The purpose of this review is to synthesize literature investigating the relationship between type 2 diabetes (T2D) and obstructive airway diseases and to identify implications for clinical care. Type 2 diabetes is a common and challenging comorbidity in patients with asthma and chronic obstructive pulmonary disease (COPD). Basic, translational and clinical studies support a bidirectional association between T2D and the lung. In animal models and human studies, insulin resistance and hyperglycemia are associated with pulmonary inflammation, respiratory exacerbation risk and disease severity. Corticosteroids are a mainstay for respiratory disease control and exacerbation treatment but promote ongoing metabolic dysregulation. Randomized, placebo-controlled trials of glucose-lowering medications for asthma are actively ongoing. Additional studies addressing clinical pathways to co-manage respiratory and metabolic risk are needed. Patients with comorbid T2D and asthma or COPD are at risk for worse outcomes. There are opportunities to improve cross-disciplinary care, potentially reducing risk and multimorbidity associated with both conditions.

To examine the role of pharmacologic obesity treatment in people with type 2 diabetes (T2D), with a focus on efficacy, safety, and clinical positioning in the context of T2D-specific metabolic and therapeutic challenges. Contemporary incretin receptor agonists enable clinically meaningful weight loss in people with T2D while improving glycemic control and cardio-renal, hepatic, and functional outcomes, including improvements in physical performance and symptoms in heart failure with preserved ejection fraction (HFpEF). However, weight loss is consistently attenuated compared with obesity without diabetes, reflecting reduced metabolic flexibility (impaired ability to appropriately adjust fuel utilization), background therapies, and social determinants of health rather than treatment failure. Obesity pharmacotherapy should be considered a disease-modifying component of T2D care. Treatment success should be defined by improvements in adiposity-related complications, organ protection, and patient-centered outcomes, not by fixed weight-loss thresholds. A complication-focused, individualized approach is essential to optimize long-term benefit in T2D.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a hepatic manifestation of metabolic syndrome, frequently occurring alongside type 2 diabetes (T2D), and it can present in varied phenotypes. This review provides a critical analysis of gut-adipose tissue-liver axis (GALA) dysregulation in MASLD pathogenesis, contextualizing the discussion within both established and emerging paradigms. The review elucidates how GALA dysregulation shapes the interplay between MASLD and T2D, emphasizing inter-organ crosstalk among the gut, liver, and adipose tissue, and highlighting the role of microbial metabolites, notably bile acids. The review further summarizes recent advances in stratifying MASLD into distinct clusters, examining intricate associations with cardiometabolic comorbidities, and critically evaluates novel therapeutic approaches targeting GALA modulation. MASLD can show heterogeneous phenotypes. It significantly increases the risk of developing new-onset T2D, and both conditions often coexist due to their shared pathophysiological basis in insulin resistance. The gut microbiota influences immune function and modulates host metabolism by regulating glucose tolerance and insulin sensitivity through a specific crosstalk between the gut, liver, and adipose tissue. The dysregulation of the GALA may be a mechanism underlying the interplay between MASLD and T2D, influencing IR and metabolic syndrome. A thorough investigation of GALA's role in the physiopathogenesis of MASLD and T2D highlights its potential to distinguish specific MASLD clusters and to identify personalized therapeutic strategies.

Diabetes self-management is accompanied by time-varying emotional and motivational challenges that impact mental health. These day-to-day fluctuations can be assessed via ecological momentary assessment (EMA), that allows the repeated sampling of psychosocial variables in everyday life. The benefits of EMA over questionnaires mirror the benefits of continuous glucose monitoring (CGM) over HbA1c. We describe the insights generated by combining EMA and CGM and highlight its potential. Research shows that glucose levels can influence subsequent mood, stress, cognitive functioning, and symptom reporting, with nocturnal hypoglycemia and overnight glucose being particularly relevant. Studies demonstrated the importance of differentiating between subjective person-interpreted and objectively sensor-assessed glucose levels. N-of-1 analyses revealed relevant intraindividual differences in the association between glycemic and psychosocial parameters. Combining EMA and CGM can enhance our understanding of the dynamic relationship between glycemic and psychosocial variables, supporting precision medicine approaches for mental health in diabetes.

