American Diabetes Association Research Articles

AimTo estimate the healthcare and economic burden associated with improved risk factor control for people with type 2 diabetes in Hong Kong over 10 years.Materials and MethodsWe obtained population‐based data from electronic healthcare records of the Hong Kong Hospital Authority. Risk factor targets were defined by American Diabetes Association guidelines. We applied a validated patient‐level diabetes outcomes model (Chinese Hong Kong Integrated Modelling and Evaluation) to estimate the health and economic outcomes for all individuals with type 2 diabetes (n = 526 672) in Hong Kong in 2021. Immediate risk factor control was compared to baseline over 10 years. Costs were estimated from a healthcare provider perspective.ResultsMost people (84.9%) failed to achieve optimal combined risk factors control (glycated haemoglobin, blood pressure and low‐density lipoprotein‐cholesterol) at baseline. Combined control was associated with population‐level increases in quality‐adjusted life‐years (QALYs) of 17 605 and healthcare cost savings of US$ 106.7 million over 10 years. Glycaemic control solely yielded the greatest QALY increases and had the highest cost savings (US$ 29.0 million) over 10 years.ConclusionsThe substantial population health and economic burden of inadequate risk factor control for individuals with diabetes in Hong Kong can potentially be mitigated through enhanced adherence, highlighting the need for effective and intensive interventions.

High levels of glycated haemoglobin (HbA1c) in people with type 1 diabetes (T1D) are associated with high mortality and cardiovascular risk. Physical activity is an affordable intervention that is available to most people, but the type and amount of exercise to induce metabolic benefits in T1D are not known with certainty. To determine the comparative effectiveness of diverse exercise modes and dosages to influence HbA1c in patients with T1D. The process involved systematically searching PubMed, Web of Science, Embase and The Cochrane Library databases; no limits were imposed on date or language of publication. Bayesian network and dose-response meta-analyses based on a random-effects model were carried out to assess the impact of exercise on the HbA1c levels. Nineteen studies were included in the systematic review. Only multi-component exercise (ME) significantly reduced HbA1c (-0.81%, 95% CrI: -1.33 to -0.34; SUCRA: 93.75%; low-quality evidence). High-intensity interval training (-0.38%, 95% CrI: -1.16 to 0.39; SUCRA: 51.52%) and aerobic exercise (-0.31%, 95% CrI: -0.74 to 0.16; SUCRA: 47.01%) showed no significant benefit. For ME, an L-shaped non-linear dose-response was observed, with statistical significance at 52 metabolic equivalent of task (MET-min/week) and the minimal clinically important difference (MCID; ≥ 0.5% reduction) achieved at 160 MET-min/week (-0.52%, 95% CrI: -0.89 to -0.13). The greatest reduction occurred at 1500 MET-min/week (-0.82%, 95% CrI: -1.31 to -0.27). A dose of ME necessary to achieve MCID (e.g., 10 min of running and curl-ups, three times per week) was well below the American Diabetes Association's minimum recommendation. For adolescents, we recommend combining aerobic and resistance training, performed for at least 12 weeks with 160 to 1200 MET-min/week (equivalent to 25-220 min per week), to balance effectiveness and minimise exercise burden. The high-quality randomized controlled trials of this dose range are required to confirm efficacy and evaluate safety.

