Diabetic Medicine[JOURNAL]
Sun
200 papers
Meaningful engagement of lived experience in diabetes research and health service improvement: A rapid review of barriers to and enablers for community involvement among adults with type 2 diabetes.
Jordan JE, Litterbach E, Geerling R … +9 more , Lam EP, Fitzgerald T, Kelly R, Manski-Nankervis J, Read M, Ekinci EI, Skinner TC, Speight J, Holmes-Truscott E
Diabet Med · 2026 Mar · PMID 41858240 · Publisher ↗
BACKGROUND: Consumer and community involvement (CCI) is increasingly recognised as critical to advancing equity, relevance and impact in diabetes research and health service improvement. However, the meaningful and repre...
BACKGROUND: Consumer and community involvement (CCI) is increasingly recognised as critical to advancing equity, relevance and impact in diabetes research and health service improvement. However, the meaningful and representative involvement of people with diabetes, particularly those with type 2 diabetes (T2D) and from diverse communities, remains limited. AIM AND METHOD: This article provides an overview of the emerging CCI literature in the context of diabetes, including a rapid review identifying barriers to and enablers of CCI in research and health services for people with T2D. RESULTS: Key barriers included negative past experiences of CCI, lack of tailored CCI approaches and experiences of diabetes stigma. Enablers of involving those with T2D include building professional-community partnerships and facilitating genuine contribution and collaboration through safe and inclusive environments, valuing community expertise and co-sharing of power and ownership of projects. While such strategies were drawn from studies involving culturally, ethnically and linguistically diverse populations, the literature is largely limited to high-income countries. Practical and conceptual directions to advance CCI in diabetes research and health services are considered, including the need for co-design of context- and community-specific approaches of CCI, routine evaluation of (community-relevant) impacts of CCI and resourcing facilitators and systems to engage meaningfully in CCI. CONCLUSION: These findings suggest key considerations to support more inclusive, representative and impactful involvement of people with diabetes and identify the need for further research to tailor CCI strategies to the diverse communities they aim to serve.
LncRNA VCAN-AS1 serves as a diagnostic biomarker and drives pathogenesis in diabetic nephropathy via the miR-205-5p/VEGFA axis.
Zhou J, Li S, Lv L … +2 more , Luo G, Xu N
Diabet Med · 2026 Jun · PMID 41858094 · Publisher ↗
AIMS: Diabetic nephropathy (DN) represents a major complication of diabetes mellitus (DM) with limited early diagnostic biomarkers. This study investigated the clinical significance and molecular mechanism of long non-co...
AIMS: Diabetic nephropathy (DN) represents a major complication of diabetes mellitus (DM) with limited early diagnostic biomarkers. This study investigated the clinical significance and molecular mechanism of long non-coding RNA (lncRNA) VCAN-AS1 in DN pathogenesis. METHODS: The patients with diabetes mellitus, including 85 with DN and 66 without nephropathy, were enrolled, along with 62 healthy controls. Serum VCAN-AS1 levels were detected using qRT-PCR. Clinical parameters and renal injury markers were analysed for correlations with VCAN-AS1. In vitro, high glucose-treated human renal tubular cells (HK-2) underwent genetic interventions including VCAN-AS1 knockdown and miR-205-5p inhibition. Functional assessments encompassed cell viability, oxidative stress, fibrosis and inflammation. Dual-luciferase reporter assays validated molecular interactions. RESULTS: Serum VCAN-AS1 expression showed a progressive increase across healthy controls, diabetes mellitus patients and DN patients. It exhibited strong diagnostic efficacy for DN with an AUC of 0.879. Elevated VCAN-AS1 correlated with deteriorated renal function parameters. VCAN-AS1 was identified as an independent risk factor for diabetes mellitus progression to DN. High glucose exposure up-regulated VCAN-AS1 in HK-2 cells, promoting cellular injury phenotypes. Rescue experiments confirmed that miR-205-5p inhibition reversed the protective effects of VCAN-AS1 knockdown. Mechanistically, VCAN-AS1 directly bound miR-205-5p, suppressing its expression and consequently enhancing vascular endothelial growth factor A (VEGFA) expression. CONCLUSIONS: VCAN-AS1 serves as a potential diagnostic biomarker for DN and promotes disease pathogenesis through the miR-205-5p/VEGFA axis, highlighting its potential as a therapeutic target.
Sampling duration matters: Intraindividual variation of glycaemic metrics in type 1 diabetes using automated insulin delivery.
Bibby BM, Bach E, Christensen M … +2 more , Fisker S, Hansen KW
Diabet Med · 2026 Jul · PMID 41858085 · Full text
INTRODUCTION: Understanding intraindividual variability in glycaemic metrics among users of automated insulin delivery (AID) is essential for interpreting data from continuous glucose monitoring (CGM). METHODS: CGM data...
