Diabetic Medicine[JOURNAL]
Sun
200 papers
How effective are CBT and CBT-based interventions in Type 1 and Type 2 diabetes? An umbrella review.
Press HS, Nicklas L
Diabet Med · 2026 May · PMID 41721493 · Full text
AIMS: Significant evidence base supports cognitive behavioural therapy (CBT) for diabetes. Large variations in practice make it difficult to assess the impact of different types of delivery. This umbrella review aimed to...
AIMS: Significant evidence base supports cognitive behavioural therapy (CBT) for diabetes. Large variations in practice make it difficult to assess the impact of different types of delivery. This umbrella review aimed to synthesise evidence on the effectiveness of CBT and CBT-based interventions for diabetes-related distress, comorbid depressive symptoms, anxiety symptoms and HbA1c levels. A secondary aim investigated whether effectiveness differs in CBT delivered by a CBT therapist compared to CBT-based interventions that are delivered by multidisciplinary staff. METHODS: Databases like CINAHL, MEDLINE, PsychINFO, PsychArticles and Cochrane Library were searched for systematic reviews and meta-analyses between 2014 and 2023. Review quality was assessed using the Scottish Intercollegiate Guidelines Network checklist. For the secondary aim, findings of randomised controlled trials were distinguished within reviews. RESULTS: Eleven systematic reviews and meta-analyses were included. Four of the reviews were rated as 'high'-quality reviews, five as 'acceptable' and two as 'low'-quality reviews. CBT-based interventions delivered by multidisciplinary staff significantly reduced depressive symptoms, diabetes-related distress and HbA1c levels. CBT therapy delivered by CBT therapists was associated with significant reductions in diabetes-related distress, anxiety symptoms, depressive symptoms and HbA1c levels. CONCLUSIONS: CBT and CBT-based interventions were similarly effective for depressive symptoms and HbA1c levels. Anxiety symptoms only improved following CBT delivered by CBT therapists, while diabetes-related distress reduced more than for CBT-based interventions. Significant heterogeneity and variation in quality in reviews mean that further research is required.
The impact of sleep and movement behaviour on daily mood in people with type 2 diabetes: A smartphone-based digital phenotyping study.
McInerney AM, Schmitz N, Matthews M … +1 more , Deschênes SS
Diabet Med · 2026 May · PMID 41714862 · Full text
OBJECTIVE: To examine how sleep and movement behaviours, measured on smartphones via ecological momentary assessment (EMA), GPS and accelerometer, impact subsequent daily mood in people with type 2 diabetes (T2D) compare...
OBJECTIVE: To examine how sleep and movement behaviours, measured on smartphones via ecological momentary assessment (EMA), GPS and accelerometer, impact subsequent daily mood in people with type 2 diabetes (T2D) compared to those without. METHODS: Sixty-one participants with (n = 32) and without (n = 29) T2D underwent 2 months of smartphone-based data collection through phone sensors (GPS, accelerometer) and EMAs. Daily sleep, movement and mood (happiness, sadness, stress, anger) were assessed. Dynamic structural equation modelling examined the impact of sleep and movement on subsequent mood, adjusted for age, gender and employment status. RESULTS: We found 18 significant within-person effects between smartphone-derived behaviour and subsequent mood, with 17 within-person effects indicating behaviour had a positive effect on mood. For people with and without T2D, higher physical activity, better sleep quality and visiting more locations predicted increased happiness, and higher physical activity predicted lower sadness. However, unique behaviour-mood effects were also found for each group, such as greater actigraphy-derived step count predicting greater anger in people with T2D (0.13 [0.05, 0.2]) but having no effect for those without. CONCLUSIONS: Though effects were small, results indicate smartphone-derived behaviour influences daily mood for both people with and without T2D, but that the nuances of these relationships may differ. If daily mood correlates differ between people with and without T2D, digital phenotyping for early detection and intervention may need to be tailored to those with T2D.
Prognostic value of triglyceride-derived metabolic parameters for micro- and macrovascular complications and mortality in individuals with type 2 diabetes: The Rio de Janeiro type 2 diabetes cohort study.
Cardoso CRL, Castro GP, Leite NC … +1 more , Salles GF
Diabet Med · 2026 Apr · PMID 41714748 · Full text
AIMS: Triglyceride-derived metabolic parameters have been proposed as indirect measures of insulin resistance and also as predictors of worse prognosis, mainly in Asian populations. However, their value as risk predictor...
