Diabetic Medicine[JOURNAL]
Sun
200 papers
'There is more to life than HbA': A comprehensive qualitative framework from the Hypo-RESOLVE project evidencing the impacts of hypoglycaemia on the quality of life of adults living with type 1 or type 2 diabetes.
Powell PA, Frances SM, de Galan BE … +10 more , Heller S, Speight J, Rosilio M, Pouwer F, Gall MA, Child CJ, McCrimmon RJ, Tait K, Carlton J, Hypo‐RESOLVE Consortium
Diabet Med · 2026 May · PMID 41664312 · Full text
AIMS: To develop a comprehensive, in-depth understanding of the impacts of hypoglycaemia on the quality of life of adults living with type 1 (T1D) or type 2 diabetes (T2D). METHODS: Thirty-one adults with T1D or T2D who...
AIMS: To develop a comprehensive, in-depth understanding of the impacts of hypoglycaemia on the quality of life of adults living with type 1 (T1D) or type 2 diabetes (T2D). METHODS: Thirty-one adults with T1D or T2D who experienced hypoglycaemia participated in semi-structured interviews. Participants were purposively sampled by age, sex and type/duration of diabetes. Informed by a health-related quality of life (HRQoL) framework and literature review, an interview guide explored hypoglycaemia-related impacts on quality of life. Interviews were audio-recorded, transcribed verbatim and analysed using Framework Analysis. RESULTS: Impacts were coded within three overall themes (physical, psychological and social) comprising 38 subthemes. Of the 11 physical subthemes, the most discussed were sleep, physiological symptoms, leisure and exercise, eating and drinking. Of the 18 psychological subthemes, the most discussed included: awareness; cognitive burden and planning; self management and coping; worry and anxiety; autonomy, independence and control. Of the nine social subthemes, the most discussed were impacts on others and relationship with partner. CONCLUSIONS: A novel HRQoL framework highlights a comprehensive range of impacts of hypoglycaemia on physical, psychological and social functioning of people living with diabetes. These findings offer insights for clinicians, researchers and other interested parties seeking to benefit person-centred outcomes, such as quality of life.
Banting memorial lecture 2025: Aligning clinical practice, policy and research.
Valabhji J
Diabet Med · 2026 Jun · PMID 41662535 · Full text
National clinical leadership, on a background of clinical practice and clinical research, provides unique perspectives. I have focused the Banting Memorial Lecture 2025 on the implementation of national programmes across...
National clinical leadership, on a background of clinical practice and clinical research, provides unique perspectives. I have focused the Banting Memorial Lecture 2025 on the implementation of national programmes across England since 2013, for which, along with colleagues at NHS England, I successfully made the case for investment, led the implementation of interventions applied at scale across the country and used routinely collected healthcare data to demonstrate clinical effectiveness in the real world. Through specific examples of implemented programmes, including the NHS Diabetes Prevention Programme and the NHS Type 2 Diabetes Path to Remission Programme, I highlight important fundamental principles when making the case for, and implementing, national policy. First, ensure granular data collection to support evaluation and exploit data linkages to harness the power of real-world datasets. Second, where good evidence exists, implement evidence-based policy; where good evidence does not exist but political pressures to implement are being brought to bear, pilot and evaluate. Third, when the opportunity arises, rapidly translate new high-quality evidence into policy and practice. And fourth, support and protect the workload of healthcare professionals, particularly of those working in primary care. Then, through an epidemiological lens, I highlight: how the COVID-19 pandemic further unlocked the potential of national routinely collected electronic healthcare datasets; how, through application of these datasets, it has been possible to demonstrate improvements in diabetes complications and mortality through routine care delivery; and how it has been possible to demonstrate the next epidemiological transition in the global diabetes epidemic to multimorbidity/multiple long-term conditions.
Post-authorization safety study to assess the risk of diabetic ketoacidosis among type 2 diabetes mellitus patients treated with ertugliflozin compared to patients treated with other antihyperglycaemic agents in a Medicare and Medicaid population.
Rai A, Marshall J, Nandyala S … +19 more , Her M, Agan AA, Huang TY, Rodriguez-Watson C, Clary A, Diessner B, Nolan MB, Djibo DA, DeVries A, Daniels K, Zhang X, Wang T, Gantz I, Shankar R, Zale MM, Ejelonu P, Frederich R, Masiukiewicz U, Toh S
Diabet Med · 2026 Apr · PMID 41662384 · Publisher ↗
AIMS: To evaluate diabetic ketoacidosis (DKA) risk among new users of ertugliflozin versus sulfonylureas (SU) or thiazolidinediones (TZD) and incretin-based drugs in patients with type 2 diabetes. METHODS: We used Medica...
