Anca-Maria Țucă, Alexandra Nicoleta Preda, Georgică Târtea, et al. · (2025) · "Dapagliflozin Preserves Peripheral Nerve Structure and Reduces Neuropathic Damage in Streptozotocin-Induced Diabetic Peripheral Neuropathy" · International Journal of Molecular Sciences · doi: 10.3390/ijms262412034 · PMCID: PMC12733237 · PMID: 41465463

Question: What is the published background on "Dapagliflozin Preserves Peripheral Nerve Structure and Reduces Neuropathic Damage in Streptozotocin-Induced Diabetic Peripheral Neuropathy"? Cite a peer-reviewed source.

Answer:
Diabetes mellitus (DM) is a chronic metabolic disease characterized by persistent hyperglycemia and impaired pancreatic β-cell function and/or insulin resistance, with systemic consequences at the vascular, renal, hepatic, and nervous levels [ 1 ]. In recent years, the global prevalence of diabetes has continued to increase, a situation that amplifies the burden of associated complications, including nephropathy, retinopathy, neuropathy, and cardiovascular disease [ 2 , 3 ].

The experimental model of diabetes induced by STZ administration in mice is widely used to investigate the pathological mechanisms related to β-cell destruction and secondary hyperglycemia. STZ is a cytotoxic agent with affinity for β-cells, which generates necrosis and insulin dysfunction, thus gradually generating a model of type 1 or “cytotoxic” type diabetes, depending on the scheme (dose, number of injections) [ 4 , 5 ]. Furthermore, this model allows for the assessment of metabolic, oxidative–inflammatory, and apoptotic changes induced by hyperglycemia, in addition to testing therapeutic strategies with translational potential [ 5 ].

In this paradigm, inhibitors of the sodium–glucose cotransporter 2 (SGLT2) have attracted considerable attention. Dapagliflozin, one such SGLT2 inhibitor, has been approved for clinical therapy of type 2 diabetes, with effects on blood glucose lowering, body weight reduction, and cardiovascular and renal protection [ 6 , 7 , 8 ]. Furthermore, recent experimental data suggest that dapagliflozin may exert beneficial effects beyond glucose metabolism, including reducing oxidative stress, inflammation, fibrogenesis, and apoptosis in diabetic target organs [ 9 , 10 , 11 , 12 ]. Building on these observations, the glucose-independent actions of dapagliflozin appear to be mediated through several interconnected molecular pathways, including activation of the AMPK/SIRT1 pathway, leading to improved mitochondrial function and reduced ROS production; inhibition of NF-κB signaling and downstream pro-inflammatory cytokines; attenuation of TGF-β-mediated fibrogenic pathways; and modulation of apoptotic balance by decreasing pro-apoptotic markers (e.g., Bax) and enhancing anti-apoptotic signaling (e.g., Bcl-2) [ 9 , 10 , 11 , 12 ].

In the context of the STZ model, preclinical studies have demonstrated that dapagliflozin administered to diabetic mice or rats can ameliorate renal, cardiac, or hepatic damage through mechanisms involving activation of the 5’ AMP-activated protein kinase (AMPK) pathway, inhibition of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), reductions in reactive oxygen species formation, and improvements in mitochondrial dysfunction [ 13 , 14 , 15 ].

Despite the progress made, the extension of the beneficial effects of dapagliflozin on metabolic, oxidative, and apoptotic parameters in an experimental model of STZ-induced diabetes in mice remains unclear. In addition, in the current literature, a “classical” preclinical study (in diabetic rats/mice) evaluating dapagliflozin directly on diabetic peripheral neuropathy (DPN) with standard neuropathy endpoints (nerve conduction, intraepidermal fiber density, hyperalgesia, etc.) is lacking. The evidence in this regard is not yet robust and generalized.

Large, long-term clinical trials with a primary hypothesis of “neuropathy” are still limited. In clinical practice, the treatment of diabetic neuropathy remains focused on glycemic control, risk factor control (hypertension, dyslipidemia), symptom relief (pain, paresthesia), and not necessarily on proven disease modifiers, agents improving long-term disease outcomes [ 16 , 17 , 18 ].

Therefore, the present study aims to investigate the effects of dapagliflozin administration in STZ-induced diabetic mice on glycemic control, clinical profile, oxidative stress, behavioral changes, and possible histopathological changes in peripheral neuropathy.

— Source (introduction, peer-reviewed): Anca-Maria Țucă, Alexandra Nicoleta Preda, Georgică Târtea, et al. · (2025) · "Dapagliflozin Preserves Peripheral Nerve Structure and Reduces Neuropathic Damage in Streptozotocin-Induced Diabetic Peripheral Neuropathy" · International Journal of Molecular Sciences · doi: 10.3390/ijms262412034 · PMCID: PMC12733237 · PMID: 41465463
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


David J. Johnson, Laura A. Buchanan, Erin M. Saner, et al. · (2026) · "Psychological Aspects and Implications of Food Addiction and Glucose Control in Type 2 Diabetes: A Pilot Mixed-Methods Study" · Healthcare · doi: 10.3390/healthcare14040420 · PMCID: PMC12941053 · PMID: 41753934

Question: What is the published background on "Psychological Aspects and Implications of Food Addiction and Glucose Control in Type 2 Diabetes: A Pilot Mixed-Methods Study"? Cite a peer-reviewed source.

Answer:
As of 2021, the Centers for Disease Control estimated that more than 38 million people in the United States were living with diabetes and over 97 million with prediabetes, underscoring the scale of dysglycemia as a public health challenge [ 1 ]. Type 2 Diabetes (T2D) management hinges on daily self-care behaviors, dietary choices, physical activity, medication use, and glucose monitoring, yet many individuals struggle to translate education into sustained behavior change [ 2 ]. Dysregulated eating, emotional eating, and loss of control around highly processed foods are strongly correlated with T2D [ 3 ].

In the face of the growing epidemic of diabetes, the introduction of continuous glucose monitors (CGMs) has changed how these patients view the direct relationship between their food intake and subsequent glucose readings [ 4 ]. Food addiction (FA) has emerged as a construct capturing compulsive, addictive-like responses to ultra-processed foods rich in refined carbohydrates and fats [ 5 ]. Population data indicates that prevalence of FA as measured by the modified Yale Food Addiction Scale (mYFAS) affects approximately 20% of adults, and with rates as high as 30% in T2D [ 6 ]. Although the FAconstruct remains an area of active debate, symptom-based measures such as the mYFAS 2.0 offer a pragmatic way to examine addictive-like eating behaviors relevant to diabetes self-management. FA symptoms, including cravings, diminished control, and continued overeating despite negative consequences, are associated with higher BMI, binge-eating pathology, and metabolic risk, and may help explain why some individuals experience disproportionate difficulty adhering to standard dietary recommendations [ 3 , 5 , 6 ]. Identifying and targeting FA-related mechanisms in T2D could therefore offer novel pathways to improving both behavioral adherence and glycemic outcomes.

