Introduction Individuals with both diabetes and hypertension are at high risk for micro- and macrovascular complications, underscoring the importance of regular monitoring of HbA1C, cholesterol, urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). Methods We analyzed laboratory tests from 4,456 adults from primary care practices with diabetes and hypertension, each with at least two blood pressure measurements between January 1, 2013, and December 31, 2017, and at least one test (HbA1C, UACR, eGFR, and LDL-C) within two years. Test completion rates and results were reported across three blood pressure categories: controlled (<130mmHg/<80mmHg), stage 1 hypertension (130-139mmHg/80-89mmHg), and stage 2 hypertension (≥140mmHg/≥90mmHg). Results Of the 4,456 individuals, 86% had HbA1C tested, 32% had UACR, 76% had eGFR, and 83% had LDL-C. Among those tested, 43% had HbA1c >7.0%, 11% had macroalbuminuria (UACR >20mg/mmol), 20% had chronic kidney disease (CKD) (eGFR <60mL/min/1.73m2), and 54% had dyslipidemia (LDL-C ≥2.0mmol/L). Those with stage 2 hypertension had higher rates of albuminuria, CKD, and dyslipidemia compared to those with controlled or stage 1 hypertension. Conclusions Our study has three key findings. UACR testing was underutilized among patients with diabetes and hypertension. Consistent screening could have identified individuals who would benefit from guideline directed antiproteinuric therapies. Uncontrolled blood pressure was associated with higher rates of albuminuria and dyslipidemia. Achievement of LDL-C < 2.0 mmol/L was suboptimal, in over 50% of patients, necessitating improved cardiovascular risk management in this high-risk group.
BACKGROUND:The rising prevalence of diabetes disproportionately impacts socially-disadvantaged communities. We aimed to determine whether trends of diabetes prevalence vary by age, sex, and neighbourhood socioeconomic status (SES). METHODS:We conducted a population-based cross-sectional time-series analysis using health administrative data for adults aged ≥20 years (>90% type 2 diabetes) from 2015 (N=10,935,448) to 2021 (N=11,885,060). Annual crude and age-sex standardized prevalence rates were estimated using a validated administrative case definition. Neighbourhood SES was measured using the Material Deprivation Domain of the Ontario Marginalization Index and categorized into quintiles (Q1 least deprived to Q5 most deprived). RESULTS:Age-sex standardized prevalence of diabetes increased nearly 6% from 10.8 in 2015 to 11.4% in 2021. Increases were consistent across all age and sex groups, with the largest relative increases among adults aged 20-34 years (males +17.1%, females +11.3%). Diabetes prevalence rose across all neighbourhood deprivation quintiles, remaining highest in the most deprived areas from 2015 to 2021 (13.3% to 14.1%). Relative increases ranged from 5.8% in the most deprived areas to 7.1% in the least deprived areas. A clear socioeconomic gradient was observed where diabetes prevalence was 42% higher in the most deprived neighbourhoods (Q5 RR 1.42, 95% CI 1.41-1.44; all p<0.0001) compared to the least (Q1) deprived areas, underscoring the structural nature of diabetes inequities. CONCLUSIONS:Diabetes prevalence continues to increase in the lowest income areas, calling for more tailored and culturally sensitive policy interventions and programs to reduce the future burden of diabetes among populations living with social disadvantage.
Objectives While technology improves glycemic control, its psychological impact in resource-limited settings is less explored. This study evaluated the impact of continuous glucose monitoring (CGM) on diabetes distress and glycemic outcomes in adults with type 1 diabetes (T1D) within a public healthcare system. Methods This prospective study enrolled 35 adults with T1D at a public center in Northeastern Brazil. Participants initiated CGM with monthly follow-ups. Diabetes distress was assessed at baseline and six months using Brazilian Type 1 Diabetes Distress Scale (T1DDS). Results Participants had a mean T1D duration of 13 ± 9.9 years and baseline HbA1c of 9.13 ± 1.87%. After six months, mean HbA1c decreased to 7.94 ± 1.28% (mean difference = -1.19%; p = 0.007). Time in range reached 54.4% within the first month and remained consistent throughout the follow-up. Total diabetes distress score decreased significantly from 2.86 ± 0.88 at baseline to 2.32 ± 0.85 at six months (mean difference = -0.28; p < 0.001; Cohen's dz = 0.76). The proportion of participants with severe distress dropped from 34.3% (n=12) to 14.3% (n=5) (p = 0.002). Major improvements in management and family/social domains. Psychosocial benefits were observed regardless of the magnitude of HbA1c reduction (r = -0.182, p = 0.384). Conclusions CGM implementation reduced diabetes distress, particularly severe cases, and improved glycemic parameters in a resource-limited setting. The improvement in well-being independent of glycemic drop suggests that CGM is a valuable tool for both clinical and psychosocial management of adults with T1D in public health systems.
