Diabetic Medicine[JOURNAL]
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200 papers
Diabetes care through video consultations: Insights from people using insulin pump therapy and healthcare professionals-A longitudinal qualitative study.
Schultz ANØ, Christensen LS, Bauer EH … +4 more , Kidholm K, Bollig G, Brandt F, Dieperink KB
Diabet Med · 2026 May · PMID 42192200 · Publisher ↗
AIMS: To explore expectations and experiences with video consultations of people with type 1 diabetes using insulin pump therapy and healthcare professionals (HCPs). METHODS: An interpretive description approach was used...
AIMS: To explore expectations and experiences with video consultations of people with type 1 diabetes using insulin pump therapy and healthcare professionals (HCPs). METHODS: An interpretive description approach was used in a longitudinal design. Semi-structured interviews were conducted with people with diabetes and HCPs at two time points (T1 and T2). T1 interviews explored expectations prior to a randomised controlled trial. T2 interviews explored experiences with intervention group participants and HCPs. A reflexive thematic data analysis was employed. RESULTS: In total, 33 interviews were conducted. Two themes for people with diabetes at T1 were: 'Is video inferior?-The fear of missing something' and 'Allows me to stay in my everyday life'. At follow-up interviews (T2): 'It is fine for smaller issues-but not for larger issues' and 'Are video consultations worth it?'. HCPs' themes at T1 were: 'Can video consultations increase empowerment?' and 'What can be done?-Something in-between a phone and an in-person consultation'. At follow-up interviews (T2): 'If carried out right, a lot can be done' and 'Obstacles for moving forward'. CONCLUSIONS: Video consultations can potentially be a less disruptive form of consultation, allowing people with diabetes to stay in their everyday lives, especially for minor issues or minor treatment adjustments. Challenges, in terms of pre-visit preparation, might outweigh the benefits. Adjustment of clinical work is required to address people with diabetes' preferences for video consultations, guidance on preparation and requirements for participants.
Persistence of proinsulin-only secretion in people with long-duration diabetes and minimal residual insulin secretion.
Metghalchi S, Bonnet-Serrano F, Alexandre L … +9 more , Daclin S, Akiki V, Laguillier-Morizot C, Dehghani L, Zientek C, Leguy MC, Mallone R, Guibourdenche J, Larger E
Diabet Med · 2026 Jul · PMID 42174769 · Full text
BACKGROUND AND AIMS: In all forms of diabetes, beta cell failure is associated with disproportionate proinsulin secretion, a marker of endoplasmic reticulum stress. Histopathological studies have suggested that defective...
BACKGROUND AND AIMS: In all forms of diabetes, beta cell failure is associated with disproportionate proinsulin secretion, a marker of endoplasmic reticulum stress. Histopathological studies have suggested that defective expression of prohormone convertases may lead to proinsulin becoming the predominant secretory product. We analysed meal-stimulated proinsulin secretion in people with minimal residual C-peptide secretion. MATERIALS AND METHODS: We studied a cohort of 320 individuals, among whom 55 exhibited poorly stimulated C-peptide levels (peak <0.3 nmol/L) during a 2-h mixed-meal tolerance test (MMTT; carbohydrates (60 g), lipids (5.5 g), proteins (10 g)). Serum C-peptide (Diasorin, LOQ 0.01 nmol/L) and proinsulin (ELISA, Mercodia, LOQ 0.5 pmol/L) were measured at baseline and at 60 and 120 min. Responses were assessed using peak values and peak-to-basal ratios. Results are expressed as median [interquartile range]. RESULTS: Among these 55 individuals, most had type 1 diabetes (n = 44); other aetiologies included type 2 diabetes (n = 1) and other forms (n = 10). Diabetes duration was 18 [8-25] years, HbA1c was 61 mmol/mol (7.7%), and all subjects were insulin-treated (0.6 [0.47-0.79] U/kg/day). Peak C-peptide was 0.03 [0.001-0.12] nmol/L, peak proinsulin was 0.8 [0.5-1.75] pmol/L. Among participants with non-stimulated C-peptide (n = 14) following MMTT, 5 showed stimulated proinsulin secretion. CONCLUSION: The presence of stimulated proinsulin secretion in long-standing diabetes with minimal residual C-peptide secretion suggests the persistence of dysfunctional yet meal-responsive beta cells.
Cost-effectiveness of control-IQ automated insulin delivery in adults with type 1 diabetes in Sweden.
Jendle J, Picado N, Bulhosa C … +7 more , Janssen M, Lepzien R, Fiorentino F, Wang SM, Patel BV, Ekelund C, Adolfsson P
Diabet Med · 2026 May · PMID 42169375 · Publisher ↗
AIMS: Type 1 diabetes (T1D) is an increasing clinical and economic concern in Sweden, as well as worldwide. Automated insulin delivery (AID) systems, combining continuous glucose monitoring (CGM) with automated insulin d...