INTRODUCTION: Understanding intraindividual variability in glycaemic metrics among users of automated insulin delivery (AID) is essential for interpreting data from continuous glucose monitoring (CGM). METHODS: CGM data over 56 days were collected from 142 individuals with type 1 diabetes using AID systems. Glycaemic metrics were derived from four 14-day periods and two 28-day periods. RESULTS: The 95% limit of agreement for the difference between two measurements of time in range (TIR) from the same individual over 14-day periods was ±13.4%. The risk that two 14-day TIR values from the same individual differed by more than 5% points was 46.5%. If TIR was based on two 28-day periods, the 95% limit of agreement decreased to ±9.0%. The risk that two 28-day TIR values from the same individual differed by more than 5% points was 27.6%. CONCLUSION: A 28-day CGM sampling period is recommended to minimise random variation and obtain more reliable glycaemic metrics.
Improving glycaemic outcomes with subsidised access to diabetes technology in a young adult population with type 1 diabetes.
Lee AH, Stokes G, Farrell K … +1 more , Holmes-Walker DJ
Diabet Med · 2026 May · PMID 41841791 · Full text
AIMS: The availability of diabetes technologies has increased, although access can be limited for young people with type 1 diabetes (T1D). In Australia, access to subsidised continuous glucose monitors (CGM) has expanded...
AIMS: The availability of diabetes technologies has increased, although access can be limited for young people with type 1 diabetes (T1D). In Australia, access to subsidised continuous glucose monitors (CGM) has expanded significantly, while insulin pump access remains limited. This study evaluated the impact of changes in availability of diabetes technologies on glycaemic outcomes in young adults with T1D. METHODS: 418 with T1D aged 15-25 years attending a young adult diabetes clinic in Sydney were reviewed between July 2019 and June 2024. The primary outcome was change in glycaemia as measured by glycosylated haemoglobin (HbA1c) across 5 years. RESULTS: CGM use increased from 29.4% to 76.2% over the study duration, and uptake increased in all sociodemographic groups likely due to universal subsidisation. Insulin pump use remained unchanged (52-57%), as pump access remains limited by cost. An increase in pump therapy was only observed in those of the lowest sociodemographic cohort, attributed to expansions in the insulin pump program targeted to low-income households, although a reduction in usage was observed in middle socio-economic groups. Use of hybrid closed loop (HCL) insulin pumps increased from 5.1% to 35.4% in line with CGM uptake. With increased uptake of technologies, median HbA1c improved from 68 mmol/mol (8.4%) to 64 mmol/mol (8.0%) (p < 0.001). CGM and HCL demonstrated independent benefits to glycaemia. Rates of severe hypoglycaemia and diabetic ketoacidosis were low at 1.08 and 4.90/100 person-years, respectively. Pump therapy was associated with reduced DKA. CONCLUSIONS: Overall, improvements in glycaemia in young adults were achieved with greater accessibility to subsidised diabetes technologies.
Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group.
Stephens JW, Dhatariya K, Beamish AJ … +6 more , Pournaras DJ, Miras AD, Raafat N, Noble-Bell G, Cadwallader Buckland R, Mustafa OG
Diabet Med · 2026 May · PMID 41840846 · Full text
The global prevalence of obesity and diabetes continues to rise, with metabolic-bariatric surgery recognised as an effective intervention for obesity and type 2 diabetes, offering potential for type 2 diabetes remission...
The global prevalence of obesity and diabetes continues to rise, with metabolic-bariatric surgery recognised as an effective intervention for obesity and type 2 diabetes, offering potential for type 2 diabetes remission and improved glycaemic control. This guideline, developed by the Joint British Diabetes Societies for Inpatient Care (JBDS-IP), provides recommendations for the management of diabetes in individuals undergoing metabolic-bariatric surgery. It emphasises the importance of multidisciplinary care and individualised treatment plans to optimise outcomes. Key recommendations include pre-operative glycaemic optimisation, targeting HbA1c <69 mmol/mol (<8.5%) where safe to do so, prevention of hypoglycaemia throughout all phases of care and providing a framework for medication adjustments during the liver reduction diet (LRD), peri-operative and post-operative phases. For type 2 diabetes, oral and non-insulin therapies such as metformin, DPP4 inhibitors and GLP-1 based therapies may be continued during LRD, while sulfonylureas, meglitinides and SGLT2 inhibitors should be discontinued to reduce the risk of hypoglycaemia. For those with type 2 diabetes on insulin, doses should be reduced by 35%-50% during LRD and adjusted post-operatively based on individual glycaemic control. To prevent diabetic ketoacidosis (DKA) in those with type 1 diabetes, insulin must never be stopped and careful planning with diabetes teams is essential. Post-operatively, regular glucose monitoring, hypoglycaemia surveillance, medication adjustments, and follow-up with diabetes specialists are recommended. This document serves as a guide for clinicians and service commissioners, aiming to improve inpatient diabetes care and outcomes for individuals undergoing metabolic-bariatric surgery.