Introduction The pandemic disrupted routine healthcare services, including preventive screening for diabetes. We examined the impact of the pandemic on diabetes screening rates and recovery patterns in a universal healthcare setting. Methods We conducted a time-series analysis using linked administrative health care and laboratory data from Ontario, Canada to compare expected versus observed monthly diabetes screening rates during the period from March 2020 to March 2023 in the non-diabetes population overall and among subgroups defined by age, sex, and neighborhood socioeconomic status. Monthly expected screening rates were predicted for the same period based on patterns observed from March 2016 to March 2020. Results Overall, the eligible, non-diabetes population was 9,359,851 in Mar 2016 and 9,894,353 in Mar 2023. Diabetes screening rates declined sharply by 70.1% during the initial lockdown period in April 2020 compared to February 2020 (1.55 vs. 4.47 per 100, -2.92 per 100) with a gradual increase to pre-pandemic levels. As well, 24.5% fewer individuals were screened during the pandemic period versus pre-pandemic levels. While the overall patterns were consistent by sex, the rate of recovery was greater among women (6.42 vs 4.85 per 100, -1.57 per 100) in March 2023. As well, screening recovery rates appeared to be two to three-fold higher among adults aged 50+. Findings were consistent across income groups with slightly higher recovery rates for those living in higher income communities. Conclusions The observed sudden decline in diabetes screening may lead to delays in prediabetes and diabetes diagnosis, resulting in missed opportunities for diabetes prevention and early management.
A link exists between Type 2 Diabetes Mellitus (T2DM) and developing cardiovascular disease (CVD). Lifestyle interventions targeting T2DM and CVD are required. Cardiac rehabilitation (CR) offers a multidisciplinary approach for management. High-intensity interval training (HIIT) may provide equivalent benefit compared to moderate-intensity continuous exercise (MICE) in improving cardiorespiratory fitness and glycemic control. HIIT should be considered when prescribing exercise for patients with T2DM; however, feasibility research is required. The objective of this study was to determine the feasibility of progressive HIIT in patients with T2DM. Patients in a 24-week CR program provided research consent at 12-weeks. Feasibility was assessed using intervention adherence, drop-out rate/reason, patient satisfaction and safety. Patients completed the HIIT protocol 3-times/week, at 80-95% HRR. Patients started at stage 1 (10x30-sec high intensity:30-sec recovery) and progressed to Stages 2-4 every 3 weeks according to patient desire and achievement of target work rate without adverse events. Possible progressions included Stage-2 (10x1-min high intensity:1-min recovery), Stage-3 (6x2-min high intensity:2-min recovery) and Stage-4 (4x4-min high intensity:3-min recovery). Twenty-two participants consented to participation and seventeen (60.2±12.4-years) completed the program (23% drop-out rate). Adherence to on-site HIIT sessions was 79% and at-home unsupervised sessions was 70%. Five patients (4 females) remained at Stage 1; 4 (2 females) progressed to Stage 2; 7 (2 females) progressed to Stage 3; and one (male) progressed to Stage 4. Satisfaction surveys revealed patients enjoyed HIIT as much as MICE (p=0.29). No HIIT-related adverse events were reported. Progressive HIIT is feasible, enjoyable, and safe among patients with T2DM.