CGMs have transformed how people with diabetes perceive the relationship between their daily choices and glucose fluctuations. Real-time continuous glucose monitoring systems provide near-continuous glycemic data, visual trend arrows, and summary metrics (e.g., time-in-range, glycemic variability) that can be used to guide both pharmacologic adjustments and lifestyle decisions [ 4 , 7 ]. Professional societies now recommend CGMs for selected adults with T2D to improve glycemic control and reduce hypoglycemia [ 8 , 9 , 10 , 11 ]. Recent qualitative and mixed-method studies in adults with T2D report that CGM can increase motivation, confidence in self-management, and perceived control by making glucose responses to meals and activities more visible and personally meaningful [ 12 , 13 , 14 , 15 , 16 ].

Beyond biomedical utility, CGMs can be conceptualized as a behavioral feedback tool embedded within self-regulation frameworks. Self-regulation and feedback-control frameworks propose that timely, interpretable feedback strengthens the perceived connection between behavior and physiological outcomes, thereby supporting self-monitoring and reinforcing adaptive health behaviors [ 17 , 18 ]. Early work has suggested that CGM-guided behavioral education and intermittent CGM use may prompt dietary modifications, increase awareness of physiological responses, and facilitate problem solving around glycemic excursions [ 19 , 20 , 21 , 22 ].

Parallel advances in digital health services offer additional context. Mobile health apps, Short Message Service (SMS)-based programs, and wearable activity trackers have been shown to improve self-management behaviors, self-efficacy, and in some cases glycemic outcomes in T2D by providing real-time or near-real-time feedback, goal tracking, and prompts [ 23 , 24 , 25 , 26 , 27 ]. For example, diabetes self-management apps and text-messaging interventions have improved hemoglobin A1c (HbA1c) and self-care behaviors by combining monitoring with tailored feedback and coaching [ 23 , 24 ]. Wearable activity trackers similarly leverage immediate feedback, self-monitoring, and goal setting to increase physical activity and support metabolic health that have explicitly examined how CGM, as a glucose-specific feedback modality, may influence addictive-like eating among adults with T2D [ 25 , 26 ].

The present mixed-methods study examines how CGM, when integrated into a structured group medical visit (GMV) program, may act as a feedback mechanism that strengthens awareness, accountability, and motivation around dietary behavior in adults with T2D. We assess changes in glycemic outcomes, patient activation, and FA symptoms (using the modified Yale Food Addiction Scale 2.0) and integrate these quantitative improvements with participants’ qualitative accounts of CGM-supported behavior change. By focusing on adults with T2D engaged in CGM-supported GMVs, this study aims to generate preliminary evidence on CGM’s potential to function as a behavioral intervention targeting both metabolic control and addictive-like eating.

— Source (introduction, peer-reviewed): David J. Johnson, Laura A. Buchanan, Erin M. Saner, et al. · (2026) · "Psychological Aspects and Implications of Food Addiction and Glucose Control in Type 2 Diabetes: A Pilot Mixed-Methods Study" · Healthcare · doi: 10.3390/healthcare14040420 · PMCID: PMC12941053 · PMID: 41753934
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


Jurga Šuminienė, Rimantas Stukas, Virginija Gaigalaite, et al. · (2026) · "Continuous glucose monitoring, diabetes distress, and well-being in adults with type 1 diabetes: findings from a National Survey in Lithuania" · Frontiers in Clinical Diabetes and Healthcare · doi: 10.3389/fcdhc.2026.1708124 · PMCID: PMC13021413 · PMID: 41908910

Question: What does the published research conclude about "Continuous glucose monitoring, diabetes distress, and well-being in adults with type 1 diabetes: findings from a National Survey in…"? Cite a peer-reviewed source.

Answer:
In this national survey of adults with type 1 diabetes in Lithuania, CGM use was associated with lower diabetes distress and higher hypoglycemia confidence compared with flash glucose monitoring. CGM was not independently associated with good general well-being after adjustment, suggesting that observed associations may operate indirectly through glycemic stability and hypoglycemia-related emotional factors. Associations appeared more pronounced in selected higher-risk subgroups; however, given the cross-sectional design and exploratory subgroup analyses, these findings should be interpreted cautiously. Longitudinal studies are needed to clarify temporal relationships and potential causal pathways.

Overall, the results support consideration of CGM as part of comprehensive, patient-centered diabetes care frameworks, particularly for individuals at elevated psychosocial vulnerability.

— Source (conclusions, peer-reviewed): Jurga Šuminienė, Rimantas Stukas, Virginija Gaigalaite, et al. · (2026) · "Continuous glucose monitoring, diabetes distress, and well-being in adults with type 1 diabetes: findings from a National Survey in Lithuania" · Frontiers in Clinical Diabetes and Healthcare · doi: 10.3389/fcdhc.2026.1708124 · PMCID: PMC13021413 · PMID: 41908910
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


Khaled Alselwy, Mogeeb Saeed · (2026) · "Awareness of Vital Complications and Associated Factors Among Type 2 Diabetic Patients in Al‐Hudaydah, Yemen: A Cross‐Sectional Study" · BioMed Research International · doi: 10.1155/bmri/3230665 · PMCID: PMC12831128 · PMID: 41583544

Question: What is the published background on "Awareness of Vital Complications and Associated Factors Among Type 2 Diabetic Patients in Al‐Hudaydah, Yemen: A Cross‐Sectional Study"? Cite a peer-reviewed source.

Answer:
Diabetes mellitus (DM) is a chronic inflammatory disease that leads to severe and even fatal complications. It is a significant public health challenge in Yemen, with a mortality rate of 15.42 per 100,000 people in 2020, ranking Yemen 120th globally for diabetes‐related mortality [ 1 ]. Common complications of Type 2 diabetes mellitus (T2DM) include diabetic nephropathy, acute coronary syndrome, retinopathy leading to vision impairment, cataracts, and myocardial infarction. These complications often develop gradually during the undiagnosed period preceding diagnosis owing to the inability of the body to control the disease process properly [ 2 – 7 ].