AIMS: Triglyceride-derived metabolic parameters have been proposed as indirect measures of insulin resistance and also as predictors of worse prognosis, mainly in Asian populations. However, their value as risk predictors of micro- and macrovascular complications in non-Asian individuals with type 2 diabetes is uncertain. METHODS: Triglyceride-derived parameters, the atherogenic index of plasma (AIP, the triglyceride/HDL-cholesterol ratio), the triglyceride-glucose index (TyG, the triglyceride-fasting glucose product) and the TyG*BMI were calculated at baseline and during the 1st year of follow-up in a prospective cohort of 667 individuals with type 2 diabetes. Multivariable Cox analyses assessed the associations between triglyceride-derived parameters (as continuous and categorical tertile variables) and cardiovascular (total and major cardiovascular events) and microvascular (renal, retinopathy and peripheral neuropathy events) outcomes and mortality. RESULTS: Over a median 10.6 years of follow-up, there were 212 total cardiovascular events (172 major ones), 263 all-cause deaths and 124 new microalbuminuria developments, 98 advanced renal function deteriorations, 154 retinopathy and 173 peripheral neuropathy development/progression events. None of the triglyceride-derived metabolic parameters, either analysed as continuous or categorical variables, were associated with significantly higher risks for any of the adverse outcomes. The best predictive performance was the 1st year TyG for retinopathy development/progression (HR: 1.24; 95%CI: 1.01-1.53, for increments of 1-SD), which attenuated to non-significant (HR: 1.16; 95%CI: 0.92-1.45) after further adjustment for serum LDL-cholesterol levels. CONCLUSIONS: No triglyceride-derived metabolic parameter was predictive of any adverse outcome, either micro- or macrovascular events or mortality, suggesting that they should not be used for risk stratification in individuals with type 2 diabetes.
Role of collagen type III/ITGB1 signalling in stellate cell-mediated regulation of β-cell survival and insulin secretion in the pancreatic islet microenvironment.
Li Q, Zhang X, Wang W … +12 more , Wang C, Wang B, Li R, Lv Q, Wang J, Liu X, Li L, Zhang Y, Liang J, Persaud SJ, Jones PM, Xu W
Diabet Med · 2026 Apr · PMID 41712464 · Publisher ↗
AIMS: The effects of various cells in the pancreatic islet microenvironment on the function of β-cells remain at the forefront of current islet-related research. Our previous study identified that islet stellate cells (I...
AIMS: The effects of various cells in the pancreatic islet microenvironment on the function of β-cells remain at the forefront of current islet-related research. Our previous study identified that islet stellate cells (ISCs) exist in the islet microenvironment, expressing type III collagen and enhancing insulin secretion from co-cultured β-cells. However, the mechanism by which they regulate insulin secretion in neighbouring β-cells via type III collagen remains unclear. METHODS: This study combined in vivo and in vitro approaches, utilising immunohistochemistry to assess protein expression, flow cytometry for apoptosis detection and Western blotting to measure the expression levels of signalling molecules downstream of the Integrin β1 (ITGB1)/Focal Adhesion Kinase (FAK) pathway. Additionally, the antiapoptotic effects of collagen type III were evaluated using caspase 3/7 assays. RESULTS: In vitro experiments demonstrated that collagen type III inhibits β-cell apoptosis, promotes insulin secretion and enhances the survival of co-cultured MIN6 β-cells through the ITGB1 receptor. This effect is mediated by the activation of the collagen type III/FAK/Src, Forkhead Box O1 (FOXO1)/Pancreatic Duodenal Homeobox-1 (PDX1) signalling pathway in an integrin β1-dependent manner. CONCLUSIONS: ISCs reduce β-cell apoptosis and enhance insulin secretion through the collagen type III/Integrin β1 (ITGB1) system, revealing a new mechanism by which stellate cells regulate neighbouring β-cell function in the islet microenvironment.
Decision accuracy of simultaneously used real-time CGM versus intermittently scanned CGM around exercise in type 1 diabetes: A secondary analysis of the ULTRAFLEXI-1 study.
Sanfilippo S, Müller A, Aberer F … +9 more , Aziz F, Kojzar H, Sourij C, Leb-Stöger U, Birnbaumer P, Pferschy PN, Tripolt N, Sourij H, Moser O
Diabet Med · 2026 May · PMID 41709363 · Full text
AIMS: Continuous glucose monitoring (CGM) systems have become important technologies to improve glycaemia in people with type 1 diabetes (T1D). However, it has been shown that during rapid glucose change, sensor performa...