Type 1 diabetes (T1D) is a chronic disease characterized by the relentless autoimmune destruction of insulin-producing pancreatic beta cells (β cells). Approximately 9.5 million people worldwide live with T1D; 1.9 million are under 20 years old. There is no cure and there are few effective treatments, making novel therapies desperately needed. All-trans retinoic acid (ATRA) has demonstrated promise in preventing and even ameliorating T1D, particularly in various rodent T1D models. The benefits are thought to be mediated by influences on T cells, particularly regulatory (Treg) and autoreactive effector T cells. Intriguingly, ATRA may also directly contribute to the differentiation and maintenance of pancreatic β cells. This mini review will focus on experiences with ATRA in rodent models of T1D, including measures of efficacy, Treg expansion, reduction of autoreactive effector T-cell activity and oxidative stress, and, perhaps most promisingly, preservation and stimulation of pancreatic β cells. We will then discuss the clinical potential of ATRA in T1D, including targeted drug delivery strategies to deliver ATRA locally to the relevant immune microenvironment, limiting its systemic exposure, reducing toxic side effects, and enhancing efficacy.
BACKGROUND:Prediabetes affects approximately 470 million adults worldwide and is an established risk factor for cardiovascular disease. Whether reversion from prediabetes to normoglycemia reduces cardiovascular risk remains uncertain. We conducted a systematic review and meta-analysis to quantify this association with major cardiovascular events, cardiovascular mortality, and all-cause mortality. METHODS:We searched PubMed, Embase, CENTRAL, Web of Science, and Scopus through February 2026 for cohort studies and post-hoc analyses of randomized trials comparing cardiovascular outcomes in adults who reverted from prediabetes to normoglycemia versus persistent prediabetes. Hazard ratios were pooled using a DerSimonian-Laird random-effects model, with Hartung-Knapp-Sidik-Jonkman (HKSJ) sensitivity analysis. Heterogeneity was assessed using I2. Publication bias was evaluated using Egger's test. RESULTS:Seven studies (71,143 participants; follow-up 2-30 years) were included. Reversion to normoglycemia was associated with significantly lower composite cardiovascular events (HR 0.72, 95% CI 0.57-0.90; P = 0.004; I2 = 76.1%) and cardiovascular mortality (HR 0.69, 95% CI 0.51-0.95; P = 0.023; I2 = 65.5%). No significant association was found for all-cause mortality (HR 0.95, 95% CI 0.88-1.02; P = 0.169). The 95% prediction interval for the primary outcome ranged from 0.37 to 1.39. Leave-one-out sensitivity analysis confirmed result stability. Egger's test showed no publication bias (P = 0.36). CONCLUSION:Reversion from prediabetes to normoglycemia is associated with significant reductions in cardiovascular events and cardiovascular mortality, supporting early identification and management of prediabetes as a cardiovascular prevention strategy. The observational nature of the evidence and wide prediction interval warrant cautious interpretation.
OBJECTIVE:To explore healthcare professionals' (HCPs) experiences of providing gestational diabetes mellitus (GDM) care, education, and support, and their perceptions of how well women's and families' needs are addressed. METHOD:A qualitative exploratory study was conducted using semi-structured interviews with 10 HCPs from obstetric and diabetes outpatient clinics in Southern Denmark. Data were analysed using reflexive thematic analysis. RESULTS:Four themes were identified: (1) benefits and limitations of a fixed GDM care system; (2) the influence of risk information, motivation, and partner support; (3) challenges related to culture, language, and health literacy; and (4) psychological and social aspects of GDM, including shock and stigma. DISCUSSION:HCPs valued the universal multidisciplinary care model but described challenges in addressing individual and complex psychosocial needs. CONCLUSIONS:While current GDM care supports high-quality treatment and prevention of complications, greater flexibility and patient-centred approaches are needed, particularly for vulnerable groups within universal healthcare settings.