AIMS: To evaluate diabetic ketoacidosis (DKA) risk among new users of ertugliflozin versus sulfonylureas (SU) or thiazolidinediones (TZD) and incretin-based drugs in patients with type 2 diabetes. METHODS: We used Medicare and Medicaid fee-for-service adjudicated claims within the Innovation in Medical Evidence and Development Surveillance network to identify three new-user cohorts: (1) ertugliflozin; (2) SU/TZD; and (3) incretin-based drugs. The outcome was a principal hospital discharge diagnosis for DKA. Adjusted hazard ratios (HRs) were estimated after 1:1 propensity score (PS) matching, separately for ertugliflozin vs. SU/TZD and vs. incretin-based drugs. Subgroup analyses were performed based on baseline insulin use. RESULTS: After PS matching, baseline characteristics were similarly distributed in each cohort. For ertugliflozin (n = 42,907) vs. SU/TZD (n = 42,907), the incidence rates of DKA per 1000 person-years (PY) were 2.95 and 1.49, respectively. For ertugliflozin (n = 42,247) vs. incretin-based drugs (n = 42,247), the incidence rates of DKA per 1000 PY were 2.76 and 1.06, respectively. For ertugliflozin vs. SU/TZD, the HR [95% confidence interval (CI)] was 1.88 [1.17-3.02]; in non-insulin users, 2.34 [1.27-4.31]; and in insulin users, 1.17 [0.54-2.52]. For ertugliflozin vs. incretin-based drugs, the HR [95% CI] was 2.40 [1.40-4.11]; in non-insulin users, 2.84 [1.42-5.66]; and in insulin users, 1.87 [0.79-4.46]. CONCLUSIONS: Ertugliflozin was associated with a higher risk of DKA relative to comparators. HRs were higher among new users with no-concomitant insulin use than those with concomitant insulin use. Results were consistent with prior SGLT2i data and highlighted the importance of caution by both patients and physicians.
Type 2 diabetes in Norway 2009-2021: Have declining incidence rates continued?
Hindenes LB, Ruiz PL, Tapia G … +4 more , Bakken IJ, Qvigstad E, Gulseth HL, Stene LC
Diabet Med · 2026 Feb · PMID 41656505 · Publisher ↗
AIMS: To describe updated trends in the incidence and prevalence of diagnosed type 2 diabetes in Norway by age, sex, country of birth and education. METHODS: A nationwide cohort study using registries on primary and spec...
AIMS: To describe updated trends in the incidence and prevalence of diagnosed type 2 diabetes in Norway by age, sex, country of birth and education. METHODS: A nationwide cohort study using registries on primary and specialist healthcare, dispensed drugs and demographic factors in Norway. We analysed incidence trends 2009-2021 using Poisson regression and JoinPoint. RESULTS: During 2009-2021, 195,935 incident type 2 diabetes cases were identified. After a decline in incidence 2009-2014, the incidence was largely stable over time, with a suggestive upward trend 2019-2021. The overall incidence rates were 651 per 100,000 person-years in 2009 and 530 per 100,000 in 2021. There were 165,432 prevalent cases of type 2 diabetes in 2009 (5.5% of the population), consistently increasing throughout the study period to a peak at 259017 (7.6%) in 2021. The time trends were largely consistent across age, sex, country of birth and education. Inhabitants with lower education and born in Asia or Africa had substantially higher incidence and prevalence than those with higher education and born in Norway or other continents, respectively. CONCLUSIONS: The previously described decline in incidence of diagnosed type 2 diabetes during 2009-2014 was not sustained, and prevalence continued to increase throughout 2009-2021.
Evaluation of a structured type 1 diabetes education program for adolescents and parents: Teens Empowered to Actively Manage Type 1 (TEAM T1).
Hagger V, Hendrieckx C, Cotterill A … +1 more , Speight J
Diabet Med · 2026 Apr · PMID 41645407 · Publisher ↗
AIM: To examine changes in psychological and clinical outcomes among adolescents and parents after structured type 1 diabetes education delivered in routine care. METHODS: Teens Empowered to Actively Manage Type 1 Diabet...
AIM: To examine changes in psychological and clinical outcomes among adolescents and parents after structured type 1 diabetes education delivered in routine care. METHODS: Teens Empowered to Actively Manage Type 1 Diabetes (TEAM T1) is a psycho-educational program (adolescents: 5-day; parents: 2-day), designed to teach adolescents (aged 12-19) and parents flexible, intensive insulin therapy and adaptive coping with diabetes. A quasi-experimental design assessed diabetes distress (DD) (PAID: teen and parent versions), diabetes management self-efficacy (DMSE), diabetes-related family conflict (DRFC: two items), and HbA1c at baseline, 3- and 12-month post-program. RESULTS: In total, 207 adolescents and 207 parents completed TEAM T1 (86% attended the full program; 178 adolescents, mean age 16 ± 1 years, 54% (n = 96) female) and 125 parents (86% (n = 108) mothers) completed baseline questionnaires. There was no change in DD, DRFC or HbA1c (p ≥ 0.05). However, at 3 months, DMSE increased (0.14, p < 0.008), and among 78 (48%) adolescents with elevated baseline DD (PAID-T ≥70), DD decreased (-7.36, p = 0.025). HbA1c decreased among those with high baseline HbA1c (>75 mmol/mol; 9.0%); 34%, n = 56; p = 0.002 but increased among those <75 mmol/mol (p = 0.001). Parental DD decreased at 3 months (-6.3, p = 0.014), and item analysis showed a significant decrease in parental concerns about the child's food and eating and glucose levels (d = 2.7-3.2, p < 0.04). At 12 months, differences were not significant. CONCLUSIONS: Overall, HbA1c and psychological outcomes did not improve significantly, although DD and HbA1c decreased among adolescents with elevated levels at baseline. The emphasis on monitoring food and blood glucose did not worsen DD and may have a positive impact on family relationships and body weight concerns.