Objectives: (1) To assess the prescription patterns of antidiabetic drugs in Type 2 diabetes patients in Rural Central India. (2) To assess compliance with American Diabetes Association guidelines for the management of Type 2 diabetes. (3) To assess the clinical and demographic characteristics, such as age, gender, comorbidities, and lifestyle. (4) To assess glycemic control based on glycated hemoglobin (HbA1c) levels. (5) Determine the most commonly prescribed antidiabetic treatments and drug selection factors. Methods: A retrospective observational study of 120 patients evaluated demographics, lifestyle characteristics, comorbidities, HbA1c, and prescribed antidiabetic treatments, with emphasis on guideline compliance. Results: The majority of participants (70.87%) were aged 41–60 years, with a near-equal gender distribution. While 89.17% adhered to lifestyle modifications, 54.17% were overweight, and 12.50% were obese. Risk factors included smoking (35.83%) and alcohol consumption (14.17%). HbA1c levels indicated that 55% had moderate glycemic control (6.5–8), though 16.67% had levels above 10. Common comorbidities included hypertension (45.00%), dyslipidemia (35.00%), and cardiovascular disease (22.50%). The most frequently prescribed antidiabetic therapy was the fixed-dose combination of glimepiride and metformin (54%), with insulin therapy used in 30% of cases. Adherence to American Diabetes Association guidelines was high (90%), though 10% showed non-adherence due to patient refusal or off-guideline practices. Conclusion: The study underscores the importance of holistic diabetes care, addressing lifestyle, pharmacological, and guideline adherence to improve outcomes.

BackgroundThe consumption of sorghum-based foods has been associated with reduced postprandial blood glucose levels and increased satiety in previous studies. Sorghum’s low glycemic index, high fiber content, and rich profile of bioactive compounds may contribute to improved health outcomes. Nutritional strategies incorporating sorghum could serve as a valuable tool for the prevention of diabetes, obesity, as well as other non-communicable diseases.PurposeTo identify and evaluate the evidence on the effectiveness of the sorghum-based foods in modulating blood glucose levels and promoting satiety in adults.Methods and expected outputsThis systematic review protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. We will include randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) published through February 2025 that assess the effects of sorghum-based food consumption. Qualitative studies, guidelines, and reviews will be excluded. Six electronic databases—MEDLINE/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and ScienceDirect—will be systematically searched. Additional sources will include ClinicalTrials.gov, The British Library, Google Scholar, International Diabetes Federation, and American Diabetes Association (ADA). No restrictions on language or publication date will be applied. Two independent reviewers will perform study selection, data extraction, and risk of bias assessment according to the study design. A qualitative synthesis will be presented. Statistical heterogeneity will be assessed using the I² statistic. If appropriate, a meta-analysis will be conducted using a random-effects model.Expected outcomesTo the best of our knowledge, this will be the first systematic review to specifically address the impact of sorghum-based food consumption on glycemic response and satiety. The findings are expected to provide robust evidence to inform future research and support nutritional strategies involving sorghum-based products for health promotion.PROSPERO registration IDCRD42023431520

ABSTRACT Clinical relevance Understanding early microvascular alterations in the retinal and choroidal structures of patients with diabetes mellitus is essential for the timely identification of high-risk individuals and the prevention of vision-threatening complications. Background This study evaluates the impact of diabetes mellitus (DM) on retinal and choroidal vascular structures using optical coherence tomography angiography (OCTA) in pre-retinopathic patients. It also explores the relationship between OCTA parameters and HbA1c levels, a marker of long-term glycaemic control. Methods Ninety-five right eyes of pre-retinopathic diabetic patients and 90 right eyes of healthy controls were included. OCTA was used to assess foveal avascular zone (FAZ) area, vascular densities, and retinal flow areas. Subfoveal choroidal thickness (SCT) was measured with enhanced depth imaging (EDI). FAZ shape irregularities, such as border disruptions and loss of circularity, were subjectively analysed. HbA1c levels were recorded, and participants were grouped based on the 8% threshold recommended by the American Diabetes Association. Results Vascular densities in both superficial and deep layers were significantly lower in diabetic patients (p < 0.05). The FAZ area was larger in diabetic patients (0.285 ± 0.147 mm2 vs. 0.259 ± 0.105 mm2, p = 0.029), with irregularities observed in 37% compared to 10% of controls (p = 0.000013). Patients with HbA1c > 8% had significantly larger FAZ areas (p < 0.05). Flow areas and SCT were reduced in diabetic patients (p < 0.05), though no relationship was found between HbA1c and vascular density. Spearman correlation analysis revealed that higher HbA1c levels were positively correlated with FAZ area (p < 0.05). Conclusion OCTA demonstrates its utility in detecting early microvascular changes in pre-retinopathic diabetic patients. FAZ enlargement and shape abnormalities, particularly in those with poor glycaemic control, highlight its potential role in identifying high-risk patients. These findings support the integration of OCTA into diabetic screening protocols to optimise patient management and prevent progression to retinopathy.

