Background/Objectives: Achieving a balanced wholefood diet while stabilising glycaemic management is challenging for many people with type 2 diabetes (T2D) due to barriers such as food preparation skills, time, and medication effects. Diabetes-specific nutritional formulas (DSNFs) are nutritionally complete products designed to support glycaemic management and overall nutritional adequacy and may complement wholefood dietary approaches when these are not feasible or are insufficient. Despite growing clinical evidence of efficacy, practical guidance for routine use is limited. Methods: A multidisciplinary expert working group developed a Clinical Practice Guide (CPG) for integrating DSNFs into diabetes care. Development was informed by a literature review and iterative consensus among experts, including representatives of the Australian Diabetes Society, Australian Diabetes Educators Association, and the Royal Australian College of General Practitioners. Results: The CPG outlines a three-step pathway: (1) assess suitability (clinical indications, contraindications, preferences, cultural context); (2) tailor the approach (individual goals, dose/timing relative to weight and body composition goals and observed glycaemic patterns, integration with lifestyle care); and (3) monitor progress (baseline, 2–4 weeks to assess initial response, then 3, 6, and 12 months for glycaemic indices, weight/body composition where available, and medication review). Conclusions: This CPG provides practical, multidisciplinary guidance for the person-centred use of DSNFs as an adjunct to standard care, supporting translation of current evidence into clinical practice and promoting consistent, multidisciplinary implementation.
Background Approximately two-thirds of Australian adults have overweight or obesity, contributing to substantial direct and indirect economic costs. Prior estimates vary widely in scope and methodology and few disaggregated costs by obesity class or allocate burden across stakeholders. Methods We quantified the 2025 economic burden of overweight and obesity among Australian adults using nationally representative data. Direct medical costs were estimated by applying population attributable fractions to Australian Institute of Health and Welfare (AIHW) disease expenditure data. Indirect costs comprised reduced labour-force participation (weighted logistic regression), absenteeism (two-part model), presenteeism (published industry-specific odds ratios), and premature mortality (productivity-loss approach; value-of-statistical-life-year [VSLY] as supplementary). Disability Support Pension payments and income losses were also estimated. Costs were disaggregated by BMI class (overweight; obesity Classes I–III), sex, industry sector, and stakeholder perspective. Results Total economic burden was AUD $45.0 billion (~ 1.6% of GDP), comprising $10.5 billion in direct medical costs and $34.5 billion in indirect costs (reduced employment $13.4B; absenteeism $10.0B; presenteeism $9.7B; premature mortality $1.4B). Per-adult costs rose monotonically with BMI class: $1,440 (overweight), $2,710 (Class I), $6,310 (Class II), and $13,720 (Class III). Government bore $21.2 billion in fiscal costs, employers $20.4 billion in productivity losses, and households $13.7 billion in net costs. Female employment and income losses substantially exceeded those of males across all obesity classes. Conclusions Overweight and obesity impose a substantial, dose-related economic burden distributed unevenly across stakeholders, industries, and population groups. Conservative assumptions throughout suggest these estimates represent a lower bound on the true societal cost.
This review is to systematically explore the relationship between muscle dysfunction and diabetes in adults, and to examine the impact of glycemic variability on muscle health and the development of diabetes-related complications. The review was conducted using three databases: MEDLINE, Scopus, and EMBASE, targeting peer-reviewed journal articles written in English and published from January 2014 to September 2024. The methodological quality assessment of the eligible studies was conducted using Joanna Briggs Institute Critical Appraisal Checklists. A total of 17 studies were included. Most studies were undertaken in Asian countries (n = 11) and focused on adults with type 2 diabetes (n = 12). There were 8,392 adults with diabetes, and their mean age ranged from 52 to 75 years old. The measurements for muscle function and glycemic variability varied across studies. The research findings regarding the relationship between muscle dysfunction and glycemic variability metrics among adults with diabetes, both with and without complications were inconsistent. For adults with diabetes and sarcopenic obesity, poor glycemic control was identified as an independent risk factor for sarcopenic obesity. Additionally, all included studies were rated as moderate or high quality in relation to their methodology. In conclusion, this review underscores the complex and inconsistent relationship between glycemic variability and muscle dysfunction in older adults with diabetes. Poor glycemic management is a significant risk factor for sarcopenic obesity, highlighting the need for tailored interventions to improve glycemic control and muscle health in this population.
In the last months, conflicting evidence on a possible association between the use of semaglutide and incident nonarteritic anterior ischemic optic neuropathy (NAION) has emerged. A recently published study, which evaluated all patients with type 2 diabetes in Denmark, has shown with robustness that once-weekly semaglutide doubles the five-year risk of NAION. In this comment, the new evidence is discussed, along with practical implications for type 2 diabetes patients. The possibility of ophthalmological evaluation regarding optic disc morphology is suggested, before initiation of semaglutide treatment or, for those patients already under treatment, during a follow-up ophthalmological visit. If a disc-at-risk pattern is detected, such information could be brought to the attention of the attending clinician involved with diabetes control and discussed with patients for a shared decision-making approach. A new risk-benefit discussion weighing the undoubted benefits of semaglutide in reducing cardiovascular mortality and cardiovascular events, heart failure hospitalization, and renal protection must be started and carefully balanced against a rare but devastating condition such as NAION.
Abstract Background Management of type 1 diabetes (T1D) requires the use of insulin, which can cause hypoglycaemia (low blood glucose levels). While most hypoglycaemic episodes can be self-treated, all episodes can be sudden, inconvenient, challenging to prevent or manage, unpleasant and/or cause unwanted attention or embarrassment. Severe hypoglycaemic episodes, requiring assistance from others for recovery, are rare but potentially dangerous. Repeated exposure to hypoglycaemia can reduce classic warning symptoms (‘awareness’), thereby increasing risk of severe episodes. Thus, fear of hypoglycaemia is common among adults with T1D and can have a negative impact on how they manage their diabetes, as well as on daily functioning, well-being and quality of life. While advances in glycaemic technologies and group-based psycho-educational programmes can reduce fear, frequency and impact of hypoglycaemia, they are not universally or freely available, nor do they fully resolve problematic hypoglycaemia or associated worries. This study aims to determine the effectiveness of a fully online, self-directed, scalable, psycho-educational intervention for reducing fear of hypoglycaemia: the Hypoglycaemia Prevention, Awareness of Symptoms, and Treatment (HypoPAST) programme. Methods A 24-week, two-arm, parallel-group, hybrid type 1 randomised controlled trial, conducted remotely (online and telephone). Australian adults (≥ 18 years) with self-reported T1D and fear of hypoglycaemia will be recruited, and allocated at random (1:1) to HypoPAST or control (usual care). The primary outcome is the between-group difference in fear of hypoglycaemia (assessed using HFS-II Worry score) at 24 weeks. A sample size of N = 196 is required to detect a 9-point difference, with 90% power and allowing for 30% attrition. Multiple secondary outcomes include self-reported psychological, behavioural, biomedical, health economic, and process evaluation data. Data will be collected at baseline, 12 and 24 weeks using online surveys, 2-week ecological momentary assessments, website analytics and semi-structured interviews. Discussion This study will provide evidence regarding the effectiveness, cost-effectiveness and acceptability of a novel, online psycho-educational programme: HypoPAST. Due to the fully online format, HypoPAST is expected to provide an inexpensive, convenient, accessible and scalable solution for reducing fear of hypoglycaemia among adults with T1D. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000894695 (21 August 2023).
