American Diabetes Association Research Articles

Glucagon-like peptide1 receptor agonists (GLP-1RAs) have emerged as a transformative class of therapies initially developed for glycemic control in type2 diabetes mellitus. Now, they are also getting recognized for their broader cardiometabolic effects. In this review, we discuss the mechanism of action of GLP-1RAs, focusing on their proposed cardiometabolic impact and the key clinical trials that have demonstrated improvement in cardiovascular outcomes. GLP-1RAs have demonstrated benefits in coronary artery disease, heart failure, blood pressure, and atrial fibrillation irrespective of type2 diabetes mellitus status, with new possible applications in peripheral arterial disease. Findings thus far have been translated into recommendations in clinical guidelines by the American College of Cardiology, American Heart Association, European Society of Cardiology, and American Diabetes Association. As GLP-1RAs become more prevalent in treating diabetes and patients with cardiovascular disease (CVD) or risk factors for CVD, clinicians will ultimately manage the practical aspects of patient selection, dosing, special considerations, and side effects of these medications. Ongoing and future clinical trials are expected to further define the cardiovascular role of GLP-1RAs, expand their therapeutic indications, and solidify their place in the evolving landscape of cardiovascular care.

BackgroundPlantar fasciopathy is a common complication in diabetes patients.ObjectiveTo evaluate the effectiveness of ultrasound in detecting diabetic tendinopathy in type 2 diabetes mellitus (T2DM) patients by assessing plantar fascia (PF) thickness and stiffness.MethodsThis study included 70 T2DM patients with heel pain, diagnosed by American Diabetes Association (ADA). B mode ultrasound was used to evaluate PF thickness. Shear wave elastography (SWE) was used to assess PF stiffness.ResultsIn T2DM patients, the PF thickness (PFT) was significantly thicker (4.40 ± 0.79 mm vs. 2.87 ± 0.26 mm, P < 0.05) and the shear wave velocity (SWV) of PF was significantly lower (3.09 ± 0.57 m/s vs. 4.00 ± 1.01 m/s, P < 0.05) than the control group. PFT and SWV values were strongly correlated with age (r = 0.880, -0.888) and BMI (r = 0.814, -0.853). ROC analysis showed that PFT > 4.33 mm had a sensitivity of 98.0% and specificity of 77.2% for diabetic tendinopathy, with an area under the ROC curve (AUROC) of 0.956, SWV < 3.22 m/s had a sensitivity of 86.3% and specificity of 60.5% (AUROC = 0.789).ConclusionUltrasound is a non-invasive and efficient diagnostic tool for PF in T2DM patients.

Introduction: Data on prevalence of prediabetes, a high-risk condition for developing diabetes and undiagnosed diabetes, are scarce for Central Europe and lacking for Austria. Hence, we report prevalence data for prediabetes and undiagnosed diabetes in relation to age and BMI categories over a period of 7 years. Methods: We conducted an analysis of two databases: the national health insurance health check-up data 2017–2023 and the cross-sectional AUSTRO-PROFIT cohort study in people undergoing health check-ups that collected more detailed clinical data and health-related quality of life. Prediabetes and undiagnosed diabetes were diagnosed using fasting glucose values according to the American Diabetes Association criteria. Results: We investigated 6,412,591 (3,556,116 females) entries of people without previously known diabetes undergoing health check-ups from 2017 to 2023 in Austria. The crude prevalence of prediabetes was 21.084% (95% CI: 21.048–21.119) and undiagnosed diabetes was 2.950% (95% CI: 2.936–2.963), with age-standardised prevalence of 19.709% (19.708–19.710) and 2.741% (2.740–2.742), respectively. Prevalence rates for both prediabetes and diabetes remained stable over the time period of 7 years. In the AUSTRO-PROFIT cohort (N = 620), the prevalence rates were comparable with health check-up data (26.6% for prediabetes and 3.4% for diabetes). Health-related quality of life was reduced in individuals with disturbed glucose metabolism. Conclusion: Prediabetes affects approximately one-fifth of the adult population undergoing health check-ups in Austria, while in 3% undiagnosed diabetes was detected. Both conditions are associated with reduced health-related quality of life and higher rates of comorbidities.

