Type 2 diabetes mellitus (T2DM) is a chronic, progressive disease driven by a complex interplay of genetic, biological, behavioural and social factors. The epidemiology of T2DM has shifted considerably, largely attributable to increasing obesity rates. Furthermore, T2DM prevalence is increasing in younger people (diagnosis <40 years of age; early-onset T2DM), which is associated with more aggressive disease progression, higher risk factor burden, earlier and more severe complications, and greater lifetime morbidity than later-onset T2DM. T2DM is traditionally associated with a high risk of microvascular and macrovascular complications, although rates of cardiovascular complications have reduced in some high-income countries. Currently, emerging and non-traditional diabetes complications, such as those related to mental health and cognitive function, are being recognized, and people with T2DM increasingly experience multimorbidity and reduced quality of life. Additionally, a growing prevalence of obesity has resulted in high rates of obesity-related complications. Novel therapies and technologies may offer considerable benefit, although socioeconomic disparities may exacerbate barriers to effective prevention and equitable access. The complex nature of T2DM and its comorbidities underscores the urgent need for a person-centred, holistic approach that integrates glucose and weight management with broader attention to comorbidities, 24-h physical behaviours, psychosocial well-being and social determinants of health.
ABSTRACT Introduction Although continuous glucose monitoring (CGM) in adults with type 2 diabetes (T2D) has known glycemic benefits, the underlying behavioural and psychosocial processes driving these outcomes remain poorly understood. We examined how CGM influences patient‐reported outcomes and whether changes in those outcomes predict glycemic improvement. Research Design and Methods This 6‐month prospective observational study included 115 adults with T2D and elevated HbA1c who did not use fast‐acting insulin and initiated CGM through a real‐world program. At baseline, 3‐ and 6‐months, HbA1c, medication use/changes and key psychosocial and self‐care behaviours were assessed. Longitudinal structural equation models assessed changes over time and predictors of HbA1c reduction. Post hoc moderation analyses explored whether the effect of self‐care behaviour improvements on HbA1c outcomes depended upon new medication starts at baseline. Results HbA1c declined significantly from 9.4% (79 mmol/mol) at baseline to 7.3% (56 mmol/mol) at both 3 and 6 months (ps < 0.001). Participants reported increased diabetes engagement, reduced distress, increased physical activity, fewer missed medications and less overeating (ps < 0.001). In multivariate models, greater HbA1c reduction was independently predicted by: (1) starting a new diabetes medication in the few months before baseline (b = −1.06, p < 0.001); (2) increases in physical activity (b = −0.13, p = 0.040); and (3) improvements in medication‐taking (b = 2.33, p < 0.001). Post hoc moderation analysis revealed that behaviour changes were most predictive of glycemic benefit among participants who had not started a new diabetes medication pre‐baseline. Conclusions Real‐world CGM initiation was associated with significant improvements in glycemic control, self‐care behaviours and psychosocial outcomes. Behaviour change—notably, improved diet and physical activity—was a key contributor to glycemic gains, particularly among those not undergoing medication adjustments prior to CGM initiation. These findings support CGM as a catalyst for engagement and behaviour change in T2D management.
The 13th Annual EndoBridge Meeting took place in Antalya, Türkiye, from October 23 to 26, 2025. Accredited by the European Council, the congress delivered a comprehensive scientific program combining state-of-the-art lectures with interactive small-group case discussions led by internationally recognized experts in endocrinology and metabolism. The meeting drew a diverse audience and provided an in-depth review of major areas within the field. Core subjects included disorders of the pituitary, thyroid, adrenal glands, and bone metabolism, as well as neuroendocrine tumors, diabetes, obesity, clinical nutrition, and lipid abnormalities. Clinical case abstracts presented in oral and poster sessions were subsequently published in JCEM Case Reports. This report highlights the principal themes and clinical insights shared during the congress. Key discussions addressed contemporary approaches to acromegaly management, therapeutic strategies for subclinical thyroid dysfunction, goal-oriented treatment models in osteoporosis, adjunctive options in type 1 diabetes management, and the evolving concept of obesity phenotyping. Additional updates covered hormonal treatment strategies for menopause and premature ovarian insufficiency, along with recent developments in male hypogonadism and infertility. Overall, the sessions reflected current advances in endocrine science while offering practical guidance for the management of common and complex endocrine disorders. The 14th Annual EndoBridge Meeting will be held in Antalya, Türkiye, from October 22 to 25, 2026.
OBJECTIVE |:The Mi Puente (My Bridge) randomized controlled trial compared a culturally appropriate, team-based discharge program versus usual discharge procedures (usual care) in reducing readmission rates (inpatient, emergency, and observation visits) among Hispanic/Latino adults with multimorbidity. Primary outcome analyses revealed the Mi Puente group demonstrated increased hospital use relative to usual care. To better understand these unexpected effectiveness findings and inform future research, we conducted a multimethod process evaluation using components of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESEARCH DESIGN AND METHODS |:Reach was assessed by examining the proportion of eligible participants enrolled and representativeness of the sample. Adoption was assessed via semistructured interviews with study staff. Implementation was examined using study fidelity forms (e.g., protocol adherence and duration/content of visits) and whether those who received the intervention per protocol differed from those who did not. RESULTS |:Mi Puente reached the target population, with high acceptance among eligible patients enrolled (75%), although participants tended to be younger, preferred English, and endorsed more behavioral health concerns. Adoption interviews and related Implementation findings revealed gaps in both the intervention content delivered and the availability of resources within San Diego County. Approximately 70% of participants received the intervention per protocol. CONCLUSIONS |:Multilevel strategies are needed to improve post-discharge outcomes in Hispanic/Latino adults with multimorbidity. These should include improved integration of inpatient and outpatient settings, the use of warm handoffs and home visits, ongoing clinical support, and implementation of structural-level interventions to address social determinants of health.
The development of diabetes complications is complex and multifactorial. Although advances in pharmacologic interventions and technology have improved diabetes management, nonmedical factors continue to drive persistent disparities in complications across the U.S. Using a socioecological framework, we examine how nonmedical factors operating at individual, organizational, community, and policy levels contribute to rising complications rates. We synthesize multilevel evidence-based interventions, real-world examples, and emerging opportunities that address these drivers. Approaches include culturally and linguistically tailored, digitally delivered diabetes education; systematic screening and documentation of social drivers within health care systems; use of health information systems technology; training for health care providers; multisector community partnerships that leverage social care resources; and policy incentives that integrate medical and social care. Coordinated interventions across socioecological levels are essential to move beyond traditional clinical approaches toward equitable, sustainable diabetes care that reduces complications.