Picture living with diabetes: A photovoice study of young adults' efforts in making diabetes care fit into their lives.
Van Gastel A, Graner-Baars M, De Koning EJP … +8 more , Montori VM, Tran VT, Dinneen SF, Mesman J, Swaak J, Aanstoot HJ, Stiggelbout AM, Kunneman M
Diabet Med · 2026 May · PMID 41645388 · Full text
AIM: This study aimed to identify what young adults with type 1 diabetes (T1D) do to make diabetes care fit in their lives and the impact of diabetes and diabetes care on living. METHODS: Dutch young adults with T1D (18-...
AIM: This study aimed to identify what young adults with type 1 diabetes (T1D) do to make diabetes care fit in their lives and the impact of diabetes and diabetes care on living. METHODS: Dutch young adults with T1D (18-30 years old) submitted photographed real-life situations of efforts to make care fit and of the impact of care on their lives. Participants organised their photos in themes, which guided the focus group discussions. We added a reflective questionnaire, semi-structured interview and iterative validation to identify participant-defined themes and summarise the data. RESULTS: Participants (N = 18) submitted 240 photographs in total, showing a broad range of situations and emotions. Participants identified 16 themes, grouped into four overarching categories describing their experiences with diabetes: (1) My diabetes: glucose levels, workload, 24/7 present; (2) My life: flow of (daily) life, special and irregular circumstances, life changes, body and health; (3) Support: devices and technology, social network, clinical (diabetes) care; (4) Mental aspects: emotional processes, perspective, being a patient. In the overlap of My diabetes and My life, they identified eating and counting carbohydrates, activity and exercise, recreational substances. CONCLUSION: Young adults with T1D face the complex challenge of fitting their care into their ever-changing lives. While support systems, such as devices, healthcare professionals and social networks can help, they can also create burdens. Participants emphasised the importance of mental health in their lives with T1D. This study highlights the need for diabetes care that acknowledges the emotional, social and practical realities of young adults' lives.
Navigating the dual burden of type 1 diabetes and mental illness: A phenomenological study.
Cooper ZW, Davis GM, Pasquel FJ … +1 more , Johnson LCM
Diabet Med · 2026 Apr · PMID 41641584 · Full text
OBJECTIVE: Despite high burdens of mental illness among people with type 1 diabetes (T1D), little is known about how affected individuals experience this dual disease burden. This qualitative study aimed to address this...
OBJECTIVE: Despite high burdens of mental illness among people with type 1 diabetes (T1D), little is known about how affected individuals experience this dual disease burden. This qualitative study aimed to address this gap. RESEARCH DESIGN AND METHODS: Five online focus groups were conducted with 21 adults with T1D and a history of mental illness. We analysed data using a six-step descriptive phenomenological approach: (1) collecting data, (2) gaining an overall sense of participants' perspectives, (3) segmenting narratives into units of meaning, (4) synthesizing units into themes, (5) determining the structure of the phenomenon, and (6) integrating features into an essential description of living with T1D and mental illness. RESULTS: Two overarching themes were identified. The first, The Weight of Unseen Struggles, encompasses pervasive stressors, including the mental load of diabetes management, experiences of medical trauma, hypervigilance, burnout and the cyclical interplay between diabetes and mental health. These stressors manifest as a range of psychological and somatic symptoms, including depression, anxiety, obsessive thoughts and behaviours, sleep disturbances and trauma responses that affect daily functioning. The second, The Burden of Being 'Othered', highlights how interpersonal, institutional and societal factors contribute to experiences of judgement, stigma and ostracism. CONCLUSIONS: Adults with T1D endure a complex interplay of psychological, interpersonal and environmental stressors that exacerbate mental health symptoms and hinder treatment-seeking. Integrating tailored clinical psychological support within diabetes care settings and developing mental health intake policies for people with T1D may enhance access to mental health treatment and improve health outcomes.