AIMS: Type 1 diabetes (T1D) is an increasing clinical and economic concern in Sweden, as well as worldwide. Automated insulin delivery (AID) systems, combining continuous glucose monitoring (CGM) with automated insulin dosing to manage glucose levels, have been evaluated for the impact on glycaemic control and quality of life. This study examines the long-term cost-effectiveness of the AID system Control-IQ compared to standard care-defined as multiple daily injections or insulin pump therapy, both using CGM-in Swedish adults with T1D. METHODS: A cost-utility analysis is performed using the IQVIA Core Diabetes Model, integrating clinical data from randomized trials and real-world sources. The model projects diabetes-related complications, direct medical costs and quality-adjusted life years (QALYs) over a lifetime period, applying Swedish-specific cost and discount rates. RESULTS: Use of Control-IQ results in a gain of 1.080 QALYs and lower projected lifetime rates of severe hypoglycaemia, renal complications, cardiovascular events and ulcer/amputation/neuropathy. Total direct costs are higher, but the incremental cost-utility ratio is 391,705 SEK/QALY, which is below Sweden's commonly accepted threshold of 500,000 SEK/QALY. Sensitivity analyses demonstrate consistent results across different scenarios. CONCLUSIONS: The results indicate that Control-IQ is a cost-effective alternative for Swedish adults with T1D and could be considered for broader use in diabetes care.
Psychological research in eating disorders/disordered eating in type 1 diabetes: A systematic review using the NIH stage model for behavioural intervention development.
Stuckey HL, Cooke D, Knehans AC … +1 more , Skinner TC
Diabet Med · 2026 May · PMID 42169365 · Publisher ↗
AIMS: Eating disorders in type 1 diabetes are 2.4 times more likely to develop than those who do not have diabetes. The aim was to conduct a systematic review on psychological interventions in IRDEB (insulin-related diso...
AIMS: Eating disorders in type 1 diabetes are 2.4 times more likely to develop than those who do not have diabetes. The aim was to conduct a systematic review on psychological interventions in IRDEB (insulin-related disordered eating behaviour)/eating disorders with adults who have type 1 diabetes. The review describes the type and quality of studies with control/comparison groups, as well as qualitative research, and synthesises the research according to the NIH Stage Model of Behavioural Intervention Development. Classification according to the Model allows for discussion of gaps and recommendations for further research. METHODS: The methodology for this research followed PRISMA guidelines, with inclusion criteria of: (1) type 1 diabetes; (2) adults (age ≥18); (3) behavioural and psychological interventions in eating disorders or disordered eating; (4) primary outcome being psychological, (5) conducted from 2014 to February 2024; (6) in English; (7) full-text, peer-reviewed articles; AND (8) quantitative trials with control or comparison groups OR (9) qualitative research. RESULTS: From a total of 28 studies related to type 1 diabetes and psychological outcomes, nine studies were found to be relevant to IRDEB and eating disorders. Although studies of disorders have risen in publication, there was only one completed full RCT since 2014, which met the inclusion criteria, the Diabetes Body Project. Methodological designs for the nine studies included six qualitative studies and three experimental studies. Six studies were categorised as Stage 0, one as Stage 1, one as Stage II and one as Stage III. Two studies included participants with 'diabulimia' alone, and the seven remaining studies combined eating disorders and eating disorder symptoms (e.g., 'diabulimia', anorexia, binge-eating, bulimia). CONCLUSIONS: With the limited research that is available, and only one recently completed RCT, the opportunities for research in IRDEB/eating disorders are capacious. There is a need to tailor existing eating disorder interventions to T1D and to continue to investigate the efficacy (Stages II and III), and effectiveness (Stages IV and V), keeping in mind the unique needs and conditions under which IRDEB and eating disorder symptoms emerge.
A retrospective sub-study of perioperative glycaemia and insulin treatment for hospital inpatients at a quaternary centre from the specialist treatment of inpatients: Caring for diabetes in surgery trial (STOIC-D Surgery).
Ho F, Kyi M, Fourlanos S … +3 more , Colman PG, Worth LJ, Barmanray RD
Diabet Med · 2026 May · PMID 42168817 · Publisher ↗
AIMS: Surgical inpatients experience variable glycaemia, with hyper and hypoglycaemia, contributing towards increased morbidity and mortality. Understanding of mechanisms for glycaemic variability and clinician responses...
AIMS: Surgical inpatients experience variable glycaemia, with hyper and hypoglycaemia, contributing towards increased morbidity and mortality. Understanding of mechanisms for glycaemic variability and clinician responses remains limited. We aimed to describe patterns of glycaemia in the immediate perioperative period and its drivers, including treatment with glucose-lowering agents. METHODS: This was a sub-analysis of participants in the STOIC-D Surgery trial, a randomised controlled trial of early specialist-led glycaemic management for inpatients with pre-admission diabetes or inpatient hyperglycaemia. Patients in this sub-study underwent at least one procedure during admission. Data from day prior to surgery, day of surgery and day after surgery were collected, including blood glucose levels and factors influencing glycaemia. RESULTS: 518 participants were included, with a mean HbA1c of 52 mmol/mol (6.9%). 295 (57%) patients received insulin during the three perioperative days; 130 (44%) of these insulin-receiving patients had a consistent increase in their total daily insulin dose across the 3 days. These patients had the highest perioperative glycaemia compared to patients with different insulin titration trends, particularly on the day of and day after surgery. Fasting duration was the only variable identified as being significantly associated with increased postoperative glycaemia. Hypoglycaemia was uncommon, occurring in 3% of all patients for each perioperative day. This was higher for patients receiving perioperatively insulin. CONCLUSIONS: This study characterised perioperative glycaemia trends and suggests that clinicians identify patients who require intensification of insulin treatment in the perioperative period, which needs to be counterbalanced with the risk of hypoglycaemia.