Screening rates for Type 2 diabetes mellitus (T2DM) in Peru remain low despite an increasing prevalence of the disease. In 2022, the American Diabetes Association (ADA) recommended screening adults aged 18-34 with overweight or obesity and at least one risk factor, including Latino ethnicity and lowered the universal screening age to 35 years. This study aimed to determine the T2DM screening prevalence in Peru and the factors associated with lack of screening in the population that meets ADA screening criteria. A cross-sectional, secondary data analysis was conducted based on the 2022 Peruvian Demographic and Health Survey database. Screening was defined as apparently healthy individuals having their blood glucose measured in the last year. Participants aged 18-34 years with overweight or obesity, as well as all participants aged ≥ 35 years, were included. Bivariate analysis was performed using the chi-squared test, and multivariate Poisson regression was used to estimate prevalence ratios (PRs), adjusting for potential confounders. Of 26,166 individuals who met inclusion criteria, 25.3% were screened for T2DM. The factors most strongly associated with lack of screening were: age 18-34 years (aPR: 1.08; 95% CI: 1.05-1.11), having only elementary education (aPR: 1.18; 95% CI: 1.13-1.23), not having health insurance (aPR: 1.15; 95% CI: 1.12-1.18), belonging to the lowest wealth quintile (aPR: 1.09; 95% CI: 1.05-1.13), and daily smoking (aPR: 1.10; 95% CI: 1.01-1.19). The national rate of screening for T2DM in Peru is low (25.3%). There is a higher prevalence for a lack of screening in people who: are younger, have only primary education, do not have health insurance, belong to the lowest wealth quintile, and are smokers. Targeted interventions are needed to improve screening coverage in these high-risk populations.

Background and objective: Prediabetes is increasingly recognized as a stage where microvascular injury begins, particularly involving renal, retinal, and neural pathways. Early detection of such changes may guide timely interventions. This study aimed to determine the frequency of early microvascular complications in prediabetic individuals and evaluate their association with clinical and biochemical risk factors.Methods: This cross-sectional observational study was conducted at Lahore General Hospital, Lahore, Pakistan, from July 2023 to June 2024. A total of 268 prediabetic adults, defined by the American Diabetes Association (ADA) 2023 criteria, were enrolled using non-probability consecutive sampling. Microvascular outcomes were assessed by urine albumin-to-creatinine ratio (UACR), the Michigan Neuropathy Screening Instrument, and the Early Treatment Diabetic Retinopathy Study (ETDRS)-based fundus photography. Biochemical tests included fasting glucose, two-hour oral glucose tolerance test (OGTT), and glycated hemoglobin (HbA1c).Results: In this study of 268 prediabetic individuals, the mean age was 46.07±7.65 years, with a higher mean age among those with microvascular changes (48.44±9.21 vs. 45.64±7.28 years; p=0.031). The mean body mass index (BMI) was 27.99±3.59 kg/m², with significantly higher values in those with microvascular changes (p<0.001). Microvascular changes were most frequent in overweight (48.8%) and obese (36.6%) participants compared to those of normal weight (14.6%; p=0.017). Hypertension (58.5% vs. 39.6%; p=0.024) and dyslipidemia (78% vs. 51.5%; p=0.002) were significantly associated, whereas smoking (p=0.126) and family history of diabetes (p=0.296) were not. Biochemical parameters were significantly higher in those with microvascular changes: fasting plasma glucose (p<0.001), two-hour OGTT (p<0.001), HbA1c (6.11% vs. 5.92%; p=0.001), and UACR (p<0.001). Microalbuminuria was detected in 10.1%, retinopathy in 4.1%, and peripheral neuropathy in 7.8%.Conclusion: Early microvascular changes were observed in prediabetes, with significant associations with age, BMI, hypertension, dyslipidemia, and glycemic indices. Screening for albuminuria, retinopathy, and neuropathy may enable timely interventions to prevent progression to diabetes and related vascular complications.

