Diabetes Research And Clinical Practice[JOURNAL]
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200 papers
Glucagon and beta-cell function changes before and after dietary weight loss-induced metabolic improvements in type 2 diabetes.
Lalama E, Zhang J, Schuppelius B … +10 more , Csanalosi M, Ruether KJA, Kabisch S, Mai K, Kraenkel N, Latz E, Christ A, Trico D, Mari A, Pfeiffer AFH
Diabetes Res Clin Pract · 2026 Jun · PMID 42341884 · Publisher ↗
UNLABELLED: Hyperglucagonemia, beta-cell dysfunction and insulin resistance drive fasting and postprandial hyperglycemia in type 2 diabetes but their changes upon guideline recommended fasting induced weight loss > 10% r...
UNLABELLED: Hyperglucagonemia, beta-cell dysfunction and insulin resistance drive fasting and postprandial hyperglycemia in type 2 diabetes but their changes upon guideline recommended fasting induced weight loss > 10% remain unclear. METHODS: Patients with type 2 diabetes treated without insulin underwent a 12-week very low-calorie formula diet (VLCD) aiming > 10 kg weight loss. Glucose, insulin, C-peptide and glucagon were determined fasting and after a standardized meal tolerance test (MTT) before, and after the diet without antidiabetic medication. We analyzed 35 participants achieving over 10 kg weight loss. RESULTS: Fasting and postprandial glucose, insulin, and glucagon levels decreased significantly, accompanied by improved insulin sensitivity. Modeling of glucose, insulin and C-peptide during the MTT showed significant improvements in beta-cell glucose sensitivity (p = 0.001) and insulin clearance (p < 0.001), independent of glucagon levels. Fasting glucagon decreased significantly (p = 0.001) only in participants above median glucagon level. Changes in insulin sensitivity and beta-cell glucose sensitivity did not differ between groups. Postprandial insulin secretion decreased and potentiation factor increased only in the higher glucagon group, suggesting improved alpha- to beta-cell crosstalk. Fasting hyperglucagonemia was associated with male sex. CONCLUSION: Weight loss > 10% improved insulin sensitivity and beta-cell function relative to baseline and normalized glucagon in participants with initial hyperglucagonemia.
Retinal microvascular geometry as a biomarker of cognitive function in patients living with type 1 diabetes.
Cappelli S, Parenti M, Scappazzoni L … +9 more , Biasco F, Rebelos E, Coppelli A, Aragona M, Giannarelli R, Campi F, Spallone V, Dardano A, Daniele G
Diabetes Res Clin Pract · 2026 Jun · PMID 42341883 · Publisher ↗
AIMS: Retinal vessels may serve as biomarkers of cognitive function in type 1 diabetes (T1D). This cross-sectional study evaluated whether parameters from the Retina-based Microvascular Health Assessment System (RMHAS) a...
AIMS: Retinal vessels may serve as biomarkers of cognitive function in type 1 diabetes (T1D). This cross-sectional study evaluated whether parameters from the Retina-based Microvascular Health Assessment System (RMHAS) are associated with Montreal Cognitive Assessment (MoCA) scores, beyond relevant covariates. METHODS: 42 adults with T1D underwent MoCA, 5-minute Low-Frequency to High-Frequency (LF/HF) ratio and retrieval of 5-year historical clinical and biochemical data. Estimated Glucose Disposal rate (eGDR) was calculated. Fundus images were analyzed with RMHAS. Retinal variables were filtered by Pearson correlation and reduced via principal component analysis (PCA). Hierarchical linear and logistic regression models, plus AUROC analysis, were performed. RESULTS: Median MoCA score was 25 [IQR 23-27]; 59.5% of participants had low MoCA (<26). A clinical model (age, sex, glucose coefficient of variation [CV], mean systolic blood pressure, eGDR and triglyceride CV) correlated with MoCA (R = 0.601, p = 0.013). Adding retinal PCA factors improved fit (R square change = 0.280, p = 0.006). For low MoCA, the clinical model (LF/HF ratio, age) showed R square = 0.208 (p = 0.018); retinal factors increased fit (R square = 0.250, p = 0.005). The combined model showed promising accuracy (AUROC 0.930, p < 0.001). CONCLUSION: Retinal parameters associated with cognitive performance by MoCA score, emerging as a promising biomarker for cognitive risk stratification in T1D.
Effects of different exercise modalities and doses on glycated hemoglobin in patients with type 2 diabetes mellitus and overweight or obesity: a systematic review and Bayesian multilevel network meta-analysis.
Ren W, Chen Z, Wang J … +1 more , Yang S
Diabetes Res Clin Pract · 2026 Jun · PMID 42341882 · Publisher ↗
This study aimed to compare the effects of different exercise intervention categories and dose characteristics on glycated hemoglobin in adults with type 2 diabetes mellitus and overweight or obesity. Randomized controll...