AIMS: Continuous glucose monitoring (CGM) systems have become important technologies to improve glycaemia in people with type 1 diabetes (T1D). However, it has been shown that during rapid glucose change, sensor performance can deteriorate. Comparative data on sensor performance during high rates of glucose change, such as during exercise, between a real-time continuous glucose monitor (rtCGM) and an intermittently scanned continuous monitor (isCGM) remain limited. METHODS: Twenty-two people with T1D (8 women, age 42 ± 11 years, HbA 59 ± 8 mmol/mol (7.6 ± 0.8%)) simultaneously used an rtCGM (Dexcom G6) and an isCGM (Freestyle Libre 1). Sixty-minute exercise sessions were performed on a cycle ergometer at moderate intensity, and glucose values from both CGM systems were compared against capillary reference blood glucose measurements (EKF S-Line; EKF Diagnostics, Germany). Data were assessed using the Median Absolute Relative Difference (MedARD) with interquartile range, as well as the Diabetes Technology Society Error Grid (DTS EG). RESULTS: During exercise, the MedARD was 14.6% [7.0;23.8] for rtCGM (2304 comparison points) vs. 11.6% [5.6;19.6] for isCGM (2266 comparison points) (p < 0.0001). When stratified by glycaemic range, the MedARD was 39.2% [31.8;46.8] vs. 27.0% [17.0;34.6] for time below range (<70 mg/dL) (p = 0.0001), 16.1% [8.1;24.8] vs. 12.8% [6.4;20.4] for time in range (70-180 mg/dL) (p < 0.0001) and 9.5% [4.7;16.0] vs. 8.0% [3.8;13.7] for time above range (>180 mg/dL) (p = 0.0064) for rtCGM vs. isCGM. CONCLUSION: In this head-to-head comparison of rtCGM and isCGM, isCGM demonstrated superior performance during exercise in adults with T1D.
A multi-centre qualitative study of experiences of managing diabetes mellitus among adults while hospitalised.
Mansbridge SE, Kozlowska O, Lumb A … +3 more , Rea R, Tan GD, Walthall H
Diabet Med · 2026 Apr · PMID 41709106 · Full text
AIMS: One in six hospital beds across England is occupied by someone with diabetes. While guidance on inpatient diabetes care is available, national audit data demonstrate that people still experience significant and avo...
AIMS: One in six hospital beds across England is occupied by someone with diabetes. While guidance on inpatient diabetes care is available, national audit data demonstrate that people still experience significant and avoidable diabetes-related harms. This study is unique in exploring how people with diabetes admitted to hospital for any medical reason experienced diabetes care from admission to discharge. It is part of a bigger project aiming to develop and test a Patient Reported Experience Measure for inpatients with diabetes. METHODS: A qualitative approach was used to explore experiences of inpatient diabetes care. Twenty-seven participants with type 1 or type 2 diabetes, hospitalised for any reason, were recruited using purposive sampling across four acute NHS Trusts in the South of England. Data collected in semi-structured interviews were analysed with reflexive thematic analysis. RESULTS: In diabetes care, the emphasis is on supporting people with self management of their diabetes. The inpatient care setting compromises this by limiting self management behaviours. These restrictions may apply to those who want to and can be actively involved in their diabetes care and may contribute to less effective diabetes management and poorer outcomes. For some participants in this study, diabetes self management was discouraged in three ways. First, their knowledge of their diabetes and willingness to self-manage were not taken into account on admission or in planning their inpatient diabetes care. Second, their involvement in decisions about their ongoing diabetes care was limited. Third, their needs related to diabetes management were not met because of the lack of flexibility in hospital practices and schedules. CONCLUSIONS: Inpatient care is not always conducive to diabetes self management. Understanding the patient experience in the inpatient setting related to self management is important in reducing harm to patients while they are in hospital. Our findings emphasise the importance of involving people with diabetes in planning and managing their care while hospitalised. Further work needs to be done to ensure that the knowledge, involvement and flexibility of care of people with diabetes are incorporated into an inpatient setting.
Refining insights on type 2 diabetes and aortic valve replacement-reply to Liu et al.
Davis TME, Davis WA
Diabet Med · 2026 Apr · PMID 41708517 · Full text
Abstract loading — click title to view on PubMed.
Refining insights on type 2 diabetes and aortic valve replacement.
Liu P, He X, Song Z
Diabet Med · 2026 Apr · PMID 41708508 · Publisher ↗
Abstract loading — click title to view on PubMed.
Enhancing diabetic foot osteomyelitis diagnosis with metagenomics next-generation sequencing, proof of concept.
Morsli M, Magnan C, Salipante F … +6 more , Dubois A, Schuldiner S, Cellier N, Sotto A, Lavigne JP, Dunyach-Remy C
Diabet Med · 2026 Apr · PMID 41693232 · Full text
Diabetic foot osteomyelitis (DFOM) is a serious medical condition that necessitates robust diagnostic tools for effective clinical management. Conventional diagnostic methods for DFOM rely heavily on bacterial culture, w...