While the prevalence of type 1 diabetes (T1D) in the pediatric population has been increasing dramatically in recent years, most youths with T1D do not meet the treatment targets recommended by the American Diabetes Association. The multiple self-report scales for parents and adolescents that have been investigated in relation to treatment adherence and glycemic control in pediatric T1D show limited predictive abilities. This longitudinal observational study investigates whether the Global Assessment of Relational Functioning (GARF) can predict the medical outcome for newly diagnosed youths with T1D. The GARF is a brief structured interview assessing important areas of family functioning. The GARF assesses three main areas of family functioning: The organization, the emotional climate, and the problem-solving attributes of the family. Fifty-one youths recently diagnosed with diabetes and their families were recruited from a care facility in Canada. The age of the youths ranged from 1 to 16 years (M = 8.89; SD = 4.2), comprising 13 preschoolers, 28 school-aged children, and 10 teenagers. Including family members, a total of 139 people participated in the assessments. Correlations were sought between GARF scores, patients' serum glycosylated hemoglobin (HbA1c) and the frequency of ER visits, hospitalizations, episodes of ketoacidosis, severe hypoglycemia, insulin resistance, and mental health referrals over 21 months. The GARF score was significantly inversely correlated with outcome HbA1c scores (r = -0.61, p < 0.001), indicating that higher family functioning is associated with better metabolic control. These results suggest the GARF could be administered at diagnosis to predict diabetes outcome among a pediatric population.

Introduction: Differences in the angiographic profile of diabetic versus non-diabetic patients with ST-elevation myocardial infarction (STEMI) may influence treatment strategies and outcomes. This study aimed to compare angiographic severity and lesion characteristics between these groups.Methods: In this prospective comparative cross-sectional study, 150 consecutively enrolled STEMI patients (75 diabetics, 75 non-diabetics) were recruited at Hayatabad Medical Complex (HMC) over 12 months (July 2022-June 2023). Diabetes mellitus (DM) was defined according to American Diabetes Association (ADA) criteria or documented use of glucose-lowering therapy. Inclusion criteria were adults aged 30-80 years presenting with STEMI (per European Society of Cardiology (ESC) guidelines) undergoing primary or early invasive angiography. Exclusion criteria included prior percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG), stage IV/V chronic kidney disease, or inadequate angiographic data. Two independent interventional cardiologists, blinded to diabetes status, assessed angiograms for vessel involvement, calcification, diffuse disease, and severity using the Modified Gensini Score. Interobserver agreement was evaluated (κ = 0.87). Statistical analyses included chi-square test and t-test with reporting of 95% confidence intervals (CIs), and logistic regression was used to adjust for confounders (age, hypertension, dyslipidemia, smoking). A priori sample size of 150 was determined to provide 80% power to detect a 15% difference in triple-vessel disease (TVD) prevalence between groups (α = 0.05).Results: Diabetic patients had a higher prevalence of TVD (30, 40.0% vs. 18, 24.0%; p = 0.031, 95% CI: 1.05-3.81), diffuse disease (41, 54.7% vs. 23, 30.7%; p = 0.003, 95% CI: 1.36-4.87), and significant calcification (29, 38.7% vs. 14, 18.7%; p = 0.007, 95% CI: 1.22-4.56). The mean Gensini score was significantly higher in diabetics (42.6 ± 9.4) than non-diabetics (35.8 ± 8.7; mean difference 6.8, 95% CI: 3.4-10.2, p < 0.001). Adjusted analyses confirmed diabetes as an independent predictor of more severe and complex coronary artery disease (CAD). No significant differences were observed in culprit vessel distribution or thrombolysis in myocardial infarction (TIMI) 3 flow post PCI. At six-month follow-up, diabetics had higher rates of recurrent angina (11, 14.7% vs. 5, 6.7%), though mortality differences were not statistically significant.Conclusion: STEMI patients with diabetes demonstrate more severe, diffuse, and calcified CAD compared to non-diabetics, even after adjusting for confounders. These findings underscore the need for early, aggressive cardiovascular risk management and tailored interventional strategies in diabetic STEMI populations. Ethical approval was obtained (Ref: 757/CD/HMC/2022), and all patients provided informed consent.