Assessing thoughts, feelings and behaviours related to hypoglycaemia: Psychometric evaluation of the Hypoglycaemia Cues Questionnaire (HypoC-Q).
Søholm U, Holmes-Truscott E, Amiel SA … +11 more , de Galan B, Pedersen-Bjergaard U, McCrimmon RJ, Heller S, Evans M, Mader JK, Choudhary P, Pouwer F, Shaw JAM, Speight J, Hypo‐RESOLVE Consortium
Diabet Med · 2026 Apr · PMID 41635019 · Full text
AIMS: To describe the design and examine the psychometric properties of the Hypoglycaemia Cues Questionnaire (HypoC-Q) for assessing thoughts, feelings, and behaviours related to hypoglycaemia among adults with type 1 di...
AIMS: To describe the design and examine the psychometric properties of the Hypoglycaemia Cues Questionnaire (HypoC-Q) for assessing thoughts, feelings, and behaviours related to hypoglycaemia among adults with type 1 diabetes (T1D). METHODS: The HypoC-Q was designed iteratively, informed by exploratory interviews with 17 adults with T1D with impaired awareness of hypoglycaemia and/or recurrent severe hypoglycaemia, and consultation with diabetologists. Psychometric analyses were completed on baseline data from the Hypo-METRICS study. Data from adults with T1D, reporting at least one hypoglycaemic event, were eligible if they had completed the baseline HypoC-Q. Completion rates, latent structure, internal consistency, construct and known-groups validity were examined. RESULTS: In Hypo-METRICS, 154 participants (62% females; mean ± SD age 44 ± 15 years; T1D duration: 23 ± 16 years) were eligible. All completed all 40 HypoC-Q items, demonstrating its acceptability. Exploratory factor analysis identified four scales with satisfactory internal consistency (α = 0.69-0.81): 1) low concern (7 items), 2) burnout (6 items), 3) missing cues (5 items), and 4) delaying treatment (9 items); plus eight items, treated separately. Construct validity was supported by significant moderate correlations between 'burnout' and fear of hypoglycaemia and diabetes distress, and between 'missing' and 'delay' with impaired awareness of hypoglycaemia; all three distinguished between those with intact and impaired awareness (known-groups validity); but not by history of severe hypoglycaemia. CONCLUSIONS: The HypoC-Q is an acceptable, valid, and reliable measure of thoughts, feelings, and behaviours related to hypoglycaemia among adults with T1D. It is available for informing and assessing the effect of interventions to reduce hypoglycaemia exposure and impact.
Burden of obesity in local health systems: A comparative analysis across three integrated care boards in England with a focus on type 2 diabetes.
Zafar A, Scarlata C
Diabet Med · 2026 Apr · PMID 41618721 · Publisher ↗
AIMS: To estimate and compare the economic burden of obesity across three Integrated Care Boards in England, with a specific focus on the contribution of Type 2 diabetes and related complications. METHODS: An adapted bur...
AIMS: To estimate and compare the economic burden of obesity across three Integrated Care Boards in England, with a specific focus on the contribution of Type 2 diabetes and related complications. METHODS: An adapted burden of obesity model integrating estimated national health costs data with local population metrics was applied to the integrated care boards to estimate health care, social care, productivity and economic and quality of life associated costs. Data were stratified by sector, age, sex, BMI and prevalence of obesity-related complications. RESULTS: Across the regions, 599,248 adults were living with obesity. Total economic burden reflected obesity prevalence, with the highest costs in Leicester, Leicestershire and Rutland, followed by Bedfordshire, Luton and Milton Keynes and then Northamptonshire. Despite this, Bedfordshire, Luton and Milton Keynes had the highest per-patient costs across all cost categories. Social care and productivity losses each contributed approximately 30% of total costs, with informal care comprising 96% of social care expenditure. Per-patient healthcare costs increased with BMI. Type 2 diabetes and hypertension were among the most prevalent and costly complications, while stroke and coronary heart disease had the highest per-patient costs. Coexisting coronary heart disease with Type 2 diabetes significantly increased treatment costs. Obesity was more prevalent among working-age adults, with males incurring higher per-patient complication costs across all conditions and integrated care boards. CONCLUSIONS: This study demonstrates the significant and variable local economic burden of obesity. Disparities in per-patient costs, sex and complication profiles highlight the need for stratified, data-driven commissioning. Targeted prevention in high-burden areas can help ICBs reduce system pressures and guide effective local strategies.
Impact of screening programmes for type 1 diabetes in youth: A systematic review and meta-analysis.
Franceschi R, Mozzillo E, Marigliano M … +22 more , Maltoni G, Maddaloni E, Amendolara R, Bernardini L, Bonfanti R, Ciambrelli F, Di Candia F, Fedi L, Fierro A, Iafusco D, Iannilli A, Leonardi L, Maffeis C, Maines E, Pertile R, Piona C, Rabbone I, Ripoli C, Scozzarella A, Tiberi V, Buzzetti R, Cherubini V
Diabet Med · 2026 May · PMID 41618706 · Full text
AIM: To evaluate the impact of anti-islet antibody (IAb) screening on the general population and first-degree relatives (FDRs)/high-risk individuals and evidence-based follow-up modalities. METHODS: We performed this rev...