Language matters: Guidance for person-centred diabetes communication in Ireland.
Breen C, Powell S, Patterson E … +20 more , Finnegan M, McInerney AM, Flynn G, Coyle A, Gajewska K, Kavanagh H, Cunningham D, Lowe J, Kelly B, Morrissey EC, Keighron C, Murphy M, Devine L, Deasy N, Forde R, Creaven AM, Lowry M, Birney S, Deschenes S, Griffin TP
Diabet Med · 2026 Jul · PMID 42165706 · Full text
BACKGROUND/AIMS: Language is a powerful tool that shapes how people experience diabetes, their engagement with care and ultimately their outcomes. This guidance document for healthcare professionals in Ireland outlines w...
BACKGROUND/AIMS: Language is a powerful tool that shapes how people experience diabetes, their engagement with care and ultimately their outcomes. This guidance document for healthcare professionals in Ireland outlines why Language Matters in diabetes care and aims to support person-centred, strengths-based and non-judgemental communication. METHODS: The guidance was developed by an Irish multidisciplinary working group, including healthcare professionals, researchers and people with lived experience of diabetes. The group drew on international Language Matters guidance, published evidence, Irish data on diabetes-related language, stigma, distress and healthcare engagement, and insights from lived experience to develop practical recommendations for person-centred diabetes communication. RESULTS: Stigmatising or judgemental words can contribute to diabetes distress, disengagement and suboptimal self-management. This guidance provides practical recommendations to foster collaboration, reduce stigma and improve quality of life. Key recommendations include using person-first language, avoiding blame and fear, ensuring consistency across teams, and embedding reflective practice and communication training within healthcare teams. CONCLUSIONS: Language is a core component of diabetes care. Consistent use of respectful, empathetic and non-judgemental communication may strengthen therapeutic relationships, support engagement with care and help create a culture in which people living with diabetes feel understood, respected and empowered.
A systematic review and meta-analysis of the relative benefit of dual versus single oral hypoglycaemic therapy following diagnosis with type 2 diabetes (T2D).
Kelly M, Saluja S, Ellis HL … +3 more , Jamil S, Whyte MB, Heald A
Diabet Med · 2026 Jul · PMID 42165377 · Full text
INTRODUCTION: Achieving and sustaining target glycated haemoglobin (HbA1c) levels is fundamental in the management of type 2 diabetes (T2D). We here aimed to assess whether initial dual oral therapy outperforms monothera...
INTRODUCTION: Achieving and sustaining target glycated haemoglobin (HbA1c) levels is fundamental in the management of type 2 diabetes (T2D). We here aimed to assess whether initial dual oral therapy outperforms monotherapy in reaching glycaemic targets in patients with treatment-naive or early-stage T2D. METHODS: This systematic review and meta-analysis were registered with PROSPERO (CRD420251111096). Parallel-group randomised controlled trials with a duration of at least 12 weeks were identified through searches of PubMed and the Cochrane Library spanning 2005 to 2025. Data at the trial arm level, including baseline and endpoint HbA1c values, were extracted for seven predefined comparisons and combined using a random-effects inverse-variance meta-analysis in R version 4.3.1 (meta package). The primary outcome was the proportion of treatment arms achieving an HbA1c level of ≤7.5% (58 mmol/mol). Secondary outcomes included the proportions achieving HbA1c levels of ≤7.0% (53 mmol/mol) and ≤6.5% (48 mmol/mol), as well as mean differences in HbA1c levels. RESULTS: A total of 20 trials, encompassing 37 treatment arms, were analysed. Dual combination therapy consistently demonstrated superior efficacy compared to monotherapy. The proportion of patients achieving HbA1c levels of ≤7.5% (58 mmol/mol) was 86% with initial dual therapy versus 82% with initial monotherapy (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.20-1.47, p = 0.002). At the more stringent threshold of ≤7.0% (53 mmol/mol), the rates were 69% versus 64% (OR 1.27, p = 0.003), and at ≤6.5% (48 mmol/mol), 42% versus 39% (OR 1.18, p = 0.056). When comparing initial dual therapy to metformin monotherapy, the respective achievement rates were 86% versus 81% (OR 1.41, p = 0.001) for a target of ≤7.0% (53 mmol/mol). The combination of metformin with a sodium-glucose cotransporter 2 inhibitor (SGLT2-i) resulted in 88% reaching ≤7.5% (58 mmol/mol), compared to 81% with metformin alone (OR 1.55, p ≤ 0.001), a difference significant across all thresholds. Dual therapy containing SGLT-2i achieved 87% at ≤7.5% (58 mmol/mol), compared with 82% with all monotherapies (OR 1.43, p ≤ 0.001). SGLT-2i monotherapy itself led to 89% reaching the target, compared with 81% with metformin (OR 1.73, p ≤ 0.001). No significant difference in outcome was observed between dual and monotherapy involving SGLT2-is (OR 0.87, p = 0.480). The pooled final HbA1c values were 6.7% (50 mmol/mol) for dual therapy and 7.9% (63 mmol/mol) for monotherapy, corresponding to a mean difference of -0.45% (95% CI -0.60 to -0.25, p ≤ 0.001). Heterogeneity among studies was low to moderate (I 25%-50%), and results remained consistent after excluding rosiglitazone arms. CONCLUSIONS: Initial dual therapy, particularly combining metformin with an SGLT2-i, results in superior achievement of HbA1c targets across various thresholds compared to monotherapy. SGLT2-i alone surpasses metformin alone in efficacy. Adding a second agent to SGLT2-i did not provide additional glucose-lowering benefit to SGLT2-i monotherapy. Early initiation of SGLT2-i monotherapy or combination therapy should be considered upon diagnosis of T2D.