Elevated glucose levels in melanoma patients - a real-world analysis.

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disease characterized by hyperglycemia due to insulin resistance, decreased insulin secretion, or a combination of both. The burden of this disease continues to increase globally, making effective, safe, and affordable management an urgent need. One widely used therapeutic strategy is the fixed-dose combination (FDC) of metformin and glimepiride. This combination is considered beneficial because the two drugs complement each other in their mechanisms of action: metformin reduces hepatic glucose production and increases insulin sensitivity, while glimepiride stimulates insulin secretion from pancreatic β-cells. Furthermore, the use of FDC can simplify the treatment regimen, thereby improving patient adherence to long-term therapy. Article searches were conducted through Google Scholar and PubMed with the keywords "((Metformin) AND (Glimepiride)) AND (T2DM) AND (Fixed Dose Combination)", covering publications from 2020–2025 in both English and Indonesian. Of the total articles found, 15 studies met the inclusion criteria for further analysis. The review results showed that the use of metformin–glimepiride FDC was able to reduce HbA1c levels between 0.33% and 2.45%, reducing fasting plasma glucose (FPG) levels by 32–65 mg/dL, and postprandial plasma glucose (PPG) by 38–103 mg/dL. Most studies reported achieving glycemic targets as recommended by the American Diabetes Association (ADA). The most commonly reported side effects were mild hypoglycemia with an incidence of 4.8%–34.5% and gastrointestinal disturbances, but the overall safety profile of this combination was still acceptable. In terms of cost, FDC was considered more economical than the use of separate single drugs. Thus, metformin–glimepiride FDC was proven to be effective, relatively safe, and affordable in glycemic control in T2DM patients, especially in countries with limited resources. These findings support its use as a primary choice in clinical practice.

Limited research has been done to evaluate the combined effect of energy reduction, Mediterranean diet (MedDiet), and physical activity on type 2 diabetes incidence. To evaluate whether an energy-reduced MedDiet (erMedDiet) plus physical activity reduces diabetes incidence compared with a standard MedDiet. Prespecified secondary outcome analysis in the PREDIMED (Prevención con Dieta Mediterránea)-Plus randomized, single-blinded, controlled trial. (ISRCTN Registry: ISRCTN89898870). 23 centers across Spain. 4746 adults aged 55 to 75 years with metabolic syndrome and overweight or obesity, without prior cardiovascular disease or diabetes. Participants were randomly assigned 1:1 to an intervention group receiving an erMedDiet (planned reduction of 600 kcal per day), increased physical activity, and behavioral strategies for reducing weight, or a control group receiving ad libitum MedDiet advice. Diabetes incidence was based on the American Diabetes Association criteria. Anthropometric measurements were obtained annually. Cox regression models were used to assess the intervention effect. The 6-year absolute risk was 12.0% (95% CI, 11.9% to 12.1%) in the control group (349 cases) and 9.5% (CI, 9.4% to 9.5%) in the intervention group (280 cases). Over a median 6-year follow-up, diabetes incidence was 31% (CI, 18% to 41%) relatively lower in the intervention group compared with the control group, with an absolute risk reduction of -2.6 cases (CI, -2.7 to -2.4) per 1000 person-years. The intervention group attained better adherence to the erMedDiet, higher physical activity levels, and greater reductions in body weight and waist circumference. Secondary outcome, single-blinded design, and self-reported dietary adherence. An intensive intervention with the MedDiet adding caloric reduction, physical activity, and modest weight loss was more effective than only an ad libitum MedDiet in reducing diabetes incidence in overweight/obese persons with metabolic syndrome. Instituto de Salud Carlos III.

