BACKGROUND: Type 2 diabetes mellitus (T2DM) is the most common type of diabetes, which can cause various complications that threaten health. Long non-coding RNA (lncRNA) is associated with the occurrence and development...BACKGROUND: Type 2 diabetes mellitus (T2DM) is the most common type of diabetes, which can cause various complications that threaten health. Long non-coding RNA (lncRNA) is associated with the occurrence and development of diabetes and its complications. AIM: The aim is to explore the regulatory mechanism of lncRNA KDM4A-AS1 on T2DM and on the function of pancreatic β cells. METHODS: We enrolled 98 T2DM patients and 91 healthy controls, measuring serum and cellular factor expression via RT-qPCR. Proliferation was assessed with CCK-8, apoptosis by flow cytometry and insulin secretion by ELISA. We confirmed KDM4A-AS1/miR-423-5p and miR-423-5p/ growth differentiation factor 11(GDF11) interactions using RNA immunoprecipitation and dual-luciferase reporter assays. RESULTS: In the serum of patients with T2DM, the expressions of KDM4A-AS1 and GDF11 were significantly downregulated, while the expression of miR-423-5p was significantly upregulated. The level of KDM4A-AS1 was negatively correlated with fasting plasma glucose (FPG) and glycosylated haemoglobin (HbAlc). KDM4A-AS1 has a good diagnostic value for T2DM. Experiments conducted in vitro demonstrated that overexpression of KDM4A-AS1 could promote the expression of insulin synthesis genes Ins1 and Ins2, increase the amount of insulin secretion stimulated by glucose and simultaneously increase the cell proliferation rate and reduce the apoptosis rate. Mechanism studies have confirmed that KDM4A-AS1 can directly target miR-423-5p and exert protective effects on pancreatic β cells by regulating the expression of downstream GDF11. CONCLUSIONS: This study reveals that KDM4A-AS1 protects β-cell function through the miR-423-5p/GDF11 axis, providing a new potential target for the diagnosis and treatment of T2DM.
AIMS: Diabetes self management education (DSME) is recommended for type 2 diabetes, with completion widely accepted as ≥60% engagement. This review utilising PRISMA extension for scoping reviews maps the literature on th...AIMS: Diabetes self management education (DSME) is recommended for type 2 diabetes, with completion widely accepted as ≥60% engagement. This review utilising PRISMA extension for scoping reviews maps the literature on the impact of full and partial completion of DSME on patient-reported outcomes (PROMs) versus a control. METHODS: Core search terms for type 2 diabetes were combined with DSME and PROMs (self care, diabetes distress and QOL) using the AND Boolean operator. Searches of CINAHL, MEDLINE and EMBASE 1 February, 2024, were checked September 2025. No restrictions were applied to study quality, location or sex. We examined quantitative studies comparing outcomes based on DSME completion [100%] vs. control [0%] vs. partial completion [1%-99%]. Studies employing ITT analyses or pre-post designs without controls were excluded to focus on outcomes by programme completion. RESULTS: Databases yielded 1307 records with an additional 12 through hand-searching key journals, reference lists and websites. Twenty-four records met inclusion criteria. No studies reported outcomes for partial DSME completion. Evidence suggests 100% DSME completion improves self management skills and QOL over 3-6 months, with greater gains in self care behaviours and mental health-related QOL. Medication adherence and physical health improved less consistently. CONCLUSIONS: Evidence of short-term improvements in self management skills and QOL was constrained by programme heterogeneity, methodological variability and predominantly high-income settings. Evidence supporting sustained benefits beyond 6-12 months is limited and impact on diabetes distress is uncertain. No studies reported the effectiveness of partial completion of DSME on PROMs, despite a widely accepted benchmark suggesting ≥60% engagement constitutes completion.
