JournalTOCs

Diabetes Therapy
Journal Prestige (SJR): 1.094

Citation Impact (citeScore): 3
Number of Followers: 13

This is an Open Access Journal

Open Access journal
ISSN (Print) 1869-6953 - ISSN (Online) 1869-6961
Published by Springer-Verlag

[2468 journals]

Prevalence of Hepatic Steatosis and Fibrosis in Asian Indian Individuals
with Type 2 Diabetes
- Abstract: Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with diabetes mellitus, representing a significant health concern owing to its potential progression to cirrhosis of the liver. We aim to determine the prevalence of MASLD using transient elastography (TE by FibroScanR by Echosens, Paris) in individuals with type 2 diabetes (T2D). Methods The retrospective data (between 2020 and 2024) of 1070 individuals with T2D (who reported no alcohol intake) who underwent FibroScan assessment at two diabetes clinics were included for analysis. Steatosis was classified using controlled attenuation parameters (CAP) (dB/m) as: S0 (
  PubDate: 2025-07-03
Continuous Glucose Monitoring Systems Can Meet the Challenge of Glucose
Management and Beyond in Individuals with Type 2 Diabetes: An Expert
Multidisciplinary Position
- Abstract: The increasing prevalence of type 2 diabetes (T2D) can be considered a global healthcare emergency, with far-reaching burdens on the health and well-being of people with diabetes, their carers and families, and the mounting costs within each national healthcare economy. Although application of diabetes technologies, such as insulin pumps, continuous glucose monitoring (CGM) systems, and a range of connected devices, is starting to have an impact on the outcomes of care for people with type 1 diabetes (T1D), similar application for people with T2D is lagging behind. This is a purely cost-based decision, since evidence from numerous randomized controlled trials (RCTs) and real-world studies has shown the significant clinical impact of diabetes technologies for people with T2D, whether they are on insulin therapy or not. Amongst available technologies, it is the lack of widespread access to CGM devices for people with T2D that is most pressing, as these systems have the potential to bring a quantum change in the way people with T2D and their healthcare professionals (HCPs) are supported to manage the adverse impact both of hyperglycemia and hypoglycemia. Central to improving diabetes care for people with T2D is the demonstration in many studies that CGM can actively support healthy behavioral changes to meal planning and physical activity, with concomitant improvements in mental health and quality of life. In this expert opinion, we review the significant evidence base on which application of CGM in people with T2D is founded, and make the case for wider access for every person with diabetes as early as possible after diagnosis, in order to mitigate the global impact of T2D.
  PubDate: 2025-06-30
Perceptions of Suboptimal Insulin Dosing from People with Diabetes and
Healthcare Professionals in Germany
- Abstract: Introduction Despite advancements in diabetes therapeutics and innovations, suboptimal dosing continues to be a barrier to glycaemic control for people with diabetes (PwD). This study aimed to understand the extent of suboptimal insulin dosing and the factors underlying this behaviour from the perspective of PwD and healthcare professionals (HCPs) in Germany. Methods This analysis included 400 German PwD employing analogue insulin pens (type 1 diabetes, n = 100; type 2 diabetes, n = 300) and 160 HCPs (general practitioners, n = 80; specialists, n = 80), and was part of a cross-sectional, multinational, noninterventional web-based survey (1150 PwD and 640 HCPs). The proportion of PwD reporting missed/mistimed/miscalculated insulin doses and the mean ± SD number of insulin doses missed/mistimed/miscalculated within the last 30 days were analysed. Results Among the 400 PwD (69.5% male, 30.5% female), the mean age was 47.1 ± 13.0 years. Within the last 30 days, 47.3% of PwD missed basal insulin doses (3.5 ± 2.9 mean number of insulin doses missed) and 58.0% missed bolus insulin doses (5.0 ± 10.1). Additionally, 47.3% and 51.0% mistimed basal insulin doses (3.9 ± 4.3 mean number of insulin doses mistimed) and bolus insulin doses (5.0 ± 7.1), respectively, and 47.5% and 63.3% PwD miscalculated basal insulin doses (4.5 ± 5.0 mean number of insulin doses miscalculated) and bolus insulin doses (5.5 ± 7.5), respectively. Of the 160 HCPs (73.1% male, 26.9% female), 98.1% were qualified for> 5 years. Overall, ≥ 67% HCPs indicated that up to 30% of PwD missed/forgot/skipped, mistimed, or miscalculated an insulin dose in the last 30 days. Reasons reported by PwD and HCPs included forgetting, being out of their normal routine, being too busy or distracted, or being unsure of how much insulin to take. PwD and HCPs suggested that having a device that automatically records glucose measurements, insulin doses, and timing and having dosing calculation guidance and real-time feedback on how insulin dosing impacts glucose levels would optimise insulin dosing. Conclusion PwD are mismanaging insulin doses largely for preventable reasons. Integrated and automated insulin dosing support may optimise insulin management and improve communication between PwD and HCPs.