Introduction Parents of young children with type 1 diabetes (T1D) frequently experience fear of hypoglycemia (FH) which contributes to higher child glucose. The Hypoglycemia Fear Survey-Parents of Young Children (HFS-PYC) is a validated questionnaire to assess parental FH, yet it lacks a clinically interpretable cut-point. We sought to identify a preliminary HFS-PYC cut-point that associates with higher parent anxiety, greater diabetes distress, and child glucose metrics. Methods Parents (n=180) completed the HFS-PYC, PROMIS-Anxiety (PROMIS-A) and Problem Areas in Diabetes Parent-Revised (PAID-PR). We derived candidate cut-points using (a) modal score distribution (Mode), (b) mean + one standard deviation (SD), and (c) an elevated-item rule (EI). We compared groups above versus below each cut-point on PROMIS-A, PAID-PR, and child glycemic metrics. We calculated indices of diagnostic accuracy using PROMIS-A T-scores ≥60 as a reference. Results Candidate cut-points were ≥61 (Mode) and ≥77 (SD); EI required ≥5 of 9 items rated “Often/Almost Always.” Prevalence of elevated FH ranged from 52% (Mode) to 18% (SD). All cut-points distinguished between parents with high versus low PROMIS-A and PAID-PR scores (p<0.001). Only the Mode cut-point differentiated among parents for some child glycemic metrics. The Mode cut-point also had the most favorable diagnostic accuracy (sensitivity=0.77, specificity=0.57) among the candidate cut-points. Conclusions An HFS-PYC total score ≥61 identifies parents with greater anxiety and diabetes distress and children with higher glycemic metrics and shows the best diagnostic performance among candidate cut-points. Pending further validation, this preliminary cut-point may offer a practical starting point for clinical screening and research.
OBJECTIVE:To investigate the role of Cav3.2 channel N-glycosylation in myelinated A-fibre dorsal root ganglion (DRG) neurons in the development of diabetic mechanical allodynia (MA). METHODS:Type 1 diabetes was induced in rats via a single intraperitoneal injection of streptozotocin. Pain behaviour, including MA and thermal hyperalgesia (TH), was assessed weekly. Diabetic rats with TH were further divided into 2 subgroups according to the presence of MA by the third week. The impact of N-glycosylation on Cav3.2 expression and pain behaviours was investigated through sequential intraplantar administration of neuraminidase (NEU) and TTA-P2, a selective blocker of T-type calcium channels. The Cav3.2 N-glycosylation levels were compared between diabetic rats with and without MA by analyzing the N-terminal fragment after enzymatic deglycosylation. RESULTS:Cav3.2 expression in myelinated A-fibre DRG neurons was significantly higher in diabetic rats with MA than in those without (p<0.001). NEU-induced deglycosylation reduced Cav3.2 expression in all groups, although diabetic rats with MA still had higher expression than those without (p<0.05). Resiniferatoxin eliminated TH but not MA, whereas NEU alleviated both, similar to TTA-P2. Diabetic rats with MA exhibited increased expression of Cav3.2 N-terminal fragments compared with those without (p<0.001). CONCLUSION:N-glycosylation of the Cav3.2 channel in DRG neurons of myelinated A-fibres contributes to diabetic MA.
OBJECTIVE:Daily glycemic variability (GV) has been proposed as a contributor to diabetic ocular complications beyond chronic glycemic management. This study evaluated whether sensor-derived GV (coefficient of variation, %CV) is associated with treatment-requiring diabetic ocular disease. METHODS:Retrospective case-control study of adults with diabetes followed by Endocrinology departments at 2 tertiary hospitals in Kingston, Ontario. Inclusion criteria were as follows: diabetes duration ≥5 years, age ≥18 years, continuous glucose monitoring (CGM) wear ≥70% in a continuous 90-day period (Jan 2023-May 2024), and a documented eye examination (Jan 2023-Dec 2024). Cases were identified as having received diabetic ocular treatment (intravitreal injection [IVI], retinal laser, and/or pars plana vitrectomy) using OHIP codes (2015-2024) and confirmed by blinded ophthalmology chart review; controls had not received such treatment. Device-reported 14- and 90-day CGM metrics were extracted. In cases treated between 2022 and 2024, IVI burden was compared by 90-day %CV (≤36 vs >36) and correlated with CGM metrics. RESULTS:Among 485 patients, 72 (14.8%) were cases. Cases were older and had a longer diabetes duration than controls (both p<0.0001). There were no differences between cases and controls in 14- or 90-day GV (%CV), mean glucose, or time in range. In 57 recently treated cases (2022-2024), IVI burden was higher in the low %CV group than in the high %CV group (9.9 vs 6.3; p=0.046). %CV had a weak negative, nonsignificant correlation with IVI count, whereas time in range correlated positively with IVI count (r=0.351; p=0.012). CONCLUSIONS:Short-term CGM-derived GV was not associated with treatment-requiring diabetic ocular disease. Within recently treated patients, GV-treatment relationships likely reflect confounding by care intensity and disease stage.