AIM: To evaluate the impact of anti-islet antibody (IAb) screening on the general population and first-degree relatives (FDRs)/high-risk individuals and evidence-based follow-up modalities. METHODS: We performed this review through systematic searches of PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.gov and International Clinical Trials Registry Platform between 15 March 2006, and 15 March 2025. We selected studies on children and adolescents screened for T1D IAbs, compared with people who were not screened or IAb+ individuals who were not followed up. PICOS framework was used in the selection process. Outcome data were extracted, and a meta-analysis of DKA risk at T1D onset was performed. Quality of evidence was assessed using the GRADE approach. This study was registered with PROSPERO, CRD42024523781. RESULTS: Sixty-six studies, 53 of moderate-to-high quality, were included. Screening was associated with lower DKA rates by 23% (95% CI 18-29%, I = 88.8%). The risk of stage 3 T1D progression was high in younger children with persistent and/or multiple IAb+. Screening was associated with higher indicators of parental anxiety, which decreased during follow-up. Children with IAb positivity were monitored according to age and T1D stage, using HbA1c, oral glucose tolerance testing and continuous glucose monitoring (CGM). Time above 140 mg/dL was a biomarker of progression. CONCLUSIONS: Population screening with IAbs and follow-up of IAb+ individuals helps decrease DKA and allows participation in intervention trials. This systematic review provides evidence for clinical practice on the screening timing, modalities and follow-up. Further studies on the use of CGM are expected.
Prognostic models for all-cause and cardiovascular mortality in type 2 diabetes: Systematic review.
Kundu M, Funnell MP, Karimi Z … +8 more , Kunutsor SK, Naderpour S, Peace A, Welford A, Zaccardi F, Khunti K, Gharibzadeh S, Routen A
Diabet Med · 2026 Mar · PMID 41603291 · Full text
AIMS: The elevated risk of all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus (T2DM) has led to growing efforts to develop prognostic models for early identification of high-risk individu...
AIMS: The elevated risk of all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus (T2DM) has led to growing efforts to develop prognostic models for early identification of high-risk individuals. This systematic review synthesised existing models to inform future model development, enhance predictive performance and guide targeted prevention strategies in diverse clinical and population health settings. METHODS: We systematically searched Ovid MEDLINE, Scopus and Web of Science for studies published between January 1, 2015, and June 11, 2024, reporting prognostic models developed and/or validated to predict all-cause or cardiovascular mortality in individuals T2DM. Data were extracted following the CHARMS checklist, and risk of bias assessed using the PROBAST tool. RESULTS: The search yielded 18,126 records; 10,921 were screened after deduplication. Of 147 full texts assessed, 26 cohort studies met inclusion criteria, with sample sizes (median [IQR]: 20,554 [1931-59,180]). Models were developed in diverse regions, with the highest number from Taiwan (n = 5) and the USA (n = 5). Most studies focused on all-cause mortality (n = 26); eight addressed cardiovascular mortality. Prediction horizons varied from 1 to 15 years, with 5-year risk being the most common (n = 10). Discrimination had a median C-statistic of 0.77 (IQR: 0.72-0.81). Calibration was reported in 20 studies, though methods varied. Cox regression was the most common statistical method (n = 16). CONCLUSIONS: Prediction models for mortality in T2DM show considerable heterogeneity in methodology, performance and validation. Limited external validation and inconsistent calibration reporting highlight the need for robust, generalisable and transparently reported models to improve clinical risk stratification in diabetes care.
Invited commentary: Advancing the management of type 2 diabetes in pregnancy.
Carrieri F, Scott EM, Murphy HR
Diabet Med · 2026 Apr · PMID 41587231 · Publisher ↗
Abstract loading — click title to view on PubMed.
Hyperosmolar hyperglycaemic state: A systematic review of management guidelines and their evidence.
Lin R, Wootton E, Gaca M … +3 more , Venkatesh B, Bellomo R, Ekinci E
Diabet Med · 2026 Mar · PMID 41587208 · Publisher ↗
BACKGROUND: Hyperosmolar hyperglycaemic state (HHS) is an endocrine emergency associated with increased morbidity and mortality. HHS management is largely varied in clinical practice due to a lack of high-quality evidenc...