Awareness and early detection of diabetic complications are vital to reduce this alarming burden. Previous studies in Yemen have reported low awareness among T2DM patients regarding potential complications, especially cardiovascular risks [ 8 – 10 ]. Understanding hypoglycemia symptoms can vary depending on individual treatment regimens and health literacy levels [ 11 , 12 ]. This study is aimed at assessing the awareness of diabetes complications, especially retinopathy, nephropathy, and hypoglycemia symptoms, and associated factors among patients with T2DM attending state‐run hospitals and clinics in Al‐Hudaydah, Yemen. The primary goal is to help reduce diabetes‐related morbidity and mortality in the country by improving patient awareness and guiding targeted educational programs.

— Source (introduction, peer-reviewed): Khaled Alselwy, Mogeeb Saeed · (2026) · "Awareness of Vital Complications and Associated Factors Among Type 2 Diabetic Patients in Al‐Hudaydah, Yemen: A Cross‐Sectional Study" · BioMed Research International · doi: 10.1155/bmri/3230665 · PMCID: PMC12831128 · PMID: 41583544
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


Erin R. Giovannetti, Rachael O. Lee, Robert L. Thomas, et al. · (2025) · "Continuous Glucose Monitoring–Guided Insulin Infusion in Critically Ill Patients Promotes Safety, Improves Time Efficiency, and Enhances Provider Satisfaction" · Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · doi: 10.1016/j.eprac.2025.05.751 · PMCID: PMC13043021 · PMID: 40562360

Question: What did the discussion section of the paper "Continuous Glucose Monitoring–Guided Insulin Infusion in Critically Ill Patients Promotes Safety, Improves Time Efficiency, and Enhances Provider Satisfaction" cover?

Answer:
The integration of rtCGM into critical care settings, particularly for ICU patients on insulin infusions, offers significant benefits. Our study demonstrates that rtCGM, when used in real-world settings with ongoing clinician validation and an IICC, provides high accuracy glucose measurements and maintains patient safety with low hypoglycemia rates. Specifically, just 0.2% of matched CGM and POC glucose values were <70 mg/dL, and we observed a 0.5% time below 70 mg/dL and 0.1% time below 54 mg/dL based on CGM metrics. Severe hypoglycemia remains a major concern in intensive insulin therapy due to its association with increased mortality and adverse neurological outcomes. Traditional blood glucose monitoring, which relies on intermittent POC measurements, may miss critical glucose fluctuations, leading to delayed detection of both hypo- and hyperglycemia. By providing continuous glucose data along with alarm capabilities, rtCGM enables earlier intervention and a more proactive approach to glucose management. Our protocol, in which a POC test was performed when glucose levels fell below 100 mg/dL, ensured timely confirmation and intervention, and further enhanced patient safety. Our findings align with previous studies supporting the safe use of rtCGM in critically ill patients, including those with shock, edema, and ECMO. 9 , 21

The low MARD of 12.5% between CGM and POC measurements, with 99.6% within zone A and B of the consensus error grid, further underscores the reliability of rtCGM in the ICU settings. While other studies have reported MARD values of 13.2% 21 and 13.9% 9 using a hybrid POC-CGM protocol for titration of an insulin infusion, our study is the first to show improved accuracy using the Dexcom G7 sensor. Another key advantage of rtCGM is its significantly faster TAT compared to POC glucose testing. While POC testing takes an average of nearly 5 minutes, rtCGM provides glucose readings in 3 seconds, offering substantial time savings ( Fig. 4 ). Over a 12-hour nursing shift, this could save an estimated 50 minutes, allowing more time for other critical patient care tasks. The reduction in manual glucose testing not only enhances efficiency but also reduces the burden on ICU staff, supporting overall workflow improvements.

In our study, critical care nurses reported high satisfaction with rtCGM implementation, citing reduced workload, improved efficiency, and perceived patient safety as key benefits. Additionally, rtCGM alarm capabilities and glucose trend arrows facilitated earlier recognition of impending hypoglycemia, allowing clinicians to intervene before critical glucose thresholds were reached. Given that ICU clinical decisions rely heavily on continuous physiologic monitoring, rtCGM has the potential to function as a vital sign itself, providing continuous glucose data rather than intermittent glycemic snapshots. This more proactive approach to glycemic monitoring and management could not only improve glycemic outcomes but may also help optimize resource utilization by reducing the frequency of POC testing and manual insulin adjustments. As a result, CGM-guided protocols have the potential to lower overall health care costs while enhancing patient safety.

We acknowledge the small sample size ( N = 35) and single-site, retrospective design limits the generalizability of our findings. However, we were encouraged by the diversity of our study population, including 45% non-White participants. Despite this strength, limitations in statistical power and demographic breadth should be considered when interpreting the results. While our study demonstrates potential benefits of CGM, there are areas that warrant further exploration. First, future studies should explore the optimal calibration strategies for CGM use in critically ill populations, as recent studies suggest that calibration frequency may impact MARD and SDRD in highly dynamic glucose environments. 22 , 23 Additionally, further research is needed to refine hospital-wide CGM-driven protocols, particularly in integrating rtCGM into the EHR for streamlined workflow implementation. Studies by Finn et al 24 and Lee et al 5 have demonstrated the feasibility of CGM policies following hospital-wide EHR integration across acuity levels. Investigating these factors will be essential to refining CGM as a clinical parameter and maximizing its impact on patient outcomes.

In conclusion, integrating rtCGM into the management of ICU patients on insulin infusions provides a promising strategy for enhancing patient safety, improving clinical outcomes, and reducing clinician workload. The combination of real-time glucose data and algorithm-driven insulin dosing offers an effective, efficient approach to managing glycemic variability in critically ill patients. By mitigating hypoglycemia risk, improving glycemic stability, and reducing the burden of frequent glucose monitoring, rtCGM has the potential to transform ICU glycemic management. As hospitals increasingly adopt digital health innovations, future research should focus on validating CGM-driven protocols, training clinician teams on CGM workflows, investigating rtCGM as a safety-net for prompting clinically significant unscheduled POC checks, and assessing the longitudinal impact of CGM implementation on morbidity and mortality in critically ill populations.

— Source (discussion, peer-reviewed): Erin R. Giovannetti, Rachael O. Lee, Robert L. Thomas, et al. · (2025) · "Continuous Glucose Monitoring–Guided Insulin Infusion in Critically Ill Patients Promotes Safety, Improves Time Efficiency, and Enhances Provider Satisfaction" · Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · doi: 10.1016/j.eprac.2025.05.751 · PMCID: PMC13043021 · PMID: 40562360
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


I-Chia Liang, Hsiang-Wen Chien, Kai Wang, et al. · (2026) · "Potential influence of carbonic anhydrase 9 genetic variants and expression levels on the progression of diabetic retinopathy" · International Journal of Medical Sciences · doi: 10.7150/ijms.131188 · PMCID: PMC13133891 · PMID: 42080080

Question: Summarize the abstract of the paper titled "Potential influence of carbonic anhydrase 9 genetic variants and expression levels on the progression of diabetic retinopathy".