This study aimed to compare the effects of different exercise intervention categories and dose characteristics on glycated hemoglobin in adults with type 2 diabetes mellitus and overweight or obesity. Randomized controlled trials were identified from PubMed, Web of Science, Embase, and the Cochrane Library from inception to February 2026. Exercise interventions were classified as high-intensity interval training, combined training, high-intensity aerobic training, moderate-intensity aerobic training, resistance training, and mind-body training. Bayesian network meta-analysis and meta-regression were used to estimate comparative effects and dose-related patterns. Sixty-seven studies involving 5,022 participants were included. Compared with control, high-intensity interval training produced the largest HbA1c reduction (MD = -0.73%, 95% CrI: -0.96 to -0.49), followed by combined training (-0.54%, 95% CrI: -0.70 to -0.38). Other modalities also favored exercise, but with smaller estimated effects. Exploratory study-level meta-regression did not identify a single optimal dose, with greater uncertainty at exposure extremes. Structured exercise interventions were associated with reductions in HbA1c in this population. HIIT and combined training showed the most favorable estimates, but the low to very low certainty of evidence and moderate heterogeneity require cautious interpretation.
Hydrogel dressings for diabetic foot ulcers: microenvironment-informed design, clinical scenario matching, and translational challenges.
Chen B, Wang Q, Liu C … +3 more , An J, Zhang Q, Cai Y
Diabetes Res Clin Pract · 2026 Jun · PMID 42336107 · Publisher ↗
Diabetic foot ulcers (DFUs) are difficult-to-heal chronic wounds characterized by ischemia, biofilm-associated infection, persistent inflammation, oxidative stress, protease-rich exudate, and abnormal biomechanics. Altho...
Diabetic foot ulcers (DFUs) are difficult-to-heal chronic wounds characterized by ischemia, biofilm-associated infection, persistent inflammation, oxidative stress, protease-rich exudate, and abnormal biomechanics. Although hydrogel dressings have been widely explored for DFU management, many reviews remain material-centered and provide limited guidance on clinical scenario matching. This review proposes a microenvironment-informed framework for DFU hydrogel design. We organize hydrogel strategies according to dominant pathological barriers, including impaired angiogenesis, chronic inflammation, oxidative injury, infection, and complex wound geometry, and compare topical/coating, injectable, patch/membrane, microneedle, and 3D-printed systems according to their clinical suitability. Preclinical evidence is synthesized by therapeutic function, while translational barriers such as model heterogeneity, sterilization, batch variability, regulatory classification, and health-economic evidence are critically examined. Pathology-guided bioactivity combined with scenario-matched formulation design may help reposition hydrogel dressings from laboratory constructs toward practical adjuncts in multidisciplinary DFU care.
Reproducibility of the diagnosis of diabetes by the 1-hour oral glucose tolerance test is substantial.
Sumner AE, Shah AJ, Bharadwaj A … +6 more , Smith GG, Ntabadde K, Izere BS, DuBose CW, Jagannathan R, Sacks DB
Diabetes Res Clin Pract · 2026 Jun · PMID 42336106 · Publisher ↗
Diagnostic reproducibility of diabetes was substantial (ҝ-statistic = 0.74, 95%CI: 0.58-0.90) in 154 African descent individuals with 1 h-OGTTs performed 10 ± 7d (mean ± SD) apart. Diabetes was diagnosed in 34 individual...
Diagnostic reproducibility of diabetes was substantial (ҝ-statistic = 0.74, 95%CI: 0.58-0.90) in 154 African descent individuals with 1 h-OGTTs performed 10 ± 7d (mean ± SD) apart. Diabetes was diagnosed in 34 individuals with 65%(22/34) detected at both visits (non-switchers) and 35%(12/34) at one visit (switchers). With insulin resistance greater in non-switchers, 1 h-OGTT reproducibility may be better if insulin resistance present.
Integrating artificial intelligence and machine learning into risk prediction for type 2 diabetes: A model for early identification of high-risk populations.
Chilu Kuri KA, Viola V, Pozzilli P
Diabetes Res Clin Pract · 2026 Jun · PMID 42331228 · Publisher ↗
Family history, body mass index (BMI), and ethnicity are three key, well-established determinants of susceptibility to type 2 diabetes mellitus (T2DM), reflecting genetic predisposition, modifiable metabolic risk, and bi...