Efficacy of glucagon-like peptide-1 receptor analogues in kidney transplant recipients with diabetes: A single-centre retrospective study.
Mei K, Casabar M, Mukuba D … +2 more , Byrne C, Chowdhury TA
Diabet Med · 2026 May · PMID 41833553 · Publisher ↗
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A call to action: A consensus statement on knowledge gaps and research priorities on the management of women with early onset type 2 diabetes in the preconception, pregnancy and postnatal periods: A report from the Diabetic Medicine Symposium at the Diabetes UK Annual Professional Conference, 2025.
White SL, Schoenaker D, Mackin S … +6 more , Forde R, Flynn AC, Dyer E, Heslehurst N, Lindsay R, Meek CL
Diabet Med · 2026 May · PMID 41830146 · Full text
AIMS: Research to inform, co-develop and evaluate optimal care for women with early-onset type 2 diabetes (EOT2D) before, during and after pregnancy is lacking. Informed by patient perspectives and the results of the Jam...
AIMS: Research to inform, co-develop and evaluate optimal care for women with early-onset type 2 diabetes (EOT2D) before, during and after pregnancy is lacking. Informed by patient perspectives and the results of the James Lind Alliance priority-setting partnership in diabetes in pregnancy, we aimed to develop a consensus statement to guide future research efforts to meet the needs of women with EOT2D in the preconception, pregnancy and postnatal periods. METHODS: Results from three systematic reviews covering interventional, observational and qualitative studies were presented at the Diabetes UK annual professional conference in Glasgow in February 2025. The results were discussed by an expert panel with audience participation. RESULTS: There is very limited research to guide care for women with EOT2D, especially in the preconception and postnatal periods. In pregnancy, there have been limited studies assessing interventions, mainly encompassing medication and glucose sensor use, but most are small and have limited generalisability. Observational data suggests that managing glycaemia, addressing maternal BMI and preventing excessive gestational weight gain improve outcomes for women with EOT2D in pregnancy. Qualitative data highlight the negative impact of EOT2D on pregnancy and the need for optimised support. Targeted, innovative and cross-cultural studies across the reproductive life course are urgently needed to address the short and longer-term maternal and offspring risks for individuals with EOT2D. CONCLUSIONS: Given the rising prevalence of EOT2D and the risk of adverse pregnancy outcomes for women with EOT2D and their children, prioritising research in the preconception, pregnancy and postnatal periods is vital to ensure that care needs are met to improve health outcomes for women and their children.
Association between type 2 diabetes and site-specific fracture risk: A systematic review and meta-analysis of cohort studies including over 13 million participants.
Naderpour S, Gillies C, O'Riordan P … +7 more , Fahimfar N, Karimi Z, Khoramdad M, Khavere S, Kundu M, Khunti K, Gharibzadeh S
Diabet Med · 2026 May · PMID 41830104 · Full text
OBJECTIVE: This review aimed to quantify the association between Type 2 Diabetes (T2D) and the risk of fracture at various anatomical sites by synthesising data from cohort studies. METHODS: A systematic search was condu...
OBJECTIVE: This review aimed to quantify the association between Type 2 Diabetes (T2D) and the risk of fracture at various anatomical sites by synthesising data from cohort studies. METHODS: A systematic search was conducted across Medline, Embase, CINAHL and Web of Science databases, from inception to 10 June 2025. We estimated pooled hazard ratios (HRs) with corresponding 95% confidence intervals using random-effects models. This study is registered with PROSPERO (CRD42024548795). RESULTS: This meta-analysis of 22 studies, selected from 6534 screened studies, assessed a total of 13,074,868 individuals (2,644,443 people with T2D and 10,430,425 without T2D). People with T2D have a 25% increased risk of fractures (all anatomical sites) compared to individuals without T2D (HR: 1.25; 95% CI: 1.20 to 1.31). T2D was significantly associated with an increased risk of appendicular lower limb fractures (HR: 1.43; 95% CI: 1.30 to 1.57), upper limb fractures (HR: 1.29; 95% CI: 1.16 to 1.45), osteoporotic/fragility fractures (HR: 1.14; 95% CI: 1.02 to 1.28) and appendicular unspecified fractures (HR: 1.25; 95% CI: 1.05 to 1.48). Subgroup analyses indicated stronger associations in prospective studies. Women with T2D had a significantly higher fracture risk than men. Meta-regression analyses showed that a higher percentage of women participants and a longer duration of T2D were associated with stronger associations between T2D and fracture risk, particularly for lower limb fractures. CONCLUSION: T2D is associated with an increased risk of fractures, especially in lower limbs (hip, ankle and foot). These findings highlight the importance of targeted fracture prevention strategies and site-specific risk assessment for individuals with T2D. However, due to the heterogeneity among studies, caution is required in the interpretation of these findings.