Diabetic foot osteomyelitis (DFOM) is a serious medical condition that necessitates robust diagnostic tools for effective clinical management. Conventional diagnostic methods for DFOM rely heavily on bacterial culture, which is time-consuming and may fail to capture the full microbial diversity present in infections. This pilot study explored the utility of metagenomics next-generation sequencing (mNGS) as a complementary diagnostic tool for DFOM. We retrospectively analysed ten bone biopsies from nine diabetic persons using both routine microbiological culture and mNGS. Routine culture identified 11 bacterial species across seven biopsies, while mNGS detected 84 species, including all those found by culture. High microbial diversity (Shannon index = 1.10) was associated with severe osteomyelitis, leading to amputation in three of seven DFOM cases. Interestingly, one culture-negative biopsy revealed high bacterial diversity by mNGS and progressed to a severe infection within 7 days. mNGS also identified resistance genes, providing additional insights for targeted therapy. Integrating mNGS into routine clinical microbiology may serve as a complementary method to conventional diagnostics, particularly for distinguishing infection from colonization and predicting clinical outcomes. However, challenges such as human DNA contamination and limited sequencing depth must be addressed to optimize its clinical application. These findings support the integration of mNGS into diagnostic workflows for bone biopsies for improved management of DFOM.
Trends in global risk factors for the development of type 2 diabetes mellitus: Evidence from the global burden of disease study, 1990-2021.
Xiang Q, Wang S, Miao Y … +7 more , Fu Z, Duan H, Xu X, Cao L, Ren Q, Yan X, Yang X
Diabet Med · 2026 Apr · PMID 41693217 · Publisher ↗
AIMS: To explore the geographical and risk factor trends associated with type 2 diabetes mellitus using Global Burden of Disease (GBD) data (1990-2021). METHODS: Age-standardized T2DM incidence, prevalence, mortality and...
AIMS: To explore the geographical and risk factor trends associated with type 2 diabetes mellitus using Global Burden of Disease (GBD) data (1990-2021). METHODS: Age-standardized T2DM incidence, prevalence, mortality and disability-adjusted life years (DALYs) were extracted from the GBD for 204 countries stratified by sociodemographic index (SDI). Trends were analysed using joinpoint regression to compute average annual percentage changes (AAPCs) and mapping. Age-standardized burden estimates were calculated across 5-year age groups. Risk factor attribution was performed using Bayesian meta-regression and spatiotemporal analysis, illustrating the relative importance of each risk factor by bubble plots. RESULTS: From 1990 to 2021, the global age-standardized incidence rate of T2DM increased (AAPC = 1.83%), with the most pronounced rises in low-middle SDI regions. Mortality slightly increased globally (AAPC = 0.30%) but declined in high-SDI regions. The burden was highest in middle-aged and elderly populations, with a concerning increase in adolescent cases. High body mass index (BMI) was the leading risk factor, estimated to account for 44.5% (95% UI: 19.0%-65.2%) of deaths and 51.9% (95% UI: 24.7%-71.5%) of DALYs in 2021, followed by ambient particulate matter pollution and physical inactivity. The contribution of dietary risks and air pollution varied significantly across SDI regions. CONCLUSIONS: Our analysis identifies high BMI, ambient air pollution and physical inactivity as the primary risk drivers of the global T2DM burden. All indicators increased most markedly in low-middle SDI regions, with substantial disparities across age and sex groups. These findings underscore the need for risk-specific and region-tailored preventive strategies.
Effect of liraglutide on subclinical atherosclerosis and cardiometabolic risk factors in adults with type 1 diabetes: A prospective pilot study.
Sánchez-García D, Luna-Garza Y, Saavedra-Castillo E … +11 more , Gómez-Martínez G, Diaz-Sallas M, Ortega-Valdez AC, Martínez-Mendoza ZF, Reyes-Valdez KR, Huitron-Ramirez RA, Martinez-Rentería JP, Rocha-Rojas R, Dominguez-Rodriguez AL, Garza-Davila KD, Quintanilla-Flores DL
Diabet Med · 2026 Apr · PMID 41693130 · Publisher ↗
AIMS: To evaluate the effect of liraglutide on carotid intima-media thickness (CIMT) and cardiometabolic risk in adults with type 1 diabetes (T1D). METHODS: We conduct a prospective, quasi-experimental study including ad...