BackgroundPrediabetes and insulin resistance are linked to the presence and progression of coronary artery calcification, but their prognostic significance in individuals with moderate-to-severe coronary artery calcification (MSCAC) remains unclear. The triglyceride–glucose (TyG) index, a validated surrogate marker of insulin resistance and a reliable predictor of cardiovascular outcomes, has not been thoroughly investigated for its role in risk stratification in patients with MSCAC. This study sought to evaluate the prognostic value of different prediabetes definitions and to determine whether the TyG index enhances risk stratification in this population.MethodsThis prospective cohort study consecutively enrolled 4195 patients with angiography-detected MSCAC. Prediabetes was defined using two criteria: the American Diabetes Association (ADA) criteria (fasting plasma glucose [FPG] 5.6–6.9 mmol/L and/or hemoglobin A1c [HbA1c] 5.7–6.4%), and the World Health Organization (WHO)/International Expert Committee (IEC) criteria (FPG 6.1–6.9 mmol/L and/or HbA1c 6.0–6.4%). The primary outcome was the incidence of major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal myocardial infarction, and stroke.ResultsThe prevalence of ADA-defined prediabetes was 36.6%, nearly twice that of WHO/IEC-defined prediabetes (17.9%). Over a median follow-up of 3.1 years, WHO/IEC-defined prediabetes was significantly associated with an increased risk of MACE compared to normoglycemia (adjusted hazard ratio [HR] 1.79, 95% confidence interval [CI] 1.07–2.99), while ADA-defined prediabetes was not. Patients in the highest TyG index tertile had a significantly higher MACE risk than those in the lowest tertile (adjusted HR 2.25, 95% CI 1.30–3.90). Restricted cubic spline analysis demonstrated a positive linear association between the TyG index and MACE risk (P for nonlinearity > 0.05). Notably, individuals with both WHO/IEC-defined prediabetes and a high TyG index had an even higher MACE risk (adjusted HR 2.43, 95% CI 1.12–5.32), whereas those with prediabetes and a low TyG index did not demonstrate a comparable increase (adjusted HR 1.60, 95% CI 0.90–2.85). Incorporating both WHO/IEC-defined glycemic status and the TyG index into the baseline risk model significantly improved its predictive accuracy compared to including either marker alone, as indicated by enhancements in the C-statistic, continuous net reclassification improvement, and integrated discrimination improvement. These findings were consistent in subgroup analyses and sensitivity analyses.ConclusionThis study highlights the prognostic value of WHO/IEC-defined prediabetes and the TyG index in identifying high-risk individuals among patients with MSCAC. Integrating these measures into clinical risk assessment may enhance prognostic accuracy and inform more targeted prevention strategies.Graphical abstract

Microvascular complications in prediabetes: a systematic review & meta-analysis.

A comprehensive systematic search will be conducted across major biomedical databases (PubMed, Scopus, Cochrane Library, Web of Science) for records published up to July 2024. We will include studies involving adults diagnosed with PD according to the American Diabetes Association (ADA) or WHO criteria, focusing on LM and pharmacological treatments. Observational and interventional study designs, including economic evaluations, will be considered. diabetes incidence (ADA or WHO glycaemic criteria). (1) CVD risk factors, (2) health utilities and (3) healthcare cost analyses. The protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guidelines and is registered with PROSPERO (CRD42024561294). Data extraction and quality assessment will be performed by two reviewers, with discrepancies resolved by the consensus of a third reviewer. Data will be narratively synthesised; if the data allow, a meta-analysis will be conducted. This systematic review was exempt from ethical approval as it involved no collection of individual patient data and posed no confidentiality risks. The findings will be shared via publication in a peer-reviewed journal or presentation at relevant conferences. CRD42024561294.