Family history, body mass index (BMI), and ethnicity are three key, well-established determinants of susceptibility to type 2 diabetes mellitus (T2DM), reflecting genetic predisposition, modifiable metabolic risk, and biological as well as social influences, respectively. These factors interact in complex, non-linear patterns that are not fully captured by conventional risk prediction models. This review examines how artificial intelligence (AI) and machine learning approaches can integrate these variables to improve risk stratification and early identification of individuals at high risk of T2DM. By leveraging large-scale, longitudinal datasets, data-driven models facilitate the capture of population-level heterogeneity and identify risk patterns that extend beyond static thresholds. Incorporating AI-enhanced prediction tools into clinical and public health settings could enable more timely, targeted, and equitable interventions. Ultimately, integrating advances in AI with a deeper understanding of the interplay between BMI, ethnicity, and genetic predisposition may support more personalised prevention strategies and risk-stratified care pathways for T2DM.
The effect of rapid improvement of blood glucose level on diabetic neuropathy in Korean people with diabetes mellitus.
Choe HJ, Koo BK, Hong YH … +10 more , Kim NH, Moon JS, Lee YH, Cho HC, Kwak SH, Lim S, Kim DL, Kim TH, Kim SG, Moon MK
Diabetes Res Clin Pract · 2026 Jun · PMID 42324037 · Publisher ↗
AIMS: Treatment-induced neuropathy of diabetes is a well-documented complication of rapid glycemic improvement, yet its frequency and severity in guideline-concordant clinical settings remain uncertain. METHODS: This pro...
AIMS: Treatment-induced neuropathy of diabetes is a well-documented complication of rapid glycemic improvement, yet its frequency and severity in guideline-concordant clinical settings remain uncertain. METHODS: This prospective observational study assessed short-term changes in neuropathy and autonomic function in two Korean cohorts undergoing rapid glycemic control: the Boramae Neuropathy cohort (n = 71, ≥2% HbA1c reduction over 12 weeks) and the TRIPLE-AXEL cohort (n = 79 newly diagnosed, drug-naïve type 2 diabetes patients with ≥ 2% HbA1c reduction). Measures included Neuropathy Total Symptom Score-6 (NTSS-6), Michigan Neuropathy Screening Instrument (MNSI), and Composite Autonomic Symptom Score-31 (COMPASS-31). RESULTS: Despite marked HbA1c reductions, neuropathy indices did not worsen. In the Boramae cohort, HbA1c decreased from 11.3 ± 1.4% to 6.9 ± 0.8%, NTSS-6 remained stable, and abnormal COMPASS-31 prevalence fell from 36.6% to 29.6%. In TRIPLE-AXEL, HbA1c decreased from 9.5 ± 0.8% to 6.4 ± 0.6%, with no increases in MNSI or COMPASS-31 scores and reduced abnormal COMPASS-31 prevalence (6.3% to 1.3%). A small subset in the Boramae cohort (8.5%) developed abnormal COMPASS-31 scores, mainly orthostatic symptoms, without increased neuropathic pain. CONCLUSION: Rapid glycemic improvement was not associated with clinically meaningful short-term worsening of neuropathy. Mild, domain-specific autonomic changes occurred in a minority without painful neuropathy, supporting the safety of intensive glycemic control with appropriate screening.
Molecular senescence, neuroendocrine metaflammation, and skeletal muscle insulin resistance in type-4 diabetes: from mitochondrial dysfunction to precision therapeutics.
Singh BP, Mehra RK, Siddiqui S … +3 more , Kahkasha K, Gupta DK, Kushwaha S
Diabetes Res Clin Pract · 2026 Jun · PMID 42324036 · Publisher ↗
With the global population aged 65 years and older projected to exceed 1.5 billion by 2050, sarcopenia-driven insulin resistance is emerging as an urgent yet still under-recognised contributor to the diabetes burden in o...
With the global population aged 65 years and older projected to exceed 1.5 billion by 2050, sarcopenia-driven insulin resistance is emerging as an urgent yet still under-recognised contributor to the diabetes burden in older adults, underscoring the timeliness of a focused molecular synthesis of this entity for guiding both diagnostic recognition and therapeutic prioritisation. Molecularly different, age-driven insulin resistance promotes skeletal muscle ageing, mitochondrial bioenergetic collapse, and prolonged neuroendocrine metaflammation in type-4 diabetes (T4DM). In ageing myocytes, poor IRS-1/PI3K/Akt signalling, GLUT4 trafficking anomalies, AMPK suppression, ROS-mediated mtDNA instability, and decreased OXPHOS capacity induce T4DM. Senescent muscle cells generate IL-6, TNF-α, and MCP-1 when p16INK4a/p21 checkpoints activate, forming a self-reinforcing inflammatory cycle. Myostatin overactivation, irisin decrease, and FGF21 imbalance influence glucose homeostasis. Metabolism declines due to hypothalamic insulin resistance, microglial inflammation, gut dysbiosis-driven TLR4/NF-κB signalling, and epigenetic remodelling via miR-29, miR-34a, and l Using precision biomarkers like GDF-15, β2-microglobulin, and p16INK4a with multi-omics phenotyping may change diagnosis. Senolytics, NAD⁺ replenishment, SIRT1 activators, mitophagy inducers, anti-myostatin medicines, and exosome-based therapies shift metabolic care towards senescence. T4DM's molecular architecture and precision geriatric endocrinology translational targets are reviewed here.
