delivery in pregnancy in the CIRCUIT trial.
Hirtle J, Goraya N, Dunlop A … +6 more , Booth J, Feig DS, Yamamoto J, Donovan LE, Chaput KH, CIRCUIT Collaborative Group
Diabet Med · 2026 Jun · PMID 42275143 · Publisher ↗
AIMS: This qualitative inquiry aimed to explore the lived experiences of pregnant women with self-management of type 1 diabetes (T1D) using closed-loop insulin delivery in the CIRCUIT trial to provide a qualitative overv...
AIMS: This qualitative inquiry aimed to explore the lived experiences of pregnant women with self-management of type 1 diabetes (T1D) using closed-loop insulin delivery in the CIRCUIT trial to provide a qualitative overview of its impacts and improve the understanding of T1D experiences in pregnancy. METHODS: We used semi-structured, individual interviews with 18 CIRCUIT randomized trial participants. Two team members analysed verbatim transcripts using inductive thematic analysis. RESULTS: Four major themes emerged: 1. Independence and isolation; 2. Support is key; 3. Closed-loop impacts; and 4. Control and autonomy. Diabetes management during pregnancy was an emotionally overwhelming experience that was managed largely independently. Closed-loop was noted as a gamechanger for diabetes management during and after pregnancy. Participants felt the transition to and use of this technology would not have been possible without their healthcare team's support. Permeating all themes was the importance of control to achieve the best possible glycaemic outcomes for the health of their babies and autonomy over personal treatment decisions. The perceptions of loss of personal autonomy were associated with high anxiety. CONCLUSIONS: Managing T1D while pregnant is an independent and isolating endeavour, due to the 'invisible labour' involved and the lack of knowledge about T1D management in personal networks. Support from partners and care providers alleviated stress. Experiences with intrapartum care providers who had limited T1D understanding were perceived as a challenge by some for maintaining autonomy. The closed-loop system was seen as a 'gamechanger' in T1D pregnancy management, with unanimous perception of positive impacts that far outweigh any challenges. Use of this closed-loop system has potential to vastly improve pregnancy experiences among those with T1D.
Integrated care for type 1 diabetes: The West Bengal model: 24-month follow-up.
Yasmin M, Mukhopadhyay P, Paul B … +5 more , Mukhopadhyay DK, Kar PS, Ogle GD, Ghosh S, Published on behalf of the Kolkata Type 1 Diabetes Study (K1DS) Group
Diabet Med · 2026 Jun · PMID 42267935 · Publisher ↗
AIMS: This study aimed to document outcomes of care for individuals with type 1 diabetes (T1D) facilitated by a government-funded model supporting establishment of clinics within secondary-level district hospitals in a l...
AIMS: This study aimed to document outcomes of care for individuals with type 1 diabetes (T1D) facilitated by a government-funded model supporting establishment of clinics within secondary-level district hospitals in a lower-middle-income country. METHODS: This prospective, multicentre, single-arm pre-post implementation evaluation study was conducted in government-funded 'model' clinics in district hospitals in West Bengal, India. All consecutive persons with physician-diagnosed T1D (N = 366) were enrolled and immediately transitioned to basal-bolus insulin regimen, with structured monthly follow-up visits. Clinical measures, psychological well-being and diabetes-related expenditures were assessed at baseline, 12 months and 24 months. RESULTS: At baseline, median age and age at diagnosis were 15 (10-21) and 8 (5-11) years, respectively, with 41.4% from lower socio-economic class, and most parents/caregivers had not completed primary education. There were no dropouts, with a mean of 23.5 follow-up visits over 24 months. Median glycated haemoglobin (HbA1c) fell from 79 mmol/mol (64-104) [9.4% (8.0-11.7)] at baseline to 72 mmol/mol (58-87) [8.7% (7.5-10.1)] at 12 months, which further fell to 64 mmol/mol (54-73) [8.0% (7.1-8.8)] at 24 months (p < 0.0001). No episodes of documented diabetic ketoacidosis, hospital admissions or deaths occurred. Psychological well-being improved. Median monthly expenditures dropped from 2600 INR (~30 USD) at baseline to 200 INR (~2 USD) at 24 months (p < 0.0001). CONCLUSIONS: This novel public health system-supported model of T1D improved clinical parameters and psychological well-being of those living with T1D and their parents/caregivers and reduced expenditures.