Continuous glucose monitors (CGMs) have undergone tremendous improvements over the last decade and have become a crucial tool in day-to-day diabetes management. Despite technological advancements and their proven benefits, barriers exist that may impede the use of CGMs in older adults. However, these barriers can be overcome with proper education and a support system. The purpose of this article is to highlight the common barriers associated with continuous glucose monitoring and to present approaches to overcoming these barriers for older adults.The authors conducted a PubMed search using the following terms: continuous glucose monitoring, type 2 diabetes, limitations, continuous glucose monitoring adherence, age: 65+, continuous glucose monitoring challenges age: 65+, use of CGM in elderly patients with type 2 diabetes, and barriers to use CGM in elderly patients with type 2 diabetes. They also obtained guideline information from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinology (AACE) on the use of CGMs in older individuals.Older adults may face several issues that could keep them from starting or continuing to use CGMs. These include lack of insurance coverage and concerns about cost, poor health numeracy and literacy, doubts about their ability to use CGMs, and lack of exposure to technology. Approaches such as assistance programs and comprehensive, hands-on education and training can help improve their ability, confidence, and willingness to use a CGM.CGMs have revolutionized the management of diabetes in older adults by alerting them to trends and fluctuations in their real-time glucose levels, which can be used to adjust their medications and prevent glycemic variation. Identifying an individual's specific barriers and then employing approaches to overcome them is crucial to empowering patients to benefit from CGM technology, optimize their overall diabetes management, and prevent complications. A patient must feel empowered and invested in managing their diabetes using their personal insights and the information and education they receive to guide care decisions.

IntroductionSocial determinants of health (SDoH) are key risk factors impacting diabetes outcomes. The American Diabetes Association has identified five principal SDoH categories influencing diabetes outcomes: socioeconomic status, neighborhood and physical environment, food environment, healthcare, and social context. Currently, no concise and valid instruments exist to measure the burden of SDoH factors for individuals with diabetes. To fill this gap, we developed the Diabetes Index for Social Determinants of Health (DISDOH).Research design and methodsParticipants with type 1 and type 2 diabetes were recruited from the regional Health Extension for Diabetes (HED) programme and a national crowdsourcing platform. Item development through a diabetes expert stakeholder group yielded a pool of 16 items, which were further refined through piloting with individuals living with diabetes. Principal component analysis was conducted with a sample of 440 HED participants, identifying a 5-factor solution. Confirmatory factor analysis supported this 5-factor solution using 215 individuals with type 1 and type 2 diabetes. Reliability and validity of DISDOH were also assessed.ResultsThe five DISDOH domains demonstrated acceptable internal consistency estimates: Domain 1, socioeconomic status (a=0.660); Domain 2, neighborhood and physical environment (a=0.812); Domain 3, food environment (a=0.801); Domain 4, health context (a=0.812); and Domain 5, social context (a=0.708). DISDOH showed strong convergent validity with related SDoH measures, and divergent validity was supported by weak or non-significant correlations with distinct constructs.ConclusionsDISDOH is the first validated, diabetes-specific SDoH assessment designed for brief, practical use in clinical and community settings. Unlike existing instruments, which are often lengthy and not tailored to diabetes management, DISDOH offers a concise yet comprehensive approach to identifying social risk factors that impact diabetes self-care and outcomes.

Type 2 diabetes mellitus (T2DM) is considered one of the top 3 causes of death in Indonesia. However, the current scenario regarding the management of T2DM in Indonesia remains unclear. Thus, the present study aimed to describe the baseline characteristics, treatment types, and quality of care indicators in T2DM patients under the DISCOVER CaReMe Registry program. DISCOVER CaReMe Registry program is a multi-centre, prospective, and observational study conducted over 3 years from 2018 to 2021. The data were collected from five different sites across Indonesia. A total of 539 patients with a mean age of 58.98 ± 9.76 were enrolled in the study. Among them, 62% (334/539) of patients were females. Further, the mean glycated haemoglobin (HbA1c) levels were 8.54 ± 2.88%, which was much higher than the American Diabetes Association (ADA) recommended target of 7%. Overall, 69% of the patients had HbA1c levels of >7%. First-line treatment in patients was mostly metformin (26%). As per the quality-of-care indicators, 72.2% of patients use glucose monitoring equipment and receive education about diabetes treatment and management. Furthermore, the knowledge of T2DM among patients was assessed in over 85% of cases, and misconceptions about the condition were clarified by healthcare professionals (HCPs). HCP advised a "diabetic diet" to 69.4% of patients. Despite a good knowledge and quality of care indices in patients with T2DM, the proportion of patients with HbA1c levels of >7% is still higher. There is an urgent need for diabetic management programs to prevent such complications in the Indonesian population.