Answer:
Diabetic retinopathy (DR) represents one of the most common microvascular complications of diabetes, and proliferative diabetic retinopathy (PDR) is the most vision-threatening form. Carbonic anhydrase IX (CA9), a hypoxia-inducible enzyme, has been implicated in several pathological processes, but its involvement in DR has not been clarified. In this study, three CA9 single nucleotide polymorphisms (rs3829078, rs2071676, and rs1048638) were genotyped in diabetic patients with and without DR. Clinical characteristics were compared between groups, and expression analyses were conducted using public databases and ARPE-19 cells under hyperglycemic and hypoxic conditions. No significant association was observed between CA9 variants and DR susceptibility in the overall cohort. However, among patients aged ≤60 years, carriers of the rs1048638 C/A and C/A + A/A genotypes exhibited a significantly increased risk of PDR. Expression quantitative trait locus (eQTL) data from the GTEx database revealed higher CA9 mRNA expression in tissues harboring the rs1048638 A allele. Moreover, both transcriptomic data and in vitro experiments demonstrated upregulation of CA9 in ARPE-19 cells exposed to high glucose and hypoxia. These findings suggest that the rs1048638 polymorphism may modulate CA9 expression and contribute to PDR development in younger diabetic patients through hypoxia- and glucose-related mechanisms. Collectively, our findings suggest that CA9 may serve as a potential risk biomarker associated with the progression of DR, particularly in younger patients.

— Source (abstract, peer-reviewed): I-Chia Liang, Hsiang-Wen Chien, Kai Wang, et al. · (2026) · "Potential influence of carbonic anhydrase 9 genetic variants and expression levels on the progression of diabetic retinopathy" · International Journal of Medical Sciences · doi: 10.7150/ijms.131188 · PMCID: PMC13133891 · PMID: 42080080
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


Chidera Okoro, Carla J.H. van der Kallen, Sara B.A. Mokhtar, et al. · (2025) · "Arterial stiffness is associated with small and large fiber neuropathy: The Maastricht Study" · Journal of Hypertension · doi: 10.1097/HJH.0000000000004126 · PMCID: PMC12582623 · PMID: 41123059

Question: What did the discussion section of the paper "Arterial stiffness is associated with small and large fiber neuropathy: The Maastricht Study" cover?

Answer:
This population-based study has two main findings. First, greater arterial stiffness, as determined by cfPWV, was significantly associated with lower small nerve fiber thickness and function, as shown by the lower composite Z scores for retinal nerve layer thickness, retinal sensitivity, and corneal nerve measures. Second, greater arterial stiffness was significantly associated with impaired large nerve fiber function, as shown by lower composite Z scores for peripheral nerve conduction velocities and lower Z scores for tibial nerve amplitude, along with a higher Z score for peripheral vibration perception thresholds. Importantly, these associations were independent of confounders, such as diabetes, hypertension, renal insufficiency, and prior cardiovascular disease. The strength of these associations was that each SD greater arterial stiffness was equivalent to approximately 1–5 years of additional aging in nerve functioning and structure, respectively.

To our knowledge, this is the first large population-based study to demonstrate that arterial stiffness is consistently associated with both ocular (small) and peripheral (large) fiber neuropathies. Specifically, our findings showed significant associations between arterial stiffness and individual components of retinal nerve layer thickness, retinal sensitivity, corneal nerve measures, peripheral nerve conduction velocities, amplitudes, and peripheral vibration perception thresholds. These findings provide new insights into the potential link between arterial stiffness and neuropathic process of both small and large nerve fibers.

Our findings are consistent with those of previous studies [ 10 – 13 , 27 – 29 ], suggesting a relationship between arterial stiffness and neuropathy. However, these studies were either relatively small [ 10 – 13 ] or did not use cfPWV [ 15 , 27 ]. Huang et al. [ 15 ] found no association between arterial stiffness and retinal neuropathy in a large population-based study. However, arterial stiffness was calculated as the arterial stiffness index using pulse waveforms from the finger, which has only been moderately correlated with cfPWV [ 30 ]. This may explain the contrasting results from the present study, as we used cfPWV, which is widely regarded as the gold standard [ 14 ] for evaluating arterial stiffness.

We observed that greater arterial stiffness was associated with lower composite scores for retinal, corneal, and peripheral nerve functions. The advantage of using composite scores is that the impact of technical and biological variability is reduced. Importantly, associations with the individual components of the scores showed directionally similar results (Table S5).

The mechanisms linking arterial stiffness and neuropathy remain incompletely understood. A plausible explanation involves microvascular dysfunction, which may arise due to mechanical stress exerted by increased pulsatile energy on endothelial cells [ 31 ]. Endothelial dysfunction involves impaired regulation of vasodilation and vasoconstriction as well as impairment of antithrombotic and anti-inflammatory properties, setting the stage [ 32 ] for a chronic inflammatory response [ 33 , 34 ], creating a self-perpetuating cycle that further exacerbates endothelial dysfunction. Additionally, localized thrombosis within the microcirculation [ 35 ] may obstruct blood flow, leading to inadequate nutrient delivery to the nerves while simultaneously promoting heightened permeability of adjacent blood vessels. The latter, in turn, may allow infiltration of inflammatory cells and molecules into nerve tissue. Interestingly, we found that greater arterial stiffness was associated with lower peripheral nerve conduction velocities but was only partially associated with lower peripheral nerve amplitudes. This may be because the process of demyelination (i.e. lower peripheral NCV) occurs first, while axonal loss (i.e. lower peripheral nerve amplitude) manifests at a more advanced stage, as has been reported in previous studies [ 36 , 37 ].

Our findings have clinical implications. The observed associations between greater arterial stiffness and both small-fiber and large-fiber neuropathy highlight the importance of vascular health in patients with neuropathy. Clinicians may consider testing for neuropathy in patients with worse cardiovascular health and, conversely, optimize cardiovascular risk management when treating patients with established neuropathy. Further interventional research is needed to investigate whether such interventions are beneficial.

Our study has several strengths. First, the inclusion of a large population-based cohort, notably oversampled for individuals with type 2 diabetes, allowed us to investigate our hypothesis specifically within this population. Second, we used cfPWV, which is considered the gold standard for assessing arterial stiffness. Third, we adjusted for mean blood pressure derived from 24-h blood pressure monitoring. Fourth, our analysis involved comprehensive adjustments for a wide range of potential confounding variables, and our results were robust after many additional adjustments.