IntroductionEmerging evidence highlights the role of selenium (Se) in glucose metabolism through selenoprotein-mediated antioxidant and anti-inflammatory pathways. However, population-specific data remains inconclusive. This study aims to investigate the association between dietary Se intake and prediabetes prevalence in Newfoundland, a population characterized by genetic homogeneity and high obesity rates (39.4%).MethodsThis cross-sectional study used data from 2,665 participants in the Complex Diseases in the Newfoundland Population: Environment and Genetics (CODING) study. Prediabetes was defined by the American Diabetes Association criteria for impaired fasting glucose (FPG: 5.6–6.9 mmol/L). Dietary Se intake was assessed using the Willett food frequency questionnaire and expressed as both absolute (μg/d) and body weight-adjusted (μg/kg/d) metrics. Multivariate logistic regression, generalized additive model regression, piecewise regression models, and subgroup stratification were employed to examine the association.ResultsThe study revealed a significant inverse relationship between body weight-adjusted dietary Se intake (μg/kg/d) and prediabetes prevalence in the fully adjusted models, with a non-linear threshold effect observed at 1.42 μg/kg/d. Below this threshold, each 1-unit increase in dietary Se intake (μg/kg/d) reduced prediabetes risk by 69% (OR = 0.31, P < 0.001). However, such an association did not reach statistical significance beyond 1.42 μg/kg/d. Subgroup analyses demonstrated consistent inverse associations across age groups, family history of diabetes, and history of smoking. However, the association was statistically significant in females (OR = 0.10, p < 0.001) but not in males. Absolute dietary Se intake (μg/d) showed no significant correlation with prediabetes after adjustment.DiscussionWeight-adjusted dietary Se intake (μg/kg/d) exhibits an inverse non-linear, threshold-dependent relationship with prediabetes risk in this high-risk population. The findings underscore the critical importance of body weight normalization in assessing Se’s metabolic effects and formulating Se guidelines.

Background: Non-communicable diseases (NCDs) such as hypertension and diabetes mellitus pose increasing public health challenges in developing countries. This study assessed the burden of hypertension and diabetes mellitus across three local government areas (LGAs) within the largest district of Lagos in south western Nigeria. Methods: A cross-sectional survey was conducted consecutively among 2,060 consenting residents from the three LGAs (Agege, Alimosho, and Ifako-Ijaiye) in Lagos State's largest district in November 2023. Health information officers collected data using a questionnaire during an outreach program. Prehypertension and hypertension were defined using the JNC-7 criteria, while the diagnosis of diabetes mellitus was based on the American Diabetes Association classification. Results: Among 2,060 participants, the mean age was 48.15 years; 78.3% were female, 70.4% self-employed, and 85% lacked health insurance. Prehypertension and hypertension prevalence were 34.4% and 39.5%, while 2.5% of the participants had diabetes and 7.5% had impaired blood glucose. The peak age group for hypertension was 40-59 years and above 60 years, for diabetes. Participants less than 40 years old were 5.8 times more likely to have normal BP than those over 40 years of age. Similarly, individuals with normal blood glucose were 3.87 times more likely to have normal blood pressure. Conclusion: This study revealed a high prevalence of hypertension and diabetes mellitus in Lagos Health District 1, emphasizing a major public health concern. The results underscore the urgent necessity for health interventions focused on preventing, early detection, and treatment of the increasing rates of these conditions among the population.