MiR-10a-5p aggravates podocyte injury in diabetic nephropathy by inhibiting E2f7-mediated autophagy.
Tong W, Liu T
Diabet Med · 2026 Jul · PMID 41821249 · Publisher ↗
AIMS: Podocyte injury is a hallmark of diabetic nephropathy (DN) and significantly contributes to disease progression. Accumulating evidence suggests that impaired autophagy exacerbates podocyte dysfunction under hypergl...
AIMS: Podocyte injury is a hallmark of diabetic nephropathy (DN) and significantly contributes to disease progression. Accumulating evidence suggests that impaired autophagy exacerbates podocyte dysfunction under hyperglycaemic conditions. However, the underlying regulatory mechanisms remain incompletely understood. This study aimed to investigate the role and mechanism of microRNA-10a-5p (miR-10a-5p) in regulating podocyte injury and autophagy in DN. METHODS: The function of miR-10a-5p was explored in high glucose (HG)-induced murine podocyte (MPC5) cells and streptozotocin (STZ)-induced diabetic mice. Gain- and loss-of-function experiments were conducted using miR-10a-5p mimics or inhibitors. E2F transcription factor 7 (E2f7) was predicted as a downstream target of miR-10a-5p via bioinformatics, and the binding between miR-10a-5p and E2f7 was assessed using dual-luciferase reporter assay and RNA immunoprecipitation (RIP) assay. Podocyte injury, cell apoptosis, inflammation and autophagy were assessed using flow cytometry, Western blotting, enzyme-linked immunosorbent assay (ELISA), transmission electron microscopy (TEM) and green fluorescent protein-monomeric red fluorescent protein-LC3 (GFP-mRFP-LC3) staining. Rescue experiments were conducted by silencing or overexpressing E2f7 to confirm its role in miR-10a-5p-mediated effects. RESULTS: miR-10a-5p was significantly upregulated in HG-stimulated podocytes and kidney tissues of diabetic mice. Inhibition of miR-10a-5p alleviated HG-induced podocyte injury, as evidenced by enhanced cell viability, reduced apoptosis and inflammatory cytokine production, and restored autophagic activity. E2f7 was identified as a direct target of miR-10a-5p. Notably, silencing E2f7 abrogated the protective effects of miR-10a-5p inhibition on podocyte survival and autophagy, and E2f7 overexpression restored the detrimental effects of miR-10a-5p overexpression on podocytes. In vivo, administration of AntagomiR-10a-5p in STZ-induced diabetic mice ameliorated renal injury and restored autophagic flux, and increased E2f7 expression in mouse renal tissues. CONCLUSIONS: This study identifies the miR-10a-5p/E2f7 axis as a critical regulator of podocyte injury and autophagy in DN. Therapeutic inhibition of miR-10a-5p may represent a promising strategy for preserving podocyte function and attenuating DN injury.
Shifting the narrative from 'what's wrong?' to 'what's strong?' MIND-MAP: A qualitative study exploring positive mental health and support needs of adults with diabetes.
Robertson N, Holmes-Truscott E, Skinner TC … +5 more , Halliday J, O'Sullivan G, Hines C, Speight J, Holloway EE
Diabet Med · 2026 Jun · PMID 41821236 · Full text
AIM: To explore factors that foster positive mental health among adults with type 1 and type 2 diabetes and identify opportunities for more accessible, person-centred mental health support within diabetes care. METHODS:...
AIM: To explore factors that foster positive mental health among adults with type 1 and type 2 diabetes and identify opportunities for more accessible, person-centred mental health support within diabetes care. METHODS: Participants were purposively sampled from the Mental health IN Diabetes Monitoring And Pathways (MIND-MAP) cohort study. Semi-structured online interviews were conducted with 32 adults in Victoria, Australia. Interviews explored factors associated with emotional well-being and experiences and preferences for mental health support. Data were analysed using reflexive thematic analysis, informed by phenomenology and constructivist grounded theory. The study was co-designed with guidance from a multidisciplinary Steering Committee and lived experience input through a Community Advisory Group comprising 12 adults with type 1 or type 2 diabetes. RESULTS: Participants described internal strengths (e.g. acceptance, perspective-taking) and external supports (e.g. peer connections, empathetic health professionals, timely access to mental health care) that supported their mental health. Several barriers to accessing mental health support were reported, including limited-service access, geographic and financial constraints, discomfort discussing emotions, and a lack of diabetes-specific mental health expertise. Emotional support was often absent at diagnosis and other key transition points. Participants called for support that is empathetic, non-judgemental, tailored and embedded within diabetes services. CONCLUSION: Adults with type 1 and type 2 diabetes show resilience in managing mental health, yet systemic, practical and attitudinal barriers remain. Care models should build on personal strengths, normalise emotional support and integrate psychological care from diagnosis, as well as harness the value of peer support.