Implementing a behavioural intervention for paediatric type 1 diabetes: Key informant perspectives of multilevel barriers and facilitators.
Price J, Deatrick JA, Curran G … +4 more , Yang CL, Perez Ramirez A, Thomas C, Kazak AE
Diabet Med · 2026 May · PMID 42163052 · Publisher ↗
AIMS: A 4-session multiple family group version of Behavioral Family Systems Therapy for Diabetes (bBFST-D) is associated with decreased glycemic levels among adolescents with type 1 diabetes; however, few families recei...
AIMS: A 4-session multiple family group version of Behavioral Family Systems Therapy for Diabetes (bBFST-D) is associated with decreased glycemic levels among adolescents with type 1 diabetes; however, few families receive this care. Using the Consolidated Framework for Implementation Research 2.0, this national qualitative study examined perspectives on barriers and facilitators of implementing bBFST-D across six key informant groups. METHODS: Psychosocial (n = 10) and medical professionals (n = 10), clinical (n = 11) and business leaders (n = 9), and adolescents (n = 8) and caregivers (n = 8) were recruited from 5 children's hospitals across the United States. Professional participants (Mage = 42.2-55.1 years) largely identified as female (55%-100%) and White (67%-100%). Most adolescents (6 females, Mage = 14.0 years; MHbA1c = 10.3) and caregivers (8 females, Mage = 41.3 years) identified as White (62.5%). Each participant completed a qualitative interview, which was recorded, transcribed, and analyzed using a rapid analysis approach. RESULTS: All groups found bBFST-D content helpful and relevant and all identified evidence that bBFST-D improves health outcomes as the most important factor for implementing bBFST-D. Each group described additional key implementation factors. Healthcare leaders noted the influence of US News and World Report rankings, whereas professionals highlighted buy-in from leadership, staffing, space, and scheduling. Caregivers and adolescents reported critical factors for engaging families in care, including evening/weekend scheduling, referrals from trusted medical professionals, and professional characteristics (empathetic, encouraging). CONCLUSION: Study findings offer foundational knowledge on factors that influence implementation of evidence-based psychosocial type 1 diabetes care, which can be used to develop and test strategies to increase delivery of this care.
Towards equitable implementation of AI-assisted screening for diabetic retinopathy: Perspectives on digital literacy, trust and system readiness in developing countries.
Putra BJ, Rohmiati
Diabet Med · 2026 May · PMID 42157507 · Publisher ↗
Abstract loading — click title to view on PubMed.
Response to letter: 'Towards equitable implementation of AI-assisted screening for diabetic retinopathy: Perspectives on digital literacy, trust and system readiness in developing countries'.
Chaudhry UAR, Chandrasekaran L, Rudnicka AR … +1 more , On Behalf the ARIAS Research Group
Diabet Med · 2026 May · PMID 42157471 · Publisher ↗
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Continuous glucose monitoring in type 2 diabetes: Evidence for glycaemic metrics and patient-reported outcomes.
Pal AW, Chong WL, Huri HZ … +1 more , Ratnasingam J
Diabet Med · 2026 May · PMID 42152528 · Publisher ↗
AIMS: In adults with type 2 diabetes (T2D), continuous glucose monitoring (CGM) provides insights beyond HbA1c. A comprehensive understanding of clinical benefits and patient-reported outcomes (PROs) associated with CGM...