A study on the efficacy and safety of fosfomycin for the treatment of Multidrug-Resistant Enterobacterales urinary tract infection in North Indian type 2 diabetes mellitus patients.
Choudhury S, Khan FA, Ashraf H … +1 more , Khan F
Diabetes Res Clin Pract · 2026 Jun · PMID 42323170 · Publisher ↗
INTRODUCTION: The incidence of multidrug-resistant Enterobacterales (MDRE) associated urinary tract infection (UTI) in patients with diabetes mellitus is increasing and it is associated with poor prognosis. Due to antibi...
INTRODUCTION: The incidence of multidrug-resistant Enterobacterales (MDRE) associated urinary tract infection (UTI) in patients with diabetes mellitus is increasing and it is associated with poor prognosis. Due to antibiotic resistance, re-emerging antibiotics like fosfomycin are garnering interest. OBJECTIVES: This study examined the effectiveness and safety of oral fosfomycin in treating MDRE related UTIs in patients with diabetes mellitus at a tertiary care centre in North India. It also studied MDRE infection risk factors present in the local population. METHOD: Seventy-three type 2 diabetes mellitus patients were recruited in this single-centre, single-arm prospective interventional study. Oral fosfomycin was tested for clinical & microbiological efficacy, and its safety profile was also assessed. Antimicrobial susceptibility and prevalence profile of uropathogens in study population was also determined. RESULTS: The average patient age was 54.32 years, with 68.49 % female. E. coli (42.4 %) and Klebsiella (31.5 %) were the most prevalent pathogens. Clinical improvement was achieved in 91 % men and in 98 % women, while microbiological improvement was noted in 82.6 % males and in 90 % for females. Overall, 78.1 % of patients recovered both clinically and microbiologically. Fosfomycin was well tolerated in general, with minimal side effects. CONCLUSION: Fosfomycin appears to be an effective and well-tolerated therapeutic option for type 2 diabetes mellitus patients with MDRE UTIs in our study, although larger comparative studies are needed.
"More Kairos, Less Chronos": Sleep, circadian rhythms and the path to cardiovascular, neurological and metabolic protection.
Calcaterra G, Akurati S, Punjabi N … +2 more , Iacobellis G, Varghese RT
Diabetes Res Clin Pract · 2026 Jun · PMID 42323169 · Publisher ↗
Sleep supports cardiovascular, metabolic, neurologic, and psychological health. Beyond duration, circadian alignment is crucial because regular sleep, light exposure, feeding, and activity synchronize central and periphe...
Sleep supports cardiovascular, metabolic, neurologic, and psychological health. Beyond duration, circadian alignment is crucial because regular sleep, light exposure, feeding, and activity synchronize central and peripheral clocks. Modern chronodisruption from artificial light, irregular schedules, shift work, late eating, and insufficient sleep misaligns these rhythms and increases chronic disease risk. This review summarizes evidence linking sleep and circadian disruption to cardiovascular disease, metabolic dysfunction, and neurodegeneration. The American Heart Association's Life's Essential 8 recognizes sleep as a core cardiovascular health metric, reflecting evidence that sleep duration, timing, regularity, and quality add predictive value beyond traditional risk factors. We also review data from cohorts, proteomics, wearables, and artificial intelligence showing that objective sleep traits can predict cardiometabolic and neurologic outcomes. Both short and long sleep duration are associated with adverse metabolic outcomes, likely through partly distinct mechanisms. Finally, we discuss clinical implications, including light hygiene, meal timing, sleep disorder treatment, sleep metrics for early risk detection, and links between circadian disruption, gut microbiota metabolic reprogramming, clock-gene regulation, and diet-based strategies targeting gut-liver and metabolic pathways.
Exercise as targeted therapy in type 2 diabetes: a phenotype-informed clinical prioritisation framework for adapted physical activity.
Corrao S, Scibetta S, Mirarchi L … +4 more , Amodeo S, Lazzara E, Corrao G, Calvo L
Diabetes Res Clin Pract · 2026 Jun · PMID 42323168 · Publisher ↗
BACKGROUND: Type 2 diabetes (T2D) is a heterogeneous cardio-nephro-hepato-metabolic disease whose clinical expression is shaped by multimorbidity, obesity, sarcopenia, frailty, chronic complications, cardiovascular disea...