  PubDate: 2025-06-23
Oral Semaglutide as an Opportunity for an Appropriate Therapeutic Switch
in People with Type 2 Diabetes: A Delphi Consensus
- Abstract: Introduction The expanding range of therapeutic options for type 2 diabetes (T2D) calls for a reassessment of clinical scenarios in which existing glucose-lowering therapies might be substituted with the oral glucagon-like peptide 1 receptor agonist (GLP-1 RA) semaglutide (OS). In light of the numerous unresolved questions, a panel of experts was convened to develop practical guidance for clinicians using the Delphi consensus method. Methods A panel of 13 experts formulated 31 statements addressing the following clinical scenarios: switch from injectable GLP-1 RA to OS; switch from sodium-glucose cotransporter 2 inhibitor to OS; switch from insulin to OS; switch from dipeptidyl peptidase 4 inhibitor (DPP4i) to OS; switch from “old” oral therapies (i.e., sulfonylureas, glinides, pioglitazone, acarbose) to OS. A panel of 28 diabetologists from the Emilia-Romagna region evaluated each statement by assigning a relevance score on a 9-point scale via a dedicated online platform. The RAND/UCLA Appropriateness Method was employed to determine the presence of disagreement among panelists. Results Panelists showed agreement for all 31 statements, all considered relevant. Panelists agreed that in many circumstances OS can represent a valuable alternative to injectable GLP-1 RAs, other oral glucose-lowering drugs, and insulin. The selection of OS is justified by its proven effectiveness in reducing glycated hemoglobin and body weight, as well as its positive impact on cardiovascular outcomes and all-cause mortality. Furthermore, OS can allow a simplification of therapy in patients treated with insulin. Conclusion In an ever-evolving therapeutic landscape, OS therapy stands as a valuable option in the management of patients with T2D.
  PubDate: 2025-06-20
Safety and Efficacy of Inhaled Technosphere® Insulin in the Postprandial
Period With Modified Initial Dose Conversion
- Abstract: Introduction A post hoc analysis from a 90-day proof-of-concept study demonstrated increased efficacy and no new safety concerns for an ultra-rapid-acting inhaled insulin, Technosphere® Insulin (TI), when a higher modified conversion dose was compared to the conversion dose in the current US prescribing insert (approx. 2 × vs approx. 1.3 × TI per rapid-acting insulin analogue [RAA] unit [U] across the 1–24 U range). This post hoc analysis evaluates the safety and efficacy of the modified conversion dose in the postprandial period. Methods Participants with type 1 diabetes (T1D) were randomly assigned to administer TI using the modified dosing (TI group) or continue using their automated insulin delivery (AID) system (AID controls) in this in-clinic standardized meal challenge. Postprandial glucose was measured via capillary self-monitored blood glucose over 2 h post-meal to evaluate mean peak glucose and mean peak glucose excursion. Results The TI group (n = 21) demonstrated faster and lower mean peak glucose and mean peak glucose excursion vs AID controls (n = 5). Mean peak glucose and glucose excursion were reached 30 min earlier with TI. One TI + AID participant (modified dose) experienced one level 1 hypoglycemia event in the 2-h postprandial period and recovered in-clinic. No serious adverse events were reported. Conclusions TI group demonstrated a more favorable glycemic response in the 2-h postprandial period vs AID control. Data from this and previous studies suggest this higher modified conversion TI dose from subcutaneous RAA may help further reduce postprandial hyperglycemia in T1D. Trial Registration ClinicalTrials.gov NCT05243628.