The present study has some limitations. First, due to the cross-sectional design, we cannot draw conclusions about causality. Reverse causality is also possible, as previous research suggests that diabetic neuropathy may contribute to arterial stiffening through mechanisms, such as reduced vascular innervation and increased arterial calcification [ 38 ]. Second, residual confounding cannot be excluded. We did not account for potential shared pathophysiological mechanisms such as endothelial dysfunction, low-grade inflammation, and oxidative stress, which may underlie both neuropathy [ 39 ] and arterial stiffness [ 40 ], which may have overestimated our results. Third, our study primarily focused on a Caucasian population aged 40–75 years. Consequently, the generalizability of our findings to other demographic groups and age ranges remains uncertain. Further research is required to investigate these associations in diverse ethnic populations and across different age groups.

In conclusion, the present population-based study demonstrated that greater arterial stiffness, determined by cfPWV, was associated with ocular (small) and peripheral (large) fiber neuropathy. These results were independent of important confounders, such as diabetes, hypertension, renal insufficiency, and prior cardiovascular disease. Future longitudinal research is needed to clarify whether arterial stiffening is a direct cause of neuropathy.

— Source (discussion, peer-reviewed): Chidera Okoro, Carla J.H. van der Kallen, Sara B.A. Mokhtar, et al. · (2025) · "Arterial stiffness is associated with small and large fiber neuropathy: The Maastricht Study" · Journal of Hypertension · doi: 10.1097/HJH.0000000000004126 · PMCID: PMC12582623 · PMID: 41123059
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


Yuxia Wei, Tomas Andersson, Shengxin Liu, et al. · (2025) · "Stable heritability of type 1 diabetes in a Swedish Nationwide Cohort Study" · Nature Communications · doi: 10.1038/s41467-025-60813-2 · PMCID: PMC12174315 · PMID: 40527903

Question: What is the published background on "Stable heritability of type 1 diabetes in a Swedish Nationwide Cohort Study"? Cite a peer-reviewed source.

Answer:
The incidence of childhood-onset type 1 diabetes (T1D) has been increasing worldwide since the 1950s, with an annual increase of 3–4% 1 , 2 . It is unclear if this trend is due to a rise in nongenetic (environmental) risk factors, increasing genetic susceptibility of the population or a combination.

Environmental explanations are generally favored since it seems unlikely that the genetic makeup of the population changes in a few decades and because incidence varies markedly between genetically similar populations 1 , 3 . Notably, the rise in T1D coincides with a rise in childhood obesity 4 , a proposed risk factor for T1D 5 , 6 . Other suggested risk factors include early-life factors like maternal smoking (protective) 7 , higher maternal age at delivery 8 and breastfeeding (protective) 9 . To what extent the prevalence of these factors has changed and contributed to a rise in the incidence of T1D is unclear.

Heritability is the proportion of phenotypic variance (including variance explained by genetic and environmental factors) in a disease explained by all genetic factors. T1D heritability has been estimated at between 50% and 88% in twin or other family-based studies of different populations 10 – 13 and we recently estimated it at 81% in Swedish children 14 . If the increasing T1D incidence is mainly driven by environmental factors, the relative contribution of environmental factors to T1D variance would be expected to increase and heritability decrease over time 15 . As far as we know, no previous study has investigated whether T1D heritability has changed over the last decades. However, a previous study from Australia indicates that the proportion of T1D cases with the highest-risk human leukocyte antigen (HLA) genotypes has decreased while the proportion of affected children with intermediate-risk HLA genotypes increased from 1980s to 2000s 16 . Similar findings have been reported from Finland, Sweden, US, and the UK when comparing cases diagnosed 1985-2008 to those diagnosed earlier 17 – 20 . This indicates that the contribution of HLA genotypes to T1D risk has changed but not lessened over time 16 . Still, only approximately half of the genetic risks of T1D is accounted for by HLA genotypes 16 and a rise in genetic susceptibility could be driven by risk alleles outside of the HLA complex. T1D proposedly has age-related endotypes, with distinct etiology and pathogenesis between individuals diagnosed before the age of seven and those diagnosed after the age of thirteen 21 . The genetic contribution to the etiology of these endotypes is scarcely investigated.

In this work, we set out to clarify if the environmental and genetic influences on childhood-onset T1D (0–18 years) have changed in Sweden over the last 30 years. We analyze the trend of T1D incidence and heritability among three million children born from 1982 to 2010 using nationwide data. We show that the heritability of T1D and its endotypes has remained stable over time. We identify environmental factors associated with T1D and find that changing prevalence of them could only explain a small proportion of the increasing T1D incidence, indicating that they are not the major driver of the rise in T1D.

— Source (introduction, peer-reviewed): Yuxia Wei, Tomas Andersson, Shengxin Liu, et al. · (2025) · "Stable heritability of type 1 diabetes in a Swedish Nationwide Cohort Study" · Nature Communications · doi: 10.1038/s41467-025-60813-2 · PMCID: PMC12174315 · PMID: 40527903
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


Ruth I. Hart, Christina Sheehan, Debbie Brewin, et al. · (2026) · "Facilitating a complex behaviour-change intervention: healthcare professionals’ accounts of their journeys to competence and confidence" · BMC Health Services Research · doi: 10.1186/s12913-025-13676-8 · PMCID: PMC12888146 · PMID: 41526884

Question: What is the published background on "Facilitating a complex behaviour-change intervention: healthcare professionals’ accounts of their journeys to competence and confidence"? Cite a peer-reviewed source.

Answer:
High-quality health-related information has been described as ‘the lifeblood of good health and wellbeing … allow(ing) us to understand how to improve our own and our family’s health’[ 1 (p.7)]. Access to such information is now firmly embedded in UK health policy [ 1 , 2 ] and its provision is a key component of many healthcare professionals’ work. However, it has become increasingly clear that where behaviour change is the goal, information may be necessary, yet not sufficient [ 3 , 4 ]. To bring about and/or sustain behaviour change, other approaches, techniques and tools, informed by behavioural theory and science may be needed [ 2 , 4 – 7 ]. Hence, in recent years, healthcare professionals have been tasked not only with information provision, but also with delivering brief, evidence-based, behaviour-change interventions, as an adjunct to routine practice [ 4 , 8 ]. In addition, in the absence of sufficient specialists with expertise in the fields of psychology and/or behaviour change, interest has been growing in whether healthcare professionals from other, disparate backgrounds can facilitate the delivery of more extended and ‘complex’ behaviour-change interventions [ 9 – 12 ]. Such interventions target individuals with complicated health needs (e.g., arising from a chronic condition), have multiple components, and incorporate more sophisticated behaviour-change techniques. They are typically delivered over a number of relatively lengthy (e.g., 30 minutes-plus) sessions.