AIMS: To evaluate the effect of liraglutide on carotid intima-media thickness (CIMT) and cardiometabolic risk in adults with type 1 diabetes (T1D). METHODS: We conduct a prospective, quasi-experimental study including adults aged 15-60 years with T1D, suboptimal control and on basal-bolus insulin regimen. Participants received liraglutide 1.8 mg/day for 24 weeks. Anthropometric measurements, laboratory parameters, insulin sensitivity (estimated glucose disposal rate, eGDR) and CIMT (high-resolution B-mode ultrasonography) were assessed at baseline, 12 and 24 weeks. Paired t-tests, Wilcoxon-signed rank tests and McNemar's tests were used for statistical comparisons. RESULTS: Thirty-five participants (median age 36 years; 57.1% women) were included. Baseline mean HbA1c was 67 mmol/mol (8.3%), CIMT 0.54 ± 0.13 mm, and median diabetes duration 11 years. After 24 weeks, liraglutide did not significantly modify CIMT (0.54 vs. 0.58 mm; p = 0.151). However, significant improvements were observed in waist circumference (82.5-79 cm; p = 0.004), body weight (70-66.7 kg; p < 0.001), BMI (25.5-24.3 kg/m; p < 0.001), triglycerides (94-75 mg/dL; p = 0.02) and eGDR (7.9-8.9 mg/kg/min; p = 0.003). HbA1c improved at 12 weeks but was not sustained at week 24. No severe hypoglycaemia, diabetic ketoacidosis, emergency visits or hospitalizations occurred. CONCLUSIONS: In adults with T1D, liraglutide improved several cardiometabolic risk factors and insulin sensitivity, although no significant short-term effects on CIMT were observed. Larger long-term trials are needed to clarify its potential role in cardiovascular prevention in this population.
Association between diabetes and in-hospital outcomes in patients with metabolic dysfunction-associated steatotic liver disease hospitalized for cardiovascular disease: A nationwide database study.
Komaki S, Nakai M, Matsuura Y … +9 more , Yamamoto K, Tanaka H, Komaki Y, Yamaguchi M, Moribayashi K, Ideguchi T, Kawakami H, Tsuruda T, Kaikita K
Diabet Med · 2026 May · PMID 41692976 · Full text
AIMS: To evaluate the impact of diabetes on in-hospital outcomes among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) who were hospitalized for cardiovascular disease (CVD). METHODS: We co...
AIMS: To evaluate the impact of diabetes on in-hospital outcomes among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) who were hospitalized for cardiovascular disease (CVD). METHODS: We conducted a retrospective cross-sectional study using data from the nationwide Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination, from April 2012 to March 2023. A total of 10,614 patients with MASLD hospitalized for CVD were identified, of whom 4550 (42.9%) had diabetes. The primary outcome was in-hospital mortality, and secondary outcomes were major cardiac and non-cardiac complications. RESULTS: The median age was 66 years, and 66.9% were male. Compared with patients without diabetes, those with diabetes had higher rates of ischaemic heart disease (35.5% vs. 30.8%), acute coronary syndrome (18.8% vs. 16.9%) and heart failure (27.3% vs. 25.4%) (all p < 0.05). In-hospital mortality (5.6% vs. 3.3%; p < 0.001) and overall complication rates (23.6% vs. 19.7%; p < 0.001) were significantly greater in the diabetes group, driven mainly by cardiac events (16.8% vs. 10.5%; p < 0.001). Multivariable logistic regression confirmed diabetes as an independent predictor of in-hospital mortality (odds ratio, 1.99; 95% confidence interval, 1.60-2.47; p < 0.001). CONCLUSIONS: Diabetes was associated with higher in-hospital mortality and complication rates among patients with MASLD hospitalized for CVD. Stratification of MASLD by metabolic phenotype, particularly in the presence of diabetes, may help improve risk assessment and inform more personalized clinical management in this population.
Estimating the economic burden of diabetes in young adults: A global analysis based on the GBD 2021 and a value of statistical life year framework.
Guo H, Guo Z, Liu Y … +1 more , Zhang Q
Diabet Med · 2026 Apr · PMID 41689245 · Full text
AIMS: The rising prevalence of diabetes in young adults threatens global health and sustainable development. However, its full macroeconomic impact, especially the welfare losses beyond conventional productivity costs, h...
AIMS: The rising prevalence of diabetes in young adults threatens global health and sustainable development. However, its full macroeconomic impact, especially the welfare losses beyond conventional productivity costs, has not been systematically quantified at a global level. We aimed to estimate the current and future global economic burden of diabetes in individuals aged 15-39 years using a welfare-based approach. METHODS: Using disability-adjusted life-years (DALYs) from the Global Burden of Disease Study 2021, we monetized health losses into a value of lost welfare (VLW) via a value of a statistical life year approach. We estimated the VLW globally, regionally and nationally, analysed its distribution by Socio-Demographic Index (SDI) and made projections to 2050. RESULTS: In 2021, the global economic burden was Int$1.16 trillion. Low-SDI regions had the highest relative burden (1.21% of GDP), whereas high-SDI regions had the largest absolute loss. Geographically, East Asia showed the highest absolute burden (Int$240.30 billion) and Oceania the highest relative impact (3.03% of GDP). Projections show the burden will more than double by 2050 to 1.32% of global GDP, driven almost entirely by type 2 diabetes. CONCLUSIONS: Diabetes in young adults represents a significant and growing macroeconomic burden. Our findings underscore the urgent need for public health strategies and economic policies focused on preventing type 2 diabetes. Such interventions are especially critical for countries with fragile health systems to mitigate substantial future economic and health losses.