AIMS: To investigate potential mechanisms for change in diabetes prevention programs (DPPs), and assess the strength of associations. HYPOTHESIS: Weight loss would be less strongly associated with improved health than ot...AIMS: To investigate potential mechanisms for change in diabetes prevention programs (DPPs), and assess the strength of associations. HYPOTHESIS: Weight loss would be less strongly associated with improved health than other mechanisms. This unfunded study was pre-registered (CRD42020154362; https://www.crd.york.ac.uk/PROSPERO/view/CRD42020154362). METHODS: Empirical articles investigating psychosocial DPPs that investigated mechanisms, mediators or moderators (MMMs) of the relationship between the intervention and health were included. Retracted, qualitative or observational studies were excluded. Five biomedical databases were searched from inception until 9/2019 on 11/26/2019. The PEDro checklist assessed study quality. Outcome reporting bias was evaluated via comparing trial pre-registration to reports. We provide a narrative synthesis of the effects of MMMs. RESULTS: Included were 108 studies (502,257 participants). Studies were heterogeneous. More studies did not support than demonstrated support for all MMMs. Because there was little evidence to support any MMM, our hypothesis was not tested; 30% of studies tested weight/adiposity, weight loss or weight loss intervention as MMMs. Of those, 79% either found no support or found that interventions were less effective/harmful for fatter people. CONCLUSIONS: Few DPP studies investigate why these interventions work. There is no compelling evidence to support any specific MMM in DPPs, and no evidence to suggest that weight loss is what causes benefits. The included studies were of good methodological quality, but tests of mechanisms were rarely pre-registered; 46% of the included studies were drawn from three datasets.
de Wit M, Klinker LY, Moore B
… +12 more, Boggiss A, Allonca LF, Asaad M, Bebbington K, Cleal B, Huisman S, Winterdijk P, Aanstoot HJ, Fransman C, Holmes-Truscott E, Hermanns N, Nefs G
AIM: The potential implementation of early type 1 diabetes (T1D) detection pathways, encompassing autoantibody screening and longitudinal monitoring, raises important psychosocial considerations for ethical, person-centr...AIM: The potential implementation of early type 1 diabetes (T1D) detection pathways, encompassing autoantibody screening and longitudinal monitoring, raises important psychosocial considerations for ethical, person-centred care. This review summarises evidence on the psychosocial impact of early T1D detection, identifying key evidence gaps and recommendations for integrating psychosocial support. METHODS: A semi-structured narrative review was conducted using PubMed-indexed international peer-reviewed literature, complemented by experiential insights from an interdisciplinary authorship team. RESULTS: Broader Health screening literature emphasises that individuals' values, beliefs about chance, severity and controllability, alongside sociocultural context, shape decision making and coping. Early T1D detection introduces inherent uncertainty regarding timing and clinical progression. Despite a limited evidence base, largely focused on parents and lacking tailored person-reported outcome measures (PROMs), studies suggest a transient increase in negative emotional responses (e.g., anxiety, depressive symptoms, distress). Individual variation appears linked to screening outcome, prior experiences with T1D and tolerance for uncertainty. Effective, stigma-free communication and psychosocial support delivered by family-oriented professionals can facilitate informed, autonomous decision making. Mental health specialists play a key role in developing behaviourally informed protocols for care and communication, training care teams and providing targeted support for families experiencing persistent distress. Community involvement in the design, testing and evaluation of these communication tools, models of care and development of PROMs are essential for acceptability and equity. CONCLUSION: Integrating psychological monitoring and care is a critical component of the early T1D detection pathway. Contextually relevant and co-designed information, support strategies and PROMs are needed to help families make informed decisions and navigate uncertainties.
INTRODUCTION: Type 2 diabetes is a complex condition with a multifactorial pathogenesis. The pathogenesis is considered to be polygenic due to complex interactions between genetic/epigenetic and environmental factors. Th...INTRODUCTION: Type 2 diabetes is a complex condition with a multifactorial pathogenesis. The pathogenesis is considered to be polygenic due to complex interactions between genetic/epigenetic and environmental factors. The aim of this study is to determine the genetic, environmental and lifestyle factors associated with the development of type 2 diabetes amongst sibling pairs (sib-pairs) in the South-South region of Nigeria and determine which is more prominent. METHODS: This multicentre cross-sectional, comparative exploratory study will recruit 250 sib-pairs living with type 2 diabetes using a simple consecutive sampling method. Participants will be assessed for bio-psycho-social and environmental risk factors that may put them at risk of developing type 2 diabetes using a structured survey instrument. Blood samples collected for multi-omic studies will be analysed for genetic and environmental factors associated with the development of type 2 diabetes. RESULTS: It is expected that the most common genetic factors associated with the development of type 2 diabetes in sib-pairs will be explored and it will be determined to what extent they are responsible for the development of type 2 diabetes when compared to lifestyle and environmental factors. CONCLUSION: While there is a strong genetic component to the development of type 2 diabetes, it is often triggered by lifestyle or environmental factors. Understanding the genetics that lead to the development of type 2 diabetes in sib-pairs when compared to the inherent environmental and lifestyle risk factors may lead to the development of new therapeutic and preventive strategies.