BACKGROUND: Type 2 diabetes (T2D) is a heterogeneous cardio-nephro-hepato-metabolic disease whose clinical expression is shaped by multimorbidity, obesity, sarcopenia, frailty, chronic complications, cardiovascular disease, chronic kidney disease, and functional decline - dimensions that frequently coexist rather than defining mutually exclusive categories. International guidelines appropriately recognise the multidimensional benefits of physical activity, including cardiorespiratory fitness, muscle strength, body composition, physical function, and quality of life; however, translating this increasing clinical complexity into personalised, prioritised exercise prescriptions remains an unresolved operational challenge. OBJECTIVE: To propose a phenotype-informed clinical prioritisation framework for Adapted Physical Activity (APA) in T2D that complements condition-specific exercise recommendations by supporting clinicians in identifying the dominant clinical complexity domain and corresponding therapeutic priority at a given point in the patient's trajectory. METHODS: Evidence from international guidelines, consensus statements, systematic reviews, and meta-analyses was synthesised within a conceptual model integrating functional status, frailty, sarcopenia, and cardiorenal risk as determinants of exercise prescription. RESULTS: Four overlapping domains of clinical complexity are described: adiposopathic insulin-resistant; muscle failure (frailty-sarcopenia); cardiorenal-metabolic; and complication-driven. For each, the dominant therapeutic priority, exercise modality, intensity, and safety considerations are defined with explicit evidence linkage. A six-step clinical algorithm integrates multidimensional assessment, risk stratification, identification of the dominant clinical complexity domain, prioritised prescription, and dynamic reassessment. CONCLUSIONS: Adapted Physical Activity should be prescribed using the same principles of multidimensional assessment, therapeutic prioritisation, monitoring, and dynamic adaptation that increasingly guide modern diabetes pharmacotherapy - supporting the diabetologist's evolving role as a clinician of complexity within a precision exercise medicine approach.
Gut-pancreas-metabolism axis: emerging anti-diabetic roles of gut-derived bioactive molecules.
Siddiqui S, Kahkasha K
Diabetes Res Clin Pract · 2026 Jun · PMID 42320750 · Publisher ↗
The rising global burden of diabetes mellitus necessitates exploration of mechanisms beyond classical pancreatic dysfunction. The gut-pancreas-metabolism axis has emerged as a central regulatory network linking gut micro...
The rising global burden of diabetes mellitus necessitates exploration of mechanisms beyond classical pancreatic dysfunction. The gut-pancreas-metabolism axis has emerged as a central regulatory network linking gut microbiota, enteroendocrine signaling, immune modulation, and pancreatic function in glucose homeostasis. Gut-derived bioactive metabolites, including short-chain fatty acids, bile acid derivatives, indole compounds, lipopolysaccharide fragments, and microbial peptides, significantly influence insulin secretion, insulin sensitivity, inflammation, and energy metabolism. These metabolites regulate key pathways such as AMP-activated protein kinase, PI3K/Akt signaling, G-protein-coupled receptor activation, and inflammatory cascades, thereby contributing to β-cell preservation and metabolic balance. Dysbiosis-associated shifts in microbial metabolite profiles are strongly associated with insulin resistance, impaired incretin responses, and chronic low-grade inflammation in type 2 diabetes. This review summarizes recent mechanistic advances in the gut-pancreas-metabolism axis and highlights the therapeutic potential of microbiota-derived bioactive compounds. Furthermore, it discusses emerging translational strategies, including probiotics, prebiotics, postbiotics, and dietary modulation of the gut microbiome, as adjunctive approaches for diabetes management. Targeting this axis provides promising opportunities for precision-based metabolic therapy in diabetes care.
Screening and staging type 2 diabetes risk with a 1 h oral glucose tolerance test and the Finnish diabetes risk score.
Bracco PA, Duncan BB, Bergman M … +2 more , Tuomilehto J, Schmidt MI
Diabetes Res Clin Pract · 2026 Jun · PMID 42309180 · Publisher ↗
AIMS: We aimed to develop a multistage schema to stratify diabetes risk using continuous plasma glucose (PG) values (fasting and 1 h) in combination with clinical variables. METHODS: In 962 Brazilian adults, we initially...
AIMS: We aimed to develop a multistage schema to stratify diabetes risk using continuous plasma glucose (PG) values (fasting and 1 h) in combination with clinical variables. METHODS: In 962 Brazilian adults, we initially estimated the probability of developing diabetes with the Finnish Diabetes Risk Score (FINDRISC). We then stratified participants with a FINDRISC score of 9 or higher into three progressive high-risk stages based on their probability of developing diabetes. We evaluated the schemás ability to predict the incidence of diabetes using robust Poisson regression with a time offset, employing bootstrap resampling for internal validation. RESULTS: Over 5.31 (0.44) years of follow-up, we observed a steep and graded increase in the risk of diabetes across stages. Initiating screening with FINDRISC reduced OGTT testing by 35.1%. The staging schema categorized 39.1% (36.1-42.2) of the sample in three high-risk stages, with relative risk for incident diabetes ranging from 2.7 (1.0-7.4) to 14.9 (7.3-30.3). Adding 2 h PG and HbA to scores produced little change. CONCLUSIONS: A staging schema based on scores derived from continuous FPG and 1 h PG values along with clinical variables, applied after a FINDRISC screening, offers a nuanced and practical approach to identifying individuals for diabetes prevention.
