Diabetes Care
· 2026 Apr · PMID 41861130
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Variations of disease patterns among populations, geographies, and time periods underpin the use of descriptive and analytical cohort analysis to define causal relationships between exposures and outcomes. This epidemiol...Variations of disease patterns among populations, geographies, and time periods underpin the use of descriptive and analytical cohort analysis to define causal relationships between exposures and outcomes. This epidemiological knowledge forms the basis for designing clinical experiments to inform practice and policies. In the 1990s, rapid environmental and lifestyle changes among Chinese living in Hong Kong led to a rising prevalence of diabetes. The benefits of structured care in a clinical trial setting motivated the establishment of the Hong Kong Diabetes Register (HKDR) in 1995 as a data-driven quality improvement program accompanied by a biobank. Systematic data collection and analysis revealed the Asian diabetes phenotype characterized by young age at diagnosis, moderately increased BMI, visceral fat excess, and propensity for chronic kidney disease. In 2000, the HKDR protocol was incorporated into the territory-wide electronic medical record (EMR) system with setup of diabetes centers/teams for implementation. This 2-yearly Risk Assessment and Management Programme for Diabetes Mellitus (RAMP-DM) contributed to marked decline in diabetes-related complication and death rates. In 2007, the HKDR and its equations were digitalized to become the first web-based Joint Asia Diabetes Evaluation (JADE) platform for risk stratification and personalized reporting with decision support aimed at closing care gaps in Asia. The HKDR with its multidimensional data provides the fulcrum for building capacity to transform care and discover knowledge, including on the vulnerability, multiple hits, and reduced capacity of β-cells underlying young-onset diabetes. Using well-designed registers and biobanks to redefine diabetes can lead to innovative diabetes prediction, prevention, classification, and treatment with value, quality, and precision.
Zhu Y, Ngo AL, Liao LD
… +5 more, Harvill R, Marafino BJ, Chehab RF, Greenberg MB, Ferrara A
Diabetes Care
· 2026 Mar · PMID 41842968
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OBJECTIVE: Management of gestational diabetes mellitus (GDM) largely follows a uniform approach, despite growing recognition of GDM heterogeneity. We aimed to identify data-driven GDM clusters by using machine learning t...OBJECTIVE: Management of gestational diabetes mellitus (GDM) largely follows a uniform approach, despite growing recognition of GDM heterogeneity. We aimed to identify data-driven GDM clusters by using machine learning techniques and clinical data and to assess their associations with perinatal complications and postpartum diabetes risk. RESEARCH DESIGN AND METHODS: In a population-based cohort study, 37,544 individuals with GDM were followed up through 12 years postpartum. In the discovery (70%) and validation (30%) sets, we applied dimension reduction and clustering methods using routinely available sociodemographic, behavioral, and clinical variables. Covariate-adjusted modified Poisson and Cox regression models were used to assess associations of GDM clusters with risk of perinatal complications and postpartum diabetes. RESULTS: Four data-driven GDM phenotypic clusters were identified. Cluster 1 (C1) (65.6%), C2 (14.5%), C3 (12.0%), and C4 (7.8%) comprised the discovery set, with similar distributions in the validation set (C1-C4 66.7%, 14.0%, 12.0%, 7.4%, respectively). C2-C4 compared with C1 (late-diagnosed, lower-BMI, and postload hyperglycemia GDM) were associated with higher risks of perinatal complications and new-onset postpartum diabetes, especially C4 (early-diagnosed, comorbidity-related, and high-glucose challenge test GDM) (adjusted relative risks: severe maternal morbidity 1.43 [95% CI 1.19, 1.72] and neonatal intensive unit admission 1.53 [1.41, 1.66]; adjusted hazard ratio for diabetes 4.32 [95% CI 3.94, 4.73]). Within the largest cluster C1, three subclusters were identified, with differential risks of perinatal complications but not postpartum diabetes. CONCLUSIONS: Our study identified distinct data-driven GDM phenotypic clusters with differential risks of perinatal complications and postpartum diabetes. These findings may inform personalized risk assessment and management strategies tailored to GDM phenotypic clusters to possibly reduce adverse health outcomes.