BackgroundThere is a lack of national data on the pooled prevalence of prediabetes among adult Saudis. This study aimed to provide a comprehensive estimate of the prevalence of prediabetes among Saudi adults.MethodsWe searched databases for cross-sectional studies conducted between January 2000 and September 2024. We included studies written in English and conducted in Saudi Arabia. The studies had to report the prevalence of prediabetes among adults (≥18 years) using American Diabetes Association (ADA) or the World Health Organization (WHO) criteria. We excluded studies that involved non-adult or non-Saudi populations. We also excluded studies published before 2000 or those without clear diagnostic criteria or prevalence data. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement guidelines. Pooled prevalence was calculated using a random-effects model. Subgroup and sensitivity analyses were performed. We assessed the quality of the included studies using the Joanna Briggs Institute (JBI) checklist for prevalence studies. We used Comprehensive Meta-Analysis software version 4.0 to perform the statistical calculations.ResultsEighteen cross-sectional studies were analyzed, including 47,718 adult Saudis from the general population. The pooled national prevalence of prediabetes among Saudi adults was estimated at 24.1% (95% CI [19.5%–29.4%]). Sensitivity analysis confirmed this pooled prevalence. Funnel plot inspection and Egger’s test indicated no substantial publication bias. Subgroup analyses revealed a higher prevalence in fasting blood glucose (FBG) studies compared to glycated hemoglobin (HbA1c) studies: 25.7% (95% CI [16.6%–37.6%]) vs. 23.7% (95% CI [16.7%–32.5%]); males had a higher prevalence than females 34.8% (95% CI [25.4%–45.5%]) vs. 18.7% (95% CI [10.9%–30.2%]). Meta-regression analysis indicated a slight upward trend in prevalence over time, with a positive coefficient for ‘Year’ (0.027).DiscussionA high pooled prevalence of prediabetes was documented among the adult Saudi population, with a markedly higher prevalence among males. These findings emphasize the need for early lifestyle interventions, optimized screening programs, and effective resource allocation to prevent the progression to type 2 diabetes. We acknowledge the high level of heterogeneity among the included studies. Additionally, we note that no eligible studies specifically from the northern region of Saudi Arabia were included in the meta-analysis.

Maintaining optimal glycemic control, as measured by hemoglobin A1c (HbA1c), is critical for preventing diabetes-related complications in older adults. The current study investigated determinants of glycemic control in older adults with diabetes in South Korea, aligning with the latest clinical guidelines from the American Diabetes Association and World Health Organization. This cross-sectional study analyzed data from the 2022 Korea National Health and Nutrition Examination Survey. A total of 372 adults aged ≥65 years with physician-diagnosed diabetes were included. Participants were categorized into well-controlled (HbA1c <7%) and poorly controlled (HbA1c ≥7%) groups. Factors influencing glycemic control, including psychological distress, physical activity, and socioeconomic variables, were assessed using binary logistic regression. Depression (Patient Health Questionnaire-9 ≥4; odds ratio [OR] = 1.986, p = 0.019), anxiety (General Anxiety Disorder-7 ≥2; OR = 1.800, p = 0.041), and insufficient strength training (<2 times/week; OR = 0.496, p = 0.025) were significant predictors of poor glycemic control. Current smoking was also associated with elevated HbA1c (OR = 2.228, p = 0.030). No significant associations were observed for demographic or socioeconomic factors. Psychological distress, insufficient strength training, and smoking are key modifiable predictors of poor glycemic control in older adults with diabetes. These findings highlight the need for integrated interventions that address mental health support, lifestyle modifications, and smoking cessation in diabetes management for older adults. Further longitudinal studies are recommended to confirm causality.

GLP-1 Receptor Agonists Associated With Improved Survival After Infrainguinal Bypass in Diabetic Patients.