AIMS: In adults with type 2 diabetes (T2D), continuous glucose monitoring (CGM) provides insights beyond HbA1c. A comprehensive understanding of clinical benefits and patient-reported outcomes (PROs) associated with CGM is needed to inform its integration into routine care. METHODS: A systematic literature search was conducted across PubMed, Scopus, Cochrane Library and CINAHL from inception to June 2025 to identify randomised controlled trials and non-randomised studies including quasi-experimental and observational designs. Outcomes of interest included glycaemic measures (HbA1c, time in range, hypoglycaemia, glycaemic variability) and PROs. Given the heterogeneity in study design and outcome reporting, findings were synthesised narratively. RESULTS: Thirty studies (N ≈ 3275) were included. CGM use was associated with improvement in HbA1c, particularly among insulin-treated individuals and those with higher baseline HbA1c. CGM use also increased time in range by approximately 9-15 percentage points (1.5-3.6 h/day) and was generally associated with reduced hypoglycaemia risk and glycaemic variability, although effects on hypoglycaemia were not uniform. In contrast, diabetes-specific PROs, including treatment satisfaction and diabetes-related distress, showed more consistent improvement, whereas changes in overall quality-of-life measures were less pronounced. CONCLUSIONS: CGM use was associated with clinically meaningful improvements in glycaemic metrics and PROs in adults with T2D. Although evidence remains limited for long-term outcomes and special populations, current findings support the clinical value of CGM in diabetes management.
Type 1 diabetes stigma: A UK survey of adults living with type 1 diabetes.
Housby H, Kaur A, Godsland I … +4 more , Wylie T, Oliver N, Scior K, McKechnie V
Diabet Med · 2026 May · PMID 42152477 · Publisher ↗
AIMS: Type 1 diabetes stigma (T1D-stigma) refers to negative social judgement towards people living with type 1 diabetes (T1D) and is linked to poorer psychological well-being and suboptimal diabetes self management. Thi...
AIMS: Type 1 diabetes stigma (T1D-stigma) refers to negative social judgement towards people living with type 1 diabetes (T1D) and is linked to poorer psychological well-being and suboptimal diabetes self management. This observational study aimed to explore sociodemographic, diabetes health and well-being factors linked to high stigma scores to inform future, targeted intervention studies. METHODS: UK-based adults (aged ≥18 years) with T1D completed an online survey comprising sociodemographic and diabetes health questions, wellbeing measures for anxiety (Generalised Anxiety Disorder Scale: GAD-7), diabetes impact (Impact of Diabetes Profile: DIDP) and depression (Patient Health Questionnaire: PHQ-9) and the Type 1 Diabetes Stigma Assessment Scale (DSAS-1). Potential relationships between sociodemographic, diabetes health and well-being factors and DSAS-1 score were identified by univariate regression and the independence of significant (p < 0.05) relationships was explored in multivariable regression. RESULTS: Of 438 participants, 96% endorsed one or more items on the DSAS-1. In multivariable regression, age (β = -0.136, p = 0.006), sex (β = 0.114, p = 0.006), BMI (β = 0.112, p = 0.023), insulin pump use (β = 0.108, p = 0.015), DIDP score (β = 0.211, p = <0.001), GAD-7 score (β = 0.192, p = 0.002) and PHQ-9 score (β = 0.195, p = 0.002) predicted DSAS-1 score. Ethnicity did not predict DSAS-1 score, nor did age at diagnosis or number of severe hypoglycaemia episodes. CONCLUSION: Most participants reported at least one instance of T1D-stigma. High DSAS-1 scores in the United Kingdom were predicted by younger age, being a woman, higher BMI, insulin pump use, higher diabetes impact and anxiety and depression scores. Future studies should further explore the impact of T1D-stigma within these groups to tailor appropriate interventions.
Active framing of health communication to and about individuals with non-communicable diseases.
Ursbak K, Fosgerau CF, Iversen PB … +2 more , Jensen BB, Kristensen LB
Diabet Med · 2026 May · PMID 42142375 · Publisher ↗
AIMS: To systematically document how individuals in vulnerable positions with diabetes or other non-communicable diseases (NCD) are portrayed in texts from Danish health care institutions. METHODS: Our dataset consists o...
AIMS: To systematically document how individuals in vulnerable positions with diabetes or other non-communicable diseases (NCD) are portrayed in texts from Danish health care institutions. METHODS: Our dataset consists of texts from Steno Diabetes Center Sjælland (SDCS) and 10 other Danish institutions related to diabetes and/or health care. We searched for text excerpts that referred to NCD and contained words with the meaning 'vulnerable'/'vulnerability'. Through semantic analysis, we systematically categorised the semantic roles of referents in the texts, e.g. whether a person was framed as performing an action (having an ACTOR role) or as undergoing an action (having a role as UNDERGOER). RESULTS: We found 1645 examples where persons were referred to as vulnerable (e.g. 'vulnerable families' or 'men in vulnerable positions'). The semantic text analysis of these examples showed that Danish health care institutions consistently portray these individuals as UNDERGOERS, who are passive participants in their own lives and treatment. They are rarely portrayed as making positive differences or being part of positive relations. CONCLUSION: There is a discrepancy between the goal that individuals with diabetes and NCD are motivated to take action, and the low-agency language that the investigated Danish health care institutions use in relation to individuals in vulnerable positions with NCD including diabetes. We recommend strategically replacing low-agency predicates with words that position individuals with diabetes as acting intentionally and being capable of self-care.