Group-based interventions to reduce diabetes distress in adults with type 1 diabetes: A rapid realist review of the Reduce and TunedIn interventions.
Sims S, Stenov V, Due-Christensen M … +12 more , Fisher L, Fabian-Therond C, Peck M, Ahuja S, O'Connor S, Abrams R, Halliday J, Holt RIG, Speight J, Sturt J, Harris R, D‑Stress Study Group
Diabet Med · 2026 Feb · PMID 41681035 · Publisher ↗
AIMS: Diabetes distress is highly prevalent among adults with type 1 diabetes, yet remains under-recognised and rarely addressed in routine diabetes care. This rapid realist review aimed to identify how, why, for whom, a...
AIMS: Diabetes distress is highly prevalent among adults with type 1 diabetes, yet remains under-recognised and rarely addressed in routine diabetes care. This rapid realist review aimed to identify how, why, for whom, and in what contexts group-based interventions reduce elevated diabetes distress in adults with type 1 diabetes, to inform the co-adaption of a new diabetes distress intervention in the UK ('D-Stress Reduce'). METHODS: Following established rapid realist review methods, we synthesised evidence from 27 papers relating to two existing diabetes distress interventions and the psychological and social theories underpinning them. Data extraction and analysis focused on identifying contexts, mechanisms and outcomes, supported by stakeholders including methodological experts and programme architects. RESULTS: Seven programme theories were generated and articulated through 20 'If-Then-Because' statements. Key theories highlighted emotional regulation, peer support and person-centred facilitation in reducing diabetes distress. Other theories included regular assessment and follow-up, motivation for action, and empowerment in self-management. The review found that interventions were most effective when adults with type 1 diabetes reported feeling emotionally safe, listened to and respected, and when group facilitators shifted from directive, hierarchical communication styles to collaborative approaches. Contextual factors, such as group composition, facilitator skill, and individual readiness for change influenced outcomes. CONCLUSIONS: This review provides a theory-driven foundation for developing, implementing and evaluating a new co-adapted diabetes distress intervention in the UK ('D-Stress Reduce') and highlights multiple components that can be addressed to improve the care pathway and group-based experience.
Where diabetes is rising fastest, the evidence is quietest: Why LMIC authorship matters.
Seidu S, Baatiema L
Diabet Med · 2026 Mar · PMID 41678716 · Publisher ↗
Abstract loading — click title to view on PubMed.
Real-world glycaemic outcomes observed with the use of Medtronic 780G, Tandem Control-IQ and Omnipod 5 automated insulin delivery systems.
Khan MS, Sivanantham S, Farouk L … +8 more , Lakshmareddy DR, De Scolasticis S, Cresta E, Godsland I, Avari P, Oliver N, Leelarathna L, Reddy M
Diabet Med · 2026 May · PMID 41677018 · Full text
BACKGROUND: No randomised controlled trials have directly compared commercially available hybrid automated insulin delivery (AID) systems, and real-world comparative data remain limited. This study evaluated glycaemic ou...
BACKGROUND: No randomised controlled trials have directly compared commercially available hybrid automated insulin delivery (AID) systems, and real-world comparative data remain limited. This study evaluated glycaemic outcomes across three hybrid AID systems in adults with type 1 diabetes (T1D). METHODS: This was a retrospective, observational, single-centre study and included adults with T1D who transitioned from multiple daily injections (MDI) or non-automated insulin pump therapy to hybrid AID. Data were collected from routinely used clinical data-sharing platforms and electronic health records. Outcomes compared across systems included time in range (TIR; 3.9-10.0 mmol/L), time below range (TBR; <3.9 and <3.0 mmol/L), time above range (TAR; >10.0 and >13.9 mmol/L), glucose management indicator (GMI, %) and coefficient of variation (CV, %). RESULTS: A total of 213 participants were included (Medtronic 780G n = 38; Tandem Control-IQ n = 81; Omnipod 5 n = 94). After adjustment for baseline TIR, diabetes duration, insulin modality and AID use duration 780G users achieved a higher TIR increase (21.1% [95% CI 18.4-23.7]) compared to Control-IQ (10.1% [3.2-17.3], p = 0.010) and Omnipod 5 (15.2% [12.9-17.5], p = 0.002), with corresponding reductions in TAR. CONCLUSION: All three hybrid AID systems were associated with improvements in glycaemic outcomes in real-world use, supporting the role of AID systems in the management of T1D. Medtronic 780G use was associated with higher TIR increase compared with the other systems; however, these findings are based on measurements from different continuous glucose monitors between AID groups and cannot be used to infer superiority in glycaemic attainment.