OBJECTIVE:Type 1 diabetes (T1D) may influence acute and adaptive responses to exercise training and performance. This systematic review aimed to summarize the evidence comparing exercise performance between individuals with and without T1D and to identify the physiological mechanisms underlying potential differences in exercise performance. METHODS:Seven electronic databases were searched for studies comparing exercise performance and underlying physiological mechanisms in individuals with and without T1D. Exercise performance was categorized as aerobic, anaerobic, or skill based, and physiological mechanisms were grouped across cardiorespiratory, neuromuscular, and metabolic domains. RESULTS:Of 6,563 studies, 28 met the inclusion criteria. Most (k=25) evaluated aerobic exercise performance with time-trial, time-to-exhaustion, and V̇O2peak tests. Five evaluated anaerobic exercise performance with one-repetition maximum, maximum voluntary contraction, and supramaximal time-to-exhaustion tests. Of the aerobic studies, 88% reported lower aerobic performance in individuals with T1D compared with those without, potentially due to cardiovascular or circulatory mechanisms. Similarly, 60% of the anaerobic studies reported lower anaerobic performance in individuals with T1D compared with those without, potentially due to mitochondrial mechanisms and recovery. Certainty of evidence was assessed using the GRADE tool and was found to be very low. CONCLUSION:Current evidence suggests that aerobic exercise performance may be reduced in individuals with T1D. However, the evidence is weak, and these differences seem to be marginal. Suboptimal glycemic management and longer T1D duration may influence physiological responses to exercise and reduce performance capacity. Further research is required to support these conclusions and to determine the impact of T1D on anaerobic and skill-based exercise performance.
OBJECTIVE:The possibility of achieving type 2 diabetes (T2D) remission is a relatively new concept and remains unknown to most people affected by T2D. To evaluate the impact (including reach, engagement, conversation rate, cost-per-click, and website engagement) of paid, targeted social media advertising featuring inspiring stories of persons with lived experience (PWLE) and still-frame advertisements as knowledge mobilization strategies to increase awareness of T2D remission. METHODS:In collaboration with PWLE, we developed the "Remission Possible" social media campaign, consisting of still-frame images and storytelling video advertisements, to highlight T2D remission and direct interested users to a website (Diabetesremission.ca) that explains the concept and provides evidence-informed resources. RESULTS:During the paid social media campaigns, we reached 235,561 unique individuals (70% female, most being >45 years old), resulting in 6,250 people accessing our website, with an average conversation rate of 2.7% and a cost-per-click of $0.36. Of these, 1,135 individuals took meaningful action (e.g. downloading material). Compared with organic posts, paid advertisements increased visitors to our website (organic posts: 10±9 users per day; paid posts: 180±72 users per day; p=0.0001; D=2.08), with no difference in the time spent on the website (7.0±6.6 min) for visitors from paid vs organic posts (p=0.576). Still-frame images designed to evoke stronger emotions decreased the cost-per-click compared with neutral advertisements ($0.29 vs $0.41). Storytelling videos were similarly effective, especially when using a short vertical format (Reels). CONCLUSION:Targeted social media advertising seems to be an effective way to promote T2D remission awareness among potentially interested individuals, while also demonstrating a favorable cost per click.
OBJECTIVE:Individuals with type 1 diabetes (T1D) experience poor subjective sleep quality and are at an increased risk for obstructive sleep apnea (OSA), yet the contribution of diabetes-related characteristics remains unclear. METHODS:This study evaluated associations between diabetes characteristics, affect, and sleep in 210 adults with T1D (M age=45.6 years, SD=15.6; 52.9% female) from the Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes study. Participants completed measures of sleep quality (Pittsburgh Sleep Quality Index), OSA risk (STOP-Bang), and affect (Generalized Anxiety Disorder-7, Perceived Stress Scale, Patient Health Questionnaire-8). Blinded continuous glucose monitoring data were collected for up to 20 days (M=18.8, SD=2.5). Bivariate correlations and hierarchical regressions evaluated relationships among subjective sleep quality and OSA risk with affect and diabetes variables. RESULTS:Overall, 47% and 37% of participants scored above clinical cutoffs on the Pittsburgh Sleep Quality Index and STOP-Bang. Those with microvascular complications reported poorer sleep quality (β=0.13, t(188)=2.23, p=0.03). Microvascular complications (β=0.15, t(200)=3.10, p=0.002) and cardiovascular disease (β=.014, t(200)=2.89, p=0.004) were associated with a higher OSA risk. Continuous glucose monitoring metrics were not associated with the outcomes. CONCLUSIONS:In this sample of adults with T1D, nearly half reported poor sleep quality, and more than one-third were at elevated risk for OSA, with microvascular complications associated with poorer sleep quality and both microvascular and cardiovascular complications associated with a higher OSA risk. Aggregate glycemic metrics were not associated with sleep outcomes. Future research should evaluate the relationships between daily variation in sleep and glucose to inform targeted clinical interventions.