Harjutsalo V, Thorn LM, Sandholm N
… +2 more, Groop PH, FinnDiane Study Group
Diabetes Care
· 2026 May · PMID 41842751
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OBJECTIVE: To investigate the association between "shrunken pore syndrome" (SPS), defined as a large discrepancy between estimated glomerular filtration rates based on cystatin C (eGFRcys) and creatinine (eGFRcr), and co...OBJECTIVE: To investigate the association between "shrunken pore syndrome" (SPS), defined as a large discrepancy between estimated glomerular filtration rates based on cystatin C (eGFRcys) and creatinine (eGFRcr), and coronary artery disease (CAD), stroke, peripheral artery disease (PAD), heart failure (HF), and all-cause mortality in individuals with T1D with and without albuminuria. RESEARCH DESIGN AND METHODS: The study comprised 3,769 individuals with and without albuminuria from the Finnish Diabetic Nephropathy Study (FinnDiane) who had both serum creatinine (Scr) and serum cystatin C (SCysC) data available. RESULTS: SPS (eGFRcys/eGFRcr ratio cutoff 0.7) was not associated with CAD or stroke. In those with SPS but without albuminuria, the hazard ratios (HRs) for HF, PAD, and all-cause mortality were 3.07 (95% CI 1.47-6.38), 3.64 (95% CI 1.75-7.57), and 3.08 (95% CI 1.86-5.11). The associations between the eGFRcys/eGFRcr ratio as a continuous variable, as well as eGFRcys alone and HF, PAD, and all-cause mortality were significant in those without albuminuria. In individuals with albuminuria, SPS was only associated with HF (HR 1.54; 95% CI 1.02-2.33), whereas the eGFRcys/eGFRcr ratio as a continuous variable was not associated with any of the outcomes. On the contrary, both eGFRcys and eGFRcr were independently associated with all studied outcomes in those with albuminuria. CONCLUSIONS: Findings highlight the clinical potential of identifying individuals at increased risk of HF, PAD, and all-cause mortality at an early stage among those with T1D without albuminuria by evaluating both eGFRcys and eGFRcr and their discrepancy.
Weiskorn J, Becker M, Kamrath C
… +6 more, Hammersen J, Bechtold-Dalla Pozza S, Müller-Roßberg E, Holder M, Burckhardt MA, Holl RW
Diabetes Care
· 2026 May · PMID 41842727
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OBJECTIVE: We investigated the prevalence of elevated LDL cholesterol in youth with type 1 diabetes (T1D), contributing factors, the frequency of lipid-lowering medication (LLM), and the achievement of target values. RES...OBJECTIVE: We investigated the prevalence of elevated LDL cholesterol in youth with type 1 diabetes (T1D), contributing factors, the frequency of lipid-lowering medication (LLM), and the achievement of target values. RESEARCH DESIGN AND METHODS: A cross-sectional analysis based on data from the Diabetes-Patienten-Verlaufsdokumentation registry (Diabetes Prospective Follow-up Registry) from 2013 to 2023. Inclusion criteria were T1D, age <18 years, and at least one documented LDL measurement. LDL cutoffs of >2.6, >3.4, and >4.1 mmol/L were defined. Application of national and international treatment guidelines was examined. Descriptive analyses and linear and logistic regression models were implemented using SAS 9.4. RESULTS: The study included 55,028 participants. Of these, 9.7% and 2.3% had LDL >3.4 mmol/L and >4.1 mmol/L, respectively. The parameters HbA1c (β = 1,142.7; P = 0.001), female sex (β = 861.5; P < 0.001), and BMI >70th percentile (β = 520.1; P < 0.001) had the strongest effect on LDL levels. Only 7.3% of the cohort with elevated LDL levels received LLM. The majority (92.7%) with LDL >3.4 mmol/L and 87.0% with LDL >4.1 mmol/L were not treated. Estimated odds ratios (95% CI) for the use of LLM were 19.13 (15.4-23.7) for LDL >4.1 mmol/L; 3.1 (1.82-5.41) for ages 12-18 years; 2.31 (1.9-2.1) for diabetes duration of 5-10 years; 1.8 (1.5-2.1) for BMI >70th percentile; 1.3 (1.0-1.6) for HbA1c >9%; and 1.18 (1.0-1.4) for female sex. However, only 15.7% of the treated patients (n = 707) reached the LDL target of <2.6 mmol/L, and LDL levels of 55% even remained at >3.4 mmol/L. CONCLUSIONS: We found a high prevalence of LDL hypercholesterolemia. The use of LLM was low, despite treatment indication, and treatment targets were mostly not achieved either due to underdosing or nonadherence to LLM. These findings confirm that dyslipidemia remains an underestimated cardiovascular risk factor in pediatric diabetology.