AIMS: Fixed-ratio combinations such as iGlarLixi are recommended over premixed insulin as first-line injectable therapy for type 2 diabetes mellitus (T2DM), yet real-world evidence on transitions from premix to iGlarLixi...AIMS: Fixed-ratio combinations such as iGlarLixi are recommended over premixed insulin as first-line injectable therapy for type 2 diabetes mellitus (T2DM), yet real-world evidence on transitions from premix to iGlarLixi remains limited. This study aimed to evaluate the efficacy and safety of switching from premixed insulin to iGlarLixi in a real-world clinical setting. METHODS: This retrospective cohort included adults with T2DM who transitioned from premixed insulin to iGlarLixi between July 2020 and July 2023 at Taipei Veterans General Hospital. Glycaemic parameters were collected at baseline, 3 and 6 months after transition. RESULTS: Forty patients (mean age 67.6 ± 10.5 years) were included. Among those with baseline HbA >58 mmol/mol (7.5%, n = 28), HbA decreased from 79 ± 18 (9.4% ± 1.7%) to 67 ± 18 mmol/mol (8.2% ± 1.6%) at 6 months (p = 0.01) and 23.1% achieved HbA ≤53 mmol/mol (7.0%). The largest HbA reduction was observed in those previously on 40-50 units/day of premix insulin (from 83 ± 21 [9.8% ± 1.9%] to 65 ± 15 mmol/mol [8.1% ± 1.4%], p = 0.037). Total insulin dose and injection frequency significantly decreased (p < 0.001), while hypoglycaemia incidence dropped from 60.0% to 12.5% (p < 0.001). Among patients with pre-existing hypoglycaemia, glycaemic control remained stable despite reductions in insulin dose and injection frequency (p = 0.001, p = 0.032, respectively). Higher HOMA-IR was significantly associated with suboptimal glycaemic response in multivariate model (p = 0.037). CONCLUSIONS: Switching from premixed insulin to iGlarLixi is a safe and effective strategy to simplify therapy and improve glycaemic management. Insulin resistance may influence response.
AIMS: Inequalities in glycaemic levels in children and young people (CYP) living with Type 1 diabetes (T1D) across different ethnic and socio-economic groups in England and Wales were first highlighted in 2016. Almost 10...AIMS: Inequalities in glycaemic levels in children and young people (CYP) living with Type 1 diabetes (T1D) across different ethnic and socio-economic groups in England and Wales were first highlighted in 2016. Almost 10 years on, we wanted to know if the gap has been closed. METHODS: Analysis of 27,919 CYP with T1D from the 2022-2023 National Paediatric Diabetes Audit (NPDA). Multivariable linear regression was used to assess any association between socio-economic status (SES), ethnicity or insulin pump use and HbA1c, adjusting for age, gender and diabetes duration. RESULTS: CYP from ethnic minority groups continue to have significantly higher mean HbA1c levels compared to White CYP with the largest difference in Black children (6.8 mmol/mol, [0.6%], 95% CI 5.7, 7.9 mmol/mol). Lower SES remains associated with higher HbA1c levels with the largest difference between the least deprived and most deprived (7.0 mmol/mol; [0.6%], 95% CI: 6.4, 7.6). CYP from ethnic minority groups (Black 34.2% vs. White 49.56%, p < 0.0001) and those living in more deprived neighbourhoods (Least Deprived 54% vs. Most Deprived 41%, p = 0.0001) were less likely to use insulin pumps. CONCLUSIONS: Ethnicity and SES remained significantly associated with HbA1c levels even after accounting for the use of insulin pumps. Black CYP continue to have the highest glycaemic levels, and lower SES remains associated with poorer HbA1c outcomes. Substantial inequalities persist in the use of insulin pump therapy highlighting the ongoing need for targeted interventions to improve equity in diabetes care and outcomes.