Wnt inhibitory factor 1 inhibits glycolysis through the HIF1α/PFKFB3 signalling pathway to regulate macrophage polarization and alleviate diabetic retinopathy.
Wang MJ, Zhao XY, Lu GH … +1 more , Sun XC
Diabet Med · 2026 May · PMID 41814504 · Publisher ↗
AIMS: Diabetic retinopathy (DR) has been associated with aberrant Wnt inhibitory factor 1 (WIF1) expression and dysregulated glycolysis. However, no study has yet reported how WIF1 links glycolysis to macrophage polariza...
AIMS: Diabetic retinopathy (DR) has been associated with aberrant Wnt inhibitory factor 1 (WIF1) expression and dysregulated glycolysis. However, no study has yet reported how WIF1 links glycolysis to macrophage polarization and thus influences DR progression. Therefore, the objective of this study was to investigate the regulation of macrophage polarization and glucose metabolism by WIF1 in DR and to determine its impact on DR progression. METHODS: To investigate the role of WIF1, a streptozotocin (STZ)-induced diabetic mouse model was utilized. High glucose was used to treat THP-1-derived macrophages, with or without WIF1 overexpression. The involvement of the HIF1α/PFKFB3 pathway was probed using the HIF1α stabilizer DMOG and the PFKFB3 inhibitor meclizine. Key analyses included retinal histology (H&E staining), macrophage phenotyping (flow cytometry for M1/M2 markers) and measurement of glycolytic activity (lactate production) and related gene expression (RT-qPCR and western blot). RESULTS: The weight loss, elevated blood glucose levels, increased plasma glycated haemoglobin ratio, decreased WIF1 expression, increased glycolysis and elevated number of M1 macrophages were observed in DR mice. HE staining revealed significant retinal tissue damage in DR mice. The pathological changes were mitigated by WIF1 overexpression. It has been demonstrated that elevated glucose levels can induce M1 polarization of macrophages, resulting in increased glycolysis, promotion of the inflammatory response and lactate accumulation. In addition, these effects have been shown to be attenuated by WIF1 overexpression. Treatment with DMOG and meclizine served to attenuate the effects of WIF1 overexpression, as evidenced by the increased expression of HIF-1α/PFKFB3, and promoted glycolysis and the M1 polarization of macrophages. CONCLUSION: Overexpression of WIF1 inhibits glycolysis via the HIF1α/PFKFB3 signalling pathway, thereby modulating the polarization of macrophages and alleviating the progression of DR. These findings suggest that WIF1 could be a promising therapeutic target for DR.
Sex-specific differences in the prevalence of intermediate hyperglycaemia states: A systematic review and meta-analysis.
Cooper L, Porter I, Meek C … +2 more , Griffin SJ, Ahern A
Diabet Med · 2026 Mar · PMID 41808269 · Publisher ↗
AIMS: To evaluate the sex-specific prevalence of isolated impaired glucose tolerance, isolated impaired fasting glucose, combined impaired glucose tolerance and impaired fasting glucose and type 2 diabetes diagnosed by i...
AIMS: To evaluate the sex-specific prevalence of isolated impaired glucose tolerance, isolated impaired fasting glucose, combined impaired glucose tolerance and impaired fasting glucose and type 2 diabetes diagnosed by isolated glucose states. METHODS: We searched MEDLINE, Cochrane Database of Systematic Reviews, Embase and CINAHL from inception to 22.04.25. Title and abstract screening, full-text review, data extraction and risk of bias assessment (Hoy et al.) were conducted by two reviewers using pre-defined eligibility criteria. Sex-stratified prevalence and odds ratio for each intermediate hyperglycaemic state in women compared with men were pooled using a random-effects meta-analysis. RESULTS: We identified 8 studies suitable for meta-analysis, including 52,256 participants (25,263 women). The pooled prevalences (95% CI) of isolated impaired glucose tolerance, isolated impaired fasting glucose (ADA thresholds) and combined impaired glucose tolerance in women were respectively 8% (7%,9%), 15% (12%,18%) and 7% (5%, 9%) and for men 5% (4%,7%), 21% (12%, 32%) and 7% (5%, 10%). Compared with men, women had higher odds of having isolated impaired glucose tolerance: 1.42 (1.23, 1.65), 0.65 (0.44, 0.96) lower odds of isolated impaired fasting glucose: 0.65 (0.44, 0.96) and similar odds of combined impaired glucose tolerance and impaired fasting glucose: 0.85 (0.46, 1.57). There was moderate certainty evidence for pooled prevalence estimates and high certainty evidence for comparisons of iIGT and iIFG between sexes. CONCLUSIONS: There are sex-specific disparities in the prevalence of different isolated intermediate hyperglycaemic states, which may contribute to underdiagnosis and undertreatment in primary care and introduce ascertainment bias into research and policy.