Warmbrunn MV, Yang L, Kishore Biswas R
… +5 more, Ryan CP, Harper A, Belsky DW, Fiorito G, Fontana L
Diabetes Care
· 2026 May · PMID 41838032
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OBJECTIVE: To investigate the long-term metabolic and hormonal consequences of sustained weight loss versus weight regain after 1 year of caloric restriction (CR), with attention to insulin resistance and type 2 diabetes...OBJECTIVE: To investigate the long-term metabolic and hormonal consequences of sustained weight loss versus weight regain after 1 year of caloric restriction (CR), with attention to insulin resistance and type 2 diabetes risk. RESEARCH DESIGN AND METHODS: In the 2-year Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy 2 (CALERIE-2) trial (n = 220), participants were randomized to 25% CR or control diet. The intervention targeted weight loss over the first 6-12 months, followed by a 12-month maintenance phase. To assess weight-regain consequences, participants were stratified by weight trajectory regardless of randomization, and group differences were balanced by propensity score weighting. Cardiometabolic and hormonal markers of available participants (n = 190), as well as a biomarker-based estimate of biological age, were compared across weight trajectory groups. RESULTS: At 12 months, weight loss ranged from 5.0 to 5.8 kg between groups. Between months 12 and 24, most participants either maintained weight (n = 112) or continued to lose weight (n = 58), whereas a smaller group regained >5% of baseline weight (n = 20). This group had the largest initial caloric reductions. Weight regain reversed improvements in insulin area under the curve and the ratio of insulin-like growth factor 1 (IGF-1) to insulin-like growth factor-binding protein 1, and sustained weight loss maintained metabolic benefits and was associated with greater reductions in biological age. CONCLUSIONS: Substantial weight loss followed by weight regain can attenuate or reverse CR-induced benefits on key regulators of the insulin-IGF-1 nutrient-sensing pathway and markers of biological aging. Sustained, moderate weight loss more effectively improves insulin resistance and maintains favorable hormonal profiles linked to type 2 diabetes risk and aging biology.
Jang S, Wang Y, Ma S
… +4 more, Hsia DS, Cossen K, Haynes D, Bensignor MO
Diabetes Care
· 2026 May · PMID 41837708
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OBJECTIVE: To evaluate whether the Area Deprivation Index (ADI) contributes to predicting type 2 diabetes development in youth with prediabetes compared with a machine learning (ML) model built with other data elements....OBJECTIVE: To evaluate whether the Area Deprivation Index (ADI) contributes to predicting type 2 diabetes development in youth with prediabetes compared with a machine learning (ML) model built with other data elements. RESEARCH DESIGN AND METHODS: Patient encounters (n = 665) from an electronic medical record were used to build supervised ML models to predict type 2 diabetes development within 1 year of prediabetes diagnosis. The ADI was constructed using patients' census block data. Two models, trained on data with and without ADI, were built. The model selection resulted in logistic regressions with 1) HbA1c only and 2) HbA1c + ADI as the best models from each data set. RESULTS: A total of 181 patient encounters (27.2%) developed type 2 diabetes. The area under the receiver operating characteristic curve of the HbA1c-only model was 0.68 and of the HbA1c + ADI model, 0.73. CONCLUSIONS: The addition of ADI to the model resulted in the best performance in predicting youth-onset type 2 diabetes development.