BACKGROUND: Hyperosmolar hyperglycaemic state (HHS) is an endocrine emergency associated with increased morbidity and mortality. HHS management is largely varied in clinical practice due to a lack of high-quality evidence. This systematic review aims to compare international guidelines and their underlying evidence base in HHS management. METHODS: Searching MEDLINE, Embase and Emcare databases and reviewing references of relevant papers identified 363 papers, of which seven met the inclusion criteria. RESULTS: The features of HHS include hypovolaemia, hyperglycaemia and hyperosmolality, but criteria for diagnosis vary from glucose ≥33.3 mmol/L and osmolality ≥320 mOsm/kg (American Diabetes Association [ADA] and Diabetes Canada [DC]) to glucose ≥30.0 mmol/L with osmolality ≥320 mOsm/kg (Joint British Diabetes Society [JBDS]). The ADA and DC guidelines recommend correction of serum osmolality <3 mOsm/kg/h, whereas the JBDS accepts an osmolality change of 3-8 mOsm/kg/h. ADA guidelines suggest 0.9% normal saline at 15-20 mL/kg/h or 1-1.5 L/h, whereas JBDS guidelines suggest replacing ~50% of the estimated fluid loss within the first 12 h. The ADA and DC guidelines recommend a fixed rate insulin infusion of 0.1 units/kg/h. The JBDS guidelines recommend 0.05 units/kg/h, increasing by 1.0 units/h as required. CONCLUSIONS: These guidelines are consensus-based rather than evidence-based because no randomised controlled trials exist. Further research specific to HHS is required to standardise diagnosis and optimise management.
Associations between impaired awareness of hypoglycaemia and mental health in insulin-treated type 2 and type 1 diabetes in the Hypo-METRICS study.
McCarthy A, Thomas J, Avila E … +8 more , Koutroukas V, Pieri B, Zaremba N, Amiel SA, Pouwer F, Choudhary P, Divilly P, Hypo‐RESOLVE Consortium
Diabet Med · 2026 Mar · PMID 41578685 · Full text
AIMS: The mental health impact of impaired awareness of hypoglycaemia (IAH) in people with type 2 diabetes (T2D) is not known. We explored this in people with insulin-treated T2D and type 1 diabetes (T1D). METHODS: Hypo-...
AIMS: The mental health impact of impaired awareness of hypoglycaemia (IAH) in people with type 2 diabetes (T2D) is not known. We explored this in people with insulin-treated T2D and type 1 diabetes (T1D). METHODS: Hypo-METRICS was a 10-week cross-sectional observation of hypoglycaemia experience, collecting data on glucose and activity. Participants (325 insulin-treated T2D, 277 T1D) completed questionnaires scoring depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and fear of hypoglycaemia (HFS-II [worry]) at baseline. IAH was defined as a Gold score ≥4. Relationships between IAH and mental health scores were explored using unadjusted and adjusted generalised linear regression analyses. Age, sex, race, diabetes duration, level of education, employment status, continuous glucose monitoring (CGM) use, hypoglycaemia, use of anti-depressants and use of anti-anxiety medications were covariates in the adjusted regression. RESULTS: In unadjusted regression in insulin-treated T2D, IAH was associated with higher PHQ-9 (6.4% [1.5%-11.3%]; p = 0.011), GAD-7 (7.6% [2.1%-13%]; p = 0.006) and HFS-II (worry) (7.4% [2.8%-12%]; p = 0.002) scores, with no differences in PAID (p = 0.655). After adjustment, IAH was associated with higher HFS-II (worry) (5.3% [0.3%-10.6%]; p = 0.048) only. In T1D, IAH was associated with higher PHQ-9 (6.2% [1.3%-10.8%]; p = 0.012), GAD-7 (6.1% [0.1%-12.2%]; p = 0.046) and HFS-II (worry) (6.1% [0.06%-11.5%]; p = 0.029) scores, but not PAID (p = 0.654), all unadjusted. These relationships remained after adjustment, which also showed higher PAID (8.43% [2.62%-14.24%]; p = 0.005). CONCLUSION: Our data demonstrated associations between IAH and a greater mental health burden in both insulin-treated T2D and T1D. Addressing these mental health challenges should be an important part of the holistic care of people with IAH and insulin-treated diabetes.
The use of diabetes technology under aviation conditions: A systematic review of human and in-vitro studies and future considerations.
Meçani R, Muka T, Cigler M … +9 more , Basta S, El-Hakouni O, Baumann PM, Sanchez D, Olsen MT, Mathieu C, Pieber TR, Koehler G, Mader JK
Diabet Med · 2026 Apr · PMID 41578663 · Full text
BACKGROUND: Despite advancements in diabetes management technologies, restrictions on insulin-treated pilots persist, underscoring the need to evaluate the safety, efficacy and performance of these technologies in aviati...