AIMS: This study aims to characterize the clinical spectrum, elucidate the temporal relationship and assess the causality of checkpoint inhibitor-associated autoimmune diabetes mellitus (CIADM) in a cohort of patients re...AIMS: This study aims to characterize the clinical spectrum, elucidate the temporal relationship and assess the causality of checkpoint inhibitor-associated autoimmune diabetes mellitus (CIADM) in a cohort of patients receiving anti-programmed cell death-1 (PD-1)/anti-programmed death ligand-1 (PD-L1) inhibitor therapy. METHODS: Individuals who developed CIADM were identified among 4382 hospitalized patients receiving PD-1/PD-L1 inhibitor therapy between 2020 and 2024. Demographic characteristics, oncological history, immune checkpoint inhibitor regimens, laboratory parameters (including glycemic control, C-peptide and islet autoantibodies) and clinical outcomes were systematically collected. Causality was evaluated using the Naranjo algorithm. RESULTS: Among 4382 patients who received PD-1/PD-L1 inhibitors, seven (0.16%) were diagnosed with CIADM during the study period. Seven patients were predominantly male, with a median age of 52 years (range: 44-62), and hepatocellular carcinoma was the most common primary malignancy (3/7). All patients developed CIADM after a median of 8 cycles (range: 5-23) of PD-1/PD-L1 inhibitors (sintilimab, camrelizumab, envafolimab or atezolizumab). Notably, 86% (6/7) of patients presented with diabetic ketoacidosis (DKA) at onset. Severe pancreatic β-cell dysfunction was universal, with undetectable fasting and postprandial C-peptide levels. Islet autoantibodies were positive in only one patient. The Naranjo score indicated a 'probable' to 'highly probable' causal relationship in all cases. All patients required lifelong insulin therapy. Following glycemic stabilization, immunotherapy was successfully reinitiated in six patients without exacerbating hyperglycemia. CONCLUSION: CIADM is a severe immune-related adverse event (irAE) characterized by abrupt onset, a high rate of DKA, and profound insulin deficiency, often in the absence of conventional islet autoantibodies. A definitive causal link exists between PD-1/PD-L1 inhibitors and CIADM. Our findings underscore the necessity for proactive glycemic monitoring in patients undergoing ICI therapy, especially in populations such as middle-aged males with cancers known to have specific demographic profiles (e.g., hepatocellular carcinoma). Importantly, the resumption of immunotherapy is feasible with careful management, highlighting the critical role of a multidisciplinary approach to optimize oncological and metabolic outcomes.
AIMS: Access to diabetes technology in the UK is significantly influenced by socio-economic status, ethnicity, and systemic healthcare inequities. This study investigates barriers faced by children and young people (CYP)...AIMS: Access to diabetes technology in the UK is significantly influenced by socio-economic status, ethnicity, and systemic healthcare inequities. This study investigates barriers faced by children and young people (CYP) from ethnic minority backgrounds and/or low socio-economic areas in accessing diabetes technologies, alongside strategies for equitable improvements. METHODS: Online semi-structured interviews were conducted across the UK with parents and caregivers of CYP (aged 2-17 years) with type 1 diabetes (T1DM) and young people (aged 14-17 years) from ethnic minority groups and low socio-economic areas. Participants were recruited via purposive sampling. Interviews were transcribed, coded, and analysed using a thematic reflexive analysis in QSR NVivo12. RESULTS: Thirty-two participants were included in the study. Of these, 27 triad interviews were completed involving parents and CYP, along with an additional five triad interviews led by young people. The majority of parents and CYP identified as being from Black African ethnic minority groups (72%), 13% were from Other Black ethnic groups, and a smaller proportion were from Asian minority groups, (8%) and Other ethnic minority groups (6%). Key themes included barriers to accessibility (e.g., financial, linguistic, and geographic challenges), variability in education and service provision, intersectional barriers (e.g., race and socio-economic status), and the need for improved communication and trust with healthcare professionals. The findings highlight the persistent inequities in diabetes technology access among underserved groups. CONCLUSION: Barriers to diabetes technology access for CYP from ethnic minority backgrounds and low socio-economic areas stem from an interplay of systemic inequities, cultural and linguistic challenges, and financial constraints. This study highlights the need for systemic reforms, including culturally tailored and standardised education programmes alongside equitable resource distribution, to address these barriers.