A small but growing body of research has examined different healthcare professionals’ experiences of, and perspectives on, this emerging area of work. The research provides qualified support for the involvement of non-specialists in the delivery of complex behaviour-change interventions, and some useful insights. For instance, a recent systematic review of 17 research studies investigating the motivational interviewing skills of healthcare professionals working in diabetes care concluded that, subsequent to training, some such professionals employed some relevant techniques [ 13 ]. However, as Kaczmarek et al. further observed, the techniques those professionals employed tended to be ones which were less challenging to learn and apply, e.g., increased use of open questions and ‘change statements’ (i.e., articulations of the rationale, or motivation for, change) [ 13 ]. Jongebloed-Westra et al. similarly concluded that healthcare professionals (specifically podiatrists) could be trained to use basic motivational interviewing techniques successfully in interactions with patients [ 14 ]. In terms of the factors supportive of healthcare professionals developing and employing more complex skills in facilitating behaviour change, several studies have highlighted the importance of adequate preparatory training, and/or ongoing, ‘in-service’ training, supervision, and support [ 13 , 15 – 19 ]. These findings are valuable, but understanding of the circumstances in which healthcare professionals from different disciplinary backgrounds become competent and confident facilitators of behaviour change remains far from complete.

Thus, as part of a wider evaluation of a novel, person-centred, cognitive behavioural intervention, designed to bring about changes in the self-care behaviours of individuals with a history of diabetes and foot ulceration, we set out to examine facilitators’ development more closely. This complex intervention, ‘REDUCE,’ (see Box 1 for more details) was facilitated by a team of registered and accredited healthcare professionals from a range of disciplines (nursing, podiatry, and psychology/talking therapies). Healthcare professionals were employed specifically to deliver the intervention by the study sponsor (University Hospitals of Derby and Burton NHS Foundation Trust). Further information on the facilitator recruitment process and their employment arrangements is provided in the Methods (Participants and recruitment) section, below.

All healthcare professionals appointed as REDUCE facilitators were required to complete intervention-specific training before being assigned any intervention participants. That training covered the therapeutic approach, use of specific behaviour-change techniques, and, for the benefit of those without relevant expertise, diabetes and diabetic foot health. We describe the organisation and content of the REDUCE facilitator training, and how it evolved over time, in detail elsewhere [ 20 ]. In brief, all facilitator training was provided virtually (i.e., on-line) over several days, to small groups of healthcare professionals. It involved a mixture of didactic and interactive components, and was designed and delivered by three experienced Cognitive Behavioural Therapy (CBT) therapists, with contributions from research team members. Trainee facilitators were also expected to undertake some homework/self-study between sessions, such as reading the participant and facilitator handbooks. Following training and alongside delivery of the intervention, facilitators were offered regular one-to-one clinical supervision and/or group-based support, with or facilitated by an experienced and accredited CBT supervisor, based at a collaborating UK university.

In this report, we consider whether, how, and why, the healthcare professionals appointed and trained as REDUCE facilitators perceived themselves as having developed competence and confidence in performing their facilitator role. In particular, we explore the influence and impact of training, supervision, and other, previously unrecognised factors (e.g., independent learning) on facilitators’ development. In so doing, our aim was to generate insights that might support the judicious recruitment, training, development, and retention of appropriately skilled facilitators to REDUCE and/or other, similar behaviour change-oriented programmes in the future.

Box 1 Outline of the intervention REDUCE : • Is a complex behaviour-change intervention designed for people (≥ 18 years) with diabetes who have recently had a diabetic foot ulcer (DFU) but on enrolment are ulcer-free. • Aims to increase the time people spend ulcer-free, by avoiding or delaying reoccurrence of a DFU, and decreasing time to healing if/when a new DFU develops. • Seeks to establish a suite of behaviours supportive of the above aims, including: effective daily foot-checking; rapid help-seeking (where changes are identified); regular and graded (i.e., appropriate) physical activity; and, personalised strategies for managing low mood. • Uses an approach informed by Cognitive Behavioural Therapy (CBT), specifically the idea that thoughts, feelings, and actions/behaviours are linked. Modifying thoughts/beliefs may therefore be necessary to change behaviours, and changing thoughts/beliefs or behaviours may change feelings. Facilitators work with participants to identify problems (e.g., barriers to behavioural change) and break these down into separate, smaller and more manageable parts for resolution. • Employs a range of recognised behaviour-change techniques including: information provision; goal setting; action-planning; self-monitoring; habit formation; use of prompts; positive re-framing; behavioural experiments; and, behavioural activation. • Is delivered remotely (by telephone or video-call) to participants around England over eight 60-minute sessions. It is supplemented by paper and digital resources available to participants during and beyond those eight sessions.

Our interviewees revealed diverse and interesting backgrounds, with the sample including individuals who said they were still working, or had until recently worked, in podiatry, nursing, and/or psychology/talking therapies. Some reported having worked in more than one of these disciplines – for example, starting out as a nurse and then re-training as a podiatrist. A few also had experience in higher education, including delivering pre-registration training. Several were partially retired, and working reduced or part-time hours in one or more other roles.

When asked how they became aware of the REDUCE programme, interviewees recalled a variety of channels. Two had been involved for many years, and delivered an earlier (group-based) version of the intervention. Others explained how they were known to and had been approached by another professional involved with REDUCE (e.g., a research team member and/or a clinical colleague), who, they surmised, perceived them as having the relevant skills and capacity to contribute: (Investigator) used to be the consultant in our foot clinic … she knew I’d reduced my hours , so she approached me (about REDUCE). (Cath).

Several described having seen targeted advertising disseminated through relevant professional bodies (e.g., the Royal Colleges) and/or more informal professional networks (see Supplementary File).

These healthcare professionals offered varied, and often multifactorial, motives for applying to be a REDUCE facilitator. The character of the intervention was often cited as a draw, with interviewees highlighting its alignment with longstanding, personal interests in health behaviour and/or psychology (see Supplementary File). Several contrasted the REDUCE model with the more medically-oriented approaches underpinning their routine work and/or indicated frustration with the constraints of practice in the NHS. Such interviewees said they had seized the opportunity to work in more satisfying ways: The reason for doing this was … I found when I worked in diabetes , is , it’s very much a medical model , and I got very frustrated with it. And then I got very excited by hearing this. So that’s why I wanted to be involved. (Josie).