  PubDate: 2025-06-18
Correction: Effcacy of Polyethylene Glycol Loxenatide in Combination
with Basal Insulin in Patients with Type 2 Diabetes Mellitus:
A Retrospective Real-World Study
- PubDate: 2025-06-18
Evaluating the Impact of mySugr® Mobile Health Application on Glycemic
Control in People with Diabetes Mellitus in India: A Real-World Data
Analysis
- Abstract: Introduction The rising prevalence of diabetes has driven extensive research into effective management strategies, emphasizing the importance of integrating self-management routines into daily life. This study presents real-world observations on the impact of the mySugr® app, used in conjunction with the Accu-Chek® Instant blood glucose monitoring device, on glycemic control and patient satisfaction in India. Methods This retrospective, observational, non-interventional study was conducted at 29 sites in India, involving people with diabetes (PwD) who used the mySugr® app in conjunction with the Accu-Chek® Instant glucose meter for at least 3 months. Data from electronic health records and paper-based records were analyzed. The primary objective was to evaluate changes in glycated hemoglobin (HbA1c) levels over 3 months. Additionally, the study assessed the frequency of hypoglycemic and hyperglycemic events, changes in HbA1c based on monitoring frequency, and the use of insulin and non-insulin therapies. Patient satisfaction with the mySugr® app was also assessed. Results A total of 111 PwD were included and had an average age of 53.2 years. The mean HbA1c level significantly decreased from 8.8% to 7.5% (p
  PubDate: 2025-06-17
The Clock is Still Ticking: Tirzepatide and the Myth of Halting the
Natural History of Type 2 Diabetes
- PubDate: 2025-06-17
Time Trends of Body Mass Index and its Impact on Glycemic Control Among
Finnish Patients with Type 2 Diabetes
- Abstract: Introduction Obesity prevalence has increased in Finland and is prevalent in patients with type 2 diabetes (T2D). Also, hyperglycemia in patients with T2D is partially attributed to obesity. We aimed to examine the time trends of body mass index (BMI) and glycated hemoglobin (HbA1c) control across different BMI categories among Finnish patients with T2D. Methods Regional data on the electronic health records (EHRs) covering all public healthcare services in North Karelia, Finland, were used to conduct this retrospective study. Annual patients with T2D from 2012 to 2022 were identified from the EHRs. In each study year, patients with ≥ 1 measurement of BMI and HbA1c were included. Linear and logistic regression analyses estimated with generalized estimating equations were performed to evaluate the time trends. Results The annual number of patients for analyses ranged from 5149 to 10,216 during 2012–2022. The unadjusted mean BMI declined slightly over time but increased after age adjustment (all p
  PubDate: 2025-06-16
The Predictive Value of Insulin Resistance Surrogates for Diabetic Kidney
Disease in Type 2 Diabetes Mellitus
- Abstract: Introduction Insulin resistance (IR) is a major feature of type 2 diabetes mellitus (T2DM) and plays a crucial role in the accelerated progression of diabetic kidney disease (DKD). It has been found that surrogates of IR are of high value in assessing IR status. This study aims to evaluate the associations between surrogates of IR and DKD in T2DM. Methods A total of 1026 patients with T2DM from January 2021 to February 2022 were selected in our final analysis. Logistic regression analysis and the receiver operating characteristic (ROC) curve analysis were performed to assess the correlation between IR surrogates and DKD. Results The levels of triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-waist to height ratio (TyG-WHtR), visceral adiposity index (VAI), and lipid accumulation product (LAP) were significantly higher in the microalbuminuria group and macroalbuminuria group compared with the normoalbuminuria group (P TG/HDL-C AUC > TyG-WHtR AUC > LAP AUC > 0.7 > TyG-WC AUC > metabolic index of insulin resistance (METS-IR) AUC > 0.6 > triglyceride glucose-body mass index (TyG-BMI) AUC > 0.5. Conclusions The predictive value of IR surrogates for DKD in T2DM varies. TG/HDL-C, TyG, TyG-WHtR, LAP, and VAI can effectively predict DKD and are expected to be simple and economic biological indicators of DKD risk.
  PubDate: 2025-06-15
Type 2 Diabetes Mellitus Remission, Dream or Reality' A Narrative Review
of Current Evidence and Integrated Care Strategies
- Abstract: Type 2 diabetes mellitus (T2DM) is a global health priority, with an estimated 629 million people projected to be affected by the year 2045. T2DM significantly increases the risk of atherosclerotic cardiovascular disease and other complications. Hyperglycaemia imprints early molecular and cellular changes, often termed “metabolic memory”, predisposing individuals to long-term microvascular and macrovascular complications, even after glycaemic normalisation. T2DM remission is increasingly recognised as an achievable target, offering substantial benefits such as reduced morbidity, improved quality of life, and preservation of beta-cell function. Among therapeutic options, metabolic surgery (MS) demonstrates the most significant impact, particularly for long-term outcomes. MS induces profound hormonal changes, including increased glucagon-like peptide 1 (GLP-1) levels and improved bile acid metabolism, alongside reductions in ectopic fat in the liver and pancreas, which improve insulin sensitivity and secretion. However, intensive lifestyle and pharmacological interventions, such as GLP-1 receptor agonists and glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 dual agonists like tirzepatide, also show promise, particularly when implemented early in the disease course. Predictors of sustained remission include younger age, shorter diabetes duration, lower baseline HbA1c, absence of insulin use, fewer medications and greater total weight loss percentage. Emerging tools such as the DiaRem score, machine learning models, and biomarkers like FGF-21 enhance patient stratification and predict remission likelihood. This narrative review explores the mechanisms and therapeutic options for T2DM remission, evaluates their impact on long-term outcomes and highlights the importance of early, multidisciplinary, and personalised interventions to optimize remission and improve metabolic health.