Analysis of plasma extracellular vesicles in normal-weight and overweight type 2 diabetes mellitus using multimodal SERS and RNA-Seq.
Parlatan U, Patel AN, Torun H … +4 more , Karim AH, Ozen MO, Palaniappan L, Demirci U
Diabetes Res Clin Pract · 2026 Jun · PMID 42297214 · Publisher ↗
AIMS: To characterize subtype-associated heterogeneity in type 2 diabetes mellitus (T2DM), particularly normal-weight diabetes, using extracellular vesicle (EV)-associated molecular features in a clinically stratified co...
AIMS: To characterize subtype-associated heterogeneity in type 2 diabetes mellitus (T2DM), particularly normal-weight diabetes, using extracellular vesicle (EV)-associated molecular features in a clinically stratified cohort. METHODS: EV-enriched isolates were obtained from plasma using ExoTIC and validated by transmission electron microscopy, nanoparticle tracking analysis, flow cytometry, and Western blotting. EV-enriched isolates from Asian normal-weight (A-NWD), Asian overweight (A-OWD), Non-Hispanic White normal-weight (W-NWD), and Non-Hispanic White overweight (W-OWD) T2DM patients were analyzed by multimodal surface-enhanced Raman spectroscopy (SERS; n = 65) and EV-RNA sequencing (n = 39). RESULTS: SERS identified subgroup-associated spectral variation across BMI- and race/ethnicity-stratified groups in this cohort. EV-RNA sequencing identified exploratory differential microRNA (miRNA) expression patterns, with higher miR-208a and miR-132 in A-OWD and higher miR-484 in A-NWD, representing prioritized candidates for future validation. Unsupervised analyses also showed partially overlapping EV-associated molecular features between A-NWD and W-OWD, suggesting that uniform BMI thresholds may not fully capture EV-associated molecular heterogeneity across populations. CONCLUSIONS: Multimodal EV profiling identified subgroup-associated spectral and exploratory miRNA features in clinically stratified T2DM and provides a framework for studying diabetes heterogeneity, including molecular patterns associated with normal-weight diabetes.
B-type natriuretic peptide level reduction and its predictors following sodium-glucose cotransporter 2 inhibitor treatment in patients with diabetic kidney disease: a Japan Chronic Kidney Disease Database Extension analysis.
Nagahiro T, Konishi M, Kanaoka T … +27 more , Wakui H, Yano Y, Nagasu H, Kishi S, Nangaku M, Hirakawa Y, Nakagawa N, Wada J, Tsuruya K, Nakano T, Maruyama S, Wada T, Yamagata K, Narita I, Yanagita M, Terada Y, Araki SI, Emoto M, Okada H, Isaka Y, Suzuki Y, Yokoo T, Kataoka H, Kanda E, Kashihara N, Tamura K, J-CKD-DB Collaborators
Diabetes Res Clin Pract · 2026 Jun · PMID 42297213 · Publisher ↗
AIMS/INTRODUCTION: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) prevent cardiovascular events in patients with diabetic kidney disease (DKD). However, limited data exist regarding the change in B-type natriuretic p...
AIMS/INTRODUCTION: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) prevent cardiovascular events in patients with diabetic kidney disease (DKD). However, limited data exist regarding the change in B-type natriuretic peptide (BNP) after treatment. This study investigated whether SGLT2i are associated with a greater BNP reduction than other antidiabetic drugs and identified the predictors of BNP reduction following SGLT2i. MATERIALS AND METHODS: Using the Japanese nationwide database, we compared BNP levels before and 30-365 days after initiation of antidiabetic medication in 1818 patients with DKD (71 ± 12 years, 68% men, BNP 71 [27-190] pg/mL, estimated glomerular filtration rate (eGFR) 51 ± 22 mL/min/1.73 m). RESULTS: BNP reduction, defined as a reduction of >10%, occurred in 474 (50.5%) of 939 patients treated with SGLT2i and 339 (38.6%) of 879 treated with other antidiabetic drugs. SGLT2i was associated with BNP level reduction in a multivariable logistic regression analysis (odds ratio, 1.497 [1.206-1.859]; p < 0.001). This association was consistent across eGFR, proteinuria, and multiple BNP endpoints. Concomitant use of loop diuretics was associated with a lower rate of BNP reduction after SGLT2i. CONCLUSIONS: Compared with other antidiabetic drugs, SGLT2i was substantially associated with BNP reduction in a broad spectrum of DKD.