AIM: Qualitative interviews were conducted as part of the development of a person-reported outcome measure (PROM) to assess biopsychosocial-spiritual outcomes of parents of children with type 1 diabetes (T1D) in the Midd...AIM: Qualitative interviews were conducted as part of the development of a person-reported outcome measure (PROM) to assess biopsychosocial-spiritual outcomes of parents of children with type 1 diabetes (T1D) in the Middle East and North Africa (MENA) region. The aims were to (i) explore the biopsychosocial-spiritual experiences of parents in the MENA region (ii) identify biopsychosocial-spiritual constructs of the PROM. METHODS: Two focus groups were conducted with n = 5 mothers of children with T1D (online), one focus group with n = 3 healthcare professionals (online) and one focus group with n = 6 policymakers (in person) interested in PROM development in Saudi Arabia. Four semi-structured interviews were conducted with n = 4 fathers of children with T1D in Saudi Arabia (online). Interviews were audio-recorded and transcribed verbatim using a thematic analysis approach. RESULTS: Four main themes and several sub-themes were identified: (1) emotional well-being: (a) 'Darkness as we face the unknown': distress, worry and anxiety (b) familiarisation and empowerment: coping and optimism; (2) bio-physical well-being: (c) 'I have to be vigilant': insomnia and fear of hypoglycaemia; (3) social impact and well-being: (d) stigma, sacrifice and support; and (4) spiritual well-being: (e) 'I leaned in on spirituality': hope and acceptance. CONCLUSIONS: The themes and sub-themes depict that diabetes has an impact on parents' biopsychosocial-spiritual well-being. All stakeholders had positive reflections in relation to the value of the development of a PROM as a tool for early detection of issues related to parents' biopsychosocial-spiritual well-being.
Cigler M, El-Hakouni O, Mecani R
… +19 more, Pouwer F, Abbink EJ, Moser M, de Galan BE, Renard E, Evans M, Brøsen JMB, Pedersen-Bjergaard U, McCrimmon RJ, Heller S, Baumann PM, Søholm U, Basta S, Divilly P, Zaremba N, Amiel SA, Choudhary P, Mader JK, Hypo‐RESOLVE consortium
BACKGROUND AND AIMS: In people with insulin-treated diabetes experiencing hypoglycaemia, the multicentre Hypo-METRICS study found that 60% of sensor-detected hypoglycaemic episodes (SDH) were asymptomatic, and over 40% o...BACKGROUND AND AIMS: In people with insulin-treated diabetes experiencing hypoglycaemia, the multicentre Hypo-METRICS study found that 60% of sensor-detected hypoglycaemic episodes (SDH) were asymptomatic, and over 40% of person-reported hypoglycaemia (PRH) occurred at glucose levels ≥70 mg/dL (3.9 mmol/L). This subanalysis explored participants' experiences of these episodes to identify possible clinical implications. METHODS: Fifty-eight Austrian participants received a 15-item questionnaire on their experience of asymptomatic hypoglycaemia and symptoms at glucose levels ≥70 mg/dL (3.9 mmol/L). RESULTS: The response rate was 86% (n = 50). Among all participants, 56% (n = 28) reported experiencing hypoglycaemic symptoms at glucose levels ≥70 mg/dL (3.9 mmol/L) "sometimes" or "often." They attributed this to a combination of a threshold shift due to chronic hyperglycaemia, rapid glucose decline and fear of hypoglycaemia. 68% of all SDH < 70 mg/dL and 59% of those below the clinically critical level of 54 mg/dL were asymptomatic. CONCLUSION: These results demonstrate that SDH and PRH each capture different, yet equally important, dimensions of the hypoglycaemia experience. Relying on only one source of information inevitably provides an incomplete picture. By integrating the patient's voice, diabetes professionals can provide appropriate support and tailor continuous glucose monitoring (CGM) alarm settings and treatment plans to truly meet individual needs.