BACKGROUND: Despite advancements in diabetes management technologies, restrictions on insulin-treated pilots persist, underscoring the need to evaluate the safety, efficacy and performance of these technologies in aviation settings. This systematic review aims to summarize the available evidence on the performance, safety and effectiveness of diabetes technologies in aviation settings. MATERIALS: Four bibliographic databases were searched, and eligible studies assessing diabetes technologies in-flight or simulated aviation conditions, focusing on glycaemic control and safety, were included. Due to high heterogeneity among the included studies, a qualitative synthesis of the evidence was performed. This systematic review was registered with PROSPERO (CRD42025634909). RESULTS: Out of 522 references, six human and in-vitro studies were included for final analysis. Human studies demonstrated the high accuracy of continuous glucose monitors (CGM) and good glycaemic control with insulin pump therapy. Automated insulin delivery (AID) systems demonstrated effective glycaemic control and safety under hypobaric conditions. However, hypoglycaemia during extended fasting was noted. In-vitro studies highlighted risks, such as excess insulin delivery during ascent and reduced delivery during descent, influenced by pressure changes. CGMs exhibited minor signal variability in hypobaric conditions. CONCLUSION: Diabetes technologies, particularly CGMs and AID systems, show promise in aviation environments. However, challenges such as insulin delivery variability, hypoglycaemia during fasting and the limited generalizability of hypobaric studies to real-flight conditions warrant further investigation. Future research should focus on larger, more diverse cohorts, real-world data, standardized protocols and a broader range of devices to further define the safety of their safety for aviation-specific diabetes management.
The association between Apolipoprotein A1, Apolipoprotein B and their ratio with diabetes-related neuropathy in elderly patients.
Budianto IR, Gosal E, Djuartina T … +1 more , Sutrisno A
Diabet Med · 2026 Mar · PMID 41578661 · Publisher ↗
BACKGROUND: Diabetes-related neuropathy is a prevalent microvascular complication among elderly individuals with type 2 diabetes mellitus (T2DM). Apolipoprotein A1 (ApoA1) and Apolipoprotein B (ApoB) play opposing roles...
BACKGROUND: Diabetes-related neuropathy is a prevalent microvascular complication among elderly individuals with type 2 diabetes mellitus (T2DM). Apolipoprotein A1 (ApoA1) and Apolipoprotein B (ApoB) play opposing roles in lipid metabolism, and the ApoB/ApoA1 ratio has emerged as a sensitive marker of cardiometabolic risk. This study aimed to examine the association between ApoA1, ApoB and the ApoB/A1 ratio with the presence of diabetes-related neuropathy as indicated by MNSI scores. METHODS: A cross-sectional study was conducted on 63 T2DM patients aged ≥60 years. Neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI), while ApoA1 and ApoB levels were measured via turbidimetry. Comparative and correlational analyses were performed to explore relationships between apolipoproteins, neuropathy status, HbA1c and lipid profiles. RESULTS: Diabetes-related neuropathy was identified in 55.6% of participants. ApoB and the ApoB/A1 ratio were significantly elevated in subjects with neuropathy (p = 0.015 and p = 0.014, respectively), while ApoA1 levels did not differ significantly (p = 0.172). MNSI scores were positively correlated with ApoB (r = 0.426; p < 0.001) and ApoB/A1 ratio (r = 0.431; p < 0.001), but not with ApoA1. HbA1c showed positive correlations with ApoB and the ratio and a negative correlation with ApoA1. CONCLUSION: Elevated ApoB and ApoB/A1 ratio are significantly associated with diabetes-related neuropathy in elderly T2DM patients. The ApoB/A1 ratio may serve as a valuable biomarker for identifying individuals at higher risk of neuropathic complications.
Higher dietary magnesium intake and lower risks of all-cause, cardiovascular and kidney disease mortality in diabetes participants: A large cross-population cohort study.
Chi K, Liang Y, Li Y … +13 more , Luo Z, Li R, Zhang B, Ying Y, Wen Y, He Y, Xing Y, Xiao Z, Yang W, Luo Z, Zhang X, Yu H, Wu Q
Diabet Med · 2026 Mar · PMID 41578652 · Publisher ↗
AIMS: To assess the associations between dietary magnesium intake and mortality from all-cause, cardiovascular disease (CVD) and kidney disease (KD) among participants with diabetes mellitus (DM). METHODS: The study cove...
AIMS: To assess the associations between dietary magnesium intake and mortality from all-cause, cardiovascular disease (CVD) and kidney disease (KD) among participants with diabetes mellitus (DM). METHODS: The study covered 6004 adults with DM from the National Health and Nutrition Examination Survey (US NHANES) and 10,130 adults with DM from the UK Biobank. We employed Cox regression models and restricted cubic spline models to evaluate relationships between daily dietary magnesium intake and mortality from all-cause, CVD and KD. RESULTS: We documented 1442 deaths in the US NHANES and 651 deaths in the UK Biobank, respectively. When comparing the highest versus the lowest quartile of dietary magnesium intake, the adjusted hazard ratios (HR) were 0.62 (95% CI 0.50-0.78), 0.54 (95% CI 0.37-0.80) and 0.22 (95% CI 0.06-0.82) for all-cause mortality, CVD mortality and KD mortality in the US NHANES, respectively. Similarly, the adjusted HR were 0.71 (95% CI 0.57-0.88) and 0.65 (95% CI 0.43-0.98) for all-cause mortality and CVD mortality in the UK Biobank. The dietary magnesium intake exhibited a significant non-linear 'L-shaped' relationship with all-cause mortality rates in both cohorts and CVD mortality rates in the UK cohort (all p for non-linearity <0.05). CONCLUSIONS: Higher dietary magnesium intake was consistently associated with reduced risks of all-cause, CVD and KD mortality in US adults with DM and with lower all-cause and CVD mortality in UK adults with DM. These findings highlight the potential prognostic benefit of dietary magnesium intake in DM management.