Diabetes, in-hospital mortality trends and life expectancy loss among a 21.8-million population in Beijing, China, 2012-2024.
Kim H, Liu C, Li MJ … +5 more , Wang H, Feng RQ, Zhao MM, Guo MN, Yang JK
Diabet Med · 2026 Jun · PMID 42249696 · Publisher ↗
AIMS: Diabetes is a major contributor to premature mortality, but whether declining mortality trends in the general population have been matched among people with diabetes remains uncertain in China. METHODS: Retrospecti...
AIMS: Diabetes is a major contributor to premature mortality, but whether declining mortality trends in the general population have been matched among people with diabetes remains uncertain in China. METHODS: Retrospective cohort study based on hospitalisation records from 207 public general hospitals in Beijing (excluding community-level primary care facilities and speciality hospitals), serving the city's 21.8 million registered residents, 2012-2024. Temporal trends by Joinpoint regression, and life expectancy using abridged life tables. RESULTS: Among 452,186 in-hospital deaths, 146,282 (32.3%) had diabetes. In-hospital mortality was 32.0 per 1000 admissions in patients with diabetes and 13.4 in those without diabetes. During 2012-2019, among adults ≥75 years, mortality declined in patients without diabetes (AAPC, -1.2%; p = 0.026) but remained stable in those with diabetes (AAPC, 0.9%; p = 0.082); among adults <75 years, declines were smaller in patients with diabetes (-2.4% vs. -4.0%). Life expectancy-estimated from hospitalisation records as a comparative measure of survival among admitted patients-was 5.0 years lower in patients with diabetes than in those without diabetes. Loss was greater with earlier diagnosis; diagnosis at ages 20-24 years was associated with a 4.8-year reduction. Loss was larger in women than in men (5.8 vs. 2.4 years). CONCLUSIONS: Diabetes was associated with substantially higher in-hospital mortality and smaller mortality improvements. Earlier diagnosis was linked to greater life expectancy loss, with disproportionate losses among women.
Comment on Clinically significant hypoglycaemia in hospitalised adults: A multicentre study of 1205 episodes in the United Kingdom.
Malik MMUD
Diabet Med · 2026 Jun · PMID 42246697 · Publisher ↗
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Clustering of technological attitudes and reasons for device (non-)uptake among Dutch people with type 1 diabetes, family members and health professionals.
Horsselenberg M, Prins JB, Boenink M … +2 more , Aanstoot HJ, Nefs G
Diabet Med · 2026 Jun · PMID 42234799 · Publisher ↗
BACKGROUND: Pump and sensor technology contributes to glucose management and quality of life for people with type 1 diabetes (PWD). However, not everyone uses these technologies. This commonly relates to technological at...
BACKGROUND: Pump and sensor technology contributes to glucose management and quality of life for people with type 1 diabetes (PWD). However, not everyone uses these technologies. This commonly relates to technological attitudes, experiences and expectations. Also, parents and partners (P/P) and healthcare providers (HCPs) may impactful decision-making. Clustering of attitudes towards, experiences with, and expectations of diabetes technology into 'subgroups' may inform meaningful interventions to support device start and continuation in the era of advanced technologies. AIM: To determine how personal reasons for device non-uptake cluster together into subgroups. METHODS: A survey was conducted among PWD aged 12+ years (n = 219), P/P (18+, n = 55) and HCPs (n = 118) in Dutch health care. K-means cluster analyses were based on attitudes towards technology (all groups) and reasons for device non-uptake (PWD&P/P) or technological readiness (HCPs). Cluster validation examined cluster differences in demographics, glucometrics and professional characteristics (ANOVAs, X-tests). Data were combined to create subgroups per sample. RESULTS: Multiple subgroups were created per sample. Larger subgroups of each sample included positive technological attitudes (31%-67%). The smallest subgroups (PWD: 9%, P/P: 32%) included multiple concerns and insulin pen use. A third subgroup of PWD focused on the burden of device wear (31%). Two subgroups of HCPs had more negative attitudes towards technology, differing mostly in technology readiness (15%-20%), while the fourth had positive attitudes, but also felt less ready. CONCLUSION: Most participants reported positive attitudes and experiences. Technological concerns clustered together in general or focused on device wear, necessitating general as well as wear-specific technology support. HCPs could benefit from support that facilitates technological readiness.