AIMS: Follow-up of the Counterweight-Plus intervention in DiRECT has demonstrated 6.1 kg weight loss and 10 % remissions from type 2 diabetes at 5 years. We previously reported cost-effectiveness based on 2-year results....AIMS: Follow-up of the Counterweight-Plus intervention in DiRECT has demonstrated 6.1 kg weight loss and 10 % remissions from type 2 diabetes at 5 years. We previously reported cost-effectiveness based on 2-year results. We now present an updated cost-effectiveness analysis, based on available 5-year data. METHODS: A lifetime cost-effectiveness analysis was conducted using the 5-year data from DiRECT, including time to relapse from remission from type 2 diabetes, intervention costs (practitioner appointment visits, low-energy formula diet sachets), routine healthcare resource use (primary, secondary, and tertiary care contacts), medications (anti-hypertensive and anti-diabetic medicines), and quality of life (EuroQol EQ-5D-3L). Modelling assumed that all those in remission at 5 years would relapse after a maximum of 10 years. RESULTS: Total (discounted) healthcare cost-savings (excluding intervention costs) per participant over 5 years amounted to £2091. On average, healthcare costs per annum were ~£480 per participant lower in the intervention arm (p < 0.05). Intervention resource use beyond 2 years added relatively little to the total intervention cost (set-up, formula diet and practice visits), which amounted to £1691 (95% CI: £1566, 1822) per participant over 5 years. Reduced hospital admissions accounted for the major part of this saving, with the remainder being across primary and secondary care, and anti-diabetic and anti-hypertensive medications. Remission in DiRECT was associated with a significant improvement in quality of life, and the intervention arm was modelled to achieve both cost-savings of ~£400 and quality adjusted life year gains of 0.043 over 5 years, with further benefits due to reduced mortality in remission. Over the full lifetime horizon of the analysis the intervention was modelled to produce 0.08 incremental QALYs, saving £496 per participant. CONCLUSIONS: The costs involved in achieving remissions from type 2 diabetes with the Counterweight-Plus diet programme were offset within 5 years through reduced healthcare resource use. Though remission may ultimately relapse, sustained weight loss brings other longer term health gains. The intervention, even using one-to-one face-to-face contacts rather than remote delivery, which is increasingly adopted, generated both health gains and cost-savings compared with current best practice.
AIMS: To map and systematise existing research on the use of artificial intelligence (AI) in mental health-based diabetes care contexts, identify trends and potential gaps in the literature, examine methodological limita...AIMS: To map and systematise existing research on the use of artificial intelligence (AI) in mental health-based diabetes care contexts, identify trends and potential gaps in the literature, examine methodological limitations and highlight future research directions. METHODS: The review adhered to PRISMA guidelines and was pre-registered on PROSPERO (CRD420251167053). Comprehensive searches were conducted across nine databases, including MEDLINE, EMBASE, PsycINFO and IEEE Xplore, using a Boolean strategy that combined terms related to diabetes, AI and clinical mental health. Inclusion criteria encompassed peer-reviewed, empirical, quantitative studies involving humans, diabetes contexts, mental health factors and AI-based methodologies. Screening and data extraction were performed independently by two reviewers. Forty-one studies ultimately met the inclusion criteria. RESULTS: Research on AI in mental health-based diabetes care contexts has grown substantially since 2020. Most studies employed observational (83%) and cross-sectional (56%) designs, focused on assessment rather than intervention (88%) and targeted depression (56%). Supervised learning algorithms were most frequently used (83%); however, deep learning models achieved the highest performance. Despite technological advances, no temporal improvement in algorithmic performance was observed. Methodological limitations included limited diversity in samples and outcomes, minimal use of prospective experimental and randomised controlled trial-based designs and overreliance on supervised learning algorithms. CONCLUSIONS: AI shows promise in addressing mental health needs in diabetes care. However, current research is narrow in scope and lacks methodological rigour in some respects. Future studies might profitably prioritise diverse populations, prospective designs, interpretability and clinical utility to enable safe, effective and equitable integration of AI into person-centred diabetes care.
AIMS: This systematic review evaluated the impact of metabolic and bariatric surgery (MBS) on weight loss, glycaemic control, insulin requirements and postoperative complications. METHODS: A PRISMA-compliant, PROSPERO-re...AIMS: This systematic review evaluated the impact of metabolic and bariatric surgery (MBS) on weight loss, glycaemic control, insulin requirements and postoperative complications. METHODS: A PRISMA-compliant, PROSPERO-registered systematic review and meta-analysis (CRD42025123500) was conducted. Medline, PubMed, Embase, Scopus and CENTRAL were searched. Primary outcomes were changes in body weight, BMI, HbA1c and insulin requirements following MBS. Risk of bias was assessed using ROBINS-I and RoB-2, and certainty of evidence using GRADE. RESULTS: Twenty-two studies, including 1324 adults with type 1 diabetes mellitus (mean age 42.2 ± 11.6 years; mean follow-up 31.6 ± 18.2 months), were analysed. Of 753 participants with reported sex, 74.6% were women (n = 562). A total of 1304 procedures were performed, most commonly Roux-en-Y gastric bypass (44.5%; n = 580) and sleeve gastrectomy (39.2%; n = 512), followed by adjustable gastric banding (13.0%; n = 170). Meta-analysis demonstrated significant reductions in body weight (mean difference 29.55 kg; 95% CI 25.72 to 33.39; I = 20%) and BMI (11.35 kg/m; 95% CI 10.36 to 12.34; I = 32%). HbA1c decreased by 4 mmol/mol (95% CI 2.05 to 6.78; I = 19%), and insulin requirements declined by 43%-48% (0.20 U/kg; 95% CI 0.13 to 0.26; I = 58%). Postoperative complications included diabetic ketoacidosis (15/182, 8%) and severe hypoglycaemia (21/516, 4%); any complication occurred in 21/495 (4%). Evidence quality was low. CONCLUSION: MBS achieves weight loss and reduces insulin requirements in adults with type 1 diabetes mellitus and obesity, but glycaemic improvements are minimal. Given the observational evidence base and inconsistent safety reporting, true metabolic risk remains uncertain. High-quality prospective studies with standardised outcome definitions are needed.
