To synthesize contemporary evidence on body mass index (BMI) variability as a determinant of cardiovascular risk, integrate mechanistic insights, and clarify its clinical relevance in individuals with and without diabetes. Large cohort studies demonstrate that greater BMI or weight variability is associated with increased risks of all-cause mortality, atherosclerotic cardiovascular disease, heart failure and atrial fibrillation, independent of mean BMI. Mechanistic evidence to explain the observed association implicates adipose tissue dysfunction, ectopic fat deposition, metabolic instability, systemic inflammation, and autonomic imbalance. Diabetes may amplify these pathways through impaired metabolic flexibility and treatment-related weight fluctuations. Evidence from diabetes-specific cohorts suggests that structured, intentional weight loss may attenuate the adverse associations seen with unstructured weight cycling. BMI variability is an emerging marker of cardiometabolic instability with implications for cardiovascular risk, particularly in diabetes. Defining actionable thresholds and determining whether stabilizing weight improves outcomes are key future research priorities.
Climate change is emerging as a clinically relevant driver of cardiometabolic risk, particularly among individuals with diabetes. Increasing frequency and severity of extreme weather events, including heat waves, cold exposure, and air pollution, can disrupt physiological homeostasis and access to essential healthcare resources. People with diabetes are uniquely vulnerable due to impaired thermoregulation, increased risk of dehydration, and high prevalence of cardiovascular and kidney disease. Temperature extremes impose significant cardiovascular stress. Heat exposure promotes dehydration, hemoconcentration, and increased cardiac workload, contributing to ischemia, arrhythmia, and heart failure. Cold exposure increases vascular resistance and blood pressure, further elevating cardiovascular risk. In parallel, air pollution and wildfire smoke amplify systemic inflammation, oxidative stress, and endothelial dysfunction, accelerating atherosclerosis and increasing the likelihood of acute cardiovascular events. Clinical risk is further modified by age, comorbidities, socioeconomic factors, and access to healthcare infrastructure. Clinically, these findings support anticipatory management strategies, including patient education on heat and cold exposure, proactive medication adjustment, and closer monitoring during periods of environmental stress. Effective mitigation requires a multilevel approach, including patient education, medication management, disaster preparedness, and climate-resilient health systems. Integrating environmental data into clinical care and the use of predictive tools may enable proactive risk reduction. Climate change should be recognized as an emerging cardiovascular risk multiplier in diabetes, requiring coordinated action across clinical care, public health, and policy.
Frameworks that classify the financial burdens of managing pediatric type 1 diabetes (T1D) primarily focus on measurable material hardship, affordability, and cost-related distress and therefore do not sufficiently detail the household-level resources that care requires from families. This study is a conceptual narrative review that aims to integrate the missing elements into a new three-level burden model, thereby linking the costs visible in clinical care, the household implementation burden borne by families, and the lived everyday experience of the child-parent-family triad. The proposed contribution of the model is to interpret the sustainability of modern T1D care not exclusively in terms of technology access, reimbursement, or clinical effectiveness, but also as a function of families’ temporal, digital, organizational, and decision-making capacity in relation to everyday self-management, educational-setting coordination, caregiver time investment, digital health literacy, and the digital divide. The literature documents direct healthcare costs, out-of-pocket expenses, informal care, dietary adaptation, technology-related costs, parental distress, and time burden well when considered separately. However, these elements often do not appear as an integrated, cumulative household implementation burden. In pediatric T1D, the actual usability and sustainability of technology depend not only on device availability and reimbursement but also on the family’s organizational, digital, temporal, and decision-making capacity. The T1D-ELB-P framework interprets the burdens placed on families as an organizing principle: it does not merely list domains but shows how financial, digital, temporal, decision-making, and institutional requirements can accumulate as household implementation burdens. The proposed Type 1 Diabetes Everyday-Life Burden-Pediatric framework (T1D-ELB-P) conceptualizes the everyday-life economic burden of pediatric type 1 diabetes as a complementary dimension interpretable at the household and caregiver levels. It highlights five interrelated domains: lifestyle and dietary adaptation; non-reimbursed or partially reimbursed consumables and accessories; digital infrastructure and digital health literacy; time, attention, and decision burden; and educational, extracurricular, and workplace coordination. In this model, technology is not a separate focus but a cross-cutting factor that makes the implementation work borne by families visible across several domains. The clinical and health-policy significance of the framework lies in its highlighting of how the real-world use of modern T1D care is embedded in the everyday functioning of the child-parent-family triad. Future cost-of-illness, health technology assessment, and patient-centered studies would benefit from explicitly measuring family implementation costs and capacities.
Consistent medication adherence is fundamental for achieving favorable health outcomes in diabetes care; however, attaining optimal adherence remains a challenge. This review summarized recent evidence on digital behavioral interventions designed to improve medication adherence in type 2 diabetes (T2D) and identified key components commonly incorporated in these interventions. Thirty-two studies evaluating digital strategies to support medication adherence were identified. Interventions were delivered through a range of digital platforms, including mobile apps, short message service messaging, telemedicine systems, conversational artificial intelligence, and remote monitoring technologies. Medication adherence was assessed using a variety of measures, including self-reported adherence questionnaires, medication-taking records, and refill-based measures. Most studies reported improvements in medication adherence, and several also observed improvements in glycemic outcomes, most commonly A1C. Effective interventions frequently combined reminders, educational content, self-monitoring tools, and patient-provider communication. Digital behavioral interventions represent increasingly utilized strategies to promote medication adherence among individuals with T2D. Multifaceted digital approaches that integrate behavioral support, monitoring, and communication may enhance long-term diabetes self-management and treatment engagement. Recent advances have focused on improving personalization, integration across digital platforms, and interactive patient support rather than introducing entirely new digital modalities.
Persistence with glucagon-like peptide-1 (GLP-1)–based therapies is important for sustained weight loss and glycemic control in adults with coexisting obesity and type 2 diabetes. This narrative review examined how persistence has been defined and measured, real-world patterns of continuation and discontinuation, factors associated with persistence, reasons for discontinuation, and supportive strategies in this population. Seven studies met the inclusion criteria, with follow-up ranging from 6 months to 2 years. Persistence generally declined over time and often fell below 60