  PubDate: 2025-06-13
Association Between Baseline Diabetes Therapy-Related Quality of Life
(DTR-QOL) and Subsequent Risk of All-Cause Mortality: A Prospective Cohort
Study (Diabetes Distress and Care Registry at Tenri [DDCRT 26])
- Abstract: Introduction We aimed to examine a cohort of people with diabetes to prospectively determine the association between diabetes therapy-related quality of life (DTR-QOL) and the subsequent risk of all-cause mortality. Methods Longitudinal data of 3795 individuals with diabetes were obtained from a single-center diabetes registry from 2011. To assess the association between DTR-QOL at baseline and the subsequent risk of all-cause mortality, a Cox proportional hazards model was used with adjustment for baseline potential confounders (age, sex, duration of diabetes, body mass index [BMI], glycated hemoglobin [HbA1c] level, urinary albumin/creatinine ratio, history of diabetic retinopathy, symptomatic diabetic neuropathy, medical history, type of diabetes, and diabetes prescriptions). Results We observed 425 deaths during a median follow-up of 8.7 years. The median (interquartile range) age and HbA1c level were 66 (60–74) years and 6.9% (6.7–8.1%), respectively. The DTR-QOL was significantly associated with younger age, female sex, higher BMI, higher HbA1c level, higher proportion of symptomatic diabetic neuropathy, higher proportion of diabetic retinopathy, and higher proportion of insulin use. In total, 425 deaths occurred during the study period. Compared with the third tertile group of DTR-QOL scores, the hazard ratios (HRs) were consistently 1.38 times higher in the first tertile group. Lower scores on “burden on social activities and daily activities” domain were associated with a higher HR, while lower scores on the other domains (“anxiety and dissatisfaction with therapy,” “hypoglycemia,” and “satisfaction with therapy”) were not. Conclusion A lower QOL related to diabetes therapy in people with diabetes was found to be associated with an increased risk of future mortality. Graphical Abstract available for this article. Graphical Abstract
  PubDate: 2025-06-10
Correction to: Association Between Type 2 Diabetes Mellitus and Heart
Failure: A Retrospective Study from a Tertiary Care Diabetes Centre
in India
- PubDate: 2025-06-04
Continuous Glucose Monitoring Among People with and without Diabetes
Mellitus and Sleep Apnoea
- Abstract: The association of sleep apnoea with insulin resistance and type 2 diabetes mellitus (T2DM) is well studied. However, little is known on the impact of sleep apnoea on glycaemic variability (GV). Continuous glu...
  PubDate: 2025-06-04
Insights on Hospitalisations from the Phase 3a ONWARDS 1–6 Trials of
Once-Weekly Insulin Icodec
- Abstract: The ONWARDS programme assessed the efficacy and safety of once-weekly insulin icodec (icodec) versus once-daily basal insulin comparators in type 2 diabetes (T2D) or type 1 diabetes (T1D). This post hoc explor...
  PubDate: 2025-06-04
Outcomes in New User Cohorts of SGLT2 Inhibitors or GLP-1 Receptor
Agonists with Type 2 Diabetes and Chronic Kidney Disease
- Abstract: People with chronic kidney disease (CKD) and type 2 diabetes (T2D) have an increased risk of kidney failure and cardiovascular disease. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like pept...