Huang X, Tian Z, Pan Y
… +9 more, Zhang J, Wu B, Gao S, Cheng Y, Hu Q, Ma J, Pan Q, Shao J, Zhou K
Diabetes Care
· 2026 May · PMID 41837567
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OBJECTIVE: mtDNA copy number (CN) reflects mitochondrial function, but prior studies have reported inconsistent associations with type 2 diabetes risk, ranging from inverse to positive or null findings. We hypothesized t...OBJECTIVE: mtDNA copy number (CN) reflects mitochondrial function, but prior studies have reported inconsistent associations with type 2 diabetes risk, ranging from inverse to positive or null findings. We hypothesized that mtDNA-CN is nonlinearly associated with incident type 2 diabetes. RESEARCH DESIGN AND METHODS: We included 34,835 adults without diabetes from the Kunshan Aging Research With E-Health (KARE) cohort and 289,338 from the UK Biobank (UKB). Associations between blood mtDNA-CN and incident type 2 diabetes were evaluated using Cox proportional hazards and restricted cubic spline models stratified by age. RESULTS: A U-shaped association was observed in the KARE cohort (P < 0.001), in which the hazard ratios (95% CIs) across increasing mtDNA-CN quartiles were 1.00 (reference), 0.94 (0.88-1.00), 0.85 (0.79-0.91), and 0.93 (0.87-1.00). In contrast, the UKB cohort exhibited a predominantly inverse linear trend. Age-stratified analyses revealed that this U-shaped association was particularly evident in younger participants (aged <65 years in KARE and <50 years in UKB), indicating elevated diabetes risk at both low and high mtDNA-CN levels. Additionally, mtDNA-CN declined with age in both cohorts, with an accelerated decrease beyond ∼65 years in KARE and ∼50 years in UKB. CONCLUSIONS: Blood mtDNA-CN showed a U-shaped association with incident type 2 diabetes in younger individuals.
Bruttomesso D, Petrie JR, Evans M
… +7 more, Fleming GA, Hanaire H, Holl RW, Sherr JL, Bergenstal RM, Heinemann L, Peters AL
Diabetes Care
· 2026 Jun · PMID 41817442
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From finger-stick blood glucose monitoring and mechanical insulin pens in the 1970s to modern automated insulin delivery systems, rapidly progressing advances in diabetes technology are transforming management options fo...From finger-stick blood glucose monitoring and mechanical insulin pens in the 1970s to modern automated insulin delivery systems, rapidly progressing advances in diabetes technology are transforming management options for people with diabetes, particularly those with type 1 diabetes but also, increasingly, people with type 2 diabetes. However, access to life-changing diabetes technologies is neither uniform nor universally covered, and there is no one-size-fits-all approach. In this position statement, we emphasize to health care professionals the importance of supporting individuals with diabetes to access and use the right diabetes technology according to personal needs, capabilities, and preferences. In doing so, we highlight the equal importance of avoiding disparities in the provision of diabetes technology by challenging preconceived barriers, which can be overcome with education and determination. We also make a series of suggestions for action to advance the more widespread adoption of diabetes technology while minimizing the "digital divide."