The American Diabetes Association (ADA) Diabetes Medical Management Plan (DMMP) was developed to serve as a gold standard. In preparation for planned revisions to address technology updates for school professionals, we surveyed diabetes health care providers (HCPs) and school nurses to understand barriers and facilitators to DMMP use. Respondents (n = 586) were predominantly school nurses (n = 509, 87%) and represented all US regions. Using a Likert-type response scale (1 = strongly disagree to 5 = strongly agree), school nurses and HCP generally indicated that the DMMP was comprehensive (school nurses 4.41 ± 0.81 vs HCP 4.61 ± 0.49, p = .16). HCP were less likely to feel the DMMP was customizable (school nurses 4.15 ± 0.94 vs HCP 3.67 ± 1.20, p = .009). We identified 10 usability issues from comments related to formatting, customization, parent-provider co-completion, and technology. School nurse and HCP perspectives from this survey were integrated into DMMP revisions to improve functionality and inform school nurses of current management strategies.

An impaired β-cell function is a key contributor to the pathophysiology of diabetes mellitus that can be estimated by the biomarker C-peptide. Measurement of C-peptide can therefore be used for prediction, diagnosis, and subclassification of diabetes. Furthermore, C-peptide assists in the prediction of therapeutic response and guiding therapeutic decisions. To support diabetes classification, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have recently introduced serum C-peptide cut-off values in their guidelines: <0.2 nmol/L C-peptide levels suggest the presence of type 1 DM while C-peptide levels >0.6 nmol/L indicate type 2 DM. However, analytical aspects limit the clinical utility of these defined cut-off values since standardization of C-peptide measurements has not been achieved. Results from different assay manufacturers still show significant variability. This discrepancy can have significant consequences, as reliance on C-peptide testing for diabetes classification and therapeutic decisions has steadily increased in recent years. Although there have been growing calls to standardize C-peptide testing and a process for standardization has been established, standardization has unfortunately yet to be implemented in practice. It therefore seems appropriate for health care providers to advocate for standardized C-peptide measurements, which is more or less in the hands of the manufacturer of the C-peptide assays, to improve diagnostic accuracy and patient safety.

Many individuals in the community have undiagnosed glucose intolerance, type 2 diabetes (T2D), and pre-diabetes (Pre-DM). This study explored screening for unknown glucose intolerance in the emergency department (ED) in an acute hospital. 1382 persons attending the ED without T2D were screened using HbA1c. T2D and Pre-DM were classified using American Diabetes Association (ADA) and National Institute for Health and Care Excellence (NICE) criteria. The Finnish Diabetes Risk Score (FINDRISC) was calculated in all patients. According to NICE criteria, 80.1% (1107 individuals) exhibited normal glucose tolerance, 11.6% (160 individuals) exhibited pre-diabetes, and 8.3% (115 individuals) exhibited diabetes. Each unit increase in FINDRISC score, using multinomial regression, corresponded to an 8% (5-12%; p < 0.001) higher risk for pre-diabetes and a 16% (10-23%; p < 0.001) higher risk for diabetes (NICE). The risk remained elevated even after adjusting for age, sex, and ethnicity. South-Asians had higher glucose intolerance rates than white British (34.8% versus 18.5%) using the NICE criteria, and even greater at 50.0% versus 37.6% using ADA criteria. The adjusted relative risk of having pre-diabetes in people of color compared with white British individuals was 1.77 (1.04-3.00; p = 0.034, ADA) and 2.84 (1.41-5.65; p = 0.003, NICE). The multinomial relative-risk ratio (RRRs) for having diabetes by ethnicity was 2.97 (1.73-5.08; p < 0.0001, ADA) and 2.80 (1.59-4.94; p < 0.0001, NICE). Routine HbA1c screening in the ED, with FINDRISC scoring, successfully identifies individuals with diabetes and pre-diabetes. This approach could enable early intervention, particularly in groups at higher risk of glucose intolerance. ClinicalTrials.gov identifier, NCT04653545.