AIMS: Diabetes is associated with poorer prognosis and treatment-related outcomes in patients with cancer. Major surgical resection is the mainstay of potentially curative treatment for colorectal cancer (CRC). This stud...AIMS: Diabetes is associated with poorer prognosis and treatment-related outcomes in patients with cancer. Major surgical resection is the mainstay of potentially curative treatment for colorectal cancer (CRC). This study aimed to assess whether the risk of adverse outcomes for individuals with diabetes and CRC varies by diabetes status and associated diabetes-related complications. METHODS: Information for all individuals diagnosed with CRC in England between 2011 and 2021 was obtained from cancer registry data. Pre-existing diabetes was identified using diagnostic codes during hospital inpatient stay. Cox regression and logistic regression were used to assess the relationship between diabetes complication status and postoperative outcomes (5-year survival, 90-day mortality, death in hospital and unplanned readmission). RESULTS: Of the 372,477 individuals diagnosed with CRC, treatment using major surgical resection was highest amongst those with no diabetes (60%) and diabetes without complications (62%) compared to those with combined (microvascular and macrovascular) complications (34%). Five-year survival was lowest for those with combined complications when compared to those with no diabetes (45% vs. 69% after major resection; 5% vs. 18% without major resection). Increasing levels of complication severity were associated with increasing rates of 90-day postoperative mortality, with combined complications associated with the poorest outcome when compared to those without diabetes (10% vs. 4%, adjusted OR 2.18, 95% CI 1.90-2.51). CONCLUSIONS: This population-based study demonstrates that the risk of adverse outcomes in patients with diabetes and CRC is heterogeneous. Future work is required to understand whether postoperative outcomes can be improved in individuals with diabetes and CRC.
AIMS: The study aimed to assess feasibility, acceptability and safety of an ILED in a randomised controlled trial of ILED vs. best NHS care healthy diet and exercise advice in women with Gestational Diabetes Mellitus (GD...AIMS: The study aimed to assess feasibility, acceptability and safety of an ILED in a randomised controlled trial of ILED vs. best NHS care healthy diet and exercise advice in women with Gestational Diabetes Mellitus (GDM) with body mass index ≥27.5 kg/m (≥25 kg/m in high-risk minority ethnic groups) in the last trimester of pregnancy. METHODS: Participants were randomised (1:1) to receive an ILED (1000 kcal on two non-consecutive days of the week with 5 days/week of best NHS care healthy diet and exercise advice) or best NHS care healthy diet and exercise advice 7 days/week from recruitment (24-30 weeks gestation) until delivery (BNC). Primary outcomes were uptake, retention and adherence to the interventions. Maternal and neonatal safety outcomes were explored, and secondary outcomes assessed fidelity of the delivery of the intervention and completeness of study data across all trial participants. RESULTS: Participants were randomised to ILED (n = 14) or BNC (n = 12) and 73% (n = 19; ILED n = 10, BNC n = 9) received their allocated intervention. There was low study retention (58%; ILED n = 7; BNC n = 8) and low adherence to the ILED median (IQR) 37% (8%-50%) out of prescribed days; however, the study achieved a feasible uptake rate (31%; n = 26). There were no adverse events specifically related to the ILED. CONCLUSION: Our findings suggest that ILED may not be feasible in the third trimester in people with GDM. Future research should explore alternative interventions and interventions earlier in pregnancy for the prevention and management of GDM. TRIAL REGISTRATION NUMBER: NCT05344066.