OBJECTIVE:To evaluate how diabetes-related professionals perceive the impact of social determinants of health on diabetes outcomes among Black and South Asian populations in Ontario and to identify perceived opportunities and gaps in current responses. METHODS:A qualitative study was conducted using stakeholder consultation data from 5 focus groups (n=21) with both frontline (individuals directly engaged in delivering diabetes care services) and population-level professionals (individuals working in public health settings or in systems-level roles that influence diabetes care delivery) across Ontario. Reflexive thematic analysis was used to construct key themes. RESULTS:Participants identified food insecurity, health care access, inadequate housing, and social support as major factors affecting diabetes outcomes for Black and South Asian populations. Although individual-level interventions provided short-term support, they were constrained by funding limitations and failed to address upstream structural barriers. Frontline professionals emphasized the need for population-level action to relieve the burden on community organizations in filling systemic gaps. CONCLUSIONS:Findings underscore the need for systems-level policies targeting upstream social determinants to support equitable diabetes prevention and management in Ontario among Black and South Asian populations.
OBJECTIVE:Polyols, natural nutritive sweeteners, are often found in the diet during pregnancy. This study investigates the association between maternal serum polyol levels and the risk of gestational diabetes mellitus (GDM) and large-for-gestational-age (LGA) infants. METHODS:This nested case-control study matched 218 women (with GDM vs. without GDM) by age and body mass index. After exclusions, the final analytic sample comprised 194 women for glucose metabolism outcomes and 177 women for birth weight and LGA outcomes. Serum polyols (sorbitol, erythritol, xylitol, and maltitol) were quantified using gas chromatography coupled with time-of-flight mass spectrometry. LGA was defined as a birth weight ≥90th percentile or ≥4000 g. Logistic regression was used to assess the associations between polyols and GDM and LGA, with adjustment for confounders. RESULTS:Among the participants, 23.7% had LGA infants, and maternal serum polyol levels were significantly higher in this group. After adjusting for confounders, a 1-standard deviation increase in serum polyol levels was associated with increased odds of LGA (odds ratio=1.71, 95% confidence interval [CI]:1.22 to 2.40) and GDM (OR=1.52, 95% CI: 1.09 to 2.14). Erythritol and sorbitol were significantly associated with the odds of LGA, whereas xylitol and maltitol had no significant associations. Furthermore, a 1-standard deviation increase in serum polyol levels was linked to higher birth weight (beta [β]=95 g, 95% CI: 33 to 157 g) and elevated homeostasis model assessment for insulin resistance (β=0.32, 95% CI: 0.12 to 0.52). CONCLUSIONS:Elevated maternal serum polyol levels were positively associated with the risk of GDM, LGA infants, and higher birth weight.
Management of cystic fibrosis (CF)-related diabetes (CFRD) is evolving as the CF population experiences increasing rates of overweight and obesity, particularly with the widespread use of CF transmembrane conductance regulator (CFTR) modulators. This article describes practical insights from implementing a pilot program that evaluated injectable semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), in adults with CFRD. Our program followed 11 participants over 12 months, revealing important considerations for patient selection, monitoring protocols, and managing adverse effects in this unique population. Although most participants tolerated semaglutide well with clinically meaningful improvements observed in glycemic management, careful screening and close follow-up proved essential. These findings offer practical guidance for diabetes educators and clinicians considering GLP-1 RA therapy as an adjunct to insulin in carefully selected patients with CFRD.