Glycation gap size, stability over time and correlates in people with Type 1 diabetes.
Begbie TN, Huang MLH, Nanayakkara N … +3 more , Ma RCW, Cohen ND, Jenkins AJ
Diabetes Res Clin Pract · 2026 Jun · PMID 42297212 · Publisher ↗
Uptake of Continuous Glucose Monitoring (CGM) by people with Type 1 diabetes is increasing. As well as real-time glucose metrics, CGM can estimate a HbA1c level from 2-weeks to 3-months of CGM data. Differences between l...
Uptake of Continuous Glucose Monitoring (CGM) by people with Type 1 diabetes is increasing. As well as real-time glucose metrics, CGM can estimate a HbA1c level from 2-weeks to 3-months of CGM data. Differences between laboratory-based and CGM-estimated HbA1c values, termed the glycation gap, can occur. Little knowledge exists about the glycation gap stability over time and of the correlates and determinants of the glycation gap. In our Australian tertiary-referral diabetes clinic we conducted a cross-sectional study of the glycation gap in 316 adults and a longitudinal study in 231 of these participants. We found frequent differences between laboratory and CGM-estimated HbA1c measures, with 64% of 316 adults having a glycation gap ≥0.3%. Whilst the glycation gap was stable over time in groups, in 118/231 adults (51%) it changed by ≥0.3%. We also evaluated correlates of the glycation gap. The glycation gap correlated inversely with age, HbA1c and haematocrit and correlated positively with eGFR and mean corpuscular haemoglobin concentration. The glycation gap differed between CGM brands, but not by insulin delivery modality. Further studies are merited to explore factors associated with larger and changing glycation gaps, as they are relevant to clinical practice.
Health behavior changes after type 2 diabetes diagnosis: a 16-year longitudinal cohort study.
Ro HJ, Ahn SV
Diabetes Res Clin Pract · 2026 Jun · PMID 42289191 · Publisher ↗
AIMS: This study evaluated the 16-year trajectories of smoking, drinking, exercise, and obesity before and after a diabetes diagnosis using a large-scale community-based longitudinal cohort. METHODS: We analyzed 5091 par...
AIMS: This study evaluated the 16-year trajectories of smoking, drinking, exercise, and obesity before and after a diabetes diagnosis using a large-scale community-based longitudinal cohort. METHODS: We analyzed 5091 participants without diabetes at baseline from the Korean Genome and Epidemiology Study (2003-2018). Participants underwent biennial health examinations to assess lifestyle behaviors. Those developing diabetes during follow-up were classified as the diabetes group. Generalized estimating equations examined temporal trends, group differences, and group-by-time interactions. RESULTS: Overall, significant reductions occurred in smoking (P < 0.001), drinking (P < 0.001), and obesity (P = 0.007), with an increase in exercise (P < 0.001) across the cohort. Notably, the diabetes group showed a significantly greater increase in exercise (group-by-time interaction, P = 0.035) and a more pronounced reduction in obesity (P < 0.001) compared to those without diabetes. No significant group-by-time interactions were found for smoking and drinking. CONCLUSIONS: A diabetes diagnosis was associated with favorable changes in physical activity and weight management, serving as a critical window of opportunity for lifestyle intervention. These findings highlight the period around diagnosis as a key window for interventions supporting sustained lifestyle change. Such evidence informs the development of timely, targeted behavioral interventions for new-onset diabetes.
Complementary value of glycated albumin and continuous glucose monitoring for assessing microvascular complications in type 2 diabetes.
Su H, Ni J, Han W … +7 more , Cai J, Zhu W, Wang Y, Zhou J, Lu J, Ma X, Peng D
Diabetes Res Clin Pract · 2026 Jun · PMID 42289190 · Publisher ↗
AIMS: Glycated albumin (GA) has recently been recommended in the 2024 American Diabetes Association guidelines as an alternative glycemic marker, yet its complementary value alongside continuous glucose monitoring (CGM)...