A mobile phone application for the prevention of type 2 diabetes in Malaysian women with gestational diabetes mellitus (MYGODDESS): A feasibility randomised controlled trial.
Benton M, Goldsmith K, Ching SM … +9 more , Forbes A, Nadal IP, Murphy HR, Sobri NHM, Yusof BM, Basri NI, Ismail IZ, Ismail K, Chew BH
Diabet Med · 2026 May · PMID 41808263 · Full text
AIMS: The prevalence of gestational diabetes mellitus (GDM) in Malaysia is estimated at 9-18%. Although GDM is associated with increased and potentially modifiable risk of developing type 2 diabetes, the effectiveness of...
AIMS: The prevalence of gestational diabetes mellitus (GDM) in Malaysia is estimated at 9-18%. Although GDM is associated with increased and potentially modifiable risk of developing type 2 diabetes, the effectiveness of diabetes prevention interventions (DPI) post-GDM in this setting is unclear. To evaluate the feasibility of conducting a future full-scale, two-arm, parallel, randomised controlled trial (RCT) of a DPI in women with GDM set in Malaysia. METHODS: Women in both arms received usual GDM care. Women in the intervention arm also received modules on diet, physical activity, and mental health via a mobile application, over six months post-partum, plus dietitian-led group sessions and motivational text messages. The primary feasibility outcomes included the proportion of women who consented, were eligible and randomised and provided outcome data. We measured biomedical and mental health outcomes for a full-scale RCT at four time points: baseline before randomisation (approximately 30 weeks' gestation), 36 weeks' gestation and 3- and 6-months postpartum. RESULTS: We screened 660 women with GDM, 294 (45%) consented for eligibility screening, of whom 164 (24.9%) were eligible and 60 (9%) consented and were randomised. The proportion who completed biomedical outcomes was 85% at each follow-up. There was no treatment effect on any other biomedical outcomes or secondary outcomes. CONCLUSIONS: The participation rate was in keeping with previous DPI trials and the attrition rate was low, suggesting it is feasible to conduct a full-scale RCT.
Feasibility and benefits of continuous glucose monitoring for type 1 diabetes in Rwanda: A real-world 12-month continuation phase.
Narayanan S, Baker J, Welsh JB … +3 more , Cappon G, Habineza JC, Niyonsenga SP
Diabet Med · 2026 Jul · PMID 41800568 · Publisher ↗
AIMS: Continuous glucose monitoring (CGM) remains underutilized in low- and middle-income countries (LMICs). We extend earlier observations on the feasibility and impact of CGM among people living with type 1 diabetes (T...
AIMS: Continuous glucose monitoring (CGM) remains underutilized in low- and middle-income countries (LMICs). We extend earlier observations on the feasibility and impact of CGM among people living with type 1 diabetes (T1D) in Rwanda in a real-world continuation phase study. METHODS: This was a 1-year continuation phase of a single-arm, mixed-methods, prospective observational study conducted in Kigali, Rwanda, from August 2022 to September 2024. Completers of the 12-month Phase I were transitioned to a current-generation CGM device and, in months 19-24, reduced frequency of clinic visits reflecting routine care. The primary outcomes were change in haemoglobin A1c (HbA1c) and the CGM-based metrics time in range (TIR, 3.9-10 mmol/L), and time below range (TBR, <3.9 mmol/L). Secondary outcomes included self-reported hospitalizations, incidences of severe hypoglycaemia and diabetic ketoacidosis, as well as diabetes-related questionnaire results. RESULTS: At the end of Phase I, 40 of the original 50 participants entered Phase II with mean HbA1c, TIR and TBR of 44 mmol/mol (6.2%), 44.9% and 5.6%, respectively, all metrics being significantly different from study start. These did not change significantly by the end of the study (48 mmol/mol [6.6%], 46.5% and 7.9%, respectively). No hospitalizations, three episodes of severe hypoglycaemia and two episodes of diabetic ketoacidosis were reported. Most respondents were satisfied with the device, used it consistently and trusted the values provided. CONCLUSIONS: CGM-related improvements in HbA1c and TIR among Rwandans living with T1D were maintained for at least 24 months. CGM should be considered as an important tool to improve diabetes self-management in LMICs.
Associations of biochemical and metabolic markers with pregnancy outcomes in women with and without gestational diabetes mellitus: A prospective cohort study in eastern China.
Bian X, Sun X, Meng L
Diabet Med · 2026 May · PMID 41761755 · Publisher ↗
AIMS: Gestational diabetes mellitus (GDM) is a frequent pregnancy complication associated with negative maternal and neonatal outcomes. However, the contribution of non-glycaemic biochemical markers to pregnancy outcomes...