Chronic kidney disease in type 2 diabetes in UK primary care: Testing frequency, coding accuracy and clinical inertia.
Zafar A, Scarlata C, Jaleel N
Diabet Med · 2026 May · PMID 41677011 · Publisher ↗
AIMS/HYPOTHESIS: To identify gaps and inconsistencies in the coding and testing of chronic kidney disease (CKD) among people with type 2 diabetes mellitus in UK primary care by evaluating clinical inertia in those with r...
AIMS/HYPOTHESIS: To identify gaps and inconsistencies in the coding and testing of chronic kidney disease (CKD) among people with type 2 diabetes mellitus in UK primary care by evaluating clinical inertia in those with reduced estimated glomerular filtration rate (eGFR) and/or elevated urine albumin-creatinine ratio (uACR) levels. METHODS: We conducted a retrospective cross-sectional analysis using SystmOne and the PARM Diabetes tool. A cohort from two primary care settings was screened to identify type 2 diabetes mellitus patients with eGFR <60 mL/min/1.73 m on two occasions. A retrospective analysis evaluated CKD coding accuracy per NICE guidelines, identifying gaps in coding and testing. RESULTS: Significant variation was observed in CKD monitoring and diagnosis between the two settings. Overall, 77.3% had eGFR testing, and 37.6% had uACR testing within the past 12 months, with significantly higher testing rates in primary care setting one (urban) compared to primary care setting two (rural). Only 35% of patients received both tests within the past 12 months, with the lowest uptake among patients under 60 years (28%) and those with advanced CKD stages. Among patients with ≥2 eGFR readings <60 mL/min/1.73 m, 61% remained uncoded for CKD if they had exactly two readings, compared to 15% uncoded among those with more than two. Coding rates increased with age but did not differ significantly between settings. CONCLUSIONS: The study emphasises the need for increased uACR testing and CKD coding in type 2 diabetes mellitus patients to ensure accurate monitoring and management. Fluctuating eGFR/ACR levels and process issues may contribute to clinical inertia. These findings specifically highlight gaps in CKD monitoring and diagnosis, particularly in younger patients and rural settings. We recommend healthcare professionals review coding practices and follow CKD guidelines to improve patient outcomes.
Antimicrobial peptide chensinin-1b attenuates T2DM progression in atherosclerotic ApoE mice.
Qiu Z, Fan F, Li Z … +2 more , Sun Y, Shang D
Diabet Med · 2026 May · PMID 41673947 · Publisher ↗
AIMS: Epidemiological evidence suggests that atherosclerosis (AS) may precede or coexist with type 2 diabetes mellitus (T2DM); however, whether anti-atherosclerotic interventions can reduce T2DM risk remains unclear. Che...
AIMS: Epidemiological evidence suggests that atherosclerosis (AS) may precede or coexist with type 2 diabetes mellitus (T2DM); however, whether anti-atherosclerotic interventions can reduce T2DM risk remains unclear. Chensinin-1b (C-1b), an antimicrobial peptide derived from the skin secretions of Rana chensinensis, has previously demonstrated anti-atherosclerotic activity, suggesting a potential therapeutic effect against T2DM in the context of AS. METHODS: In an apolipoprotein E-knockout (ApoE) mice model induced by high-fat diet (HFD), the developed process of pathological changes and inflammatory levels of pancreas and aorta were detected at early, middle and late stage of AS, meanwhile the anti-atherosclerotic and anti-diabetic effects of chensinin-1b were investigated. RESULTS: In the early and middle stages of AS (6-10 weeks), mice fasting blood glucose (FBG) did not change, but atherosclerotic symptoms were significantly exhibited, such as the increased pro-inflammatory factors levels, aortic plaque and blood lipid levels. During the late stage of AS (14 weeks), it was found that the FBG of ApoE mice increased significantly, the pancreas was damaged, the insulin and blood lipid levels were unbalanced, and T2DM symptoms appeared. Treatment with chensinin-1b alleviated the progression of both AS and T2DM, particularly when it was administered in the early stage of the disease. CONCLUSIONS: In ApoE mice, prolonged atherosclerotic pathology is associated with T2DM development. The antimicrobial peptide chensinin-1b attenuates AS and improves metabolic parameters, indicating potential multitarget intervention capabilities. These findings identify chensinin-1b as a candidate molecule for preventing AS-related metabolic abnormalities.
Prevalence and outcomes of DKA in type 1 and type 2 DM patients treated and not treated with SGLT-2 inhibitors.