AIMS: Glycated albumin (GA) has recently been recommended in the 2024 American Diabetes Association guidelines as an alternative glycemic marker, yet its complementary value alongside continuous glucose monitoring (CGM) metrics remains uncertain. METHODS: A total of 3251 individuals with type 2 diabetes were included. All participants underwent CGM, from which time in range (TIR) was calculated. Diabetic retinopathy (DR) was assessed by fundus examination, and diabetic kidney disease (DKD) was defined based on urinary albumin excretion and/or estimated glomerular filtration rate. Composite microvascular complications were defined as the presence of DR and/or DKD. RESULTS: Median GA and TIR were 20.5 % (16.8-25.9) and 75.0 % (60.0-87.0), respectively, and 45.8 % of participants had microvascular complications. After adjustment including TIR, the highest GA tertile wasindependently associated with higher odds of DR, DKD, and composite microvascular complications (odds ratios [ORs]: 1.31 [95 % CI 1.04-1.64], 1.58 [1.24-2.02], and 1.44 [1.17-1.79], respectively). These associations remained significant among participants achieving TIR > 70 % (ORs: 1.38 [1.04-1.83], 1.95 [1.43-2.65], and 1.57 [1.20-2.05], respectively). GA and TIR showed comparable C-statistics, while adding GA to TIR-based models improved net reclassification for microvascular complications by 13.2-16.3 %. CONCLUSIONS: In type 2 diabetes, GA is associated with microvascular complications independently of TIR and may provide complementary information when considered alongside TIR.
Exercise snacks to combat hyperglycaemia in patients with abnormal glycaemic control: Use of a novel strategy based on individual continuous glucose data in a real-world setting.
Gross K, Rinne K, Braun A … +8 more , Plappert M, Vaitl M, Scheibler L, Schwensfeier L, Riemer L, Predel HG, Joisten C, Brinkmann C
Diabetes Res Clin Pract · 2026 Jun · PMID 42289189 · Publisher ↗
AIM: To investigate the effectiveness and feasibility of continuous glucose monitoring (CGM)-guided exercise snacks (ES) to reduce time in individual hyperglycaemia in individuals with abnormal glycaemic control in a rea...
AIM: To investigate the effectiveness and feasibility of continuous glucose monitoring (CGM)-guided exercise snacks (ES) to reduce time in individual hyperglycaemia in individuals with abnormal glycaemic control in a real-world setting. METHODS: Twenty-five participants (56 ± 10 years; HbA1c ≥ 5.7%) underwent four consecutive 3-day experimental periods separated by 4-day washout periods. They were instructed to continue their daily living under the following conditions: (a) without exercise (CONTROL), (b) performing ES whenever individualised CGM-derived hyperglycaemia alarms occurred (CGM-ES), (c) performing the same number of ES at fixed times without CGM (NON-CGM-ES), and (d) performing a once-daily long exercise session (cumulative ES time) (SINGLE-EX). RESULTS: Time spent in individual hyperglycaemia over 72 h differed significantly between experimental conditions (p < 0.001). It was reduced by approximately one third in both CGM-ES and NON-CGM-ES compared with CONTROL or SINGLE-EX. Adherence was high: 85% (CGM-ES), 88% (NON-CGM-ES), and 93% (SINGLE-EX). Intentions to continue CGM-ES, NON-CGM-ES, and SINGLE-EX differed significantly (p = 0.042), with CGM-ES and SINGLE-EX showing the highest mean scores on the 5-point Likert scale. CONCLUSIONS: The results suggest that regular ES reduce time in individual hyperglycaemia more effectively than a single long exercise session. CGM-ES may enhance motivation and facilitate rapid attenuation of hyperglycaemia in a real-world setting.
Glycemic trajectory after face-to-face diabetes self-management education: a dose-response meta-analysis.
Dughmosh R, Hamdan A, Moghassabi W … +6 more , Al-Kahlout L, Syed A, Alwisi N, Al-Sharif N, Othman M, Doi SAR
Diabetes Res Clin Pract · 2026 Jun · PMID 42289188 · Publisher ↗
This dose-response meta-analysis (DRMA) examined HbA1c trajectories after face-to-face Diabetes Self-Management Education (DSME) and whether program duration, frequency, or intensity modified outcomes over time. MEDLINE,...
This dose-response meta-analysis (DRMA) examined HbA1c trajectories after face-to-face Diabetes Self-Management Education (DSME) and whether program duration, frequency, or intensity modified outcomes over time. MEDLINE, Embase, and CINAHL were searched to February 15, 2025. Eligible studies included adults with type 2 diabetes receiving face-to-face DSME and reporting pre- and post-intervention HbA1c levels. Intervention-arm data from randomized, quasi-experimental, and observational studies were analyzed as single-group pre-post cohorts. Risk of bias was assessed using the NIH Before-After Studies tool, and REMR-based meta-regression with restricted cubic splines modeled HbA1c change over time. Of 161 eligible studies, 103 were included after excluding outliers and studies outside the predefined baseline HbA1c range. DSME was associated with a rapid HbA1c reduction of approximately 1.3% within 30 weeks, followed by gradual attenuation toward baseline by 52 weeks. Sensitivity analyses across restricted baseline HbA1c ranges showed similar trajectories, suggesting regression to the mean did not fully explain the findings. Data beyond one year were sparse. Conventional face-to-face DSME programs produce substantial short-term glycemic improvement, but benefits diminish over time and this was unrelated to initial program intensity.
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