What barriers need to be removed to incorporate resistance exercise into the lives of older adults with long-term diabetes and prefrailty? A deductive framework analysis using the Capability, Opportunity, Motivation and Behaviour (COM-B) behavioural science model.
Stocker R, Russell S, Taylor GS … +3 more , Witham MD, Shaw JAM, West DJ
Diabet Med · 2026 Jul · PMID 42141826 · Full text
AIMS: Maintaining physical function, and thus independence, is essential for people ageing with diabetes. For older adults with long-term insulin-treated diabetes, managing frailty, preserving body mass index (BMI) and m...
AIMS: Maintaining physical function, and thus independence, is essential for people ageing with diabetes. For older adults with long-term insulin-treated diabetes, managing frailty, preserving body mass index (BMI) and muscle strength and mitigating hypoglycaemia risk are key challenges. Resistance training (RT) offers benefits, including reduced hypoglycaemia risk, increased bone density and improved muscle strength, yet its uptake remains low. This study explores behavioural influences and barriers to RT participation among older adults living with insulin-treated diabetes and prefrailty. METHODS: A qualitative approach was employed, involving semi-structured interviews with individuals living with prefrailty aged 60 years or older with insulin-treated diabetes (type 1 diabetes (n = 12); type 2 diabetes with BMI < =30 kg/m2 (n = 4)). Frailty was assessed using the Rockwood Clinical Frailty Scale (3-4). Data were analysed using framework analysis and aligned to the COM-B model of behaviour change to deductively identify barriers and facilitators. RESULTS: Barriers to RT were identified across psychological capability, physical capability and social opportunity COM-B domains. Key barriers included fears of fatigue, hypoglycaemia and injury, diabetes-related complications and difficulties using RT equipment. Outdated advice about exercise safety and lack of awareness of RT's benefits further hindered participation. Facilitators included tailored education on diabetes-specific RT benefits, a supportive, flexible training environment and the presence of an exercise-competent partner. CONCLUSIONS: This study highlights perceptual and practical barriers that discourage older adults with diabetes and prefrailty from engaging in resistance exercise. Addressing these barriers through educational initiatives and creating adaptable exercise programmes could enhance exercise participation rates in this population.
The Ligustrum lucidum-derived glycoside specnuezhenide alleviates metabolic-associated fatty liver disease in mice via modulation of gut microbiota and the PPARα signalling pathway.
Gao K, Wang K, Hao J … +9 more , Zhang W, Zhao M, Xu D, Tao X, Guo C, Li W, Liu M, Lu Y, Wang J
Diabet Med · 2026 May · PMID 42141713 · Publisher ↗
BACKGROUND: Metabolic-associated fatty liver disease (MAFLD), particularly advanced metabolic dysfunction-associated steatohepatitis (MASH), leads to irreversible liver damage. Specnuezhenide (SPE), naturally isolated fr...
BACKGROUND: Metabolic-associated fatty liver disease (MAFLD), particularly advanced metabolic dysfunction-associated steatohepatitis (MASH), leads to irreversible liver damage. Specnuezhenide (SPE), naturally isolated from Ligustrum lucidum Ait, has been demonstrated to exert hepatoprotective effects. However, its functional role and underlying mechanisms in MAFLD remain poorly understood. PURPOSE: This study investigated the therapeutic effects and potential mechanism of SPE on MAFLD. METHODS: MAFLD mice induced by high-fat diet (HFD) were employed to assess SPE's therapeutic effects in vivo. The impact of SPE on gut microbiota was analysed by 16S rRNA sequencing. RNA-seq analysis was conducted to uncover SPE's molecular mechanisms. Complementary in vitro investigations utilized FFA-treated HepG2 cells to systematically examine SPE's cellular-level impacts and regulatory pathways. RESULTS: The results indicated that SPE could improve hepatic steatosis, liver injury and oxidative stress in MAFLD mice. SPE treatment also affected the diversity of gut microbiota and altered their composition by decreasing the Firmicutes/Bacteroidetes (F/B) ratio. The results of 16S rRNA sequencing, RNA-seq and Western blot analysis indicated that the effect of SPE on MAFLD was related to fatty acid beta-oxidation and the PPARα signalling pathway. Moreover, in HepG2 cells, SPE reduced FFA-induced lipid accumulation and oxidative stress, which was dependent on PPARα up-regulation. CONCLUSION: This is the first study to demonstrate that SPE alleviates MAFLD and is associated with modulation of gut microbiota composition and activation of the PPARα signalling pathway. Our findings suggest a potential link between gut microbiota remodelling and PPARα-mediated fatty acid oxidation, highlighting its potential as a therapeutic candidate for MAFLD.
Detection of prediabetes and undiagnosed type 2 diabetes in underserved communities using community pharmacy point-of-care testing: A prospective feasibility study.