Zelnick LR, Trikudanathan S, Hall YN
… +11 more, Ayers E, Anderson L, Ashford N, Jones E, Rivas-Nieto AC, Hsu S, Kabytaev K, Wang Z, Hoofnagle AN, Hirsch IB, de Boer IH
Diabetes Care
· 2026 May · PMID 41805834
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OBJECTIVE: Accurate assessment of glycemia in patients treated with maintenance dialysis is imperative and hampered by known biases of glycated hemoglobin (HbA1c) in kidney failure (KF). This study evaluated the accuracy...OBJECTIVE: Accurate assessment of glycemia in patients treated with maintenance dialysis is imperative and hampered by known biases of glycated hemoglobin (HbA1c) in kidney failure (KF). This study evaluated the accuracy, variability, and covariate bias of three glycemic biomarkers compared with glycemia measured by continuous glucose monitor (CGM) among people with and without diabetes treated with maintenance dialysis. RESEARCH DESIGN AND METHODS: In a prospective community-based cohort study, 251 participants treated with maintenance dialysis wore a Dexcom G6 Pro CGM for 10 days. We compared correlations of HbA1c, glycated albumin (GA), and fructosamine with CGM-derived mean glycemia and examined sources of bias. RESULTS: Participants (43% women; 63% with diabetes) had a median of 9.3 (interquartile range 8.5-9.4) valid days of CGM data. Mean (SD) HbA1c, GA, fructosamine, and mean CGM glucose were 6.2% (1.4%), 19.6% (6.3%), 351 (99) µmol/L, and 170 (63) mg/dL, respectively. HbA1c, GA, and fructosamine all strongly correlated with mean CGM blood glucose, with HbA1c and GA more correlated than fructosamine (overall, r = 0.85, r = 0.87, and r = 0.70, respectively; in diabetes, r = 0.84, r = 0.84, and r = 0.64, respectively). Compared with mean CGM glucose, HbA1c was significantly biased by erythropoiesis-stimulating agent dose, BMI, hemoglobin, and serum albumin; GA and fructosamine were biased by dialysis modality and vintage, residual kidney function, and BMI. CONCLUSIONS: HbA1c and GA were strongly correlated with mean CGM blood glucose, but all biomarkers had substantial bias by relevant clinical characteristics. HbA1c and GA may be useful assessments of average glycemia in patients treated with maintenance dialysis, if bias can be adequately addressed.
Chehab RF, Greenberg MB, Lee C
… +4 more, Ngo AL, Feng J, Zhu Y, Ferrara A
Diabetes Care
· 2026 May · PMID 41779453
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OBJECTIVE: Children exposed to gestational diabetes mellitus (GDM) face an increased risk of obesity. We examined whether offspring obesity risk varied by maternal glycemic management trajectories during pregnancy compar...OBJECTIVE: Children exposed to gestational diabetes mellitus (GDM) face an increased risk of obesity. We examined whether offspring obesity risk varied by maternal glycemic management trajectories during pregnancy compared with offspring unexposed to GDM. RESEARCH DESIGN AND METHODS: This population-based prospective cohort included individuals who delivered at Kaiser Permanente Northern California (2011-2017) and their offspring with BMI measured at ages 2-10 years through 2022. Glycemic management trajectories (optimal ≥80% of glucose values meeting American Diabetes Association targets) were identified from GDM diagnosis to delivery. Associations with offspring BMI and obesity risk were estimated using adjusted generalized estimating equations. RESULTS: Among 206,464 pregnant individuals, 14,870 (7.2%) had GDM, among whom four glycemic management trajectories were identified: stably optimal (T1), rapidly improving to optimal (T2), slowly improving to near optimal (T3), and slowly improving to suboptimal (T4). Associations showed a dose-response pattern across T1-T4. By age 10, offspring in T1 had BMI (β = 0.27 [95% CI -0.13, 0.66]) and obesity risk (risk ratios 1.07 [0.91, 1.26]) similar to those of offspring unexposed to GDM. In contrast, offspring in T2, T3, and T4 had progressively higher BMI (1.00 [0.55, 1.46], 1.22 [0.67, 1.76], and 2.15 [1.48, 2.49]) and obesity risk (1.37 [1.18, 1.59], 1.53 [1.29, 1.81], and 1.62 [1.33, 1.98]). Associations were attenuated but persisted after adjustment for prepregnancy BMI. CONCLUSIONS: Early and sustained glycemic management after GDM diagnosis was associated with lower childhood obesity risk comparable to that in offspring unexposed to GDM. These findings suggest an opportunity for prenatal risk stratification and prevention for children at higher obesity risk.