AIMS: Gestational diabetes mellitus (GDM) is a frequent pregnancy complication associated with negative maternal and neonatal outcomes. However, the contribution of non-glycaemic biochemical markers to pregnancy outcomes remains unclear. This study aimed to compare biochemical markers and clinical outcomes in women with and without GDM and to identify associations between these markers and adverse pregnancy outcomes (APOs). METHODS: In this prospective cohort study, 246 pregnant women at Shandong Provincial Third Hospital were divided into GDM (n = 123) and non-GDM (NGDM; n = 123) groups. Fasting glucose, HbA1c, lipid profile, liver and kidney function markers, and OGTT values were assessed. Pregnancy outcomes, including caesarean section, macrosomia, and premature rupture of membranes (PROM), were recorded. Multivariable logistic regression was used to determine associations between biochemical markers and outcomes, adjusting for age, BMI, and gestational weight gain. RESULTS: GDM women had significantly higher fasting glucose levels, HbA1c, gestational BMI, and caesarean section rates (p < 0.001). Serum albumin levels were slightly higher in the GDM group (p = 0.028), whereas alkaline phosphatase (ALP) and direct bilirubin were higher in NGDM women. Higher serum albumin levels were associated with lower odds of macrosomia (AOR = 0.43, 95% CI: 0.20-0.93) and PROM in NGDM women. Creatinine was also inversely related to macrosomia risk in NGDM (AOR = 0.75, 95% CI: 0.60-0.94). CONCLUSION: Distinct biochemical profiles were observed between GDM and NGDM pregnancies. Albumin and creatinine may serve as simple, cost-effective indicators of reduced obstetric risk among normoglycaemic women. Incorporating these routinely measured markers into prenatal screening could improve individualized risk prediction and early intervention strategies..
Policy gaps in type 1 diabetes: A UK audit of National Governing Bodies.
Abdel-Magid M, Cockcroft EJ, Bright C … +3 more , Mann RH, Pulsford R, Andrews RC
Diabet Med · 2026 Jun · PMID 41757558 · Full text
AIMS: National Governing Bodies (NGBs) for sport in the United Kingdom (UK) are responsible for setting standards and ensuring safe, inclusive participation for all, including people with type 1 diabetes (T1D). This audi...
AIMS: National Governing Bodies (NGBs) for sport in the United Kingdom (UK) are responsible for setting standards and ensuring safe, inclusive participation for all, including people with type 1 diabetes (T1D). This audit systematically assessed the extent and quality of policy provision among UK-based NGBs, focusing on support for athletes with T1D. The findings were compared with epilepsy, asthma and allergies to evaluate equity and consistency in safeguarding and inclusion practices. METHODS: A systematic policy audit of UK sport NGBs to assess the presence and content of policies addressing athletes with T1D, asthma, epilepsy and allergies. Policy documents were accessed through public materials on NGB websites. NGBs were contacted by email to confirm the existence of relevant policies and to request any documents not currently included on their website. Sports were included if their NGB had a publicly accessible website. RESULTS: Of 185 NGBs, 20 (11%) had policy documents mentioning diabetes, 14 (7.7%) asthma, 12 (6.6%) epilepsy and 4 (2.2%) allergies. Of the 20 NGBs with documents mentioning diabetes, only 4 had dedicated diabetes policies. The remaining 16 referred to diabetes in broader documents. CONCLUSION: Despite increasing emphasis on inclusion in sport, few NGBs have clear policies to support individuals with diabetes. This is also the case for asthma, epilepsy and allergies. We recommend the development of national policies for diabetes, which can be adapted by individual sporting bodies.
Cardio-renal-metabolic syndrome: A concept in question, a clinical impact beyond doubt.
Koufakis T, Hatziagelaki E
Diabet Med · 2026 May · PMID 41757422 · Publisher ↗
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High prevalence of maturity-onset diabetes of the young in the Czech Republic: A 25-year nationwide registry-based study.
Dusatkova P, Pavlikova M, Cermakova M … +6 more , Vesela K, Kolarova K, Elblova L, Sumnik Z, Lebl J, Pruhova S
Diabet Med · 2026 May · PMID 41733136 · Full text
AIMS: Maturity-Onset Diabetes of the Young (MODY) results from a single-gene defect. This study aimed to determine the minimal prevalence, screening indicators, as well as clinical characteristics of MODY in the Czech Re...