Radley A, Beer L, Farre A … +3 more , Rauchhaus P, Thom G, Sutherland C
Diabet Med · 2026 Jul · PMID 42141696 · Full text
AIMS: Early detection of type 2 diabetes (T2D) and prediabetes is critical to reduce disease burden, yet disadvantaged populations often remain undiagnosed. We assessed a pharmacy-based pathway using verified point-of-ca...
AIMS: Early detection of type 2 diabetes (T2D) and prediabetes is critical to reduce disease burden, yet disadvantaged populations often remain undiagnosed. We assessed a pharmacy-based pathway using verified point-of-care HbA1c testing to identify prediabetes and enable engagement with a digital prevention programme and established the detection rates for undiagnosed T2D. METHODS: We conducted a prospective feasibility study across 16 community pharmacies in NHS Tayside, Scotland (Feb 2024-Jan 2025). Adults at high risk of T2D, identified using the Diabetes UK 'Know Your Risk' tool, were offered HbA1c testing. Participants with HbA1c 42-47 mmol/mol (6.0-6.4%) were referred directly to a digital diabetes prevention programme (DDP); those with HbA1c ≥48 mmol/mol (6.5%) were advised to attend their GP. Comparator data were drawn from GP patients identified for engagement with the same DPP. RESULTS: Of 499 pharmacy participants, 75 (15%) had prediabetes; 38 (51%) enrolled in DPP. Nineteen (4%) had HbA1c ≥48 mmol/mol (6.5%); 17 attended GP. Compared with GP-identified prediabetes (951 patients; 212 enrolled, 32%), pharmacy-based recruitment doubled DDP engagement (RR 2.08, 95% CI 1.61-2.67). Pharmacy recruited relatively younger participants from more deprived backgrounds (63% SIMD 1-2 vs. 33% in GP cohort). CONCLUSION: Community pharmacies provided effective, equitable access to HbA1c testing and diabetes prevention, identifying individuals with prediabetes and undiagnosed T2D being missed by current pathways and doubling engagement of this underserved population with DPP. Pharmacy-based screening offers a scalable opportunity to reduce health inequalities and expand primary care capacity.
Association between gestational diabetes, ethnicity and migrant length of residence: An Australian cohort study.
Pham S, Qian H, Elhindi J … +10 more , Byrnes O, de Vroome M, Gilroy G, Nippita T, Talla G, White L, Zachariah D, Cheung NW, Pasupathy D, Melov SJ
Diabet Med · 2026 May · PMID 42141380 · Publisher ↗
AIMS: Investigate the relationship of gestational diabetes (GDM) risk for specific migrant groups compared to the Australian born of each ethnic group and length of residence (LOR) in Australia. METHODS: Retrospective ob...
AIMS: Investigate the relationship of gestational diabetes (GDM) risk for specific migrant groups compared to the Australian born of each ethnic group and length of residence (LOR) in Australia. METHODS: Retrospective observational cohort study from June 2020 to November 2023 at 10 Australian hospitals. Ethnicity was self-identified by participants. Log-binomial regression models were adjusted for confounding factors. Relative risk (RR) was determined for GDM by both ethnicity and duration of residency. RESULTS: There were 60,701 participants, 32,391 (53.4%) were Australian born with South Asian the highest reported ethnic group (18.3%, n = 11,121). Women who migrated ≥5 years ago made up 31.8% (n = 19,282) of the cohort. GDM prevalence was 18.2% (n = 11,076). The recent migrant GDM rate was 2068/9028 (22.9%), LOR ≥5 years migrants were 4835/19,282 (25.1%) with Australian born 4173/32391 (12.9%). The adjusted relative risk (aRR) for GDM in migrants with an LOR <5 years was 1.37 (95%CI 1.31-1.43) when compared to Australian born. Among the ethnic groups, Middle Eastern women with LOR <5 years had the highest risk for GDM compared to those from the same ethnic group born in Australia (aRR 1.86; 95%CI 1.84-1.88). CONCLUSIONS: This study identifies that the most ethnic migrant groups were at a higher risk of GDM than those of the same ethnicity born in Australia and this higher risk of GDM continued over time. Recognising migration effects may improve targeted and meaningful interventions to reduce GDM risk.
Diabetes stigma and language use among medical students: A cross-sectional survey study.
Beverly EA, Saunders A, Whistler K
Diabet Med · 2026 May · PMID 42130123 · Publisher ↗
BACKGROUND: Stigmatizing language in diabetes is well-documented among practicing health care professionals, but less well known about medical students. This study examined the use of stigmatizing language among medical...