Treatment burden and health-related quality of life in young adults with type 1 diabetes.
Van Gastel A, Graner-Baars M, Stiggelbout AM … +9 more , Tran VT, Giltay EJ, Dinneen SF, Mesman J, Swaak J, Aanstoot HJ, Montori VM, De Koning EJP, Kunneman M
Diabet Med · 2026 Jun · PMID 42233704 · Publisher ↗
AIM: This study aims to assess the treatment burden and health-related quality of life (HRQoL) in young adults with type 1 diabetes (T1D). METHODS: Online survey on experienced treatment burden (Treatment Burden Question...
AIM: This study aims to assess the treatment burden and health-related quality of life (HRQoL) in young adults with type 1 diabetes (T1D). METHODS: Online survey on experienced treatment burden (Treatment Burden Questionnaire, TBQ, 0-150, higher scores indicate higher burden) and HRQoL (Type 1 Diabetes and Life questionnaire for ages 18-25 and 26-45, T1DAL, 0-100, higher scores indicate better HRQoL) among Dutch young adults with T1D (aged 18-30). RESULTS: In total, 294 young adults with T1D completed the survey. Mean TBQ score was 59.5 (SD = 24.9). Regular medical care reminding participants of their health problems scored highest. Mean T1DAL scores were 55.9 (SD = 12.9) for ages 18-25, and 62.1 (SD = 13.2) for ages 26-30. Lowest scores were in the subcategory 'Emotional experiences and daily activities' (18-25: median = 41.7, IQR = 24.9; 26-30: median = 47.8, IQR = 22.5). TBQ was strongly negatively correlated with T1DAL (r = -0.69, 95% CI [-0.74, -0.62], p < 0.001). Characteristics associated with higher treatment burden and lower HRQoL included female gender, lower time in range and dissatisfaction with diabetes management approach. CONCLUSION: Young adults with T1D report considerable treatment burden and moderate HRQoL, suggesting a high impact of diabetes care on their lives. Treatment burden is particularly affected by regular medical care activities, whereas diabetes affects the daily functioning and emotional experiences domains of HRQoL. Further research is needed to understand how young adults make care fit and to improve care for these patients, resulting in minimally disruptive care plans. While cautiously interpreted, this may be especially relevant for women and those with adverse clinical outcomes.
Application of construction and validation of logistic regression model in risk prediction of non-proliferative diabetic retinopathy in type 2 diabetes mellitus.
Zhang J, Cao X, Yu X … +4 more , Jiang M, Xie T, Wang Y, Tang Z
Diabet Med · 2026 May · PMID 42216430 · Publisher ↗
AIMS: Diabetic retinopathy (DR) is a leading cause of vision impairment in type 2 diabetes mellitus (T2DM), with non-proliferative DR (NPDR) representing its most prevalent form. Early identification of high-risk individ...
AIMS: Diabetic retinopathy (DR) is a leading cause of vision impairment in type 2 diabetes mellitus (T2DM), with non-proliferative DR (NPDR) representing its most prevalent form. Early identification of high-risk individuals remains challenging due to the complexity and poor interpretability of existing machine learning models. This study aims to develop a clinically interpretable Logistic regression model for NPDR risk prediction using routinely available clinical indicators. METHODS: A retrospective cohort of 421 T2DM patients from a single centre was divided into training (n = 295) and validation (n = 126) sets. Demographic, glycemic (fasting glucose, HbA1c), renal (UACR) and ophthalmologic (macular oedema) data were collected. Univariate and multivariate Logistic regression with stepwise selection identified independent predictors. Model performance was evaluated using area under the ROC curve (AUC), sensitivity, specificity and Hosmer-Lemeshow goodness-of-fit. Internal validation was performed via bootstrapping (1000 replicates), and external validation used an independent cohort. RESULTS: Four independent predictors were identified: macular oedema (OR = 3.247), fasting glucose (OR = 2.194), HbA1c (OR = 2.799) and UACR (OR = 1.153). The model demonstrated excellent discrimination in the training set (AUC = 0.949, sensitivity = 86.4%, specificity = 95.5%) and good calibration (H-L test, p = 0.358). Bootstrap validation confirmed stability of HbA1c and UACR. External validation yielded an AUC of 0.918, with a positive predictive value of 91.1% and maintained calibration (p = 0.282). CONCLUSIONS: The constructed Logistic regression model accurately predicts NPDR risk using four readily available clinical variables, offering high discriminative power, interpretability and clinical utility for stratifying high-risk T2DM patients in primary care settings.