Shacham EC, Sharif S, Tatoor R … +1 more , Ayalon S
Diabet Med · 2026 Apr · PMID 41673901 · Full text
AIM: To compare the clinical characteristics, biochemical presentation, and short- and long-term outcomes of DKA in hospitalized adults with T1DM and T2DM, including the impact of SGLT2 inhibitor therapy. METHODS: A retr...
AIM: To compare the clinical characteristics, biochemical presentation, and short- and long-term outcomes of DKA in hospitalized adults with T1DM and T2DM, including the impact of SGLT2 inhibitor therapy. METHODS: A retrospective cohort of 2283 adults (838 with T1DM; 1445 with T2DM) hospitalized with DKA between 2013 and 2023 across Clalit Health Services hospitals was analyzed. Patients were stratified by SGLT2 inhibitor use within 4 months before admission. Outcomes included AKI, 30-day mortality, 1-year mortality, and readmissions. One-year mortality was assessed using Cox proportional hazards regression, 30-day mortality using logistic regression, and recurrent readmissions using a negative binomial model. RESULTS: 2.3% (N = 19) of T1DM and 16% (235) of T2DM patients were treated with SGLT-2 inhibitors. A total of 115 patients from all cohorts presented with eu DKA, characterized by lower glucose and bicarbonate levels. In T2DM, the incidence of AKI was higher among SGLT2 users (26% vs. 17%; p = 0.030) but lower in euDKA cases (9.6% vs. 19%; p = 0.020). In Cox regression analysis, treatment with SGLT2 inhibitors was independently associated with reduced 1-year mortality (HR 0.55, 95% CI 0.36-0.82; p = 0.004). Predictors of increased 1-year mortality included older age, higher HbA1c, cardiovascular disease, CKD and insulin therapy. In the negative binomial model, higher readmission rates were independently associated with T1DM, higher HbA1c, higher BMI, CKD and pre-admission insulin use, while SGLT2 inhibitor use was not linked to increased readmissions. CONCLUSIONS: Pre-hospital SGLT2 inhibitor therapy in patients presenting with DKA was associated with substantially lower long-term mortality and no increase in short-term mortality or readmissions, supporting the safety of these agents when appropriate monitoring is in place. Pre-hospital SGLT2 inhibitor therapy in patients presenting with DKA was associated with improved long-term survival and no increase in short-term mortality, supporting their continued use with appropriate clinical monitoring.
Targeting inflammation in cardiometabolic disease: Icosapent ethyl modulates monocyte-derived macrophages isolated from patients with cardiovascular disease with or without type 2 diabetes.
Ward JK, Shah MU, Lee K … +2 more , Squires PE, Hills CE
Diabet Med · 2026 Apr · PMID 41664438 · Full text
AIMS: Despite intensive lipid-lowering therapy, individuals with atherosclerotic cardiovascular disease (ASCVD) exhibit residual inflammatory risk, which drives recurrent cardiovascular events. This risk is amplified in...
AIMS: Despite intensive lipid-lowering therapy, individuals with atherosclerotic cardiovascular disease (ASCVD) exhibit residual inflammatory risk, which drives recurrent cardiovascular events. This risk is amplified in type 2 diabetes mellitus (T2DM), where a pro-inflammatory milieu accelerates atherogenesis. Monocyte-derived macrophages (MDMs), key mediators of vascular inflammation, contribute significantly to this process. Icosapent ethyl (IPE), a highly purified ethyl ester of eicosapentaenoic acid (EPA), reduces major adverse cardiovascular events (MACE) beyond triglyceride lowering, yet its cellular mechanisms remain unclear. This study aims to determine whether IPE modulates inflammatory pathways in patient-derived MDMs and to distinguish direct EPA effects from therapy-mediated changes. METHODS: This single-centre, open-label, randomised observational cohort study will recruit ASCVD patients, stratified by T2DM status, who are prescribed IPE (Vazkepa®). MDMs and plasma/serum samples will be collected from patients, either IPE-naïve or following 6 months of therapy. In parallel, direct EPA effects will be assessed by treating MDMs from healthy donors and ASCVD patients with physiologically relevant concentrations of EPA. We will evaluate NOD-like receptor protein 3 (NLRP3) inflammasome priming and activation, inflammatory cytokine profiles, and markers of cellular senescence. RESULTS: The study will investigate mechanisms that potentially underlie the cardiovascular benefits of IPE, focusing on the modulation of inflammatory pathways. We hypothesise that IPE attenuates priming and activation of the NLRP3 inflammasome in monocyte-derived macrophages, thereby reducing cellular inflammation and senescence. CONCLUSIONS: This study will provide mechanistic insight into how IPE influences macrophage-driven inflammation in ASCVD and T2DM, informing strategies to target residual inflammatory risk in high-risk cardiometabolic populations.
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