Digital technologies and clinical decision support tools available for diabetes triage in the inpatient setting: A systematic literature review.
Murfet G, Carey N, Ng AH … +5 more , Walters R, Pearce K, Barmanray RD, Wischer N, Rothmann MJ
Diabet Med · 2026 Mar · PMID 41568935 · Full text
AIMS: People with diabetes who are admitted to hospital are at risk of adverse in-hospital outcomes due to glycaemic dysregulation. Both the prevalence of diabetes and adverse outcomes are higher in rural and regional ho...
AIMS: People with diabetes who are admitted to hospital are at risk of adverse in-hospital outcomes due to glycaemic dysregulation. Both the prevalence of diabetes and adverse outcomes are higher in rural and regional hospitals where infrastructure is more limited. Digital solutions may facilitate diabetes assessment on admission, so timely care coordination can be provided by inpatient diabetes teams. The aim of this systematic review was to identify and characterise the digital technologies and clinical decision support tools used to triage people with diabetes in the inpatient setting. METHODS: Six electronic databases were searched for studies published between January 2014 and August 2024 on the use of digital technology or decision support tools to triage adult inpatients with diabetes during a hospital stay. Narrative synthesis was used to report results. The review followed PRISMA guidelines and was registered on PROSPERO (CRD 42021257655). RESULTS: Nine studies met the inclusion criteria. Three developed or improved systems for referrals to an in-hospital diabetes team. The remaining six reported on efforts to improve information to support referral and included risk prediction for iatrogenic hypoglycaemia, persistent adverse glycaemia and in-hospital mortality among Intensive Care Unit patients with diabetes, and perioperative glycaemic management. CONCLUSIONS: Digital technologies and clinical decision support tools can improve inpatient triage of people with diabetes. A two-tiered approach consisting of a simple admission risk screen tool followed by dynamic electronic health record surveillance focussed on immediate iatrogenic hypoglycaemia risk for ongoing prioritisation would balance sensitivity at admission with dynamic inpatient risk monitoring.
A UK key opinion leader perspective: Navigating the immunological and logistical transformation brought by stem cell-derived islets for the treatment of type 1 diabetes.
Strakosch T, Forbes S
Diabet Med · 2026 Mar · PMID 41559876 · Full text
AIMS: To explore UK key-opinion leader perspectives on the future role of stem cell-derived islets (sc-islets) in islet transplantation for people with type 1 diabetes (T1D). METHODS: Four UK-based key-opinion leaders ev...
AIMS: To explore UK key-opinion leader perspectives on the future role of stem cell-derived islets (sc-islets) in islet transplantation for people with type 1 diabetes (T1D). METHODS: Four UK-based key-opinion leaders evaluated current limitations of donor islet transplantation and reviewed emerging evidence, clinical pathways and logistical considerations for sc-islet transplantation, including alternative delivery sites and implications for kidney transplantation strategies. RESULTS: Conventional islet transplantation is constrained by donor scarcity, variable graft quality and lifelong immunosuppression, with associated risks of infection, malignancy and calcineurin inhibitor (CNI) nephrotoxicity. Stem cell-derived islets, generated from human embryonic and induced pluripotent stem cells, provide a scalable and standardised alternative. Early investigational products, including Zimislecel (VX-880), demonstrate potential for insulin independence and may offer an alternative to simultaneous pancreas-kidney (SPK) transplantation. Strategies to reduce or eliminate systemic immunosuppression particularly CNI immunosuppression through local immunomodulation, gene editing and encapsulation technologies may further broaden access. Ethics, infrastructural and economic considerations remain central to equitable implementation. CONCLUSION: Stem cell-derived islets may redefine islet transplantation for T1D by enabling more scalable, less invasive and sustainable therapeutic pathways while maintaining access to technological diabetes management options.
Ketone test strip use is low in adults with type 1 diabetes and is not associated with HbA1c or glucose metrics on continuous glucose monitoring.
Stimson RH, Dover AR, Lyall MJ … +4 more , Barclay JI, Mackenzie SD, Forbes S, Gibb FW
Diabet Med · 2026 Mar · PMID 41549335 · Publisher ↗
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