Bariatric surgery is a highly effective treatment for obesity that yields durable weight loss with significant improvement or resolution of T2D and other weight-related chronic cardiometabolic diseases. While the advantages of laparoscopic sleeve gastrectomy (LSG), the most performed bariatric surgery procedure, include procedural simplicity, short operating time, lower complication rate, durable weight loss, and significant improvement including remission of type 2 diabetes, a major drawback is gastroesophageal reflux disease (GERD). The purpose of this review is to summarize the prevalence of and predictors of GERD after LSG, physiological mechanisms that explain the risk, and novel surgical management and strategy. Studies note high rates of de novo GERD and worsening of pre-existing GERD following LSG; however, estimates vary due to inconsistent definitions and length of follow-ups across the cohorts. Physiological studies demonstrate that LSG increases intragastric pressure and esophageal acid exposure in conjunction with specific anatomic alterations, which together can explain the rise in reflux seen postoperatively. Preoperative reflux, including undiagnosed preoperative GERD, is the strongest predictor of postoperative GERD. For patients with persistent GERD symptoms, conversion to gastric bypass is a common treatment, and experimental work suggests that adaptations of principles from fundoplication to sleeve anatomy can offer a pathway to minimize LSG-induced reflux. Future studies should be aimed at determining which elements of the antireflux barrier that must be preserved or reconstructed to reduce reflux after LSG. Additionally, there is a need to fully understand how the mechanics of fundoplication can be adapted and applied to sleeve anatomy to create a reliable antireflux barrier.

Most youth with type 1 diabetes (T1D) do not meet the guidelines for physical activity engagement, thereby diminishing potential benefits to physical and mental health. This review synthesizes the recent literature on physical activity among youth with T1D and offers recommendations for future research. Studies highlight challenges related to the use of inconsistent measurement tools, which prevent definitive conclusions about the mechanistic factors underlying low physical activity in youth. There has been limited research examining young children and youth newly diagnosed with T1D. Additionally, most interventions to promote physical activity in youth with T1D have involved structured and supervised exercise sessions, leaving a gap in knowledge regarding the potential impact of unstructured and unsupervised exercise interventions. To address these gaps, rigorous studies employing validated measures of physical activity in youth are needed. Interventions should incorporate developmentally appropriate behavioral science theories and emerging technologies in their design. Additional priorities include integrating diabetes technologies into clinical care, more real-world data to improve the accuracy of machine learning models for predicting dysglycemia, and advancing personalized mHealth interventions to promote physical activity in youth. While physical activity is an important area of pediatric diabetes research, gaps remain in our knowledge and intervention development. Physical activity consultations should be a part of routine diabetes care for youth. Research can inform these consultations by providing strategies to promote physical activity uptake and maintenance and by exploring ways to leverage new technologies to help youth with T1D exercise safely.

Purpose of ReviewThe pharmacologic management of type 2 diabetes prioritises sodium-glucose cotransporter 2 (SGLT-2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists for their demonstrated cardiovascular benefits in individuals with atherosclerotic cardiovascular disease or multiple cardiovascular risk factors, chronic kidney disease, and heart failure. However, while current guidelines recommend these drug classes alone, combination therapy is not explicitly advocated. Herein we summarise the rationale and available evidence in support for combination therapy.Recent FindingsEvidence suggests that combining SGLT-2 inhibitors and GLP-1 receptor agonists improves metabolic outcomes, including HbA1c, body weight, and blood pressure. More importantly, combination therapy can offer potential advantages for addressing residual cardiovascular risk, particularly in high-risk populations. Data from cardiovascular outcomes trials and real-world studies demonstrate consistent benefits of combination therapy across diverse subpopulations, including those with established atherosclerotic cardiovascular disease or chronic kidney disease. However, robust evidence remains limited for individuals at low cardiovascular risk, where therapy should primarily focus on metabolic goals. Of note, combination therapy faces significant barriers, including safety concerns in older or frail individuals, underutilisation in disadvantaged populations, while economic challenges may further hinder the accessibility of these therapies.SummaryUpfront combination therapy with both SGLT-2 inhibitors and GLP-1 receptor agonists could further reduce cardiovascular risk in people with type 2 diabetes, although it is crucial to pare down cost and disparities to access to maximise widespread benefits at population level.