Other interviewees said they were motivated by the prospect of extending their knowledge and/or skills (of preventive footcare or, more commonly, psychological therapies) either to enhance their current practice or to accrue experience supportive of longer-term career ambitions: I saw this role , and I thought , this is brilliant … (because) my kind of goal was to also become a CBT therapist , which I’ve now trained as! (Regina).

Pragmatic factors were also cited by some. For those based in less populous regions, where possibilities for exploring new roles were more limited, remote working was portrayed as offering a welcome, logistically straightforward, development opportunity. A few others noted how they were attracted by REDUCE’s flexible employment arrangements and the rare opportunity (for those employed within the NHS) to work from home: (Husband)’s totally retired … (and) I’m 58 , so I’m slowing down , I’m moving to retirement at 60 , and I wanted to just work at home. (Frederica).

— Source (introduction, peer-reviewed): Ruth I. Hart, Christina Sheehan, Debbie Brewin, et al. · (2026) · "Facilitating a complex behaviour-change intervention: healthcare professionals’ accounts of their journeys to competence and confidence" · BMC Health Services Research · doi: 10.1186/s12913-025-13676-8 · PMCID: PMC12888146 · PMID: 41526884
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


L Hallin Thompson, Ö Makay, L Brunaud, et al. · (2021) · "Adrenalectomy for incidental and symptomatic phaeochromocytoma: retrospective multicentre study based on the Eurocrine® database" · The British Journal of Surgery · doi: 10.1093/bjs/znab199 · PMCID: PMC10364866 · PMID: 34270711

Question: What is the published background on "Adrenalectomy for incidental and symptomatic phaeochromocytoma: retrospective multicentre study based on the Eurocrine® database"? Cite a peer-reviewed source.

Answer:
Phaeochromocytoma is a neuroendocrine, catecholamine-secreting tumour, arising from chromaffin cells of the adrenal medulla. Clinical presentation is variable, and depends on the magnitude, type, and pattern of hormone release (adrenaline, noradrenaline, and dopamine), as well as individual sensitivity to catecholamines and their metabolites 1 , 2 .

Clinical presentation includes a triad of symptoms: headache, sweating, and palpitations 1 . Other symptoms include anxiety, tremor, nausea, dyspnoea, and abdominal pain. Hypertension is a common sign of phaeochromocytoma, reported in up to 78–93 per cent of patients with adrenal and extra-adrenal phaeochromocytoma 3 , 4 . Only 0.04 per cent of patients with hypertension are, however, diagnosed with a phaeochromocytoma 5 . Paroxysmal catecholamine release may cause sudden peaks in BP, leading to severe cardiovascular events. Preoperative α-adrenergic blockade is recommended by guidelines to prevent vasoconstriction, and perioperative cardiovascular complications and death 6 . With improvements in anaesthetic methods and minimally invasive surgery, this practice has recently come under scrutiny. A meta-analysis by Schimmack and colleagues 7 demonstrated a lack of evidence for preoperative α-blockade. Most larger series of patients who had surgery for phaeochromocytoma have, however, been reported from high-volume tertiary centres and the results might therefore suffer from selection bias 8 , 9 .

An increasing proportion of phaeochromocytomas are discovered as adrenal incidentalomas. Phaeochromocytomas without clinical symptoms represent 4–7 per cent of adrenal incidentalomas 10–12 . Among histologically diagnosed phaeochromocytomas, up to 29 per cent were detected as incidentalomas 3 .

The aim of this study was to investigate contemporary clinical features, evaluation, preoperative medical treatment, surgery, and outcome in patients undergoing adrenalectomy for phaeochromocytoma. A special focus was to analyse outcomes for those diagnosed by clinical symptoms compared with incidentalomas, and in patients with or without preoperative treatment with α-blockers. Data were retrieved from Eurocrine®, a pan-European quality registry for endocrine tumours.

— Source (introduction, peer-reviewed): L Hallin Thompson, Ö Makay, L Brunaud, et al. · (2021) · "Adrenalectomy for incidental and symptomatic phaeochromocytoma: retrospective multicentre study based on the Eurocrine® database" · The British Journal of Surgery · doi: 10.1093/bjs/znab199 · PMCID: PMC10364866 · PMID: 34270711
License: CC-BY-NC. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


Xuemei Li, Qimei Yang, Xia Zhang, et al. · (2025) · "Misoprostol combined with artificial membrane stripping showed the best effect of induction among women with gestational diabetes mellitus: a retrospective cohort study" · Revista da Associação Médica Brasileira · doi: 10.1590/1806-9282.20251162 · PMCID: PMC12711119 · PMID: 41417370

Question: Summarize the abstract of the paper titled "Misoprostol combined with artificial membrane stripping showed the best effect of induction among women with gestational diabetes mellitus: a retrospective cohort study".

Answer:
The aim of this study was to explore the optimal method of induction of labor in women with gestational diabetes mellitus and its impact on delivery outcomes.

This retrospective cohort study was conducted among nulliparous women with gestational diabetes mellitus delivering at the First Affiliated Hospital of Fujian Medical University and the First People's Hospital of Yunnan Province from 2018 to 2023. Data were extracted from electronic medical records.

A total of 600 patients who delivered met the inclusion criteria: the double-balloon group (Group B, n=198), the misoprostol vaginal insert group (Group M, n=200), and the Misoprostol combined with artificial membrane stripping group (Group MA, n=202). Group MA showed higher induction of labor success rates (93.5%) compared to Group M (86.0%) and Group B (81.5%, p=0.002). The time to labor onset was shortest in Group MA (32.5±6.5 h), followed by Group M (35.8±2.5 h) and Group B (45.8±4.5 h, p<0.001). Vaginal delivery time was also significantly shorter in Group MA (47.4±4.3 h) compared to Group M (49.1±7.4 h) and Group B (57.1±5.7 h, p<0.001). Chorioamnionitis rates were lower in Group MA (2.5%) and Group M (3.0%) compared to Group B (8.5%, p=0.007). No significant differences were observed between groups for cesarean rates, fetal distress, abnormal labor, or neonatal outcomes (p>0.05).

The combination of misoprostol vaginal insert and artificial membrane stripping effectively enhances cervical ripening and improves vaginal delivery success in gestational diabetes mellitus patients, providing a promising strategy for labor induction.