AIMS: Maturity-Onset Diabetes of the Young (MODY) results from a single-gene defect. This study aimed to determine the minimal prevalence, screening indicators, as well as clinical characteristics of MODY in the Czech Republic based on data from 25 years of the nationwide registry. METHODS: Clinical and genetic data were collected from individuals suspected of having MODY referred for genetic testing and registered in the National Registry for Monogenic Diabetes between 1999 and 2023. Prevalence estimates were calculated using Czech national census data. The cluster analyses of probands with the absence of a detected monogenic cause of diabetes were performed with the Mclust library. RESULTS: In total, 1879 probands with suspected MODY were registered, and 728 (39%) received a confirmed diagnosis (in total, 1473 individuals). GCK, HNF1A and HNF4A gene variants accounted for 93% of all diagnoses. The average prevalence of MODY was 136 per million inhabitants, peaking at 240 per million in the northeast region of the country. If the highest recorded minimum prevalence is applied to the total population in the Czech Republic, approximately 44% of cases remain undiagnosed. A cluster statistical analysis identified five overlapping, clinically defined subgroups within the probands with no identified monogenic cause of diabetes. CONCLUSIONS: This study provides one of the highest national prevalence rates of MODY to date. Nevertheless, approximately half of the expected cases remain undetected. The negative group included several different subtypes of glucose tolerance disorders, which should guide future research into the pathogenesis of different types of diabetes.
Characterising the impact of shift work on diet and glucose variability in healthcare employees living with type 2 diabetes: The Shift-Diabetes study.
Gibson R, D'Annibale M, Palla L … +6 more , Tejo F, McGowan B, Vetter C, Lorencatto F, Oliver N, Guess N
Diabet Med · 2026 May · PMID 41733108 · Full text
AIMS: To characterise differences in dietary intake, glucose variability, and activity in free-living healthcare shift workers with type 2 diabetes (T2D) across varying work conditions. METHODS: Healthcare shift workers...
AIMS: To characterise differences in dietary intake, glucose variability, and activity in free-living healthcare shift workers with type 2 diabetes (T2D) across varying work conditions. METHODS: Healthcare shift workers with T2D were monitored over 10 days, covering night shifts, day shifts, and rest days. Data were collected using blinded continuous glucose monitoring, activity trackers, and diet/sleep diaries. Within-person comparisons were made for mean glucose (MG), coefficient of variation (CV), mean absolute glucose change (MAG), mean amplitude of glycaemic excursion (MAGE), continuous overlapping net glycaemic action (CONGA), dietary intake (food choices, nutrient intake), and activity/rest periods. RESULTS: The study sample (n = 37; 89.2% women) were mainly employed as nurses or midwives (62.2%). Energy intake was highest (2199 kcal SD 648) on a day when a night shift was worked. Percentage of energy intake from sweet snacks was higher on a night shift compared with a rest day after a night shift (13.4 SD 12.0% vs. 7.8 SD 11.8%, p = 0.013). Night shifts had the highest eating occasions (7.0 SD 2.2) and rest after night (RAN) the lowest (3.4 SD 1.6), p < 0.001. No differences were reported for MG, MAGE, or CV. MAG and CONGA were higher for night shift compared with RAN shift (p = 0.029). Step counts were higher on night shift days (13,775, SD 4270 p = 0.016), and participants were awake longer (22.2 h SD 2.4 h, p < 0.001) compared with other day types. CONCLUSIONS: Night shifts are associated with prolonged wakefulness, increased activity, and distinct dietary behaviours. Tailored interventions are needed to support night shift workers with T2D in managing their condition effectively.
Beyond the wound: A scoping review of the psychosocial impact of diabetes-related foot ulcers.
Hanlon M, McGuire BE, MacGilchrist C … +7 more , Kirwan E, Neachtain DN, Dhatariya K, Blanchette V, Durand H, Dragomir A, McIntosh C
Diabet Med · 2026 Apr · PMID 41721498 · Full text
OBJECTIVES: To explore the emotional consequences of diabetes-related foot ulcers (DFUs) and examine the psychosocial factors that influence their progression, management and self care behaviours. METHODS: A systematic s...
OBJECTIVES: To explore the emotional consequences of diabetes-related foot ulcers (DFUs) and examine the psychosocial factors that influence their progression, management and self care behaviours. METHODS: A systematic scoping review was conducted following Arksey and O'Malley's six-stage framework and the Joanna Briggs Institute guidelines, and reported in accordance with PRISMA-ScR standards. Studies were eligible if they examined emotional or psychosocial experiences of adults living with DFUs. RESULTS: Forty-nine studies were included: 28 cross sectional, 13 qualitative, 5 prospective, 2 randomized controlled trials and 1 case study. Individuals with DFUs experienced heightened emotional distress and substantially reduced health-related quality of life (HRQOL), largely due to physical limitations, challenges in diabetes self management and fear of future complications. Key psychosocial influences included low self-efficacy, feelings of powerlessness, loss of independence and perceived burdensomeness. Disparities related to gender, socio-economic status and cultural background further shaped emotional outcomes and self care behaviours. CONCLUSIONS: Psychosocial factors substantially influence emotional well-being, treatment adherence and wound healing in people living with DFUs. Integrating psychosocial assessment, tailored education and emotional support into standard care may improve outcomes. PRACTICE IMPLICATIONS: Routine psychological screening, health literacy-sensitive education and multidisciplinary counselling should be incorporated into DFU management to enhance self care and quality of life.
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