Pharmacological Guideline Concordance with American Diabetes Association (ADA) Standards of Care (SoC) among Medicare Fee-For-Service (FFS) Beneficiaries with T2DM

Suboptimal glycemic control in individuals with diabetes is one of the major contributors to the development of diabetic retinopathy (DR). However, the role of ambulatory blood pressure (ABP) in this association remains unclear. The purpose of this research was to assess the associations among ABP, glycosylated hemoglobin (HbA1c), and DR in a diabetic population, with an emphasis on individuals exhibiting suboptimal glycemic and BP control. This study included 498 diabetic patients with comprehensive ABP data. The assessment of diabetes is based on the criteria of the American Diabetes Association (ADA). We adopted Least Absolute Shrinkage and Selection Operator (Lasso) regression to identify key variables and used logistic regression to investigate associations, followed by subgroup analyses. After adjustment for covariance variables, HbA1c showed a strong correlation with DR (OR: 1.228, 95% CI: 1.010-1.368). Among participants with low ABP, the prevalence of DR rises significantly with higher HbA1c levels (OR: 1.217,95% CI:1.057-1.402), whereas in those with elevated ABP (OR:1.366,95% CI:1.122-1.662), this relationship was markedly stronger, particularly in the context of Awake systolic blood pressure (SBP). Comparable findings were noted in both categorical models, as well as in subgroup analyses. However, heterogeneity was observed in subgroup analyses stratified by age. ABP may modify the relationship between HbA1c and DR; specifically, suboptimal glycemic management in patients at elevated ABP levels exacerbates the risk of DR. Therefore, it is imperative for diabetic patients to prioritize both BP regulation and glycemic management in their comprehensive disease management strategy.

BackgroundWorldwide, glucose dysregulation (GD) and diabetes mellitus are common complications in transfusion-dependent β-thalassemia (β-TDT) patients. Impaired insulin sensitivity and insulin secretion are both involved in the deterioration of glucose tolerance from a normal to a glucose-intolerant state.ObjectiveThe main aim of the present study was to evaluate the plasma glucose (PG) increment (PG %) retrospectively at two h during oral glucose tolerance test (OGTT) over fasting plasma (FPG) concentration as a simple parameter to recognize early β-cell dysfunction in normoglycemic β-TDT patients with NGT and different severities of iron overload (IOL).Patients and MethodsA total of 19 β-TDT young adult patients with normal OGTT were re-evaluated according to the American Diabetes Association (ADA) guidelines. Venous blood samples were collected at baseline and at 30, 60, and 120 minutes to determine PG (mg/dL) and insulin concentrations (μIU/mL). The time required for the PG concentration to return to the fasting level was calculated by computing the percentage increment of 2-h PG with respect to FPG (PG%), using the formula [(2-h PG-FPG)/FPG]x 100. The early phase of insulin secretion (IGI) and sensitivity were assessed by validated surrogate indices calculated from parameters obtained during the four-point OGTT.ResultsThe mean age of patients was 30.3 ± 5.7 (range: 23.10–44.3). The mean ± SD, median, and range of PG% increment between 2 h-PG and FPG were 35.5 ± 20.2, 38.7, and 0 – 68.2 mg/dL, respectively. The PG% increment was negatively correlated to the patient’s age, FPG, and IGI, and positively correlated with 2-h PG post-glucose load. IGI was negatively correlated with 1-h and 2-h PG after post-glucose load and positively correlated with oral disposition index (oDI).ConclusionsThe PG% increment is a simple, useful screening parameter that can expand the clinical weight of OGTT and can provide valuable metabolic information on β-cell dysfunction.

Iohexol clearance, but not estimated GFR, reveals a steeper GFR decline in patients with prediabetes.