— Source (abstract, peer-reviewed): Xuemei Li, Qimei Yang, Xia Zhang, et al. · (2025) · "Misoprostol combined with artificial membrane stripping showed the best effect of induction among women with gestational diabetes mellitus: a retrospective cohort study" · Revista da Associação Médica Brasileira · doi: 10.1590/1806-9282.20251162 · PMCID: PMC12711119 · PMID: 41417370
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


Chloë Royston, Simon Bergford, Peter Calhoun, et al. · (2024) · "Safety of options to ″Boost″ (enhancing insulin infusion rates) and ″Ease-off″ (reducing insulin infusion rates) in CamAPS FX Hybrid Closed-Loop system: a real-world analysis" · Diabetes technology & therapeutics · doi: 10.1089/dia.2024.0298 · PMCID: PMC7617696 · PMID: 39146468

Question: Summarize the abstract of the paper titled "Safety of options to ″Boost″ (enhancing insulin infusion rates) and ″Ease-off″ (reducing insulin infusion rates) in CamAPS FX Hybrid Closed-Loop system: a real-world analysis".

Answer:
The usage and safety of the Boost and Ease-off features in the CamAPS FX hybrid closed-loop system was analysed in a retrospective analysis of real-world data from 7,464 users over a 12-month period. Boost was used more frequently than Ease-off, but for a shorter duration per use. Mean starting glucose was above range for Boost (229±51 mg/dL), and within range for Ease-off (114±29 mg/dL). Time spent below 70 mg/dL was low during Boost periods [median (IQR) 0.0% (0.0, 0.5%)], and lower than during no Boost periods [2.1% (1.2, 3.4%)], while time spent above 180 mg/dL was lower during Ease-off periods (15±14%) compared to no Ease-off periods (25±12%). There were no episodes of severe hypoglycaemia or DKA attributed to Boost or Ease-off use. Boost and Ease-off allow users to engage safely with CamAPS FX to manage their glucose levels during periods of more-than-usual and less-than-usual insulin needs.

— Source (abstract, peer-reviewed): Chloë Royston, Simon Bergford, Peter Calhoun, et al. · (2024) · "Safety of options to ″Boost″ (enhancing insulin infusion rates) and ″Ease-off″ (reducing insulin infusion rates) in CamAPS FX Hybrid Closed-Loop system: a real-world analysis" · Diabetes technology & therapeutics · doi: 10.1089/dia.2024.0298 · PMCID: PMC7617696 · PMID: 39146468
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.


Cassie D Turner, Kishor Patel, Katherine Freeman, et al. · (2025) · "Low-Carbohydrate Nutrition Counseling With Continuous Glucose Monitoring to Improve Metabolic Health Among Veterans With Type 2 Diabetes: Pilot Quality Improvement Initiative Study" · JMIR Diabetes · doi: 10.2196/75672 · PMCID: PMC12705128 · PMID: 41397294

Question: Summarize the abstract of the paper titled "Low-Carbohydrate Nutrition Counseling With Continuous Glucose Monitoring to Improve Metabolic Health Among Veterans With Type 2 Diabetes: Pilot Quality Improvement Initiative Study".

Answer:
One in 4 Veterans who receive care through the Veterans Health Administration has type 2 diabetes (T2D). Dietary carbohydrate restriction can promote weight loss and improve blood glucose control, but Veterans taking certain medications (eg, insulin) may experience serious complications (eg, hypoglycemia) without adequate support and monitoring.

This study aims to develop and evaluate the feasibility, acceptability, and clinical effectiveness of a pilot low-carbohydrate (LC) nutrition counseling program guided by continuous glucose monitoring (CGM) for Veterans with T2D receiving insulin (ie, LC-CGM).

This is a pragmatic, nonrandomized, pre-post quality improvement pilot program. Eligible patients were Veterans with T2D who were prescribed ≥3 daily injections of insulin. The 24-week LC-CGM program consisted of virtual visits with a registered dietitian (RD) and clinical pharmacy practitioner (CPP); CGM data were used to guide tailored nutrition counseling and de-escalation or cessation of glucose-lowering medications. To evaluate changes from baseline, intention-to-treat analyses were conducted for all enrollees, with separate analyses for program completers. Primary outcomes were program feasibility and acceptability (ie, program enrollment and completion rates and mean number of RD and CPP visits). Secondary outcomes included mean weight change, percent weight loss, achievement of ≥5% and ≥10% weight loss, change in glucose-lowering medication use, and change in laboratory measures (eg, hemoglobin A 1c [HbA 1c ]).

Program evaluation occurred from March 19, 2021, to May 3, 2024. Among 43 Veterans referred to the LC-CGM program, 38 (88%) enrolled. Most were men (37/38, 97%), white (29/38, 76%), with an average age of 63.7 (SD 9.6) years. Mean BMI and HbA 1c were 38.1 (SD 5.8) kg/m 2 and 7.8% (SD 1.3). Of 38 enrollees, 27 (71%) completed the program. Enrollees averaged 9.5 (SD 3.3) RD visits and 12.8 (SD 4.7) CPP visits. In intention-to-treat analyses, mean weight change was −11.5 kilograms (SD 8.7; 95% CI −14.4 to −8.6), corresponding to 9.5% weight loss (SD 7.2; 95% CI −14.9 to −4.2), with 58% (22/38) achieving ≥5% weight loss and 32% (12/38) achieving ≥10% weight loss. Overall, use of glucose-lowering medications decreased from 3.5 (SD 0.8) per patient at baseline to 2.4 (SD 0.9) per patient at 24 weeks ( P <.001), with 72% (26/36) of Veterans discontinuing short-acting insulin and 50% (18/36; P <.001) discontinuing long-acting insulin. Use of glucagon-like peptide-1 receptor agonists increased from 39% (15/38) at baseline to 61% (23/38) at 24 weeks ( P =.02). Among program completers (n=27), mean percent weight loss was −11.8% (SD 6.5) and median HbA 1c decreased by 0.7% (95% CI −0.9 to −0.3; P =.001).

This pilot program provides preliminary evidence that supports feasibility, acceptability, and clinical effectiveness among Veterans with T2D. Additional research is needed to rigorously test longer-term clinical and cost-effectiveness among a larger cohort of eligible Veterans.

— Source (abstract, peer-reviewed): Cassie D Turner, Kishor Patel, Katherine Freeman, et al. · (2025) · "Low-Carbohydrate Nutrition Counseling With Continuous Glucose Monitoring to Improve Metabolic Health Among Veterans With Type 2 Diabetes: Pilot Quality Improvement Initiative Study" · JMIR Diabetes · doi: 10.2196/75672 · PMCID: PMC12705128 · PMID: 41397294
License: CC-BY. Retrieved from PubMed Central full text.

Note: This reproduces published research findings. It is not individualized medical advice. Please discuss your situation with your healthcare provider or care team.