Diabetes Care
· 2026 May · PMID 41778928
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OBJECTIVE: To evaluate the comparative effectiveness of dulaglutide or semaglutide versus tirzepatide on cardiovascular outcomes in adults with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). RE...OBJECTIVE: To evaluate the comparative effectiveness of dulaglutide or semaglutide versus tirzepatide on cardiovascular outcomes in adults with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). RESEARCH DESIGN AND METHODS: Two target trial emulations included commercially insured adults (June 2022-December 2024) with T2D and ASCVD who initiated subcutaneous tirzepatide, dulaglutide, or semaglutide. The primary outcome was modified major adverse cardiovascular events (MACE), defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause death. First, new users of tirzepatide and dulaglutide were propensity score (PS) matched one to one. Second, new users of tirzepatide and semaglutide were PS matched one to one. Incidence rates (IRs) per 1,000 person-years and hazard ratios (HRs) were estimated. RESULTS: After PS matching, 9,233 pairs of tirzepatide or dulaglutide initiators and 25,266 pairs of tirzepatide or semaglutide initiators were identified. Tirzepatide initiators experienced a lower rate of modified MACE versus dulaglutide initiators (IR 31.3 vs. 39.4, respectively; HR 0.80 [95% CI 0.65-0.99]), which seemed to be driven by lower all-cause mortality among tirzepatide versus dulaglutide initiators (HR 0.60 [95% CI 0.43-0.83]). In post hoc analyses, tirzepatide was associated with lower rates of pneumonia-related hospitalization when compared with dulaglutide. Rates of modified MACE were similar among tirzepatide and semaglutide initiators (IR 23.7 vs. 23.2, respectively; HR 1.03 [95% CI 0.90-1.17]). CONCLUSIONS: Among adults with T2D and ASCVD in routine care, tirzepatide was associated with a lower risk of modified MACE when compared with dulaglutide, driven by reduction in all-cause mortality. Risks of modified MACE seemed similar with tirzepatide and semaglutide.
Ganeshalingam AA, Uhrenholt N, Arnfred S
… +4 more, Gæde P, Pedersen AK, Bilenberg N, Frystyk J
Diabetes Care
· 2026 May · PMID 41778920
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OBJECTIVE: To examine the effects of semaglutide on insulin sensitivity, insulin resistance, and β-cell function and explore whether these changes were mediated by weight loss in overweight or obese individuals with schi...OBJECTIVE: To examine the effects of semaglutide on insulin sensitivity, insulin resistance, and β-cell function and explore whether these changes were mediated by weight loss in overweight or obese individuals with schizophrenia and prediabetes receiving second-generation antipsychotics. RESEARCH DESIGN AND METHODS: In this 30-week, double-blind trial, 154 participants were randomized to semaglutide (n = 77) or placebo (n = 77); 141 (91.5%) completed the study. Baseline and end-of-study assessments included fasting glucose, insulin, C-peptide, HOMA2 of β-cell function, HOMA2 of insulin sensitivity, HOMA of insulin resistance, and body weight. RESULTS: Participants (56% women, mean age 38.3 years) provided complete insulin data in 131 cases. Compared with placebo, semaglutide significantly reduced fasting glucose (-0.87 mmol/L [95% CI -1.15, -0.59]; P < 0.001), improved insulin sensitivity (8.60 [5.82, 13.65]; P = 0.001), and lowered insulin resistance (-0.69 [-1.00, -0.20]; P = 0.006). Mean weight loss was 9.2 kg and mediated improvements in insulin sensitivity (estimate 7.82; P = 0.01) and insulin resistance (estimate -0.75; P = 0.01). Nonsignificant trends were observed toward reduced fasting insulin (-52.3 pmol/L; P = 0.11) and C-peptide (-182.9 pmol/L; P = 0.096), with a modest, nonsignificant increase in β-cell function (8.10; P = 0.19). CONCLUSIONS: Semaglutide significantly improved insulin sensitivity, reduced insulin resistance, lowered fasting glucose, and promoted substantial weight loss in patients with antipsychotic-induced metabolic disturbances. Weight loss partly mediated the metabolic improvements, while β-cell function remained largely unchanged. These findings support semaglutide as a potential strategy for mitigating metabolic dysfunction in this high-risk population.