To investigate the predictive value of the hepatic steatosis index (HSI) in the first trimester for gestational diabetes mellitus (GDM), and explore the association between HSI and the risk of developing GDM. A total of 2795 pregnant women were included in this cohort study. Maternal baseline data and basic laboratory data, including alanine aminotransferase, aspartate aminotransferase, fasting plasma glucose (FPG), and others were collected during 8–13 weeks of gestation. The 75-g oral glucose tolerance test was conducted at 24–28 weeks of gestation, and according to the criteria of American Diabetes Association, the participant would be diagnosed as GDM if one of the thresholds was met: fasting blood glucose ≥ 5.1 mmol/L, 1-h blood glucose ≥ 10.0 mmol/L, or 2-h blood glucose ≥ 8.5 mmol/L. The relationship between first-trimester HSI and GDM outcomes was analyzed by using Logistic Regression, Restricted Cubic Spline and Subgroup Analyses. The nomogram model including HSI, FPG and other factors was established, and diagnostic efficacies of the nomogram model, FPG, HSI, and white blood cell count (WBC) were analysed by using the receiver operating characteristic curve. 212 pregnant women were diagnosed with GDM among 2,795.After adjusting for the covariates, compared to women in the lowest quartile (Q1), those in the highest quartile group (Q4) of first-trimester HSI had a 2.328-fold risk of developing GDM (95% CI 1.262–4.295, p < 0.05). There was a positive nonlinear dose–response relationship between the first-trimester HSI and GDM (p for overall < 0.001; p for nonlinear = 0.010). Subgroup analyses found that HSI didn’t interact with covariates such as age, gravidity, parity, etc. (p > 0.05). The diagnose efficacies of the nomogram model, HSI, FPG and WBC were 0.737 (95% CI 0.702–0.773), 0.696 (95% CI 0.658–0.734), 0.631 (95% CI 0.593–0.670), and 0.569 (95% CI 0.526–0.611), respectively. First-trimester HSI, FPG, WBC, and age may jointly predict the occurrence of GDM.

Diabetic Hand Complications in Prediabetes: A Controlled Observational Study.

Machismo and Marianismo are social constructs that influence individuals' behaviors in society. These behaviors can negatively impact decisions about healthcare, potentially increasing the risk of type 2 diabetes. Analyze the relationship between Machismo, Marianismo beliefs, and the risk of Type 2 Diabetes in Indigenous Mexican adults. A cross-sectional study focusing on Nahua and Totonaca Indigenous people from the communities of Ahuacatlán and Huehuetla, in the northeastern and north of the State of Puebla. The study was conducted between March and June 2019. The study employed the Male Norms Conformity Inventory, the Marianism Belief Scale, and the American Diabetes Association Diabetes Risk Calculator. A total of 491 people participated. The average age of participants was 39.5 (SD = 7.0) years. Machismo and Marianismo were significantly correlated with diabetes risk. The Machismo dimensions associated with increased diabetes risk included work primacy, risk-taking, and status-seeking. The Marianismo belief dimensions linked to diabetes risk were submission to others and being virtuous and chaste. Machismo and Marianismo, both contribute to the increased risk of Type 2 Diabetes among Indigenous Nahuas and Totonacs in Mexico. These findings are helpful to identify and evaluate such factors in at-risk individuals, enabling the future implementation of targeted interventions.

DiaBar: Predicting type 2 diabetes remission post-metabolic surgery utilizing mRNA expression profiles from subcutaneous adipose tissue.

Diabetes mellitus is a chronic condition associated with diverse complications, and comprehensive initial evaluation at the time of diagnosis is crucial for long-term management. Recent clinical guidelines, including those of the American Diabetes Association and the Korean Diabetes Association, emphasize a structured assessment encompassing glycemic control, comorbidities, diabetes-related complications, cardiovascular and renal risks, hepatic function, psychological status, and patient self-management capacity. This review outlines the essential components of the initial evaluation based on current guidelines and proposes practical strategies for implementation in clinical practice. Focus is on timely screening for complications, cardiovascular risk stratification, and psychosocial evaluation, which serve as a foundation for personalized diabetes care and prevention of long-term adverse outcomes.