BACKGROUND: Stigmatizing language in diabetes is well-documented among practicing health care professionals, but less well known about medical students. This study examined the use of stigmatizing language among medical students to identify opportunities for early intervention. METHODS: We conducted a descriptive, exploratory cross-sectional survey study to examine medical students' use of and perceptions of diabetes-related language and diabetes stigma. We summarized language use and perceptions using descriptive statistics. To examine differences by year in medical school and intended career path, we conducted Kruskal-Wallis H tests with Dunn's post hoc comparisons. Spearman's rank correlations were used to assess associations among language use, perceptions and diabetes stigma. RESULTS: Among the 245 respondents (mean age = 25.0 ± 2.4 years, 65% women, 71% White), nearly all (96%) reported using at least one non-recommended term, with 61% using six or more terms frequently. The five most common used terms included 'test', 'diabetic', 'blood sugar', 'control' and 'obese'. The five most negatively rated terms were 'unmotivated', 'fail', 'failure', 'noncompliant' and 'nonadherent'. Language use and perceptions varied by year in medical school and intended career path; however, the differences did not follow a specific pattern. Spearman's rank correlations showed respondents who reported more frequent use of non-recommended terms also perceived them more positively. Furthermore, respondents who expressed more negative attitudes towards diabetes were more likely to use non-recommended language. CONCLUSION: Stigmatizing language and negative attitudes towards diabetes were common among medical students. Future research should evaluate whether educational interventions produce sustained improvements in diabetes language use and attitudes toward diabetes among medical students over time.
Understanding interconception experiences of women with previous gestational diabetes mellitus across Ireland.
George CV, Silverio SA, Dunne P … +11 more , James L, Benton M, Payne E, Forde R, Schoenaker D, White SL, O'Reilly SL, Walsh A, Timon CM, Lavelle F, Flynn AC
Diabet Med · 2026 Jul · PMID 42124333 · Full text
AIM: To explore the interconception experiences of women after GDM across Ireland to inform how to optimise health between pregnancies. METHODS: A qualitative descriptive study was implemented. Online semi-structured ind...
AIM: To explore the interconception experiences of women after GDM across Ireland to inform how to optimise health between pregnancies. METHODS: A qualitative descriptive study was implemented. Online semi-structured individual interviews were conducted (April-May 2025) with women living on the island of Ireland who had experienced GDM ≤5 years ago. Data were transcribed and analysed inductively using reflexive thematic analysis. RESULTS: Twenty-seven women participated, and four themes were generated: (1) Shaping health behaviours beyond pregnancy, (2) GDM's emotional legacy, (3) Understanding interconception care and future risk management and (4) Interconception needs and support preferences. CONCLUSIONS: This study provides novel insights into women's interconception experiences following GDM across Ireland and shows behavioural, emotional and healthcare-related impacts between pregnancies. Although education received during pregnancy facilitated behaviour change that persisted postpartum, maintaining GDM-related positive health behaviour changes was often challenging without ongoing support. Postpartum care gaps and a lack of interconception support left women uncertain about their future GDM risk and appropriate pregnancy preparation. These findings highlight the need for interconception care including timely postpartum follow-up, clearer communication about recurrence risk and accessible preconception support for women planning a subsequent pregnancy.
Efficacy and safety of automated insulin delivery system in very young children with type 1 diabetes: A systematic review and meta-analysis of randomized controlled trials.
Lin Q, Zhou Y, Lei M … +7 more , Ling P, Ni Y, Lin Z, Yang D, Xu W, Deng H, Yan J
Diabet Med · 2026 Jul · PMID 42108409 · Publisher ↗
AIM: To evaluate the efficacy and safety of automated insulin delivery (AID) systems in very young children with type 1 diabetes (T1D). METHODS: PubMed, Embase, Scopus, and Web of Science were searched until 10 October 2...
AIM: To evaluate the efficacy and safety of automated insulin delivery (AID) systems in very young children with type 1 diabetes (T1D). METHODS: PubMed, Embase, Scopus, and Web of Science were searched until 10 October 2025. Inclusion criteria were randomized controlled trials (RCTs); T1D populations under 7 years old; comparing AID systems with standard care (SC). Primary efficacy endpoint was the percentage of time-in-range of 70-180 mg/dL (TIR) derived from continuous glucose monitoring (CGM), secondary outcomes included glycated haemoglobin (HbA1c), other CGM metrics, and insulin dose. Safety endpoints included severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA). RESULTS: Four RCTs involving 292 participants were included. The mean age was 4.70 years, with a mean T1D duration of 1.96 years. The study duration ranged from 8 to 16 weeks. Compared with SC, AID significantly improved TIR by mean difference (MD) +9.29% (95% confidence interval [CI]: 7.27-11.30, I = 70%, p < 0.001) accompanied by a favourable effect on HbA1c by MD -4 mmol/mol (-0.39%) (95% CI [-6 to -2] (-0.57 to -0.21), I = 82%, p < 0.001). A favourable decrease in time-above-range (TAR, >180 mg/dL; >250 mg/dL) and mean blood glucose were also observed in AID over SC (all p < 0.05). No significant differences were observed between AID and SC groups in time in hypoglycaemia, insulin dose, and risk of SH and DKA (all p > 0.05). CONCLUSION: AID systems may outperform SC in improving short-term glycaemic control (TIR, HbA1c, TAR) in very young children with T1D, without increasing time in hypoglycaemia, insulin dose, or risk of SH and DKA. These preliminary findings support the clinical potential of AID systems and highlight the need for longer term studies.
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