Diabetes Care
· 2026 May · PMID 41770120
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OBJECTIVE: Timely screening for type 1 diabetes can prevent life-threatening diabetic ketoacidosis and offers the opportunity to delay disease onset with emerging disease-modifying therapies. Yet, population-wide screeni...OBJECTIVE: Timely screening for type 1 diabetes can prevent life-threatening diabetic ketoacidosis and offers the opportunity to delay disease onset with emerging disease-modifying therapies. Yet, population-wide screening is costly, raising questions on whether its benefits justify the costs and the optimal age and frequency of screening. This study examined the cost-effectiveness of general population versus targeted autoantibody screening at alternative ages and frequencies. RESEARCH DESIGN AND METHODS: Using a hybrid decision tree-Markov model, this study compared six strategies defined by different populations screened (i.e., general population vs. only groups at high genetic risk or those with a family history), and frequency and age of screening (once at age 4 vs. twice, at ages 2 and 6) versus no screening. Costs were estimated from the Canadian health system perspective, and effectiveness was measured as the number of at-risk children detected. RESULTS: Compared with family history-based screening at ages 2 and 6, general population screening at age 4 cost $404,534 more but detected 35 more cases (per 10,000 children) for an incremental cost-effectiveness ratio of $11,383/case detected. General population screening at ages 2 and 6 cost an additional $462,679 and detected 18 more cases (per 10,000 children) at an incremental cost of $25,923/case detected. Screening targeted at only infants at high genetic risk involved higher costs and detected fewer cases than general population screening. CONCLUSIONS: General population screening detects more at-risk children than targeted approaches but also incurs higher costs. The incremental cost per case detected is comparable to that reported for other pediatric screening initiatives.
Sherr JL, Molinsky RL, Pakalapati T
… +4 more, Sherwood JS, Peter ME, Cornelius EM, Pettus J
Diabetes Care
· 2026 Apr · PMID 41747141
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OBJECTIVE: To assess longitudinal trends in glycemic metrics, prevalence of severe hypoglycemic events (SHEs), impaired awareness of hypoglycemia (IAH), and technology use (continuous glucose monitoring [CGM], automated...OBJECTIVE: To assess longitudinal trends in glycemic metrics, prevalence of severe hypoglycemic events (SHEs), impaired awareness of hypoglycemia (IAH), and technology use (continuous glucose monitoring [CGM], automated insulin delivery [AID]) in a real-world U.S. cohort of adults with type 1 diabetes. RESEARCH DESIGN AND METHODS: This was a cross-sectional study of adults with type 1 diabetes conducted ∼2 years after participants enrolled in the original retrospective observational study. Participants self-reported technology use, insulin delivery method, glycated hemoglobin (HbA1c), IAH, and SHEs. Change was assessed among these variables from the initial and follow-up study. RESULTS: Approximately 2 years after the original survey, 1,056 adults responded to the follow-up survey and were eligible for analysis (53% response rate; mean [SD] age: 46 [16] years; mean [SD] type 1 diabetes duration: 29 [16] years; 71% female; 97% White). Most reported using CGM in the original study (91.8%) and at follow-up (94.4%), while the use of AID increased 17.7%. In the original study, 61.7% reported HbA1c <7% vs. 67.4% at follow-up. Proportions of individuals with IAH and SHEs remained high at ∼30% and ∼20%, respectively, in both studies. CONCLUSIONS: Although most participants used CGM and the use of AID increased, approximately one-third of respondents did not achieve HbA1c targets, ∼20% continued to have SHEs in the last year, and ∼30% had IAH. This highlights that while CGM and AID systems are a significant advancement, their use alone has not mitigated the risk of severe hypoglycemia, and glucose management still remains suboptimal.