Background: Hepatitis C virus (HCV) infection is recognized not only for its hepatic complications but also for its metabolic impact, particularly its association with type 2 diabetes mellitus (T2DM). The viral-driven insulin resistance and beta-cell dysfunction significantly increase the risk of dysglycemia. While global estimates suggest a considerable burden of diabetes in HCV-infected individuals, local data in Pakistan remain limited. Understanding this comorbidity in high-burden settings is crucial to guide screening and integrated care strategies. Objective: The study aimed to determine the prevalence of T2DM among adult HCV-positive in-patients and to examine its association with age, gender, body mass index (BMI), and family history of diabetes. Methods: A descriptive cross-sectional study was conducted in the medical wards of Jinnah Postgraduate Medical Centre (JPMC), Karachi. A total of 320 adults (≥18 years) with confirmed HCV infection were consecutively enrolled. Demographic, anthropometric, and clinical details were collected, alongside biochemical assessment including fasting blood glucose (FBG) and glycated hemoglobin (HbA₁c). T2DM was defined by American Diabetes Association criteria. Univariate associations were assessed, and predictors were identified using multivariable logistic regression. Statistical significance was set at p &lt; 0.05. Results: Of the 320 participants, 96 (30.0%) were diagnosed with T2DM. Prevalence differed across age groups: 18.8% in those &lt;40 years, 36.3% in 40–59 years, and 31.3% in ≥60 years (p &lt; 0.001). Diabetes was more common among males (33.7%) than females (25.0%), though this was not significant (p = 0.08). T2DM prevalence rose with BMI: 7.8% in normal weight, 32.9% in overweight, and 76.9% in obese patients (p &lt; 0.001). A positive family history was strongly associated, with T2DM in 50.0% versus 18.0% without (p &lt; 0.001). In multivariate analysis, independent predictors included advancing age (OR 1.03, 95% CI 1.01–1.05; p = 0.002), higher BMI (OR 1.15 per unit, 95% CI 1.08–1.23; p &lt; 0.001), and family history of diabetes (OR 3.10, 95% CI 1.85–5.20; p &lt; 0.001). Conclusion: Nearly one in three HCV-infected in-patients had T2DM, far exceeding general population rates. The strong influence of age, adiposity, and family predisposition underscores the need for routine diabetes screening and integrated care pathways in HCV management within Pakistan.

The American Diabetes Association standards recommend that people with diabetes mellitus (DM) and their caregivers and family members be screened for diabetic distress at least annually, and more often if necessary. It is especially important for Ukrainians to pay attention to this, since in wartime conditions, life in stress and anxiety can increase the risk of developing DM. Objective to investigate the features of the use of continuous glucose monitoring (CGM) in patients with diabetes of the older age group against the background of sleep disorders, existing anxiety and depression. Мaterial and methods. A total of 40 patients with sleep disorders were selected and surveyed for the presence of anxiety and depression. The control group consisted of 40 diabetic patients without sleep disorders. Results. Our research revealed that among all patients with type 2 DM in the control group, 67.5% did not exhibit significant anxiety, 22.5% were suspected of having anxiety, and only 10% had a high likelihood of anxiety. In contrast, among individuals with diabetes and sleep disorders (study group), only 17.5% had no significant signs of anxiety, 27.5% were suspected of having anxiety, and 55% had a high likelihood of anxiety. When assessing patients for depression, 52.5% of the respondents in the control group showed no signs of depression, 35% were suspected of having depression, and 12.5% had a high likelihood of depression. Meanwhile, among patients with sleep disorders, 25% showed no signs of depression, 30% were suspected of having depression, and 45% had a high likelihood of developing depression. These findings indicate that anxiety and depression levels in patients with sleep disorders were nearly equal — 55% and 45%, respectively. All patients with sleep disorders were equipped with continuous glucose monitoring to assess their glycemic parameters and evaluate the impact of CGM on their emotional state. After two weeks, psychotherapy sessions were introduced in addition to CGM. Conclusions. The study demonstrated that in elderly patients, the use of CGM could provoke sleep deterioration, increased anxiety, and worsening glycemic control. However, combining psychotherapy with continuous glucose monitoring significantly improved glycemic control, reduced anxiety and depression, and consequently contributed to better sleep quality.