D-ACTnow-A diabetes-specific group-based psychological intervention for young adults with type 1 diabetes and elevated diabetes distress: Results from a single-arm pilot study.
Schmidt T, Just-Østergaard E, Mouritsen JD … +3 more , Pedersen GS, Pouwer F, Juhl CB
Diabet Med · 2026 May · PMID 42210751 · Publisher ↗
AIM: To test the feasibility of a group-based psychological intervention for young adults with type 1-diabetes and elevated diabetes distress. METHODS: Young adults (18-30 years), screened for diabetes distress using the...
AIM: To test the feasibility of a group-based psychological intervention for young adults with type 1-diabetes and elevated diabetes distress. METHODS: Young adults (18-30 years), screened for diabetes distress using the Type 1 Diabetes Distress Scale (T1-DDS), participated in six group sessions led by a psychologist and a diabetes nurse. The intervention was based on Acceptance and Commitment Theory (ACT) and focused on reducing diabetes distress. Feasibility was assessed through trial recruitment, intervention completion, intervention acceptability and preliminary estimates of effect size (T1-DDS, HbA, continuous glucose measurement), using descriptive statistics, t-test and systematic text condensation of interviews. RESULTS: During May 2023-December 2023, 22 young adults were recruited; 20 completed the intervention with high acceptability. Participants (85% women, mean age 23.6 years) showed significant reductions in diabetes distress (T1-DDS: 1.2, p < 0.0001). No changes were found in HbA or glucose time-in-range. Qualitative analyses highlighted benefits of sharing experiences with peers, gaining clarity and practicing coping strategies, supporting the intervention's feasibility and potential effectiveness. CONCLUSIONS: The intervention is feasible and acceptable with encouraging diabetes distress improvements. Minor adjustments will optimize the intervention for the upcoming RCT.
Cost-effectiveness of investing in earlier access to diabetic foot services: A multi-centre pre-post study.
Nghiem S, Lazzarini PA, Ward LT … +8 more , Jensen S, Charles D, Mann R, Sagoo M, Finch J, Gavaghan B, McBride LJ, Byrnes J
Diabet Med · 2026 May · PMID 42192577 · Publisher ↗
AIMS: We evaluated the cost-effectiveness of implementing a novel funding model to incentivise earlier access of patients with diabetes-related foot disease (DFD) to diabetic foot services (DFS). METHODS: In this multi-c...
AIMS: We evaluated the cost-effectiveness of implementing a novel funding model to incentivise earlier access of patients with diabetes-related foot disease (DFD) to diabetic foot services (DFS). METHODS: In this multi-centre pre-post study, we compared the cost, quality-adjusted life year (QALY) and clinical outcomes of patients with diabetes-related foot disease who had usual access to ambulatory DFS (controls) to patients who accessed the new DFS (intervention) across 15 regions in Queensland, Australia. A generalised linear model was used to estimate the difference in controls and intervention group outcomes, and a Bayesian Markov model estimated transition probabilities between seven health states over a 5-year time horizon from an Australian health service perspective. RESULTS: Overall, 1687 patients were included (830 control, 857 intervention). Compared to controls, the intervention group had a lower projected probability of hospitalisation, particularly after 20 months. The intervention also had reduced costs (-$8429 [95% confidence intervals: -$8461, -$8397]) and increased QALYs (0.06 [0.05, 0.07]) compared to controls. On average, $AU1 invested in the intervention generated a return of $AU7.86 [$7.63, $8.09]. CONCLUSIONS: We found investing in earlier access to DFS to be cost-effective and generated considerably improved patient outcomes, cost savings, and return on investment.
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