  PubDate: 2025-06-04
Association Between Diabetes Management Behaviors and State-Level Social
Vulnerability: A Cross-sectional Study
- Abstract: Introduction Type 2 diabetes mellitus remains a major public health concern in the United States. Previous research demonstrates that social determinants of health, including inequities in living conditions, directly affect the biological and behavioral outcomes associated with diabetes control and prevention. New tools such as the social vulnerability index (SVI) can be used to assess these inequities. This paper aims to assess the impact of state-level social vulnerability on diabetes management behaviors. Methods We used data from the Centers for Disease Control/Agency for Toxic Substances and Disease Registry’s Social Vulnerability Index (SVI) and the Behavioral Risk Factor Surveillance System (BRFFS) Survey. The final sample included data from 2016 to 2021 and 89,643 people diagnosed with type 2 diabetes. We averaged the SVI and its component indices for each state and categorized them into terciles. The outcome measures included whether the respondents received diabetes education, conducted self-monitoring of blood glucose levels, and received medical care for diabetes. We ran logistic regressions to test the impact of the SVI on the outcomes, adjusting for state and fixed time-fixed effects and covariates. We weighted according to BRFFS guidelines. Results Individuals in states with moderate social vulnerability were 1.87 times more likely to receive diabetes education than those in states with the lowest vulnerability (p
  PubDate: 2025-05-29
Perceptions and Attitudes Toward Oral Semaglutide Among Japanese
Physicians and Individuals with Type 2 Diabetes: A Web-Based Survey
- Abstract: Introduction The oral formulation of the glucagon-like peptide-1 receptor agonist semaglutide has dosing requirements that could impact adherence. We compared perceptions of physicians and individuals with type 2 diabetes (T2D) in Japan, before and after initiating oral semaglutide, with respect to adherence to dosing requirements. Methods In this observational study, online questionnaires were completed by treating physicians and adults with T2D who had received either oral semaglutide or other oral antidiabetic medications for ≥ 6 months. Physicians reported the expected adherence of their patients to oral semaglutide and expected patient difficulties around the dosing requirements prior to (baseline) and after (time of survey) initiating oral semaglutide. Patient-reported adherence and difficulties experienced with the dosing requirements were assessed after oral semaglutide was initiated. Results Overall, 330 physicians and 412 individuals with T2D responded. There was a statistically significant difference (P
  PubDate: 2025-05-28
Time to Treatment Intensification with Glucagon-Like Peptide-1 Receptor
Agonists Versus Comparators in People with Type 2 Diabetes Treated with
Metformin
- Abstract: Introduction Treatment intensification is often required to attain glycemic targets in people living with type 2 diabetes (T2D) but can introduce regimen complexity and increase medication burden. Whether rates of treatment intensification differ by glucose-lowering medication class is unclear. This study investigated comparative treatment durability of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus standard T2D treatments, with implications for longitudinal risk mitigation and the need for treatment intensification. Methods This retrospective cohort study used US ambulatory electronic medical record data from January 2006 to November 2021 (covering market availability of first-generation GLP-1RAs) to assess time-to-treatment intensification following initiation of treatment with GLP-1RAs versus sodium–glucose cotransporter-2 inhibitors (SGLT2is), dipeptidyl peptidase-4 inhibitors (DPP-4is), and sulfonylureas (SUs) in 1:1 propensity score-matched adults living with T2D treated with metformin. The primary outcome was the time to treatment intensification (i.e., initiation of a third glucose-lowering medication). Secondary outcomes included change in glycated hemoglobin (HbA1c) level and body mass index (BMI) at 12 months after treatment initiation. Results Overall, 59,958 participants were included in this study (GLP-1RA [n = 11,933], SGLT2i [n = 13,726], DPP-4i [n = 14,415], SU [n = 19,884]). Initiation of treatment with GLP-1RAs was associated with a significantly lower rate of initiation of a subsequent glucose-lowering medication compared with SGLT2is (hazard ratio [HR]: 0.93 [95% confidence interval, CI, 0.88, 0.97]; p = 0.001), DPP-4is (HR: 0.77 [95% CI 0.74, 0.81]; p
  PubDate: 2025-05-22
Expert Opinion on Optimizing Suboptimal Basal Insulin Titration in India:
Addressing Challenges and Leveraging Digital Solutions
- Abstract: Basal insulin titration is crucial for achieving optimal glycemic control in patients with type 2 diabetes mellitus (T2DM), yet many patients and healthcare providers encounter persistent challenges in adjusting insulin doses to meet individualized targets. In October 2024, an expert panel of digital health specialists comprising endocrinologists, and diabetologists convened to discuss the limitations associated with suboptimal basal insulin titration and explore the potential of digital health solutions to address these issues. The discussion focused on how digital health tools like app-based services could facilitate more effective self-management, enhance patient engagement, and enable real-time communication in T2DM management. The panel’s deliberations underscored the promise of digital health technologies as one of the means to overcome current complexities in basal insulin titration. By leveraging real-time data monitoring, remote consultations, and tailored treatment approaches, these tools offer a scalable progress to improving glycemic outcomes and overall diabetes management.
  PubDate: 2025-05-20

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